The importance of consultation....

Its the last week of the year and everyone is in the jolly holiday mood until the New Year before we start striving hard. Its pretty quiet in my office too, most people are away for holidays and will only be back in the weekend.

Taking this quiet time, I manage to organize my thoughts and plans for t he next year. Its a lot of things definitely, but proper planning will ensure things get done right. Which is why I decided to talk about consultations.

Many people do not realize how important a doctor's consultation is. Many just assume going to doctors when you have a problem and immediately it will be fixed. In medical aesthetics, it is a different ball game. Aesthetic medicine is an elective procedure to the patient, and therefore a good informed consent must be given before the procedure is done.

Its like going to see a gynae because of infertility problems. You talk to the gynae, she examines you and then puts up the options. She informs you of the pros and cons and you decide based on your expectations and budget. It then allows you to plan ahead as to the suitable time for you to commence the treatment or whether any other treatment is required first before you engage the treatment that you wish to choose.

Its the same with aesthetic medicine consultations. Despite giving online replies, I would prefer to meet up with the patient, discuss expectations and also what is their main concern and explain modalities of treatment. A face to face consultation is important to allow examination of the face or body to give a more accurate treatment plan to patients. It will also allow you to discuss your budget and how you wish to proceed.

Feel free to come and talk to me in my clinic. For appointments, call 03-21440080 or emaill to info@faceworksclinic.com

Botox and Fillers Q & A

Botox and fillers are the bread and butter for any aesthetic physician. It is what differentiates us from normal general practitioners. However, in my consultations, I have noticed that a lot of my patients have the initial belief that everything injected to the face is Botox. So instead of writing up long entries, I decided to write this as a Q&A session for better understanding of injectibles (injectibles : things that you can inject) .

1. What is Botox or BTA?
Botox or BTA is a protein derived from botulinum A toxin which is a type of bacteria that causes tetanus.

2. What is Botox used for?
It is used to relax muscles and therefore can be used to reduce spasticity in celebral palsy children, correct ticks and strabismus problems, and in medicqal aesthetics we use botox and BTA to relax muscles that forms wrinkles i.e. get rid of dynamic wrinkles. We can also use botox for face reshaping, calf reshaping and to reduce excessive sweating.

3. Is Botox safe?
Depending on the indication of use, you will need at least 5 vials of botox or 10 vials of BTA to cause paralysis of the whole body. The usual clinic use is half a bottle for one patient.

4. How long does it last?
Botox usually lasts 3-6 months but it will depend on the body's self metabolism because we do observe that active young people have a shorter duration of botox span compared to a more elderly less active person. Also, we do notice that repeated botox injections would prolong the duration that the effect lasts. However, there are some people who develop resistance to botox i.e. if too frequent injections were given. Therefore, we normally recommend the first follow-up to be around 3 months, and subsequently only twice a year or less.


5. What are fillers?
Fillers are substances used to fill up areas of the face and body which needs to be filled. Usually fillers are used on the face to enhance features or to return volume loss due to aging.

6. What are the types of fillers and duration it lasts?
There are many types of fillers as follows:

• Hyaluronic acid fillers (lasts 6-24 months depending on type, area and molecule size)
• Calcium hydroxypatite filler - Radiesse (lasts 15-18 months)
• PRP fillers derived from own blood (Lasts up to 15 months)
• Bioalcamid - lasts up to 3 years.
• Fat harvested from other parts of body (lasts 3 months-3 years depending on skill of surgeon).
• Collagen fillers (last 1-3 years depending on skill of surgeon)
• Silicon liquid filler - permanent but banned due to complications related to cancer.

7. Are fillers safe?

Technically they are except silicone, but it really depends on the skill of the injector.








8. Can you do botox and fillers in one sitting?

Yes.



9. Are the procedures painful?

Botox is usually tolerable with ice numbing prior to procedure. For fillers, it will depend on type and area injected. Hyaluronic acid fillers are the least painful. Nose tip and lip injections are painful but the doctor can make you comfortable by giving proper local anesthesia or nerve blocks.



10. If I had botox or fillers does it mean forever I have to use the products?

Contrary to belief, no you don't. However, vanity is addictive and the reason most people repeat the usage of these products because they are cheaper than permanent procedures, safe and has a short downtime. It will depend on your individual assessment of yourself.

For more personalized info, please email us at info@faceworksclinic.com .

Radiesse Workshop......

Last Sunday, I was at Pantai Hospital, Bangsar for the Radiesse Workshop organized by Servicom. The guest speaker was Dr Peter Huang, a well-known aesthetic plastic surgeon from Taiwan. It was my second encounter with Mr Huang, and both times I have been very impressed with his technique and work. Previously, it was a workshop on hyaluronic acid fillers, this time its Radiesse.

What is Radiesse? Radiesse is also a type of filler that you can inject into the face to fill up spaces or add volume to areas you need adding. It is made out of calcium hydroxypatite, which is almost equivalent to your bone. Compared to hyaluronic acid (HA) fillers (such as Restylane, Juvederm, or Teosyal) Radiesse is much harder and last approximately 15-18 months.

It is really good for nose bridges, because it does not expand as much as HA fillers do and it lasts longer. It can also be used for chin, nasolabial folds, marionette lines and for midface areas and enhancing cheek bones.

The injections are similar to HA technique where ideally you are given nerve blocks or analgesia to reduce pain initially. The process takes around 15 minutes to 1/2 an hour depending on how many areas you are doing. In terms of pain, some say that it is more painful than HA fillers, but nothing unbearable, and its only for a few hours after the blocks run out. Swelling is more than HA and usually it goes off after 2-3 days. Bruising is a complication and you may consider having the procedure done during the less busy days just in case, or use concealer if needed. The filler is soft and moldable within the first week - but I would usually ask my patients to wait until the swelling is gone before they try to remould the filler. Top-ups usually 2-4 weeks later, depending on suitability.

The only down side of it, is that you can't remove it once its in - so I would suggest that unless your mind is already set on having the filler done, you should keep to HA fillers which lasts shorter and can be dissolved with hyaluronidase. Another more important aspect is to be confident with your doctors injecting skills, which would make a difference to the outcome.

Interested to know more? You can email me at info@faceworksclinic.com or book an appointment for a chat at Faceworks Clinic - Tel : 03-21440080.

Faceworks Clinic Products

Its about time I posted the newer products available in myclinic. After trying out a number of them, I finally rested my convictions on these products, which I find does give results at an affordable price.

1. Obagi Nuderm System.

This is one of the most impressive sets I've ever come across. The Nuderm System is a 6 step care which is targeted at changing the skin environment to reduce acne break-outs, reduce pigmentation and also tackle fine wrinkles. Its active ingredients contains Hydroquinone 4% (which is the recommended % to treat pigmentation problems) and in combination with retin-A is the complete solution for acne with post-inflammatory hyperpigmentation and melasma which are the 2 major concerns in facial skin health. It is a prescribed skincare and would require physician monitoring but the results can be seen as early as 2 weeks after initiating the product. The product is used in small quantities and a travel set can last up to 3 months.

2. Obagi C treatment System.

This is a skincare range for people who have mild pigmentation or have flawless skin that they wish to maintain and add more luminance to the skin. Vitamin C being a potent anti-oxidant has shown benefits in skin brightening and evens out of skin tone. It comes in 2 forms of preparations, i.e. with Hydroquinone 4% or just Arbutin. The product is light and non-greasy, absorbs into the skin almost immediately.

3. Obagi Vitamin C serum 15% and 20%

The Vitamin C serum from Obagi is one of the most stable vitamin C compounds in the world. Multiple studies done has shown that over time, the Obagi Vitamin C does not get oxidized as fast as other brands. In terms of its solution, it is highly absorbable and has that nice orange scent. it comes in concentrations as high as 20% and for those vitamin C serum lovers would love this as an adjunct to your current skincare regimes.

4. Obagi Clenziderm for Acne.

Clenziderm is a range produced to treat acne in younger people and those who are not keen to be using hydroquinone or retin-A preparations. The active ingredient is salicylic acid and liquid benzyl peroxide for elimination of P. acnes bacteria which is the cause of pustular acne breakouts. Some may say why liquified benzyl peroxide and not your normal Oxy - well, in view of its form you get evenly distributed lotion with better penetration into the pores. Results can be seen as soon as 2 weeks of usage. The pack lasts up to 4 months.

5. Obagi Elastiderm Eye treatment.



Elastiderm eye treatment from Obagi comes in two forms, the eye gel and the eye cream. Both are made for different types of skin and the main function is to treat under eye fine wrinkles and increase elasticity around the eyes. It has been proven to increase elasticity by 46% in 9 weeks and visibly reduce fine wrinkles around the eyes in 9 weeks. As aging occurs, the elasticity around the eyes are compromised thus giving rise to fine wrinkles and thining of the skin around the eyes.

6. Obagi Elastiderm Decolletage.

Now we have a system to maintain that sexy neck and decolletage area. Obagi Elastiderm Decolletage offers a system to help keep the decolletage area supple and even out the skin tone in the neck area to give you a more youthful bust to flaunt. It is good for sun damaged bust areas as it contains hydroquinone 4% or arbutin to help reduce pigmentation. It also tackles fine lines and wrinkles around the bust area and returns some of the elasticity. Results can be seen as early as 4 weeks.

7. Under EyeBryten for severe dark eye circles and puffiness.



Under EyeBryten could be the solution to your dark eye circles and puffiness. The active compound is called Haloxyl and is recognized as the accepted treatment for undereye discolouration. It works better when combined with regular chemical peels which can also be done in the clinic. One package of 30 mls lasts up to 2 months based on twice daily usage.

8. Skintech Vitamin E cream.

Most people would agree that when you peel your face with laser, IPLs or chemicals, the most common side effect is dryness of the skin. Skintech Vitamin E cream is a wonderful adjunct for people with flaking skin due to treatment. Its a definite keeper for your late night mousterizer after retin-A creams or other treatments and it helps reduce flaking post chemical peel and dryness post laser. Its a moisturizer that can suit most skin types, and most would agree that the texture of your skin in the morning after an overnight application feels wonderful.

9. PK24 Natural 24 hours Feminine Tightening Creme.



This is a weird addition to my range of products but since I do consult cases for vaginoplasty and hymenoplasty, why not. PK 24 is only sold in USA and Malaysia. It is made out of natural ingredients and acts as a feminine tightener. The viscous gel-like substance acts within 5 minutes of application and lasts up to 24 hours. It is recommended for sexually active women after childbirth or those who just want to enhance what they already have.

10. Heliocare SPF 50 Gel sunblock.

Personally I love this sunblock. Its gel based and its tinted so it does not clog up my pores and I don't get that chalk like appearance with other sunblocks. It has a nice scent of oranges and it absorbs swiftly into the skin. I would recommend this for daily use, although for sporting activities, it may not last long enough on the face when you sweat.

11. Foltene Hair treatment system for men and women.



Foltene is a hair care range from Europe. Its a system that consists of a shampoo, a conditioner and treatment ampules. Its good for people who are having problems with hair fall or some scattered baldness patterns, and early balding. The whole set is for a months use and it is recommended to be used for 6 months at least, although there are some reports of results as fast as 2 weeks. It is made out of plant base products and has separate systems for men and women.
For more info check out http://www.foltene.eu .

For enquiries about these products, feel free to email us at info@faceworksclinic.com or call 03-21440080.

Obagi...........

It has been a really hectic month and one of the things that I have seem to neglect is this blog which I started to share my journeys in anti-aging and aesthetic medicine. With a lot going around, it was quite hard to actually find time to sit and write but I guess I have to since my BOD has started asking me about the blog. So probably today, I'm just gonna give a sneak peak on the few new items I have in my clinic.

I have recently started to use Obagi Medical skincare in my clinic, and me being the skeptic I usually am, was given a full set sample to try on my own face. The verdict - I absolutely love it! Not only it helped even out my skin tone, but also reduce the appearance of my laser burn which has been stuck to my face for the past 2 years. Yups, 2 years....... despite laser, IPLs, kojic acid, regular peels. All thanks to the hydroquinone content in the product - the post-inflammatory hyperpigmentation is not as obvious.

The good thing, it comes in a cute travel set pack and the price is reasonable. However, it is a prescribed skincare since it contains hydroquinone and therefore requires monitored use. But you can get them in my clinic after a quick consult and proper analysis.

There is a wide range of Obagi products so in my subsequent entries I'll fill in with the details. As for now, I'm pretty happy with the results and can confidently go out without any foundation or make-up and still look good.