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. 

Its All About the C's

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

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

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

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

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

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

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

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

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

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

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

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

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

Swisscelin - Revolutionary Swiss Cell Therapy to Halt Ageing.

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

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

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

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

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

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

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

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

                             

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

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

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

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

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

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

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

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

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

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

OMNILUX - LED therapy at its best.

It has been a very eventful week for me with so many things taking place at the same time and in the midst of excitement of the Malaysian 13th General Elections less than 2 weeks away. Everywhere you go, you can see flags from different parties being put up and billboards related to the coming election. Which is why perhaps, this new device that I have in my clinic would appeal to most people in this busy time.

Say Hello to the Omnilux. What is Omnilux?

The Omnilux is a Light Emitting Diode (LED) machine with a narrow band technology and has been patented since 1998 for dermatological conditions. It uses light modulation technology that promotes tissue and cell healing as opposed to Lasers which are mostly thermoablative. What it means is that the machine uses low energy light (LED) at certain wavelengths, help to stimulate and modulate tissue and cell healing as opposed to controlled tissue destruction as we see in Laser usage.

It came about by accident in 1996, when a British cancer researcher Dr Colin Whitehurst used a photodynamic lamp to activate photosensitive drugs on skin cancer patients, he also noticed that the surrounding skin around the skin cancer lesion was rejuvenated. Later from here, they started to experiment on different wavelengths and discovered different uses for it. As of today, the Omnilux has 7 FDA clearances and is used by over 3000 physicians worldwide. 

The current Omnilux has 3 different lamps which are labeled Omnilux Blue, Omnilux Revive and Omnilux Plus. Omnilux Blue is more for acne prone skin. It acts by killing P. acnes bacteria which is responsible for acne. The wavelength is 415 nm (+/- 5nm). The Omnilux Revive is aimed more for skin rejuvenation and has been found to boost collagen and elastin production. The wavelength is 633 nm (+/- 6nm) and it comes out bright red. The Omnilux Plus is an infra red beam targeted for deeper tissue hence promotes tissue rebuilding and healing. The wavelength is 830 nm (+/- 5 nm). Sometimes when you google, you will find another lamp called Omnilux PDT. Actually, that is the first lamp created for aesthetic use and non-melanoma skin cancers. Now they've replaced it with Revive. Newer products from Omnilux would be the hand held Omnilux Clear-U and New-U, which is not available in Malaysia yet.

The chart is a summary of the things the Omnilux can do. However, you have to be pretty realistic. A patient would require more than 1 treatment to achieve noticeable results. And the results do not come instantly but rather 3-6 weeks after treatment done. After scanning through the clinical papers, I would say 6-8 treatments would be recommended within a short interval of 3-5 days. Technically you can do this treatment daily due to non-invasive nature of treatment although whether any additional benefits seen is yet to be concluded. 

So far I've done 3 treatments on my face since the machine arrived. 2 times with the Revive, and once with Plus. The first treatment was done with just a Milk peel. We used Revive and the red light was blinding despite the goggles given. My skin felt warm as the red light hit the surface. It was not painful. The LED light placed so near to my face was actually cool. 20 minutes went by pretty fast despite the blinding red light. Post treatment, there was residue of warmth on my face and it looked more radiant probably from the heating of the tissue. 

The second treatment was initially for my back. I hosted a birthday party on Friday night and was dancing on killer heels for a good 3 hours. Of course my back hurts. There was mainly trapezius muscle strain. So we put on Plus and shined it 20 minutes on my back. Since I was bored in my clinic that day, after we finished I asked for iontophoresis vitamin C and shined Plus another 20 mins on my face. Plus is infra red light so we would not be able to see any of the LED beams. Instead they placed yellow diodes just to show that the machine is being turned on. Infrared beams are relatively harmless however poses a threat to the eye if concentrated and beamed on the same spot for 10 seconds or more. Hence why all the precautions that we take to cover the eyes. The Plus beam is less bright and produces less heat than Revive. It did however improve my back and the muscle appear less tender. I was even told that they use this lamp for race horses in Hong Kong to aid healing after race. As for face, I did not see much difference with my face except for the vitamin C application that made it glow in comparison to the Revive lamp which gave instant radiance probably due to more heating effect.

For the third session we used the Revive lamp again. Before putting on the lamp, I asked the girl to apply Intense White C serum via iontophoresis. No peeling was done since my face was just peeled recently. After this session I noticed a lot of difference. Pores appeared smaller, and my tone improved quite a bit. The next day, my skin was still good, pores were small plus it felt tighter. Can't wait for another 'tanning' session (it doesn't tan you at all actually). 

Omnilux is used for:

•          Minor Muscle and joint pain management e.g. Treatment of Sports Injuries

•          Non Melanoma Skin Cancer. Basal Cell Carcinoma (BCC) – Most common form of cancer in the United States (75% of all skin cancers). Basal cell carcinoma is normally a slow-growing form of skin cancer. In some rare cases, BCCs can multiply more rapidly and spread (metastasize) to other parts of the body.

•          Bowen’s disease is a very early form of skin cancer. In Bowen’s disease, the skin cancer is located only in the epidermis.

•          Actinic keratosis is caused by sun exposure. About 5% develop into skin cancer.

•          Wound Healing. The Omnilux has shown to accelerate wound healing, proven treatment for post laser ablation-(removal of unwanted tissue from the body), reduces pain, swelling and erythema. Skin Area Treatment Pre and Post Laser Resurfacing Moderate, Severe, Cystic Acne Treatment. Skin Rejuvenation and Combined Chemical Peel Protocols.

•          Periorbital Wrinkles Combined Treatment of: Chemical Peels with Photorejuvenation.

•          Anti- Inflammation Skin Area Treatment.

LASER VS OMNILUX     

Omnilux also :

• Plumps fine lines and wrinkles

• Smoothens skin texture

• Stimulates collagen and elastin production and firms skin

• Help heal sun damage, psoriasis, dermatitis and eczema

• Improves pigmentation and evens skin tone

• Calms rosacea

• Relieves headaches and minor muscle and joint pain

• Accelerates wound healing

• Reduces scarring

At the moment we are giving the Omnilux treatments at a very special price. Interested to try out this cool device. Call us today for an appointment at 03-21440080 or text to 014-2233268. Limited time only. For more enquiries, do email to info@faceworks-clinic.com / faceworksclinic@gmail.com .

Medical Aesthetics for age groups......

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

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

Early 20s (18-25)

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

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

Late 20s- 30s (26-35)

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

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

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

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

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

After 46 (46 to 65 or more)

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

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

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

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

New Service from Faceworks.... Milk Peel

We are proud to introduce our latest peel from Dermaceutics - Milk Peel. Milk Peel is a much stronger peel than the classic glycolic peel of 20% because it combines 50% glycolic with 10% lactic acid + salicylic acid making it penetrate deeper but with less pain. In combination with our whitening Intense C serum, you can see how it instantly lightens superficial pigmentation and even the deeper ones. Look closely at the picture and you will also notice an improvement in texture and reduction of fine wrinkles and this is just immediately after. Some people may experience some redness which normally subsides within the day. As for peeling? Well, some may have some peeling which I describe like having dry glue on your face and peeling it off, otherwise most are fine. The trick to a better lasting results is applying lots and lots of moisturizers and serums immediately after and up to a week since the penetration of products will be superb during this period. Oh.... And do not forget sunblock as it is a must. This short procedure only takes 40 minutes to complete with the given results.

Feel your skin dull and non-radiant, starting to see those big pores and fine wrinkles forming, No time to take off from your busy schedule?? This is definitely the right peel for you. Don't settle for any peel, Choose MILK PEEL - the immediate solution with minimal downtime.

To know more or to book appointment, do call us at 03-21440080 or email to info@faceworksclinic.com

Mirror, mirror on the wall.... who's the fairest of them all....?

I have come across a lot of patients who wanted fairness and even to the point of luminant skin. Being an aesthetic physician in Asia this is not uncommon. The Asian's model for beauty is to have fair flawless skin like the Japanese, and Korean counterparts. So I've decided to give my two cents on it, based on the things that I have read and researched.

Before I start explaining on the products that claims to make a person fairer, first we need to understand the difference in skin types and tans which determines how fair or tan you will be and the factors that lead to a more exaggerated tanning. There are 6 skin types based on Fitzpatrick's Skin Colour Classifications ranging from type 1-Type 6. For Asians, Type 1 are the extremely fair Scandanavians with blue eyes and yellow hair, type 2-3 are mainly Caucasians some are the Japanese and Korean Asians and for people like us, living at the equator would likely have type 4-5 skin type. Type 6 are the African origins or dark Indians. This genetic predisposition to skin colour depends on the distribution of melanin at the basal layer of the epidermis (skin). The environment also plays a role, whereas, where there is a overstimulation of the melanin - leads to more tanner skin. The most common cause is exposure to UVA/UVB sunlight. What it means in simple tense is that, even if we were to exclude environmental factors, our genetic built up will be the limitation to the fairness that we can achieve despite any treatment. I usually tell my patients that if you want to be fair, you can only achieve fairness as much as your non sun exposed areas and not more than that unless you bleach yourself.

According to most of the clinical studies that I have come across, topical Vitamin C in high concentrations does lead to a brightening of the skin because of its anti-oxidant effects and skin healing properties which allows better new skin formations. However, a lot of the creams/serums in the market have problems in delivering the vitamin C into the skin effectively leading to reduced efficacy. (Check out blog entry What's Up with Vitamin C -  http://faceworksclinic.blogspot.com/2011_04_01_archive.html ) The better ones are more expensive and prices range from a few hundred for a bottle. Furthermore, you need to use it on a more consistent basis in order to achieve lasting results. 

Similarly, there are some bleaching agents such as hydroquinone (HQ) - which is still the gold standard for treating pigmentary problems. However, long term use of hydroquinone will lead to a condition called onochronosis which is a bluish discolouration of the skin at the area of usage. Onochronosis is really difficult to treat and require multiple laser treatments to reduce the appearance. This was the main reason why there is a lot of bad press and reports on HQ. A lot of beautician products use HQ in the creams to get fast results as fast as 1-2 weeks but in long run causes damage to the skin. The FDA approval for concentration of HQ in skin products is only 4%. I know some beautician products that use up to 8% HQ and is sold over the counter with no restriction. Therefore, if you plan to use HQ to treat your pigmentation issues, please make sure you are under a follow-up by a doctor who actually know what they are prescribing.

Then we come to the non-HQ bleaching agents such as kojic acid, arbutin, mendelic acids etc. The most common nowadays are the kojics and arbutins. In high topical concentrations, you can see an instant lightening of pigments. However, if you are using a topical cream, containing these products, you will only see results after perhaps 4-6 weeks, in contrast to HQ where you see improvement in 2-4 weeks. Because these bleaching agents are taken from natural sources, you can actually use them up to whenever you feel like it without much side effects. However, I have noticed that after 6-9 months, some patients feel that the bleaching ingredient does not give any additional effects and sometimes I shift them back on HQ. Although this may appear to be the miracle product for avoiding and brightening up pigmentation, some people are allergic to these products and develop rash and itchiness. I see this more common with kojic acid preparations.

There are some products in the market which claims oral intake can help lighten up the skin. Some offer vitamin C in high doses of 1000-2000mg daily, others claim glutathione up to 5000mg daily oral intake. Although these may appear appealing, the high concentrations may not benefit in view that the gut can only absorb as much and overconsuming of vitamin C can lead to orange discolouration of skin, gut disturbances, etc. There are some products in the market which contain melanin blockers and acts at the cellular level of melanin production. I found one product interesting called White Beaute. It is an oral supplement that acts as a melanin blocker. I have seen some of my patients who improved in skin tone when taking this product after 3-6 months. The only thing with oral supplements, it takes longer to see the results compared to other methods, and that may be the reason some people prefer not to try it out. I have also tried out oral sunblocks such as Heliocare Oral Sunblock Pynocare - I find that it does give a fair results for about 3 months but prolonged use did not appear to benefit much in terms of skin brightening. But I did notice that I got less sunburnt compared to prior being on the product and you need to take it 2 weeks prior to any sun vacations to get the best results. My consultant consumed this product only 1 week before a beach holiday and she still got burnt, so perhaps the other general precautions such as hat, umbrella,shades and topical sunblock and sunscreen should be applied despite using the product.

Now we go to the injections. The most common injections for whitening sold are the Vitamin C's and Glutathione injections. Personally, I've never tried since I'm pretty happy with my tan, but maybe for research purposes, I would subject myself to this trial in the future. However, I do have girl friends who swear that it really does work. It works fast, but you need a maintenance program to keep yourself fair and you still have to avoid direct sun exposures. Furthermore, in view that you are trying to get the anti-oxidant benefits and the glutathione overdose side effect, you need to understand that there are factors that will cause these injections to not work. Basically, oxidative stressors.

There are many different processes and substances that chronically damage cells and contribute to oxidative stress including:

• Toxic chemical compounds and pollutants in your body
• Hydrogenated fats
• All kinds of pollution , including air, water, and food
• Oils that have been heated to very high temperatures
• Cigarette smoke, directly inhaled or secondhand
• Dehydration
• Too much sugar
• Too much animal protein in your diet
• Geophysical stress like living near power lines or waste dumps
• Microbial imbalance, including bacterial, fungal and viral infections
• Preservatives in your food
• Drugs (over the counter and prescription)
• Artificial food colorings and flavorings
• Plastics
• Chemical cleaning supplies
• Chlorinated water that you drink, shower in or swim in
• Alcohol
• Pesticides in your food
• Radiation exposure
• Psychological and emotional stress

Which is why in smokers, sometimes the whole course does not work. Another issue is gaining a good IV access and being careful enough to not shoot the products too fast because it will cause damage to the vein endothelium. And the most problematic part would be the commitment to come to the clinic according to the recommended intervals. If you skip 1 even, it may not work. I have come across a few alternative studies which links the usage of Vitamin C extreme high does as a cytotoxic agent to treat cancer cells. Therefore, injections for whitening using vitamin C and glutathione although some say may not benefit the person much, I do believe would help reduce oxidative damage that causes aging and is not just an expensive urine. But whether you are willing to fork out for a treatment that you may or not become fair from, its up to the person's personal choice. I would rather the person comes to a proper doctor in a clinic who understand the benefits and complication rather than shoot it up in a beauty saloon or a hotel room by some unlicensed person. Its always better to be safe than sorry. 

So maybe one day we will find a way to lighten up skin even from darker skin subtypes. But is fairness really that important? Perhaps, since we have all been brainwashed since we were really young- remember snow white? Mirror, mirror on the wall........ who's the fairest of them all? My belief is beauty is not just skin deep, it comes from within.

For more enquiries please email to info@faceworksclinic.com or call +603-21440080 for an appointment.