Nose-shaping (Fillers vs. Threads)

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We live in an extremely visual society where many impressions are made on first glances of our faces.  Among the most prominent and immediately distinctive feature on our faces is our nose.  Hence, much has been made about what an ideal nose should look like.  The idea of a perfect nose exists but is age, gender and culturally specific.  A woman’s ‘ideal’ nose has generally been defined as one with a bridge that is high, straight and narrow with a turned up tip whereas a man’s nose should ideally project confidence, balanced with the chin and profile.  The truth is, the ideal nose differs for each person but the idea of harmony with the rest of the face is most important i.e.  the nose should flow gracefully with pleasing lines and contours.  In general, a higher nose bridge does create the illusion of a slimmer face and enhances other facial features.

Most of us are satisfied with our existing noses.  However, some of us continue to strive to correct certain deficiencies as we view them, to achieve the look that we’ve always desired.  Rhinoplasty was amongst the first aesthetic surgeries performed and continues to be popular.  Nonetheless, we now live in a time where there are effective, safer and less invasive options to nose augmentation with less downtime.  The two most popular methods on the market currently are: nose fillers and Korean nose threadlifts.

This article serves to explain the two procedures, how they differ and hopefully, help you decide which is more suitable for you.

Nose Filler

This is typically a hyaluronic acid injection which when done appropriately can augment the nose bridge effectively.

This is done under a local anaesthetic and takes about 15 minutes.  The results are immediately visible i.e. a higher nose bridge.  It continues to improve over 1-2 weeks after which a review with your doctor will be arranged.

 

Possible side effects:

A nose filler injection is typically safe other than the initial redness and mild discomfort at the injection site.  This normally resolves quickly and you can resume daily activities almost immediately.  Occasionally bruising may ensue but this is also temporary.  Certain complications have been associated with nose filler injections and these include infection and vascular complications.  This is exceedingly rare and will be discussed with you again prior to the procedure.

How long does it last:

A nose filler typically lasts for about 1-2 years after which the nose contour typically reverts back to its original appearance.  The injection can then be repeated.

Korean Nose Threadlift

Korean nose threadlift, when used alone or in combination with nose filler, is able to lift your nose bridge and nose tip, making your nose look sharper and higher.

Our Korean nose threadlift utilises advanced PDO (polydioxanone) 3-dimensionally barbed threads which are placed under the skin to improve the contour of the nose i.e. elevate the nose bridge and/or tip.  They also stimulate collagen formation to lift and support the desired contour.

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This treatment is done under local anaesthesia and requires about 15-30 minutes.  The number of threads required will be determined by the attending doctor based on the existing shape of the nose.  The results are immediately visible and trained doctors and staff will also advise you accordingly about the post-treatment dos and don’ts.

Possible side effects:

The Korean nose threadlift is a procedure with a very good safety profile.  The procedure itself is done under strict sterile conditions to minimise any risk of infection.  The placement of the threads is normally done in such a way that no scars will be visible.  As with fillers, some discomfort, redness and bruising may occur immediately after the procedure but this is temporary.  Korean threadlifts, however, are not associated with any of the previously mentioned vascular complications that can rarely occur with fillers.

How long does it last?

The embedded threads normally completely dissolves after about 6 months but the collagen that forms during that time will help to support the new shape of the nose for a much longer period.  Therefore, Korean nose threadlift normally lasts for 1 to 1.5 years.

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Should I get a filler or a threadlift

To highlight some of the similarities and differences between nose filler injection and Korean nose threadlift:

  • Threadlifts are able to achieve a higher nose tip, which is more difficult to achieve with nose filler injections
  • Threadlifts are not associated with some of the rare, but serious vascular complications that can be associated with filler injections
  • Threadlifts do not spread out to broaden the nose which can occur with nose filler injections
  • Both can give excellent improvement in the nose contour when done properly
  • Both treatments have good longevity and can be repeated when the effects start to wane

In actual fact, nose fillers and threadlifts need not necessarily be done in isolation.  The effects can be combined to give a more dramatic, longer lasting result.  Consult an experienced physician who will be more than happy to advise you further on how you can attain the nose contour that you’ve always wanted.

Korean Threadlifts (V-shaping)

As mentioned in my previous post on ageing and sagging, there are different modalities of treatment for sagging and loose skin.  Amongst the latest and most sought after treatments nowadays is Korean Threadlifting which is recognised as a minimally invasive procedure.  This procedure is suitable for:

  1. People with sagging/loose facial tissue but are not keen for surgical face lifts
  2. People with pronounced jowls/cheeks/lower faces leading to poor definition and broadness in their lower face

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How does Korean Threadlifting work

Korean threadlifting works by the careful insertion of dissolvable barbed threads into the skin to stimulate collagen as well as to exert a gentle pull and provide support to the treated area.  This leads to an improved contour and a more desired facial aesthetic.

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How is the Procedure Done

As with all all aesthetic procedures, a trained physician will first assess your facial condition to ascertain if you’re indeed a good candidate for a facial threadlift.  The procedure is  then explained to you in detail including the benefits, risks and side effects so that you can give informed consent.  A numbing cream is applied to the skin after which a local anaesthetic is infiltrated into the area to be treated.  PDO threads of suitable length are then inserted carefully into the skin according to predetermined vectors/direction to give you the suitable lift that you need.  Everything is done with strict cleanliness guideliness so as to minimise any possibility of infection.  The whole procedure should take less than an hour and the improvement should be seen immediately.

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Post-procedure, the doctor will prescribe you with a short course of antibiotics to prevent against any infection.  Also you’ll be advised to avoid doing  vigorous exercise for up to two weeks.   A follow up appointment will be given to you at an appropriate date.

The threads dissolve after a period of 6 months but the effects and improved contours will normally last for well up to a year.

Minor side effects commonly seen in patients include:

  • Minor swelling for two to three days
  • Bruising (varies from person to person)
  • Mild discomfort (typically for a just one day)

 

Did you know the Korean threadlifts can even be used to augment features in the nose? Look out for the next article on this hot topic!

Skin Ageing and Sagging

Sagging skin getting you down?  As we age, so does our skin – this is an inevitability. Wrinkles and lines appear deeper and the contours on our face appear less well defined. Why does this happen? The main reason for age related skin changes like wrinkling and sagging is the loss of collagen in our skin. Collagen fibres act as a scaffold or foundation around which the skin is supported so when the collagen fibres diminish or loosen with time, the skin ‘collapses’ around it and leads to the changes that we’ve mentioned.

Non-invasive Skin Tightening Treatments – What are your Options?

Skin tightening treatments are available to prevent and reverse wrinkling and sagging skin. These treatments can be broadly divided into invasive (e.g. face lift surgery), minimally invasive (e.g. threadlift procedures) and non-invasive treatments (e.g. Thermage RF and HIFU treatments). This is to cater to different treatment requirements and preferences as determined by the severity of the patient’s skin condition as well as the patient’s comfort level with undergoing skin tightening treatment.

Non-invasive skin tightening treatments have become very popular with patients who have mild to moderate skin wrinkling and those who are not comfortable with more invasive methods of treatment. Non-invasive treatments do NOT involve incisions or use of foreign material like threads  to achieve the tightening and lifting results. Thus, these non-invasive skin tightening treatments have proven to be very effective while resulting in minimal downtime post-treatment.

The two most popular and well established non-invasive treatment modalities available in today’s market are Radiofrequency (RF), e.g. Thermage and Ultrasound (US), e.g. HIFU, based treatments.

How does HIFU work?

Popularised in S. Korea, this technology is referred to as High Intensity Focused Ultrasound, but better known as HIFU. As the name suggests, this is the use of highly magnified ultrasound waves to generate heat in precisely targeted layers of the skin.

Treatment of each layer produces different benefits:
– Treatment at a depth of 3.0mm promotes tightening of collagen fibres and generation of
new collagen as well. This translates to the progressive tightening of the skin.
– Treatment at a depth of 4.5mm targets the Superficial Muscular Aponeurotic System (SMAS) and the heat generated here causes contraction of this layer and the resultant lifting of the skin.

The superficial skin is normally spared as the HIFU beams are targeted into the deeper layers of the skin. Hence, this non-invasive treatment has minimal downtime as compared to treatments which require surgery.

Thus, HIFU can be used as a preventive treatment as well as to reduce existing fine lines while also effective in tightening the skin and giving a much desired lifting effect.
The results of the HIFU treatment are expected to last for about 12 months although patients with a greater severity of sagging may benefit in a repeat treatment after 6 months for optimal results.

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How does Thermage work?

Thermage is a very well-established and premium non-invasive skin rejuvenation and tightening procedure. Thermage works using radiofrequency waves, penetrating deep into the skin to stimulate your body’s natural renewal of collagen, resulting in skin tightening and contouring.

Thermage is FDA approved for the non-invasive treatment of facial wrinkles, and is also the only system which is FDA- approved for non-invasive treatment of the eyelids. Thermage treatment, when done appropriately results in improved skin texture, tauter skin as well as a more defined youthful facial contour. Wrinkles and saggy skin in the treated area are smoothened out and become less obvious, resulting in a more refreshed appearance.

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How is it done?  

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During the procedure, your doctor controls the amount of RF energy, to produce optimal results while maintaining your comfort. The RF energy is delivered via a tip that is applied to your skin and this energy uniformly heats up the collagen in the dermis resulting in an immediate tightening. New collagen is also stimulated and your skin actually progressively improves over time, finally resulting in tighter, smoother skin and a more youthful appearance.

Using the new Thermage CPT ensures that the RF energy is delivered effectively to the treated area while maintaining your maximum comfort during the procedure. The entire procedure may require about 1 hour, depending on the size of the area to be treated.
The results last for about 12 months but your doctor may advise you on an appropriate interval between your Thermage treatments.

Which non-invasive skin tightening treatment is suitable for you?

As you can probably tell from the information provided so far, both procedures are effective ways of treating saggy and wrinkling skin while resulting in little or no downtime. What are the differences between the two treatments and which one is more suitable for you?

– The main difference is the different types of energy used. HIFU uses high intensity focused ultrasound energy while Thermage uses radiofrequency energy.
– Thermage is the only FDA-approved treatment for use on the eyelids.
– HIFU allows targeting of different layers including the SMAS layer which allows a greater lifting effect.
– Both treatments may result in slight discomfort during treatment but you can rest assured that the physician will do his utmost to ensure your comfort during the entire procedure and afterwards as well.
– Both treatments are available at different price points as well and may appeal to you if you have a certain budget in mind.
So, which treatment is most suitable for you? The best way to find out is to have a consultation with an experienced and trained physician as he’ll be in the best position to advise you. In some cases, both may not be suitable whereas in other cases, a combination of both may be used! You can rest assured we’ll do our utmost to tailor make the most effective and suitable treatment for you.

Look out for the next blog post where I’ll be talking about threadlifts and how they can be used to achieve your ideal face shape and contour!

 

Common skin ailments (2) – Acne scarring

Now that we’ve discussed acne in the previous post, I’ll go on to discuss what worries us most about acne in the first place – the scarring that occurs after the pimple settles down.

Just as not all skin is created equal, scarring occurs more for some people than others.  Genetic factors come into play and the duration of acne also affects the likelihood of scarring.  In general, the longer inflammatory acne is left untreated, there is a higher chance of scarring.  Scarring can be just a minor issue for some but much more devastating for others, affecting a person’s self-esteem and self confidence.  Many people with acne scarring are hesitant to leave home without the appropriate make up on to hide these blemishes.  Scarring has also been shown in many cases to lead to depression as people feel helpless and don’t know what they can do to improve their acne scars.

If you suffer from acne scars, you should at least know that there are different treatments available to minimize the scars effectively.  First of all, we’ll look at the different types of acne scars that are commonly seen.

Acne Post-inflammatory Hyperpigmentation (PIH)

acne PIH

Acne PIH is the discolouration that you see in your skin after inflammatory acne settles.  The inflammation leads to production and deposition of excessive pigmentation in the skin.  This is in fact not a ‘true’ scar as PIH is often a self-limiting condition but may require between 6 months to 1 year to resolve.  In some cases, longer.  This feels like a life-time to many sufferers who then look for treatments to lighten the pigmentation.  In my opinion, the best treatment is still prevention:

  • Prevent acne and treat it early with the appropriate steps discussed
  • Avoid excessive sunlight (use sun protection) as UV rays selectively darken these pigmented areas even more, making the PIH even more obvious
  • Avoid picking at the acne (this includes going for frequent extraction procedures) as the trauma to the skin often causes worse PIH

If you already have acne PIH, here are some treatment options:

cream

Over the counter treatments: Alpha-hydroxy acids (AHA), Beta-hydroxy acids(BHA) and Vitamin A and C.  These are commonly found in many over the counter skin lightening products and are effective in milder cases of PIH.

Hydroquinone:  Hydroquinone works by inhibiting the enzymes which produce melanin.  It is available in different preparations (stronger preparations e.g. 3% and 4% are only available by prescription).  They can be used by themselves or in combination with other substances e.g. vit C which tend to make them more effective.

Topical retinoids (e.g. retin-A, differin): topical retinoids works by increasing exfoliation of skin cells; this can also help areas of PIH.

Glycolic acid: this also works via exfoliation of skin cells

Tips to usage:

  1. avoid accidental application to areas of normal skin to avoid unwanted lightening
  2. These substances can lead to dryness, irritation and photosensitivity especially with initial usage. In such cases, consider application only on an every other night basis until the skin becomes less sensitive.

Procedural treatments:

peel

Chemical peels: A chemical peel is the exfoliation and also resultant peeling of a layer of the skin by means of application of a chemical substance (e.g glycolic acid) to allow new skin growth – normally resulting in smoother texture and clearer skin appearance. Chemical peels are an effective way of treating acne PIH.  Different acids at different concentrations can be used to achieve this; although it can be done at home, you are advised to seek medical advice from a physician who will be better equipped to help you perform this effectively and safely.

 

Lasers: Post-inflammatory hyperpigmentation has also been shown to be treated effectively by lasers e.g QS Nd:YAG laser.  This normally requires several sessions to break down the pigments sufficiently to be reabsorbed by the body.  These treatments are usually safe with minimal down time and effective in most cases.

The above-mentioned treatment methods can and are often used in combination to produce faster and better results.

 

Atrophic scarring

Acne atrophic scars are the depressed pitted scars that are left behind by acne and are normally permanent if left untreated.  It is still unclear why some people develop these scars and others do not.  In fact, the degree of scarring does not always correlate to the severity of the acne in the first place.  Nonetheless, these are the scars which frequently are the most disfiguring and cause the most distress and sense of hopelessness.

Different types of atrophic scarring:

Acne-Scars1

 

Prevention of acne atrophic scarring is exactly the same as the prevention of acne PiH i.e.

  • Prevent acne and treat it early
  • Sun protection
  • Avoid picking

 

Resurfacing procedures – these are procedures which remove skin from top down and also stimulating collagen, leading to smoother healthier new skin

1) Chemical peel – as discussed earlier

2) Lasers – Resurfacing using either ablative/non ablative lasers have been shown to be effective in acne scar treatment.

a) Ablative lasers – Ablative lasers vaporises the epidermis and causes thermal injury to the dermis to  stimulate new skin growth.  The most commonly used ablative lasers in acne atrophic scar treatment are the CO2 and the Er:YAG lasers. CO2 ablative lasers are traditionally thought to be slightly more effective than the Er:YAG laser but with higher risk of side effects.

What to expect with ablative laser therapy: Prior to treatment, you will be given a topical anesthetic to numb the skin.  The procedure itself may take about 30 minutes.  After ablative laser treatment, treated areas will be red, raw, swollen and may itch.  These areas may become weepy and crusts will form.  Your doctor will advise you on how to care for your treated skin.  Most people prefer to rest at home in the initial period after the laser (for about 5 days).

b) Non-ablative lasers  – Non-ablative lasers leave the epidermis undisturbed.  Instead, the laser induces dermal collagen healing and remodelling to improve the appearance of acne scars.  Treatment with non-ablative lasers typically require more sessions but come with minimal downtime and have much fewer side effects than ablative lasers.

3) Radiofrequency microneedling – This is a relatively newer technique to improve acne scarring.  It works by using microneedles to deliver radiofrequency energy to the dermis to induce collagen stimulation and remodelling.  As this treatment spares the epidermis, there are fewer side effects and minimal downtime.

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Intracel Radiofrequency Microneedling

Lifting Procedures – These are procedures which ‘free’ the scar and raise it up so they don’t appear so deep and obvious

1)  Subcision: This is a safe effective way to help improve rolling and some box car scars.  The doctor will use a needle to free up the fibres which tether the scars down to the underlying tissue, thereby improving its contour and appearance.  It is normally used in combination with other scar improving treatments.

acne injection

2) Fillers: Soft tissue fillers can be used to volumise and buttress these scarred areas to make the scars less obvious.  This treatment is normally more effective for rolling scars.  Done properly, this is a safe and effective treatment.  Your doctor will advise you further on the choice of fillers available and examine your scars to see if you’re a good candidate for this type of treatment.

 

 

After having read this, I hope you better understand what options are available to you to improve your acne scarring.  Don’t suffer in silence as there are effective, safe methods of getting rid of those unwanted scars today.  You just have to take that first step in seeking and getting the help you need.

Common skin ailments (1) – Acne

There are some common skin ailments which many of us face on a daily basis.  I thought this would be a good place for me to try to help explain these problems and what you can do about them to achieve better skin.  The goal here is to empower everyone with the knowledge and know-how to overcome some of these problems or at least to let them know that there are treatments available out there.  You just have to know where to look and this is a good place to start.

I thought we’d start by talking about acne, or pimples!  Pimples, acne, zits, 青春痘, jerawat … whatever you’re used to calling it, this is a remarkably common skin problem that all of us have probably experienced at some time in our lives.  At the same time, if left untreated, acne can lead to unsightly scars, diminished self-confidence and in severe cases, even depression.

How does acne occur?

Acne occurs in the presence of 4 factors:

  1. sebum/skin oils
  2. dead skin cells
  3. clogged pores
  4. bacteria

Excessive sebum production and presence of dead skin cells for a plug and can cause clogged pores.  When the clogged pores lead to bulging of the hair follicle wall, this is a whitehead. A blackhead is when the plug is exposed and darkens on the surface of the skin. A pimple occurs when these blocked hair follicles become infected and inflamed

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Different types of acne

There are different types of acne, and they often occur in combination.   From milder to more severe:

whitehead blackhead
Whiteheads/blackheads – as described earlier are due to clogged pores in the absence of infection and inflammation
Papular acne – tiny bumps which occur on the skin and are rough to the touch, in the absence of pus
Papular acne – tiny bumps which occur on the skin and are rough to the touch, in the absence of pus
Pustular acne – the presence of yellowish liquid pus in the acne
Pustular acne – the presence of yellowish liquid pus in the acne
Nodular acne – bigger, deeper blocked pores leading to hard, painful lumps
Nodular acne – bigger, deeper blocked pores leading to hard, painful lumps
Cystic acne – larger pus filled lumps
Cystic acne – larger pus filled lumps

Severity of acne can also be classified by number of acne, although this is not always easily done:

No of acne lesions  on half-face Severity
0-5 mild
6-20 moderate
21-50 severe
>50 Very severe

So why is it that certain people have worse acne than others?

Common risk factors for acne include:

  • Hormonal changes. Such changes are common in teenagers, women and girls.  Hence the common phenomenon of worsening acne during ‘that time of the month’.  This can also affect people using certain medications, including those containing corticosteroids, androgens or lithium.
  • Family history. Genetics plays a role in acne. If both parents had acne, you’re likely to develop it, too.
  • Greasy or oily substances. You may develop acne where your skin comes into contact with oily lotions and creams or with grease in a work area as pores can become clogged
  • Friction or pressure on your skin. This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
  • Stress. Stress hormones e.g. cortisol may trigger increased oil production in the skin during times of stress like exams and lack of sleep.
  • Diet. Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods — such as bread and chips — may trigger acne. Chocolate has also long been suspected of making acne worse.

acne squeeze

How to prevent acne

  1. Universal skin care tips: Nothing beats the basics! Healthy eating, drinking lots of water, de-stressing, not smoking, sun protection, cleansing and moisturising are a must!
  2. Light acne-friendly makeup: The products that you use could actually worsen your skin condition if you don’t choose wisely.  Look for “non-comedogenic” products i.e products which don’t clog the pores and cause comedones (white and blackheads).  Avoid oily, greasy products with mineral oils and cocoa butter if you’re acne prone because they can cause worsen acne outbreaks.  Oil-free products are preferable in this case.  In all cases, lightening the makeup almost always works in helping to control breakouts.
  3. Change your pillow case weekly – if you don’t change your pillow case regularly, you’re basically just planting your face against built up dirt, sweat and grime for 8 hours a night.  This, after spending all that time and effort to cleanse that skin thoroughly before sleep – not a good idea.
  4. Change your shampoo and conditioner if you’ve been developing more frequent acne outbreaks since trying that new product.  Shampoos and conditioners with lots of fragrance and chemicals are a known trigger for acne especially over the forehead, neck and back
  5. Avoid touching your face unnecessarily to avoid transference of the oils and dirt.  If you can’t help it, at least wash your hands more regularly.
  6. Laundry detergent residue can sometimes cause irritation to the skin and worsen acne over the neck and body; this is especially the case with detergents which have harsh chemicals and strong fragrances.
  7. Exercise – It’s untrue that people who exercise have more acne.  In fact, exercise promotes blood flow to the skin resulting in a more radiant complexion.  Also, sweating is the body’s natural way of eliminating toxins and dirt.  Just remember to cleanse thoroughly after exercise!
  8. Clean your phone – you can only imagine how much dirt and oil is on your phone and how we don’t give that any thought when we put it up against our faces.

Quite often it is the simplest things we do that make the biggest difference.

Acne Treatment

Sometimes despite our best efforts to prevent them, the occasional acne is inevitable.  For some people, it is a constant problem.  As discussed earlier, acne lesions are more likely to leave scars the bigger they are and the longer they are left untreated.  There are so many treatments available nowadays that I thought it would be good to help clarify what are the indications and common side effects of some of them.

Mild -moderate acne:Acne-Cream-3

Patients with mild to moderate acne normally respond quite well to milder topical medications which are available over-the-counter i.e. these are medications which you don’t need a prescription from a doctor for.  Here are some common active ingredients you will find in OTC acne medication:

Active ingredient How it works Possible Side Effects
Benzoyl Peroxide (e.g. Oxy) kills the bacteria that cause acne, helps remove excess oil from the skin and removes dead skin cells, which can clog pores dry skin, scaling, redness, burning and stinging, especially if you have sensitive skin
 Salicylic acid Unclogs pores mild stinging and skin irritation
Alpha hydroxy acids (e.g. glycolic/lactic acid) remove dead skin cells, reduce inflammation, stimulate the growth of new, smoother skin Sun sensitivity and skin irritation
Sulfur removes dead skin cells that clog pores and helps remove excess oil Dry skin and unpleasant odour

Here are some general guidelines for choosing and using acne products:

  • Begin with benzoyl peroxide.If you’re not sure which acne product to buy, start with one that contains benzoyl peroxide. It’s effective and well-tolerated by most people. Give it a few days before expecting to see results. Check product labels for the type and amount of its active ingredient. Stronger isn’t always better with benzoyl peroxide. In some cases, a 2.5 percent product works as well as those with stronger concentrations — and with fewer side effects.
  • Start with lower strength acne products.This can help minimize redness, dry skin and other skin problems. If needed, slowly — over several weeks — increase the strength of the product you use and how often you use it. This helps your skin adjust to the treatment gradually.
  • Use products with different active ingredients to treat stubborn acne.Acne ingredients work in different ways, so you may find it helpful to use varying products and ingredients to treat stubborn acne. Apply one product in the morning and a different one at night to prevent skin irritation.
  • Be patient.Treating acne with acne products takes time and patience. It may take two or three months of daily use of an acne product to see results. And acne may look worse before it gets better.
  • Experiment with what works.You may need to try different products with varying active ingredients before you find what works for you.

Moderate-severe acne  (or if your acne fails to respond to OTC medications after 2-3 months) – you should see a doctor as you could be a candidate for prescribed medications/therapies to help control your acne.

Topical preparation How it works Possible Side Effects
Retinoids e.g. tretinoin, adapalene Prevents clogged pores, decreases inflammation and minimises scarring Skin dryness and irritation
Antibiotics e.g. Clindamycin killing excess skin bacteria and reducing redness Skin dryness and irritation

Tips on retinol/retinoid use:

  1. Retinoids can lead to dryness and irritation. You want to use the strongest retinoid possible for acne, but the stronger the retinoid, the more likely dryness is going to occur.  Facial moisturizers before and after use of the retinoid, can help with the dryness.
  2. Every other day use or every 2-3 day use can also be utilized if the retinoid you have is too drying despite using a moisturizer.
  3. You may need to initially use an over the counter retinol if prescription strength is too strong. Report these symptoms to your prescribing doctor so he/she can advise you accordingly
  4. The longer you use these medications the better you will be able to tolerate them and avoid dryness.
  5. If you are prescribed a retinoid cream from above that you can tolerate, it would be wise to stay on that medication long term even if your acne improves do not stop this medication.

Single-Dose-Oral-Medication

If you are unable to tolerate topical preparations or if they fail to control your acne, don’t worry, there is still hope! Oral acne medications are the next step.

Oral Medication How it works Possible Side Effects
 Antibiotics e.g. doxycycline

 

Reduces bacteria and controls inflammation Gastrointestinal upset, photosensitivity.  (Note: can also cause fetal/growth abnormalities in pregnancy)
Combined oral contraceptives e.g. Yaz Regulates hormones which contribute to acne Nausea, menstrual irregularities, high blood pressure, blood clots
Anti-androgen agent e.g. spironolactone Helps block possible sebum production inducing effect of hormones Breast tenderness, electrolyte disturbances
Isotretinoin e.g. Accutane Reduces skin sebum production Birth defects, photosensitivity, severe skin reactions, dry eyes, mood changes, anxiety, visual changes

Note that the possible side effects mentioned in this article are not exhaustive.  Always read the medication label in detail and consult with your physician for further advice on possible adverse reaction with all acne medications.

Treatment How it works Possible Side Effects
Chemical Peel Exfoliates and unclogs pores Redness, burns, post-inflammatory hyperpigmentaion
Lasers (including Intense Pulsed Light) Regulating sebum control, kills bacteria, controls inflammation Burns, post-inflammatory hyperpigmentation
Carbon Peel Laser treatment in progress
Carbon Peel Laser treatment in progress
IPL treatment
IPL treatment

There are many different types of acne treatments on the market and most people actually respond quite well to over-the-counter products.  Nonetheless if you’re dealing with stubborn or severe acne, then it could be time to see a doctor who can help you figure out the next step in your fight against acne.  This is because acne medications come with their own possible side effects and normally, the stronger and more effective the medication, the harsher the possible side effects as well.

clear skin

I hope the information here will help you towards having better, acne-free skin!  In my next posting, I shall be talking about acne scars! So please look out for that.

About Dr Gary Si

Qualifications
MBBS (Singapore), MRCS (Edinburgh), GDFM (Singapore), GDFP Dermatology (Singapore)

Education and Experience

Dr Gary Si graduated from the National University of Singapore with a Bachelor of Medicine and Bachelor of Surgery (MBBS).  He also holds a post graduate degree from the Royal College of Surgeons Edinburgh (MRCS Edinburgh), a Graduate Diploma in Dermatology (GDFPD ) as well as Family Medicine (GDFM Singapore).  He is a registered Family Physician with the Singapore Medical Council.  Dr Si is a certified member of the American Academy of Aesthetic Medicine (AAAM), having been accredited in various aesthetic procedures by the AAAM, Dermatological Society of Singapore and National Skin Centre (DSS-NSC) as well as the Aesthetic Dermatology Education Group (ADEG).

Dr Si developed a passion for aesthetics during his years in surgery and as a Senior Family Physician; having been exposed to numerous patients with a wide variety of skin ailments seeking further treatment. Combining his love of procedural medicine with a keen eye for aesthetics, Dr Si always aims to help provide tailored and holistic treatment for each and every one of his patients.  His ability to help patients and strong dedication to his field has led him to garnering numerous awards during his medical career including the prestigious Singapore Public Service (PS21) Star Service Award in 2012.

Dr Si believes there is beauty in all his patients; he only seeks to enhance this natural beauty using the newest and most modern of modalities of treatment available in the field of aesthetics today. This can range from the treatment of pigmentation and textural issues, to enhancing facial features with the appropriate use of botulinum toxin, facial fillers and thread lifts.  He also has a strong interest in weight management and body sculpting, and would be more than happy to share his personal journey of weight loss with you when you sit down with him.

Dr Si continues to keep abreast with the latest in aesthetic medicine by attending local and international conferences and workshops when his schedule allows.

Outside His Practice:

A family man and a father of two beautiful little boys, Dr Si dedicates most of his free time to his family. Naturally, Dr Si also loves art and can often be found drawing and working on a new piece of art every so often. He has always been an avid basketball player and you can often catch him on the courts or doing some running.

Languages Spoken:

English, Chinese, Malay, Bahasa Indonesia, Cantonese

gary

Haze and your Skin

The haze – we find ourselves talking about it and reading about it in the news all the time. We’ve all become ‘experts’ on the subject and we know all about how the haze is bad for us, or do we?  Have you noticed your skin being a little bit drier, the recent acne outbreaks and the worsening of your winkles and pigmentation? Could it possibly have something to do with the haze? Yes, unfortunately the haze has a detrimental effect on your skin just as much as it does on your lungs and general well being.

How does the haze ruin your skin?

  • It causes direct irritation to the skin and cause exacerbation of common skin problems like eczema, causing itching and redness
  • It can clog pores and lead to pimples and worsen acne outbreaks
  • It damages cells in the skin by causing increased production of toxic free radicals, leading to premature skin ageing, uneven pigmentation, loss of elasticity of the skin and worsening wrinkles

What can I do about it ?

  • Drink lots of water, keep your body and your skin well hydrated
  • Load up on lots of fresh fruits and vegetables which contain vitamins C and E and anti-oxidants to help deter premature skin ageing.
  • Avoid spending time outdoors unnecessarily if you’re known to have sensitive skin and when the PSI is in the unhealthy range
  • Consider covering up in long sleeved clothing to minimize pollutant contact with your skin
  • Cleansing your skin – do it whenever you’ve been outdoors, up to 4-5x a day with a gentle cleanser for normal skin. If you have dry skin to start with, avoid cleansing excessively especially with harsh drying soaps.
  • Moisturise – hydrate the skin because dry skin is irritable skin. Remember, the moisturizer also acts as a protective barrier between your skin and the airborne pollutants
  • Sunblock – do this regularly even though the sunlight feels less intense with the presence of the haze as the haze actually traps and amplifies the detrimental effect UV rays have on our skin.
  1. choose a sunblock with Sun Protection Factor (SPF) of 30 or more
  2. apply the sunblock at least 20 minutes before stepping out
  3. reapply the sunblock every 2-3 hourly when prolonged sun exposure is expected.

Take home message:

The haze is literally all around us and although we’ve been having a slight respite from it recently, the only thing we can be sure of is that we’ve not seen the last of it.  That doesn’t mean we can’t take measures to protect ourselves and our loved ones from its negative effects, why take the chance?  With the festive season around the corner, today is the perfect time to start paying closer attention to your skin and how you treat it.  That additional 10 minutes you spend a day on taking care of your skin could mean a world of difference; don’t be lazy, you know it’s hazy!

A Beginner’s Guide to Great Skin

I recently asked a patient (and a well-known blogger) what makes a good blog.  She said that as long as it is humorous, insightful or educational, there will be people who are willing to read it.  In this blog, I’ll be writing regularly on beauty and skin, but also a little bit on myself, my family and my friends.  I hope everyone will find something they can relate to here, something they can learn or at least have a good laugh (or  cry).

Let’s talk skin

What is skin? The skin is the soft tissue outer covering our entire body which protects us fom the elements, microbes, helps us regulate temperature and also a huge collection of sensors which connects the brain to our environment.    Many of you already know this but the skin is the largest organ in the entire body.  What you may not know is how complex the skin really is but I’ll try to simplify it as much as possible here.

The skin is made up of three different layers – the epidermis, the dermis and the subcutaneous layer (from outermost to innermost).   Each layer contains different structures and has different functions and each layer can be affected differently by different skin ailments.  Always refer to the diagram below if references are made  in subsequent blog articles to any specific layer of the skin.

The different components of your skin
The different components of your skin

Skin Color

As we look around us, everyone has a slightly different skin color and even on the same person, skin can have different colors depending on location.  So what determines skin color? Melanin is the pigment which gives our skin its color.  Many of us wish we were fairer and had ‘less melanin’ but did you know that melanin is actually protective against the sun’s UV rays? And for that particular reason, people who live in tropical regions have more and darker melanin particles in their skin.  People who live further from the equator have less and lighter melanin particles to enable adequate vitamin D production through sun exposure.

Melanin and it’s pattern  of deposition in the skin is behind many of the skin pigmentation abnormalities we encounter daily including freckles and even skin cancers like melanoma.

colour-of-skin melanin

Skin texture

We hear and use this term frequently – skin texture.  What is skin texture?  Skin texture refers to the feel, appearance and consistency of the skin.  Everyone wishes for baby skin – soft, supple, flawless but more often than not, we either have sun damaged, age-wrinkled or acne scarred skin.  Good skin texture depends on interplay of all the different components and layers of the skin.

Beautiful skin

Without a doubt, skin is one of the major determinants of a person’s beauty; hence the expression “beauty is skin deep”.  Everyone desires beautiful skin, we want to have beautiful skin and we want to look at beautiful skin.  What exactly do we mean by beautiful skin?  Basically ‘beautiful skin’ is defined as naturally having the following characteristics:

  • Clear and blemish free
  • Smooth
  • Firm
  • Elastic (not saggy)
  • Well hydrated
  • Dewy (in between matt dry and shiny oily)beautiful skin

If you have all the above, congratulations, you are probably one of the very few who have achieved the holy grail of skin perfection.  If you haven’t achieved the above, not to worry, you’re not alone.  In fact you’re one of a majority of people who desire to see improvements in their skin.

Good skin care

Like most men, I never used to pay much attention to my skin and am still guilty of that nowadays.  I have been blessed with relatively good skin despite some early struggles with acne.  Patients ask what sort of skin care regimen they should use and in my opinion, there are skin care tips which are universal and should be practised by everyone; there are also particular skin types which require particular skin care regimens.

Let us begin with universal skin care tips (things you should definitely already be doing!):

  1. Eat healthily and drink lots of waterCesto con agrumi misti

You are what you eat and that applies to your skin too.

Water: Drink at least 6-8 glasses of water a day to keep your skin well hydrated and supple.  Dehydration makes your skin look dry, tired and feel less supple.

Vitamin C: Vit C is an excellent anti-oxidant which can prevent free-radical damage to cells and prevent premature skin ageing.  It also helps with the immune system in general to ward of infections. Sources: berries, oranges, papaya, guava, broccoli

Vitamin E: Vit E also acts as an anti-oxidant.  Sources: nuts, avocado, sunflower and corn oil

Selenium: Selenium is also an anti-oxidant.  Sources: nuts, broccoli, tomatoes, eggs and fish

Zinc: Zinc is important for skin repair and keeping it supple.  Sources: fish, lean red meat, nuts

Omega-3 and -6 fatty acids: Omega fatty acids can protect against inflammatory skin diseases like eczema and psoriasis Sources: oily fish, flaxseed

  1. Manage stressstress

We often feel like our acne worsens during times of stress but did you know that stress can also worsen other skin problems like eczema, rosacea and alopecia (hair loss)?  Stress has been shown to increase our body’s level of stress hormones e.g. cortisol which increases oil production in the skin and its related skin ailments.  Also stress has been shown to trigger auto-immune conditions as well.  This can be a vicious cycle as poor skin can cause a person to feel distressed and the additional stress than worsens the skin condition.  So take some time to relax and de-stress with your favourite activities.  You might just be surprised how much your skin improves and of course a smile doesn’t hurt either 🙂

  1. Don’t smoke smoking

We all know smoking worsens the appearance of our skin.  How does this happen? The heat from the cigarettes directly damages cells around the lips and peri-oral region.  The elastic fibers of the lips and skin are also damaged by vasoconstriction of blood vessels and free radical generation.  All this leads to premature ageing of the skin including wrinkle formation, broken blood vessels (telangiectasia) and uneven skin tone.  Smoking has also been shown to be associated with an increased risk of skin cancers and oral cancers.  So now you have another reason to put that cigarette out! Remember, it’s never too late to quit.

  1. Protect yourself from the sun 

We all know the sun damages our skin and causes premature ageing.  It does this by causing uneven pigment deposition in the epidermis (e.g. freckles) and also damage elastin fibres causing wrinkling and sagging.  In Singapore, this is particularly a problem as a tropical country like ours receives intense and direct sunlight all year round.  Be smart when it comes to the sun; avoid unnecessary prolonged unprotected exposure.  You can do this by staying indoors or with long sleeved clothing.  Also sunblock should be part of your regular skin regimen, to protect your skin against those harmful UV rays.  Here are some important sunblock tips from the American Academy of Dermatologists that you should always keep in mind:

  1. Choose a sunscreen that has an SPF of 30 or higher, is water resistant, and provides broad-spectrum coverage
  2. Apply sunscreen generously before going outdoors. It takes approximately 15 minutes for your skin to absorb the sunscreen and protect you. If you wait until you are in the sun to apply sunscreen, your skin is unprotected and can burn.
  3. Use enough sunscreen. Most adults need at least one ounce of sunscreen, about the amount you can hold in your palm, to fully cover all exposed areas of your body. Rub the sunscreen thoroughly into your skin.
  4. Apply sunscreen to all bare skin. Remember your neck, face, ears, tops of your feet and legs. For hard‐to‐reach areas like your back, ask someone to help you or use a spray sunscreen. If you have thinning hair, either apply sunscreen to your scalp or wear a wide‐brimmed hat. To protect your lips, apply a lip balm with a SPF of at least 15.
  5. Reapply sunscreen at least every two hours to remain protected, or immediately after swimming or excessively sweating. People who get sunburned usually didn’t use enough sunscreen, didn’t reapply it after being in the sun, or used an expired product. Your skin is exposed to the sun’s harmful UV rays every time you go outside, even on cloudy days.

I find most people follow the above tips quite strictly except for no. 5.  It is especially hard for women to reapply sunblock regularly especially when they’ve applied their makeup.  What I normally suggest is to bring a simple makeup kit to work and find time during lunch to reapply the sunblock and a light layer of makeup.  That extra effort with the sunscreen can make a world of difference.

  1. Cleanse cleansing

Cleansing should be part of everyone’s skin care regimen, no matter what the skin type.  The only difference is how often you should do it and the type of cleanser you use.  Cleansing, as the name suggests, rids our skin of overlying dirt which can damage the skin and make it look tired and sallow.  Are you cleansing your face correctly?  Here’s how you should be doing it.

  • Wash your hands before you cleanse your face
  • Wash your face at least twice a day (morning and bedtime) using lukewarm water and an appropriate cleanser
  • Rinse – Gently but thoroughly rinse off all cleanser from the face using lukewarm water
  • Don’t use water that is extremely hot or extremely cold since this can damage your skin and trap grease and dirt inside your pores.
  • Gently massage your face with slow, circular motions. Don’t scrub! Scrubbing will cause skin irritation, redness, or breakouts.
  • Treat the skin around your eyes extra gently, as it is the most delicate, sensitive skin on your face. Plus you don’t want to end up with cleanser in your eyes!
  • Don’t over-wash your face! Even if you have oily skin, over-washing can cause dryness, and your skin will produce more oil to compensate, which means you could end up with oilier, more blemished skin.
  • Pat dry – Always pat dry using a clean soft cloth rather than a used hand/body towel. Avoid excessive rubbing especially since your skin is most sensitive after a good cleansing
  1. Moisturise

Moisturisers don’t really add moisture to your skin; instead it traps the existing moisture in the skin to that it doesn’t dry out quite so quickly.  Dehydrated skin tends to be irritable and appear dull and lifeless.  In the long run, dehydration leads to permanent loss of skin elasticity and wrinkling.  A good moisturiser also act as a barrier to protect the skin from environmental irritants and pollutants.  The best time to moisturise the skin is always after cleansing.

There you go, 6 skin care tips that everyone should take note off for better skin.  If you’re not already doing all the things mentioned, it’s time to start.  In case you’re worried you’ll forget, cut out the below and put it somewhere easy to see to remind yourself.  Now sit back, and watch your skin improve.

6 STEPS TO BETTER SKIN

1.       EATING WELL, DRINKING MORE WATER

2.       DE-STRESS

3.       STOP SMOKING

4.       SUN-PROTECTION

5.       CLEANSE

6.       MOISTURISE

My Journey from Fatness to Fitness

Weight loss is and always will be a topic that is very dear to my heart.  This is because at my ‘peak’, I weighed 92kg (!!).  For a man that’s 1.75m tall, that gave me a Body Mass Index of 30kg/m2 putting me in the obese category.  Nobody wants to hear they’re ‘obese’ and nobody wants to look into the mirror and see that they’re obese.  Nonetheless it wasn’t the labelling that made me finally decide to lose the weight seeing as i was already quite used to the fat jokes by then.  It was just a decision that I made towards the end of 2013 that I wanted to be around for my wife and 2 boys for as long as possible.  I wanted to live forever with them and for them; so I made a conscious resolution to start by losing weight.

Honestly it wasn’t the first time I had told myself I wanted to lose weight but this time something felt different.  It’s really like a switch went off in my head and I knew I was willing to do what it took.  Being a family physician at the time, I knew exactly what I needed to do and how to do it to lose the excess weight – diet and exercise! That was something I had advised to numerous patients on numerous occasions over the years.  Truthfully, easier said than done.  Telling somebody who likes to eat to cut down on his food is like telling a smoker to cut down on his cigarettes.  Eating is a lifestyle, almost an addiction.  Actually it’s even more difficult to cut down on overeating than smoking because everyone has to eat; it’s just knowing and complying with what and how much you can eat.  You can’t just go cold turkey.


food2

For me, lunch part (a) used to be a big plate of economy rice followed by lunch part (b): likely another plate of carbs just because lunch part (a) never felt enough.  That’s right, I would frequently eat two full servings of lunch previously! It would now be a bowl of Special K Red Berries cereal in milk with a serving of fresh fruit in place of my regular hawker/coffee shop fare.  No snacking in between meals.  Dinner would be the same delicious home cooked food I normally take, just with slightly less rice.  And no supper (unless it’s a fruit).  Doing that for the first week is tough.  Doing that for the first month is very tough.  Doing that for almost a year is almost impossible.  I did it and actually found my wife to be my biggest supporter during that time.  I love my colleagues and friends but nobody is going to be very kind to you when they see you eating cereal every day for lunch; inevitably comments like ‘CEREAL AGAIN?!’ or ‘WAH HOW LONG ARE YOU GOING TO KEEP THIS UP MAN?’ became commonplace.  For me it wasn’t a fad; it was the means to an end.

cereal

I’ve always found myself to be compulsive when it comes to certain things and I guess in this case it helped.  The first time I stepped on a scale after a week of dieting, I was half hoping that dieting wouldn’t work so at least I could tell myself I tried but it didn’t work, oh well… Darn, it did work, and it continued working.  I was losing about 1-2kg/week demonstrating how effective dieting can be (and how bad my previous diet used to be).  Needless to say the results were encouraging and I decided, time to exercise and get that weight down even faster! After all, diet and exercise was something that I had been preaching for so many years, they should go hand in hand, right?  Not for me.  I remember going down to Clementi Stadium one evening after work in running gear thoroughly impressed with my resolve.  Crossing the overhead bridge. I already felt a little winded but I told myself it’s just cos I hadn’t warmed up yet.  It would get better.  The run started and I remembered why I had stopped running for almost 13 years, I hated it.  I got winded. My mouth got dry.  My muscles began to ache.  Even worse, I was being overtaken by little children and older folks.  I had always considered myself to be in ‘okay’ shape before that but it was a real eye-opener.  After just 2km, I decided to call it quits.  My lungs screamed, my legs heart and my knees wobbled all the way back across that darn overhead bridge back to my car.

jogging

Deflated and discouraged I then tried to figure out what had gone wrong.  I just wasn’t ready, simple as that.  I tried to do too much, too early.  I knew if I didn’t stop, I would have injured myself and set myself back even further.  After all, my pride had already taken quite the beating.  Since my dieting was working, I then decided to concentrate on that first and it worked.  Sure it was difficult but the scales didn’t lie, it was encouraging so that’s where I put all my energy and discipline and by the end of the first month I had lost almost 6kg.  After losing 12kg at my new weight of 80kg, I was feeling infinitely lighter and more energetic.  That’s when I decided to give running another try.  Back to the dreaded stadium track I went and this time it was so much easier.  Putting things in perspective, running with the additional 12kg on me was like piggy backing by kid for my entire run – not something i would recommend anyone to do! I managed to finish my first 2.4km run in almost 13 years eventhough there were still little children and older folks overtaking me.

People had begun to take notice of my significant weight loss too and it was encouraging but the best part is you really do feel lighter on your feet and more energetic.  By then I had already gotten used to my new diet and I actually looked forward to my lunch time cereal and fresh fruit.  I also started allowing myself some snacks and the occasional supper as well. As I approached my target weight, I went back to taking normal fare for lunch and anybody who has sat down with me at a buffet will testify that I still have a very healthy appetite and can indulge with the best of them.  The difference is I actually have a food conscience nowadays and I actually feel just a little bit guilty when I overeat.  I still exercise (running and basketball) on a regular basis albeit a bit less frequently then I did at my stage of peak activity.  The good news is my weight has been keeping stable, I feel I haven’t overdone it, I can go back to a normal (healthy) diet and I know I’m definitely healthier after having gone through this whole process.

I’m sure my family appreciates that I did this and I appreciate my family for having motivated me through the whole thing.  There is no exact science or magical formula to getting to your target weight; everyone will have their own comfort level at doing things.  It’s sort of like shooting a basketball.  Everyone’s technique may be different but as long as it works, it works.  For myself, it was important to see results to keep motivated and that is why it had to be so drastic for me.  Hey, it worked!

After
After – 72kg
Before
Before – 90kg

Here are some tips for those who may be looking to shed some extra weight:

·        Set achievable goals to keep yourself motivated

·        Remember why you’re doing what you’re doing – keep your eyes on the prize

·        Friends who seem discouraging are just afraid of change – don’t hold it against them but you don’t have to listen to them either

·        It may be difficult to dive right into strenuous exercise in the beginning.  Lose some weight with good ol’ dieting first before adding in the exercise

·        Treat yourself once in a while

·        Do activities which you enjoy!

·        Make sure your family understands why you’re doing what you’re doing.  They can be your biggest motivator

·        Calorie count! ( a simple way to determine your daily caloric requirements for maintenance of your current weight is 30kcal/kg/day)