Know Your Injector........

Fillers and BTA (botox/dysport) are still perhaps the bread and butter of medical aesthetics despite the emergence of new technologies and machines. It is a simple technique requiring injection of products into the skin layers/muscle to create a more appealing youthful look almost instantly. It is a very lucrative business too. Because of this, a lot of people try to learn to inject. Even if they have no medical background. Hence you will see that in certain places, beauticians or aestheticians as they call themselves injecting fillers and products into customers and so-called 'cheaper' price than doctors. (Really?)

What most people do not realize is that hypodermic needles and syringes are only licensed to be used by doctors in this country (and also most other countries as well). Even nurses or MAs are not licensed to use needles unless under the supervision of a doctor or in Emergency cases. I remembered this so well because during my practice in the government sectors, the nurses at that particular hospital refused to do any blood taking and kept quoting this rule in the nurse/MA handbook. Funnily, when you move to the private sector the nurses are all so willing to do injections, especially fillers and BTA.

The thing a lot of people do not get about doing injections to your face, although you can get really good results with minimal downtime, you can also have very bad results that would last you quite a bit and for some cases of those using semi permanent or permanent fillers it can be life long and would require surgery. A lot of people know this, but why do they still risk going to beauticians or other unqualified injectors to do their face? The most common reason is peer pressure, second would be cost and third would be some bad experience with an untrained doctor somewhere that made them lose confidence with professionals. Between fillers and BTA, fillers are worst because usually the beauticians use illegal products that lasts too long and has no reversal.

So for those who wish to indulge in injection rejuvenation, I will give you a few tips:

1. Know your injector - Are they a qualified injector i.e. a real doctor? (A lot of fake ones parading in my country). Are they really trained to do the injections? Not all doctors are trained to do aesthetic injections so they maybe a licensed doctor but may not have the skill. Going for 1 workshop does not quite cut it as being trained. Are you comfortable with the doctor? Has he/she answered all your queries and doubts? Will he/she be following you up? Will he/she be responsible for the work done if any problem arises? 

2. Know your product. What is it that the person is injecting into your face. Is it hyaluronic acid filler? Is it Radiesse or Aquamid? Is it collagen - if it is collagen - purely collagen/bovine/marine or porcine? A lot of the collagen fillers from beauticians are mixed with liquid silicons hence why it just does not disappear. Is the product safe? Just because the person says so, doesn't mean its safe. Ask for safety profile. Are you sure its the product claimed by the injector or did they take out another product from a different box for the injection. Google information about the brand.

3. Are the products sterile? The last thing you want is getting an infection under the skin from using products already contaminated. In my clinic, I open a new syringe in front of the patient to show its sterile. Infections due to contaminated fillers are a nightmare and may take weeks to heal. It would require high end antibiotics, dilution of filler or even excision. In some cases, we would be giving steroids to stop inflammation from the infection. It can cause you to have a mark or a scar from a so-called suppose to be very safe procedure.

4. Is the premise you are receiving an injection a proper medical facility with license? Beauty salons are not licensed to do injections, nor are hotel rooms, cars nor boutiques nor spas. So if it is not a clinic, better think twice because likely the hygiene of the place is not up to par and you cannot sue the person if anything went wrong since it is not in the right premise. You'll just be bombarded by the defense lawyer, stating that you agreed to be injected in the premise when you know its illegal.

5. Check the current market price for services before deciding on having it done to give you a rough idea of what is the normal range. Usually for promotions, the price of the service would not be discounted more than 30% in view the cost to acquire original products is expensive. If the clinic or center is giving too cheap a promotion, you should bear in mind a few things. Its either the product is expiring (already expired) or they've reduced the amount of filler/bta given but charged at a cheaper price. The end result would be unsatisfactory results or treatment not lasting what it should. And this would not only cause disappointment but also reduce confidence towards the treatment altogether.

Courtesy of http://www.plasticcelebritysurgery.com/2011/09/worst-celebrity-plastic-surgery-before.html

For more info you can email us at info@faceworks-clinic.com / faceworksclinic@gmail.com. For appointments, please call us at 03-21440080 or text 014-2233268.

Sweat Sweat here... sweat sweat there........

It has been a super hectic month. With Fashion Week started end of September in New York, so a lot of the boutiques were having their fall/winter collection show. Fashion is a personal interest even though I am not really a shopper. I love seeing the designs and colour themes that come out which are distinct from years before. 

The fall and winter collections are very interesting although perhaps not the best suited for Malaysia's climate. Malaysia so hot and humid, so it's almost impossible to wear tweed or fur or long coats. Besides, we do not have snow here. Its sunny year round. Because of this sort of hot humid weather..... the major problem everyone have is sweat. A quick stroll between shopping malls and you will start sweating. If the sun shines a little bit more, everyone will start sweating.

But some people sweat more than others due to hyperactive sweat glands. The term for this is hyperhidrosis. According to PubMed, "Hyperhidrosis is a medical condition in which a person sweats excessively and unpredictably. People with hyperhidrosis may sweat even when the temperature is cool or when they are at rest."

The causes can be primary or secondary to other medical illnesses. For primary hyperhidrosis, it is usually limited to a few areas of the body commonly arm pits, hands, face and back. It affects 2-4% of the world population and seem to run in families. It is a simple problem, but it can be pretty annoying to those who have it. Especially in social functions in a hot country like this, you'll be needing to bring a hanky and wear sleeveless. 

There is no permanent cure for this problem. Yes, some surgeons say you can do ETS (Endoscopic thoracic sympathectomy) but its like a double edge sword. Despite solving 85-90% of primary hyperhidrosis in palms, there is a compensatory sweating risk that occurs in 20-80% (Notice the wide range means that it is different for each individual). Not to mention the other risks which can be minimized in very careful hands but still, it is hard to say since you will be tampering with your sympathetic nerves. Plus, the procedure costs a bomb between RM 10-15K depending on center.

The over the counter aluminium chloride preparations to help inhibit sweating does work to a certain extent and is much more affordable. However, this is only for mild cases and the concentration of this compound has to be more to have a more visible effect. The common side effects would be skin irritation and later leads to darkening of the skin (note how using certain deodorants the armpit area becomes darkened?)

So the next modality of treatment that comes into my field of interest is the use of botulinum toxins (Botox/Dysport/BonTa) to help control symptoms. In the past, we learn about the use of botulinum toxins to relax muscles causing dynamic wrinkles. Then it extended to skin tightening, pore closure (yes, it can do these too if you are willing to fork out the cost) and now sweat glands. How did this came about? Well, it was observed during the early usage of BonTa on the forehead and the patient would complain of less acne or sweating. So, they studied it more and found that it does help to stop overproduction of sweat by sweat glands by making them inactive for a certain period of time. Usually, we will dilute the toxin more compared to what we use on the face as our aim is more for the sweat glands and so lower doses at a more distributed area is ideal. In fact, recently FDA of America has approved the usage for underarm sweating.

The procedure involves multiple superficial injections aiming at the subcutaneous of diluted botulinum toxin. The pain is tolerable although now with advancement of more potent pain relief, it can be minimized. It takes about an hour to complete since it involves a few things. There would be some local swelling, but usually subsides in a couple of hours. Results can be observed between 1-2 weeks after injection and lasts 4-9 months on average depending on how severe the hyperhidrosis was to begin with. Complications? Less sweating at the area of injection and dilution but for palms, there may be some muscle weakness of the palms. Cost wise - depending on the area and the technique used can be between RM 2-5K per session. Regardless, comfort is valuable and not being shy due to wet armpits and sweaty palms is makes a huge difference to your life.

For more inquires or appointments, please email to info@faceworksclinic.com or call the clinic at 03-21440080

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.