Botox

Botox has become a household name in recent years primarily due to its popularity in cosmetic usage. Botox has been used in the medical field for many years to treat medical conditions such as cervical dystonia, chronic migraine, eye twitching and lazy eye. In this article, we are going to focus on cosmetic usage of Botox.

Before we go into the details, we need to be clear that “Botox” generally means Botulinum toxin A. As of now, there are 4 approved brands of Botulinum Toxin A to be used in Singapore for medical and cosmetic purposes – Botox, Dysport, Xeomin and Neuronox. For the purpose of discussion, we will use the term Botox because it is a common household name. It is like how we refer to all portable cassette devices as Walkman (if you are old enough to know this) and all diapers as Pampers.


What can Botox do?

Improve Facial Wrinkles

Botox works by blocking certain chemical signals from nerves that cause muscles to contract. By doing so, it can reduce the appearance of facial wrinkles caused by excessive facial expressions. The most common use of Botox injections is to temporarily relax the facial muscles that cause wrinkles on the upper part of the face. 

Some examples of commonly treated areas are:

Forehead wrinkles – Lines that appear on your forehead when you raise your eyebrows.

Frown lines – Wrinkles between your eyebrows that make you appear unfriendly or unhappy.

Crows feet – Wrinkles that appear at the corner of your eyes when you smile.

Bunny lines – Fine lines that appear when you scrunch up your nose.

Chin wrinkles – Wrinkles at your chin that make your chin appear to have multiple small dimples.

Marionette lines – Wrinkles at the corner of your mouth that make you appear sad.

Perioral lines – Fine lines around your mouth (google Helen Hunt for an example).

Each treatment result with Botox can typically last for about 3-4 months, after which repeated treatments will be required. 


Jaw Shaping

Botox is commonly used in the cosmetic field to improve the appearance of a squared or broad jaw. Treatment is also sometimes known as jaw reduction or jaw slimming. This treatment is more commonly done for women. However, due to the popular K-pop culture, we are also seeing a rise in male patients having this treatment done. In K-pop culture, a smaller or more feminine male’s face is perceived as looking more attractive.

If you dislike the fact that you are blessed with a broad muscular jaw due to large jaw muscles (also known as masseter muscles), Botox treatment can help reduce the broad jaw appearance.

Once Botox is being injected into the masseter muscles, it will reduce the muscle activity and muscle contraction. The muscles will then shrink in size gradually over a few weeks, the same way as how your biceps shrink over time if you do not work out. This way, you will observe a gradual reduction in your broad jaw appearance. 


Excessive Sweating (Hyperhidrosis)

Botox has the ability to temporarily block the secretion of the chemical that is responsible for activating the sweat glands. This way, it can “switch off” sweating at the area where it has been injected.

Areas that are commonly treated with Botox for excessive sweating are underarms, palms and forehead. After injection, improvement can be seen within 1-2 weeks. The effect of sweat reduction can last for about 4-6 months, after which repeated treatment will be required to maintain the efficacy of the treatment.


Teeth Grinding (Bruxism)

Botox can be used to improve excessive teeth grinding, the same way as how it helps with jaw reduction. 

Most people with bruxism have no symptoms and are not aware they are doing it. Some may experience facial pain and headaches especially when they wake up in the morning. If you wake up every morning with a headache, you may well be suffering from bruxism. By injecting Botox into the masseter muscles, it reduces the muscle contraction and shrinks the muscles over time. This way, it also reduces the severity of bruxism. 


Skin Lifting

Botox, in particular Dysport brand of botulinum toxin A, can be used for a skin lifting procedure known as Dysport dermalift. Dysport dermalift is a unique non-surgical face lifting technique invented by a renowned plastic surgeon in South Korea, popularised by its efficacy, immediate and long lasting result.

This treatment involves multiple micro-injections of Dysport into the skin at specific points on the face. This stimulates the fibroblast cells in the skin to produce more collagen. It also stimulates cellular cytoskeleton of the skin cells to bind to more elastin and collagen. These changes result in an instant skin tightening and face lifting effect which improves in the next 1-2 weeks.


Body Parts Slimming

Although not popular in this part of the world, Botox can be used to slim body parts such as calves and upper arms. Botox, when injected into specific areas of calf or upper arm muscles, can effectively shrink the bulk of the muscles and make the calf or upper arm appear slimmer over a period of time. The slimming results can usually last for about 4-6 months.

However, this procedure can only be performed by highly trained doctors because of the risks involved. 


In summary, besides treating wrinkles, Botox can also be used to treat many other conditions. It is very important to note that in Singapore, Botox can ONLY be administered by professionally trained doctors. Botox treatment is safe but is not without risks. Therefore, if you wish to get Botox treatment done, please remember to discuss with your doctors in detail before the treatment.

Dry skin is no fun to deal with wherever it crops up. When it happens under the eye, it can be especially bothersome. Not only does it make us look tired, it also can cause concealers and make up to cake. 

What causes dry skin under the eyes? 

The skin under our eye is thinner and more delicate than on other parts of the body. This also means that it is not as able to retain moisture and is more susceptible to drying out. This can lead to flaky skin which can become itchy, irritated, red, and discoloured. Chronic dry skin can also affect elasticity which can lead to early fine lines and wrinkles. The good news though is that we can manage this and prevent it from happening again. 

How to treat and care for dry skin under our eyes? 

Start by simplifying your beauty routine. The right products along with consistent cleansing and hydrating goes a long way. 

1. Avoid harsh products 

Overuse and overzealous regular use of cleansers and skincare products such as scrubs, deep cleansers and peels that contain harsh chemicals or alcohol can seriously dry out your skin. The skin around your eye is especially susceptible to this. 

2. Be consistent 

Make a habit of washing your face once in the morning and once at night. Switch to a mild or soap free facial cleanser and use gentle strokes with lukewarm water instead of hot water. Lightly dab your moisturizer or eye cream onto the sensitive eye area. Also, it is especially important to remove makeup before going to bed. 

3. Reduce oxidative stress to your skin 

This includes reducing the booze and the tobacco, protecting your skin against the harsh effects of ultraviolet rays (UV). Other lifestyle factors changes you can make include not rubbing beneath your eyes, using only lukewarm water on your face, avoid reapplying under-eye makeup too often and always using clean makeup brushes. 

4. Look after your diet

Adequate hydration is essential for health. It is also a good countermeasure against dry skin. Make sure you get enough antioxidant-rich foods and avoid overly processed foods, refined carbohydrates and soda drinks. 

These are some measures that can help us delay the onset of fine lines and devitalized looking eyes. A skincare routine that is easy to commit to in the morning and night will treat existing dry skin and prevent it from tipping over to becoming a chronic issue. 

If it does not improve however, it is important to speak to your doctor. Get it looked at to rule out any underlying medical issue, and to seek advice regarding more heavy duty measures such as polynucleotide, hyaluronic acid injectables or fillers that the doctors may advise to help with it.

Do you seek advice for your skin issues from the internet? 

Social media has become such an inherent part of our lives that often, the first thing that comes to mind when we have a question to answer is scroll through our Facebook, Instagram, TikTok feeds for the solution. This often gives us a mix of results, some work, and some do not work. We often just laugh off the ones that do not work and promise ourselves not to follow it again, just to go through the same cycle soon after. 


This is benign in many circumstances, but more recently, a survey published (Yousaf A et al. Pediatr Dermatol. 2020 Jan 15. doi: 10.1111/pde.14091.) suggests that many patients consult social media for advice even on acne treatment. Also showed in that same study is that the majority of people who do will go on to follow recommendations that do not align with proven clinical guidelines. 

The study surveyed 130 patients of whom 45% consulted social media for advice on acne treatment and 52% of those went on to follow recommendations that do not correspond to medical guidelines. Most patients reported no (40%) to minimal (53%) improvement in their acne after following the advice. 


Of the most common social media platforms used, YouTube and Instagram came tops, with 58% each, followed by Pinterest (31%), Facebook (19%), Twitter (9%), Snapchat (7%). [patients could select more than one platform].

The social media advice patients went on to follow included using over the counter products (81%), making dietary adjustments (40%), using self-made products (19%) and taking supplements (16%). 

Of these, only 7% reported significant improvement in their acne. This is a concerning trend, and poor results are likely due to inaccurate content on social media compared to healthcare sources. 


It is not difficult to see why there is so much misinformation on the internet. Social media is increasingly becoming not just the main route of marketing products, it has also indirectly fueled emotional and mental associations of an individual to their appearance by increase in usage of social media and photo-editing apps. The global anti-acne cosmetics market size was valued at USD2.07 billion in 2018 and continues to grow year on year. With multiple parties trying to get a share of the market, unscrupulous parties have marketed products either with false claims, using a variety of marketing tactics to reach these vulnerable patients. 

Acne patients are prone to suffer from anxiety, depression, low self-esteem, poor quality of life and loneliness, and it is not rocket science as to why that is. Acne can be a debilitating disease, and may leave permanent scars which are sometimes even more difficult to treat than the acne itself. In the survey, about half of the patients (51%) had moderate acne, while 38% had severe acne. Only 11% of the patients surveyed had mild acne. Taking up the advice on social media means that patients with moderate to severe acne may have been delayed in their seeking medical treatment for their acne, and deprived of early treatment. It is especially crucial in these patients that medical treatment of acne is instituted quickly and effectively to prevent lifelong scarring. 

Acne is not only a social concern. It is a medical condition with medical treatments that are able to address it. Solutions seen on social media may be effective for one person, but the results may be the complete opposite in another individual. Treatment of acne is never a once-size-fits-all solution and a tailored treatment based on the assessment of the doctor is crucial for its success. Unproven treatments are never a replacement to medically proven treatments that have not only been reviewed for their efficacy in labs, but in large randomized controlled trials all over the world. 

If you are suffering from acne, speak to your doctor about treatments before speaking to Dr. Social Media.


ultherapy singapore

An Overview of Common Ultherapy Myths in Singapore.

I wrote this article in response to some of the most frequently asked questions in my practice about Ultherapy treatment. There is a lot of confusion and misunderstanding about Ultherapy and I hope this article will help you answer some of your concerns.

Ultherapy treatment uses microfocused ultrasound energy to stimulate the body in renewing and replacing existing collagen under the skin. This non-invasive ultrasound treatment, if used correctly by trained doctors, can effectively lift and tighten loose and saggy skin areas such as the cheeks, jowls, jawline, brows and neck area. Here are some of the facts about Ultherapy treatment:

  • FDA approved skin tightening treatment
  • Totally non-invasive
  • Works for women and men
  • Minimal to zero downtime
  • 1 treatment produces results
  • Results last for 12-18 months
  • Good safety profile

Myth 1: Ultherapy will melt my fillers

There are no clinical studies that show that Ultherapy dissolves fillers. On the contrary, in my experience, fillers such as Ellanse and Radiesse work synergistically with Ultherapy to stimulate collagen production.

Ultrasound energy from Ultherapy works at an optimal temperature of approximately 60-70°C. To put things in perspective, the sterilization process of hyaluronic acid gel requires a temperature of approximately 120°C. Even at a high temperature of 120°C, filler gel remains solid and intact. So how would a temperature of 60-70°C melt your fillers?  

Furthermore, Ultherapy has a real-time visualisation screen that allows us doctors to see in detail the structure of the skin, fat and muscles, and the exact location of the fillers. An experienced or well trained doctor will be able to deliver the energy precisely into the correct layers of your skin and avoid touching the fillers in the process.

Myth 2: Ultherapy will melt my fat and make my face look sunken

There are no clinical studies that show that Ultherapy can melt away fat. Ultherapy, if done correctly by experienced doctors, should not have any impact on fat cells. 

However, in theory, if the person performing the treatment is not well trained or not meticulous with the treatment, the continuous ultrasound heat energy delivery into the same spot repeatedly can generate high enough temperature to destroy fat cells. 

Therefore, it is important to get Ultherapy done by a doctor who has been trained to perform Ultherapy correctly and safely.

Myth 3: Ultherapy treatment is very painful

When Ultherapy was first introduced in 2007, it was indeed a painful treatment, hence the stigmatisation. 

However, since then, technology has advanced significantly and  many improvements have been made. The new generation of Ultherapy machines are able to deliver much more comfortable and precise ultrasound energy that produces wonderful results.

In my practice, with adequate pain management protocol, all my patients are able to undergo Ultherapy treatment comfortably.

Myth 4: Ultherapy treatments are the same everywhere because everyone uses the same treatment protocol

Being a trained Ultherapy expert, I get very disappointed when I hear this statement from patients. The fact of the matter is, ultherapy equipment is uniquely designed for women and men with different facial anatomies. In my practice, every single patient is treated with customized protocols based on their gender, age, ethnicity, facial anatomy, skin type and concerned areas. It is not just about the number of shots and the energy level. Customizing the treatment protocol is a complicated process that takes into account many factors after a thorough facial assessment is done. 

I do not deny that a lot of people out there treat every patient with the same protocol. The reason they do so is because they do not have a clear understanding of human anatomy and are not properly trained to handle the equipment. Sometimes, it is just because it is less time consuming. If you choose to receive Ultherapy treatment in a medical spa or by poorly trained professionals just because the price is lower, then you will get what you paid for.

Myth 5: The more shots I receive, the better results I get.

Recently, there is a trend going around where patients specifically ask about the number of Ultherapy shots given, and choose to go for places that offer the most number of shots. Ironically, some of these places that offer the most number of shots also offer ridiculously low prices. 

As mentioned in the previous paragraph, an effective and safe Ultherapy treatment is not just about the number of shots. The more important thing to look out for is whether or not the place uses authentic Ultherapy equipment, and if the person performing Ultherapy treatment is a well trained doctor. In my practice, every patient is treated with customized protocols taking into account multiple factors after a thorough assessment. 

Myth 6: Ultherapy result only lasts for 6 months

Ultherapy stimulates production and regeneration of collagen, which takes about 3 months to mature and get strong enough to provide visible support to the skin structure. After that, results can last for 12 – 18 months. Ultherapy treatment produces long lasting results after one single treatment.

Myth 7: Ultherapy can only be done on the face

Besides face and neck, Ultherapy treatment can be used on various parts of the body to tighten the skin. Some of the areas that can be treated by Ultherapy are: Chest, butt, arm, under butt, above knee, abdomen, double chin.


What do I think of Ultherapy treatment as a doctor?

  • One of my favourite treatments so far.
  • I personally perform this treatment for my patients.
  • I highly recommend Ultherapy for my female and male patients.
  • I customize the treatment for each patient. 
  • I start Ultherapy treatment for patients around early to mid 30’s. 
  • I use it in combination with other treatments such as fillers and pico laser.

I hope this article clears some confusion and misunderstanding about Ultherapy. Lastly, I urge you to choose your Ultherapy provider wisely to get the treatment done safely with good and long lasting results.


Nose Job

Dermal filler treatment has become one of the most popular cosmetic treatments ever since it was popularised by Hollywood celebrities and influencers such as Kylie Jenner and Kim Kardashian. Information about dermal fillers is widely available on the internet and social media. However, there are still a lot of misconceptions and confusion regarding filler treatment. For the purpose of this discussion, the fillers that I refer to in this article are the more commonly used fillers these days such as hyaluronic acid (HA) fillers. 

I am going to clear some of the misconceptions my patients have regarding dermal fillers treatment.


Misconception #1: I can use 1 syringe of filler to treat every part of my face

I often get patients who request to use only 1 filler to treat multiple areas, presumably due to budget concern or the fear of having too much fillers injected in the face. For example, a patient may ask for 1 filler for the chin, the under eye and the lips. 

There are 2 issues here. Firstly, different areas of the face have to be treated with different types of fillers. Secondly, 1 filler is often insufficient to treat so many different areas. 

There are many different types of fillers designed for specific areas of the face. For example, fillers for the chin (such as Restylane Lyft, Juvederm Volux and Belotero Intense) are what we commonly refer to as hard fillers. These fillers are designed to sculpt areas that require definition and absolutely cannot be injected in the under eye areas.

Therefore in this example case, this patient will require at least 3 fillers to treat the 3 areas mentioned – 1 hard filler for the chin, 1 hard filler for the temples and 1 soft filler (such as Belotero balance, Juvederm volbella or Teosyal Redensity II) for the under eye areas.

In other words, 1 filler is often not suitable or insufficient to treat multiple areas of the face.


Misconception #2: I will look worse if I stop doing fillers

A very common misconception is that once you start filler treatment, you will never be able to stop, because once you stop and the fillers wear off, you will look worse and older than before.

Some people also use this as an example of being “addicted” to injecting fillers.

Fillers are designed to restore volume loss and lift the skin to produce a more youthful look. With an adequate amount of fillers injected in the right place, I repeat – in the right place, it can help make your face look younger than your actual age. 

Once injected, fillers also stimulate your skin collagen production. Therefore after just one filler treatment, you will look better than when you started even after fillers have disappeared over a period of time. After repeated treatments, the results last longer and longer.

However, one day if you decided to stop doing fillers, it is absolutely fine. The fillers that have already been injected into your face would have done its job of delaying and interrupting the continuous ageing process of your facial skin. 

Don’t get me wrong. You will still continue to age. But you WILL NOT look worse than before you have had any filler treatment. In fact, you will look younger than your actual age.


Misconception #3 : Filler treatment makes my face look weird and unnatural (often quoting examples of Hollywood actress)

You may have seen pictures of celebrities who look more and more horrible over time, presumably from botched cosmetic treatment. Yes, filler treatment may be one of the culprits, but this is often due to poorly done or excessive cosmetic treatments they receive over the years – a combination of surgical and non-surgical cosmetic treatments.

As I mentioned before, an optimal amount of fillers injected in the right place with the right technique will never make your face look unnatural. In fact, a good filler treatment result is often “invisible”.

One of the biggest problems with filler treatment nowadays is excessive treatment or overfilling. This is often due to 2 reasons: patients keep asking for more fillers, and doctors fail to tell patients that more fillers will be too much for them. Excessive treatment will almost always result in a weird and unnatural looking face. Fillers, when administered by an experienced doctor, should produce beautiful and natural results. 


Misconception #4: Filler treatment is easy. I can get it done by anyone.

Filler treatment can only be performed by well trained and qualified doctors. Filler injection is an extremely complicated procedure. It requires an extensive understanding of human facial anatomy, a professional facial assessment skills and a well trained pair of hands to deliver the injection safely and effectively.  

Your doctor will need to understand your concerns and expectations, and explain to you how he or she can help you achieve a realistic result. Filler treatment is a complex procedure. Please do not get it done by just anyone.


Misconception #5: I am paying too much for the filler product. I would rather go to a cheaper place. 

Filler treatment prices vary in different places. A common scenario is when patients “shop” around for the cheapest price and make a decision on where to get filler treatment done based on which place offers the lowest pricing. 

Many people fail to realise that when it comes to cosmetic treatment such as filler injection, you are paying for the skills and professionalism, NOT the product. 

Let me give you an example. If you need a good haircut, you will pay a good hair stylist to cut your hair. You are paying for the hair stylist’s skills. You are not paying to have a pair of scissors and just let anyone cut your hair. Similarly, if you wish to have a good filler treatment, you will be paying for the doctor’s professional skills, not the filler product.

Having said that, the type of filler products being used do play a major role in the pricing of the filler treatment. As the saying goes, you get what you paid for. It is important to ask what fillers your doctor will be using on your face because safety is still the top priority when it comes to cosmetic treatment.


Misconception #6: The longer lasting the filler is, the more bang for the buck I get

There are many different brands of fillers out there. The common brands that are approved in Singapore are Juvederm, Belotero, Restylane and Teosyal fillers. Each brand has a whole range of different fillers that have different longevity, consistency, cohesivity and character.  Many patients tend to request to have the “longest lasting” filler because of the idea of making the money spent more worthwhile. Very long lasting filler may not necessarily be a good thing. In fact, it may potentially cause more problems in the future such as infection and formation of hard lumps (granuloma). 

We need to understand the ageing process well in order to understand why temporary (short term) fillers are the choice of fillers for most doctors these days. Skin ageing is a continuous process. Therefore, any cosmetic or anti-ageing treatment, including filler treatment, has to be intermittent and ongoing. A long term filler, once injected, stays with you for a long time. However, the filler does not automatically mold or change its shape and consistency according to how your face changes when you age. If it sticks around for too long, you may end up looking odd and unnatural. 

By using short term fillers, your doctor will be able to treat you at different stages of your ageing process effectively and safely. 


Misconception #7: If my friends did not notice that I have had fillers done, it is a waste of money – the doctor must have done a terrible job

As I mentioned earlier, a well done filler treatment is often “invisible” – no duck lips, pillow face or louhan fish forehead. In my practice, I often stress the importance of looking natural after filler treatment. If your filler can be specifically pointed out by a lay person, it usually means that it is not done well or there is too much filler being injected. When administered by an experienced doctor, the result should look natural and not dramatic. 

A skillfully done filler will have your friends commenting that you look more refreshed, younger or more attractive, but they will never be able to work out what treatment you have undergone. 

So the next time your friends did not ask you if you have had fillers done, do not worry. Your doctor has most likely done a very good job!        

I hope I have successfully clarified some of your misunderstanding regarding filler treatment. Please remember this the next time you wish to have fillers done : Safety is of the utmost importance. Choose your doctor carefully. Talk to your doctor, let your doctor assess your face thoroughly, address your concern and plan a good treatment based on your budget. Trust me, you will get the most out of your money this way.


One too many times do we meet a person who has been dieting and exercising regularly, but just cannot get rid of a few spots of stubborn excess fat. The only solution used to be liposuction, that is until the last few years when the advent of fat busting treatments on the medical aesthetics market changed this. They became a new trend in removing excess fat, and it is easy to see why – non-invasive, low-risk, minimal to no downtime.

Over the last decade, many different technologies for body contouring by means of permanent fat reduction appeared in the market. Two of the best body contouring technologies are radiofrequency and cryolipolysis (cold induced fat cell death). 

This leads to a common conundrum among people considering taking up a treatment for body contouring – which is better? 

FIRST, HOW DO THEY WORK

The two types of treatment are actually very similar, but polar opposites at the same time. They both work by killing off fat cells, which our body subsequently eliminates via the lymphatic system and liver. However, the great difference that sets them apart, is the temperature: radiofrequency destroys fat cells by heating them up, while cryolipolysis works by freezing them.  

The reason both treatments can be used selectively on fat cells is because fat cells do not contain much water, rendering them sensitive to these treatments. 

SO, WHICH IS BETTER? 

This is a tough call to make. Each treatment has its own advantages and might be more suitable depending the results you are after. 

Cryolipolysis treats pockets of fat well, but it can be hard to reduce fat uniformly. Radiofrequency on the other hand can treat over a large area, and is useful when treating someone with uniform fat. Radiofrequency also triggers the body’s natural healing responses which stimulates collagen production, so it is a great treatment when there is also loose skin. 

WHICH IS FASTEST?

With radiofrequency, optimal results are typically seen only after 4-8 sessions, whilst for cryolipolysis, it takes about 2-3 treatments per area. Maximum results are typically 2-3 months after the sessions. 

BEST FOR PAIN AND RISKS?

Both treatments are non-invasive, and there is no downtime. Typical effects after treatment are mild redness and swelling. For both cryolipolysis and radiofrequency, there is the odd case of skin burns. This is typically due to usage of machines that aren’t safe to use, or if the practitioner is not up to standard. To avoid this, make sure you do your homework. 

IN SUMMARY


Fat Freeze (Cryolipolysis)Radio Frequency
ProsGood for treating stubborn fat
pockets
Results in 1-3 sessions an area
Can treat deeper fat
15-25% fat reduction in treated
area
Good for treating uniform
fat
Comfortable
Short sessions (20-30 mins)
Skin tightening
ConsEach treatment takes an hour
Discomfort and soreness may set in
after a day or two
Results may need numerous
sessions
Some machines may feel
very hot

CAN I COMBINE TREATMENTS

Of course you can! Patients who combine treatments see better results. This is because fat freeze is useful in treating fat pockets, which are most commonly deep, whilst radiofrequency is better at targeting uniform fat that is often superficial in nature. Radiofrequency also treats the skin and tightens your skin after the loss of fat volume. Do be aware however that heating and freezing treatments should NOT be done on the same day. 

BEFORE YOU MAKE YOUR FINAL DECISION

Do… check the brand of device your practitioner is using. Not all cryo or radiofrequency machines are created equal. There are many copy-cat cryolipolysis machines to be wary of as not all are FDA approved. It is already difficult to pick where to go for the treatment, and picking the pedigree of the device can even be more so. One thing NOT to do is to be led by the price 

Don’t… think of body contouring procedures as weight loss treatments. The treatments are more of a case of shifting a stubborn bit of fat that exercise and diet just won’t budge, especially the lower tummy, love handles, flanks and thighs. In most clinical studies done for these treatments, patients saw loss in inches rather than loss in weight. If you are interested in dropping your Kgs rather than just inches, there are appetite suppressant treatments such as Saxenda, or the good old fashioned diet and exercise.  


5 Things You Can Do to Have Healthy Skin in the COVID-19 Circuit Breaker

The recent COVID-19 Circuit Breaker means that a lot of us have now either brought our work home, or are on a period of extended leave. It also means that we are now not able to go for our routine facials and skin treatments. 

How can we keep our skins looking healthy and not look like we aged a decade when we complete this month-long social segregation?

Below we share five things we can do to keep our skins supple and healthy in this period. 

1. Hydration

Now that we are stuck at home, whether working or not, “having no time” is no longer an excuse for skipping or forgetting that all important H2O that we too often have no time for. Water is one of the most important liquid to drink as it acts as a transporter and is also an important substrate in many of our body processes.

For our skin, water keeps it hydrated and youthful looking by filling and plumping up the hyaluronic acid molecules bounded within the collagen fibres in our skin. It can also improve complexion and early fine line and dull skin.

It can also help weight loss by replacing our modern day calorific rich drinks such as sodas, sweetened coffees etc. 

2. Balanced Diets

Being asked to stay at home does not mean we can relax on our diets. In fact, it may be a good time to assess our diets and ask ourselves if we are eating as healthy as we ought to be. With the decreased energy expenditure now that we are not commuting daily to work, or for those of us who have a job scope that is more physically active, now that our days are more sedentary, it is important that we try to cut out as much as possible refined and processed foods.

Swap a meal for a healthy salad, or do that home cookout instead of reaching over to your phone for the next takeout meal. These will allow us to incorporate into our diets more antioxidant-rich foods that have been proven to push back ageing while removing the refined, processed and sugary ones that are now known to add years onto our skin and health. 

3. Exercise

Now that we have time to plan our day out, including an exercise session at least 3 times a week can help not just our health, but also our skin. Exercise is great for the body and mind, and can also do wonders for our complexion.

Sweating can help flush out toxins from our pores. Do be aware to wash after a session, as leaving sweat, dirt and sebum on your skin can cause breakouts and sensitivity. By working out, we can also maintain healthy levels of the stress hormone cortisol and help stimulate collagen production to keep our skin firm and supple.

Improving muscle tone can also make our skin look firmer and reduce the appearance of cellulite. There is also the post-workout glow which happens when our skin receives a good dose of oxygenated blood and our skin starts producing its natural oils. 

4. Get Sufficient Rest and Sleep

One of the things most of us loathe on a workday is needing to sleep late and wake up early. There is now little excuse to deprive our bodies of its much-needed sleep. Benefits of sleep for skin include fewer wrinkles, less sagging, rejuvenated colour, fewer acne blemishes and less inflammation. The reasons for these are many, but some of them are because the skin repairs itself at night.

During this overnight process, our skin builds collagen, elastin and hyaluronic acid, all of it responsible for our skin’s plumpness, translucency and elasticity. Getting sufficient sleep also boosts our immune system and reduces the stress hormone cortisol which then reduces our propensity to developing acne and inflammation.

Increased blood flow during sleep into our facial area also helps remove free radicals and pollutants accumulated throughout the day and helps repair any damage incurred and restore our complexions to a radiant colourful glow.

5. Overhauling Our Skincare Regimen

Now that we are deprived of our weekly/fortnightly facials, we need a skincare regimen that can continue to target our active skin issues whilst protecting us against oxidative stressors and ageing. How do we go about this? 

a) Select your skincare products based on your skin type and lifestyle, e.g. cleansers should not only suit your skin type, but also be sufficient in removing the type and amount of makeup that you use, or in removing any type of occupational exposures. Foaming liquids are generally suitable for people with oily or acne-prone skin, whilst micellar water are more suitable for individuals with normal skin. Mature skin may require cleansers that are more moisturizing such as a melting balm or cream-based cleanser.

b) Gone are the days of toners being an alcohol-based product used for drying up oily skin and removing any leftover dirt after cleansing. In the modern day regimen, toners are a good way to add in specific ingredients that you may not have in your other products. These can be alpha and beta hydroxy acids, hyaluronic acids, vitamins or even simple things such as rose water. They should be done after cleansing, before putting on anything else.

c. Serums are powerful skin allies which we can use to address specific issues, such as pigmentation, dark spots or wrinkles. These are usually applied after your toners but before moisturizers. Some ingredients to look out for are hyaluronic acid to seal in moisture, vitamin C to brighten dull skin and decrease dark spots, retinol, vitamin B3 and peptides for anti-ageing.

d. Moisturizers should like cleansers, be selected based on your skin type and lifestyle. Everyone needs moisture but the texture of your moisturizer will differ based on your skin type. What a moisturizer should provide however is to protect your skin from environmental aggressors and replenish moisture levels.

e. Protecting your skin with a sunscreen. It goes without saying that sunscreen is hands down the most crucial skincare product. Daily and consistent use of sunscreen helps to prevent the development of fine lines and wrinkles, textural imperfections and changes in the appearance of pores over time.

With these, we hope that you are now better equipped to deal with the different set of challenges that the COVID-19 Circuit Breaker throws our skin. Let us all be consistent, and take good care of our health, well-being and skin during this difficult period. 

Hydroquinone is one of the most famous whitening agents. It is most studied to date, and very effective. However, it does have some serious side effects, can be irritating to skin and has been heavily restricted in some countries. 

Today, we look at some of the other whitening agents on the market, how they work and what side effects they have. 


HOW DO SKIN WHITENING AGENTS WORK?

Whitening agents in the market work in a number of different ways, some in more than one way. But most will generally slow down the production of melanin, which is what gives our skin it’s colour and tone.

The agents available on the market generally work by acting on the first step of melanin synthesis – the conversion of tyrosine into DOPA and dopaquinone by an enzyme called tyrosinase. They work by either:

  • Acting as a mimic of tyrosine – essentially keeping tyrosinase too busy to produce as much melanin as before (hydroquinone, mequinol, azelaic acid, arbutin, licorice extract) 
  • Blocking off important copper ions in tyrosinase and thus preventing the enzyme from working (kojic acid) 

There are also other ingredients that can reverse or slow down hyperpigmentation using other pathways: 

  • Slowing down production of the tyrosinase enzyme (N-acetylglucosamine)
  • Reversing the reaction that tyrosinase does (ascorbic acid/Vitamin C)
  • Slowing down maturation of melanosomes (arbutin and derivatives)
  • Preventing melanin from travelling from melanocytes to skin cells (soy, niacinamide, retinoids)
  • Dispersing pigments (licorice extract)
  • Increasing skin turnover, meaning less pigments to go around (alpha and beta hydroxy acids, retinoids) 

There are also other ingredients that can reverse or slow down hyperpigmentation using other pathways:

In general, side effects are less of a concern for less effective ingredients, but combining different agents may result in a more potent product without too much irritation. 

Below, we investigate the agents individually: 

1. Mequinol

Mequinol is the main alternative prescription alternative to hydroquinone. It is not entirely clear how mequinol works, but it seems similar to hydroquinone in that it mimics tyrosine and decreases tyrosinase’s ability to produce melanin. It comes in concentrations of 2% and sometimes in combination with 0.01% tretinoin and ascorbic acid to enhance penetration.

It is supposed to be less irritating than hydroquinone but can sometimes cause temporary postinflammatory hyperpigmentation (PIH). Rarely, it can lead to reversible depigmentation. 

2. Retinoids

Retinoids are Vitamin A analogues used for treating many conditions such as acne, sun damage as well as acting as a penetration enhancer for other treatments. Examples are: tretinoin, adapalene, tazarotene, isotretinoin (prescription) and retinol (non-prescription).

Retinoids are thought to work in multiple pathways to reduce pigmentation, including increased skin turnover, interruption of melanin transfer to skin cells, reduced tyrosinase production in skin and dispersal of melanin. Retinoids are commonly used in combination with other treatments for hyperpigmentation as on their own, they can take several months to achieve results.

In general, the more effective a retinoid is, the more irritating its side effects. Common side effects include redness, dryness and peeling. PIH is also a risk, especially in darker skin. 

3. Azelaic Acid

Azelaic acid is another common alternative to hydroquinone. It is produced by a fungus which sometimes infects humans and causes light patches of skin. It is slightly milder than hydroquinone but in combination with retinoids, can come close to the effects of hydroquinone.

Azelaic acid works by interfering with tyrosinase activity as a tyrosine mimic, and suppresses and kills abnormal melanocytes. It is known for its lack of side effects, which are mild stinging and redness. 

4. Arbutin

Arbutin is sometimes also known as the “natural hydroquinone”. Its chemical structure is very similar to hydroquinone. It is found in extracts of bearberry leaves and to a lesser extent in cranberry and blueberry leaves.

It works in our bodies by slowly turning into hydroquinone and acting as a tyrosine mimic to slow down production of melanin. It also interferes with maturation of melanosomes. Results from studies on its efficacy are mixed.

The most common formulation is 5% although there are higher formulations. Higher concentrations of arbutin increase the risks of PIH. 

5. Kojic Acid

Kojic acid is produced by bacteria in the fermentation of rice in the manufacture of Sake.

A derivative of kojic acid, kojyl-APPA has also been investigated on its whitening effect and improved skin penetration. It works by binding to copper in tyrosinase, preventing the enzyme from performing its role in the production of melanin.

It is often combined with hydroquinone, retinoids, glycolic acid, emblica extract or corticosteroid. It is very irritating and is a potential allergen. Preparations typically include steroids to reduce the chances of a reaction. 

6. Licorice Extract

Licorice extract is extracted from the root of the licorice plant (Glycyrrhiza glabra) and is widely used as a whitening ingredient in cosmetics. It contains a number of antioxidants and anti-inflammatory chemicals. Its main effects are through two whitening components, glabridin and liquirtin.

Glabridin protects skin from UV-B induced pigmentation whilst also acting on tyrosinase to slow down melanin production. Liquirtin disperses melanin. Licorice extracts are mild and have few side effects, likely due to its anti-infammatory and anti-irritant ingredients. 

7. Ascorbic Acid (Vitamin C)

Vitamin C is an ingredient in many skincare products. It is a potent antioxidant, but is very unstable and is usually combined with other ingredients.

Vitamin C works by turning dopaquinone back into L-DOPA, undoing the reaction that tyrosinase does. It is less irritating than hydroquinone and has an excellent safety profile. 

8. N-Acetylglucosamine

N-acetylglucosamine is a sugar found abundantly in nature and is a precursor of hyaluronic acid. It works by slowing down the production of tyrosinase, which is a crucial enzyme in the synthesis of melanin.

It has been found to improve pigmentation at 2% in clinical studies and is often used in conjunction with niacinamide. It can cause mild to moderate skin irritation occasionally. 

9. Niacinamide

Niacinamide is also known as nicotinamide and Vitamin B3. It is an antioxidant but unlike vitamin C, it is very stable. It works by inhibiting the transfer of pigments to skin cells. 2-5% is the typical concentration and has been found to be effective in reducing hyperpigmentation in several studies. Some skin irritation can occur. 

10. Cysteamine

Cysteamine is a new kid on the block when it comes to pigments. It is a chemical compound that can be biosynthesized in mammals (this includes humans) by degradation of co-enzyme A. It was conventionally used as a treatment for cystinosis.

Recently, ScientisPharma had compounded it into a 5% cream for treatment of hyperpigmentation and to lighten skin overall. Cysteamine is a metabolite of L-cysteine which inhibits melanin synthesis. The ways it is thought to work through includes inhibition of tyrosinase and peroxidase, scavenging of dopaquinone, chelation of iron and copper ions and increasing intracellular glutathione.

Randomized controlled trials have confirmed the efficacy of cysteamine cream in treatment of epidermal melasma, a hyperpigmentation disorder. Side effects are generally mild, with temporary heating up or burning sensation and redness that is typically short-lived. 

In Conclusion

That is 10 alternatives to hydroquinone for hyperpigmentary disorders, all with different modes of action. If you are wary of hydroquinone, or your skin cannot handle it, there are still plenty of options for treatment of hyperpigmentation. Feel free to speak to your doctor if you have concerns with hydroquinone or if there is pigmentation on your face that you are concerned about. 

This is one of the most commonly asked questions by patients when it comes to skin injectables. If you happen to not know any of the treatments on the title, you can refer to one of our posts here: 

Why did we compare these treatments? 

These 3 treatments are similar in a few ways, and to the layperson, it is also these similarities that confuse us to think that they are the same:

  1. They are all injectable treatments, usually delivered in the form of multiple injections on the skin of the face either manually or with an injector. 
  2. They improve ageing skin which typically is plagued with dryness, fine lines, and laxity. 
  3. They do not change the shape of our faces. 
  4. Profhilo and Skinboosters both contain hyaluronic acid (HA) like dermal fillers, but due to structural differences, they do not add to volume in the face. 

So, which treatment is the best? 

Well, there is no right answer to this question. Profhilo is not better than skin boosters and vice versa, and the same applies to Rejuran. The right question to ask rather is: 

“Which is the best treatment for me?”

All 3 treatments have their own special qualities and have been proven to be effective in their respective domains, giving significant results if done properly. More importantly, it is imperative and essential that the treatment that is chosen is best suited to target the patient’s unique skin needs and concerns. These concerns could be skin laxity, dryness, skin texture, pore size, scars, uneven skin tone or even all of them. 

Below, we will first look at some basic differences between these 3 products: 

InjectableHA contentPain ScoreFrequencyEffects
Profhilo64mg/syringe2ml
per syringe
2/102 sessions,
1 month apart
Hydration
Plumps skin
Improves skin quality
Reduces skin laxity
Modest lifting effect
Skinboosters15-20mg/syringe1ml/syringe4/103-4 sessions,
1 month apart
Hydration
Skin brightening
Rejuran Healer0mg2ml/syringe6/103-4 sessions,
1 month apart
Improve skin quality
Minimal hydrating effect

So, who will benefit from which treatment?

Skinboosters

What are skinboosters and who will benefit most from Skinboosters?

Skinboosters are colloquially known as injectable moisturizers. It is a treatment that is based on multiple micro-injections of free hyaluronic acid into the skin to increase hydration level in the skin. HA is a water-binding molecule that is able to hold up to 10,000 times its own weight in water. Common brands include Restylane Vital Lite and Teosyal Redensity I. 

Patients who primarily want to improve skin dryness as well as want some glow and radiance to their complexion will benefit most from skinboosters.

A course of skinbooster treatment involves 3 sessions one month apart to achieve long-lasting radiance. Downtime is typically 3-5 days due to the many injection points and depth of injection, typically as small injection marks, although bruising is also a possibility. Skin boosters can be administered via manual hand injections by your doctor or using an injector, or a mixture of both. 

Rejuran

What is Rejuran and who will benefit most from Rejuran?

Rejuran is an injectable based on polynucleotide derived from Salmon DNA from Korea. Its main benefits are creating skin healing and collagen synthesis. 

Patients who have acne scars, open pores, sensitive skin, uneven skin tone as well as redness stand to benefit most from Rejuran injections. 

Rejuran injections also require a minimum of 3 sessions, one month apart. Due to the superficial nature of the injections – it is placed in the superficial layer (basement membrane) of the skin, patients get “mosquitoe bites-like bumps” immediately after treatment that typically take 24-48 hours to subside. Injection marks may remain for up to 3 days, but bruising is exceedingly rare. 

Profhilo

What is Profhilo and who will benefit most from Profhilo? 

Profhilo is an injectable based on both high molecular weight and low molecular weight HA which had been treated with just thermal reaction to form hybrid cooperative complexes. It works by multilevel dynamic remodeling, and hence in addition to skin hydration, it also stimulates collagen production and improves skin laxity. 

Patients with ageing skin that is affected by both dryness, laxity and loss of elasticity with early sagging will benefit most from Profhilo treatment. 

Profhilo requires 2 sessions one month apart due to presence of cooperative hybrid complexes which renders it more resistant to hyaluronidase breakdown. 

Profhilo also has the advantage of requiring only 5 injection points on each side of the face using the Bio-Aesthetic Points (BAP) technique which means the treatment only causes minimal downtime in the form of swelling over the injection points that usually subside within the day. In all 3 treatments, Profhilo has the least downtime due to this. 

Below is a summary table comparing the 3 products 


ProfhiloSkinboosterRejuran
IngredientsH-HA & L-HAFree HAsPolynucleotides
BenefitsHydration
Multilevel bio-remodelling
Collagen+Elastin production
HydrationRadianceSkin barrier rejuvenationSkin repairCollagen production
TargetAgeing skin with laxity and early saggingDry skinSensitive skin, open pores, acne scars, uneven skin tone, redness
Age group30-50yo for anti-ageingSagging thinned skin20yo above with dry, dehydrated dull skin20yo above with problematic, acne or sensitive skin
Administration BAP techniques – 5 injections per sideMultiple manual microinjections with hand or injectorMultiple manual microinjections with hand or injector
Treatment Regime2 sessions, 4 weeks apart3-4 sessions 1 month apart3-4 sessions 1 month apart
Duration of efficacy6-9 months6 months6 months
DowntimeMinimal downtime – mild swelling on injection pointsInjection marks 3-5 days with risk of bruisingInsect bite like swelling for 24-48 hours, injection marks 2-3 days
Treatment areasFace, neck, décolletage, arms, handsFace, neck, décolletage, handsFace, neck, hands
Combination with other treatmentsYesYesYes
Pain Score+++++++++
Price$$$$$$$

So, which treatment is right for you? 

This really depends on your skin concern and what you are looking to achieve with treatment. There is no “one size fits all” solution in aesthetic practice and it is always advisable to speak in detail with your doctor about what you want to achieve. 

Teleconsult

Get your skin and aesthetic concerns checked from wherever you are!

In light of the COVID-19 social distancing measures, we are offering SAC Teleconsult. This SAC Teleconsult service allows our current and potential clients to connect with our aestheticians and doctors during clinic operating hours for non-urgent consults.

After assessment and consultation, we will be able to advise you on the next steps, and can even deliver medications straight to your doorstep if required.


Skin concerns we can address during teleconsult:

  1. Acne
  2. Skin Ageing
  3. Pigmentation
  4. Body contouring
  5. Skin Health
  6. Body contouring
  7. Dark circles
  8. Face slimming

How Does SAC Teleconsult Work?

*Our Whatsapp Video Consultation is not an official medical consult. A video consultation does not replace an actual in-clinic medical advice and consultation with our doctors.

Step 1: Set-up an Appointment

Arrange for a SAC teleconsult appointment during our business hours (see below)*

a. Click here to message us on our website
b. WhatsApp us at +6590207234
c. Call us on +6562350338
d. Send us an email at hello@saestheticsclinic.com

If you require any in-person appointments, we will be able to arrange this for you.

*Contact us during these hours for an appointment
Monday -Friday: 10am – 8pm
Saturday: 10am – 6pm

Sunday & Public Holidays: Closed

Step 2:

Our doctors and aestheticians will give you a call back at the appointed time. After the consultation has completed, we will email or WhatsApp you a customized treatment plan.

What are the Fees?

(Only Medication & Delivery Charges)

A) No Charges for SAC Teleconsult.

B) Medication charges: As per usual in-clinic charges.

C) Delivery charges:
– From S$10 Singapore Mainland* (*Except restricted areas, Alps Ave and Mandai)
– A S$5 surcharge applies for Sentosa deliveries