Face shaping..... it only takes 5 minutes.

I have been busy with multitudes of tasks - events, training sessions, functions, patients, kids - you name it, at some point, I feel like I need to either clone myself or grow extra 4 arms but then I'd be too weird. During one of my training sessions, one of the doctors I was training asked me to teach them masseter hypertrophy botulinum toxin A injection technique.

Before I go to detail, masseter hypertrophy is a term to use when your lower cheek muscles are enlarged. What is so important about this? This is one of the reasons that makes a person's face more rounded and they feel that they lose the sharpness of the jaw angle. As Asians, most of us tend to have a square face due to a few reasons i.e. the anatomical structure of our skull which is rounder compared to caucasians, and our diet and habits which includes chewing of nuts and pacifiers when small, and also teeth grinding problems (bruxism). It also helps to reduce bruxism so this is also another indication besides beauty. Other causes of the face appearing to be more square would also be excessive fat around face area and enlarged parotid glands hence eliminating the angle of the jaw. 

So how to know whether its due to muscle or other tissues? Just do a simple test. Clench your teeth and touch your cheek in front of a mirror. If you feel a stronger bulge when you clench I can assure you that it will most likely improve with botulinum toxin injections. 

A lot of people will ask me, is it safe? Yes, if the doctor knows what he/she is doing. The common side effect from the injections is feeling of heaviness of your lower jaw which usually makes you feel lazy to chew or eat. Occasionally you may have some temple muscle spasm if the injections were too high, and the other thing is your jaw may feel loose or weaken. This feeling usually lasts between 1-3 months, and subsequently you will regain normal feeling. But what is more exciting is that you will start seeing a more slimmer face as fast as 2 weeks and it will stay up to 1-2 years depending on a few factors:

1. How strong your muscles were to begin with.

2. Your eating and chewing habits.

3. Dose given during the 1st visit.

Personally, I prefer to give high dose of 200-260 units of dysport (Cost between RM 2500-RM 3000)  - or botox (different units) during the first sitting and review my patient at 1 month, then 3 months and then decide whether more is needed. Usually after 1 session would be suffice, unless the patient has habitual chewing or bruxism then they would need to repeat every 6 months. Some doctors prefer low doses but multiple visits.

The best results are seen in the younger age group, because of better skin turgor. In more advanced aged patients, sometimes they will complain of loose skin, as the muscle bulk disappears. However, this can be fixed by skin tightening procedures like RF or laser tightening. Another issue that usually pops up is that when the jaw is reduced, some patients will notice their chin appear to be smaller. This can also be fixed by putting in fillers for chin. 

How many injection points? There are many techniques but for ladies, I prefer 3 points, men usually 3-5 points depending on muscles size. This procedure also helps to fix facial asymmetry due to uneven muscle size and another benefit is the compensation of your upper cheek muscles make your cheeks look fuller after 3 months. So, because of this, I'd normally tell my patients who want to augment their cheeks to wait 3 months after this procedure to avoid the cheeks to look over done. In most cases, I don't even need to inject the cheeks anymore.

It is painless, simple and takes 5 minutes and results can be seen as early as 2 weeks. Oh, I forgot to mention, I just had mine injected less than 2 weeks ago and I am already noticing the difference. Also loving the fact that I don't feel like eating much so its easier to maintain my weight after the HCG diet I just completed. Will definitely post up my own photos for you to see the difference.

Interested to know more or to do the procedure? Please contact the clinic for an appointment today at 03-21440080 or email info@faceworksclinic.com for more questions.

KISS Mineral Make-UP Workshop

         Last Saturday, Faceworks Clinic hosted its first KISS Mineral Make-Up workshop in Starhill. It was a 2 hour session of knowledge, fun and laughter. The idea of the workshop was to help patients understand about the difference between pure mineral make-up with semi-mineral and non-mineral make-up and the correct application techniques to apply the make-up since the way is not so conventional. Thank you so much for those who came and made the session a success. Thank you to Priscilla and her team for their dedication to the cause. Hope everyone liked the food prepared - it was a simpler brunch with some roti jala, seri muka, sandwiches, macaroni and panacotta from Mr Belo's Pudding.

Personally, I feel that this is a very good effort from KISS since even I found that I learnt a new thing or 2 during the workshop even though I did go through make-up and grooming class before. Perhaps one of the few things that fascinated me during the presentation was about how pure mineral make-up was used since the ancient Egyptians i.e. Cleopatra herself, but it was so expensive then that only the royals could use make-up (how lucky we are now), and that some of the substance used in cosmetic lip sticks is actually the same thing they put in our tar road i.e. lead. 

Another cool fact was because the make-up is purely mineral - you can keep it till it finishes, unlike the normal counter make-up that has a shelf life from 6 months to 2 years depending whether it is liquid or powder, and you do not need to worry about bacteria build up since the bacteria cannot stick to the powders.

We even had a male participant, and we also learnt that even men can use mineral make-up without appearing to wear make-up to cover blemishes, oil spots and make their skin look more even with additional benefit of a sunscreen of SPF 27 that lasts more than 8 hours. Because mineral molecules are big, it allows water or sweat to evaporate through it and it does not clog pores. This also allows Muslims to take ablution without having to remove the make-up since water is able to pass through. You just dab afterwards (do not wipe else it will all be gone) - I've personally tried this, only need to learn to not smudge the eye liner.

KISS also came up with a make-up remover and cleanser with vitamin C and a nice absorbant moisturizer with swiss apple stem cells for skin conditioning before applying sunblock and make-up. Yes, we still need to use a sunblock despite the sunscreen properties for best protection. 

So who should use KISS?

• People who love organics and natural items would love this product since it is void of any chemicals.
• Anyone who is in the working group that needs make-up on for long hours - KISS allows your face to breathe thus maintaining good skin health.
• People with acne problems because the conventional make-up and foundations will only make it worst. KISS contains zinc oxide that is anti-inflammatory, thus reduces redness as well.
• People post aesthetic procedures - YES you can use KISS immediately after lasers or peels to cover any signs of the procedure, as additional sunscreen, and to reduce inflammation. (We have a counter in our clinic for all our patients).
• People who haven't started to use any make-up yet - start with KISS, it does justice to your skin.
• People who haven't found the right make-up for their skin - try KISS, it's gentle.
• People with sensitive skin.
• Busy people - because you do not need to touch up much.
• Stewards and stewardess - because it does not dry up ur skin, it lasts long, SPF and allows your skin to breath.
• Everybody.

KISS Mineral make-up is very safe and pure that I even use it on my girls (6 and 10) without worrying about carcinogens or excessive chemicals that may harm them. Keep it safe, Keep it Simple - KISS.

Interested to know more? Contact our clinic at 03-21440080 or info@faceworksclinic.com and we will try to assist as best we can. The workshop is RM 120 per participant for 2 hours and is limited to a max of 6 each time. We will be holding a few workshops this year so do let us know if you are interested to attend, and we will inform you the next coming date. 

Dieting tips for weight reduction and maintenance. (Part 1 - MYTHBUSTING)

Recently I posted on HCG diet and definitely, it is one of the most amazing diets in the world because you lose fat weight and you do not sag and you do not need to exercise much. The only problem is that it is a prescriptive diet, and the diet is super strict that you need to be under a care of a physician to ensure you are doing it properly to get the desired results.

So I decided to write this entry, for those who want to lose a few pounds and start eating healthy. The key to good weight is mainly the food you eat i.e understanding what you put in your mouth, coupled with some physical activity. First of all, let's unlearn a few things that we learnt when we where younger:

MYTH NO 1 : You will be fat if you eat fats.

Not necessarily. We need some fats to help with the function of the membranes of our cells. We also need fat for transport of Vitamin A,D,E & K in our body. In fact, you need to consume 3500 calories of fat to gain 1 pound of fat in the body. The general consensus on fat is - not to take visible animal fats and say NO to all forms of processed fats like margarine, vegetable spreads etc. If you like butter - take butter, it is much better. Cook with ONLY palm oil for high heat, olive oil for low and moderate heat. Do not use excessive heat with other forms of oils because the phenol bonds break and the biproduct can be precancerous. Low fat or No Fat foods can be more harmful because of hydrogenated fat contents, so it is safer to just take the fat. People who take good oils tend to have better skin hydration too. (Try takin virgin coconut oil/olive oil daily)

MYTH NO 2: Carbohydrates are a must in meals.

Although the old food pyramid puts the portion of carbohydrate as the lowest and most intake, studies have shown that over consumption of refine carbohydrates (i.e. white rice, white bread, pasta, mee, beehoon, white flour, processed sugar, etc) is the major cause for obesity leading to diabetes, hypertension and heart problems. YES - EATING REFINED CARBOHYDRATES LEADS TO FAT. That is why nowadays most diets focus mainly on protein and fat. We can survive with minimal carbohydrates. In the past, the carbohydrates were not as processed as it is now. When carbohydrates are processed and refined, it increases the ability of absorption into the body and leads to a quick increase in blood sugar level, which triggers high insulin release to stabilize the blood sugar level, which leads to storing of the sugar into liver and fat cells. 

MYTH NO 3: Eating Cereals and fruit juice is good.

It really depends on what type of cereal you eat. Most children contains corn syrup and colourings which studies have shown to lead to child hyperactivity. Even in fresh juices, there is a very high sugar content as a preservative as well as to give it a good taste. These are all refined sugars and get absorbed easily. Corn syrup is actually one of America's biggest bi-product because of excessive corn and studies have shown it to be highly associated with obesity. As for juices, most of the fiber content has been destroyed. Furthermore, it makes it too easy to consume more fruit sugars compared to eating the fruit itself. Some fruit juices were also reported to have traces of arsenic. So if you are craving for some juice, go for freshly made ones minus the sugar.

MYTH NO 4: Meal Replacement Drinks are the only way to keep my weight down.

Although I do admit, the meal replacements do help, but understanding what you eat is more beneficial in the long run, plus minus the cost of buying the expensive meal replacements. Imagine spending between RM 500-800 a month for meal replacements which after awhile bores you (who wouldn't be bored taking a shake drink everyday) - when you can actually spend less at a grocery store buying healthy food or eating at a healthy diner. But then you will need to know what to buy, that topic will be covered in my next blog.

MYTH NO 5: Multivitamins makes my appetite increase and hence will make me gain weight.

Although some vitamins causing appetite increase, we need vitamins and trace minerals in order for our body cells to function properly. This leads to better metabolism. Take multivitamins on an empty stomach as it will give the best absorption. Some nutritionists even recommend splitting the vitamin into two and taking it twice instead of once a day. Some people do not believe in supplementing vitamins and minerals but in view of how our foods are cooked and processed, most of the vitamins and minerals  disappear or damaged. Try to go for organic based vitamins and minerals as there is less chemicals involved.

MYTH NO 6: You Should NOT eat late at night because it will just turn to fat.

It is not what time you eat, its how many calories you consume within a period of 24 hours. A full grown adult needs approximately 1200-1600 calories a day depending on sex and body built. However, in Malaysia, a lot of us tend to over eat because we are not aware of how much calories we take in a meal. A simple plate of nasi lemak is 680 calories, a roti canai is 360 calories, lasagna is 390 calories per serving, a KFC snack plate minus the drink is 890 calories. Despite this fact, I would still not recommend people to sleep late because when you stay up at night, you tend to consume more food that is required i.e. munching snacks, teh tariks and you don't really notice because you're hanging out. 

MYTH NO 7: I Can always do a Crash diet when my weight goes up.

Although crash dieting is one way of getting the weight down in the short run, it may stop weight loss in the long run. Most of the time, crash diets involve completely abstaining from foods hence you not only lose some fat, but also your protein mass and connective tissue. In fact, when you starve yourself, you lose your sugar stores first, your protein stores break up and fat is the last to go. This leads to lesser lean mass and thus less energy is needed to sustain your body functions, so less calories are used. Losing weight fast also causes your skin to sag more because of the loss in connective tissue. The best way to lose weight is to target long term, by changing the way you eat, understanding what to eat.

MYTH NO 8: I Can eat anything if I exercise.

This may sound right but it is still not true. Depending on what type of exercise we do, the calories burned are just a few hundred for 30 minutes, compared to the intake we take in a day. Therefore, even though we go to the gym, we still need to watch what we eat, as sometimes easily in 1 meal, we can be consuming 1400-2000 calories (especially buffets). Too strenous exercise breaks down protein stores more than fat, so we should make sure we keep our heart rate only between 40-60% of the max heart rate allowed for our age. Even athletes are very concern about their diet and their main focus would be on high protein and good fats for better muscle building, not high sugar foods that leads to more adipose and cellulite. (Yes, all those sweet sugary things leads to more cellulite - that's why when you are skinny you also have it).

MYTH NO 9: If I Quit smoking I will be fat.

Biologically it has no relation but psychologically, most people who try to quit smoking, tend to use a comfort food as a replacement and hence leads to weight gain. They choose things like sweets, chewing gum, biscuits, asam jeruk, etc. as an excuse to curb cravings. I have a simple technique for people to quit smoking gradually and avoid cravings. I usually tell my patients to buy a cigarette holder, and only smoke what's inside the cigarette holder for the day - and no asking ciggies from buddies. After 1 week, drop down by 2 ciggies and continue for a week, before dropping down another 2 every week. If that week you feel okay, we continue, but if not then stay on the amount of ciggies of that week for another week. Other supporting techniques would be to take coffee with no sugar, sugar free chewing gum, nicotine patches and if you have an urge to chew, then chew on healthy nuts (low sugar not fried) or vegetable sticks (carrots/celery) or fruits (apple/orange/plum).

MYTH NO 10: It is really water retention, not fat.

Fat is fat. If you really want to know what is water retention, weigh yourself in the morning and weigh yourself again in the afternoon. The weight difference is due to water. That is why when dieting, we advise you to measure your dry weight in the morning. It is the most accurate - i.e. after more than 6 hours without water, likely the body is in a mild dehydration state. Similarly when you go to beauty salons, and they measure, weigh you, wrap you up an heat you up in a warm blanket, the weight you lose is the water weight dehydrated from you which can be anything from 400gms to 2 kg. The few  centimeter lost is due to cells being dehydrated, thus becomes smaller. (Plus the fact that they wrapped you, so the body retains some of the shape for awhile before bouncing back to normal).

These are but a few of the dieting myths I have compiled. Feel free to comment and if you have any other myths that need clarifying, do email me at drmarr@faceworksclinic.com. Let's work in understanding and changing the way we think about food. 

For a more intensive prescriptive diet, please come in for a consultation at my clinic. CAll 03-21440080 for appointments.

HCG diet - My experience.....

I am definitely a foodster - I love food, I love eating, and experimenting with different tastes. Friends on my Facebook see all sorts of delicious food being posted which definitely makes people drool. Unfortunately, like any other person, I tend to gain weight a lot on my excursions. The price for great food, is it so? So I decided (or was rather forced into) trying out the HCG diet - Personally I call it the anti-social diet because you have problems eating socially. When I first started, a lot of my friends and colleagues said I would quit half way... but hey, its the 26th day and I'm still on it, and I have lost a good 9 kilos which mainly is fat, I'm down at least 2 dress sizes, and my butt looks smaller. Yippee....But honestly, it requires good motivation, high discipline and consistency.

So since everybody is curious about what I have been doing, I'll explain as simply as possible.

1. What is the HCG diet?

The HCG diet was founded by Dr Simeon who discovered that low levels of HCG hormone (the one that goes up in pregnant ladies) has effects on fat metabolism and facilitates fat usage as fuel when the body is in semi-starved state. He came up with a figure, i.e. 125 iu per day and coupled it with 500 calorie diet a day. However, this effect only works when there is no increase of blood sugar level or rather insulin - hence why no form of carbohydrates are allowed. The diet is very strict and you are only allowed to eat the food on the list and that is it. Dr Kevin then made a modified version which enhanced the effect and lead to maintenance.

2. What is the real purpose of the diet?

Although reporting fat loss in grams daily is perhaps the best thing about this diet, the real function of this diet is to retrain our hypothalamus to eat properly. One of the reasons people become fat or obese is because of cravings and lacking of self-control when it comes to food. They eat regardless they are hungry or not and tend to overeat so much. Foods high in sugar, preservatives and other forms of chemicals in food nowadays causes the brain to not be able to register how much food has entered the system hence the person just keeps on eating. When you abstain from carbohydrates, junk food and fastfood, the brains receptors in the hypothalamus will resensitize again, so that you do not have much cravings. That is why, once you complete the 25 days of 500 calories diet, you have another month to slowly introduce more food with simple refine carbohydrates being last and complete ban on fast food or junk food. If you don't do this, that is why you see people on this diet acting like yoyo's and at the end, think it is just a short term treatment.

3. Is this diet safe?

According to all studies and reports, it is the safest diet in the world. However, because we prescribe hormones, you MUST be under a doctor's follow-up. It is not just for the injections supply, but also motivation, weight tracking, diet tracking and to tackle issues like ketosis and hypoglycaemia symptoms . (Yes, sometimes you get it). Some doctors also prepare the food for you to eat from their clinic with some additional charge whilst on the VLCD (500 caloric diet).

4. Is 500 calories a day enough?

Yes. The reason is because when the body utilizes in-store fat, it produces 2000-3000 kcals of energy. If you eat more than 500 calories a day, some of it will be stored hence weight loss will be affected. This is also another reason why people gain weight on this diet - it acts like a double edge sword. If you eat too much, or cheat on carbohydrates, it will restore into the body hence making you bigger. (Yes, I've tested this theory on myself).

5. Since I'm producing so much energy, should I exercise?

Despite the energy produced, we do not recommend you to do strenous exercise during the course of the injections because it can speed up ketosis symptoms and you will feel hungry. Furthermore, if you do exercise during this period, you need to continue even after the diet if not your weight will go up. Even for myself, I limit my jogging activities and I reduce my weight lifting regimes to half just to keep my exercise freak bit happy. However, after you stop injecting, I would recommend a more frequent exercise like walking and weights ideally everyday.

6. Since I can only take 500 calories a day, can I fast?

The answer is no. The reason is because, you have to eat on this diet at least between 4-6 hours if not you will go into ketosis - and have symptoms like headache, nausea, disorientation etc. Another reason is that you need to be well hydrated for the burning process to be optimized, i.e. 2-3 liters of water daily. I've tried not eating for almost 8 hours and I was so disoriented I almost hit a lamp post. I've also been dehydrated (testing) and there was reduced weight loss the next morning and I felt lethargic.

7. Injections or drops?

I would have to say injections. With injections you have an option of 23 or 42 days but with the drops you definitely must do 42 days. In terms of weight loss, the injections are much more predictable compared to the drops, less plateau if you do not cheat on the diet. But not many people like the idea of jabbing themselves everyday. Even for myself I felt exhausted of jabbing my own butt for 23 days. For my patients, some of them come to the clinic daily to get the jab. So if you are not keen for injections, which drops to take? I have my own medical pharmaceutical drops provided - so not sure about the rest.

8. What are the things I need to have at home to start this diet?

Simple things. A weigh to measure every morning after your first pee with minimal clothes on. (This is your dry weight). A kitchen weighing scale to measure your 100gms of protein a meal. (I prefer you to measure your own meal and decide what proteins to take). A non-stick pan to cook the protein. 

9. Should I be on supplements?

Yes and no. I would only recommend a multivitamin in the morning with water. Because you are going on a strict diet, you require to supplement this because if you fall sick, you cannot take much medication. I would also recommend calcium - ideally coral calcium, because you will get some cramps after the second week due to lowering levels of calcium in the body. A colon cleanse before you sleep is recommended although I only took one every 3 nights since I couldn't stand the diarrhoea I get the next morning. L-carnithine supplements before you sleep because L-carnithine make the fats more available as fuel to your body. Be careful of supplements that have a lot of sugar in it because it will disrupt the diet.

10. I'm on the diet and I have the urge to cheat - can i cheat with 1 spoon?

No. Even 1 spoon is hazardous. I was preparing lasagna for a function in my office and I took 1/2 spoon of red sauce and 1/2 spoon of white to taste. The next day, my weight went up by 400gms, and the next day it went up another 300gms despite adhering to the diet, so I drank more water and went on strictly white protein and salad - and it went down 400gms, then subsequently another 500gms. I would have lost an extra 700gms or more if I did not taste the sauces. Another time was at a dinner and I ate extra angus steak, maybe 50gms more and my weight went up, stayed up for 2 days. It takes about 2-3 days after you cheated to get back on tract. So ask yourself. is it worth cheating?

11. With so much weight loss, wouldn't I sag?

The best thing about this diet is also the fact that you lose the fat, but the hormones keep your skin tight, so you do not sag.

This is a prescriptive diet and I would recommend those interested to come in for a proper consultation with me in my clinic. For those who find me to far, you can also visit my friend Dr Kuljit at Damansara Height Wellness Clinique - the guy who actually put me up to it. He also provide food for you during this diet.

For those interested, do call my clinic at 03-21440080 for a consultation.