Its All About the C's

Its the start of spring and we are entering the second quarter of the year. Busy schedules and a lot of hard work for most of us due to the current economic slow down that is happening worldwide. In the hustle and bustle of keeping up with the rat race, it is really important to keep our health intact to meet up with our expectations. So for the next couple of weeks, I will be explaining about vitamins, minerals and supplements required for the body to function better. 

​​

 

Let's start with the big C. Vitamin C is a very important nutrient for our body. Humans are the only mammals in the world that does not produce their own vitamin C. Other animals produce C's internally and it plays a major role in their immune system and survival. Because of this, we need to consume vitamin C's on a regular basis to keep our stores up.

In humans, the benefits of vitamin C has been established more and more. It is involved in the formation of certain proteins to make skin, bones, cartilage and blood vessels. It is also useful in wound healing and formation of scar tissue, repair and maintenance of bones, cartilage and teeth, and it also aids iron absorption. 

It also plays a strong role in aiding the immune system and helps alleviate colds, flus and otehr viral illnesses. Historically, it was used to avoid scurvy but nowadays, this problem is relatively rare due to reduced long sea travels. It is also used to maintain gum health, treatment of acne, treatment of bronchitis, H. pylori bacter related stomach ulcers, control of HIV, treat tuberculosis, dysentry, skin infections and help in curing infections of the bladder and prostate.

Recent studies also shown the benefits of Vitamin C in relation to brain functions. It helps reduce depression, Alzheimer's disease, reduce physical and mental stress, improve concentration, improve ADHD and reduce fatigue. It has also shown in a study recently that it reduces heart rate during exercise and reduces the perception of fatigue and exertion. 

Latest studies also show that it aids in heart disease and diabetes by improving endothelial functions and reducing inflammation thus improving the outcome. However, you will need to take more than 500mg daily in order to see the benefits. With improved endothelial functions, there is a reduced risk of artherosclerotic disease which is involved in stroke and heart disease. 

Other benefits of Vitamin include improves glaucoma, prevent cataracts, prevent gall bladder disease, relieves constipation, improves dental caries, improves Lyme disease, helps with heat stroke, hay fever, asthma, cyctic fibrosis, infertility, chronic fatigue syndrome, autism, collagen disorders, arthritis and bursitis, back pain and disc swellings and improves osteoporosis.

High doses of vitamin c has also been used in alternative cancer treatments and as adjuncts to chemotherapy to reduce chemotoxic effects and has shown to improve patient outcomes. It is also an anti-aging supplement that helps reduce signs on aging, whether applied topically, consumed or given IV.

The next popular question that I normally get is how to take the vitamin. Well, for skin problems, the best is to apply topically. If you can get a 'medical grade' vitamin C more than 20% concentration it would definitely benefit your skin by reducing wrinkles after 6 weeks of diligient bidaily application of serum. If you notice I purposely highlighted medical grade, because a lot of cosmetic skin care claim to have more than 20% vitamin C inside their products but in actual fact, when you test them most don't even hit 10%. Sometimes, they put 20% concentration prior to manufacturing and after processing, the vitamin C being a water soluble vitamin, the percentage reduces. If you want to try a good medical grade Vitamin C serum, we do carry a few brands.

The next easiest method is to consume orally. However, most people do not realize that the gut can only absorb 600mg of Vitamin C per 4-6 hours and this also depends on how good your digestive system is. Most Malaysians have really bad digestive system due to diets high in fats and carbohydrate and lack of fiber. We also have a lot of irritable bowel syndromes and leaky gut syndromes which causes poor absorption in the gut. Now with our hair profiler system, we can screen for leaky gut syndrome and improve your gut health with just a simple test. The other issue with concuming orally is the form of vitamin C that you are consuming. Some believe L-ascorbate is the best form to take, the clinical data on it is scarce. And at the end of the day, how much vitamin C can the body actually absorb in a day? Maybe 2 grams. However, really high doses of vitamin C taken orally can cause nausea, diarhoea and abdominal discomfort.

Some medical practitioners advocate intravenous vitamin C in high doses for immune curve shifting. This is to avoid gut wastage of the C's and deliver accurate high doses. The idea has been used for many years in treating people with cancer and severe immune problems and now some are advocating as an anti-aging regime. Personally, I did try 10gms of vitamin C over 30 minutes with a combination of glutathione 600mg, ALA and B Complexes. The infusion was a little bit uncomfortable despite being diluted with normal saline, and I felt stiff in the arm during the infusion process. Immediate effect for me was actually lethargy but I noticed improvements in my skin tone, pigmentation and feel. Immune wise, I guess I improved, because my sinuses improved without needing antibiotics. However, one off therapy wouldn't be sufficient and usually you will need a course to achieve a good concentration. Being water soluble, the vitamin gets excreted out by 3-7 days. However, the high dose concentration for a few hours is what gives the body that extra boost to jumpstart the immune system.

Regardless, if you are unsure or planning to start high dose vitamin C regimes, please consult a medical practitioner that is well verse in the indications, contra indications and side effects. There are some contra indications to the use of high dose vitamin C that you will need to discuss with your doctor to ensure it is safe for you.

For more information please email us at drmmclinic@gmail.com or call us at 03-21106608 or send a msg to 0123301585.

Swisscelin - Revolutionary Swiss Cell Therapy to Halt Ageing.

I am back to my usual try and tested mode where I try out new products in the market and review them. Today, let's talk about Swisscelin. The first time I came across this product was when I was invited to a Hi-Tea event in Carcosa Sri Negara. It was a lovely event with beautiful setting. The principal from Hong Kong had come down for a soft launch of the product and a beautiful explanation was given by the guest Dr. speaker. Unfortunately, I was running late from my clinic appointment thus I missed out the whole talk. Such a pity.

Luckily, the marketing principle was there and she ran through with me regarding the product and the scientific evidence behind it. I'm not usually the type of person who listen much to marketing sales talks but what caught my interest was that this is perhaps the first supplement that I came across which includes the TAE or telomerase activating enzyme which was discovered in 2008 and the study published in the Journal of Lancet Oncology naming the enzyme TA-65. They won a nobel prize in 2009 and since then more and more studies have been conducted on supplementing this enzymes and its benefits and possible disbenefits. It brings a whole new ball game to the placenta cum stem cell supplementation as this enzyme has been proven to keep the DNA telomere elongated. One of the most accepted cause of ageing is when the cells fail to divide again and this has been seen related to the telomere shortening.

So of course, I was super excited when I read the ingredients. I just had to try the product for myself and see how it fairs. I stopped all supplements and medications during this experiment. There were 30 capsules per box and I religiously took a capsule a day first thing in the morning when I wake up. The capsule is quite big compared to other supplements, but because of the shape and softness, it was easy to swallow. There was a bit of a fishy smell but it was okay. I did not get any indigestion or acid reflux consuming on an empty stomach, but this is entirely on the individual. You can also take the supplement after your breakfast, although for the best absorption I would prefer eating it on an empty stomach.

So how did I fair? Day 1 to 3 was nothing much to shout about except that I had more energy in the morning compared to before. I was having fatigue issues waking up and I was blaming it on my late nights. I also realized that my sleep was deeper eventhough I slept around 5 hours a day. After the 1st week, I noticed my skin changing. It appeared softer and smoother. I also have more energy and was able to wake up fresh every morning. The pigmentation on my face improved, and I did not develop as much post inflammatory hyperpigmentation of my scars compared to previously. Sleep was great. I have enough sleep despite less hours. I even noticed an increase performance when I run every week. In terms of weight, there was no weight gain. Other things like heatiness, not as bad as taking sheep or deer placenta. I looked a lot healthier. In fact after 2 weeks, I did PRP for my face and the results was so much better than before. There was a marked reduction in pigmentation and skin glowed better. During this time, I stopped all other supplements or injections just to see how it goes. I also noticed that I do not have to take coffee first thing in the morning. I am able to delay my coffee till afternoon. I also noticed my mood swings to be less erratic and I was a lot calmer, although there was an increase of libido. But I didn't really go crazy about it. In terms of menses, I did have a early cycle that month, which lasted a little bit longer but otherwise I did not have the usual period cramps , or PMS symptoms I usually do. Even my migraine seem to have taken a holiday. After the 2nd strip I decided to try every other day. I took a capsule every other day to see if the results I obtained reversed since I've only been on it for 20 days. To my greatest pleasure, it didn't and I continued until I finished the last 10 capsules. After I finished the box, I decided to rest for awhile to see how long the effects would wear off. I only started to feel fatigued again after 10 days of completely stopping the supplement.

According to the Company's recommendation, they recommend 2 capsules daily for adults above the age of 40 for 2 months and then monthly until at least another 4 months and it will give the body enough supplement to repair itself. For younger people 1 capsule a day is sufficient unless you want to expedite the skin results. However, this supplement is not cheap and maybe realistically to maintain such expensive regime is not feasible.

Saying so, if cost was not the issue, personally I would be on this supplement for long term since I do beleive it does help to delay a bit of the ageing process the body undergoes. A friend of mine was on the supplement for 5 months and when I did her hair profiler epigenetics screening, she did not show any signs of amino acid depletion or severe aging. And she was 12 years older than me with 3 life births. She looked as fresh and beautiful as ever even without any make up on. Can't wait to start again.

For more information or product enquiry, please email us at drmmclinic@gmail.com or Whatsapp enquiries to +60123301585.

Welcome Year 2016

 

It is a hot and fiery new year as we leave 2015 behind and enter 2016. Dr MM Clinic is my latest project and as of today has just reached the 3rd month of operation. After almost a year of planning and a few hiccups along the way, finally I've decided to take a leap of faith in changing the whole concept of the clinic to a more functional one.

Besides the usual aesthetic stuffs to keep you young on the outside, Dr MM Clinic also intends to focus on overall health and wellness of you as a patient. We have a few new investigative panels and also our new epigenetics hair profiler that can help detect problems and deficiency with just 3 strands of hair, within 15 minutes of sampling. With this new device, we are able to have a general overview of yourself, to guide you towards a more healthier and youthful you. We also have new stemcell products and supplements to give you the extra boost based on your needs and requirements. 

We have also perfected our aesthetic treatments to give you more solutions to your needs and come up with a comprehensive detox program to lose weight and change your perception towards dieting and healthy eating.

As for the blogs, follow us today and you will discover a lot more about the medical technology related to aesthetics and anti-aging. I will also be posting a few Vlogs that will play a good role of explaining the things I write about.

We also have a few alliance partners i.e. other clinics or parties who offer services that we do not offer and thus you can be assured of the similar hospitality. As for this new setup, Visit us today and take a nice selfie from our beautiful view. The clinic is inside an office building with valet facilities for working days from 9am to 9pm at only RM 5/hour. There is also a basement carpark or if you prefer by foot, it is walking distance from Monorail stations and very close to Pavillion KL and Changkat Bukit Bintang. We have equipped the clinic with toilet and shower facilities for the ease of our patients. There is a comfortable waiting room, and high speed wifi for your convenience. And, as our usual policy, appointment times are flexible to not just working hours, Saturdays, Sundays, Public Holidays, early or late based on the patient's preference but only with prior booking. Otherwise, most likely I am elsewhere sipping a latte and writing the blog.

I'm really excited with this new year and hope the clinic can give its best service to you. Happy New Year Peeps. May this year bring prosperity and good health to me and you.

For more information and details feel free to email us at drmmclinic@gmail.com or visit our website at http://drmarrfaceworks.wix.com/drmmclinic

Thermage - To do or not to do?

Doing freelance without an office has really made my life go upside down trying to keep up with the stuff I have to do. Recently I have just been appointed as a consultant and module writer for a Basic Aesthetic Course for supporting staff under Open University Malaysia. Its a tedious job, but I feel honoured to be given the chance to contribute to the younger generation. So on and off, I see some of my aesthetic patients in Gleneagles. Its not really the Shangri-La, but for the time being, it will do to keep the service running. Perhaps the coolest thing there is my Consultant owns a Thermage that he barely uses, so he's allowed me to use it instead. Yay.

So what is Thermage?

Thermage is a machine created for skin tightening. Using radiofrequency technology, it generates a controlled heat at the end of the tip to allow equal heating of the dermis. Studies have shown that controlled thermal injury to the skin leads to collagen remodelling subsequently which takes between 4-12 weeks depending on extent of stimulation. Thermage technology has been around for more than a decade with constant improvements to the machine. So far it is still one of the best technologies for skin tightening that is able to deliver results with just 1 treatment. Other radiofrequency devices usually require 4 or more treatments for similar effects. I have been studying this technology since I started Starhill and it has been impressive.

Areas of treatment

The Thermage was initially created for face tightening with focus on to the eye area to delay need for eye lid surgery. As we age, the skin becomes lax and starts to droop. Some physicians use botox to keep the lid up, but even botox requires a good skin elasticity to allow the effect to occur. Thermage made its name as the first non-surgical device to give eye lid tightening. And the results are pretty much impressive.

Other indications would be face tightening, jaw line definition, neck and body. But as all other aesthetic procedures, results will vary based on individual and also the doctor who conducts the treatment. 

Pain Concerns

Yes, I admit many people claim Thermage is painful. Personally, I would give it a rating of 9/10 for pain for the older generations. The newer ones i.e. the CPT with built in vibrator functions drops the pain score to around 7/10 without any topical anaesthesia. Although some may argue that topical anaesthesia is a placebo effect, all my patients admit it is less painful on areas with local and areas without. I can also offer some Ultracet prior to the procedure to make it more comfortable. Other factors influencing pain is the steadiness of the hand doing the procedure, the speed and the area that is being done. In a well trained practitioner, the pain felt is negligible and confined to perhaps at most 1 hour after the procedure.

Downtime

The coolest thing about this treatment, there is no social downtime. Yeah, there maybe some redness up to 1 hour after the procedure, or maybe slight oedema swelling the next day, but its still concealable and does not look so obvious. 

The Cost

Well this is the real pincher. The cost for 1 treatment properly done at 900 shots is between RM 10- RM 12K locally. Yes, I said it, it costs a bomb. But the justification for this is that you only need 1 treatment done properly and the results will last you between 6 months to 2 years, depending on the severity of your problem. But look at it this way, 1 treatment for 10K spread over 12 months, it's only RM 833 spent a month compared to other tightening treatments for example Gentle-YAG (Yes, you can use this machine for tightening) RM 1200 per session X 4 weekly during the initial stage, then monthly X 3 and then probably repeat after 6 months (RM 9600 over 8 visits per annum) or other medical tightening devices whose selling price is usually approximately RM 800/session but you will need around 10-16 sessions to get close to the tightening effects of thermage. When you add up the transport and time costs, sometimes it could be more. And let's not even mention the beauty salon grade RFs - Yes, they look nice immediately but you will not have any lasting effects because of the Joules limitation on their machines. In order to start the collagen remodelling cascade, the dermis and up to 20mm into the subcutaneous tissue needs to be heated up to the range of 42-55 degrees. 

What to Expect?

Initially you will see instant tightening of the skin due to dehydration of the cells from the heat and you may appear a little bit flushed. The results may be good or average on the first day with subsequently there may be mild oedema lasting up to 3 days. After 2 weeks you will start to notice improvement in skin texture. The pores start to appear smaller and many say they feel the skin softer. The initial tightening effect will start after the first month with the best results seen after 3 months, so be sure to keep a photo to compare. Sometimes, the changes appear subtle, sometimes very marked. Depending on your initial skin condition, if your skin is still supple, effects can last up to 2 years. If you are very sagged, lax or you are targeting shaping a fleshy face, you may need to repeat every 6 months to achieve the desired results.

Results?

Here are the few results obtain from a good treatment.

Pretty amazing results huh? For more information or to enquire treatments, contact us via email at faceworksclinic@gmail.com or call us at 014-2233268. Please be reminded that we are no longer in Starhill so please contact us before dropping by. Thermage is available in Gleneagles for a limited time only so do contact us early to avoid disappointments.

Easy Dew - Simple solution for Asian skin....

                             

Happy Chinese New Year Peeps..... It seems like the New Years are pretty much closer together this year with a mere 1 month apart of each other. In Malaysia, Chinese New Year is celebrated with massive decorations, fireworks, reunion dinners, loh sangs and dragon dances. This year is the year of the horse and everyone is feeling the spirit of the wooden horse energising efforts of productivity for the year.

So to start of this year,  I would like to introduce a new medical cosmetic product from Korea. It's called Easy Dew.

Well, what is so special about this range of products? The Koreans are known for their enthusiastic approach towards medical aesthetics and the in depth research and development of products and techniques. EGF is not a new player in the world of aesthetics. Initially the technology was used mainly in scar treatment to aid treatment and reduction. The development of Easydew followed from a request of a patient receiving diabetic foot treatment from a sister product called Easyef dermal solution. Seeing as how the product was able to help with her healing diabetic wound, she wondered how it would affect her face. Dr Jun-Pyo Hong, M.D. , a plastic surgeon of ASAN Medical Center decided to take up the challenge and presented a cosmetic R&D proposal to Daewoong Pharmaceuticals. Together, they developed a medical cosmeceutical that helps to prevent post treatment unwanted side effects while maximizing treatment efficacy starting from the cells using the skin restoration mechanism of the protein EGF that exists in the system. Although initially the skincare range was designed for post procedures, we do find that it works for most normal to dry skin with very marked improvements.

This product came out in Korea in the year 2012 and has made quite an impression in the medical cosmetic world. Using the latest technology of DW-EGF, allows the creation of a stable safe skincare that gives wonderful results. 

So what are the effects of DW-EGF to our skin? Here's a simple diagram to demonstrate:

Here is a control study on the skincare that show's the improvements within weeks. 

Well, we did our own study with the product. We had 5 subjects who volunteered their faces. Each subject was given a treatment ranging from PRP to peeling to Dermaqueen facials and was given a sample of the products with instructions to use on only on the left side 2x daily. The study was suppose to go on for 4 weeks but after the 2nd week, we decided to stop because all of the participants experienced the left side being lifted more than the right side, thus was looking more obvious as the day went. Overall all 5 participants found that the product was easy to apply. The texture suited more of the Normal to Dry skin. All of the participants noticed an improvement as early as the first week, and the improvements seen were the skin textures, pores, lightening of pigments and lifting effects. Even after stopping the products after only 2 weeks of usage, the tightening effect lasted for another good 2-3 weeks after. 

I took a set to try out. The cleanser was pretty good. A small amount was required to clean the whole face and it strips of all the oil from your face. The active soothing serum is perhaps one of my favourites. The light texture serum absorbs almost immediately into the skin leaving it soft and smooth. I had an Obagi peel done on my face prior to using this product, and I do feel that it does reduces the downtime. Usually my face will peel for 5-7 days on Obagi Blue Peel Radiance, but this time round, I had minimal peeling or redness for 3-5 days. However, the most highest concentration of EGF is found in the Easydew EGF Repair Control which is also the most expensive product for the range. It comes in a long fancy bottle. You only need a little bit of cream to apply to your whole face. I loved the texture and how it absorbs almost instantly without a sticky feel. After these 2 steps, you may want to maintain with a good moisturiser. This range comes with 2 types of moisturiser - The Easydew Renewal Intense Moisturiser or the Easydew Renewal Moisturiser. The Intense moisturiser is designed for more elderly or dry skin and is a tad too rich for people below 45. However, if you have very dry skin, this is perhaps a good solution for you. It comes in a 50ml packaging but you will just need a small amount to apply on your face and neck. The Renewal moisturiser is a less thick cream which is more suitable for younger or oily skin. I've also tried out the sunblock which is an SPF 40 with both UVA and UVB coverage. My verdict, its a good sunblock but I think it made me look a bit white. Although it may feel sticky in the beginning, but it absorbs within minutes and the stickiness disappears. It also has some EGF in it that helps to lighten pigmentation.

So now we come to the most important bit, the price. To be honest, it is not exactly cheap. But for the results it can show within 2 weeks I would say its worth every penny. Especially when too many cosmetic products promise so much but delivers so little. The price for each product is between RM 88 - RM 160 with the Easydew EGF Repair Control priced at RM 268 per bottle. If we were to compare to the other cosmetic counter products like Lancome, La Mer or SK II, the price is acceptable. The best part is, there is also a trial kit you can purchase to try out this product before making a decision. 

This trial set consists of 6 items is only RM 248/= and consists of a toner, Active Soothing Serum, Repair Control EGF, Renewal Moisture, Sunblock and BB Cream. These products are available in the clinic with preorder, so if you are interested to purchase or try out, please feel free to contact as at 03-21440080 / 0142233268 or email your enquiry to faceworksclinic@gmail.com. You can also Like us on Facebook ( https://www.facebook.com/FaceworksClinic ) and send your enquiries there. 

Dermclar Liposomes - Virtual Mesotherapy

Its been awhile since I have time to actually sit and write my blog. Motherhood definitely takes the toll onto most of my time with both my girls in school, hence more attention need to be given to the sprouting young ones. Its the Chinese New Year holidays, and finally I have some time on my own.

Last January I launched a new product in my clinic called Dermclar Liposomes. This is a very unique product from Spain which requires no needle injections. Sounds interesting? Well the results are more interesting. Before I go on about this new product, let me explain a bit about mesotherapy. Mesotherapy is the practice of injecting products into the dermal or subdermal layer and involves multiple injections per site for better distribution. The common uses are for skin hydration, PRP implantation, adipocyte destruction (but injecting into the subcutaneous layer directly to the fat), tightening or even nutrient injection to correct things like pigmentation and texture. 

According to Wikipedia :

Mesotherapy (from Greek mesos, "middle", and therapy from Greek therapeia, "to treat medically") is a non-surgical cosmetic medicine treatment. Mesotherapy employs multiple injections of pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients into subcutaneous fat. Mesotherapy injections allegedly target adipose fat cells, apparently by inducing lipolysis, rupture and cell death among adipocytes.^[1]

Coming back to Dermclar Liposomes - It is a new technology whereas the creators have discovered a new transport system called liposomes that allows products to enter the skin deeper than just standard application and reach the dermal and subdermal layers. The results are similar to treatment with mesotherapy minus the downtime, risk of bruising or pain. And with the no needle technology, treatment around the eye areas and other sensitive areas become a lot easier.

How does this thing work again? Well, with the latest technology of liposomes, it enables the product to be carried through the skin to the subcutaneous or subdermal where it takes effect. The liposomes technically replaces injections into the skin (mesotherapy) but delivers the products to the same level hence why it is called virtual mesotherapy. A single application without using any machines shows instant results in 6 minutes. Phoebe, my friend who introduced me to this product actually did a a mock demo on my arm one day when I was sitting in the clinic - she applied the Face-Neck-Low Neck onto my left arm and there was instant tightening after 6 minutes. No machines used. So we left it at that and its been almost 4 months and people can still see a significant difference between the tightness of my left arm compared to my right arm. Gees.

But in order to get a more stable and balanced result, we recommend that the treatment be combined with their Anti-Age Radiofrequency and transdermal delivery device. We usually recommend weekly with an ampule for 5 times and this will give a stable result between 3-6 months. Using the ampules as homecare will also help prolong and maintain the results. For those who are familiar with mesotherapy, you will notice that this is same with the injections where we usually recommend weekly injections 4-8x then maintenance monthly. 

So what other ampules do they have:

Oh yeah, they thought of everything. My personal favourite would still be the face-neck-low neck for tightening since its one of my main concerns (especially arms). Now its even cooler, since they have also brought in their hand held homecare delivery device to give you an easier and more even distribution of the products.

For more information call us at 03-21440080 / 014-2233268 or email to info@faceworks-clinic.com

Medical Aesthetics for age groups......

I went to Penang two weeks ago and enjoyed beautiful sun rises and sunsets on the beach, despite some haze but the ambiance was wonderful. The only thing was the lack of internet access in my room which made it less convenient to update my blog. Still, I did get nice writing ideas which I would like to share.

Today's entry is about medical aesthetic procedures for age based groups. It is just a simple suggestion of things you can get done based on your age to improve how you look. As I always tell my patients, it is always better to do something than nothing because by doing something, there will be some change in your end result. I would also include a rough budget of how much the procedures will pinch you just as a guide.

Early 20s (18-25)

Usually at this age group, you will not have much aging issues. However, acne control and skin tone problems are very common because in this age group, you will still have some hormonal imbalance and is more active outside. Acne treatments would include chemical peeling, extractions, hormone pills or even retinoid A to clean up the skin and control sebum production. The usual skincare would range from acidic wash to exfoliators and gel based products to cope with the active sebum productions. You need to treat acne, because if you don't, you may end up with scars. Medically, we do have oral medications to help control sebum and a change of habits is usually advised. Smoking, late nights, low personal hygiene, stress and food selection does influence worsening of acne. Treatment for acne will depend on severity. Usually doctors would charge between RM 200-RM 1000 per treatment depending on what is involved in the treatment. Skin care can range between RM 300-RM 1000 for a full range depending on brand. Some doctors will use IPL or long pulse lasers to reduce sebum production and reduce P. agnes bacteria that is abundant in acne prone skin. To even out skin tone, I normally would recommend regular skin peeling and religious use of sunblock. Laser peels are also an option but if you have acne issues, there is a high chance of acne breakouts post procedure due to heat stress.

Besides acne and skin tone, this would be a good age to fix asymmetry of the face or to augment. The skin is young, hence fillers will sit in better. But because of the young age, I normally would only recommend doing hyaluronic acid fillers (Juvederm, Teosyal, Restylane) which are non permanent because it is easier to change the look when you've decided and because as you age, a lot of your face fat pads disappear so putting a permanent structure there may look awkward after a couple of years. For face shaping, you can slim down your face with a simple injection of botulinum toxin A (Botox/Dysport). You can read more about this in my previous entry on face shaping. (http://faceworksclinic.blogspot.com/2012/03/face-shaping-it-only-takes-5-minutes.html) Filler prices would range between RM 1400 - RM 2000 per syringe depending on type and how long the filler lasts. 

Late 20s- 30s (26-35)

This is usually when a person is most prime in their life. Biologically for most people, the hormones have settled and you start losing the baby face and your face becomes more defined. The early signs of aging start appearing such as wrinkles on your forehead, frown lines, crows feet and some loss of volume especially at the malar area. (cheeks) Pigmentation problems start occurring and the skin texture becomes drier. Botulinum toxin A can help with dynamic wrinkles. Fillers can help with the slight loss of volume and also to define the face to make it more attractive. Regular peeling can help with the skin texture but a definite skin care range change need to be considered. For pigmentation, using hydroquinone will help to reduce the pigmentation substantially but requires constant use. Lasers can help to reduce pigmentation and improve the skin texture but if proper sunblock used religiously is not applied, there is a high recurrence rate and may even worsen the pigmentation. This is also the point where I would normally suggest to add serum vitamin C into the skin regime as a maintenance and preventive program to help with texture and pigments. Supplements and vitamins are also important at this point to keep the skin glowing healthy. 

Another issue would be the body contour change, where most people find that certain areas are not as attractive as before. For this, I would recommend body contouring programs using medical grade radiofrequency machines (http://faceworksclinic.blogspot.com/2012/02/radiofrequency-tightening-rf.html) , or other medical grade body contouring machines to help. For some people, they prefer mesotherapy injections to reduce fats n certain parts but this requires recurrent treatment of specific area and so may add up to be costly. Regular exercise helps, and target specific exercises are more warranted.

Late 30s to 40s (36- 45 years old)

Most people are more stable at this age but due to the aging process, coupled with stress of work and family and other responsibilities can cause you to look older than you really are. For the face, At this age, most people would start complaining of more pronounced wrinkles on the forehead, frown lines and crows feet. There would be a more marked loss of volume in the malar and lower face, especially around the mouth and the folds by the side of the nose looks more prominent. The skin texture is still good, but pigmentation is more seen if nothing has been done before. Sagging of the cheeks is felt, although not extremely obvious and causes a lot of concerns in some people. Fillers and botulinum toxin A are a good investment for non-invasive treatment to treat lines, wrinkles and volume loss. Some would consider lip fillers because the upper lip has started to thin out more and you lose that youthful look. (Check out http://faceworksclinic.blogspot.com/2012/05/sexy-lips-in-15-minutes.html) Regular chemical peeling and face tightening with radiofrequency devices or lasers would help improve overall skin texture and turgor. At this point, you should also consider having a retin-A or derivatives cream supplement to the face to help with fine wrinkles. 

For the body, you can still opt for body contouring and tightening programs but the expectations should be more realistic. There will be improvement although subtle, and you may need to consider options of skin lifts and fat grafts to get a more marked improvement. Weight control can be achieved by modifying the diet and exercise and I do suggest most everybody above 36 with BMI more than 25 to go on HCG diet (http://faceworksclinic.blogspot.com/2012/03/hcg-diet-my-experience.html) to not only lose the excess weight and reduce body fat percentage but also to retrain yourself to a much more healthy diet and lifestyle. If done properly, you will be able to maintain your weight and enjoy a better life. It also helps increase personal health consciousness as only organic and non-processed meats are allowed during the diet.

After 46 (46 to 65 or more)

At this age, the skin texture is more wrinkled and you will need more moisturizers to help maintain suppleness. Laser resurfacing treatments are a good investment as it helps to improve your skin texture and tightens it as well. Radiofrequency device tightening of the face is another method to help improve sagginess. At this point, fillers are used for volumnization, and a lot of fillers would be needed to have a good effect. (At least 3 syringes per sitting usually). Semi permanent fillers (Aquamid) can be considered for structures like lips and cheek. Mesotherapy treatment with PRPs (http://faceworksclinic.blogspot.com/2011_02_01_archive.html) or non-cross link hyaluronic acid fillers (Dermaqueen, Restylane Vital, Juverderm Hydrate, Teosyal Redensity) is also an option to increase hydration of the dermis layer. Skin peeling is still a good way to maintain the skin. Surgical options would be fat graft to the face and face lifts. Vitamin E  and hyaluronic acid topical creams can help maintain hydration as dryness is always a problem. 

After 46, a lot of our natural hormones start to decline. Because of this, we will have vague tired symptoms that we cannot explain. Another thing that you should consider is to undergo anti-aging consultation and the use of bioidentical hormones to help supplement the decline of hormones. The blood test are expensive (a complete test would cost around +/- RM 1000). The hormone supplements are in cream form. Please be sure to go to a proper anti-aging doctor (trained) because not all doctors are trained properly.

This is just a rough guide of procedures you can do at the certain age. However, the current environment pollution, poor diet and nutrition, work stress and health problems can always make you look aged more than you really are. A proper consultation can help give you a good idea of the possible intervention to help make you maintain a healthy and youthful you. But one thing for sure, you need to start taking care of yourself early, to stay younger longer.

Any enquiries please email to info@faceworksclinic.com or call 03-21440080 and book an appointment to see me.

Exercise is a must - Even if you don't have time.

Recently, my good friend gave me a 3 month free pass to use a gym. Despite not being a gym person, I thought I'd give it a try. The gym was near my office, but getting there was already a 15 minute aerobic cardio exercise from walking. This was good, since I needed to warm up before getting started. The first machine they normally put you on is a thread mill, and yes, it was the same for me too. Then after that they got a PT to guide me (or rather try to close PT training sessions sales). It kinda pissed me off a bit, since the PT was suppose to show you how to use machines but he was busy making me do 3 laps of butterfly jumps and then tell me I have bad stamina when the chick next to me can't even complete 1 lap. So in a way, I was pretty discouraged to go to the gym, since I know that they are just trying to make you buy more and more packages to sign up. Whatever, I still have my 3 months pass, so I don't really give a hoot to what they want to think or say.

Regardless, exercise is a crucial must in our daily lives. Yes you got me right, it has to be daily. But it doesn't mean you have to jog every single day. There are many types of exercises you need to understand and plan them according to target.

1. Cardiorespiratory work out

This is the most common work out everybody does because it is perceived as the most important. It can be anything from running to jogging, or brisk walking to dancing, aerobics, swimming. Regardless, most professionals agree that 30-45 minutes a day is enough and can help reduce a lot of heart related problems such as reduce risk for coronary artery disease, hypertension, diabetes, lipid levels etc. I would normally recommend doing some cardio workout before targeted exercises as it helps to improve your blood circulation, muscles are more prepared and warmed up so it reduces injury. But if you have existing problems like back pain, obesity, joint pains - you should start with low level exercises like walking first before jogging or running. When is the best time to exercise? When you can slot a time of 30 minutes of no disturbance of the routine. An exercise is only effective if you do it continuously for at least 10 minutes at a time. 

2. Body strength and composition exercises.

One of the most interesting things I learnt during my previous anti-aging conferences was that in order to maintain weight you need to lift weights. So I decided to follow this technique and bought myself some dumbbells. And sure enough, I did notice my weight maintaining better despite my lack of running around. So I decided to read more and understand why. The main reason is that if you have a lot of muscle bulk, you burn more energy in your sleep maintaining them compared to if you didn't. The problem when you are obese or overweight, most of the muscles are mixed with too much fat, and fat is a storage organ, so you don't really burn that much calories with them. Now, when we go on a starving diet, our protein stores in our muscles are the first to go hence leading to smaller muscle mass thus why the weight doesn't go down. That is why a lot of diets nowadays preach on a higher protein consumption, more fiber and no refined carbs for a better weight loss result. Another new thing I learnt was that sudden usage of energy for example short sprinting exercises burns more energy and brown fat compared to a 60 minute cardio. So for people like me, who persistently have a V/Q mismatch or poor respiratory endurance, 5-10 minutes sprinting in between my regular jog benefits more in terms of fat loss, compared to trying to sustain 45 minutes of running that would exhaust me more. As for heart rate, although most people believe that you cannot exceed 80% or your max heart rate as it can cause problems, this is not entirely true. High velocity sprinting causes your heart rate to jump even higher than the so-called maximum heart rate level, and studies have shown that it is safe in short outbursts.

3. Flexibility exercises

When I was younger, we use to have this game where we would try to flex our body backward all the way and walk. It was so much fun then. Flexibility exercises are important to maintain the elasticity of the joints and avoid injuries especially in sudden movements. How to stretch? Basically it needs to involve the muscles in each group i.e. extensors or flexors. Still gibberish? Try Yoga or Pilates - these involve a lot of stretching exercise in the routine that is done in stages. Other simple stretch methods are the stretch exercises we use to learn in school during PE (If we did). Or when you learn martial arts or dancing half of the routine are flexible exercises. I normally do stretching exercises after all the cardio and sprinting as the joints are already warmed from the 2 other work outs. Otherwise, I do it on my bed before getting up :).

Basically you need to have a mixture of all three types for a complete work out. There are many forms of exercise to choose from besides the typical treadmill so choose one you are most comfortable and happy with. Other benefits of exercise also includes:

1. Reduce risk of cardiovascular diseases. Even if you already have cardiovascular disease it helps to improve it.

2. Reduces risk for diabetes by increasing insulin sensitivity and improving glucose metabolism. So even if you already have diabetes, it helps. This is also true for resistance exercises, not just the normal aerobic.

3. Reduces hypertension - this is true for aerobic exercises. High intense exercises have not shown much effect.

4. Reduces blood TG, Cholesterol and LDL. This is true when you burn 1000-2000 calories a week usually from constant aerobic or sprint exercises.

5. Reduces risk of stroke due to all above.

6. Reduces risk of colon, breast, lung and multiple myeloma cancers with 30-60 minutes of moderate to high impact exercise daily.

7. Reduces osteoporosis. Lunge exercises and medium impact exercises stimulate bone growth.

8. Improves muscle health and reduces sarcopenia. Sarcopenia is the age-related muscle wasting that we see in elderly people. In some it occurs faster than others. Regular exercise helps maintain muscle masses thus reduces sarcopenia.

9. Maintains body composition and reduces obesity.

10. Reduces Arthritis.

11. Reduces stress. This is only true when you make the exercise fun. Like I said, there are many forms of exercise you can choose from.

12. Improves mood.

13. Reduces Depression and anxiety due to the improvement of mood and reduction of stress.

14. Improves self-esteem. When you exercise and feel good about it, reduces stress and elevates your mood, your self-esteem improves. Plus the multiple health benefits and the figure benefits would definitely boost the inner you.

For busy people like me, there are studies on people who do exercises only on weekends or once or twice a week and it does shows improvement and benefits. So even if you are strung out during most the week, at least take a day off to do some exercise. The recommended is to burn at least 1000 calories a week and this would give you a reduced risk of 20% of dying prematurely. 

Like I always tell my patients during aesthetic consultations, Doing something is always better than doing nothing. So even if you do not get an optimum exercise routine, at least doing some exercise would benefit.

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

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.