A little more kindness, A little less judgement!

It has been a few months since my last blog post. The past few months have been extremely intense with work and home matters (yes…mainly the kids) which I chose to focus on first. In the meantime, I have thought about several Health & Beauty topics that I would like to write about. Yes! Regularly updating my blog will definitely be one of my 2018 resolutions, but before I start writing about those topics, I would like to share a good quote that we could all use as we embrace this coming new year.

(FYI aside from medicine, I enjoy reading story books, inspirational books or autobiography books by successful people in the world. I find that it helps keep me motivated, have an open-mind and allows me to also share with everyone any useful information I am able to gain from it)

kindnessquote

Cosmetic Dermatology / Aesthetic Medicine has been around for quite some time now, but back then it was a hush-hush and not-talked about. In the recent years, with the boom of Selfies and Social Media, issues surrounding Self-Image is more openly talked about and suitable treatments available are also more openly discussed. However, in my experience and observation, I find that many people still have strong judgements on others wanting to do cosmetic procedures. Perhaps it is the fact that we are on this side of the world, people are more reserved and shy to discuss self-image issues.

I have treated both men and women of different religion and cultures, young and old, different socioeconomic status and the one common goal they all have is to ‘be healthier, look better and feel better’.

We do not know what others are truly going through in their lives and sometimes subtle improvements may give that boost of confidence and self-esteem which may affect their mental health and overall daily life. I have found that some people have very valid reasons for seeking such treatments. It could be about having extra confidence to handle a newly appointed job promotion, or women gaining body-confidence post-childbirth, or even regaining self-esteem post-emotionally/physically abusive relationship. Everyone has their own stories & reasons for undergoing such procedures. Just a little advice… when considering such procedures, ‘Do it for YOURSELF’ & not for someone else.

So let’s embrace the new year with a little more kindness & a little less judgement!

[Disclaimer: As medical practitioners, each new patient seen during consultation will be assessed thoroughly to ensure patients do not have underlying untreated mental health issues such as Body Dysmorphic Disorder before undergoing any type of cosmetic-related procedures]

To Fill or Not to fill ~ Part 2

Now that we know dermal fillers can be used to restore volume loss, the next question is:

Which dermal filler is the most suitable one for me?
There are many brands out there that claim they have the best fillers on the market, so much so that consumers and even physicians sometimes find it challenging to choose the right one. In reality, though, the ‘Perfect’ filler is yet to be available, and therefore some Filler-101 knowledge comes in handy before making that final decision.

Firstly, let’s look at how fillers can be classified:

Based on the Longevity:
– Temporary (usually lasting less than 12 months)
– Semi-permanent (usually lasting between 1-2 years)
– Permanent ( usually lasting more than 2 years)
Based on Filler Material Origin:
– Heterograph (from donor of different species)
– Allograph (from a donor of the same species as the recipient but not genetically identical)
– Autograph (from the same individual)
– Synthetic Material
The classification above is rather broad and technical. However, during consultations, what is more commonly asked is whether the dermal fillers are:
1. Hyaluronic Acid Fillers or
2. Non-Hyaluronic Acid Fillers
Hyaluronic Acid Fillers
Hyaluronic acid is a naturally occurring glycosaminoglycan in the dermal extracellular matrix (deeper layer of our skin) that provides structural support and nutrients and through its hydrophilic (water-loving) capacity, adds volume and hydrates the skin. Native hyaluronic acid would break down very quickly if injected into the skin and needs to be altered and stabilized primarily by cross-linking to have a longer resident-life in the skin. This is known as HA fillers.
HA fillers are currently the most popular choice for volume restoration because of these factors:
1. Relatively long lasting (some HA fillers on the market now can last up to 24 months)
2. Have minimal adverse effects (side effects are minimised especially in the hands of a skilled injector)
3. Relatively affordable (This is subjective, but definitely a more affordable option than surgery. Price range differs due to injector knowledge and artistry skills, brand of HA filler used by the physician, and also the intricacy of the area of treatment i.e. tear-trough, nose and jawline which are higher risk area and needs more careful and detailed attention by the physician to achieve best results)
4. Minimal downtime (with new techniques involving cannula, minimal puncture site is needed and tendency to bruise from procedure is minimised)
5. Minimal discomfort (most HA fillers have Lignocaine and make the procedure a more comfortable one)
6. No skin-allergy testing is needed prior to treatment.

I feel that HA filler is most suitable if you are considering getting your first dermal filler procedure done. In the events when an undesirable outcome occurs or a sudden change of mind, correction is possible with the injection of commercially available hyaluronidase, which breaks down the unwanted HA filler.

HA DERMAL FILLER BA 4-01_preview

Picture: Hyaluronic Acid Filler for chin retrusion and bone atrophy of mandible (jawline)

Non-Hyaluronic Acid Fillers
Other non-HA dermal fillers (i.e.Poly-L-lactic polymer or Calcium Hydroxylapatite CaHA) have the properties to create a tissue response in the dermis that will produce more collagen to reinforce the structure of the skin. The longevity may also play a role in why one would choose this type of fillers; therefore this can be considered after having tried HA fillers first and are comfortable with the treatment outcomes by the attending physician.

Whose choice is it? Physician vs Patient
Preferences for physician and patients may vary. With temporary fillers such as Hyaluronic Acid fillers, per injection costs are less and complications are minor and rare when treatments are done by a fully-trained aesthetic practitioner. However, in the long run, maintenance costs are higher due to the requirement of repeated injections. On the other hand, with semi-permanent or longer-duration fillers, the time-and-cost horizon is shortened but any complications can potentially be more significant.
Therefore, upon deciding whether ‘to fill or not to fill’ or ‘what to fill’ those factors above should be taken into consideration. A balance is achieved when those are well-thought-out and strengthened by the physician’s expertise and patient’s expectations and acceptance of potential outcomes.

Resources:

  1. Draelos. (2016). Cosmetic Dermatology: Products and Procedures. Second Edition Wiley Blackwell, p 376-377.
  2. Small. (2012). A practical Guide to Dermal Filler Procedures. Lippincott Williams & Wilkins, p11.

To Fill or Not to Fill ~ Part 1

As social media hits our society intensely in the recent years, the rise of ‘selfies’ has made us extra conscious of our facial features. There is also an increase in the cosmetics & fashion industry because what is a social media post without #ootd or #makeup hashtags right?

When it comes to make-up, the techniques have also changed whereby the play of different shades to create better contouring for beautiful feature-enhancing ‘selfies’ are more desired these days.

As for the cosmetic medicine side of the world, the ‘contouring’ part can be obtained with dermal fillers. But firstly, I would like to share a little bit about the process of aging, because only then we would understand how dermal fillers can be used optimally.

A youthful face has 3 unique features:
1.High cheekbones
2.Full cheek volume
3.Well-defined jawline

1.5_Inverted_Triangle_Contouring

Having these three attributes are often referred to as the “triangle of youth” with the base of the triangle being at the cheeks and the point at the chin. As we age, this triangle becomes inverted. The cheeks flatten, jowls start to appear and the face generally looks more oblong-shaped.
There are four key layers of our facial anatomy:
1. The bone
2. The fat pads
3. The muscles
4. The skin
All four layers play a role in aging and by understanding the aging process of these four layers, one can achieve the most ideal face rejuvenation treatment.
BONE
The facial bones give us a strong structure for the muscle and skin to ‘drap-on-to’. As we age, bone atrophy (reduction in bone density) reduces tissue support and this can cause structural changes in the face.

bonechangeswithaging

FAT PADS
Good news – as we age we do lose fat, bad news – we all wish it would be those belly or thigh fats, but no! It is at our facial fat pads and this fat loss together with gravity’s effect on it descending down inverts the ‘triangle of youth’. As the fat pads travel down, the skin overlying it will automatically be pulled down south as well!

fatchangeswithaging

MUSCLE
Our daily facial expression causes repetitive muscle contraction which can then make the overlying skin above it forms wrinkles. For instance, habitual frowning can lead to the glabella ‘11’ lines formed between the eyebrows.

SKIN
The skin loses elasticity due to collagen breakdown as we age and gives that sagging skin appearance.

agingfacepicture.png

So the question of whether ‘to fill or not to fill‘ depends on how the anatomical changes affect our general appearance. If there is a volume loss due to the reduction of fat pads and noticeable bone resorption, having dermal filler injection procedure would be beneficial to the person.
In part two, I will zoom in on various types of fillers available in the market and considerations to take when choosing the right one to achieve optimal results!

Acne: Focus on Five 

We all have encountered a sudden outburst of acne at some point in our lives. Whether it was puberty, pregnancy or the few pimples that appear just before monthly menstruation.

The 3 main reasons how and why acne happen:

  1. Sebaceous Gland Hyperactivity

Sebum is continuously produced by the sebaceous glands and secreted to the skin surface through the hair follicle pore. This is controlled hormonally. Active acne is seen during puberty due to the increase in androgen which promotes sebum production. For women, the sebaceous gland activity also increases post ovulation due to the surge in Luteinizing Hormones, and this explains the acne breakouts just before menstruation.

  1. Keratinocytes Clumping

In acne patient, the keratinocytes (cell in the top skin layer) tends to stick together and block the pore, creating open comedones ‘blackhead’ or closed comedones ‘whitehead’. This clogged pore is a great nutritional source for bacteria.

  1. Impact of Bacteria

Propionibacterium acnes – commonly found on the surface of the skin in an adult face with or without acne. The increase in sebum production and keratinocytes clumping leads to an increase in P. acnes around the hair follicle.

acnepic2

The 5 essential steps of  acne management are:

  1. Exfoliation – Normalize Keratinization

The first step to control acne is to prevent the exfoliated keratinocytes from clumping together. Retinoids are great to achieve this. Many dermatologists prescribe some form of retinoids as part of ‘Acne Care Management’ due to the ability to eradicate existing comedones and prevent new ones.

  1. Reduce Bacteria

Depending on the severity of the acne, anti-bacterial medications such as Topical Clindamycin and Oral Tetracycline / Doxycycline are commonly used in the treatment of acne.

Benzoyl Peroxide can also eliminate bacteria, however by generating reactive oxygen species in the sebaceous follicle causing free radical formation, this may lead to accelerated aging of the skin therefore it should be used sparingly.

  1. Remove Pore-Clogging Material

AHAs and BHAs (Salicylic Acid) are used to loosen the keratinocytes, therefore ‘unclogging’ the pores. This is usually done in clinics and known as ‘chemical peel treatment’. 

  1. Manage Inflammation

Anti-inflammatory products such as Salicylic Acid helps soothe active acne. For severe cystic type acne, the physician may even suggest intralesional steroids in order to prevent scarring.

  1. Decrease Sebum Production

It is also recommended to have hormone profile test done, as many women who suffer from persistent acne turns out to have Polycystic Ovarian Syndrome, and by managing the excess testosterone with anti-androgen oral treatment, drastic improvement can be seen even after 1 month of this hormonal stabilization treatment.

The 5 steps mentioned are mainly for prevention of future eruptions, therefore optimal results will only be seen between 6-8 weeks from commencement of treatment.

“Patience is not the ability to wait, but the ability to keep a good attitude while waiting”

So…stay positive, ensure good compliance to the recommended treatment plan and that clear radiant skin will be yours again in due time!

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IMAGE ABOVE IS MY ACTUAL PATIENT. KINDLY DO NOT DISTRIBUTE IMAGES WITHOUT WRITTEN PERSMISSION. THANK YOU.

References:

Baumann, L. (2009). Cosmetic Dermatology: Principles and Practice. McGrawHill,  pp121-125.

 

 

 

Double Celebration

Last Saturday – 12th August 2017, was a memorable day indeed.

I turned 21 (yeah…I wish) and celebrated the official opening of our second branch in Kuala Lumpur.

We started in December 2014 in Kelana Jaya. It was not any special reason we chose our first outlet to be in Kelana Jaya but it was more of the convenience of working nearby home and where my kids go to school. I grew up in Kelana Jaya too, so it felt very much ‘at home’ for me.

Over the years, we have many patients who live in the heart of the city (Kuala Lumpur) and have travelled so diligently for their treatments. I truly appreciate the support they have given us despite having to battle through horrible traffic at times. I guess it is alright for some face treatments which needs once a month travel, but since we also do a lot of body contouring treatments which involves weekly visits, the distance may disrupt the programme and I am always concern about how this would affect them obtaining their optimal results.

By early 2016, we had many requests to open a branch in the city itself. I was unsure about this at first, and after visiting many places, I still didn’t feel I quite found THE place.

It was December 2016, my family and I went for dinner at BLVD, in Platinum Park. After dinner, my ‘forever-hungry’ kids wanted to get some snacks from the convenience store which was at the building next door. We walked outside and saw the beautiful view of Petronas Twin Tower. It was almost sunset, the skyline was beautiful, kids were happily running around and that was when I saw ALAINN KUALA LUMPUR right there!

It was love at first sight.

Fast forward half a year later and here we are in the heart of the city, and very thankful to have such amazing support from our Kuala Lumpur clients. We had a simple and intimate Opening Ceremony and a truly meaningful birthday celebration this year!

A blessed 12th August indeed!

@alainn_kualalumpur

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Embracing Those Tiger Stripes?

Not too long ago, the famous model Chrissy Teigen showed off the side of her body that we don’t usually see in magazines. She shared a revealing shot of her stretch marks on Instagram and that caught the attention of many women who then also posted their #stretchies picture in support of that bold move.

chrissyteigan

Yes, stretch marks are common and do occur even in supermodels. 90% of the population has 1 or more stretch mark somewhere on their body. It is not a disease, but usually an aesthetic concern of many women. As a mother myself, who has ‘earned her stripes’ (three times to be specific), I am extra passionate about this topic!

Stretch marks, also known as striae, are defined as “linear dermal scars accompanied by epidermal atrophy’

Striae – skin that is subjected to continuous and progressive stretching; increased stress is placed on the connective tissue due to increased size of the various parts of the body. Skin distension may lead to excessive mast cell degranulation with subsequent damage of collagen and elastin. 1

The onset of stretch marks can often be seen during puberty (growth spurts), pregnancy or a rapid weight gain.

New stretch marks are usually pink (striae rubra). Over time usually after six months, the pink colour fades and turns to white (striae alba) – an old stretch mark which becomes permanent.

What is interesting is the fact, that striae are also related to an excess of certain hormones, namely cortisol.

This can be seen when people with no stretch marks commence steroid therapy and they then develop new stretch marks even if their weight doesn’t change. Similarly, as seen in Cushing’s syndrome.

So how do we manage stretch marks?

Prevention is better than cure

With stretch marks, prevention is best but early interventions would yield satisfactory results too.

The current medical devices that can be used for external treatments are:

  1. Pulsed-Dye Laser
  • Best for newly formed stretch marks because it aims to correct, and improve the blood vessels responsible for circulating oxygenated blood supply to the location of stretch marks.
  1. Fractional Non-ablative Laser
  • Helps stimulate coagulation in the dermal connective tissue which is effective in old stretch marks. Treatments are done every 6 to 8 weeks. After 4-5 sessions, texture of stretch marks is remarkably improved by 50%.
  1. Microdermabrasion
  • Improves skin texture and hyperpigmentation and encouragement of new epidermal layer. Since microdermabrasion affects mainly the epidermis, improvements are minimal.
  1. Skin Tightening Device – Radiofrequency
  • Radiofrequency devices deeply heat the target soft connective tissues, resulting in stimulation of collagen and elastin, which leads to increase in skin tightening.
  1. Acoustic Wave Therapy 
  • By mechanically stretching and relaxing and the released energy of acoustic waves initiates physiological processes.

The types of treatment that are suitable may differ from person to person depending on genetic, hormones and ethnicity.  The likelihood of Asians getting PIH (post-inflammatory hyperpigmentation) with aggressive fractional laser settings must be taken into consideration when choosing the right treatment.

New treatment tools, clinical studies, and multi-approach protocols are introduced every so often. Many physicians have tried a combination of PRP (Platelet-rich-plasma) or Sculptra (Poly-L-lactic-acid) injections, and hormone analysis as part of their treatment regime. I have definitely used those mentioned combinations before in treating stretch marks and happy to see good results.

I am always looking forward to discovering new methods to battle with this #stretchies, because as much as women can readily embrace their newly earned tiger stripes, they also love that bikini-beach-body-ready for sure!

2016-06-22-PHOTO-00000130

JUNE 2016 – INTERNATIONAL THAI COSDERM CONGRESS ON AESTHETIC MEDICINE . (6TH ITCAM BANGKOK)
PRESENTATION ON STRETCH MARKS : REVIEW AND UPDATE ON TREATMENTS

Resources:

1.Sheu HM, Yu HS, Chang CH. Mast cell degranulation and elastolysis in the early stage of striae distensae.J Cutan Pathol. 1991 Dec. 18(6):410-6.

 

Defying The Aging Eye 

Are your eyes the window to your soul or your age?

Unfortunately, the first signs of aging are often related to the eye.

The common comments by family and friends are usually:

“Are you tired?”

“Did you get enough sleep last night?”

Rejuvenating the eye is one of my favourite treatment as it instantly makes one look FRESH post-procedure!

But first let’s find out what is THE AGING EYE:

  1. Tear Trough Deformity – sunken appearance of the eye that results in the casting of a dark shadow over the lower eyelid, giving the person a fatigued appearance despite adequate rest. This is due to the diminish fat stores in the lower eyelid as we age.
  2. Dark Circles – this is often a result of tear trough deformity. However, the cause of the dark circles can be multifactorial. Changes in skin thickness, laxity and hyperpigmentation can also play a role. Thin skin or prominent subcutaneous venous pooling accentuates the periorbital darkening. 1
  3. Upper Eyelid Sagging Skin – As skin loses its elasticity, this creates a droopy upper eyelid and makes one look sad and tired.
  4. Crow’s Feet – the wrinkles at the outer corner of the eye, more prominent in people who has habitual squinting and often related to a person above 30s.

teartroughstagesofaging

 

Tear trough deformity can be treated non-surgically with Hyaluronic Acid Fillers. The right choice of products (brand and type of filler) and a skilled injector will ensure good results. HA fillers for tear trough usually lasts between 6-12 months.

Not everyone needs HA Fillers for eye rejuvenation, as I have discussed above there are several factors contributing to THE AGING EYE. A proper assessment and careful examination is needed to know if you are a suitable candidate for this type of procedure.

I am just pleased to share that there are non-invasive treatment options such as this procedure, which does not involve surgery and yet can still help one to rejuvenate those tired eyes!

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Image above is my actual patient. Kindly do not distribute images without written permission. Thank you.

Resources:

  1. Sadick NS, Bosniak SL, Cantisano-Zilkha M, Glavas IP, Roy D. Definition of the tear trough and the tear trough rating scale. J Cosmet Dermatol. 2007;6:218–22.

Crystal Tomato Skin Supplement

I was asked to write an article for MIMS Hong Kong on Crystal Tomato® supplements and I would like to share some of the information in this blog.

Asian skin by nature has an increased amount of melanin, and the cells that produce melanin tend to be more sensitive to any type of inflammation or injury. Therefore, the incidence of pigmentary conditions such as melasma, solar lentigos and PIH (Post-inflammatory Hyperpigmentation) are much higher in this part of the world.

The usual treatments include a combination of topical skin lightening agents, light-based device, and prescription-based oral medications.

In the recent years, there have been several oral supplements developed to help people treat skin pigmentation and help prevent further UV damage.

Crystal Tomato® is a type of food supplement which has been scientifically proven to reduce pigmentation and have overall skin brightening benefits. It consists of a unique breed of non-genetically modified white tomatoes and also an amino acid L-Cysteine which helps to boost the liver’s production of Glutathione.

The main benefits and mechanism of action:

  1. It inhibits melanin synthesis and reduces the existing melanin

Crystal Tomato® alters the metabolic processes of melanocytes to turn dark pigmentation (eumelanin) into light pigmentation (pheomelanin).

melaninpathway

  1. It acts as a natural sunscreen and gives protection against UVA/UVB damage

These carotenoids lack any visible colour and they absorb light in the ultra-violet range which makes them ideal for offering protection against UVA/B damage from within.

  1. It has an anti-oxidant and an anti-inflammatory effect

Crystal Tomato® carotenoids can block free radicals from the UV rays. Hence, they act as anti-oxidants to protect against free radical damage by environmental aggressors.

The patients I see in clinic with skin pigmentation such as melasma or solar lentigo find that by consuming this supplement, their pigmentation becomes much lighter after the second month of consumption. It has also benefited patients with post-acne PIH to help lighten the pigmented scar faster.

It is recommended to consume 1 caplet a day continuously for the first three months to see the full effects. Visible radiance and lightening of the pigmentation can be seen from 2-3 months of consumption, however, some patients have also reported lightening effects as early as 3 weeks.

One of the main reasons people are more confident in consuming Crystal Tomato® is because it is 100% made of natural food supplement. To ensure the safety of a supplement, it should be reversible and does not cause long term effects. When the consumption of the Crystal Tomato® supplement is stopped, the brightening effects will also slowly diminish and revert to original form.

I have been recommending Crystal Tomato® as part of Pigmentation Treatment Regime for the past few years and glad to see that results have been consistent and my patients are happy with the noticeable difference too.

In Malaysia, Crystal Tomato® supplements are sold only in clinics. It is registered and approved by  Ministry of Health and every box comes with a hologram sticker and registration number. Just be mindful when purchasing, as there are many counterfeit “Crystal Tomato” supplements out there!

CT-box-imposed-2

A Smarter Approach to a Slimmer Waistline – Part 2

According to the American Society for Aesthetic Plastic Surgery, liposuction continues to be the number one leading cosmetic surgical procedure in 2016, and has seen a 134% increase in the number of procedures performed since ASAPS initiated in 1997. 1

The demand for body contouring is growing so rapidly and this has sparked many new non-invasive technologies to cater to people who are unsuitable candidates for surgery and downtime.

The devices that are available on the market deliver some form of energy that creates changes in the adipocytes (fat cells), which results in shrinkage, apoptosis or necrosis (fat cell death). Some of the energy sources are:

  1. Laser light
  2. Radiofrequency
  3. Acoustic shock waves
  4. Cold (Cryolipolysis)
  5. High-intensity Ultrasound

Many patients have asked me which method is the best for them, at the moment, there is no gold-standard procedure yet, and the methods highlighted above differ by:

  1. Mechanism of action
  2. Response rate
  3. Side effects
  4. Level of discomfort
  5. Number of treatments required

HOT vs COLD

In Malaysia, to date, the top two non-invasive body contouring technologies being used are:

  1. Cryolipolysis – COLD
  2. Radiofrequency – HOT

Freeze the Fat

cryovacum

The device for cryolipolysis has an applicator which is applied to the targeted treatment area, allowing tissue to be vacuumed up between 2 cooling panels for 30 to 60 minutes per treatment session. The current FDA-cleared market leader for cryolipolysis is CoolSculpting by Zeltiq.

An early animal study showed that subcutaneous fat exposed to cold had nearly 80% reduction in fat layer and temperature of -5 to -7 celcius had higher possibility of fat damage after 28 days.2

Some of the temporary side effects with cryolypolisis:

  1. Erythema (redness of skin)
  2. Bruising from the vacuum hand piece
  3. Clay-like skin
  4. Pain
  5. Nodular or diffuse infiltration at treatment area

This would be an ideal method to use for smaller, defined fat accumulation areas where one can benefit from shorter and fewer treatment sessions which will mean time and cost savvy!

Heat the Fat

There are various types of radiofrequency (monopolar/bipolar) device that can be used for body contouring. Heat generated by the radiofrequency device at the adipose tissue can cause apoptosis (cell death) of the fat cells.

Personally, I’ve always been more on the team ‘HOT’ because I find treatments using heat more comfortable, therefore in the past years I have tried many radiofrequency devices as part of body contouring regime, but what caught my attention in 2014 was Vanquish ME by BTL Aesthetics. The first non-contact radiofrequency machine that selectively targets fat cells and has minimal effect on other surrounding tissues.

Vanquish_issue_selectivity

 

The applicator is placed 1cm above the skin of targeted treatment area and duration of one treatment session is about 45 minutes.

Recommended treatment sessions depend on the targeted circumferential loss, but generally, 4-6 sessions can result in a reduction between 4-8cm in abdominal circumference.

Some of the temporary side effects:

  1. Erythema (redness of skin)
  2. Tenderness
  3. Panniculitis – (localised volumes of fibrosis-encapsulated fat)

Vanquish would be ideal for large body area in patients with high BMI, ie>25 as a single application can easily cover the abdomen and flanks (love-handles) bringing it close to competing with liposuction for those not willing to undergo surgical procedures. 3

In conclusion, there is no ‘one-method-fits-all’ when it comes to achieving that slimmer waistline. Different people have different targeted treatment areas and fat volume, therefore a full and thorough assessment is crucial to ensure treatment regime are the most optimal!

Resources:

  1. International Society of Aesthetic Plastic Surgery. Global Statistics. Available at: http://www.isaps.org/news/isaps-global-statistics.
  2. Manstein D, Laubach H, Watanabe K, et al. Selectivecryolysis: a novel method of non-invasive fat removal. Lasers Surg Med. 2008;40:595-604.
  3. Chilukuri S, Mueller G. “Hands-Free” Noninvasive Body Contouring Devices: Review of Effectiveness and Patient Satisfaction. Journal of Drugs in Dermatology. 2016;15:11:1402-1406.

A Smarter Approach to a Slimmer Waistline ~ Part 1

 

“Lose the belly FAT and you will look FAB!”

“Oh he has a belly, he surely is married!”

Do you notice how much attention we give to the fat around our abdomen (tummy)?

In some certain way, a little stigma is somehow related to having that excess fat around the waist.

The subject of fat loss and body contouring have somehow always been brought up in my consultations since day one.

The patients who come to see me usually have already exhausted their options at achieving the ideal figure. Some have spent countless hours at the gym combined with healthy food options or diet supplements and despite all that, their love-handles remained the same.

Through the years, we discovered that when it comes to weight loss, the “one approach fits all” practice, does not actually fit it all.

We are of different genetic backgrounds with different lifestyle and eating habits and different daily calorie intake requirements.

Identical twin studies have proven that between 30% to 50% of the variation in human weight is due those factors.

Surely a multidisciplinary approach tailoring to individuals would be an ideal method for efficient weight loss.

So…what do we need to analyze?

  1. Nutrition

That input…can stay put!

Nutrition is the basis for all human form and function, the source of fuel that provides energy for all biological work.

Our weight is determined by the energy balance – if energy intake exceeds output, the excess calorie will then be stored in our body, therefore the weight increases.

energybalance

A well-balanced nutrition is much desired and the understanding of one’s minimal daily calorie intake requirements and the energy expenditure used can prevent from rapid fluctuations in body weight.

Some studies show that vigorous-intensity aerobic exercise (with caloric restriction) do not lead to a preferential loss of abdominal fat and there are more practical exercises that can be prescribed to ensure higher patient compliance [1].

Choose a fun and enjoyable activity to increase that energy expenditure and make it a consistent routine!

Without commitment, you’ll never start.

Without consistency, you’ll never finish.

2. Hormones

Since early 1990, physiologists have discovered a ‘still-growing’ list of hormones (aka gut-brain peptides) and pathways that control short- and long-term appetite and body weight. The interactions of these hormones in the body, play a major role in overall body weight, and not forgetting that as we age, the fluctuation in hormones make it harder for one to lose that excess fat.

There is enough evidence in the existing literature for the association between increased abdominal adiposity and insulin resistance.

People with low DHEA levels, women with PCOS (Polycystic Ovarian Syndrome) and men with low testosterone will find that their efforts at losing weight especially around the abdomen can be a losing battle.

Therefore, a full blood and hormone profile are highly recommended to ensure proper diagnosis and optimal treatments are prescribed.

3. Lifestyle

lifestyle

There have been studies to show that excess sedentary time is associated with increased accumulation of central adiposity and other markers of cardiometabolic risk. [2]

In one survey in the USA, 65% of the population claimed to live an active lifestyle, however when people’s level of activity was actually measured, research shows only 5% of the population is living an active lifestyle [3].

In part 2, I will share on how non-invasive medical devices can assist you to go from belly fat to belly flat…stay tuned!

 

Resources:

  1. Nicklas, B. J., Wang, X., You, T., Lyles, M. F., Demons, J., Easter, L., … & Carr, J. J. (2009). Effect of exercise intensity on abdominal fat loss during calorie restriction in overweight.
  2. Wijndaele K, Healy GN, Dunstan DW, Barnett AG, Salmon J, et al. (2010) Increased cardiometabolic risk is associated with increased TV viewing time. Med Sci Sports Exerc42: 1511
  3. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometerMed Sci Sports Exerc 40: 181–188, 2008.