Wednesday, February 24, 2016

What you should know about fillers......

It has been a while since I wrote anything about fillers. However, recently during one of my socializing events I was faced with a lot of questions regarding fillers and botox. There was a great confusion between the two, still, despite both being very separate and totally different entities in terms of chemical compound and function.



1. So what Are Fillers?

Fillers are substances you use to fill up areas of your face or body which has underwent volume depletion and is also used to reduce static lines. It can be from any substance like silicone gel, collagen, hyaluronic acid, calcium hydroxypatite, PLLA, PMMA or even biological fillers like heated PRP or fats. The most commonly used in a medical aesthetic practice are the hyaluronic acid fillers which are non-permanent and lasts between 6 months all the way to 24 months depending on how the cross-linking and molecular weight of the filler.

2. Are All Fillers the Same?

Definitely not. Different chemicals form different fillers. Therefore it is really important to know what type of fillers were used on your face. Some may not be reversible. Always ask your doctor what he or she is using. Not only it is good for you to know, but it also helps the subsequent treatments if you require any.

3. If I do not like the filler effect can I remove or change it?

Only Hyaluronic acid fillers can be diluted with hyaluronidase. The other fillers are almost impossible to remove without any surgical intervention. So make sure you know what you are putting under your skin.

4. How much does fillers usually cost?

Fillers are usually quoted by per syringe of usage. An original high-end filler product can cost anywhere from RM 1600-RM 3600 per syringe. Some other lesser brands cost between RM 800- RM 1500 per syringe depending on where it was made and specifications. Anything sold cheaper than that would either be non-original products or maybe expired fillers? Or sometimes the doctor is not so experienced that they give cheaper pricing to practice. Honestly, who would charge super cheap for well trained hands? The training itself requires a lot of money.

5. Does it hurt?

Honestly, any procedure involving needles would hurt to some extent, but depending on the type of filler, some fillers hurt more than the rest. It also depends on whether there is any lidocaine inside the filler that will reduce pain tremendously. Local numbing like creams can be used although it doesn't really make much difference physically (maybe psychologically) and local infusion of lidocaine does help to reduce pain effectively although very specific filler work would be impaired as there is already tissue distortion. You can discuss with your doctor pain management techniques that can make your experience much tolerable. So apparently, you do not need to suffer too much pain for beauty. If, in event the doctor injects and suddenly there is severe pain, please speak up and tell him or her. Severe pain might mean that an artery is being hit, or other crucial vessels, or even allergy to the filler.


 

6. What can fillers do for me?

I always tell my patients, imagine fillers are like cement or plasticine. You can create volume which is not there like nose, cheeks or chin. You can redefine areas of your face and make contours, you can even smoothen deep lines. You can redefine your lips to make it more prominent or replenish the younger look. You can put it at your tear trough areas and reduce the sagged eye look and make you look fresher. You can reduce appearance of scars and improve photo angles (if your doctor is really really good). 

7. If I use a good filler, will it guarantee a good effect on me?

A good filler is always recommended to get the best effect. However, the other more important component is the doctor. How good is he/she at creating the effect you want? A lot of people think that filler injecting is just about injecting, but actually it is not. The best filler injectors in the world can put fillers on to a persons face and make him or her look more attractive but at the same time make it look as natural as possible that to most people, it doesn't look like any fillers were done. (Until you compare the before picture).

8. So say that I am interested, how sure can I be safe to do the procedure?

For newbies and virgins, I usually tell them to stick to hyaluronic acid fillers for any work because at least if you do not like it, we can dissolve it or wait for the effect to go off. The other most important thing is how well the doctor is trained because not all doctors are trained to do fillers. In my years of training other doctors practical filler techniques, I notice that even the way a doctor holds the syringe is enough to tell me how experienced they are. It is not the same as blood taking or other hospital procedures. Furthermore, to train the hand to be steady enough to evacuate the product from the syringe equally is quite a task if you are not use to it. To create beautiful natural looking work requires an additional artistic eye to detail which not all doctors have. Furthermore, if any problems from the procedure were to arise, a trained aesthetic physician would know what to do. Beautician filler injectors are the worst because for 1, you do not know what are they really using (they have no access to original medical grade products), 2. They are not trained to understand surgical anatomy or deal with complications, 3rd, if you allow a beautician to inject you, you cannot take any action on to them if the job is not done well, as they are not regulated by law, and you would have committed the first offence of going to a non-professional. Furthermore, there is a science and mathematical equation when we put fillers on to a person's face that is being taught in our training so that you remain looking like a human (and not some weird alien from star trek or some other sci-fi movie).

If you have any more questions on fillers, feel free to contact us at drmmclinic@gmail.com or 03-21106608.







Monday, February 22, 2016

Mind your Allergies ........

A lot of people believe they have allergies. Its common to hear, Owh, I'm allergic to so and so and so. Thus, they avoid certain foods and things due to some experiences in the past. But how allergic are you really to the things that you believe you are? Hmmm.... Before we can answer that question. First of all, let's understand what allergies really are.



According to Wikipedia : Allergy or Allergies is defined as a damaging immune response by the body to a substance, especially pollen, fur, a particular food, or dust, to which it has become hypersensitive.

In medical terms, we describe allergies as an abnormal response of the immune system towards certain triggers termed allergens which can be anything from food, dust, mites, items in contact, heat cold et cetera, et cetera. For some reason, these allergens trigger a misguided immune response that causes physical symptoms on to a person that sometimes can be life threatening.
How I explain in to my patient is it basically like, you pinching someone and the person slaps you back. The trigger can be small, but the counter effects can be really extensive. There is a genetic link that causes allergies. Usually if a parent has an allergy, there is a 15% chance of the child having similar allergies. Some quote 30-60% chance if both parents have allergies. However, the environment still plays a major role in determining how bad your reaction would be.

The most common allergies are hay fever (which is all the seasonal flus and nasal related allergies), eczema (skin), allergic eyes (usually related to hay fever), hives (which are those wheals that form on your skin when exposed to allergen), asthma which is quite common in children and in severe cases anaphylaxis which involves severe allergic reaction that causes mucous membranes inflammation and may lead to breathing difficulties and death.

The trend of allergies seem to have increased over the years, and some believe it is due to the amount of processed diet that we are consuming daily. Certain chemicals in processed foods and colouring trigger an IgE response (immunoglobulin that reacts to allergens) thus making us more and more sensitive to certain allergens.



So how do we tackle this issue? The only way is to figure out which allergen is affecting us, and avoid it. Sounds simple? Well, not exactly. Like I always say to my patients, we do not live in a bubble. Everyday, we are exposed to pollution and the environment so there is always a chance to have an allergy. 
The mainstay of being healthy is to look after our gut. Even if you ask old Chinese traditional medicine people, or the indian Ayurvedics, they will always put a strong priority to gut health. And why is that so? In the recent years we have discovered that in adults 80% of our immune system is produced in the gut. So if the gut is not healthy, thus our immune system will not be healthy. And how do we keep the gut healthy? It all comes back to what we consume. Which is why I totally love the hair profiler epigenetics test, because it gives me an idea of how healthy a person's gut is.

But the hair profiler is just a screening device that is non-specific. So, what else can we do? In the past, we use to do skin prick Rass Test to test for allergens that may affect a person. It involves pricking the skin with the allergen and waiting for a reaction which is usually observed after a few days. However, some patients are not keen for this sort of testing that requires skin pricking and maybe uncomfortable. Luckily, with advancement of technology, we can just do a simple blood test to determine allergens. Based on which part of the world you live in, different allergens would be tested. 

In the Asean Panel we test 36 different allergens which are:

1. Total IgE               10. Milk                        19. Codfish                       28. Cladosporium
2. Latex                     11. Chocolate                20. Tuna                           29. Penicillium
3. Banana                  12.  Egg Yolk                21. Salmon                       30. Dog Dander
4. Orange                  13. Egg White               22. Mucor                         31. Cat Dander
5. Rice, White           14. Chicken                   23. Timothy Grass           32. Cockcroach
6. Wheat, Food         15. Beef                         24. Bermuda Grass          33. Housedust
7. Sesame Seed         16. Clam                        25. Alternaria                  34. Mite farinae
8. Soybean                17. Crab                         26. Aspergillus                35. Mite pteronyssinus
9. Peanut                   18. Shrimp                     27. Candida                     36. Blomia Tropicalis


Don't worry too much about the weird names, your doctor will be able to explain (hopefully) what they are. And all it takes is 5 mls of blood and 5 working days and you can get your allergy profile done. The cost for the test is around RM 600 together with consultation and the blood taking service. This is mainly for external allergens taht causes immune response. There is another test called food intolerance test which tests out around 100 different food substances but that is for a blog on another day.
Interested to do the allergy test or want to know more, feel free to contact us at drmmclinic@gmail.com or call 03-21106608.