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.

Happy New Year... 2014

Its the start of a new year. Time flies ever so fast. Reminiscing back to the earlier days of running the clinic, how much things have changed. Now, my skills are more than grown, I have started to train other doctors for most of the filler and botulinum toxin techniques. I have a good team, with a strong manager to help manage most of the clinic day to day dealings. We've established the appointment only concept that not only allows you to plan for your appointment, but for us to make the best of your time. My foreign patients love this concept, the locals are still trying to get use to it.

We've made a lot of new allies for this year, and new projects are unveiling. We may have dropped a few, but the aim is to move forward, hence we need to focus on the positives. We have good and loyal patients, we have a lot of new ones too. With the new regulations hopefully Malaysia will be able to compete with its neighbouring countries in terms of Medical Aesthetics more proactively and provide overall great service and good reputation.

Unfortunately, there are still a lot of people who fall prey to beauticians doing injections etc, providing so called professional exclusive services. An overall price comparison, their prices compared to doctor prices are pretty much similar with perhaps a few hundred difference. I have been consulting patients whom have had beautician work done on their face and overall most of them are not happy with the work, but the worst part is you can't remove it, unless of course surgically. And most surgeons would charge a bomb for having to clean up someone else's mess, plus the complications that may arise from the surgery.

So for the start of this new year, I would like to give a take home message to all my readers who may consider improving their looks for this year.

5 Reasons Why You Shouldn't Let Anyone Else But A Trained Dr Poke A Needle to Your Face

1. The Face is the first thing a person notices when they look at you. Getting fillers or BTA from an untrained hand may make you look weird / disproportionate / abnormal. Every trained medical aesthetic practitioner goes through measurement training and ratio training that allows them to make an educated assessment of your face's needs and amount required. Beauticians only inject base on what they think is pretty but not based on scientific guidelines. What may be pretty to them may not be pretty to anyone else.

2. Beauticians are not taught surgical anatomy. Yes, they may argue, they have anatomy syllabus in their courses but it is very non-specific and mostly related to massage techniques. Even doctors who are not trained in medical aesthetics have issues with face anatomy (I conduct training, I know) and most only know basic. You need a really in depth knowledge of the anatomy of the structures of your face before you can safely poke a needle in it. There are many areas which you cannot inject or even if you did required high level of care. There are reported cases of skin necrosis, granulomas, etc with filler injections even with the most trained hands, what else an untrained hand? And what more a non-medical personnel who doesn't even have the basic.

3. The collagen that beauticians keep saying they are injecting are not 100% collagen. The source is questionable, most are taken from China since its super cheap there and unlikely to be sterile. For those with religious preferences, most collagen for fillers are bovine (cow) or porcine (pig) in origin. We will never use marine sources because of very high allergy rates in humans. Sometimes, they even use human collagen (which I have no idea how they extract). Another issue is that most of the time, liquid silicone is included in the concoction to give it better volume for less usage and for the effect to stay longer (rather permanent). My simplest advice would be to be inquisitive about the product you use - see the packaging, make sure the box and the filler is the same thing, make sure it is sterile, and make sure you can actually read the label on the box.

4. Any break in the skin allows bacteria and viruses to come in and cause a local infection. Doctors are drilled with need for sterility for all procedures even before they graduate. Beauticians and other non-medical injectors are not trained towards sterility. How sure are you that the needle they use has not been used before, how sure are you that their swabs are not expired? What about communicable diseases? How healthy is your injector? You have no idea about their own medical background. Furthermore, if a doctor's procedure gets infected, the doctor can treat and prescribe antibiotics, what can your beautician do besides ask you to seek help from a doctor?

5. Beauticians charge cheaper? On contrary, you may be paying so much more for what they are worth. Most beauticians will charge 5-10 fold of their cost price, whilst most doctors would charge base on the market price for a certain product and their experience. I had one patient who went to a beautician for a nose filler and was charged RM 15K. Luckily she only paid half, but with the amount of money, I told her she could have gotten a proper rhinoplasty done. She was unhappy with the filler work which made her nose look so big that she was depressed. Then she had to spend another RM 6K to remove it from a surgeon and a few more $$ for a proper rhinoplasty. Altogether, she spent almost RM 50K for something that she could have saved if she had consulted a proper doctor to begin with.

The medical aesthetic industry is a very lucrative industry which most Malaysians are starting to realise nowadays. Hence many people will try to grab the opportunity to be in this industry. Its not a bad thing, but personally I feel that you should only sell a skill that you possess and able to handle inclusive of the consultation and complications. Although the government has imposed certain regulations on Medical Aesthetics and Beauticians, however, enforcement in Malaysia is very poor. Because of this, as a consumer, it is your own responsibility to make an informed educated decision when deciding on any procedure. Remember, all medical aesthetic procedures are elective - take your time to do your own research and sleep on it before deciding. If you are not comfortable with the injector, just walk away. Its your face anyway. Hesitation is better than regret.

Happy New Year Peeps!! Look out for more interesting blog entries for this year.

For more information or to contact us directly please call the clinic at 03-21440080 / 014-2233268 or email to us at faceworksclinic@gmail.com. 

Caviarlieri - Supplements for vitality.

A lot of people ask me about stem cells and placenta supplements and whether it is worth taking. I think that the word 'stem cells' has been overly used that it confuses a lot of people including doctors. According to wikipedia:

'Stem cells are biological cells found in all multicellular organisms, that can divide (through mitosis) and differentiate into diverse specialized cell types and can self-renew to produce more stem cells. In mammals, there are two broad types of stem cells: embryonic stem cells, which are isolated from the inner cell mass of blastocysts, and adult stem cells, which are found in various tissues. In adult organisms, stem cells and progenitor cells act as a repair system for the body, replenishing adult tissues. In a developing embryo, stem cells can differentiate into all the specialized cells, but also maintain the normal turnover of regenerative organs, such as blood, skin, or intestinal tissues.'

Oral supplements which claim to be stem cells are not stem cells but are rather supplements. But depending on the bioavailability of the supplements to the body and the concentrations, thus will give varying effects despite the component being the same. Which is why I am very skeptical about the efficacy of supplements claiming to be stem cells.

I was approached by Caviarlierli's people 3 months ago during the start of the fasting month. Caviarlieri is a new type of supplement which contains DNA from marine source i.e. expensive caviar from sturgeon fish and collagen from salmon and the sturgeon. Produced from perhaps the only lab with the recognized technology for extraction of DNA and creation of high quality stem cells in Switzerland, it comes in an interesting box sealed neatly. The accreditations were printed on the box, with a Halal certification from Singapore. Still being skeptical, I asked for the internal clinical studies done on the product and the results from the studies were promising. Prior to this, most stem cells were derived from either human or animal source, mainly from the placenta or the yolk cells. Despite its benefit, a lot of questions arise on the products as whether they contain any hormones since there are some results suggesting it does although there were no statements from the producing companies. Another issue was for Muslims and people who do not take red meat, some feel that it is not okay to consume or take placenta supplements due to beliefs.

The only downside of this product is that because it is made out of fish collagen, people allergic to fish is an absolute contraindication. In US, 2.4% of the whole population is allergic to seafood in general. In Malaysia, there is no statistics on allergies published but I believe it would be somewhere around 1% at least.

I'm already at my 3rd box and I would say that it would be a really good supplement if you can afford it. (Yes, the price is pretty expensive approximately USD$400/box). Certain changes I noticed after starting on the supplements:

• Initial 1st week I was so sleepy and slept more but after the 5th day, the sleepiness disappeared and I found that I was pretty hyper.
• I had more energy in the morning and I was able to sleep late and wake up the next day fresh.
• I slept better at night with less waking up.
• My appetite improved, and I found that the 1st month I think I gained a few pounds, but subsequently the weight reduced.
• After the 1st box, people started to notice my skin appears to glow, and it feels softer. My girls were the first to tell me.
• I also noticed my hair growing more and faster. I use to have thinning hair on my head, but after 2 weeks my hair felt heavier. Even my eyebrows grew faster. Initially I thought I was just imagining things but after a visit to my hairdresser, he reconfirmed that I had better volume.
• I noticed after 1 month, my nasolabial lines have improved without using fillers, Radiofrequency or BTA.
• The appearance of my cellulite has also improved dramatically without any procedures done at the area.
• I have less sinus problems. I recover from illness pretty fast compared to when I wasn't on it.
• I have less PMS symptoms and although initially my menses was delayed for a week. Subsequently it remained the same.
• It elevates your mood so that you feel less stressed and happier.
• What it doesn't do is avoid you from getting illnesses, so you can still fall sick. If you have PIH or post-inflammatory pigmentation like me, it still remains but maybe lightens faster. You may have a lighter skin tone, but don't expect to be extremely fair.

The listed benefits of Caviarlieri are as follows:

• Reversing the degeneration of aging and age-related conditions like arthritis, chronic fatigue, asthma, degenerative brain disease and osteoporosis.
• Strengthening the body's immune system.
• Substantially increases energy and stamina.
• Increases sexual desire and performance.
• Increases sexual satisfaction and elevates mood.
• Delaying premenopausal symptoms and delays menopause.
• Improvement of mental concentration and alertness.
• Substantial reduction in joint pains.
• Lowers glycemic index and thus leading to weight loss.
• Visible increase in radiance and glow of skin.
• Reduces appearance of lines and wrinkles significantly.
• Prevents macular degeneration.

For more info about this product you can visit http://www.swisscaviarlieri.com

I would recommend this supplement to anyone who can afford it, ideally those with chronic diseases like diabetes and hypertension to help control the disease better. The ideal is to take continuously but for those who wants to try, at least 3 months for best results.

For more information please contact Faceworks Clinic  at 03-21440080 or email to info@faceworksclinic.com