Dr Des Fernandes, a plastic surgeon from Cape Town, South Africa, has devoted more than 30 years to researching skin. Nearing 70, he shows no signs of slowing down. Fernandes was in Hong Kong recently to showcase his techniques - such as skin needling for collagen stimulation - and raised a few eyebrows with his dismissal of mainstream procedures.
He criticises treatments such as microdermabrasion (a mechanical form of exfoliation using a vacuum) and laser resurfacing, which he says damage the skin, and certain peels, which can cause pigmentation, especially in Asian skin. He also says costly face creams are no better than their low-cost counterparts. "People buy expensive creams expecting a better result, but they're probably getting the same as they'd get from a simple moisturiser."
Fernandes began his career as a surgeon at various hospitals, including the famous heart transplant unit at Groote Schuur Hospital in Cape Town along with Christiaan Barnard, a cardiac surgeon who performed the world's first human heart transplant in 1967. Fernandes was responsible for the illustrations of the "piggy-back" or "double" heart transplant.
In 1975 he returned to plastic surgery and eventually became the head of the Cleft Lip and Palate Division at the Red Cross War Memorial Children's Hospital in Cape Town, a post he held until 2000. He entered private practice in 1979.
Fernandes' research into the skin and skin cancer was motivated by the loss of two young melanoma patients in the 1980s. This led to the creation of a skincare line crammed with higher doses of vitamin A than others, which he officially launched as the brand Environ in 1990.
"[Vitamin A] is the crucial keystone in keeping up the health of the skin, controlling how cells grow," he says. "However, it is destroyed by sunlight. In addition, every time a woman menstruates, her levels of vitamin A drop, which means she is more prone to getting skin problems. It is essential to keep up the skin's vitamin A levels; they will determine how you age."
He explains that one of the biggest differences between Caucasian and Asian skin is their inherent natural sun protection factor (SPF) levels. Fair skin offers only about SPF 1 protection. Asian skin falls between 2.5 and 4, and is far less susceptible to photo-ageing.
But whatever race, he suggests that children from age four upwards should be using vitamin A on their skin, adding that most skin ageing happens before age 20. "If you start in your 40s, you're about 30 years too late to make a big difference. You can improve but can never make as much collagen as in young skin."
Fernandes' new range of face creams are said to be more intense than the original formula to fight anti-ageing, and also skin problems such as couperose, rosacea and scarring. Peptides - active protein molecules that tell cells how to react and what to do - have been added to the combination of vitamin A, C and E, resveratrol and beta carotene.
He has also developed an anti-ageing machine that uses iontophoresis (an electric charge) and sonophoresis (low-frequency ultrasound waves) to increase vitamin penetration, and the medical skin-needling tool to reduce scarring, lines and wrinkles. He has performed his needling technique on over 2,000 people, himself included. "Needling is good for every single type of skin," he says. "We treat patients once a week for six weeks, and you get better for up to a year. We've set up a factory under the skin to make more collagen and elastin. It is the first treatment in the world to do that."
Fernandes self-tests all his products.