Let me answer the multiple questions which are outlined above.
Firstly, for your pigmentation, I think it will be easier if you consult a doctor to see what sort of pigmentation it is. But judging from the history that it worsened after pregnancy, it may well be melasma which is patchy pigmentation in the face, primarily over the cheek area. There are various treatments available, including topical and machine-based treatments such as lasers. Risks and benefits such as rebound worsening or pigmentary hypopigmentation from over treatment should also be discussed.
As you noted from your friend, sometimes excessive or poorly administered treatments can worsen the pigmentation. In our practice, we have seen hypo pigmentation from excessive laser treatments, or worsening of pigmentation, and even facial burns.
Your second question is about the difference between beauty spas, medical aesthetic centres, and aesthetic clinics. Clinics fall under the purview of the Ministry of Health (MOH), and we are bounded by guidelines that ensure we don’t over-sell or over-promise, or use words which are promotional. This is really to ensure that clinics give the various options, explain some of the benefits/risks, and allow the patient to make their choice.
Laser treatments at clinics are done by doctors, who understand and recommend treatment protocols based on experience.
Beauty spas and medical aesthetic centres are not bound by the same MOH guidelines, which lead them to use words like “BEST”, “ONLY”, “AMAZING”, and “INSTANT in their advertisements. Unfortunately, most of these claims are un-founded, and many spas (not all) play on patients’ confidence. Huge packages are signed up for, which tend to under-deliver their promises.
Spas are primarily operated by beauticians/therapists, and what they usually provide is facial extractions and facial massages. However with the advent of machines, some of them have started doing machine treatments. Some spas purchase laser machines, which under NEA's purview should only be provided to license holders (usually doctors). I am not entirely sure what framework they get these under, maybe doctors “lending their names”? The lasers are then done by the therapists which is not appropriate in accordance to Singapore regulations.
Medical aesthetic centres I would actually call a step up from simple spas. There is the added confidence of a “medical” supervision of patients. But as long as they are not clinics, they are actually still spas in reality. Some spas hire 1-2 doctors who may lend the medical credence, but they are generally running around many branches.
There may be the occasional “lucky-hit” by patients who actually get to see the doctor for consultation, but by and large as you have experienced, “the doctor is not in” is the usual answer by the staff. Fortunately many of the medical aesthetics tend to focus on machine-based treatments, so much less harm is done. And to date, there have been very few issues of non-doctors doing fillers/injectables, as compared to overseas practices, that have arisen in Singapore.
In summary: clinics are clinics for a reason in that the doctors play a primary role in the consultation, diagnosis and follow-up of the patient, even if some of the safer treatments are done by therapists/staff. Injectables and lasers in Singapore are done by doctors, and clinics are obliged to generally toe the legislative line drawn by the Ministry of Health in advertising.
Medical aesthetic centres, in my opinion, are spas trying to gain patient confidence by adding the term “medical”, while there is little or no follow-up by the doctors (if the patients even get to see one during their treatment protocols). They also have the added advantage of not being bound by Ministry of Health rules.
Ultimately, caveat emptor, and the patient has to make their own choices on what is the best or safest option for themselves.
Hope the above helps!