TOTAL EYE REJUVENATION TREATMENT

Sagging eyelids not only make the eyes look smaller and more tired, it can cause vision concerns as well. What are the causes and can sagging eyelids be treated? What are the treatments available?

One of the common problems plaguing middle aged to older people is drooping of the eyelids. Eyelid drooping is excess sagging of the upper eyelid. The issue can be further dissected into 2 distinct problems:

1. The edge of the upper eyelid is lower than it should be (ptosis)
2. Presence of excess baggy skin in the upper eyelid (dermatochalasis)

Eyelid drooping is often a combination of both conditions.

While the normal ageing process is the most common cause, there are situations in which ptosis can be present from birth, or can occur as a result of an injury or disease such as neuromuscular disease, stroke, swelling in the eyelid, diabetes or even as a complication of botox treatment.

This can cause disturbance to one’s lifestyle. In mild cases, it may not be aesthetically pleasing as a droopy lid is often associated with feeling tired, sleepy or not paying attention. In severe cases however, it can disturb with function if vision is affected and increased tearing despite feeling of dry eyes may be noticed.

In assessing a droopy eyelid, doctors will often first rule out any medical condition as a cause. If a disease is found, it will be treated. However as most cases of drooping eyelids are due to ageing process, treatment is often focused on reversing or addressing how the ageing process causes a droopy eyelid. Coupled with age-related changes around the eyes, such as excess skin causing wrinkling and bags under the eye, fatty tissue deposits that make the eye look puffy, periorbital hollows worsening dark circles and tear troughs, it can make us look older and more tired than we are.

The choice of treatment of course depends on the severity of the condition and the predominating factor that is causing the ptosis. For mild cases, there are a number of treatment options available; conversely, severe cases typically require surgical intervention.

Treatment options for mild cases include:

1. Eyedrops

Certain eyedrops can stimulate a muscle that elevates the eyelid and cause the muscle to contract, allowing an extra 1-2mm eye opening. It required daily use to maintain the effect. However, it will not work for people who have droopy eyelid due to excess skin, saggy eyebrows or underlying nerve or eye injury.

2. Botox

Injectable products that contain botulinum toxin (such as Botox or Dysport) can be used to help smooth out wrinkles and when applied to the right muscles, can accentuate muscle activity in the opposite direction to help brighten and open up the eyes. For the brow, Botox can also be used to elevate the brows.

3. Fillers

Fillers, when correctly placed, whether in the temples, forehead or brows can help to restore volume in surrounding areas of the eye to lift and open up the brows and lids.

4. Skin tightening devices

Skin tightening devices such as Thermage and Ultherapy again can be used to tighten and lift skin above the eyelids to stimulate collagen production and give a lift to heavy looking lids. These treatments are suitable only for mild cases of ptosis or in cases where there is not too much excess skin.

5. Threadlift

Often, one of the areas that start to droop are the corner of the eyes and the edge of the brows. By performing threadlifts to lift the skin, we can help anchor the skin to reverse the downward sag of the skin on the outer side of the eyes

6. Stitch blepharoplasty

In this procedure, certified doctors/ surgeons perform a procedure in which a surgical stitch is used to elevate the eyelids. This procedure is suitable only for patients who have a mild ptosis not associated with significant laxity of skin in the upper eyelids.

7. Surgical blepharoplasty

This surgery is performed by a facial plastic surgeon, plastic surgeon or ophthalmologist on an outpatient basis, usually under local anaesthetic. The main goal of the surgery is either to elevate the upper eyelid, and/or to remove the excess skin in the upper eyelid. This procedure however is typically associated with downtime and recovery period.

To decide which treatment is best for you, speak to your doctor.

Dark splotches and spots that dot the surface of the skin are common, especially in sunny Singapore. Known as skin hyperpigmentation, this general term refers to the presentation of a skin condition that increases pigmented spots in the skin.

In other words, the correct diagnosis of the underlying skin condition is important before initiating any form of treatment for the skin hyperpigmentation in order for the treatment to be safe and effective.

Let’s take look at some of the common causes of skin hyperpigmentation and how we can treat them.

Melasma

Melasma is a common skin disorder that affects mainly women after 30 years old. While causes are still not fully understood, it is thought to be caused by hormonal changes, triggered by UV exposure and genetically linked. It often develops or becomes worse during pregnancy, and may also occur in women who are taking hormonal pills and hormonal replacement therapy after menopause.

Melasma typically appears as poorly-defined brown patches over the cheeks and forehead. Sometimes, they worsen very quickly after excessive sun exposure.

It is a tricky skin condition to treat. For a start, preventing it from getting worse is important. That means adequate sun protection and diligent usage of sunscreen because UV exposure makes melasma worse.

Failing which, first line treatment usually consists of prescribed topical creams such as hydroquinone, tretinoin, steroid and azelaic acid. Anti-oxidant skin care products such as ascorbic acid can sometimes be useful.

Lastly, lasers targeting melanin, such as Pico laser and Q switch laser can be used to treat hyperpigmentation caused by melasma. Chemical peels can sometimes play a role in treating melasma as well.

Sun spots

Sun spots are sometimes also known as age spots, liver spots (although it has nothing to do with the liver) or solar lentigines. Caused by excessive sun exposure over time, sun spots appear as flat brown spots that develop on skin areas that are commonly exposed to the sun, like the face and hands.

Unlike moles, sun spots do not pose any risk to health because they are not cancerous. With the exception of cosmetic reasons, they generally do not require treatment.

If you do want to treat sun spots, then energy devices such as Intense Pulsed Light (IPL), Pico Lasers and skin resurfacing lasers are useful in treating sun spots. Chemical peels may sometimes be effective in improving sun spots.

Freckles

Freckles are sun spots are similar because they are both due to overproduction of melanin as a result of sun exposure.

However, freckles are genetically linked. If you have inherited a particular gene from your parents, your skin can form freckles after sun exposure. Freckle spots are usually smaller and lighter in colour, and appear earlier in life. In addition, freckles typically fade away with age while sun spots stick around.

Freckles are harmless, and do not need to be treated unless they stick around long enough to cause cosmetic concerns. Freckles can be treated effectively with energy devices such as Pico laser.

Post inflammatory hyperpigmentation (PIH)

PIH is a result of injury or inflammation to the skin. Common causes are acne, skin infections, cuts and burns. After the injury or inflammation recovers, the skin over the area usually becomes hyperpigmented.

Fortunately, PIH is usually temporary. it may take weeks or months to get better depending on the skin type, but it is generally harmless, even if it can be unsightly.

Treatment usually involves topical prescription lightening creams such as hydroquinone, retinoids and cysteamine. Pigment lasers such as Pico lasers can help speed up the recovery process.

During recovery, sun protection and sunscreen are also important because excessive sun exposure can prolong the duration of PIH.

Pigmented Birthmarks

Birthmarks appear at birth or just a few weeks after birth. Examples of pigmented birthmarks are cafe-au-lait, nevus of ota, Mongolian spots and nevi (moles). Mongolian spots tend to disappear by the age of 4 and do not require any treatment. However, the other types of pigmented birthmarks may persist into adulthood.

Unfortunately, birthmarks are difficult to treat and often do not respond very well to treatment. Assessment has to be done by an expert before any treatment, such as topical medications or laser treatment, is used. Some birthmarks, such as nevus of ota and nevi, will need to be monitored closely by doctors.

Dealing with Skin hyperpigmentation is complex. Therefore, it is key that patients get the right diagnosis in order to receive safe and effective treatment of their conditions. If you wish to have yourskin hyperpigmentation treated, make sure to consult a doctor before taking any action of your own.

Tags: rejuran healer, facelift singapore, ultherapy singapore

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A shift in our lifestyle due to pandemic made constant video calls, zoom meetings and webinar a part of our lives. There is an increased consciousness of facial appearance in this era of virtual meetings. Some may seek make-up techniques to improve appearances while others seek longer term solutions to improve facial flaws.

What can be done to improve appearance?

The COVID-19 pandemic has caused a radical shift in our lifestyles. Instead of working from the office, work has now moved from our physical workplaces into our homes. Constant video calls, zoom meetings and webinars have become the “new normal”. This sudden surge in video conferencing has also led to an increase in the consciousness and concern of one’s facial appearance in this era of virtual meetings. In this “new normal”, we spend more time looking at our own faces through the lens of our webcams. This self-examination may subsequently bring to our attention small details about our appearance that we never noticed. Indeed, not only has there been an increase in the use of facial tuning apps alongside video conferencing applications, there has also been an increase in the number of people who did not have any prior facial cosmetic treatments, now planning to pursue treatments based on concerns from their video conference appearance alone.

In the quest to appear better in these virtual meetings, various methods have been employed. Some may seek make-up techniques, some using make-up techniques with camera app filters, while others seek medical aesthetic treatments for a longer term solution.

So, what can we do to make ourselves always camera-ready?

1. Mind your skin

Our skin is one of the most important factors to our looking good in front of the camera.
Webcams tend to highlight even the slightest grease or acne mark, making it look ten times worse than it would have in the real environment. Simple habits such as cleansing before a zoom meeting and applying a tinted moisturizer or sunscreen can help to make our skin look matte and evenly toned. Avoid greasy or oily products as web cameras tend to accentuate any shine that you have on your face. Also, by looking after your skin well, you can avoid having a large zit on your face during a zoom meeting. If you have acne prone skin, make sure to manage your acne in consultation with a doctor. If you have dry devitalized skin, then your doctor may advise more intensive treatments such as skin boosters and polynucleotide injections.

2. Addressing facial lines

During a zoom call, facial lines tend to be accentuated the most because instead of being in a 3-dimensional world, we now appear 2-dimensional. Indeed, one of the most commonly requested procedures since the start of the pandemic is neuromodulators, i.e. Botox and fillers to address facial lines, or to achieve a younger, more youthful look. Wrinkles or lines such as forehead lines, frown lines, crow’s feet can often be addressed with a simple 15-minute Botox treatment. This helps relax facial muscles and give a smoother look and softened facial expressions within a few days and typically lasts for about three to six months. For people with deeper etched lines, more invasive treatments such as fillers, chemical peels or resurfacing lasers may be needed to smoothen out these lines. Fillers may also be used to smooth deeper lines such as laugh lines and marionette lines in the lower face and volumize cheeks and create a youthful jawline. Hyaluronic acid can help naturally plump the skin to give it a youthful fullness and firmness. In more severe cases however, a combination of treatments such as skin tightening and lifting procedures such as Ultherapy and fillers may be required.

3. Pigmentation

Facial pigmentation can make our skin tone look uneven and create a distraction to our audience. In a world where we often look at our video reflection, we may become more aware of our appearance, and start scrutinizing our features from the neck up. The treatments for pigmentation can vary widely. These may include the use of sunscreens, depigmenting creams, pigment lasers and rarely, ablative lasers. These treatments all aim to reduce the difference in skin tone so that our skin has an even radiant glow.

4. Facial features

Facial features are a contentious matter. This is because webcams may distort and degrade the video quality and inaccurately represent one’s true appearance. Camera angle and focal distance makes a significant difference to the image that appears on screen. This is especially true for nose size and face shape. At shorter focal lengths, our faces often appear more rounded, with wider set eyes, broader nose and taller forehead. The lack of 3-dimensional perception also leads to shadow gradients appearing as a flat darkened area. These elements often require a consultation with a doctor to accurately ascertain if the perceived negative feature is indeed true, or just a trick of the camera. This is important so that we do not end up in a cycle of treatments and self-dissatisfaction. More often than not, if the concern is that of a facial feature, it is likely due to a trick of the camera rather than a true issue. However, if the facial issue is ascertained to be true, then treatments such as fillers, non surgical facelifts can provide a non- to minimally-invasive solution to improve the harmony of facial features.

5. Eyes

One of the most common concerns is “looking tired”, especially so in the area around the eyes. Concentrating on the screen often makes us squint, causing the eyes to look older and smaller. As our eyelids become hooded, and our lower eyelids sag, it can also make us look worn out, sad and angry. Botox can be used as a non surgical treatment to “lift” the brows and eyes to give a more refreshed look while softening wrinkles around the eyes. If there is significant volume loss in the under eye, treatments such as tear trough fillers may be needed to restore our facial volumes while lasers and energy based devices such as Thermage can help tighten the skin around our eyes and reduce fine wrinkles.

With the rise of K-pop culture all over the world, the flawless, supple and glowing complexion of young Korean celebrities has left us all envious of their beautiful, young-looking skin. Indeed, much there is much hype about K-beauty, from the 10-step Korean skincare to Korean cosmetic brands and even medical aesthetic treatments.

How can we improve our skin texture to look like these Korean superstars?

Well, first, we have to delve into what are the features of the “Korean glow”. This can be generalized into: minimal pores, smooth glass-like texture, radiant and fair complexion free of imperfections, and a tight looking appearance with few signs of ageing.

Now, there are many different regimens, some as simple as slathering on a serum and moisturizer and some as extensive as going through 10 steps. But, no matter how many steps they go through day in day out, no product – fine-line smoothing, plumping, brightening, or otherwise – is as effective as an injectable, a laser, or a high intensity ultrasound based treatment. However, to achieve the Korean glow, treatment must be individually customized to the issues that are prohibiting you from achieving the glass glow.

Below, we will discuss features of the “Korean glow” and how best to achieve each of them.

Skin Texture and Pores

The first step in achieving the “Korean glow” is to have a smooth glass-like skin texture. As we age, a complex cascade of ageing happens in our skin. After the age of 20, our skin loses about 1% of collagen each year. This loss of collagen as well as elastin in the dermis leads to progressive sagging of the skin. Slowing of the epidermal turnover rate and cell cycle length also leads to progressive thinning of the skin. Not only does collagen decrease, the hyaluronic acid levels in our skin also decreases, which leads to drying and wrinkling of our skin. Therefore, as we age, our skin starts to become loose, saggy and we start noticing an increase in fine lines and visibility of our pores.

Enlarged pores is also one of the commonest complaint people have after wrinkles. What makes our pores look big? One of the most important factors that gives the appearance of a large pore vs a small pore is the size of the pore opening. Secondly, pores also look smaller and less obvious if they are cleared of blackheads and blockage. Lastly, collagen loss – when we lose collagen as we age, it also means the skin around the pores gets looser, making the pores look larger.

So, how do we achieve the glass-like skin texture of the K-Pop celebrities?

To minimize the appearance of wrinkles and pores, 3 things have to happen on the skin:

1. Tightening and thickening of the dermis (the deeper layer of the skin) by means of new collagen formation and replenishing the levels of hyaluronic acid

2. Reversing the slowdown in skin turnover

3. The surface of the skin should be clean of debris and pores cleared of comedones and blackheads
Hence, treatments should be able to achieve the above to be able to give us glass-like skin. Of course, we continually lose collagen as we age, hence no treatment is permanent when it comes to minimizing pores and we will generally need to stick to a schedule of aesthetic procedures to be able to maintain the effects of treatment.

Skin texture and pore treatments can be broadly classified as:

1. Exfoliative and cleansing treatments

By removing dead skin debris and blackheads from our skin, we can clean up the pore opening and reduce the appearance of the pores. By exfoliating dead skin cell debris, we also encourage our skin to produce new epidermal cells and make our skin look more radiant. Treatments that can achieve this includes exfoliative and deep cleansing facials such as hydrafacial, mild superficial exfoliative acid peels and laser peels such as the Hollywood and Carbon Peels. By regularly using cleansers that exfoliate and cleanse such as ones that include salicylic acids or Vitamin C, we can also help prevent and reduce the build up of comedones and debris on our skin, while glycolic acids can help to increase skin turnover and reduce fine wrinkles.

2. Lasers

Lasers work to minimize the appearance of pores by stimulating collagen production in the dermis. In the market today, there are numerous lasers, each providing a different effect. The important factor here is to stimulate collagen production in the skin, so lasers that do well in this respect include fractional ablative lasers such as fractional CO2 lasers, fractional non-ablative lasers like the fractional (MLA/DLA) Picolaser or high energy lasers such as long pulsed Nd:YAG lasers that help to stimulate collagen within the dermis. These collagen-building lasers can help your skin fight against signs of ageing such as fine wrinkles, enlarging pores and laxity.

3. Collagen stimulating injectables

Ageing leads to the gradual loss of collagen as well as total hyaluronic acid level in the dermis of the skin. Injectables such as polynucleotide injections (e.g. Rejuran Healer injections), hyaluronic acid injectables (e.g. Profhilo, SkinBooster, Filmed NCTF 135HA) can help rejuvenate our skin by replenishing collagen and hyaluronic acid levels, and thus helps to tighten the appearance of pores.

4. Wrinkle reducing botulinum toxin

Botulinum toxins such as Botox, when injected into our expression muscles can help to soften our expression and prevent expression lines from becoming static lines and thus prevent formation of permanent wrinkles. When injected into the skin instead, Botox on the other hand can help to relax the erector pili – fine muscles in the skin that control pore size and hence help the skin look more refined and smooth.

5. Topical creams

Creams or cosmeceuticals that help with pores generally need to fulfil 2 requirements: increasing skin turnover and stimulating collageneogenesis in the dermis. Important ingredients to look out for include: alpha-hydroxylase acids such as glycolic acid, citric acid/ beta-hydroxylase aids such as salicylic acid, and vitamin A derivatives such as retinols, or the prescription retinoic acid. These can increase skin regeneration, smoothness, and elasticity, thus minimizing pores.
Due to the dryness that comes with ageing. It is also important to use moisturizers that help to seal in moisture in our skin so that it does not dry out and appear wrinkles and old.
These daily creams may seem trivial, but the accumulative effect of regular care can significantly change the quality of our skin and slow down the loss of collagen.

6. Energy based devices

In addition to the regular lasers, injectables and topical creams, high energy based devices should also form a part of a pore care regimen on a yearly to bi-yearly basis. Radiofrequency devices such as Thermage and ultrasound based devices like Ultherapy have a very strong capacity to stimulate new collagen formation in the skin. This not only helps fill up collagen in the dermis and hence help tighten ageing pores and reduce fine lines, it can also tighten the collagen rich superficial musculoaponeurotic system (SMAS) layer in our skin. This layer has been likened to the scaffold layer of the skin and by tightening the collagen fibres in this layer, we can reverse the laxity and sagging that comes with ageing.

Skin tone and complexion

The second part of achieving the “Korean glow” is to have a clear and radiant complexion. This means addressing issues that can lead to our skin tone either appearing uneven and treating spots on our skin that appear due to accumulated sun damage over the years

To achieve this, treatments include:

1. Skin lightening creams

Skin lightening creams can help to reduce pigmentation tat develop as a result of chronic sun exposure. These include the prescription medications such as hydroquinone and hydroquinone alternatives such as cystseamine (Cyspera), alpha-arbutin, bearberry extract, kojic acid and topical tranexamic acid. The creams work through different pathways to suppress excess pigment production by the pigment cells in our skin, thus helping to lighten imperfections and spots on our skin.

2. Regular use of sunscreens

Prevention is better than cure.

Prevention is better than cure. Excessive exposure to ultraviolet rays from the sun can lead to premature photo ageing. Ultraviolet rays causes a deterioration of biological functions and ability to manage metabolic stress in the skin that leads to functional and aesthetic decline. By using broad spectrum sunscreens, we can reduce the amount of ultraviolet rays penetrating into our skin and protect against ageing.

3. Retinoids

Retinoids bind to retinoic acid receptors and retinoid X receptors that induces a cascade of cellular processes that ultimately lead to an increase in collagen production and epidermal thickening, thus helping to reduce the appearance of skin sagging and wrinkling. Using this as secondary protection can help us fight off the damage done by ultraviolet rays.

4. Lasers

Lastly, pigmentation or dyspigmentation that has formed can be treated with a variety of lasers. Pigment lasers typically target pigmentation that has developed and help to shatter these into smaller particles so that they can be cleared by the body. These can target not only spot pigments, but can also target uneven skin tones and help us achieve that even, radiant glow.

5. Oral supplemets

Oral supplements containing antioxidants such as L-cysteine, Glutathione, Co-Q10 enzymes are antioxidants that can help our bodies defend against oxidative free radicals that accelerate photo ageing. These supplements again help suppress excess pigments from forming due to sun damage.