Happy New Year... 2014

Its the start of a new year. Time flies ever so fast. Reminiscing back to the earlier days of running the clinic, how much things have changed. Now, my skills are more than grown, I have started to train other doctors for most of the filler and botulinum toxin techniques. I have a good team, with a strong manager to help manage most of the clinic day to day dealings. We've established the appointment only concept that not only allows you to plan for your appointment, but for us to make the best of your time. My foreign patients love this concept, the locals are still trying to get use to it.

We've made a lot of new allies for this year, and new projects are unveiling. We may have dropped a few, but the aim is to move forward, hence we need to focus on the positives. We have good and loyal patients, we have a lot of new ones too. With the new regulations hopefully Malaysia will be able to compete with its neighbouring countries in terms of Medical Aesthetics more proactively and provide overall great service and good reputation.

Unfortunately, there are still a lot of people who fall prey to beauticians doing injections etc, providing so called professional exclusive services. An overall price comparison, their prices compared to doctor prices are pretty much similar with perhaps a few hundred difference. I have been consulting patients whom have had beautician work done on their face and overall most of them are not happy with the work, but the worst part is you can't remove it, unless of course surgically. And most surgeons would charge a bomb for having to clean up someone else's mess, plus the complications that may arise from the surgery.

So for the start of this new year, I would like to give a take home message to all my readers who may consider improving their looks for this year.

5 Reasons Why You Shouldn't Let Anyone Else But A Trained Dr Poke A Needle to Your Face

1. The Face is the first thing a person notices when they look at you. Getting fillers or BTA from an untrained hand may make you look weird / disproportionate / abnormal. Every trained medical aesthetic practitioner goes through measurement training and ratio training that allows them to make an educated assessment of your face's needs and amount required. Beauticians only inject base on what they think is pretty but not based on scientific guidelines. What may be pretty to them may not be pretty to anyone else.

2. Beauticians are not taught surgical anatomy. Yes, they may argue, they have anatomy syllabus in their courses but it is very non-specific and mostly related to massage techniques. Even doctors who are not trained in medical aesthetics have issues with face anatomy (I conduct training, I know) and most only know basic. You need a really in depth knowledge of the anatomy of the structures of your face before you can safely poke a needle in it. There are many areas which you cannot inject or even if you did required high level of care. There are reported cases of skin necrosis, granulomas, etc with filler injections even with the most trained hands, what else an untrained hand? And what more a non-medical personnel who doesn't even have the basic.

3. The collagen that beauticians keep saying they are injecting are not 100% collagen. The source is questionable, most are taken from China since its super cheap there and unlikely to be sterile. For those with religious preferences, most collagen for fillers are bovine (cow) or porcine (pig) in origin. We will never use marine sources because of very high allergy rates in humans. Sometimes, they even use human collagen (which I have no idea how they extract). Another issue is that most of the time, liquid silicone is included in the concoction to give it better volume for less usage and for the effect to stay longer (rather permanent). My simplest advice would be to be inquisitive about the product you use - see the packaging, make sure the box and the filler is the same thing, make sure it is sterile, and make sure you can actually read the label on the box.

4. Any break in the skin allows bacteria and viruses to come in and cause a local infection. Doctors are drilled with need for sterility for all procedures even before they graduate. Beauticians and other non-medical injectors are not trained towards sterility. How sure are you that the needle they use has not been used before, how sure are you that their swabs are not expired? What about communicable diseases? How healthy is your injector? You have no idea about their own medical background. Furthermore, if a doctor's procedure gets infected, the doctor can treat and prescribe antibiotics, what can your beautician do besides ask you to seek help from a doctor?

5. Beauticians charge cheaper? On contrary, you may be paying so much more for what they are worth. Most beauticians will charge 5-10 fold of their cost price, whilst most doctors would charge base on the market price for a certain product and their experience. I had one patient who went to a beautician for a nose filler and was charged RM 15K. Luckily she only paid half, but with the amount of money, I told her she could have gotten a proper rhinoplasty done. She was unhappy with the filler work which made her nose look so big that she was depressed. Then she had to spend another RM 6K to remove it from a surgeon and a few more $$ for a proper rhinoplasty. Altogether, she spent almost RM 50K for something that she could have saved if she had consulted a proper doctor to begin with.

The medical aesthetic industry is a very lucrative industry which most Malaysians are starting to realise nowadays. Hence many people will try to grab the opportunity to be in this industry. Its not a bad thing, but personally I feel that you should only sell a skill that you possess and able to handle inclusive of the consultation and complications. Although the government has imposed certain regulations on Medical Aesthetics and Beauticians, however, enforcement in Malaysia is very poor. Because of this, as a consumer, it is your own responsibility to make an informed educated decision when deciding on any procedure. Remember, all medical aesthetic procedures are elective - take your time to do your own research and sleep on it before deciding. If you are not comfortable with the injector, just walk away. Its your face anyway. Hesitation is better than regret.

Happy New Year Peeps!! Look out for more interesting blog entries for this year.

For more information or to contact us directly please call the clinic at 03-21440080 / 014-2233268 or email to us at faceworksclinic@gmail.com. 

September October Promotion....

I remember a senior colleague of mine who whenever he conducts training... he will always tell us, " You know, for every Asian who walks into the clinic, definitely will look better with a nose filler in," Initially I laughed at his remark, but after a few years, I realized he did make sense. Traditionally Asians tend to have a more flatter nose bridge, hence makes the distance between the two eyes more far apart and appear smaller and less attractive. But by inserting a filler at the nose bridge, and even elongating the tip slightly, it helps reduce the distance and automatically makes the face more appealing. The eyes become more obvious and bigger (relatively). Nowadays with advancement of injection techniques, you can even do it as a lunch time procedure without much bruising or even being noticed by your colleagues. But there is a certain accepted norm for Asian nose, thus you need to go to a well trained practitioner in order to get a natural looking  nose. The most common comment you will get from your friends is that, you look different - but most wouldn't realize that you had your nose done unless pointed out or if you really had no bridge at all. The immediate improvement is superb and it really helps with self confidence without feeling fake. Besides, it is only 1 injection away.

Interested to try out our promotion? Do call us at 03-21440080 or email to info@faceworksclinic.com for appointment. See you there.

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