Thermage - To do or not to do?

Doing freelance without an office has really made my life go upside down trying to keep up with the stuff I have to do. Recently I have just been appointed as a consultant and module writer for a Basic Aesthetic Course for supporting staff under Open University Malaysia. Its a tedious job, but I feel honoured to be given the chance to contribute to the younger generation. So on and off, I see some of my aesthetic patients in Gleneagles. Its not really the Shangri-La, but for the time being, it will do to keep the service running. Perhaps the coolest thing there is my Consultant owns a Thermage that he barely uses, so he's allowed me to use it instead. Yay.

So what is Thermage?

Thermage is a machine created for skin tightening. Using radiofrequency technology, it generates a controlled heat at the end of the tip to allow equal heating of the dermis. Studies have shown that controlled thermal injury to the skin leads to collagen remodelling subsequently which takes between 4-12 weeks depending on extent of stimulation. Thermage technology has been around for more than a decade with constant improvements to the machine. So far it is still one of the best technologies for skin tightening that is able to deliver results with just 1 treatment. Other radiofrequency devices usually require 4 or more treatments for similar effects. I have been studying this technology since I started Starhill and it has been impressive.

Areas of treatment

The Thermage was initially created for face tightening with focus on to the eye area to delay need for eye lid surgery. As we age, the skin becomes lax and starts to droop. Some physicians use botox to keep the lid up, but even botox requires a good skin elasticity to allow the effect to occur. Thermage made its name as the first non-surgical device to give eye lid tightening. And the results are pretty much impressive.

Other indications would be face tightening, jaw line definition, neck and body. But as all other aesthetic procedures, results will vary based on individual and also the doctor who conducts the treatment. 

Pain Concerns

Yes, I admit many people claim Thermage is painful. Personally, I would give it a rating of 9/10 for pain for the older generations. The newer ones i.e. the CPT with built in vibrator functions drops the pain score to around 7/10 without any topical anaesthesia. Although some may argue that topical anaesthesia is a placebo effect, all my patients admit it is less painful on areas with local and areas without. I can also offer some Ultracet prior to the procedure to make it more comfortable. Other factors influencing pain is the steadiness of the hand doing the procedure, the speed and the area that is being done. In a well trained practitioner, the pain felt is negligible and confined to perhaps at most 1 hour after the procedure.

Downtime

The coolest thing about this treatment, there is no social downtime. Yeah, there maybe some redness up to 1 hour after the procedure, or maybe slight oedema swelling the next day, but its still concealable and does not look so obvious. 

The Cost

Well this is the real pincher. The cost for 1 treatment properly done at 900 shots is between RM 10- RM 12K locally. Yes, I said it, it costs a bomb. But the justification for this is that you only need 1 treatment done properly and the results will last you between 6 months to 2 years, depending on the severity of your problem. But look at it this way, 1 treatment for 10K spread over 12 months, it's only RM 833 spent a month compared to other tightening treatments for example Gentle-YAG (Yes, you can use this machine for tightening) RM 1200 per session X 4 weekly during the initial stage, then monthly X 3 and then probably repeat after 6 months (RM 9600 over 8 visits per annum) or other medical tightening devices whose selling price is usually approximately RM 800/session but you will need around 10-16 sessions to get close to the tightening effects of thermage. When you add up the transport and time costs, sometimes it could be more. And let's not even mention the beauty salon grade RFs - Yes, they look nice immediately but you will not have any lasting effects because of the Joules limitation on their machines. In order to start the collagen remodelling cascade, the dermis and up to 20mm into the subcutaneous tissue needs to be heated up to the range of 42-55 degrees. 

What to Expect?

Initially you will see instant tightening of the skin due to dehydration of the cells from the heat and you may appear a little bit flushed. The results may be good or average on the first day with subsequently there may be mild oedema lasting up to 3 days. After 2 weeks you will start to notice improvement in skin texture. The pores start to appear smaller and many say they feel the skin softer. The initial tightening effect will start after the first month with the best results seen after 3 months, so be sure to keep a photo to compare. Sometimes, the changes appear subtle, sometimes very marked. Depending on your initial skin condition, if your skin is still supple, effects can last up to 2 years. If you are very sagged, lax or you are targeting shaping a fleshy face, you may need to repeat every 6 months to achieve the desired results.

Results?

Here are the few results obtain from a good treatment.

Pretty amazing results huh? For more information or to enquire treatments, contact us via email at faceworksclinic@gmail.com or call us at 014-2233268. Please be reminded that we are no longer in Starhill so please contact us before dropping by. Thermage is available in Gleneagles for a limited time only so do contact us early to avoid disappointments.

Medical Aesthetics for age groups......

I went to Penang two weeks ago and enjoyed beautiful sun rises and sunsets on the beach, despite some haze but the ambiance was wonderful. The only thing was the lack of internet access in my room which made it less convenient to update my blog. Still, I did get nice writing ideas which I would like to share.

Today's entry is about medical aesthetic procedures for age based groups. It is just a simple suggestion of things you can get done based on your age to improve how you look. As I always tell my patients, it is always better to do something than nothing because by doing something, there will be some change in your end result. I would also include a rough budget of how much the procedures will pinch you just as a guide.

Early 20s (18-25)

Usually at this age group, you will not have much aging issues. However, acne control and skin tone problems are very common because in this age group, you will still have some hormonal imbalance and is more active outside. Acne treatments would include chemical peeling, extractions, hormone pills or even retinoid A to clean up the skin and control sebum production. The usual skincare would range from acidic wash to exfoliators and gel based products to cope with the active sebum productions. You need to treat acne, because if you don't, you may end up with scars. Medically, we do have oral medications to help control sebum and a change of habits is usually advised. Smoking, late nights, low personal hygiene, stress and food selection does influence worsening of acne. Treatment for acne will depend on severity. Usually doctors would charge between RM 200-RM 1000 per treatment depending on what is involved in the treatment. Skin care can range between RM 300-RM 1000 for a full range depending on brand. Some doctors will use IPL or long pulse lasers to reduce sebum production and reduce P. agnes bacteria that is abundant in acne prone skin. To even out skin tone, I normally would recommend regular skin peeling and religious use of sunblock. Laser peels are also an option but if you have acne issues, there is a high chance of acne breakouts post procedure due to heat stress.

Besides acne and skin tone, this would be a good age to fix asymmetry of the face or to augment. The skin is young, hence fillers will sit in better. But because of the young age, I normally would only recommend doing hyaluronic acid fillers (Juvederm, Teosyal, Restylane) which are non permanent because it is easier to change the look when you've decided and because as you age, a lot of your face fat pads disappear so putting a permanent structure there may look awkward after a couple of years. For face shaping, you can slim down your face with a simple injection of botulinum toxin A (Botox/Dysport). You can read more about this in my previous entry on face shaping. (http://faceworksclinic.blogspot.com/2012/03/face-shaping-it-only-takes-5-minutes.html) Filler prices would range between RM 1400 - RM 2000 per syringe depending on type and how long the filler lasts. 

Late 20s- 30s (26-35)

This is usually when a person is most prime in their life. Biologically for most people, the hormones have settled and you start losing the baby face and your face becomes more defined. The early signs of aging start appearing such as wrinkles on your forehead, frown lines, crows feet and some loss of volume especially at the malar area. (cheeks) Pigmentation problems start occurring and the skin texture becomes drier. Botulinum toxin A can help with dynamic wrinkles. Fillers can help with the slight loss of volume and also to define the face to make it more attractive. Regular peeling can help with the skin texture but a definite skin care range change need to be considered. For pigmentation, using hydroquinone will help to reduce the pigmentation substantially but requires constant use. Lasers can help to reduce pigmentation and improve the skin texture but if proper sunblock used religiously is not applied, there is a high recurrence rate and may even worsen the pigmentation. This is also the point where I would normally suggest to add serum vitamin C into the skin regime as a maintenance and preventive program to help with texture and pigments. Supplements and vitamins are also important at this point to keep the skin glowing healthy. 

Another issue would be the body contour change, where most people find that certain areas are not as attractive as before. For this, I would recommend body contouring programs using medical grade radiofrequency machines (http://faceworksclinic.blogspot.com/2012/02/radiofrequency-tightening-rf.html) , or other medical grade body contouring machines to help. For some people, they prefer mesotherapy injections to reduce fats n certain parts but this requires recurrent treatment of specific area and so may add up to be costly. Regular exercise helps, and target specific exercises are more warranted.

Late 30s to 40s (36- 45 years old)

Most people are more stable at this age but due to the aging process, coupled with stress of work and family and other responsibilities can cause you to look older than you really are. For the face, At this age, most people would start complaining of more pronounced wrinkles on the forehead, frown lines and crows feet. There would be a more marked loss of volume in the malar and lower face, especially around the mouth and the folds by the side of the nose looks more prominent. The skin texture is still good, but pigmentation is more seen if nothing has been done before. Sagging of the cheeks is felt, although not extremely obvious and causes a lot of concerns in some people. Fillers and botulinum toxin A are a good investment for non-invasive treatment to treat lines, wrinkles and volume loss. Some would consider lip fillers because the upper lip has started to thin out more and you lose that youthful look. (Check out http://faceworksclinic.blogspot.com/2012/05/sexy-lips-in-15-minutes.html) Regular chemical peeling and face tightening with radiofrequency devices or lasers would help improve overall skin texture and turgor. At this point, you should also consider having a retin-A or derivatives cream supplement to the face to help with fine wrinkles. 

For the body, you can still opt for body contouring and tightening programs but the expectations should be more realistic. There will be improvement although subtle, and you may need to consider options of skin lifts and fat grafts to get a more marked improvement. Weight control can be achieved by modifying the diet and exercise and I do suggest most everybody above 36 with BMI more than 25 to go on HCG diet (http://faceworksclinic.blogspot.com/2012/03/hcg-diet-my-experience.html) to not only lose the excess weight and reduce body fat percentage but also to retrain yourself to a much more healthy diet and lifestyle. If done properly, you will be able to maintain your weight and enjoy a better life. It also helps increase personal health consciousness as only organic and non-processed meats are allowed during the diet.

After 46 (46 to 65 or more)

At this age, the skin texture is more wrinkled and you will need more moisturizers to help maintain suppleness. Laser resurfacing treatments are a good investment as it helps to improve your skin texture and tightens it as well. Radiofrequency device tightening of the face is another method to help improve sagginess. At this point, fillers are used for volumnization, and a lot of fillers would be needed to have a good effect. (At least 3 syringes per sitting usually). Semi permanent fillers (Aquamid) can be considered for structures like lips and cheek. Mesotherapy treatment with PRPs (http://faceworksclinic.blogspot.com/2011_02_01_archive.html) or non-cross link hyaluronic acid fillers (Dermaqueen, Restylane Vital, Juverderm Hydrate, Teosyal Redensity) is also an option to increase hydration of the dermis layer. Skin peeling is still a good way to maintain the skin. Surgical options would be fat graft to the face and face lifts. Vitamin E  and hyaluronic acid topical creams can help maintain hydration as dryness is always a problem. 

After 46, a lot of our natural hormones start to decline. Because of this, we will have vague tired symptoms that we cannot explain. Another thing that you should consider is to undergo anti-aging consultation and the use of bioidentical hormones to help supplement the decline of hormones. The blood test are expensive (a complete test would cost around +/- RM 1000). The hormone supplements are in cream form. Please be sure to go to a proper anti-aging doctor (trained) because not all doctors are trained properly.

This is just a rough guide of procedures you can do at the certain age. However, the current environment pollution, poor diet and nutrition, work stress and health problems can always make you look aged more than you really are. A proper consultation can help give you a good idea of the possible intervention to help make you maintain a healthy and youthful you. But one thing for sure, you need to start taking care of yourself early, to stay younger longer.

Any enquiries please email to info@faceworksclinic.com or call 03-21440080 and book an appointment to see me.