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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PRP Updates - The Vampire Facial?

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

(Sourced from www.tagroom.com)

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

So what is new to our Vampire Facial regime?

(sourced from ieeet.com)

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

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

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

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

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

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

Dermaqueen - a solution for hydration.....

Finally, a quiet Sunday I can sit and write my blog. I know I owe my readers a lot of entries, hopefully before month end, I will be able to write up all of them. Today, I'm going to write on Dermaqueen. It took me awhile to write this entry because I was trying to decide how I felt about this treatment. 

Nowadays, a lot of people are looking for more solutions for their skin besides lasers and IPLs although there are some die hard fans of these procedures. The reason is because now we realize that there are a lot of complications with energy based procedures especially for Asian skin type IV or V i.e. burns, scarring, post-inflammatory pigmentation and also the fast recurrence of pigmentation post procedure. The other issue that most doctors worry about is trying to get the patient to abstain from sunlight for 3 months to avoid complications which in a country of 12 hours hot blazing sun is pretty difficult. Yes, we do advise sunblock but most people only use sunblock when they plan to leave the house only, and apply it once in the morning. (Seriously, you need to reapply every 2-4 hours for sunblock and 6-8 hours for sunscreen). Another issue post-laser/IPL is dryness of the skin and loss of hydration due to high heat procedure which can be tackled with religious application of a good lipophilic moisturizer but there is always a group with severe dryness that requires more intervention.There are also a group of patients on retinoid acid creams or Obagi which have persistent dryness until you can see cracking and fine wrinkles appearing. And not to forget the peri and postmenopausal women who have generalized dryness due to hormonal issues, despite using vitamin E oils and taking evening primrose still have problems.

That is why they came up with the Dermaqueen system. So what is Dermaqueen? Dermaqueen is a procedure that you can do to improve hydration of your skin as it delivers hydrating solutions/brightening solution and even non-cross link HA intradermally and this helps to give you instant hydration. It uses fine needles and a vacuum assisted device and plants the desired solution into the mid dermis. The good thing about this system is that it is preprogrammed to deliver an accurate dose at the accurate site. The only thing that makes people worry is the needles part. But nowadays with better lignocaine creams to numb the the face, the procedure is almost painless. Added with the vacuum suction allows doses to be delivered accurately into the skin with just a slight pricking sensation.

Its a pretty short procedure and takes about 20-30 minutes to do. In terms of downtime, although it claims to have no downtime, I would still say that it will depend on your skin and what solution you are using, so normally I'd advise patients to have 1 day off for the first time and see how long it takes to recover. As for myself, There was only  minimal needle prick marks on my face, and not much pain. It disappeared after 1-2 days. For those who have tendency for bruising or rosacea issues, yes, you may bruise but it can be covered with concealer and it will depend on your own system how long you would bruise.

So what is is good for? Mainly hydration and brightening. We use peptides solution from Dermaheal which is an established product from Korea and has been in the market for the past 3 years. I love Dermaheal as the results are fascinating and almost instant. The only thing about this system is that you will need more than 1 session. They recommend 3-6 sessions done weekly for best results and then maintenance every 3-6 months afterwards.The major complaint will be the cost of the treatment. At the moment 1 session is between RM 900-RM 2000 depending on solutions used. Some even argue say, why not I do laser instead. But the function of this treatment is different i.e. it is more for hydration of the skin and overall rejuvenation.

Other functions of Dermaqueen are as follows:

Other functions not included in the table is also Breast rejuvenation which helps sagging breasts that has loss the upper volume and also hand rejuvenation to make your hands look as young as your face. So what can you expect from this treatment?

Reduction in melasma - I think this was after 6 sessions

This one used non-cross-link HA mixed with peptides after 8 sessions

Rejuvenation of hands - 1 session with non-cross link HA

Pore reduction and skin tone improvement - this was after 1 session.

 I've met this guy. This was after 6 sessions of using Dermaqueen with hair restoration peptides. Although still a bit bald, but there is improvement in hair texture and volume.

So my take on Dermaqueen? I think this is a good alternative to doing Laser treatment for texture issues and for pigmentation improvement. It also helps those who have very dry skin to improve the hydration. The only setback is the cost as 6 treatments can set you back to around 10K but it does solve certain issues with more comfort and less complications.

Interested? Please contact the clinic at 03-21440080 or email us at info@faceworksclinic.com for appointment.

Faceworks Clinic Products

Its about time I posted the newer products available in myclinic. After trying out a number of them, I finally rested my convictions on these products, which I find does give results at an affordable price.

1. Obagi Nuderm System.

This is one of the most impressive sets I've ever come across. The Nuderm System is a 6 step care which is targeted at changing the skin environment to reduce acne break-outs, reduce pigmentation and also tackle fine wrinkles. Its active ingredients contains Hydroquinone 4% (which is the recommended % to treat pigmentation problems) and in combination with retin-A is the complete solution for acne with post-inflammatory hyperpigmentation and melasma which are the 2 major concerns in facial skin health. It is a prescribed skincare and would require physician monitoring but the results can be seen as early as 2 weeks after initiating the product. The product is used in small quantities and a travel set can last up to 3 months.

2. Obagi C treatment System.

This is a skincare range for people who have mild pigmentation or have flawless skin that they wish to maintain and add more luminance to the skin. Vitamin C being a potent anti-oxidant has shown benefits in skin brightening and evens out of skin tone. It comes in 2 forms of preparations, i.e. with Hydroquinone 4% or just Arbutin. The product is light and non-greasy, absorbs into the skin almost immediately.

3. Obagi Vitamin C serum 15% and 20%

The Vitamin C serum from Obagi is one of the most stable vitamin C compounds in the world. Multiple studies done has shown that over time, the Obagi Vitamin C does not get oxidized as fast as other brands. In terms of its solution, it is highly absorbable and has that nice orange scent. it comes in concentrations as high as 20% and for those vitamin C serum lovers would love this as an adjunct to your current skincare regimes.

4. Obagi Clenziderm for Acne.

Clenziderm is a range produced to treat acne in younger people and those who are not keen to be using hydroquinone or retin-A preparations. The active ingredient is salicylic acid and liquid benzyl peroxide for elimination of P. acnes bacteria which is the cause of pustular acne breakouts. Some may say why liquified benzyl peroxide and not your normal Oxy - well, in view of its form you get evenly distributed lotion with better penetration into the pores. Results can be seen as soon as 2 weeks of usage. The pack lasts up to 4 months.

5. Obagi Elastiderm Eye treatment.



Elastiderm eye treatment from Obagi comes in two forms, the eye gel and the eye cream. Both are made for different types of skin and the main function is to treat under eye fine wrinkles and increase elasticity around the eyes. It has been proven to increase elasticity by 46% in 9 weeks and visibly reduce fine wrinkles around the eyes in 9 weeks. As aging occurs, the elasticity around the eyes are compromised thus giving rise to fine wrinkles and thining of the skin around the eyes.

6. Obagi Elastiderm Decolletage.

Now we have a system to maintain that sexy neck and decolletage area. Obagi Elastiderm Decolletage offers a system to help keep the decolletage area supple and even out the skin tone in the neck area to give you a more youthful bust to flaunt. It is good for sun damaged bust areas as it contains hydroquinone 4% or arbutin to help reduce pigmentation. It also tackles fine lines and wrinkles around the bust area and returns some of the elasticity. Results can be seen as early as 4 weeks.

7. Under EyeBryten for severe dark eye circles and puffiness.



Under EyeBryten could be the solution to your dark eye circles and puffiness. The active compound is called Haloxyl and is recognized as the accepted treatment for undereye discolouration. It works better when combined with regular chemical peels which can also be done in the clinic. One package of 30 mls lasts up to 2 months based on twice daily usage.

8. Skintech Vitamin E cream.

Most people would agree that when you peel your face with laser, IPLs or chemicals, the most common side effect is dryness of the skin. Skintech Vitamin E cream is a wonderful adjunct for people with flaking skin due to treatment. Its a definite keeper for your late night mousterizer after retin-A creams or other treatments and it helps reduce flaking post chemical peel and dryness post laser. Its a moisturizer that can suit most skin types, and most would agree that the texture of your skin in the morning after an overnight application feels wonderful.

9. PK24 Natural 24 hours Feminine Tightening Creme.



This is a weird addition to my range of products but since I do consult cases for vaginoplasty and hymenoplasty, why not. PK 24 is only sold in USA and Malaysia. It is made out of natural ingredients and acts as a feminine tightener. The viscous gel-like substance acts within 5 minutes of application and lasts up to 24 hours. It is recommended for sexually active women after childbirth or those who just want to enhance what they already have.

10. Heliocare SPF 50 Gel sunblock.

Personally I love this sunblock. Its gel based and its tinted so it does not clog up my pores and I don't get that chalk like appearance with other sunblocks. It has a nice scent of oranges and it absorbs swiftly into the skin. I would recommend this for daily use, although for sporting activities, it may not last long enough on the face when you sweat.

11. Foltene Hair treatment system for men and women.



Foltene is a hair care range from Europe. Its a system that consists of a shampoo, a conditioner and treatment ampules. Its good for people who are having problems with hair fall or some scattered baldness patterns, and early balding. The whole set is for a months use and it is recommended to be used for 6 months at least, although there are some reports of results as fast as 2 weeks. It is made out of plant base products and has separate systems for men and women.
For more info check out http://www.foltene.eu .

For enquiries about these products, feel free to email us at info@faceworksclinic.com or call 03-21440080.