Botox vs Fillers

Even though more people are aware of cosmetic medicine and the basic ‘tools’ Aesthetic Practitioners have been using for years to reduce wrinkles and restore volume loss, there is still a big misconception when it comes to Botox & Fillers.

Here are the 5 most common questions I receive in the clinic during consultation:

1. Is Botox a Filler?

No, Botox is NOT a filler, also do note that Botox is a brand name. The key ingredient in Botox is Botulinum Toxin Type A (BTX-A).  Other approved brands in the market are Dysport and Xeomin.

BTX-A is used to reduce dynamic wrinkles which are wrinkles that occur during motion or facial expressions. The injections are targeted to the MUSCLE as opposed to fillers which are usually injected to lower level of the skin (subdermal), fat pad area, or deep to the bone.

To understand how Botulinum Toxin works, we first need to know a little bit about muscle contraction/movement. Acetylcholine (Ach) is the neurotransmitter associated with induction of muscle movement. When BTX-A is injected into the muscle, it causes a disruption of the proteins required for the release of ACh, therefore resulting in temporary targeted muscle paralysis. This effect is temporary and persists approximately 3-5 months. Muscle function returns as new neuromuscular junctions form.

Botulinum-toxin-Mechanism-Action

2. Will I have an expressionless face or the ‘frozen-fake’ look?

No, having BTX-A injections does not necessarily lead to ‘frozen-fake’ outcome. It is essential for you to inform your Aesthetic Practitioner your habitual facial expressions which will be considered when your doctor decides the injection sites.

For instance, someone who uses a lot of the Frontalis muscle (forehead muscle) when talking, may not want to eliminate those lines totally as it will affect their daily facial expressions and positioning of the eyebrows.  The right amount of BTX-A Units and the appropriate injection sites should result in a ‘Rejuvenated & Natural’ outcome.

3. Am I too young for Botox?

Many people think that Botulinum Toxin injections are only given to people above 50 years old. In the recent years, more women and men are getting their injections in their 30s as a preventative-type intervention to delay the process of wrinkles from forming prematurely.

4. Do men get Botox injections too?

The phenomenon of ‘Brotox’ is real. Men are getting BTX-A injections just as much as the women these days. However, the technique of injections may differ slightly in order to respect the anatomical differences between men and women.

5. Will my wrinkles get worse if I decide to stop getting the injections?

No, if you decide to stop the injections, the muscle function returns as usual and it would not be worse than before. However, people may perceive it as being worse, because they were used to seeing their face without wrinkles for months and the sudden reappearance of wrinkles may be slightly overwhelming. Due to reasons like these, most of the aesthetic procedures will require before/after photo documentation.

***Botulinum Toxin injections are not only used in cosmetic procedures but are widely used in the hospitals to treat medical conditions such as muscle spasms (blepharospasm, cervical dystonia).

 

 

 

 

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]

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!

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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.

 

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!

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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.