The Sagging Face .......... Part 2 (Treatment Options)

Well, that was a long hiccup from my last entry. My apologies to my fellow readers. Sometimes it is hard to find that quiet time to let the words flow and produce good quality writing. Well, anyway, as I promised before. Let's continue our discussions on the sagging face.

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So now we know that there are many factors causing the face to appear to sag, from anatomical differences i.e. weight loss or gain or alternating of the two, skin texture loss or just the very process of ageing which leads to bone resorption especially around the orbits and the maxilla. Let's discuss the options of treatment. Bear in mind, the options are not sequenced according to the most effective method. Based on the patient, sometimes 1 or more modalities are required or multiple sessions.

1. Botulinum Toxin A facelift injections.

I remembered when I first started to  join the Medical Aesthetics field, my seniors were in the hype of the 'Botox-lift' which uses diluted BTA intradermal meso-injection techniques at certain areas of the face and neck to produce a slimmer tighter look and feel. The jawline tightening was dubbed the Nefertiti lift and was published in one of the medical journals. It was a quick and simple way of getting a tighter look by only spending 15 minutes in the office. Although the results were quite good, unfortunately, it only lasts between 1-3 months post injection and it does not tackle volume loss issues. Complications may include asymmetry of the face especially if there is a marked power difference from one side of the face to the other, or if the injections were too deep and inoculated into the underlying muscle. Per procedure will cost around RM 1000 - 2500, depending on the units used and the patient would have to come back to the clinic every 2-3 months to sustain the results. Some doctors are still doing this technique. Personally, I only do this upon patient's request.

2. Dermal Fillers - Hyaluronic Acids (HA)

Besides volume filling, dermal fillers can also be used for tightening. Nowadays with the newer HA fillers that gives better volume than the previous ones, we can do point injections to lift up the overlying tissues (muscle,skin, etc) to give a more tighter look. The injection sites usually involves the temples and the cheeks, with additional fillers used to fill up volume deficiency. However, you will need at least 2 syringes of a good volume filler (3-4 of the less dense fillers) to get the best effect. The good news is that it will last at least 12 months, and some of these HA fillers last up to 24 months or more. For non-HA fillers, Radiesse also has a tightening protocol using similar point techniques with an additional vector technique aimed to sharpen the jawline and bring up jowls. It requires at least 2 syringes on the first sitting, with possibly a follow-up syringe after 3 months for it to last 6-15 months. However, for both these types of fillers would require a fairly good texture of the skin in order to get the result. Other things consider is how good is your doctor at doing the procedure and the risks of bruising and lumpiness is always there. Cost wise, you will be spending around RM 5,000 (since its definitely going to be more than 1 filler) but if done well, you an have a good satisfactory result lasting 9-18 months on average.

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3. Poly-L-Lactic Acid Fillers

These are a different type of filler that stimulates your own collagen formation by means of injecting PLLA into the face. There are 2 common ones in Malaysia which is Sculptura and Aesthefill. The procedure requires 3 sittings, once every 1-2 months. Per sitting 1-2 vials of the product is injected into the face. The effects of the procedure can be seen as early as 2 weeks but usually 4 weeks you can start appreciating difference. The only problem is the downtime. It requires multiple injections to the skin which may lead to bruising. Usually the bruising subsides in a few days to a week, but some patients can bruise up to 2 weeks. Another problem is that it may cause some fibrosis under the skin thus making future filler injections pretty difficult especially if the injector is less experienced. Despite the downtime and the bruising, I must say, I am pretty impressed with the results. I had a good friend who decided to go on an extreme diet and exercise regime which caused him to have very severe sagging and a turkey neck. However, after 2 months of the first session, he improved so much that he looked younger than when I first met him a couple years back. Its been almost 2 years, and he still looked great. He just redid his face recently.  For this procedure, patients are required to take a whole course since you need to come back at least 2-3 times. The solution requires preparation, so you will really need to schedule the appointment beforehand. The price of 1 vial is RM 2500. Usually 3 sessions (4-5vials) would be charged at RM 10,000 for the package.

3. Radiofrequency Devices. (RF Devices)

This is perhaps one of the oldest techniques used for skin tightening but is still considered the best solution for skin tightening. However, bear in mid that there are different spectrums of machines used. The ones used in beauty salons are beautician grade, thus the power and intensity of the machine is much less. Some doctors buy these machines because they are cheaper (perhaps 10x cheaper) than the medical grade ones. Medical grade machines have to undergo series of clinical testing and approvals before sold to the market. It also requires proper training to avoid complications and deliver the best results. The medical grade machines in the market are like Thermage, Accent and Pelleve. Actually, there are so many RF devices in the market. Depending on which machine you are using treatment can be as low as RM 300 per session on the lower end of the spectrum to a whooping RM 12K per treatment with Thermage. Most RF machines except Thermage require repetitive treatments. The medical grade devices uses recommend 4x minimum. The beautician grade ones, usually 8-10x. The difference between medical grade and beautician grade device is that the medical grade devices are guaranteed to deliver the 40mJ of energy required to heat up the dermal tissue between 42-60 degrees. Thus, the results can be reproducible and repeat with more accuracy. However, the other factor in the delivery of treatment is the skill of the person handling the machine. A well trained user will deliver a better result, despite the machine being the same. 

4. Intense Pulse Light (IPL)

IPL is one of the oldest light based devices used in aesthetics. Using filters to control wavelengths of light enables the user to target specific needs to the patients face. Similar to the RF devices, there are medial grade and beautician grade IPLs, which differs in terms of intensity and function. The usual wavelength filter used for skin tightening is between 500-1200nm and has shown great results in reducing skin laxity, wrinkles and also telangiectasia. Treatment price ranges from RM 800  - RM 1500 , depending on the type of IPL and area used. However, being a much older technology requires more skill on the doctors side to handle the device and the treatment. Complications are more common in darker skin types and are not limited to blistering, burns and peeling. Usually skin tightening procedures are not very painful compared to hair removal and is tolerable without anaesthesia. This treatment requires repetition to reach the best results, usually 4-10x depending on the type of IPL used. 

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5. Ultrasound Devices

The latest hype on skin tightening devices would be the ultrasound devices or also known as HIFU devices (High Intensity Focused Ultrasound). The most famous perhaps is the Ultherapy device that has been competing with Thermage since it first came into the market in 2009. Nowadays, other companies have also started to produce their own HIFU devices for skin tightening. My experience on Ultherapy was during the initial phase of its launch. The treatments were painful, but according to the latest protocols, the intensities have been reduced and still produced similar results. Tightening results were good, but may need annual repetition to maintain. What I love is that they have new FDA clearance for other things like neck tightening etc. What I don't love is the cost per treatment ranges between RM 12-18K  and that the device costs a bomb. 

6. LED Devices.

Some believe that LED devices give tightening effects to the skin. Although it is more for skin rejuvenation as a whole, it does to a certain extent help to tighten the skin. The wavelength used is the 633nm red light that helps with rejuvenation. The only problem is that the tightening effect is overall and not targeted, so although it may work, it will take a longer time. Treatment prices range between RM 300 - RM 800 per session depending on the type of LED device.

7. LASER Devices

Most LASER devices are designed for rejuvenation or ablation and as a side result, some skin tightening are observed. However, there are LASERs that can use for skin tightening. ND YAG long pulse LASERs have been seen to give a good lift for sagging skin. It can be pretty uncomfortable and repetitive treatments are required. Treatment costs between RM 800 - RM 1800 depending on area and machine used.

8. Platelet Rich Plasma Procedures (PRP)

PRP treatments made a huge hype when Kim Kardashian posted on her social media about getting it done. Obviously she had more than PRP done on herself, but her stunt put PRP as one of the medical aesthetic treatments available in the market. Although PRP does help with rejuvenation, it only gives minimal tightening effect immediately. In the long run, maybe with volume increase and skin thickness increase, it will appear tighter but it would not be working specifically for the jowls. Treatment costs anywhere between RM 1600 - RM 5000 depending on which system they use and which method they inject it with. If its too cheap, be wary, it could be under treatment or done by an unexperienced doctor and you may not get the results you want. 

9. Threads

Threads use to be only the plastic surgeons territory for lifts, but now less invasive threads are available giving you an in-office procedure. There are 2 types of threads used in clinics which are the suspension threads and the PDO threads. Suspension threads like Silhoutte Soft suspends in the fat layer of the face giving a temporary lift immediately lasting anywhere from 6 months to up to 2 years. The main determinant will be the amount of threads used and the technique. Plus whether any anchoring to the SMAS was done. It works on lax skin making it tighter. However, usually 20% of the tightening effect will reduce after 2 months when the swelling from the initial procedure completely subsides hence why sometimes, the doctor tends to pull a lot tighter in the beginning. It would be a good solution to jowls except the cost of the treatment is around RM 4000 - RM 8000 per sitting depending on number of threads used. Some threads requiring anchoring can cost up to RM 20,000 per sitting, which makes you want to consider visiting the plastic surgeon instead. The other threads available are the PDO threads. Now the Koreans have modified them to allow longer lasting effects compared to the first generation of PDOs. Although we can use PDOs for tightening via collagen stimulation, it takes a few sessions (3-5 sessions) over a period of a couple months to get a really good result. The cost is cheaper than suspension threads, roughly around RM 2500- RM 5000 per sitting depending of amount and types of PDO used. Sometimes, doctors would used a combination of both suspension and PDO threads for a better result and this can cost a whopping RM 7000 - RM 12000 per sitting. The only problem with threads is the downtime. If you are lucky you may not bruise, but most of the time it takes between 5-14 days for the bruising and swelling to subside.

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10. Mesotherapy

Mesotherapy is the practice of giving micro injections to the face. For face tightening, certain mesotherapy cocktails can be used to improve skin tightening. However, it may be temporary lasting only 2-4 weeks and they maybe risk of pain and bruising. You also require to do multiple sessions (5-10 sessions on average) to get a good result. Some clinic use mesorollers, mesostamps or mesoguns to aid the process.  The cost can vary between RM 250-RM 1200 per session depending on the cocktail and the method used. 

11. Tightening Creams 

I included this in as now a lot of clinics sell products that promises instant tightening of the skin. There are a few scientifically proven substances that can help with skin tightening. One of the most mentioned are the DMAEs (di-methyl-amino-ethanol) which has clinically proven to tighten up the skin. Another common component would be the non-cross link hyaluronic acids which claim to help with hydration and skin tightening too. Personally, i think the molecules maybe too big to be absorbed well. Plus it is aquaphilic, and our skin is water proof. Another amino compound that has made highlights is the 8-hexapeptide complex that helps to reduce wrinkles for 8-12 hours dubbed as the alternative to botulinum toxin. (Honestly, BTA works faster and better). Other active ingredients include retinoids (Vitamin A derivatives), salycilic acid, ATP, Coenzyme Q-10, and other peptides and cytokines. Epidermal Growth Factors (EGF) also plays a role although it is more of rejuvenation of the skin compared to just tightening.

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Regardless of whatever treatment modality that appeals to you, a good consultation with your aesthetic doctor is always important to get a better idea of which treatment or treatment combinations suit you best. It is always good to preplan the procedure so that you can afford the social downtime if required.

For more question or to book an appointment, do contact us at drmmclinic@gmail.com or call / text /whatsapp to 0129660852 .

Fasting Month 2014

'Its raining its pouring, the old man is snoring, he went to bed and bumped his head, and couldn't get up in the morning.' It finally rained after a few hot days of haze and sun. My head was throbbing so bad this morning, I predicted heavy rain. And my prediction of rain was correct. Its funny how my head hurts with the change of weather. I use to call it my barometer. 

Fasting month is a peaceful month. Muslims are commanded to fast during this period from fajar till the setting of the sun. There are so many restrictions in fasting, and breaking fast is perhaps the most joyful event of the day. It also helps bring together people as in Malaysia, the culture is to have breaking fast events where friends and family gather. With the football season on board, even sahur (meal prior to fasting) becomes a gathering, where friends and family gather to watch the world cup whilst enjoying sahur together. A lot of my patients ask me about medications you can use during fasting and I've gathered some info for the benefit of my readers.

Treatments That Are Allowed During Fasting

1. Eye drops, ear drops and ear washes as long as it doesn't pass the ear drum.

2. Sublingual GTN (Nitroglycerin) pills or other sublingual drugs that are palced under the tongue and     not swallowed to reduce angina, etc.

3. Dental works such as tooth extraction, filling, polishing as long as you do not swallow anything 

    during the procedure.

4. All forms of injections i.e. intradermal, intramuscular or IV as long as it is not nutritional.

5. Blood donation or transfer or blood taking.

6. Local application of medications in form of cream, plaster, bandage, patch etc on skin.

7. Intravascular catheter insertion for examination e.g. angiography.

8. Laparoscopic examination of the abdominal cavity via the abdominal wall.

9. Gargling water as long as it does not involve any swallowing.

10. Taking biopsy of liver or other organs for examination.

11. Dialysis treatment for kidney patients whether hemodialysis or pertoneal dialysis.

12. Local anaesthesia or partial anaesthesia with sprays or injections.

13. Usage of haemorrhoids medication to reinsert the haemorrhoids into its place without involving 

       internal cavities.

Treatments that can cancel fasting

1. Usage of inhalers for asthma or Chronic Lung diseases.

2. Using pessaries or medicine into the vagina inclusive of wash, vaginascopes, or digital 

    examination.

3. Insertion of any catheters, or urethroscope into the urinary tract, barium studies or wash for both 

    male and female.

4. Use of enemas, suppository tubes, medication protoscpe or digital examination into the anus or 

    rectum for examination.

5. Endoscopic procedures of such as ERCP, gastroscopes, etc to examine the gastrointestinal     

    system.

6. General anaesthesia.

(Source Ustaz Asmadi Mohamad Naim / Buku Panduan Pesakit JAKIM)

I hope this helps clear some of the doubts. Happy fasting peeps. :)

Ramadhan promo......

Salam Ramadhan peeps.... a picture tells a thousand words. Sharing this for the benefit of my patients. Don't miss the exciting promotion.

For more information Call us at 014-2233268 or email to faceworksclinic@gmail.com

Beautiful Breasts...... How to fix my sagging breasts.....

When we think about women, breasts are one of the things that pops in mind. Despite the gender differences in aspects of discussion, it will always still be a topic. Men would normally talk about cleavage and size (one of the first thing a man notices in a woman they bump in the street), whilst women would be talking about size, sag, lag, etc.... In this modern world, looking our best is now a requirement not just an option. The way you look really plays a major role in the confidence you portray. Despite what some people may say about looks does not matter, reality is, it does. We all know that. 

Breasts are part of every women. It is a differentiating anatomy between male and female and serves as feeding organ for babies. One thing that a lot of women worry about is size. Most women prefer big breasts but it needs to be proportionate to the body. Too big breasts can lead to health problems and it estimated that too large a bust can reduce a woman's lifespan by 5 years. The main problem that most women with a huge bust will have is additional pressure to the spine which causes pain in the long run. Its either they extend their back more to compensate for the weight or slouch due to gravity hence leads to long term abnormal posture thus causes spine problems and even muscle pains. Sometimes when the size is too big, women have difficulty in breathing and are unable to sleep on their backs because the breasts add pressure to the chest. It can also cause headaches and migraine due to constant strain to the surrounding structures. Too huge breasts also can have skin implications as fungal infections occur easier due to bigger folds and bigger bra straps can cause abrasions and affect skin health. There is also a more significant risk of weight gain for women with bigger breasts as the big bust limits a lot of physical activities due to strain onto the muscles, ligaments and spine from the weight. Thus there is a reduction in exercise that leads to weight gain. Big breasts also causes stress for a lot of women, especially with their own self-confidence. A study done shows that women with excessive breast size have reduced confidence due to the breast size, especially if it becomes an object of banter or joke in their society. If you have any of these symptoms, the solution to it is breast reduction surgery which should always be done by a trained plastic surgeon.

In Asia, the more problem is small breast size and breast sag especially after breastfeeding. Luckily for us, medical technology has come a long way to helping solve these woes. For breast size, despite multiple methods promised by the media I would still say if you are really decided go for surgical breast implants by a well-trained plastic surgeon. The high-grade silicone implants would be good for at least 10 years without any other complications. Low grade implants may burst and cause massive tissue scarring and would require surgical removal. Normal saline implants are still encased in silicone and may leak and reduce in size over time. Silicone injections are banned for use in many parts of the word due to the complications that arises from it. There was a hype for fillers but the effects were only a maximum 1/2 cup increase and lasts longest 1 year in terms of aesthetic effect but may cause scarring and calcifications. Not to mention the cost than is not cheap and usually I would advise my patients for permanent implants instead. Fat grafts are also used but it depends on the skill of the doctor. You may need to top up after 3-6 months and the effect can last up to 2 years. There is still risk for tissue scarring and failed fat graft, not to mention the cost.

Now, we come to sagging breasts. Why do breast sag? 

1. Age 

The most common factor is age. As we grow older, there is more gravity pull and our ligaments start to become more lax. There is no muscles in the breast, only mainly breast tissue, fat and other connective tissues. The connective tissue is also called the "Cooper Ligaments" starts loosing its elasticity as we age.

2. Running without proper support.

Over-bouncing of the breasts can make the breasts sag faster. Hence why we are recommended to wear proper sports bra to support our breasts. When a person runs or does strenuous exercises, the breasts move everywhere in an 8-like motion. Without proper support, the breasts move too freely that can lead too over-stretching of the Cooper's ligaments leading to sagging.

3. Changes in weight and/or hormones.

Extreme diets and extreme weight loss/weight gain can lead to sagging. Pregnancy causes sagging in women and is proportionate to the number of pregnancies she has. The key here is gradual changes to the body, will not affect the breasts too drastically. Breastfeeding DOES NOT contribute to breast sagging, so give your babies all the milk that he/she needs.

4. Smoking

If you love your breasts then you should quit smoking. Smoking not only causes other harmful effects to the body, it also breaks down elastin which is a protein that gives the skin elasticity. Reduce elasticity causes sagging.

So how to improve sagging?

The definitive treatment is to do a breast lift but even this surgical procedure is not permanent due to the factors which cause sagging and after awhile the ligaments are just going to lose its elasticity and sag again. Not to mention the cost, the downtime and risk for scarring. Other methods in medical aesthetics includes use of Laser to tighten the skin around and above the breast to lift it up but this also is temporary. My favourite would be to use Gentle-YAG or any long pulse ND-YAG 1064nm at a tightening setting to give that additional lift. It can be a little bit painful during the procedure as it requires a longer interval that the normal rejuvenation protocol. Cost for each treatment varies on type of laser ranging from RM 1000-RM 2500 per session. In my clinic, we have Fraxel that can also help to a certain extent for breast tightening but it would be more of skin rejuvenation over the décolletage area avoiding the breast tissue. Some places do RF tightening for breasts, but it requires multiple sessions at close intervals and results can sustain up to 6-9 months after completing the course. However, we do not recommend RF on the breast tissue areas since it may lead to reduction in volume. This method also requires good knowledge of anatomy on the person handling the RF, but at least it is a cheaper alternative. 

Threads for breast lifting.

The Korean influence has increased the usage of threads in medical aesthetic practice. Now more doctors are promoting threads for breast lifting as an alternative to surgical breast lifting. The results are quite interesting although the is still risks of bruising and pain, and some downtime. If placed correctly, you will not be able to feel the threads. Depending on what you wish to achieve, the doctor would advise you on type of threads and how many you need. The two common ones used are suspension threads and PDO threads. Other threads would require surgical anchoring to allow the threads to stay in place. Suspension threads would give you a good lift for 18-24 months almost instantly and usually you will need 2-3 per side. Cost for the procedure is anywhere between RM6-10K at the moment. PDO threads on the other hand takes up to 3-6 weeks to start showing results as its mechanism of lift is more of collagen stimulation. You may require anything from 50-100 threads per side and probably a combination with suspensory threads. PDO threads is common in Korea, China and Japan. In Malaysia, be aware of beauticians and unregistered 'doctors' also doing this procedure since it is so easy to buy it off Alibaba.com. Price ranges anything from RM 2000-RM 6000 per session but you will need multiple sessions (3-5X)  in short intervals before the end result. The complications also includes pain, swelling, bruising and possible failure or infections if not done properly. For the record, I have not started this service but if you wish to try it out, I can direct you to my colleagues who do.

PRP for breast lift and rejuvenation.

Now this is a method that I am pretty interested about. This year, I have been studying a lot on this particular technique and had the chance to tutor under a very knowledgeable senior on this matter. Dr Rahmat has been practicing for over 20 years and at one point was teaching anatomy to students. Anatomy plays a very important role in achieving good results and avoiding complications. Using his technique which involves using PRP as a natural glue to strengthen the Cooper's ligament and keeps it perked. The growth factors concentrated in the PRP also helps to rejuvenate the ligament via encouraging new cell growth and improving collagen and elastin. The real mechanism is still uncertain. More superficial injections are also done to improve the overall breast appearance and lighten the areola to for a more rejuvenated and youthful look. I have done a couple of treatments for patients and overall were happy with the treatment. I injected myself with my own PRP to observe the changes and I noticed there was initial swelling and fullness that lasted approximately a week. There was a size change, and I had an extra 1/2 cup that lasted me at least 6 weeks before shrinking again. There was definitely a lift and my nipples points a more symmetrical fashion nowadays. There was not much areola lightening since I didn't inject much at the areola (Its painful when you are doing it on yourself). I did one on my manager and she had a better lift and 1/4 size improvement and results lasted about the same. I believe that there is a cumulative effect, hence you will need repeated 3-5 treatments to get a more lasting effect. So I am getting another round today :). We charge RM 1800 per treatment and there are packages available. The procedure takes approximately 1 hour with numbing. The good thing is that its autologous, meaning that it comes from yourself, so there is less chance of allergic reactions or risk of excessive scarring. The best thing about doing this is the superficial effect on the skin. My bosom feels softer and look more refine compared to before and the skin tone is fairer. I have found very fascinating results with PRP, and am really considering to conduct a proper controlled study on this topic.

Preventing Breasts From Sagging

Recent studies have shown that wearing a bra causes more sagging to the breast. Prof Roullin from France did a 15 year comprehensive study on hundreds of women and recently published his findings. Rouillon found that women who never wore bras had nipples on average seven millimeters higher in relation to their shoulders each year than regular bra users. Apparently, the slight bounce that you get when you walk is important for the ligament's development and using tight bras from a very young age for long term impedes this process. So it looks like we have to reduce our bra wearing activities... O...o.

Cutting down and quitting smoking is another way to prevent early sagging. Nutrition has shown to play a role too. A healthy diet that consists of good proteins help to keep the breasts in shape. Vitamin C and E plays a role for skin health and helps to keep the skin around the breast firm to reduce sagging. Some people believe in phytoestrogens to perk up breast size and keep it firm. Although it may be beneficial, be careful with hormones as some preparations may increase risk for breast cancer and other problems.

Exercise is another important factor. Push ups, arm lifts, free weight lifting, resistance exercises or any form of exercise that strengthens your chest muscles (pectoralis, trapezius etc) will help to keep your breasts firm and looking good. Postural fixing, and back exercises helps with excessive weight of the chest.

For more info on the treatments mentioned here or for appointments please call Faceworks Clinic 03-21440080 or 014-2233268 or email us at faceworksclinic@gmail.com. Like us on Facebook https://www.facebook.com/FaceworksClinic to get the latest news and blogs.

PRP Updates - The Vampire Facial?

Recently, there is a lot of hype about Platelet Rich Plasma (PRP) facial since our beloved Kim Kardashian decided to get hers done and post the video on Youtube. There were multitude of responses from complete horror to complete awe. And whilst the whole population was amazed to see the procedure, it is not really a new thing.

(Sourced from www.tagroom.com)

However, the in the medical world - more and more doctors are realising the potential benefits of PRP to treat their patients. As for myself,  PRP is like a lifeline to medical aesthetics alternatives of treatment to patients. We have multiple studies conducted on rejuvenation of the skin and most seem promising. My own patients have also shown great improvements in terms of texture, hydration, pigmentation and scars. The most rewarding was one patient with recalcitrant melasma who improved so much after a few treatments - despite previously tried with IPL, peels and Fraxel. We also had patients doing breast rejuvenation where most are satisfied with the tightening effect and skin rejuvenation effect of using PRP. In terms of volume, only time could tell, since the cases are pretty new. Most PRP facial patients are satisfied with the results and are looking forward for the next one.

So what is new to our Vampire Facial regime?

(sourced from ieeet.com)

After attending so many lectures, hands-on, friendly exchange of ideas with colleagues and literature study, nowadays I do my PRP facials differently than before. Prior to this, I only take 10cc of blood per session, but now I prefer to take between 60-120 mls of blood depending on area needed and indication. For face, usually 60cc of blood is suffice. The centrifuge process is also different where I start with a soft spin, extraction then a second faster spin. From the 6 bottles, I would usually obtain 12 cc of concentrated PRP - and roughly 12 cc of PPP. So what's the difference again?

The Platelet Rich Plasma is the layer between the red blood cells and the upper clearer serum part. The serum part is also called PPP (Platelet Poor Plasma). The platelet rich plasma is where all the growth factors and cytokines are available. The upper portion although has some platelets have minimal benefits, thus sometimes we just give it to the patient as a home mask. Some studies say the white cell are detrimental to healing but others say they have no role or helps with healing. The red cells play no significant role nor does it causes any reduction in effect. And thus, we have an autologous (coming from oneself) cells stimulator.

Luckily with Dermaqueen technique, PRP can be delivered evenly throughout the face without much downtime. Last weekend, I asked my nurse to help inject using the Dermaqueen vacuum assisted needle device onto my face with minimal anaesthesia. (I am still a baby when it comes to pain). There were only minimal needle marks at the thinner skin areas but there was still a remarkable difference. My face was brighter, and some of the pigmentation disappeared. Its been 2 days only and my skin still glows. The tear trough injected manually appear to still keep the volume injected which is good, thus making me look less tired. For a PRP facial, the best results would only be seen after 3-4 weeks although immediately after you would have a refreshed look and brightening of the skin. The best part is that we do observe continuous healing even up to 3 months after the initial procedure. Average results lasting period for a single treatment is between 6-9 months. However, most literature suggest a minimum of 3 sessions per year.

From my observation of doing my patients, I do have a few recommendations for patients planning to try this out. As PRP is from the patient, the patient him/herself has to be optimum to achieve the best results. You should keep yourself well-hydrated and well-nourished before going for a procedure. Smoking and drinking alcohol excessively seems to reduce the effectiveness of the treatment. You should be fit with no underlying infection going on as it will affect the outcome too. Patients with underlying blood or metabolic disease should consult the doctor thoroughly as some conditions are contraindicated for PRP. Use of health supplements that promote healing and cell growth may have some beneficial effects, although a proper study to compare the results is warranted to conclude. Vitamin C and other antioxidant supplementation may also benefit but is still subjected to further proper research.

Personally, I love this treatment as it offers a less aggressive treatment modality for skin rejuvenation as compared to energy devices. At the moment, we are studying the effects of PRP on stretch marks. Can't wait to report the finding.

For more information or to book an appointment with us contact the clinic at 03-21440080 / 014-2233268 or email to faceworksclinic@gmail.com

PRP Facial Rejuvenation.....

How about using your own blood to rejuvenate your face? I get a lot of reaction when I ask this question. "Blood - ewww... scary" Some would say. "Is it safe?", and most would ask me "Why blood?"

Its really a simple procedure you can do in my clinic. Using a special kit from Regen-Lab (biotechnology Swiss company) called Regen-ACR, I can provide a facial rejuvenation using your own blood (the plasma platelet component that is) to improve texture, and act as a collagen stimulator.

Platelets have been known to have many functions and is now being considered as a regenerative treatment due to its functions and properties such as:

• Tissue regeneration and rejuvenation
• Increase collagen production
• Recruitment of other cells to the site of injury
• Initiation of vascular in – growth
• Induction of cell differentiation
• Allo-allergenic since it comes from your own body thus eliminating risk of donor transmissible infections.
• Acts as a biological Glue: for tissue adhesion especially in skin flaps, bone grafts and trauma.
  

How is it done?

It is a very quick and easy procedure. 1st of all, I would withdraw some blood - approximately 8-10cc and put it into a sterile Regen-Lab PRP tube. The blood is then centrifuged for 8-10 minutes. Once the process is complete, there will be a good definition between red blood cells and the plasma component of the blood. The plasma component is then withdrawn carefully into a syringe and the PRP (Platelet Rich Plasma) is then used on the face using either Nappage technique, dermaroller or as a filler at nasolabial area and other wrinkle sites.

PRP has been used in many otehr medical fields such as orthopedics, stomatology and reconstructive surgery for the opast 10 years. In medical aesthetics, it was first introduced in Europe since 2003 and has been used for improvement of:

• Cheeks
• Nasolabial folds
• Eye areas - crow feet, eyelids
• Lips, chin and forehead
• Neck and nape of neck folds
• Cleavage
• Hands
• Improving acne scars
• Male type alopecia

It has shown to give the skin youth and vitality, improve density and tension of skin, nourishes and regenerates the skin and improves the structure and colour of the skin.

How long does it last?
Based on the literature surrounding the usage of PRP, it recommends for patients 30-45 a one time treatment and for >45 years old 2X treatments in a year. This is for facial rejuvenation. Immediately after you normally feel a tightness which is due to the techniques used which lasts a week or 2, but the rejuvenation process of diminishing fine lines and collagen stimulation would take 3 weeks or more to occur. Most patients would agree that there is immediate tightening and hydration of the face, with a healthy glow which lasts up to 2 weeks or more. However, if you are treating alopecia (balding) or acne scars, you may need monthly treatments and results will only be obvious after a few months.

Contraindications:

Despite this cool new technology, not anyone can have this procedure done. It is contraindicated for patients with:

• Skin disease (SLE, porphyria, allergies),
• Cancer,
• Chemotherapy,
• Severe metabolic and systemic disorders,
• Abnormal platelet function (i.e. blood disorders).
• Anti-coagulation therapy
  
• Underlying sepsis

Also, smoking, alcohol or drug abuse and unhealthy lifestyles would contribute to minimal outcome of treatment. Otherwise, you should normally get a satisfiable result immediately and months to come.

Interested to try? Call or email us now for an appointment : 03-21440080 / info@faceworksclinic.com