The perfect nose........

The nose has always been one of the most concerned aesthetic areas of the face. Depending on your ethnicity, the problem with the nose would differ from a Caucasian wanting to perfect a defect, or an Asian whom are more likely to have a flatter nose bridge. The nose, being the center of your face would be among the first thing a person would notice when they look at you. Therefore, most people would want a perfect nose.

There are many techniques of improving the nose from rhinoplasty to implant insertion, reduction of the ala nasi and fillers. Filler injections have shown to be the easiest non-invasive method of nose augmentation and reshaping. When we mention fillers, most people will relate to hyaluronic acid fillers such as Juvederm, Teosyal, Perlane or the calcium hydroxypatite based i.e. Radiesse. Although these fillers give wonderful results in the hands of a skilled injector, many patients would start thinking about the hassle of having to come back and reinject every few months. If the fillers were in the cheeks or folds, it will be less noticeable when it becomes smaller, but the nose? It would be kind of funny to have the perfect nose in the beginning of the year, and by christmas it is reduced again. 

Hence, the appearance of semi-permanent fillers into the market such as collagen fillers, Bioalcamid and Aquamid. Collagen fillers although shows promising results has increased the worry of practitioners as to allergic reactions towards the animal component. In a few religions like Muslims and some Hindus, the use of bovine or porcine collagen is not preferred. Furthermore, results last up to 3 years only or even less. Hence we have non-animal products such as Bioalcamid and Aquamid.  Bioalcamid is more like an implant in gel form. When placed under the skin in the right manner will encapsulate and stay for 3-5 years with minimal change. It is removable by expressing out the capsule. However, it does require a good injecting skill and knowledge of the doctor to understand the gel implant and identify any risks early. For the nose, it can be placed at the bridge and will likely stay there, but there has been reported cases of migration (which I believe is due to the injector's technique). The only downside is that it needs bolus injections of the substance, hence fine sculpting of the nose may not be achievable.

Which comes to the next filler which is Aquamid. Aquamid is also a semi-permanent filler which has a lasting profile of 3-5 years but recently cross-section studies have shown that even after 10 years it is still there. It is 97% water based and does not form capsules. Usually after the 2nd month, the patient could not even feel the filler anymore because it integrates with the skin. It requires multiple injection techniques and a lot of local is given during each sitting. Because of this, usually 2-3 visits is required to achieve the best results. As far as anyone is concerned, Aquamid is the most preferred non-surgical nose augmentation technique for plastic surgeons and advanced filler injectors. In fact, the rate of surgical rhinoplasty has declined with the advancement of this product because it allows the surgeon to tailor the nose according to the patient's face, less aggressive and invasive, minimal downtime, and the best part, no sutures. It allows the doctor to fix defects in the nose in the clinic, and the patient can resume work the very first day with minimal redness or bruising compared to doing a rhinoplasty. 

How I usually consult a patient who wants to get their nose done will depend on how much the patient knows about fillers and what it does. For virgin noses, if the patient is unsure, I'd ask them to choose between HA or Radiesse first, then later plan for Aquamid. For Aquamid, I would normally only inject 1 syringe at a time with a 2 weekly follow-up for the 1st 3 months to ensure no signs of infection. Remember, it is almost irreversible, so doing 1 syringe at a time would be the best approach. As for pain, usually the first few injections to numb the nose will be felt. Some people do complain of a slight pain sensation after doing the filler for a few days and gradually improves. Most patients are happy with the filler and the results. Even a review after 1 year showed that there was not much change in the filler shape.

So what is the perfect nose? It depends on the individual patient's perception. At this moment a lot of people are interested in getting a Korean nose as how the Korean drama series actors and actresses look. Is it achievable? To a certain extent, yes, and the best part it does not involves surgery.

For more information or further inquiries, kindly contact the clinic for a proper consultation at 03-21440080 or email to info@faceworksclinic.com

Year End Promotions mot to be missed.......

Once a year opportunity not to be missed. For booking and enquiries please contact the clinic at 03-21440080.

Year End Promotions.....

I almost forgot to post this one up... My bad :).

 

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Don't miss these exciting deals :).

Caviarlieri - Supplements for vitality.

A lot of people ask me about stem cells and placenta supplements and whether it is worth taking. I think that the word 'stem cells' has been overly used that it confuses a lot of people including doctors. According to wikipedia:

'Stem cells are biological cells found in all multicellular organisms, that can divide (through mitosis) and differentiate into diverse specialized cell types and can self-renew to produce more stem cells. In mammals, there are two broad types of stem cells: embryonic stem cells, which are isolated from the inner cell mass of blastocysts, and adult stem cells, which are found in various tissues. In adult organisms, stem cells and progenitor cells act as a repair system for the body, replenishing adult tissues. In a developing embryo, stem cells can differentiate into all the specialized cells, but also maintain the normal turnover of regenerative organs, such as blood, skin, or intestinal tissues.'

Oral supplements which claim to be stem cells are not stem cells but are rather supplements. But depending on the bioavailability of the supplements to the body and the concentrations, thus will give varying effects despite the component being the same. Which is why I am very skeptical about the efficacy of supplements claiming to be stem cells.

I was approached by Caviarlierli's people 3 months ago during the start of the fasting month. Caviarlieri is a new type of supplement which contains DNA from marine source i.e. expensive caviar from sturgeon fish and collagen from salmon and the sturgeon. Produced from perhaps the only lab with the recognized technology for extraction of DNA and creation of high quality stem cells in Switzerland, it comes in an interesting box sealed neatly. The accreditations were printed on the box, with a Halal certification from Singapore. Still being skeptical, I asked for the internal clinical studies done on the product and the results from the studies were promising. Prior to this, most stem cells were derived from either human or animal source, mainly from the placenta or the yolk cells. Despite its benefit, a lot of questions arise on the products as whether they contain any hormones since there are some results suggesting it does although there were no statements from the producing companies. Another issue was for Muslims and people who do not take red meat, some feel that it is not okay to consume or take placenta supplements due to beliefs.

The only downside of this product is that because it is made out of fish collagen, people allergic to fish is an absolute contraindication. In US, 2.4% of the whole population is allergic to seafood in general. In Malaysia, there is no statistics on allergies published but I believe it would be somewhere around 1% at least.

I'm already at my 3rd box and I would say that it would be a really good supplement if you can afford it. (Yes, the price is pretty expensive approximately USD$400/box). Certain changes I noticed after starting on the supplements:

• Initial 1st week I was so sleepy and slept more but after the 5th day, the sleepiness disappeared and I found that I was pretty hyper.
• I had more energy in the morning and I was able to sleep late and wake up the next day fresh.
• I slept better at night with less waking up.
• My appetite improved, and I found that the 1st month I think I gained a few pounds, but subsequently the weight reduced.
• After the 1st box, people started to notice my skin appears to glow, and it feels softer. My girls were the first to tell me.
• I also noticed my hair growing more and faster. I use to have thinning hair on my head, but after 2 weeks my hair felt heavier. Even my eyebrows grew faster. Initially I thought I was just imagining things but after a visit to my hairdresser, he reconfirmed that I had better volume.
• I noticed after 1 month, my nasolabial lines have improved without using fillers, Radiofrequency or BTA.
• The appearance of my cellulite has also improved dramatically without any procedures done at the area.
• I have less sinus problems. I recover from illness pretty fast compared to when I wasn't on it.
• I have less PMS symptoms and although initially my menses was delayed for a week. Subsequently it remained the same.
• It elevates your mood so that you feel less stressed and happier.
• What it doesn't do is avoid you from getting illnesses, so you can still fall sick. If you have PIH or post-inflammatory pigmentation like me, it still remains but maybe lightens faster. You may have a lighter skin tone, but don't expect to be extremely fair.

The listed benefits of Caviarlieri are as follows:

• Reversing the degeneration of aging and age-related conditions like arthritis, chronic fatigue, asthma, degenerative brain disease and osteoporosis.
• Strengthening the body's immune system.
• Substantially increases energy and stamina.
• Increases sexual desire and performance.
• Increases sexual satisfaction and elevates mood.
• Delaying premenopausal symptoms and delays menopause.
• Improvement of mental concentration and alertness.
• Substantial reduction in joint pains.
• Lowers glycemic index and thus leading to weight loss.
• Visible increase in radiance and glow of skin.
• Reduces appearance of lines and wrinkles significantly.
• Prevents macular degeneration.

For more info about this product you can visit http://www.swisscaviarlieri.com

I would recommend this supplement to anyone who can afford it, ideally those with chronic diseases like diabetes and hypertension to help control the disease better. The ideal is to take continuously but for those who wants to try, at least 3 months for best results.

For more information please contact Faceworks Clinic  at 03-21440080 or email to info@faceworksclinic.com

Keep it Simple and Safe - K.I.S.S

 

Every women in their life time would require to wear some form of make-up. In a lot of formal cultures, it is an essential tool for all women and for some, it would be rude not to wear any. However, choosing the right make-up to suit your skin can be a difficult task. The most common problem that arise with make-up is not getting the right colours, but rather making sure you don't get any reactions to the chemicals they use to create the make-up in the first place. The most common problem would be break-outs after wearing foundations, development of itchiness or rash with lipsticks, gloss, blushers etc. Red eyes with eyeliners and mascaras.

After treating my face with Obagi for post-inflammatory hyperpigmentation from acne, I felt a little bit worried to use make-up in case I clog up my pores again and start having break outs again. Then I was approached by KISS. What is KISS? It is a range of mineral make-up mainly produced in Australia and has 100% concentration of minerals in all powders and maximum mineral in sticks.

I was skeptical at first, but gave it a try. Initially it looked like so much work having to put layers and layers of loose powder but amazingly, after it sets in - it looked very natural. And since it is pure mineral, it only stays on my skin, so I don't have to remove it when ablution prior to prayers, and if I'm lazy, I can sleep on it till morning and not get any break outs. It has nice coloured lipsticks which help to moisturize the lip and the lip gloss has a nice minty taste to it. The eye brow pencil was soft and easy to apply. My only problem was the eye-pencil which was a nice soft black but it runs if you don't set it properly. The blusher comes in one colour, which didn't seem to last too long and I preferred orange hues rather than pink. Amongst all the products I liked the foundation the most because it acts like a concealer and a foundation 2 in one and that it lasts long on the skin with a natural look. Another cool thing is that it also has a good brush from goat's hair which absorbs all the powder thus leading to zero wastage. You just need a small amount for each application to get a good coverage.

Why should you choose mineral make-up over the commercialized cosmetic counter brands? Well, personally, if you have no skin problems, you can use whatever you like. But if you have acne or sensitive skin, using KISS would be one of the best investments because of these reasons:

• KISS mineral make-up is 100% from minerals.
• It is chemical-free, preservative-free, fragrance-free and free of synthetic colouring that may cause irritation to skin.
• It does not contain any talc thus does not clog pores. Talc is also considered harmful since long term exposure may lead to lung cancer or silicosis.
• It does not contain bismuth oxychloride which is commonly found in other mineral make-up preparations to help make the product stay longer on the face. However, this compound is not safe to be used on skin and may cause itchiness, rashes and it worst cases mild to severe cystic acne.
• It gives natural broad spectrum UVA & UVB protection as it contains zinc oxide and titanium dioxide for an SPF 24 cover.
• It is very water resistant (true for foundation and setting powder) thus rarely a need for reapplication. Even though it is water resistant, it does not stop water from reaching the skin surface (hence no  need to remove during ablution).
• Provides complete coverage for acne, rosacea and redness following clinic procedures such as chemical peels, microdermabrasion and laser resurfacing without irritating the skin.
• It is dry and inorganic which makes it impossible for bacteria to survive - thus making it have no expiry date.
• Each application of the make-up is minimal, thus one foundation will last approximately 6-9 months on daily usage and wear.

So when putting all this in consideration, perhaps it is a good investment after all for busy people like me who need to look good all the time. It does however take a lot of practice in the beginning, especially when you are use to conventional make-up methods which some are not applicable to mineral make-up use. At the end of the day, it all depends on the person's own opinion whether they would opt for this or not. If you are curious to try it out, you can try out in Faceworks Clinic where we do have a set for patients to try out the product on themselves and if you want, our nurse can do a make-over for a minimal sum.

For more information or to purchase this product please visit us at Faceworks Clinic or call 03-21440080 / Email to info@faceworksclinic.com .

Mirror, mirror on the wall.... who's the fairest of them all....?

I have come across a lot of patients who wanted fairness and even to the point of luminant skin. Being an aesthetic physician in Asia this is not uncommon. The Asian's model for beauty is to have fair flawless skin like the Japanese, and Korean counterparts. So I've decided to give my two cents on it, based on the things that I have read and researched.

Before I start explaining on the products that claims to make a person fairer, first we need to understand the difference in skin types and tans which determines how fair or tan you will be and the factors that lead to a more exaggerated tanning. There are 6 skin types based on Fitzpatrick's Skin Colour Classifications ranging from type 1-Type 6. For Asians, Type 1 are the extremely fair Scandanavians with blue eyes and yellow hair, type 2-3 are mainly Caucasians some are the Japanese and Korean Asians and for people like us, living at the equator would likely have type 4-5 skin type. Type 6 are the African origins or dark Indians. This genetic predisposition to skin colour depends on the distribution of melanin at the basal layer of the epidermis (skin). The environment also plays a role, whereas, where there is a overstimulation of the melanin - leads to more tanner skin. The most common cause is exposure to UVA/UVB sunlight. What it means in simple tense is that, even if we were to exclude environmental factors, our genetic built up will be the limitation to the fairness that we can achieve despite any treatment. I usually tell my patients that if you want to be fair, you can only achieve fairness as much as your non sun exposed areas and not more than that unless you bleach yourself.

According to most of the clinical studies that I have come across, topical Vitamin C in high concentrations does lead to a brightening of the skin because of its anti-oxidant effects and skin healing properties which allows better new skin formations. However, a lot of the creams/serums in the market have problems in delivering the vitamin C into the skin effectively leading to reduced efficacy. (Check out blog entry What's Up with Vitamin C -  http://faceworksclinic.blogspot.com/2011_04_01_archive.html ) The better ones are more expensive and prices range from a few hundred for a bottle. Furthermore, you need to use it on a more consistent basis in order to achieve lasting results. 

Similarly, there are some bleaching agents such as hydroquinone (HQ) - which is still the gold standard for treating pigmentary problems. However, long term use of hydroquinone will lead to a condition called onochronosis which is a bluish discolouration of the skin at the area of usage. Onochronosis is really difficult to treat and require multiple laser treatments to reduce the appearance. This was the main reason why there is a lot of bad press and reports on HQ. A lot of beautician products use HQ in the creams to get fast results as fast as 1-2 weeks but in long run causes damage to the skin. The FDA approval for concentration of HQ in skin products is only 4%. I know some beautician products that use up to 8% HQ and is sold over the counter with no restriction. Therefore, if you plan to use HQ to treat your pigmentation issues, please make sure you are under a follow-up by a doctor who actually know what they are prescribing.

Then we come to the non-HQ bleaching agents such as kojic acid, arbutin, mendelic acids etc. The most common nowadays are the kojics and arbutins. In high topical concentrations, you can see an instant lightening of pigments. However, if you are using a topical cream, containing these products, you will only see results after perhaps 4-6 weeks, in contrast to HQ where you see improvement in 2-4 weeks. Because these bleaching agents are taken from natural sources, you can actually use them up to whenever you feel like it without much side effects. However, I have noticed that after 6-9 months, some patients feel that the bleaching ingredient does not give any additional effects and sometimes I shift them back on HQ. Although this may appear to be the miracle product for avoiding and brightening up pigmentation, some people are allergic to these products and develop rash and itchiness. I see this more common with kojic acid preparations.

There are some products in the market which claims oral intake can help lighten up the skin. Some offer vitamin C in high doses of 1000-2000mg daily, others claim glutathione up to 5000mg daily oral intake. Although these may appear appealing, the high concentrations may not benefit in view that the gut can only absorb as much and overconsuming of vitamin C can lead to orange discolouration of skin, gut disturbances, etc. There are some products in the market which contain melanin blockers and acts at the cellular level of melanin production. I found one product interesting called White Beaute. It is an oral supplement that acts as a melanin blocker. I have seen some of my patients who improved in skin tone when taking this product after 3-6 months. The only thing with oral supplements, it takes longer to see the results compared to other methods, and that may be the reason some people prefer not to try it out. I have also tried out oral sunblocks such as Heliocare Oral Sunblock Pynocare - I find that it does give a fair results for about 3 months but prolonged use did not appear to benefit much in terms of skin brightening. But I did notice that I got less sunburnt compared to prior being on the product and you need to take it 2 weeks prior to any sun vacations to get the best results. My consultant consumed this product only 1 week before a beach holiday and she still got burnt, so perhaps the other general precautions such as hat, umbrella,shades and topical sunblock and sunscreen should be applied despite using the product.

Now we go to the injections. The most common injections for whitening sold are the Vitamin C's and Glutathione injections. Personally, I've never tried since I'm pretty happy with my tan, but maybe for research purposes, I would subject myself to this trial in the future. However, I do have girl friends who swear that it really does work. It works fast, but you need a maintenance program to keep yourself fair and you still have to avoid direct sun exposures. Furthermore, in view that you are trying to get the anti-oxidant benefits and the glutathione overdose side effect, you need to understand that there are factors that will cause these injections to not work. Basically, oxidative stressors.

There are many different processes and substances that chronically damage cells and contribute to oxidative stress including:

• Toxic chemical compounds and pollutants in your body
• Hydrogenated fats
• All kinds of pollution , including air, water, and food
• Oils that have been heated to very high temperatures
• Cigarette smoke, directly inhaled or secondhand
• Dehydration
• Too much sugar
• Too much animal protein in your diet
• Geophysical stress like living near power lines or waste dumps
• Microbial imbalance, including bacterial, fungal and viral infections
• Preservatives in your food
• Drugs (over the counter and prescription)
• Artificial food colorings and flavorings
• Plastics
• Chemical cleaning supplies
• Chlorinated water that you drink, shower in or swim in
• Alcohol
• Pesticides in your food
• Radiation exposure
• Psychological and emotional stress

Which is why in smokers, sometimes the whole course does not work. Another issue is gaining a good IV access and being careful enough to not shoot the products too fast because it will cause damage to the vein endothelium. And the most problematic part would be the commitment to come to the clinic according to the recommended intervals. If you skip 1 even, it may not work. I have come across a few alternative studies which links the usage of Vitamin C extreme high does as a cytotoxic agent to treat cancer cells. Therefore, injections for whitening using vitamin C and glutathione although some say may not benefit the person much, I do believe would help reduce oxidative damage that causes aging and is not just an expensive urine. But whether you are willing to fork out for a treatment that you may or not become fair from, its up to the person's personal choice. I would rather the person comes to a proper doctor in a clinic who understand the benefits and complication rather than shoot it up in a beauty saloon or a hotel room by some unlicensed person. Its always better to be safe than sorry. 

So maybe one day we will find a way to lighten up skin even from darker skin subtypes. But is fairness really that important? Perhaps, since we have all been brainwashed since we were really young- remember snow white? Mirror, mirror on the wall........ who's the fairest of them all? My belief is beauty is not just skin deep, it comes from within.

For more enquiries please email to info@faceworksclinic.com or call +603-21440080 for an appointment.

IMCAS 2011

Wow.... its been so long since I had time to write on this blog. Yes, I have been very busy since returning from IMCAS in Singapore last July. What is IMCAS - it stands for International Master Course for Aging Skin. Its a conference that connects all doctors like me to the rest of the world.
We get to meet the real pioneers of the industry, from USA, UK, Middle East, Japan, Thailand, Korea, and Israel even.

It is a 3 day conference with every session around one hour and in one session there are around 5-7 topics given at 8-15 minutes interval each. Yes, sounds crazy - by the end of the day, the only thing I can think of is food, because its so brain draining. But in a good way. It is meant as an update to what you already know and if you really pay attention, you will be able to grasp a lot of things in the conference that is useful for practice.

There are also demo sessions showing injection techniques and machines, and I was so happy to be able to see Dr Woffles Woo inject Radiesse. If you don't know who Woffles is, well, I regard him as the father of medical aesthetics in this region. I would love to meet him one day, as he is a true inspiration to my practice. He developed so many techniques in facial aesthetics that is excellent and gives great results. He practices in Singapore.

I learnt a lot on the latest laser technologies available and most important they stressed on treating complications. You also get an overview of what other parts of the world does, for example in middle east - a lot pf phenol peels are used. You learn botox and filler injection techniques that differ and gives more excellent results. These people are credible due to their many years of experience in medical aesthetics, 10-20 years. When I look at myself, with a mere 4 years under my belt, it feels like nothing, but still I do work hard to keep the standard of my practice to be good at all times.

I was honoured to meet up with Dr Michael Goldberg, whom I met earlier in the practice and his books were my guidelines to keeping the practice safe, I met Dr Diane Duncan, who shared a lot of tips on chin, lower face and neck tightening, I met Dr Bob Khannan, who shared his lower face botox tips. Dr Sebina Zenker, again, who also shared some of her injection techniques and laser tips. I met other new doctors from Korea, Japan, Indonesia, India, Pakistan, its a whole list.

Meeting up with your so-called super seniors in the field gives me a great sense of security and confidence to practice what I do. I remembered when I was an undergraduate, and my professor, Prof Christina use to say, its not about the degree, its about after that. Do you just want to be a doctor, or do you want to be a good doctor? I chose to be a good doctor and hopefully by broadening my knowledge in this feel I can safeguard my patients from harm. Who knows, a few years from now, I'd be addressing people from all around the world to share my experiences. :)

Silkpeel training.....

Last Thursday, we had a training session for Silkpeel conducted by Mr David from Redo Marketing. It was a short and sweet session, where my staff were taught about the machine, and we discussed about the benefits of using Silkpeel.

Besides the usual facial regime, we were also shown the technique for eye area and lips. Lips was really interesting because prior to this, I never thought we could use the silkpeel on the lips. This to me is a very exciting new thing, since there are very limited procedures you can use on your lip. I was the model for the training and when it came to the lip part, it was pretty cool. The lines of my lips smoothen, and my lips was rehydrated again, and the colour became a lot redder than previously. It looked really healthy and it didn't hurt one bit. It is a good way to return the softness of lips, and actually you can puck out the lip more. Combined with a lip conditioner, my lips have remained soft till today and I'm just checking to see how long does the softness effect lasts.

For the eye area, David suggest 4-6 treatments for people with dark eye circles or fine wrinkles around the eyes to get the best results. Interval between treatment is approximately 2-4 weeks.

Another interesting part was learning about the off-face usage for Silkpeel. Apparently, it is good for the next to rehydrate, the decolletage area for people who love to use low necks, to whiten underams, to smoothen dry elbows and knees, and you can even use it for the bikini and brazilian areas post waxing to lighten up darker areas and give the area a more smoother feel.
I think I will be starting this bikini and Brazilian lightening treatments soon once I get an additional tip for those areas.

Information about Silkpeel:

SILKPEEL DERMALINFUSION : a breakthrough treatment that combines non-invasive exfoliation with deep delivery of skin-specific solutions to improve and revitalize your skin.

Why SilkPeel DermalInfusion?

• Goes beyond microdermabrasion by providing simultaneous exfoliation and DermalInfusion topical delivery treatment
• Painless,soothing treatment
• Noticeable, immediate outcomes and lasting skin improvement
• Return to normal activities at once
• Patient-specific topical formulations to address your unique skin care needs
• Eliminates the risk and health concerns of aluminium-based crystals

And the best part is that it takes around 30-45 minutes per session with no downtime. You can go back to work immediately after the procedure.

For more information or appointments, please call 03-21440080 or email to info@faceworksclinic.com

My personal experience with Obagi......

Recently I had a visit from a good friend Richie who also supplies the Obagi products for my clinic. He was preparing to go for the World Congress for skin which will be held in Korea. I was suppose to come along but due to the hectic clinic schedule, well suffice to say, my patients have to come first. Probably next year I'll be able to go.

He was asking me for some of the photos of my patients who were on Obagi. However, I had to politely decline his request since I haven't asked the patients whether I am allowed to disclose their pictures to anyone else. So in the end, I decided to give my picture instead.

Going through my files I came across one particular picture that was taken before I used Obagi products that was in September last year. Now its been close to 9 months on Obagi and I am pretty shocked at the difference it made.

I have tried many products and procedures but seriously, the Obagi gave a marked difference.
During this period between September to May, I have had 1 fraxel dual 1920 nm done in October, 2 glycolic 20% chemical peel(Dec, Feb), 1 2-coat Obagi blue peel(Apr) and 1 session of rev-light done in April. I used 2 sets - 1 Nuderm travel set, and 1 C-Rx set.

For more inquiries, you can email me at drmarr@faceworksclinic.com or call 03-21440080 for an appointment to see me.