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

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

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

1. Botulinum Toxin A facelift injections.

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

2. Dermal Fillers - Hyaluronic Acids (HA)

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

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3. Poly-L-Lactic Acid Fillers

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

3. Radiofrequency Devices. (RF Devices)

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

4. Intense Pulse Light (IPL)

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

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5. Ultrasound Devices

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

6. LED Devices.

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

7. LASER Devices

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

8. Platelet Rich Plasma Procedures (PRP)

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

9. Threads

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

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10. Mesotherapy

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

11. Tightening Creams 

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

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

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

What you should know about fillers......

It has been a while since I wrote anything about fillers. However, recently during one of my socializing events I was faced with a lot of questions regarding fillers and botox. There was a great confusion between the two, still, despite both being very separate and totally different entities in terms of chemical compound and function.

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1. So what Are Fillers?

Fillers are substances you use to fill up areas of your face or body which has underwent volume depletion and is also used to reduce static lines. It can be from any substance like silicone gel, collagen, hyaluronic acid, calcium hydroxypatite, PLLA, PMMA or even biological fillers like heated PRP or fats. The most commonly used in a medical aesthetic practice are the hyaluronic acid fillers which are non-permanent and lasts between 6 months all the way to 24 months depending on how the cross-linking and molecular weight of the filler.

2. Are All Fillers the Same?

Definitely not. Different chemicals form different fillers. Therefore it is really important to know what type of fillers were used on your face. Some may not be reversible. Always ask your doctor what he or she is using. Not only it is good for you to know, but it also helps the subsequent treatments if you require any.

3. If I do not like the filler effect can I remove or change it?

Only Hyaluronic acid fillers can be diluted with hyaluronidase. The other fillers are almost impossible to remove without any surgical intervention. So make sure you know what you are putting under your skin.

4. How much does fillers usually cost?

Fillers are usually quoted by per syringe of usage. An original high-end filler product can cost anywhere from RM 1600-RM 3600 per syringe. Some other lesser brands cost between RM 800- RM 1500 per syringe depending on where it was made and specifications. Anything sold cheaper than that would either be non-original products or maybe expired fillers? Or sometimes the doctor is not so experienced that they give cheaper pricing to practice. Honestly, who would charge super cheap for well trained hands? The training itself requires a lot of money.

5. Does it hurt?

Honestly, any procedure involving needles would hurt to some extent, but depending on the type of filler, some fillers hurt more than the rest. It also depends on whether there is any lidocaine inside the filler that will reduce pain tremendously. Local numbing like creams can be used although it doesn't really make much difference physically (maybe psychologically) and local infusion of lidocaine does help to reduce pain effectively although very specific filler work would be impaired as there is already tissue distortion. You can discuss with your doctor pain management techniques that can make your experience much tolerable. So apparently, you do not need to suffer too much pain for beauty. If, in event the doctor injects and suddenly there is severe pain, please speak up and tell him or her. Severe pain might mean that an artery is being hit, or other crucial vessels, or even allergy to the filler.

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6. What can fillers do for me?

I always tell my patients, imagine fillers are like cement or plasticine. You can create volume which is not there like nose, cheeks or chin. You can redefine areas of your face and make contours, you can even smoothen deep lines. You can redefine your lips to make it more prominent or replenish the younger look. You can put it at your tear trough areas and reduce the sagged eye look and make you look fresher. You can reduce appearance of scars and improve photo angles (if your doctor is really really good). 

7. If I use a good filler, will it guarantee a good effect on me?

A good filler is always recommended to get the best effect. However, the other more important component is the doctor. How good is he/she at creating the effect you want? A lot of people think that filler injecting is just about injecting, but actually it is not. The best filler injectors in the world can put fillers on to a persons face and make him or her look more attractive but at the same time make it look as natural as possible that to most people, it doesn't look like any fillers were done. (Until you compare the before picture).

8. So say that I am interested, how sure can I be safe to do the procedure?

For newbies and virgins, I usually tell them to stick to hyaluronic acid fillers for any work because at least if you do not like it, we can dissolve it or wait for the effect to go off. The other most important thing is how well the doctor is trained because not all doctors are trained to do fillers. In my years of training other doctors practical filler techniques, I notice that even the way a doctor holds the syringe is enough to tell me how experienced they are. It is not the same as blood taking or other hospital procedures. Furthermore, to train the hand to be steady enough to evacuate the product from the syringe equally is quite a task if you are not use to it. To create beautiful natural looking work requires an additional artistic eye to detail which not all doctors have. Furthermore, if any problems from the procedure were to arise, a trained aesthetic physician would know what to do. Beautician filler injectors are the worst because for 1, you do not know what are they really using (they have no access to original medical grade products), 2. They are not trained to understand surgical anatomy or deal with complications, 3rd, if you allow a beautician to inject you, you cannot take any action on to them if the job is not done well, as they are not regulated by law, and you would have committed the first offence of going to a non-professional. Furthermore, there is a science and mathematical equation when we put fillers on to a person's face that is being taught in our training so that you remain looking like a human (and not some weird alien from star trek or some other sci-fi movie).

If you have any more questions on fillers, feel free to contact us at drmmclinic@gmail.com or 03-21106608.

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

Fasting Month 2014

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

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

Treatments That Are Allowed During Fasting

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

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

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

    during the procedure.

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

5. Blood donation or transfer or blood taking.

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

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

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

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

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

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

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

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

       internal cavities.

Treatments that can cancel fasting

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

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

    examination.

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

    male and female.

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

    rectum for examination.

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

    system.

6. General anaesthesia.

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

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

Know Your Injector........

Fillers and BTA (botox/dysport) are still perhaps the bread and butter of medical aesthetics despite the emergence of new technologies and machines. It is a simple technique requiring injection of products into the skin layers/muscle to create a more appealing youthful look almost instantly. It is a very lucrative business too. Because of this, a lot of people try to learn to inject. Even if they have no medical background. Hence you will see that in certain places, beauticians or aestheticians as they call themselves injecting fillers and products into customers and so-called 'cheaper' price than doctors. (Really?)

What most people do not realize is that hypodermic needles and syringes are only licensed to be used by doctors in this country (and also most other countries as well). Even nurses or MAs are not licensed to use needles unless under the supervision of a doctor or in Emergency cases. I remembered this so well because during my practice in the government sectors, the nurses at that particular hospital refused to do any blood taking and kept quoting this rule in the nurse/MA handbook. Funnily, when you move to the private sector the nurses are all so willing to do injections, especially fillers and BTA.

The thing a lot of people do not get about doing injections to your face, although you can get really good results with minimal downtime, you can also have very bad results that would last you quite a bit and for some cases of those using semi permanent or permanent fillers it can be life long and would require surgery. A lot of people know this, but why do they still risk going to beauticians or other unqualified injectors to do their face? The most common reason is peer pressure, second would be cost and third would be some bad experience with an untrained doctor somewhere that made them lose confidence with professionals. Between fillers and BTA, fillers are worst because usually the beauticians use illegal products that lasts too long and has no reversal.

So for those who wish to indulge in injection rejuvenation, I will give you a few tips:

1. Know your injector - Are they a qualified injector i.e. a real doctor? (A lot of fake ones parading in my country). Are they really trained to do the injections? Not all doctors are trained to do aesthetic injections so they maybe a licensed doctor but may not have the skill. Going for 1 workshop does not quite cut it as being trained. Are you comfortable with the doctor? Has he/she answered all your queries and doubts? Will he/she be following you up? Will he/she be responsible for the work done if any problem arises? 

2. Know your product. What is it that the person is injecting into your face. Is it hyaluronic acid filler? Is it Radiesse or Aquamid? Is it collagen - if it is collagen - purely collagen/bovine/marine or porcine? A lot of the collagen fillers from beauticians are mixed with liquid silicons hence why it just does not disappear. Is the product safe? Just because the person says so, doesn't mean its safe. Ask for safety profile. Are you sure its the product claimed by the injector or did they take out another product from a different box for the injection. Google information about the brand.

3. Are the products sterile? The last thing you want is getting an infection under the skin from using products already contaminated. In my clinic, I open a new syringe in front of the patient to show its sterile. Infections due to contaminated fillers are a nightmare and may take weeks to heal. It would require high end antibiotics, dilution of filler or even excision. In some cases, we would be giving steroids to stop inflammation from the infection. It can cause you to have a mark or a scar from a so-called suppose to be very safe procedure.

4. Is the premise you are receiving an injection a proper medical facility with license? Beauty salons are not licensed to do injections, nor are hotel rooms, cars nor boutiques nor spas. So if it is not a clinic, better think twice because likely the hygiene of the place is not up to par and you cannot sue the person if anything went wrong since it is not in the right premise. You'll just be bombarded by the defense lawyer, stating that you agreed to be injected in the premise when you know its illegal.

5. Check the current market price for services before deciding on having it done to give you a rough idea of what is the normal range. Usually for promotions, the price of the service would not be discounted more than 30% in view the cost to acquire original products is expensive. If the clinic or center is giving too cheap a promotion, you should bear in mind a few things. Its either the product is expiring (already expired) or they've reduced the amount of filler/bta given but charged at a cheaper price. The end result would be unsatisfactory results or treatment not lasting what it should. And this would not only cause disappointment but also reduce confidence towards the treatment altogether.

Courtesy of http://www.plasticcelebritysurgery.com/2011/09/worst-celebrity-plastic-surgery-before.html

For more info you can email us at info@faceworks-clinic.com / faceworksclinic@gmail.com. For appointments, please call us at 03-21440080 or text 014-2233268.

Interesting gifts to help your loved ones.......

Today I've decided to write on something less serious and more entertaining. Having a lot of friends, family and meeting a lot of people, you tend to come across many personalities that sometimes does not appeal to your own positive self. There are just some people who are forever negative, and regardless of how you try to lighten things up, they seem to be able to dampen your spirits. 

Funnily, medical aesthetics does have a lot to do with psychology and maybe a bit of psychiatry. Apparently 60% of the world population are concerned on how they look and what other people perceive onto them. Especially since nowadays, looks play a very importance role in career and confidence. Which is why the cosmetic and beauty industry is one of the most fast growing industries in the world with a 16% increase revenue per annum despite recession. 

So, what can you suggest to your loved ones to make your life happier:

1. Glabella BTA 

In simpler tense, botox / dysport into your muscles that makes the nice 11 on your forehead (frown lines). This is extremely good for those depressing, whining, or stressed out relatives and friends who makes your sunny days go cloudy with their negativity. Apparently, studies have shown that people who are depressed / upset feel less upset when we freeze their glabellar muscles due to lack of frowning feedback from the forehead to the brain - hence the brain registers it as less stressed/depressed/upset thus equates to being happier. Its a simple 5 minute procedure which will cost roughly RM 600 / session (some cheaper services uses BTA from China/Korea) and will last the person between 3-6 months. It may be temporary but at least they stop complaining much for this period of time. How about that for price of peace?

2. Marrionette lines

Have you ever seen a puppet or a marrionette? Puppet shows were made popular in the UK before the invention of television. They would cut out a stage and create puppets or marrionettes on strings and move them around telling a story. One of the most popular puppet shows till today is the comedy Punch and Judy. Marrionette lines refer to lines extending from the edge of the lip to the border of the jaw, just like a puppet. Some people have these lines even when they are not frowning and it makes them look sad all the time. Depending on the severity of the line, it can be fixed with just using BTA to the Depressor Anguli Oris muscles to reduce the pull (only 2 injections at each side ~ RM 200/procedure) or in combination with hyaluronic acid (HA) fillers for a more complete fix. The good thing with fillers is that it lasts between 9-12 months or even longer, so your frowning buddy would look happier for at least a year. Although it may wrack up your wallet a bit (filler prices start as low as RM 1K - 2K for HA). This procedure only takes 15 minutes or less, so you can even drag your friend in during lunch time.

3. Lethargic looking and no luster skin.

Its one of those people who look tired all the time, no matter how much caffeine you pump into their body. Not to worry, perhaps all they need is a chemical peel to get rid of all the dead skin accumulated on their face. A lot of us do not realize but if you look tired most of the time and your skin lacks luster or shine, it could be because of the dead skin accumulation. When the horny layer of the epidermis has too much dead skin and is not exfoliated, it causes the surface to be bumpy, thus when light hits the skin, it does not reflect well and hence looks dull. A simple solution is to try out our Clear & Bright Facial which not only peels off all the dead skin but we also infuse vitamins to your skin to give it a nice radiant glow. The facial takes approximately 20 minutes with no downtime, so you would need not worry about hiding your face for a day. Sunblock is advised due to the peeling process that happens in clinic. Usually this facial would set you back by RM 500/session, but do call our clinic for any special promotions going on.

4. Panda Eyes

Some people look so tired and lethargic because of their panda eye look. Some panda eyes look so bad, you start wondering whether they are on drugs or why they are not sleeping. There are many causes of panda eyes, some being hereditary pigmentation, some being vein congestion. A quick and simple fix that we can do for you is doing a chemical peel and then infusing some bleaching agents at the area, to reduce the pigmented look. Subsequently, we would recommend eye creams/ ampules to help strengthen the skin to reduce the appearance more. As us today about this new treatment.

5. Sagging Sad Face

Some people have sagging skin that makes them look worn out and sad most of the time. A simple Relax-F facial will be tightening up skin in no time. Even after the first session, there is a mark improvement and after a few more, the skin will appear tighter than ever. The best part about this facial is that it is painless, takes approximately 30 minutes and no downtime, and results can last up to a month even with 1 session. For a more lasting and faster effect, you can combine this with our liposome face-neck-low neck ampules. With DMAE as a powerful skin tightener, the sagging face will be no more in no time. Hence, gone is the need for facelift or threads which are more invasive.

Here are but a few gift ideas for your loved ones. Email us for more solutions to day to day problems.

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

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.

The perfect nose........

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

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

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

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

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

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

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