The sagging face....... PART 1 ( The Why?)

In my years of aesthetic practice, one of the most common complaints I have from patients is that they feel that their face is sagging. Most complain of jowls seen under the jawline making them look older. So they start consuming products to sort of enhance their collagen to improve the sagging skin but most products do not seem to work.

Before you can treat the problem, you need to understand what it is. As we age, our body undergoes a lot of changes in terms of anatomy and fat, muscle, or tissue redistribution. Here is a nice picture depicting the changes of ageing taken from The Journal of Facial Plastic Surgery Clinics of North America.

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1. Thinning of hair and receding hairline.

2. Forehead rhytids and ptosis.   ----> (Forehead lines and loss of volume)

3. Glabellar Rhytidosis.    ------>  ( Also know as frown lines)

4. Brow ptosis.

5. Temple rhytidosis and ptosis.

6. Upper lid redundancy and ptosis.   -----------> (Lid droop)

7. Lateral canthal rhytidosis.    -------------> (Crow's feet)

8. Nasal root rhytidosis.       ----------------> (Bunny lines)

9. Lower lid redundancy and rhytidosis    --------------> (Under eye wrinkles)

10. Lower lid fat pseudoherniation.     ---------> (eye bags)

11. Malar bag formation.                       ---------> (eye bags)

12. Cheek rhytidosis.

13. Periauricular rhytidosis.                  

14. Nasal tip ptosis and dependency.

15. Cheek sagging and fat atrophy changes.      ----------------> (face hollowness)

16. Deepening nasolabial crease                     ---------------> (laughing lines)

17. Facial rhytidosis and sagging.                  ---------------> (cheek wrinkles and sagging)

18. Perioral rhytidosis.  --------------------------> (perioral wrinkles or smoker's line)

19. Upper lid flattening and lengthening.

20. Thinning and atrophy of the vermillion (red lip)

21. Chin pad ptosis and retraction.

22. Jowl formation  ---------------------------> (jowls or face sagging)

23. Cervical rhytidosis    ----------------------> (Neck wrinkles)

24. Submental fat accumulation   ----------------->  (double chin)

25. Platysmal banding

26 Rhytidosis and midneck hollowing

27. Submaxillary gland ptosis.

I like this diagram because it covers all the possible facial ageing signs on a persons face. Yes, it is also a very ugly picture. Most people may have only 5 or 6 on the list after a certain age, but ageing is not just chronological. It also depends on your sun exposure, your lifestyle, nutrition, genetics, etc. 

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So what was once upside down triangle face that most people regard as youth, slowly, gravity starts pulling downwards until the triangle becomes bottom down. 

This image shows a more colourful and easier diagram than the first of what happens as we age. Our eye sockets appear bigger due to reabsorption of the bone and the shifting of the fat pads to either due to prolapse or loss of volume. The prolapse seen around the eye also is related to the increase laxity of the surrounding ligaments. Bags form around the eyes develop from laxity of the tissue surrounding it. Lines form on the face from loss of volume and movements that form expressions of the face. Combined with thinned out, unhealthy skin, it can look worst in some people.

So basically, the phenomenon of sagging of the face is not as easy as taking strings and pulling it to make you look tighter. It involves a more comprehensive knowledge and practical approach to getting the best results that is suitable for you.

Usually, my approach would be to see what bother's my patient most. And from there, we decide, what is the likely cause i.e. loss of volume in the temples or malar fat pads, reduce skin elasticity due to exposures to sun, over wrinkling due to over expressions, or other reasons that contribute to the sag look that the patient is not happy with. By explaining the cause of sagging, then only can the doctor prescribe the best form of treatment to a patient and whether surgical intervention is more likely a better choice in the patient's best interest.

So is there a treatment for sagging? 

The answer is, not a single treatment but more likely a series of combined treatment treating each and every problem located above. Honestly, looking at the above diagrams, most of us would have more than 1 issue. What is more important is to sit and discuss treatment options and costs and do a proper planning of how to achieve the best results.

I will continue in my next blog on what are the treatment options available to treat the sagging face.

For more questions or appointment enquiries please email to drmmclinic@gmail.com or msg us at 0123301585, or call 0321106608.

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.

Tried And Tested....... Part 4 ........

Its been a quiet Ramadhan month. Personally, I have found the idea iftar at home is more inviting. Probably all the caloric restriction diets I've been on throughout the pass year has reduced my crave for food as much as I did before. The only thing driving me nuts now is the lack of caffeine.

Recently, I was visited by a new patient who turned out to be a follower of my blog. I felt really honoured that she enjoyed the contents and was really looking forward to my posts. So Killah, this one is for you.

I was quiet for a bit due to a very hectic schedule. However, in the huff buzz, I managed to try out a few products for this review.

1. Neostrata Skin Active Line Lift

     This is the newest product from Neostrata Skin Active range. As the name suggests, it helps to reduce appearance of deep lines and wrinkles. After 5 years of research, Neostrata labs discovered a technology they patented as Aminophil that acts by stimulating the skin's own hyaluronic acid and collagen creating volume to replace the loss areas. It is a regarded as a topical filler and results can be seen after a few minutes of application. However, you need to be religious in applying the product, since it relies on your own cells for the lasting effect. There are 2 products in this range - Step 1 Aminophil Activator is applied first. This compound has the ability to pump up skin 4 times more than inactive substance. It penetrates deep into the skin to stimulate collagen and hyaluronic acid production thus improving the appearance of deep lines instantly. It is also a potent antioxidant that helps to reduce free radicals responsible for premature aging skin. The Step 1 is applied with a roller ball to allow light massage and precision thus making it convenient for areas like under the eyes. Step 2 is the Finishing Complex that complements the action of Step 1. It contains NeoCitritate and NeoGlucosamine ingredients which enhances the production of collagen and hyaluronic acid. It also contains optic blurring agents that improves the appearance of deep lines. I find this product a tad too oily for me but Step 1 was nice.

         I tried out this product via the samples they gave me and managed to apply religiously for a week (and then I got busy so sort of gave up). There is an instant line reduction of at least 30% after 5 minutes of application. After a week, I notice that there was up to 75% improvement after application. However, later during the day, I did notice a return of the lines, and when compared to baseline, It looked almost similar. According to the research papers and recommendations, they ask you to use for at least 4-6 weeks for lasting effect. I guess this is a good solution for people scared of needles or not keen for filler injections. However, you need to apply constantly twice a day in order to keep the desired effect. Practically, for busy people like me, I think fillers would be a better solution so that I do not have to worry about it if I forget to apply. It would also be cool to use prior to functions, for that pumped up look since it does last for a couple of hours in a day. You will need to have both Step 1 and Step 2 in order to have the desired results. Each tube is sold at RM 135/= retail.

2. Strath tablets - Herbal Yeast Food Supplements

During the haze period, I developed very bad sinusitis until I lost my voice for 3 days and had sinus headaches up to 2 weeks with altered voice for a month. It was during this time, my medical colleagues suggested that I try out this particular supplement. He mailed it to me and insisted that I try it out to help reduce my sinus symptoms. 

     So what is Strath? This is a natural herbal and yeast preparation that is available in both liquid and tablet form. The one I was given was tablet form - 100 tablets per box. It naturally contains 11 vitamins, 19 minerals, 20 amino acids, 2 nucleic acids and other stuff such as s lecithin, choline, L-carnitine

and co-enzyme Q10, as well as glucan and mannan. There were not much research papers on this product and I have yet to find any literature that explains scientifically how it works. How they actually prepared this supplement is by introducing herbs and supplements to the yeast over a 2 month period and subsequently plasmolyising (getting rid of the yeast membrane) the yeast and the solution inside is used as the supplement. In a way, the nutrients are incubated inside the yeast and perhaps with some component of the yeast helps with the body's immune system and metabolism thus gives the beneficial outcome. There was a paper on mice that showed a significant increase in lifespan of mice that took the plasmolyzed yeast supplement after injected with Staph. Aureus bacteria in comparison to the placebo group.

I have to admit, I was pretty skeptic when I received the supplements but I decided to give it a go. I initially took 2 tablets 3 times a day as recommended by my friend. After a few days, I noticed an improvement in my sinus flu-like symptoms. However, I felt pretty lethargic the first week with some giddiness. I didn't think much of it as I was also on antibiotics short course, but looking in retrospec, I recovered much faster that I normally did. I continued taking the tablets twice daily due to hectic schedule, occasionally only once daily. After finishing the whole box in a month (Supposedly 17 days) - I did noticed relief of my allergy symptoms. I usually have a stuffed nose in the morning but for the past 2 months, my nose hasn't dripped as much. Despite my office manager having a really bad flu, I stayed fine although we were always in close contact. Generally, I felt healthier and less lethargic. The beauty of this product is that it is not that expensive to try. The retail price is RM 162 for 100 tablets or the liquid form. There is also a preparation with alcohol that costs RM 180. Another cool thing is that there is an animal preparation for your pets called Animastrath that helps improve your pets well-being and possibly help reduce harm from animal flu.

Bio-Strath is 100% natural and free from preservatives, colourings and any artificially produced substances.

• For fatigue (school fatigue, spring fatigue).
• For nervous tension, stress.
• To strengthen immune defence.
• To increase physical and mental efficiency.
• To promote vitality.
• To help during convalescence (recovery phase after illness).
• During pregnancy and lactation period.
• To help concentration, development and calmness in children
• To help recovery in sports

This is a pre-order item, so it is not readily available in the clinic.

3. Lash Booster - Eye Lash Conditioner

This is a cool product that I love especially since there are times I need to wear mascara and excessive eye make-up and sometimes I notice I am losing some of my lashes (especially after wearing fake ones). It is not really a new item in the market, however, due to certain FDA regulations, the formulation has been changed a couple of time. The latest formulation has FDA approval and works just as good as the previous one or perhaps a little better? I tried this product continuously for a week and the significant change was the volume of my lashes and brows (yes, I even applied on my brows) appeared more and even friends noticed that my brows and lashes look thicker. In terms of length, I didn't see much difference but perhaps, it would take 3 weeks to actually see length difference. It comes in a small mascara like tube, and you apply the solution at the roots of your lashes and your brows. This product comes from USA, and is a sister product of Revitalash. Perhaps the only downside is that you need to consistently apply the product in order to achieve the desired results although its once daily application at night. Another problem that may arise is sensitivity to the chemicals used in this formulation that may cause some eye irritation or redness despite the company claiming that it is even suitable for the most sensitive eyes. The key is to avoid as much as applying the solution into the eyes. Regardless, it is still a cool product for lash growth and conditioning. This is not really the first time I am trying out this product - I started prior when it first launched and I feel that the formulation has definitely improved. Time to start applying daily for beautiful lashes for Hari Raya. If you are concern about irritation, you can come over to the clinic and try out our sample. This Product is sold at RM 280 per tube and it can last approximately 1 1/2 - 2 months if applied daily. For a limited time only, we are selling this product at an intro price of RM 250 (Save RM 30 till 15th August). Get yours today.

For more information concerning the products kindly call us at 03-21440080 / 0142233268 or email to faceworksclinic@gmail.com .

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 .

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.

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.

Tried and tested........... (Part 1)

I have been super busy with so many things that sometimes I wonder what is it that is making me so busy to begin with. Well, one of the things I was up to was actually testing out supplements and products to see how good they are. So here are a list of things I have been trying and the outcome.

1. Tiox-C Glutathione and Vitamin Capsule tablets.

At first when I saw this product I was skeptical. Oral glutathione and vitamin C? But since it was provided in gelatin capsules, it would survive the acidic PH of the stomach. I took some for the clinic and some of my patients tried it out. I gave a box to my sister, and she took 10 capsules a day at different intervals. (The recommended was 2 capsules daily). In one week she was fairer than me by at least 2 shades. Anotehr patient took 4 tablets a day, and she was fairer after 2 weeks, despite spending some time in the sun over that weekend. Besides the fairness, my patients also commented on the brightness of the skin and healthier glow. So I decided to try it out, so I am currently on my 2 week and I think I am a tan lighter compared to usual. This product is from Japan but packed in Malaysia. The bovine gelatin capsules are from Pakistan, and has a Halal certification. Other benefits of this product is that it is a good anti-oxidant and was actually promoted as a supplement for detox. One box comes with 90 tablets with 150mg of vitamin C and 150mg of glutathione in each one. The price for a box is around RM 328/= which is pretty good since you have 90 tablets to take. So instead of going for vitamin C injections, you can take orally for cheaper with results. You can get this product in my clinic.

2. Linurase Serum from Phiderma

This is a new product in town called Linurase. As the name entails it is designed to erase wrinkles and lines. Fine ones that is. I have tried this product for about more than 2 weeks everyday twice daily application without fail and this is what I think about it. First of all, the product is in a serum form. It absorbs quickly within 2 minutes. Initially I had a little bit of a tingling from using this product but after a few days it felt better. After a few minutes, I do notice my wrinkles improving, even the dynamic ones. They claim to be better than botox or BTA, but after 2 weeks, I'd say that they are competitive, but you need to apply daily to get the best effect. Once you stop, the muscle action will return and expressive wrinkles will come back again. Nevertheless, it is a good alternative for people who have needle phobia or not keen to get BTA/botox done yet. Daily usage of this serum actually stalled some of the wrinkles on my forehead, until I stopped a few days ago to try out another product. The lines came back after a few days. After reading more about the active ingredient, you need to use it consistently for more than 30 days to have a lasting effect. It contains Acetyl Hexapeptide-8 which acts on the same acetyle choline receptors as bta/botox thus blocking muscle actions. Other ingredients are Hyaluronic acid, anti-oxidants and seaweed biopeptide extracts. If you are interested with this serum, you can contact my clinic and we will order for you. It is selling at RM 300/bottle which may well last up to 3 months.

3. Double X from Nutrilite

Previously being on stem cell supplements and later HCG diet has actually turned me into a pretty health freak where I am seriously into organics and reducing artificial colourings, flavours and sugar based foods. But stem cell supplements are expensive, and it would be not so ideal for people of the working class to take on a monthly basis. So I scoured the internet for solutions and I came across this particular brand of multivitamins. Nutrilite actually has the largest organic farm in the states, and has passed accreditation for few years already. (4 or more) My major turn off was the fact that it was sold under Amway which is a multi-level company. However, being a curious and caring doctor, I decided to search for it anyway and give my opinion on it. I have been taking this vitamin for almost a month now and for what it is, it is super affordable. (RM 150 per box of 62 X 3 tablets for non Amway members). What I felt after taking these vitamins is that my energy level came up again, despite my super busy schedule. I looked less tired and these changes started perhaps after a few days after taking them twice daily and after a week I felt healthier. What I really like about it is the fact that they divide 2 separate doses in a day which is actually what is recommended by all Nutritionists and dieticians since 3 years ago. The reason for this is that the gut has a saturation level for all nutrients so if you were to take too high a dose at a time, you will only absorb as much as the saturated level allows thus wasting the vitamin. Another good thing is that they separate vitamins from minerals which allows accurate concentrations to be achieved since in processing a lot of the minerals get binded by the vitamins - e.g. sodium to vitamin c - ascorbate and others. They even added a third component which is more of a traditional preparation but known to have good benefits like cranberry extracts, apple extracts, etc as anti-oxidants to complete the multivitamin. The only thing is, you cannot take this on a completely empty stomach since when I tried, there was some reflux felt, so I'd recommend some food before taking them, but definitely not on a full stomach. Another downside would be having to swallow 3 hard tablets which I know there are some people who do not like popping pills. But otherwise, this is certainly a keeper to maintain on a daily basis for good health. Personally I do not sell this, but if you are interested to get some you can contact my clinic and we will get you in touch with my friend Ed.

These are but a few of the other things I've been testing. I welcome any feedback or comments.

For more information or if you would like to try out these products you can contact my clinic at 03-21440080 or email to info@faceworksclinic.com.

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