Medium Face Peels - TCA Peel

In my previous entry I talked about how chemical peeling has been one of the oldest but most effective (and economical) ways to keep skin looking healthy and tackle some of the superficial signs of ageing. Being in Malaysia, where there is 12 hours of sunlight daily, and constant heat of 27-35 degrees year round, a lot of the deeper peels like Phenol peels and Obagi Blue Peels are banned from being used here. The weather and skin type of most asians do not allow the usage of these medium to deep peels. But they really do wonders.

So we are stuck with the light peels and some light to medium peels that doesn't really give much difference, especially if you are a hard core peeler like me. Ironically, the medium depth peels get banned, but the rampant use of Lasers do not. But then again, my country is pretty funny when it comes to policies. And then there are TCA peels. TCA peels in Malaysia are strictly in clinic procedures and must only be done by the doctor and not a nurse. 

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So what are TCA peels?

TCA stands for trichloroacetic acid. When we talk about TCA peeling, it is meant for superficial-medium peeling of the skin. Unlike the AHA peels, it goes beyond the epidermis,and thus encroaching the upper dermis which allows a much more skin peeling to occur. Because of this, it has a downtime of between 5-14 days depending on the strength of the TCA used and the method and duration applied on to your skin. Usually it is more painful than your standard glycolic peel, and water is enough to neutralise the peel.

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What are the benefits?

It peels deeper than the conventional superficial peels. So it does help to reduce fine lines, pigmentation and other epidermal issues. It lightens up melasma and previous hyperpigmentation due to various reasons and may remove some of your age spots.

What's the catch?

The main catch is the down time. It will be pretty obvious if you peel, and usually would last a couple of days. The dead skin will appear darker and thus it is difficult to hide. In my case, I did the peel on Monday and although it has been a week, I still see some peeling areas especially laterally. I suffered during the second to the fifth day, as it was obvious I was peeling, but I had to go out and see patients and attend social events. I did try covering it with make up, but it became more obvious, so lastly yesterday, I did not wear any foundation, but rather enhanced the eye make up around my eyes instead. What would you feel? The first day, the skin would feel super tight. By day 2 and 3, the peeling would start and it usually starts from the midline. The skin that is going to peel would be scaly and turn darker and sometimes it looks like you have more pigments on your face. However, once it falls off by itself, you get pink fresh skin from below with less pigmentation seen. 

It doesn't look too bad on the photographs especially with all these new phone apps that make you look flawless, but it took a lot of confidence to just act normally although I know my face was peeling away.Plus, I had a tendency for post-inflammatory hyperpigmentation, so I had to be very careful not to accidentally peel off any of my skin by force that would cause PIH instead. 

TCA-LP

TCA-LP is a product from enerpeel, that is used in the clinic for TCA peeling. I've tried a few TCA peels in the market from Skintech, Obagi and others and I find that TCA-LP has some good points.

For starters, true to its name, it is less painful than your usual TCA (LP means Less painful). During this experiment stage, I was applying the TCA to my own face since my nurse and supplier was too afraid to do it. It came in single vials with a brush tip, and was for single use. I applied few layers on until frosting, and was left for 2 minutes before neutralizing.

The only thing I was a bit sad was that the suppliers cannot bring the 40% TCA-LP in as that would do wonders for more aged skin. Another thing is, you will need around 3-4 sessions to be done monthly to achieve the best results that can last for a year depending on your expectations. The good thing is, you can use superficial peels to maintain the results, although it may be every 2-3 months.

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Suitable candidates

Since it is a medium peel, only for skin types I-IV . On a general rule, I try not to do medium peels on anyone darker than me, and for those with PIH tendencies like me unless they are a seasoned face peeler who really understands the complications and limitations. SO in English, it means caucasian skin, fair chinese and some other fair races. If you are chocolate milk come in for a consult. If you are darker than that, stick to superficial peels only and preferably by an experienced dermatologist or aesthetic doctor. Also if you are the type of person who cannot afford any social downtime, better stick to the superficial peels. 

Complications

Still think that this is a home based procedure? The complications of a TCA peel may not be as bad as the deep peels but can cause a lot of distress to the patient. 

1. Even though it removes hyperpigmentation, there are chances it can cause hyperpigmentation. Especially if the dead skin is forcibly removed and you have a PIH tendency. 

2. Hypopigmentation - sometimes it can cause hypopigmentation especially if the TCA concentration is too deep and it was not neutralized properly or the person has skin types IV-VI. This is why we err on side of caution in darker skins. HYpopigmentation is harder to treat than hyperpigmentation.

3. Infection - sometimes you may get infection of the skin as it peels off but this is rare. Maybe in some cases of severe acne where the source of infection is already there or in immunocompromised people.

4. Scarring - scarring is always a risk especially if the procedure was not done properly or neutralisation part was not complete. 

Doing this procedure in a proper medical doctors office can help reduce chances of complications. If your doctor does not know how to handle the complications, better find a more experienced one.

So in summary, the TCA peel is a very good skin rejuvenation method that is fast but requires downtime. The cost for a session of TCA-LP is RM 350 and you will need 3-4 sessions every 3-4 weeks for the best results.

For more information or appointments do contact us at drmmclinic@gmail.com or text us at +60129660852. Or you can send us a message through our FB page under DR MM Clinic.

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Chemical Peeling - Old technique, new advances, economical and still good results.

Recently, I have been asked what would be my favourite method of maintaining skin health and youth. To their surprise, laser was perhaps last on my list. Living in a super hot tropical country with high humidity, perhaps doing laser on your face is maybe a bad idea. Especially if you are not particular enough to consistently wear sunblock (even in the house) and keep yourself protected from direct rays. Unfortunately, so many clinics, medispas and beauty salons are promoting laser as if its just a simple facial, that they forget the complications that entails when not advised properly.

Perhaps, this is why I decided to come back to work and start reeducating the public about medical aesthetic treatments and procedures. The science of beauty is real, not just some money making scheme.

Well, anyway, enough rambling. Back to the facts. Let's talk about chemical peels. This is perhaps the oldest method of beautification brining us back to the Egyptian reign where Queen Cleopatra was well known for her milk yogurt baths to exfoliate her skin and leave it smooth and flawless. Nowadays, we have more specified chemicals to give us the controlled exfoliation that we need to achieve the result we want.

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So why all this exfoliation business? Our skin consists of multiple layers of epidermis with the outer most layer being the one most exposed to the environment called the keratin layer or the stratum corneum which is mainly made out of keratocytes which are completely devoid of nucleus. This is also referred to as the outer skin or the dead skin layer. Most of the superficial peels and microdermabrasion take off this layer of the skin, thus revealing a much more fresher newer skin. However, some medium strength peels tend to peel deeper into the stratum lucidum and some into the stratum spinasum. No matter the strength of the peel, the doctor doing the procedure must be aware of the level of peel he or she is doing for the patient and how to monitor for side effects. Many times over the years, my suppliers come to me with a picture of a patient burned from chemical peels done by other doctors and asking how to resolve the problem.

So why do burns occur? The most common reason is bad technique during the procedure where either the application was too thick, the time was too long or neutralization was not done when it was warranted. The problem with chemical peel burns, sometimes it takes up to 2 weeks to heal and you may leave the patient with an unsightly scar. Whatever it is, if you have trained yourself well, you will be able to handle peelings easy since it is perhaps the simplest thing, that a lot of people take for granted.

Why do I love chemical peels? Because it is one of the simplest things you can do for the patient to remove all excess dead skin and make the patient's skin look brighter and cleaner. The procedure usually takes anywhere between 1 to 30 minutes depending on the type of peel and how it is applied and how many layers. A study published in medscape in the year 2006, caught my attention on regular chemical peelings and how it affects the skin. They wanted to see whether regular skin peeling would cause patient's skin to be thinner but on contrary, there is a few millimeters improved thickness instead. This was due to the increase skin turnover due to the feedback that the stratum corneum is thinner, thus increases cells production. However, bear in mind, the procedure has to be done correctly at the right intervals in order to have this effect. Over peeling, or complications due to peels can also cause worsening of skin texture which is what we see with certain local cosmetic products which are too aggressive and uncontrolled. 

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So recently, my clinic has been trying out new types of peels since our older ones are being phased out and I am forever in the quest of looking for super no-downtime treatments for my patients. Among all, we found some that we like. One of the newer chemical peeling treatment that we would be bringing in is called the Elsa Peel. It consists of 3 layers of peelings followed by a clay mask. The good thing about this peel is that there is no downtime after the procedure, and yet it gives you a good clean peel and helps lighten up pigmentation. So far I did once on my face and the results was satisfying. I have been peeling my face for years, and even with 1 treatment I noticed at least 2 tones lighter skin compared to before. During the peel I had an acne pop and even afterwards, the post-inflammatory pigmentation was much lighter compared to the rest. 

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The Elsa peel is suitable for most skin types. The recommended is to do a peel once every 7-14 days up to 4 times to achieve a much better skin tone with reduced pigmentation. Subsequently, you can maintain by doing it once every 1-2 months. Coupled with serum vitamin C or any other dermal replenishment creams, it would be superb for people with skin that is prone to pigmentation or for those who want a more even and brighter skin tone.

The usual price for this treatment is RM 450 / session and takes approximately 30 minutes to complete. Since we are launching this new product, we are giving a special introductory offer of RM 350 / session. Take up a package and get more discounts but this you have to ask my nurse.

For more info, or to book appointments, please email us at drmmclinic@gmail.com or drop us a message at 0129660852. Or you can like us on FB and pm us from there. 

Fasting month......

Its the fasting month and after a week of fasting, most of us have probably gotten into the cycle. The hectic afternoon jams and the sleepy mornings, make a lot of us try our best to stay indoors and not come out.

Despite so, fasting month is also a good time to get treatment done, as there are less social gatherings, and working hours are shortened. Furthermore, input from Muslim scholars have clarified on things that are not allowed to do during fasting and medical treatment has a lot of leeway. So to answer a lot of questions regarding getting things done in the fasting month, I can safely say that most everything is allowed except infusions of drips containing nutrients as that will hydrate the body. Yes, that means your fillers and botulinum toxin (bta) injections do not break your fast because most are injected either in the skin or intramuscular.

So when is the best time to get things done? For fillers and bta, I always tell my patients, at least 2 weeks before your function. Although filler results appear instantly, but the molding after 2 weeks makes it look more natural. Similarly for bta, it takes up to 3 days to start working, and at 1 week you will have the full effect and usually after 2 weeks it will soften a bit. For chemical peeling, the mild ones you can do a few days before, the deeper ones at least a week before. For Fraxel, although redness lasts about 3 days, I'd always say, reserve a week for swelling since some people react differently.

For those who are fasting, I'd recommend to drink more water at night since the skin does not heal well when dehydrated. Water as in plain water, not those sugary substances or teh tariks that will just dehydrate you more.If you tend to get dryness and skin peeling, use an extra moisturizer at night. For a healthier glow, invest in a good vitamin C serum or cream that allows good absorption. And last but not least, sunblock, sunblock, sunblock. The worst thing you can do is be out in the sun, in a dehydrated state with no sunblock - its a recipe for bad skin definitely.

For appointments do call us at 03-21440080 or email to info@faceworksclinic.com. We are open from 10am-10pm daily but for consultations, appointment required.

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.

July-August Puasa Promotion....

Its the start of July and soon we will be having the fasting month and Hari Raya Celebration.
Faceworks Clinic is giving away wonderful promotions to make yourself look good for the coming festive season.

Interested? Call us today for your appointment at 03-21440080 or email us at info@faceworksclinic.com (if from abroad). Don't miss this great opportunity.