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]

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!

IMG_6679

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

ES_7007

 

ES_7241

ES_7276

ES_7290

ES_7369

 

 

 

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!

IMG_2198

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