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.

Farewell to Starhill ....... But its not the End

It has been a gruesome month where if some of you may have noticed, our clinic has been pretty much inactive. I have to apologise to all my patients and blog readers for the hiccup. The reason for the long silence was because we were busy moving. Yes, finally Faceworks has left Starhill.

For the initial part, I thought of taking a break from seeing patients and running a clinic. Faceworks has been my blood, sweat and tears since 2008. Being a lonely captain, it can be tough sometimes especially since the rentals were exorbitant, and the economy was flip flopping year to year. Not to mention the non-stop ongoing renovations that just seems endless.

However, despite the odds, I do have many patients and followers who have supported me all this while. So my initial thought of rest, was cut short. I have an obligation to my patients. So after the move, I started negotiating venues in order to continue my service of care for my loyal patients, to allow them the benefits that they have had before. After a few discussions, finally I've decided to join up with a senior of mine in Gleneagles Medical Office block, i.e. the private clinics.

For this month, the intended suite is still under renovations, so for appointments, I'd have to use his current suite, hence the appointment only basis is a complete must. I've retained one of my nurses Mia to help keep track of all the appointments and assist during procedures. There is so many small things to do and complete like switching phone lines etc, which would take awhile. But do not fret, our clinic mobile and gmail is still functioning - Email us and we will respond as soon as possible.

The coolest thing about moving is I get to breathe better and I get to play with Thermage. Oh yes, my senior has a Thermage that have tips expiring in this year and he has given me the permission to use and promote so that the consumables do not go to waste. So for the past week I have been doing a few Thermage cases, that actually gave not just the patient satisfaction but even my team, especially when my extended protocols for neck, and breasts are applied. I will write a full entry on Thermage in the next couple of days so that you understand what the hype is all about. If you are to curious, you can check out their official page here http://www.thermage.com/ .

So basically, all our usual services are available except for some machines since I need to arrange for them to be moved over. We are thinking to fix up my Starlux, so then I can expand my services to more interesting things. We'll see how it goes. We'll be having a mother's day event to invite patients over to introduce the new place and new services. Do email or text us if you are interested to attend. I also realised that some people are having problems accessing our website. Our website is currently on www.fwclinic.com  in view of a miscommunication with our previous web hoster. Even our store has moved to a different URL but the function is still the same http://fwclinic.com/store/.

I would like to thank all my patients, friends and followers who have been with me and supported us all this way. Without patients, I am no longer a doctor - without the patience and the care, I wouldn't be where I am now. Faceworks in Starhill is much loved, and we had so much fun there with events, parties, memories. It is sad to leave but in order to succeed we need to move on. So worry not, Faceworks may no longer be in Starhill, but we are still available, still functioning to provide to you the best aesthetic treatments with that pampering touch. Hope to see you soon.

For more information or appointments please email us at faceworksclinic@gmail.com or call us at 014-2233268.

What's up with Vitamin C?

I have been asked about this question a couple of times, so I've decided to write about it in my blog. A lot of people wanted to know whether Vitamin C actually works.

After going through a few papers and a few professional opinions, this is what I have managed to gather:

Benefits of Vitamin C

1. Reduces fine wrinkles around eyes and mouth.
2. Improve skin hydration.
3. Improve pigmentation appearance and age spots.
4. Improves wound healing through fibroblast stimulation nad migration.
5. Increases capacity of fibroblasts to repair potentially mutagenic DNA lesions.
6. Prevents scurvy.
7. Potent anti-oxidant that protects skin from UVA oxygen radicals.

However bear in mind that:

1. Ascorbic acid or vitamin C is pretty unstable and oxidizes easier when exposed to air.

Because of this, most vitamin C preparations have a pretty short shelf life and usually will change colour after a few months if stabilizing agents are not added in. An oxidized form of vitamin C is sometimes more harmful to skin and may cause sensitivity. An easy tip to keep it stabilize is to keep the bottle sealed tight, away from sunlight and chilled in the fridge.

2. Vitamin C is a water soluble vitamin whereas the skin is protected by water by our keratinized layer.

Because of this, you need to be very careful when selecting vitamin C creams or gels to ensure that absorption can occur. Look for products which are lipophilic as it will absorb better into the deeper layers of the skin.

3. Topical Vitamin C has shown to have more benefits towards skin health compared to other methods, although oral vitamin C of 1000 mg daily is sufficient to maintain good health and good skin. Never exceed 2000mg daily as this will lead to vitamin C toxicity which gives you an orange discolouration of the skin, and some have reported renal side effects.

So what would I recommend for a good topical vitamin C?

Obagi has just launched its new range of Vitamin C + Hydroquinone 4% for whitening effect. So far I have been using this serum for the past 1 month and have noticed a significant increase in radiance. Recently, they launched another product which replaces the hydroquinone with Arbutin instead, thus making long term usage possible. Although I do admit these serum are not exactly cheap, but one bottle would last you a good 3 months with the benefits of vitamin C and enhanced whitening. There are also topical vitamin C ranges from 5%-20% for those who are looking for only vitamin C.

For more information, contact us at info@faceworksclinic.com or call 03-21440080.

Botox and Fillers Q & A

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

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

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

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

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


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

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

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

7. Are fillers safe?

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








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

Yes.



9. Are the procedures painful?

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



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

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

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