Tried & Tested for this season..... Lalala......

It has been a very dramatic weekend in Malaysia as the 13th General elections took place and for the first time in history the turn up of voters were estimated around 10 million people which is the most so far. And most people were parading for change. So with the announcement of BN still remaining as the federal government, there were a lot of grouses and dissatisfaction from the voters. Especially since they are calling foul play as to be the reason for the current party to retain its victory. Despite the results are out, there is possibility of a rematch, or change in power in view the opposition leaders are determined to get justice. Many Malaysians wore black as a sign of protest as to how the election results were finalized, with many who were on duty confused as to how the amount written on the Form 14 and mutually agreed upon suddenly became a different number when announced by the election committee. Some were even more confused with the sudden black outs during the finalizing of vote counts, and TNB (the national electric company) claims they have nothing to do with it which made more people suspect foul play. Not to mention the appearances of ballot boxes that may have possibly fallen from the sky to side more on the ruling government. 

Since the election fever has not really subsided, I finally have some time to review some products that I have been trying out.

1. Rejuve TruWhite & Black Magic Whitening Soaps.

These are 2 whitening soaps from the same company. Black Magic has glutathione with papaya extract to help reduce inflammation. It is mainly for acne prone skin. Personally I haven't tried this one since I do not really have acne much except for the occasional hormonal spike break outs but based on what I gather from those who have tried, it does help to a certain extent especially for acne on the back and very oily skin on the face. I have been using TruWhite for the past month since I came back from Penang. It is a 100gm bar soap. Normally I am not a fan of bar soaps as the usual commercial ones give me break outs. Out of curiosity, I decided to give this a try. The soap has a very nice fragrance and on application makes the skin feel very clean. Its active ingredients are glutathione and sheep placenta extracts. It is slightly drying for those with dryer skin. After a week of using this soap, my skin does feel a little bit softer. In terms of whitening, I did notice an improvement of tan (I was really tan from Langkawi, Penang and Singapore). Fairer than I usually am? Perhaps not, but what could you expect from just a soap. Still, it does give me a softer feel, a more evener skin tone and it is very safe, even for children. Aina loves it. The retail price for this soap is roughly RM 35 +/- only, and is worth trying out. 

2. Age Defy Crystal Tomato

This is a new product in town which I found during my conference in Singapore. Crystal Tomato is a 100% vegetal extract from a special type of tomato grown in a controlled environment. The colourless caratenoid has been found to be a very potent skin whitening agent and through research and technology, they have managed to extract it into an oral form taken once daily. To make these tablets more effective, they have also included L-Cysteine which is a precursor for glutathione production in the liver to give you a more anti-oxidant effect.

Crystal Tomato™ has been scientifically proven to offer the following benefits:

1. Serves as a natural sunscreen against UVA and UVB rays to protect against UV damage, photo-oxidation and sunburn.
2. Acts as anti-oxidants to protect against free radical damage caused by environmental aggressors.
3. Contains anti-inflammatory properties against wounds and UV damage.
4. Inhibits melanin synthesis to prevent pigmentation spots from forming.
5. Reduces the melanin present in the cells including dark acne scars, freckles, dark underarms and age spots for an anti-ageing and anti-photo ageing effect.
6. Prevents DNA damage.
7. Promotes even skin tone and radiant complexion.
8. Protects and enhances the efficacy of other active ingredients and their activity.

Personally, I have been consuming this product religiously every morning and now entering my second week. The most striking difference I can see is the radiance that emits from my skin even without having to wear make-up. My skin tone seems to even out more, but pigmentations still remain. According to the literature study, it is suppose to help with pigmentation as well as it also affects the eumelanin pathway. I also notice that I do not tan as much as compared to before even without applying sunblock and this could be the sun protective effect that they mentioned about. But its only 2 weeks, I'll have to finish the box and write another review later with more explanation about the science. This product's retail price should be around RM 450 a box of 30 capsules, single tablet a day. The tablet is pretty big, but you can chew on it, it has a tomato taste actually. The product is still undergoing registration process in Malaysia. It is already registered in Singapore since last year. 

3. SRS e-Co2 Gel Mask

This is not a new product in the market. I have been using this mask on my patients for the past 4 years. as a rescue mask after doing procedures. One of the most significant case was a patient who was allergic to arbutin and developed redness and swelling over the face. She was allergic to a lot of other stuffs as well and her birthday was in 2 days. We tried the mask on her, and it help reduce the redness by 50% on the 1st application. I gave her another one to use at home and by the second day, only a slight redness that is concealable by make-up. Not only the redness disappeared, but her skin became softer and more radiant afterwards. So why does it work so well? Carbon dioxide has been known to cause blood vessels to dilate if present in a concentrated amount. When applied into the mask, the CO2 granules create a relative gradient of higher concentration of Co2, hence increases blood circulation to the area of application (usually face). It also increases local tissue metabolism and enhances the separation of oxygen from haemoglobin thus increasing tissue oxygenation. This in turn improves tissue healing and thus, the almost instant result. 

I tried out this mask last night after having a chemical peel and arbutin iontophoresis done to the face. It had a warm prickly sensation which was not uncomfortable. After the 30 minutes, we took it off and I can feel that my face felt tighter and my pores appeared smaller. Even pimples seem to have shrunk. Immediately, my skin felt very soft and smooth. Today when I woke up, my face still felt smooth and soft. The whitening effect of arbutin kicked in, hence my face did appear brighter so I can't really say it was an attribute of the mask. However, for the past couple of days, I noticed my face to be very oily when I wake up in the morning that I require Turnover to reduce the oil. This morning, my face was not  oily and I only washed it with water before sending my kids to school and chilling out in KLCC for breakfast. Even without any make up or sunblock my skin looked healthy. This mask is sold at RM 250 a piece if you would like to bring it home. If you like to try the effects yourself, you can opt for one of our rescue facials - I have taken the liberty to include this mask into some of our treatments since it has shown to be very effective.

Interested in any of the above products, feel free to contact us at  Faceworks Clinic : 03-21440080 / 014-2233236 or email your enquiries to faceworksclinic@gmail.com. For facials, please book prior appointment. Thanks.

Interesting gifts to help your loved ones.......

Today I've decided to write on something less serious and more entertaining. Having a lot of friends, family and meeting a lot of people, you tend to come across many personalities that sometimes does not appeal to your own positive self. There are just some people who are forever negative, and regardless of how you try to lighten things up, they seem to be able to dampen your spirits. 

Funnily, medical aesthetics does have a lot to do with psychology and maybe a bit of psychiatry. Apparently 60% of the world population are concerned on how they look and what other people perceive onto them. Especially since nowadays, looks play a very importance role in career and confidence. Which is why the cosmetic and beauty industry is one of the most fast growing industries in the world with a 16% increase revenue per annum despite recession. 

So, what can you suggest to your loved ones to make your life happier:

1. Glabella BTA 

In simpler tense, botox / dysport into your muscles that makes the nice 11 on your forehead (frown lines). This is extremely good for those depressing, whining, or stressed out relatives and friends who makes your sunny days go cloudy with their negativity. Apparently, studies have shown that people who are depressed / upset feel less upset when we freeze their glabellar muscles due to lack of frowning feedback from the forehead to the brain - hence the brain registers it as less stressed/depressed/upset thus equates to being happier. Its a simple 5 minute procedure which will cost roughly RM 600 / session (some cheaper services uses BTA from China/Korea) and will last the person between 3-6 months. It may be temporary but at least they stop complaining much for this period of time. How about that for price of peace?

2. Marrionette lines

Have you ever seen a puppet or a marrionette? Puppet shows were made popular in the UK before the invention of television. They would cut out a stage and create puppets or marrionettes on strings and move them around telling a story. One of the most popular puppet shows till today is the comedy Punch and Judy. Marrionette lines refer to lines extending from the edge of the lip to the border of the jaw, just like a puppet. Some people have these lines even when they are not frowning and it makes them look sad all the time. Depending on the severity of the line, it can be fixed with just using BTA to the Depressor Anguli Oris muscles to reduce the pull (only 2 injections at each side ~ RM 200/procedure) or in combination with hyaluronic acid (HA) fillers for a more complete fix. The good thing with fillers is that it lasts between 9-12 months or even longer, so your frowning buddy would look happier for at least a year. Although it may wrack up your wallet a bit (filler prices start as low as RM 1K - 2K for HA). This procedure only takes 15 minutes or less, so you can even drag your friend in during lunch time.

3. Lethargic looking and no luster skin.

Its one of those people who look tired all the time, no matter how much caffeine you pump into their body. Not to worry, perhaps all they need is a chemical peel to get rid of all the dead skin accumulated on their face. A lot of us do not realize but if you look tired most of the time and your skin lacks luster or shine, it could be because of the dead skin accumulation. When the horny layer of the epidermis has too much dead skin and is not exfoliated, it causes the surface to be bumpy, thus when light hits the skin, it does not reflect well and hence looks dull. A simple solution is to try out our Clear & Bright Facial which not only peels off all the dead skin but we also infuse vitamins to your skin to give it a nice radiant glow. The facial takes approximately 20 minutes with no downtime, so you would need not worry about hiding your face for a day. Sunblock is advised due to the peeling process that happens in clinic. Usually this facial would set you back by RM 500/session, but do call our clinic for any special promotions going on.

4. Panda Eyes

Some people look so tired and lethargic because of their panda eye look. Some panda eyes look so bad, you start wondering whether they are on drugs or why they are not sleeping. There are many causes of panda eyes, some being hereditary pigmentation, some being vein congestion. A quick and simple fix that we can do for you is doing a chemical peel and then infusing some bleaching agents at the area, to reduce the pigmented look. Subsequently, we would recommend eye creams/ ampules to help strengthen the skin to reduce the appearance more. As us today about this new treatment.

5. Sagging Sad Face

Some people have sagging skin that makes them look worn out and sad most of the time. A simple Relax-F facial will be tightening up skin in no time. Even after the first session, there is a mark improvement and after a few more, the skin will appear tighter than ever. The best part about this facial is that it is painless, takes approximately 30 minutes and no downtime, and results can last up to a month even with 1 session. For a more lasting and faster effect, you can combine this with our liposome face-neck-low neck ampules. With DMAE as a powerful skin tightener, the sagging face will be no more in no time. Hence, gone is the need for facelift or threads which are more invasive.

Here are but a few gift ideas for your loved ones. Email us for more solutions to day to day problems.

For more info please call 03-21440080 / 014-2233268 or email to info@faceworks-clinic.com

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

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

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

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

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

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

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

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

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

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

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

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

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

What's up with Vitamin C?

I have been asked about this question a couple of times, so I've decided to write about it in my blog. A lot of people wanted to know whether Vitamin C actually works.

After going through a few papers and a few professional opinions, this is what I have managed to gather:

Benefits of Vitamin C

1. Reduces fine wrinkles around eyes and mouth.
2. Improve skin hydration.
3. Improve pigmentation appearance and age spots.
4. Improves wound healing through fibroblast stimulation nad migration.
5. Increases capacity of fibroblasts to repair potentially mutagenic DNA lesions.
6. Prevents scurvy.
7. Potent anti-oxidant that protects skin from UVA oxygen radicals.

However bear in mind that:

1. Ascorbic acid or vitamin C is pretty unstable and oxidizes easier when exposed to air.

Because of this, most vitamin C preparations have a pretty short shelf life and usually will change colour after a few months if stabilizing agents are not added in. An oxidized form of vitamin C is sometimes more harmful to skin and may cause sensitivity. An easy tip to keep it stabilize is to keep the bottle sealed tight, away from sunlight and chilled in the fridge.

2. Vitamin C is a water soluble vitamin whereas the skin is protected by water by our keratinized layer.

Because of this, you need to be very careful when selecting vitamin C creams or gels to ensure that absorption can occur. Look for products which are lipophilic as it will absorb better into the deeper layers of the skin.

3. Topical Vitamin C has shown to have more benefits towards skin health compared to other methods, although oral vitamin C of 1000 mg daily is sufficient to maintain good health and good skin. Never exceed 2000mg daily as this will lead to vitamin C toxicity which gives you an orange discolouration of the skin, and some have reported renal side effects.

So what would I recommend for a good topical vitamin C?

Obagi has just launched its new range of Vitamin C + Hydroquinone 4% for whitening effect. So far I have been using this serum for the past 1 month and have noticed a significant increase in radiance. Recently, they launched another product which replaces the hydroquinone with Arbutin instead, thus making long term usage possible. Although I do admit these serum are not exactly cheap, but one bottle would last you a good 3 months with the benefits of vitamin C and enhanced whitening. There are also topical vitamin C ranges from 5%-20% for those who are looking for only vitamin C.

For more information, contact us at info@faceworksclinic.com or call 03-21440080.