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.

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.

OMNILUX - LED therapy at its best.

It has been a very eventful week for me with so many things taking place at the same time and in the midst of excitement of the Malaysian 13th General Elections less than 2 weeks away. Everywhere you go, you can see flags from different parties being put up and billboards related to the coming election. Which is why perhaps, this new device that I have in my clinic would appeal to most people in this busy time.

Say Hello to the Omnilux. What is Omnilux?

The Omnilux is a Light Emitting Diode (LED) machine with a narrow band technology and has been patented since 1998 for dermatological conditions. It uses light modulation technology that promotes tissue and cell healing as opposed to Lasers which are mostly thermoablative. What it means is that the machine uses low energy light (LED) at certain wavelengths, help to stimulate and modulate tissue and cell healing as opposed to controlled tissue destruction as we see in Laser usage.

It came about by accident in 1996, when a British cancer researcher Dr Colin Whitehurst used a photodynamic lamp to activate photosensitive drugs on skin cancer patients, he also noticed that the surrounding skin around the skin cancer lesion was rejuvenated. Later from here, they started to experiment on different wavelengths and discovered different uses for it. As of today, the Omnilux has 7 FDA clearances and is used by over 3000 physicians worldwide. 

The current Omnilux has 3 different lamps which are labeled Omnilux Blue, Omnilux Revive and Omnilux Plus. Omnilux Blue is more for acne prone skin. It acts by killing P. acnes bacteria which is responsible for acne. The wavelength is 415 nm (+/- 5nm). The Omnilux Revive is aimed more for skin rejuvenation and has been found to boost collagen and elastin production. The wavelength is 633 nm (+/- 6nm) and it comes out bright red. The Omnilux Plus is an infra red beam targeted for deeper tissue hence promotes tissue rebuilding and healing. The wavelength is 830 nm (+/- 5 nm). Sometimes when you google, you will find another lamp called Omnilux PDT. Actually, that is the first lamp created for aesthetic use and non-melanoma skin cancers. Now they've replaced it with Revive. Newer products from Omnilux would be the hand held Omnilux Clear-U and New-U, which is not available in Malaysia yet.

The chart is a summary of the things the Omnilux can do. However, you have to be pretty realistic. A patient would require more than 1 treatment to achieve noticeable results. And the results do not come instantly but rather 3-6 weeks after treatment done. After scanning through the clinical papers, I would say 6-8 treatments would be recommended within a short interval of 3-5 days. Technically you can do this treatment daily due to non-invasive nature of treatment although whether any additional benefits seen is yet to be concluded. 

So far I've done 3 treatments on my face since the machine arrived. 2 times with the Revive, and once with Plus. The first treatment was done with just a Milk peel. We used Revive and the red light was blinding despite the goggles given. My skin felt warm as the red light hit the surface. It was not painful. The LED light placed so near to my face was actually cool. 20 minutes went by pretty fast despite the blinding red light. Post treatment, there was residue of warmth on my face and it looked more radiant probably from the heating of the tissue. 

The second treatment was initially for my back. I hosted a birthday party on Friday night and was dancing on killer heels for a good 3 hours. Of course my back hurts. There was mainly trapezius muscle strain. So we put on Plus and shined it 20 minutes on my back. Since I was bored in my clinic that day, after we finished I asked for iontophoresis vitamin C and shined Plus another 20 mins on my face. Plus is infra red light so we would not be able to see any of the LED beams. Instead they placed yellow diodes just to show that the machine is being turned on. Infrared beams are relatively harmless however poses a threat to the eye if concentrated and beamed on the same spot for 10 seconds or more. Hence why all the precautions that we take to cover the eyes. The Plus beam is less bright and produces less heat than Revive. It did however improve my back and the muscle appear less tender. I was even told that they use this lamp for race horses in Hong Kong to aid healing after race. As for face, I did not see much difference with my face except for the vitamin C application that made it glow in comparison to the Revive lamp which gave instant radiance probably due to more heating effect.

For the third session we used the Revive lamp again. Before putting on the lamp, I asked the girl to apply Intense White C serum via iontophoresis. No peeling was done since my face was just peeled recently. After this session I noticed a lot of difference. Pores appeared smaller, and my tone improved quite a bit. The next day, my skin was still good, pores were small plus it felt tighter. Can't wait for another 'tanning' session (it doesn't tan you at all actually). 

Omnilux is used for:

•          Minor Muscle and joint pain management e.g. Treatment of Sports Injuries

•          Non Melanoma Skin Cancer. Basal Cell Carcinoma (BCC) – Most common form of cancer in the United States (75% of all skin cancers). Basal cell carcinoma is normally a slow-growing form of skin cancer. In some rare cases, BCCs can multiply more rapidly and spread (metastasize) to other parts of the body.

•          Bowen’s disease is a very early form of skin cancer. In Bowen’s disease, the skin cancer is located only in the epidermis.

•          Actinic keratosis is caused by sun exposure. About 5% develop into skin cancer.

•          Wound Healing. The Omnilux has shown to accelerate wound healing, proven treatment for post laser ablation-(removal of unwanted tissue from the body), reduces pain, swelling and erythema. Skin Area Treatment Pre and Post Laser Resurfacing Moderate, Severe, Cystic Acne Treatment. Skin Rejuvenation and Combined Chemical Peel Protocols.

•          Periorbital Wrinkles Combined Treatment of: Chemical Peels with Photorejuvenation.

•          Anti- Inflammation Skin Area Treatment.

LASER VS OMNILUX     

Omnilux also :

• Plumps fine lines and wrinkles

• Smoothens skin texture

• Stimulates collagen and elastin production and firms skin

• Help heal sun damage, psoriasis, dermatitis and eczema

• Improves pigmentation and evens skin tone

• Calms rosacea

• Relieves headaches and minor muscle and joint pain

• Accelerates wound healing

• Reduces scarring

At the moment we are giving the Omnilux treatments at a very special price. Interested to try out this cool device. Call us today for an appointment at 03-21440080 or text to 014-2233268. Limited time only. For more enquiries, do email to info@faceworks-clinic.com / faceworksclinic@gmail.com .

Happy New Year 2013

Happy New Year Peeps... it's 2013 already. And this year my life has turned a serious 180 degrees from a super party queen to more of a soccer mum. Oh well, hence the late entry for the year. Yes, handling 2 school going children is a pretty major task and takes up a lot of my play time.

Still, this year Faceworks Clinic has a new direction and there are a lot of new things in stored for all our lovely patients and fans. It is also entering the 5th year of me holding the helm of this clinic, so we will definitely be having a big anniversary event at year end to celebrate this wonderful achievement. 

For the time being, let me give you a brief of all the new products we have decided to bring into the clinic.

This is just a brief review of what we will be carrying this year, the full review will be written up later:

1. Neostrata Skin Active Range

This range came out early last year and I have to say, it is one of my favourite. (Especially the cleanser). Its designed for more mature skin, to help exfoliate dead skin as well as rehydrate the epidermis. The eye cream helps reduces fine wrinkles around the eyes. However, for best results, you will need to continously use this product diligently and studies shown 87% improvement after 3 months. The price for a whole set is : RM 840/= which is affordable if you are comparing with high end cosmetic brands like Lancome, Shisheido and SKII.

2. Neostrata Enlighten Range

This is a new range just launched end of last year. I've been trying this out and I find that it helps to lighten out my PIH (post inflammatory hyperpigmentation) post acne in a span of 2 weeks. I was a bit sensitive to the pigment controller since it has retinol in it but otherwise, it is a good set for peiople who wants a brighter face and have pigmentation scar issues like me. The whole set costs only RM 475 and can last you up to a month and a half. 

3. Dermaceutic Home Care Range

Dermaceutic is a new range from UK which came about during early last year. The trend of physicians in Europe going away from lasers and concentrating more on peels have led to this. It has a variety range of peels but unfortunately in Malaysia, we are only allowed until the Spot Peel. Neverless, it does have a very good home care range which is more versatile to be used together or combined with other things. Each product is pretty affordable with prices starting from RM 150 onwards for a bottle that can last approximately 1-2 months. My personal favourite in this range is the turnover cream which I use at night before my serums if I feel my skin is not up to par. Love the silky feeling and evening out of skin tone in the morning.A must have for busy people like me.

4. Heliocare Sunblock Oral and Compact Powder

I admit. I am crazy about sunblock. The SPF 50 gel is my all time favourite but now I am also bringing in the compact and the oral sunblock (although actually it has been around for years). The compact is a cool kit for ladies since it has 2 tones, a fair and skin tone. So instead of carrying your compact powder around you can use this oil-free compact to touch up as well as get the sun protection you need. The oral sunblock is also a cool thing to have especially if you are planning on outdoor training or beach holidays. I was consuming this when I went to Legoland recently. It helps to reduce risk for sunburn and redness although it does not replace topical sunblock. The compact is selling at RM 120/= each and the oral sunblock is RM 180 per bottle of 60 tablets.

5. Instant Demake - Make-Up remover & Instant Calm Spray.

These are two new products that can come in handy. I love this make up remover because its really clean despite no water. I use it before doing fillers on patients hence reduces washing face time by half. Also if I partied hard the night before and have some left over mascara, it helps take them off. It comes in a big bottle of 250mls which is more than enough to last months. The instant calm spray is another cool item that helps to reduce redness almost instantly. I use this after extractions or procedures which causes redness. I've even used this to soothe skin irritation. It is made of natural products that you can actually drink it. The make up remover is going for RM 108/= 1 bottle and the instant calm is priced at RM 99/= each.

6. Phiderma Cerum, Retinol and Linurase

This is another range of products that I love. Cerum is vitamin C serum in small ampules. Each tub has 50 ampules which is for 50 applications. This eliminates spills, hassle of having to keep in the fridge, oxidation issues and it is very hygiene and easy to bring on travels. The revitalizing retinol complex is an alternative to people using retin-A creams. It is a lot softer but penetrates deep and helps control acne and other skin problems. Linurase contains alpha hexapeptide-8 that acts on the same area as botulinum toxin A to help reduce wrinkles. Single application lasts between 6-8 hours but daily usage continuously for 2 weeks or more shows significant reduction in line appearance. It is a good adjuct to people who have had botox/BonTA done to make the effects last longer or for those not keen for injecting the toxin into the body. The prices are RM300 for Cerum, RM 320 for Linurase, and RM 350 for Revitalizing Retinol Complex.

7. SRS Home care range

SRS is known for its mesotherapy range. However, it also has a cool home care range of serums for a lot of needs. I will be launching this range this coming weekend, so will write more on this later.

8. Dermclar Biological Homecare Range & Dermclar Liposome Range.

This is the latest product in the clinic which comes from Spain. Dermclar specializes in transdermal delivery of products which has enabled them to come up with this special range called virtual mesotherapy. Imagine having mesotherapy like results using products without having to endure the pain of multiple needle injections to the skin. At first I thought that they were kidding me, but after trying it myself, I am a believer. It tackles things like eye bags, skin tightness, double chin, cellulite, lifting and also wrinkles. I will be launching this product this weekend, so if you are interested to know more, just drop by the clinic between 2-5pm this Saturday where we will be having a talk and live demo on this product. Lucky draws and more goodies to be won during this event. We are also having a spring sale of product items up to 50% off.

For more info please contact us at faceworksclinic@gmail.com or call 03-21440080 / 014-2233268.

Radiofrequency Tightening - RF

I think a lot of us are aware about radiofrequency devices which are used for tightening and contouring. Beauticians and doctors alike are fascinated by the discovery of what these machines can actually do. However, in the past a lot of misconceptions have been translated to patients and customers by over promising results and also lack of understanding of what it actually does. 

So what is the science behind radiofrequency treatments? The idea of radiofrequnecy is tissue heating. We all believe that when our skin tissue is heated to temperatures between 40-45 degrees Celsius, the collagen remodelling cascade will start and correct the damaged collagen strings to give us tighter skin.Whether this is completely true or not, or how long should the heat be administered, there is no hard and fast rule, but most believe more than 1 minute. Histological cross sections of skin treated with heat does show a realignment of the collagen fibres and a better structure is formed but whether this applies to all machines that produces heat to the body, it is still unknown. As for fat reduction, most slimming centers would say that the radiofrequency will liquidify the fat due to the heat, but this is not true at all. Heat from the radiofrequency device, or whatever device that increases the tissue temperature merely increases vasodilatation of the small capillaries surrounding the fat cells hence allows more free fatty acids to enter the bloodstream and be used up by the body. What about the instant tightening and slimming effect? I guess the best explanation would be cell dehydration and shifting of fluids into other spaces. Also our elastin fibers recoil to the heat, thus giving a more tighter look.

After reading the technical details behind the technology, you would start wondering whether it would really work. From my observations and trying out many radiofrequency devices in the market, I do believe that they do give significant improvement, but it will be dependent on:

1. The machine as to how much energy does it really transmit to the body and how deep does it go.
2. The ability to achieve the temperature of  >41° and duration it can be sustained.
3. The technique of the user to achieve and overall tightening or slimming effect.
4. The frequency of treatments that shouldn't lapse too far apart from each other to get a cummulative effect. Once a week is ideal, and not more than 1X a month. Too frequent may run health risks instead.
5. The cooperation from the patient to also help maintain the effect via home products for tightening or good diet and exercise.

There are many radiofrequency devices in the market from the lux brand once like Thermage, to others like Relax-F, Accent-RF, Thermacell, etc. Some RF devices are used by beauticians in salons which gives pretty good results but temporary because the energy allowed in their machines are not as advanced as the ones sold to doctors. Yes, there are differences, that is why the price differs greatly as well.

In my clinic, I use a Relax-F and after experimenting on the machine a lot, I find that the best results can be achieved when the treatments are done on a weekly basis with a minimum of 4 sessions. Subsequently, the result can last as long as 6 months given a proper diet and exercise. Otherwise, a maintenance session once a month has proven to benefit the patient to have a better result. It is non-invasive, not painful and most patients say it feels like going for a hot-stone massage. It is also extremely good for post-partum ladies who have loose skin and water retention post pregnancy to tighten up their abs if they are not keen for tummy-tucks. 

Other benefits of Relax-F:

     * Skin tightening and rejuvenation

     * Improvement of scar appearance (also stretch marks)

     * post liposuction treatments for smoother skin 

     * Acne treatment

     * Long-lasting body contour

     * Cellulite reduction

Currently we are having radio-frequency promotions for tummy - kindly refer to Spring Promotions post at http://faceworksclinic.blogspot.com/2012/02/spring-promotions.html . For more info or appointment please contact us at 03-21440080 or info@faceworksclinic.com