Things You Should Know About Whiteheads & Blackheads – Beneath the Skin With Dr Benji


Consultant Dermatologist
Central Dermatology Specialist Clinic

For most skin conditions, there is always a treatment. Hence, there is no need to suffer in silence because you have a skin condition that makes you feel self conscious about your appearance. I have encountered patients that are distressed about whiteheads, blackheads, and melasma. If you have any of these skin conditions, please join me as I share with you some useful information about these conditions and available treatments.


Acne is a common skin disease that affects about 85% of adolescents at some time of their lives. The most common type of acne is acne vulgaris, which makes up 99% of acne cases and affects about 95% of boys and 83% of girls by the time they are 16.1,2

Blackheads and whiteheads are common characteristics of acne vulgaris.1

They are the result of the pores or hair follicles of the skin being blocked by dead skin and sebum (the oil produced by the skin).1,2

The primary lesion of acne is called a comedo.3 The plural form of comedo is comedones.
Whiteheads form when the comedones are closed and follicles are completely blocked.

Blackheads form when the comedones are open and the surface is dark black in colour due to oxidation of the lipid and melanin contents of the comedones.2,3

Acne vulgaris on its own is not associated with any mortality, but it can cause scars to form.3 These scars can cause psychosocial challenges such as depression, anxiety, and more.3

Common causes of acne vulgaris. Click on the image for a larger, clearer version.


Be wary of treatment or management given by non-medical doctors when it comes to treating acne—there is a risk that these procedures may worsen the acne or cause scarring. Always consult a general practitioner or dermatologist first, so that you will receive evidence-based treatments and advice in line with the Malaysian clinical practice guidelines.

The following are the recommended treatment options for acne

First line treatment
The first line treatment is the first recommended treatment for a certain disease.

When it comes to acne vulgaris, the first line treatment is pharmacological treatment, usually in the form of topical creams, gels, lotions, solutions, and other forms that can be applied onto the affected area of the skin.4

Medical topical treatments. These contain active ingredients such as benzoyl peroxide, retinoids, antibiotics, and others.4 They may be used on their own or, for moderate cases, in combination with other creams.4

Systemic treatments
Medications such as oral antibiotics as well as combined oral contraceptives may be prescribed by the doctor depending on the severity of the acne and other factors.5

Supplementary treatments
Physical treatments. Corticosteroid injection into the affected area of the skin may be helpful, either to complement existing therapy or to improve the appearance of skin after treatment.6

Chemical peels—in particular salicylic acid and glycolic acid peels—may be beneficial. However, they need to be carried out with care under the supervision of an experienced dermatologist.6

Energy-based devices. Laser treatment on the affected skin area may be beneficial when applied alongside other treatments.6


‘Retinoid’ is an umbrella term for a family of chemical compounds that share structural and functional similarities with vitamin A.

They normalize shedding of the skin (desquamation) by reducing the proliferation of a common type of skin cells called keratinocytes as well as promoting the differentiation of these cells.4,6

Topical retinoids also block several important inflammatory pathways that are activated in acne: toll-like receptor, leukocyte migration, and AP-1 pathways. Blocking these pathways can reduce the release of inflammatory cytokines and nitric oxide as well as inhibit cellular inflammation.7


Adapalene is a third-generation retinoid. Compared to earlier generation retinoids, it interacts with the retinoid receptors of the skin in a different manner, so it causes less irritation compared to earlier generation retinoids while remaining just as effective.8

How effective is adapalene?

A meta-analysis of 5 large studies with 900 patients for over 12 weeks demonstrated that gel containing 0.1% adapalene is as effective as gel containing 0.025% tretinoin, another retinoid commonly used to treat acne (Cunliffe et al, 1998). After 12 weeks, both agents were equally effective but adapalene had a faster onset of action and less irritation.8

Another study (Cunliffe et al, 1997) compared 0.1% adapalene and 0.025% tretinoin on 323 patients for 3 months. They found that adapalene caused more decrease in total and noninflammatory lesions than tretinoin. However, there was no significant difference in terms of inflammatory lesions.9

Also, there is a study (Korkut and Piskin, 2005) that demonstrated how adapalane is more effective in treating non-inflammatory lesions compared to inflammatory lesions. The use of adapalene gel may yield results in as early as two weeks, but overall, it will take some time to see significant results.10

General adverse reactions

These include dryness, redness, irritation, and burning or stinging. These symptoms usually peak at the 2nd- to 4th-week mark before subsiding.11

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Things You Should Know About Melasma – Beneath the Skin With Dr Benji

Consultant Dermatologist
Central Dermatology Specialist Clinic

For most skin conditions, there is always a treatment. Hence, there is no need to suffer in silence because you have a skin condition that makes you feel self conscious about your appearance. I have encountered patients that are distressed about whiteheads, blackheads, and melasma. If you have any of these skin conditions, please join me as I share with you some useful information about these conditions and available treatments.


Melasma is a common skin condition that causes brown patches and spots, usually on the face, which are darker than your natural skin tone.12,13

Melasma is not associated with any mortality but has significant psychosocial morbidity.12,14 It is shown in a systemic review and metaanalysis that prevalence of depression was as high 48.5% in Asia!14


Melasma is linked to an increase in the production of melanin, a skin pigment that gives the skin a darker tone.15

This increased production of melanin is linked the presence of ultraviolet (UV) light.15

However, the exact mechanism of how increased melanin production can lead to the development of melasma is still being researched upon.15

Common causes of melasma. Click on the image for a larger, clearer version.


Increased production of melanin is linked to the presence of UV light and UV light is a component of sunlight. Therefore, it is essential to reduce your skin exposure to sunlight.

Use a broad-spectrum sunscreen when you spend time under the sun. One study found that SPF 60 sunscreen is found to offer greater improvements than SPF 30 ones.16


Such a topical cream includes the active ingredients fluocinolone acetonide, hydroquinone, and tretinoin.17

The cream works to disrupt pigment production in the skin and lighten the existing dark spots on the skin.18

It is considered a prescription medicine, available only with a doctor’s prescription, so you should consult a doctor to discuss whether this cream would be suitable to treat your melasma.

What’s in the cream?

Hydroquinone is considered the primary and most effective topical agent for blocking the enzyme tyrosinase, which is a very important enzyme in the pathway of melanin production.18

On top of that, it also is known to play a role in the degradation of melanin-producing cells (melanocytes) and melanin-storing cell structures called melanosomes.18

Tretinoin, a retinoid, works by motivating epidermal and dermal turnover, which may cause rapid loss of cell pigment. In addition, it inhibits tyrosinase, facilitates the penetration of hydroquinone, and neutralizes the stratum corneum thinning effects of corticosteroids.18

Fluocinolone acetonide is a moderate potent topical steroid used to reduce the irritation caused by both hydroquinone and tretinoin.

General adverse reactions

Some people may develop allergic reaction to one or more of the active ingredients. Both tretinoin and hydroquinone have been known to be cause irritation in some people. Some people may experience adverse reactions related to the general use of retinoids, which include redness, peeling, burning, dryness, or itching.


Available over-the-counter creams to manage melasma commonly contain ingredients such as vitamin C, azelaic acid, kojic acid, salicylic acid, cysteamine, niacinamide, ascorbic acid, tranexamic acid, glutathione, and soybean extract.18

These ingredients help to reduce pigmentation by disrupting the pigment production process in the skin.18

These products, however, are categorised as cosmeceuticals and they may not work as well or as fast as a medical-grade treatment. The effectiveness of their use is still being researched upon, and they may also cause irritation to the skin of some people.

Chemical peel and laser treatments may also be useful for superficial melasma.12

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Perfect Skin For The Holidays

Perfect Skin For The Holidays

May 8, 2022   Return

Dr Ch’ng Chin Chwen

Consultant Dermatologist


Well, there is no such thing as perfect, but with some tender loving care (and the help of a skin specialist), we can certainly make improvements to our complexion.

We all want to look our best during the holiday season. But how do we do that when we all have different skin qualms? This month, consultant dermatologist Dr Ch’ng Chin Chwen provides some tips about some of the most common skin troubles we face and how to fix the problem.



It depends on the type of acne you have and whether the acne is matured. Generally, there are two types of acne:

  • Non-inflammatory acne

Also known as comedones or more commonly referred to as blackheads and whiteheads. It is best not to squeeze or pick these. Anti-acne medications are able to dissolve them. Be careful though; comedones typically do not leave scars, but forcefully squeezing them might cause scarring.

  • Inflammatory Acne

These include pustular and cystic acne. If you have pustular acne and it is matured and ready to pop, I would recommend extracting it, but make sure your hands and equipment are clean or sterile. Cystic acne is more severe and would normally require oral medication to treat. Furthermore, some larger cystic acne may need to be injected with a low dose of steroids to reduce inflammation and to shrink it. This way, scars are less likely to form. Pustular and cystic acne tend to leave scars if not treated properly.




For mild cases of acne, topical anti-acne gels and creams are effective. These come in the form of antimicrobials, topical retinoids, azelaic acid and others. Some products contain AHA and BHA which can help dissolve comedones. With these products, you’ve got to be patient because it takes a few weeks for improvements to be seen. When applying topical products, I would not advise people to only dot the product on the pimples. It is better to apply a thin layer onto the entire face to prevent new ones from popping up.

Oral medication for acne includes oral antibiotics, synthetic retinoids and hormonal treatment (for women). However, more and more dermatologists are steering away from these options, particularly antibiotics and hormonal treatment. Previously, doctors would first prescribe antibiotics to acne patients for three to six months to try. If it doesn’t work, they upgrade to other treatment options. But on top of the unwanted side effects of long-term use of antibiotics, doctors found that when the patients stopped taking them, the acne came back. Hormonal treatment is a good option for women, especially those with polycystic ovary syndrome (PCOS) which also causes acne. However, the side effects of hormone treatments include bloating, weight gain and water retention. Retinoids are considered the gold standard of acne treatment, but are not suitable for women of childbearing age because retinoids can pass through the placenta and cause neural tube defects.

Physical methods to treat acne are gaining popularity. These include light-based therapy, laser treatment, chemical peels and radiofrequency. Each method works differently, but they all share the common aim of shrinking the sebaceous glands that cause acne. For me, creams and oral medications are still the first line treatments, and physical methods are used as adjunct treatments.


Food with high glycaemic index (sugary foods and bad carbs) aggravate acne. It’s best to avoid them when having a breakout.


If you get pigmentation which appears immediately after a breakout, these will fade eventually on its own. Scars that are protruding (keloid scars) will need procedures such as low- dose steroid injections to get rid of them.

Those with scars that are sunken (for example, ice pick scars), can opt for the chemical reconstruction of skin scars (CROSS) technique. This procedure involves trichloroacetic acid being dotted into scarred areas to smoothen them. Box scars or uneven skin can benefit from fractional ablative laser treatment. This involves a dermatologist dotting small injuries onto the scarred skin, so that the area will heal with a reduction of scarring.



Ageing is a natural and inevitable process, and unfortunately, we get wrinkles as we age. Intrinsically and genetically, our cells continuously multiply throughout our lifetime. As this happens, our telomeres shorten and we accumulate cell damage as we go along. Extrinsically, environmental factors like sun exposure makes you age faster. Collagen begins to break down after 15 minutes of being in the sun. People who smoke will also age faster and develop fine lines.


There are two types of wrinkles: dynamic wrinkles are those that appear when your face muscles move, and fine lines are those that are there even if there is no movement.

People with less facial expression tend to get less dynamic wrinkles. But if you really want to slow down wrinkle formation, having a healthy lifestyle is the best way to go about it. Diligent sun protection helps too. In terms of products, retinol or retinoids and antioxidants are key ingredients that slow down the appearance of fine lines. You can’t completely prevent wrinkles from forming, but you can slow down the process.


You could opt for botulinum toxin injections – these are most effective for lessening dynamic wrinkles. For fine lines, you can use retinoids or retinol products, or you can go for laser treatments or chemical peels which stimulate collagen production.

Lines that are very deep are called fixed lines. These initially appear as dynamic lines, but over time they become fixed and are there even when you don’t smile or frown. To lessen these, you would need fillers. Wrinkles can also appear due to sagging, especially when you lose weight. People who have these will benefit from skin tightening procedures and fillers.




There are many kinds of pigmentations, caused by various factors. Freckles occur due to genetic reasons. Solar lentigo is caused by accumulated years of sun exposure. Melasma is a little more complicated. It can appear due to emotional factors such as stress but can also be caused by hormonal factors and excessive sun exposure. Some people call melasma a mask of pregnancy because women can get it when they are pregnant.


No matter the cause of pigmentation, the best way to prevent them is sun protection. Freckles, melasma and solar lentigo all darken and worsen when exposed to the sun.


Again, sun protection. If you protect your skin from the sun enough, it will lighten with time since the skin has the ability to self-repair. If you feel your skin needs some extra help, there are products and procedures that can lighten pigmentation.

Bleaching creams have hydroquinone in them, but I wouldn’t advise to use these long-term because you might get side effects like developing a greenish/bluish tint to the skin (it happens if you use too high of a concentration for too long). Another key ingredient that works is arbutin. It is safe to use as long as your skin is not allergic.

Alternatively, you can go for laser treatments or chemical peels to lighten your skin tone. All these treatment options must be followed by sun protection because freckles and pigmentation can potentially reappear again.


Get a broad-spectrum sunscreen that protects against UVB and UVA. Textbooks will tell you that you’ll need SPF  of at least 30 or 35, but that’s based on a measurement of 2g per cm2 (that’s a thick layer). Most people do not apply that much due to the white cast it gives and it might not feel very comfortable on the skin.

I would advise people to get as high an SPF as they can afford. You are not going to get the exact level of SPF labelled on the bottle. For example, if you apply SPF 35, you might get 7 in actuality.


Don’t forget to apply on areas like the ears, neck, hands and toes. Also, note that each application does not protect you for long hours. Guidelines say if you are indoors, you should re-apply every two hours, and if you are outdoors, every hour. Although you have sunscreen on, it’s still important to seek shade especially when the sun is strong. Wear a wide-brimmed hat and large sunglasses for more protection. If you’re worried about vitamin D deficiency, you can always get it from food such as salmon or vitamin supplements.



The reason for redness on the skin depends on whether a person has any pre-existing conditions. People can get redness due to acne, eczema or rosacea. Rosacea generally does not get enough awareness in Asia. It is characterized by facial flushing with redness, visible blood vessels, rough skin or even acne-like eruptions, which is why when acne appears on mature skin, we always need to make sure it is not rosacea. People with rosacea tend to get flushes of redness especially when they are hot or eat spicy food.

Other uncommon causes of redness on the skin include photosensitivity – certain people cannot tolerate sunlight and whenever they get exposed, they get red. Some autoimmune diseases like systemic lupus erythematosus (SLE) can cause redness too.


It is important to get the diagnosis right, and then to treat accordingly. If you get lots of redness on your skin and you’re concerned, it’s best to consult a dermatologist. HT



May 8, 2022   Return


Body sculpting treatments have been around for quite some time now. With the promise of being a safe, non-invasive method of removing even the most stubborn fat, it has become a popular beauty treatment across the world.

But does it really work? What are the risks involved? Dr Ian Tan answer our questions.

How does body sculpting work? 

Body sculpting refers to a non-surgical treatment that gets rid of fat cells from the body. One of the most common examples is the cryolipolysis procedure, which has been approved by the US Food and Drug Administration (FDA). 

In this treatment, fat cells underneath the skin are crystallized (frozen) using cold, before being gradually being removed from the body through the body’s natural degradation process. See Figure 1 for more information.

Let’s get the million-dollar question out of the way: is this the weight loss solution that we have all been dreaming of?

Body sculpting is not a weight loss programme. It is not intended to be a solution for weight loss!

Rather, it is a fat-reduction procedure and a great way to reduce the amount of subcutaneous fat in stubborn areas without having to undergo surgery. 

To ensure the results last as long as possible, it is important to maintain your weight with a healthy diet, a healthy lifestyle, and regular exercise.

How can body sculpting complement efforts to lose weight, such as eating healthy, balanced meals and exercising?

After losing weight through diet and exercise, your fat cells become smaller, but the number of fat cells remains the same. There are areas in the body where the fat cells shrink less than others and persist in their size despite the amount of exercise that you do. These places include: the love handles, the underarms and the back of your thighs. Cryolipolysis treats this by reducing the number of fat cells at treated areas by 20-25% in a single treatment. It effectively reduces the number of fat cells rather than the size of those fat cells.

Are the treatments performed by a medical doctor?

Clinical assessments and treatment planning are to be performed by a trained medical doctor. The treatments may be carried out with the assistance of trained nurses that specialize in body sculpting procedures.

Here, I would like to stress that it’s not just about performing this treatment, but selecting the best candidate for the treatment to get the best possible outcome. 

Who would benefit most from body sculpting treatments?

The cryolipolysis procedure is specially designed for those who wish to get rid of unwanted fat in targeted areas but are not keen to go under the knife. The non-invasive nature of this treatment makes it one of the most popular fat-loss treatments in this current era. 

Which parts of the body are the body sculpting treatments usually done on?

The cryolipolysis procedures can be performed on many parts of the body. It can treat:

• Visible fat bulges in the under the chin (double chin)

• Fat in the inner and outer thighs

• The abdomen and flanks (love handles)

• Bra fat, back fat and fat underneath the buttocks (also known as banana rolls)

• Fat in the arms

Your medical practitioner will work with you to create a customized treatment plan that’s tailored to your body and your goals. 

What can patients realistically expect from this treatment?

Patients can expect up to an average of 20% to 25% reduction of fat in the treated area. 

Because the body requires time to eliminate the dead fat cells, results from these body sculpting treatments are not immediate. 

While some people may see results as early as one month after the initial treatment, the optimal results is typically seen three months after the procedure. 

Depending on your desired results, you may request for more than one treatment to achieve your goals and to get the most out of this body sculpting technology.

How long do the results last?

The fat cells in treated areas are gone for good. The results are long-term, as long as you maintain your weight, stay active, and partake in periodic maintenance treatments.

However, if you eat poorly and gain weight after your body sculpting procedure, the surrounding fat cells may overgrow. When this happens, the likelihood of the lasting effects of your body sculpting treatment will be lessened.

Are there risks involved in these treatments? Does it hurt?

Body sculpting treatments are relatively low risk, and no, it does not hurt. During the first few minutes of the session, you may feel an intense cold, tingling, and a cramping sensation. But these feelings subside as soon as the area becomes numb. You may also experience sensations of pulling, tugging or mild pinching when suction is applied during the treatment. Generally, there is a slight discomfort, but the treatment does not cause pain.

Is there any downtime involved after a body sculpting session?

I would say most patients experience little to no downtime after the treatment. Often, patients can return to work immediately after their body sculpting treatment. 

Sometimes but rarely, there is minor redness, swelling, bruising or soreness at the treated area, but it typically subsides over a week or two.

Toners – A Consumer’s Trap?

Toners – A Consumer’s Trap?

May 8, 2022   Return

What do toners actually do? Are they necessary in your skincare regimen?

Words Hannah May-Lee Wong

Every skincare brand has their own series of toners. They come in big hefty bottles and, for the most part, look like fancy packaged water. We are reminded time and time again that the full cleansing regimen consists of cleansing, toning and moisturising. Yet, toners have always been that in-between product – the step that’s easiest to skip and opt out of, mainly because we don’t know if they’re worth the time or money. After all, they may as well just be glorified bottles of spring water.

To make matters worse, some beauty lovers – even the avid ones – aren’t exactly sure what toners are for. That said, every time we pass by a beauty counter, we can’t help but wonder: should we give it another shot? Why are there so many types? How do we choose the right one? How would it benefit my skin? Well, it’s time we investigate some of these questions.

Removing residues

Options for toners are aplenty. You may find that different toners claim very different skincare benefits. It all depends on the ingredients contained in each product. For the most part, they do have some things in common. Overall, most toners work as an aid to your cleansers. Even after cleansing with your regular face wash, there may still be traces of oil, makeup residue, dirt and dead skin cells that might have been missed. Toners help remove these.

Preparation for moisturising

After cleansing and drying, patting a toner onto your face wets it again in preparation for other products to lay atop. Moist skin is known to help other products (such as your serum or moisturiser) penetrate faster and absorb more effectively. But wait, wouldn’t plain water do the trick as well? Yes, it would. However, most toners have an added benefit of containing ingredients that shrink the pores after cleansing. This helps prevent dirt and impurities from re-entering the skin. Furthermore, the newer toners act as water-based vessels that carry other active ingredients as well.


Active ingredients

The beauty industry is competitive and brands find all sorts of ways to incorporate popular ingredients into their products to market them as multi-functional. This isn’t necessarily a bad thing. With good guidance in choosing the right products for your skin, you will likely reap the benefits and most probably will end up with a multi-functional product that you love. More specifically, many toners double up as exfoliators, moisturizing lotions or pH balancers. It all depends on the formulation of the product. Active ingredients could range from certain acids, glycerin, antioxidants, anti-inflammatories and even anti-aging ingredients.

The acids are helpful for oily, acne-prone skin. Salicylic and glycolic acid help exfoliate the skin, prevent clogged pores (which cause blackheads and pimples) and prevent ingrown hairs. Antioxidants such as vitamin C brighten the complexion, while aloe vera and vitamin E are anti-inflammatories which calm red and sensitive skin.

Glycerin and glycol are good humectants, which means they bind to and help retain moisture on the skin. They also buffer the skin’s pH levels. Due to the alkaline properties of most cleansers and soaps, they could leave your skin’s pH levels imbalanced after washing. In turn, the cleansing process may stress your skin out, leading to an overproduction of oil. Toners with these ingredients help bring your pH back to its natural acidic pH of between 5-6.

Beware of harsh ingredients

Some toners, especially the older generation, traditional ones, are also known as astringents. These are potent but harsh alcohol-based products, and their main function is to remove excess oil from the skin. Alcohol as a skincare ingredient is good for oil control as it is drying and has antibacterial properties for fighting acne. Unfortunately, too much of it may irritate and strip the skin of its natural barriers. Most dermatologists advise against using products like these as they can bring more harm than good. Plus, there are many other options out there that are not as harsh on the skin.

How and when to use toners

Toners are best used immediately after cleansing. Some beauty gurus even say you should apply within a minute after cleansing. There are many methods of application, but as with most matters of beauty, there are no rules set in stone (so you should just have fun with it!). You may want to use a cotton ball or pad to pat it on your face, spritz it on (if it comes in a spray) or even tap it into your skin with your bare fingers; it’s up to you. Just be sure to cover your entire face and neck while applying. It’s worth to note that some toners contain particles of ingredients that settle at the bottom of the bottle, so don’t forget to shake thoroughly before use.

Bonus: If you’re really looking to amp up your beauty regimen, try the newest Korean beauty craze that claims to maximize hydration by fully utilizing your toner. It’s called the “7 Skin Method”, so named because in Korea, toners are popularly referred to as “skins”. Typically, a hydrating alcohol-free toner or essence should be used. Although the method is as easy as ABC, it is time consuming. As the name suggests, you apply your toner seven times, and you wait for your toner to dry on your skin each time before applying the next layer (it takes 2-3 minutes each time).

For more insight, here is an expert’s take on toners.

Dr Ch’ng Chin Chwen

Consultant Dermatologist

Are toners necessary?

First of all, what are toners? The “first generation” toners were mainly astringents containing alcohol, which are drying to the skin. Some people, especially those who feel their skin is “too oily”, use it as a second cleansing step to wipe off sebum on the skin’s surface. Others use it to enhance the absorption of serums and moisturisers, which are often applied after the toner. If you are referring to these types of toners, then they are absolutely not necessary to incorporate into your regimen. In fact, I will advise against using these types of toners as they strip away your natural moisturising factors and are harmful to the skin’s barrier function.

The “newer generation” toners have somehow evolved into something more like “water moisturisers”. They restore the skin’s pH and moisture levels after face wash, and some even have antioxidants added into them. That said, toners are still not completely necessary, but they can be beneficial. If you don’t mind an extra step in your skin care routine and if you have the budget for some pricey “broths of water”, then why not?

How do you choose the right toner for your skin?

If you have acne-prone skin, choose those that contain AHA, BHA or glycolic acid. Those with salicylic acid may help too but use with caution as they can be irritating.

If you have dry and sensitive skin, choose those with pH balancing and hydrating properties. Avoid those with parfum (fragrance) or those that have sensitisers as preservatives. Beware, even those labelled “hypoallergenic” may sensitise the skin too. Apart from parfum and known skin sensitisers, please avoid the following ingredients: denatured alcohol (SD), witch hazel and menthol (unless used in very minimal concentrations, as this “refreshing feel” ingredient can be irritating to the skin).

Lastly, if you have dull or mature skin, choose a toner with antioxidants and hydrating properties.

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Be a Natural Beauty

Be a Natural Beauty

May 1, 2022   Return


Young girls even before they reach puberty are pampered with beauty routines consisting of hair care, massage and a purifying bath.

The traditional way

Mashed noni fruit (Morinda citrifolia) is applied to their hair followed by a scalp massage using coconut oil, keremak leaves (Alternanthera sessilis L.), buah keras (Aleurites moluccana) and pandan leaves (Pandanus odorus). This hair routine is believed to strengthen hair roots and promote the growth of thick, glossy hair besides making it fragrant.


A mixture of thick coconut milk and a pinch of salt is applied on their skin to make it strong and to add shine. Fresh coconut water or rice water is used to wash their face to soften skin and get rid of dead skin cells while keeping skin moist.


Bedak sejuk made from rice flour, jasmine roots and turmeric diluted with a little rose water is lightly applied to their face and neck. This helps to refresh skin while keeping it smooth and supple. For dry skin, bedak sejuk is mixed with coconut oil or olive oil.

Crushed guava leaves (Psidium guajava) are used in purifying baths. Before having a bath, a scented herbal scrub or lulut, is applied all over their body. The scrub contains either normal or glutinous rice, cekur (Kaempferia galanga), sandalwood, ginger and jerangau (Acorus calamus). These ingredients are ground finely and mixed with rose or pandan water to form a paste. The scrub is thought to exfoliate dead skin cells and encourage new cell growth.

From your kitchen and garden

You can always use natural products from your kitchen or garden in your beauty routine. For starters, when you soak rice before cooking it, keep the water as you can use it as a cleanser. For toner, you can use turnip, lime or cucumber juice.

Soaked rice when pounded with turmeric makes for a good scrub. For masks, try honey or egg. Coconut oil can be used to massage the scalp while coconut milk can be used as a hair conditioner.


The western approach

You can also use local or imported produce from supermarkets nearby in your beauty routine. Eight ingredients namely avocado, cucumber, whole grains, banana, papaya, coconut oil, strawberries and apples, are featured here.

Avocado can balance oil production in your skin and hair while protecting against damage caused by sunlight and pollution. You can apply plain mashed avocado to your face, body and hair, or add 1 tablespoon each of raw organic honey and organic mayonnaise or almond oil. Leave it for 15 minutes then rinse well and shampoo if needed.

Cucumber is good for cell growth and skin repair – you can apply sliced cucumbers on your face and neck. You can also blend cucumber into a smooth puree and apply to your scalp. For a mask, add ¼ cup plain organic yogurt, 1 teaspoon aloe vera juice and a pinch of sea salt to 1 pureed or diced cucumber. Mix well, apply to your face and hair and leave it for 10 to 15 minutes. Rinse off.

Whole grains like oats and quinoa are good for detoxing, exfoliating, hydrating and softening skin. You need to cook ½ cup whole or ground organic oats or quinoa with water or almond/ rice milk. Let it cool, apply and rinse off.

For anti-aging, try banana fudge on your skin, hair and nails. Just mix 1 ripe banana, ½ cup cocoa powder, 2 tablespoons macadamia nut oil or butter, 1 egg, 2 tablespoons heavy cream, 1 tablespoon organic brown sugar and a pinch of cinnamon powder. Apply this fudge on your face, body and scalp, leave it for 15 minutes and rinse off.

For glowing skin, mix 1 papaya (blended), 1 teaspoon fresh lime juice, 1 teaspoon fresh orange or tangerine juice and 2 tablespoons raw organic warmed honey. Apply to your face and neck and rinse off after 10 minutes.

For healthy hair and skin, mix 2 tablespoons coconut oil, ½ cup pureed organic carrot, 10 drops of geranium oil, 5 drops of chamomile oil, 5 drops of jasmine oil and a pinch of rosemary, sage and sea salt. Apply on your skin and hair and leave it for 20 minutes. Rinse off. You may need to shampoo lightly.

Besides cleansing, toning and brightening your skin, strawberries can also be used to whiten your teeth. Blend 1 tablespoon of crushed fresh organic strawberries, 1 tablespoon of cream of tartar or baking soda, ½ teaspoon of fresh organic lemon or lime juice and 1 teaspoon of organic tooth powder or non-toxic toothpaste. Apply to your teeth, leave it for 5 minutes and rinse off. You can do this once a week.

Apples can be used to revive dull saggy skin, tighten pores and reduce inflammation. For this, you need a full bath. Add 1 finely sliced apple, 1 cup of rose petals and 3 bags of chamomile tea. Soak in this fragrant bath until you feel refreshed. If you are rushed for time, just boil the ingredients for 10 minutes and leave it to cool. Strain the mixture into a spray bottle and spray your face and body to refresh yourself whenever you need to.

Natural is not always safe especially if you are prone to allergies. Always test a small amount on your hand before applying it on your face and the rest of your body. Here’s to a naturally beautiful you!


8 Natural Beauty Treatments – From Your Kitchen. Available at

Bodeker G, ed. Health and Beauty from the Rainforest – Malaysian Traditions of Ramuan. Kuala Lumpur: Editions Didier Millet; 2009.

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Goodbye, Acne Scars!

Goodbye, Acne Scars!

April 28, 2022   Return

E_Dr Lim Ing Kien

Dr Lim Ing Kien   Aesthetic & Skin Doctor

Acne, jerawat, cheng chun tao, blemish, pimples – many cultures have their own name for one common problem. Acne can be treated but what happens after acne disappears? Sometimes, scars are left behind, much to one’s dismay

Aesthetic and Skin Doctor Dr Lim Ing Kien says that 2 things happen after acne: redness (probably due to inflammation) and scarring. Redness usually disappears after about 48 weeks but scars will remain.

“Post acne scar prevalence is 59%, which means more than half of those with acne will get some form of acne scarring. A 2014 study showed that 6-in-10 Malaysians with acne will scar. So, in a population of about 30 million in Malaysia, that’s  15 million people! This condition should not be taken lightly,” says Dr Lim.

Why do scars form?

There is open skin damage when acne is formed, due to inflammation and bacterial infection. Treatment can clear up the acne but one may end up with deep gaping holes in the skin.

Now, the nice firm and elastic layer of the skin is made of type 1 collagen, which takes years to build up. When the skin is injured due to acne, the body acts to plug the hole as fast as possible by produces type 2 collagen. This process can take place within days.

“Type 2 collagen is weaker than type 1 collagen and is less dense. So, what happens is that after the hole is plugged, there will be a depression in the affected scar area. In some people, collagen is produced at a faster rate, resulting in a raised scar,” says Dr Lim.

There are 4 main types of scars: ice pick, boxcar, rolling and hypertrophic. If the acne was small but deep, it will leave an ice pick scar. Larger and deeper acne leave boxcar scars, while large and shallow acnes tend to leave rolling scars. If too much scar tissue is formed, , the result is a hypertrophic scar.

What can you do to prevent or treat scars?

Firstly, acknowledge that you have a problem with acne. Then, see your doctor or pharmacist to get appropriate treatment. Ensure that you follow through with the treatment until you are completely free of acne.

While undergoing treatment for acne, you can use a post-acne scar product to prevent or treat scars. “When you have acne, act quick so you have less scars,” says Dr Lim.

These products, which typically contain allantoin, vitamin E, aloe vera, pionin and/or Allium cepa, help to prevent and treat acne scars. Allantoin moisturises and exfoliates the skin while promoting wound healing. Vitamin E promotes normal cell healing. Aloe vera also moisturizes and promotes normal cell healing. These ingredients prevent the formation of type 2 collagen and also encourage your body to produce type 1 collagen. Pionin has antibacterial properties and can kill any remaining bacteria in the skin. Allium cepa reduces the redness of scars.

If post acne scar products do not show results after 4 to 8 weeks, you should visit a dermatologist. Dermatologists can treat your scars using various treatments such as chemical peels, microdermabrasion, dermarollers/ dermapens, laser and surgery, says Dr Lim.


References: 1. Muthupalaniappen L., et al. (2014). Acne prevalence, severity and risk factors among medical students in Malaysia. Clinical Therapeutics 165(4): 187-92.

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Does Your Child Have a Lazy Eye?

Does Your Child Have a Lazy Eye?

April 28, 2022   Return


Karen Mcmain  Orthoptist, Dalhousie University, Canada

Recently, orthoptist Karen McMain from Dalhousie University, Canada, visited Tun Hussein Onn National Eye Hospital (THONEH) to train and share her experiences with local eye care specialists. Despite her busy schedule, Ms McMain managed to find some time to share with us some insight on lazy eye.

HT: In the old days, lazy eye was considered by superstitious people to be a “curse” or the result of sinister supernatural forces. What is lazy eye, actually?

KM: Lazy eye, also known as amblyopia, is a common childhood eye condition in which a child’s sight in one eye does not develop as it should.

I personally feel that the term “lazy eye” is inaccurate, as the eye is not really lazy. It would be more accurate to say “lazy brain” as amblyopia, the medical term for lazy eye, is actually a developmental problem within the brain.

What happens is that, normally, the brain and the eyes work together to produce vision. When a child has amblyopia, the brain does not acknowledge the vision from the lazy eye and focuses on the vision from the other eye. If the lazy eye is not stimulated properly, the visual brain cells do not mature normally. 

HT: What are the causes of this condition?

KM: Most commonly, it is due to the misalignment of the two eyes – a condition called strabismus. As a result of strabismus, the eyes are not aligned in the same direction, the eyes can cross in (esotropia) or turn out (exotropia). This misalignment prevents the eyes from focusing together on an image and may cause double vision. To overcome the double vision, the child’s developing brain chooses to ignore the image from the eye that is not straight, causing the vision in that eye to become lazy.

Differences in the way each eye processes vision can also be a factor, such as when one eye suffers from nearsightedness, farsightedness or astigmatism.

Sometimes but very rarely, the condition can also be caused by obstruction or cloudiness that prevents light from getting through one eye. Such obstructions can be due to cataract, eye tumours or droopy eyelids. Such amblyopia is called deprivation amblyopia.


HT: What happens if the condition is left untreated?

KM: Amblyopia is the most common cause of partial or total blindness in one eye, affecting 3% of children. Studies have shown that sufferers also face a significantly higher risk of losing vision in their good eye, either from injury or eye disorders such as macular degeneration.

HT: What are the treatment options for this condition?

KM: The most common treatment for amblyopia is to force the brain to start using the ‘bad’ eye.

This is done by first correcting any underlying problem in that particular eye. Then, we either put a patch over the ‘good’ eye or blur the vision in the ‘good’ eye with eye drops, to force the ‘bad’ eye to be used. The eye drop method is less commonly used in countries like Malaysia, which has a very sunny climate, as these drops dilate the pupil making the eye very sensitive to bright light.

Treatment is often helped by having the ‘bad’ lazy eye do periods of close work such as drawing or reading. The child will wear a patch over the ‘good’ eye during these activities.

Most children with amblyopia will also need glasses to help them focus their vision.

The doctor will discuss with parents what treatment is most appropriate for their child and their type of amblyopia.

HT: Do you have any advice for parents worried about their children’s eye health?

KM: I recommend all children to be screened for amblyopia, preferably at specialist centres, before they are school-aged. Young children have the greatest potential for successful treatment even though recent studies show that treatment in older children can also improve their vision.


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“Doctor, Make My Eyes Prettier.”

“Doctor, Make My Eyes Prettier.”

April 28, 2022   Return

Words Hannah May-Lee Wong

Dr Somasundaram Sathappan

Consultant Plastic and Reconstructive Surgeon

Having large, round eyes with well-defined double eyelids has been a long-standing trait of conventional beauty. Genetically, however, many Asians are born with a mono-lid (single eyelid) or have upper eyelid folds that are covered with excess skin, making them less obvious. While beauty is in the eye of the beholder and double eyelids are certainly not a necessity to look and feel beautiful, men and women can opt for a blepharoplasty if they desire to add the double eyelid to their looks. Dr Somasundaram explains the procedure and the risks involved.


A blepharoplasty refers to surgery on the eyelid and is also known as the double eyelid surgery. It is one of the most common cosmetic procedures that plastic surgeons perform in Malaysia. The procedure involves the removal of excess skin from the upper eyelid and reconstruction of the eyelid to create a fold when you open your eyes. Actually, most people already have a fold in their upper eyelid, but in most Asian people, the fold is covered by excess skin, so you can’t see it.

If a person has puffy eyes, the surgeon will also remove some fat during the blepharoplasty, but not too much. If the surgeon removes too much fat from the eyelid, the person may have hollow-looking eyes, and those tend to look a little sickly (not a good thing aesthetically).

The age range of people getting blepharoplasties is quite wide. People can get it done anytime from their teens to their 80s. Older folks may have more excess fat and skin which could droop over the eye and block their vision. When these are removed during the blepharoplasty, their vision would be improved.

A double eyelid surgery is different from an eye lift. An eye lift is done via an eyebrow lift, whereby the surgeon increases the distance between the eyelash and eyebrow. People do it because they may think that the distance between eyebrow and eyelash is very short, which may not look very pretty – the preferable distance is at least 1.5cm. To create that ideal distance, surgeons make a cut and raise the eyebrow. They can also do this with botulinum toxin, a method not involving surgery.

What happens during a blepharoplasty?

It’s a very straightforward procedure. A patient will come for a preoperative consultation. We go through their medical history, allergy tests and make sure they are not on any blood thinning products, vitamin E or gingko biloba that can cause bleeding.

Before we tell the patients what they can do to their face to make them happier and prettier, we assess their face anatomically. We take note of their condition before surgery: whether they have extra skin or extra fat around the eyelids and whether their eyebrows are drooping. Then, we can recommend the type of procedure they should go for based on the results they want. It could involve raising their eyebrows, removing excess skin to create a double eyelid or both. The choice of procedure also depends on how much time the patient has to recover as they will need to take time off work. Of course, we must take the cost into consideration as well.

Once that’s all done, we show the patients before and after pictures, especially of past patients who have similar facial features. If they are happy with the expected results, we explain the complications of surgery before making a booking. A blepharoplasty is usually done under local anaesthesia, with pre-operative markings on the eyelids indicating how much skin is needed to be excised. The surgery will take around half an hour to 45 minutes; it’s a fairly quick day procedure and patients can go back home on the same day. In five days to a week after the surgery, the patient comes back to the hospital to get the stitches removed. Thereafter, there may be swelling for two to three weeks before it subsides completely and the patient gets the results that he or she was hoping for.

What are the risks?

When you put a knife to the skin, there are always risks. The possible complications could include bleeding, allergies to medications or infections (which are rare). In eyelid surgery, asymmetry may happen, where the right and left eyelid turn out to be uneven. In fact, 1-2mm asymmetry is quite common, and may be present even before surgery. If the patient already has asymmetry before the blepharoplasty, it is the surgeon’s duty to point it out as the surgeon may not be able to equalize the eyelids perfectly. There is also a small risk of blindness, but that is extremely rare. As far as I know, blindness caused by a double eyelid procedure has never happened in Malaysia, but there have been reports of it happening overseas.

How does a person prepare for a blepharoplasty?

If a patient has existing medical conditions such as diabetes, heart disease or is on medications, we run a blood test to make sure they are fit for surgery.

Patients have to take at least a week off work and they’ll need to get someone to drive them home after the surgery (because their eyes are going to be bandaged). Although they are still able to see clearly, their eyes are going to feel heavy after the surgery and injections. Post operation, the patient manages with antibiotics, painkillers and ice packs.

Will the result of blepharoplasty stand the test of time?

Aging is a constant process. It is genetically induced and you age according to your genetic make-up; it is also affected by the stressors you put your body through. A poor diet, lack of sleep and exercise and binging on alcohol or cigarettes can make a person age a lot faster than someone who leads a healthy lifestyle. But whatever procedure you do, it will deteriorate over time. Generally, a blepharoplasty lasts a long time, up to 15 to 20 years. But if excess skin redevelops, it will have to be removed again.

Can a patient have other aesthetic procedures done at the same time?

Yes, the combination of eyelid surgery, face lift and neck lift is quite popular. It takes about four-and-a-half hours.

In recent years, there has been a trend of going to Korea to get cosmetic procedures done. Do plastic surgeons in Malaysia provide the same services as they do in Korea?

Yes, Malaysian surgeons offer the same aesthetic procedures that are available in Korea, it’s just that the Korean marketing may be a lot better. Unfortunately, we have been seeing a lot of complications. Sometimes, patients return from Korea with problems such as bleeding, unevenness or infections and local doctors have to manage those complications.

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What Men Should Know Before They Go For The Snip-Snip

What Men Should Know Before They Go For The Snip-Snip

 April 27, 2022   Return


Professor Dr Christopher Ho Chee Kong

Consultant Urologist

Oriental Melaka Straits Medical Centre



To understand the procedure better, first let Prof Dr Chris Ho give an overview on the sperm production process. Sperm cells are made by cells called Sertoli cells in the testicles and are stored in the structure called epididymis. A tube called the vas deferens carries these sperm cells from the epididymis towards the urethra, and along the way, they are mixed with seminal fluids, produced by separate glands called seminal glands, to form ejaculate during sexual intercourse.

What happens during vasectomy is that the vas deferens is cut. As a result, sperm cells are unable to leave the testicles and pregnancy is no longer possible after sexual intercourse.

Because vasectomy does not affect the seminal glands, the man can still produce semen.


Vasectomy does not affect the nerves in the penis or the blood supply to it, so Prof Dr Chris Ho states that there shouldn’t be any changes in the man’s ability to achieve an erection or attain sexual pleasure. There shouldn’t be any changes to the man’s semen either, aside from the absence of sperm cells.

Improperly done vasectomy, however, may damage blood supply to the testicles, which in turn can lead to reduced testosterone production. As a result, the man’s sexual performance may be affected, but such occurrence is very rare.


“There is a failure rate of 0.3% to 9%, usually due to the surgeon’s technique or skill level,” says Prof Dr Chris Ho.

Also, sometimes the cut vas deferens may rejoin on their own, but this rarely happens.


It’s possible. Prof Dr Chris Ho will explain more about this later. Still, he cautions that reversing a vasectomy is more complicated, and hence is an expensive procedure with a chance of failure, when compared to vasectomy.

Therefore, a man should be absolutely certain that he doesn’t want children before going for the snip!


There are two methods, according to Prof Dr Chris Ho.

Conventional vasectomy will see the surgeon using a scalpel to make an incision on the skin of the scrotum to perform the snip.

No-scalpel vasectomy, on the other hand, sees the surgeon using a specialized surgical instrument, called the sharp haemostat, to puncture a small hole in the scrotum. Unlike the previous method, this method has a smaller risk of bleeding, infection and pain. The procedure also takes less time to perform compared to conventional vasectomy.

However, Prof Dr Chris Ho points out that the equipment needed for no-scalpel vasectomy may not be available at certain clinics and hospitals. Also, not every surgeon is capable of performing this type of vasectomy, as it requires a little bit more training and experience.


Prof Dr Chris Ho shares that one will need to rest for about 24 hours after the surgery, and he can perform light activities after 2 or 3 days. Sports, lifting and other heavy activities should be avoided for the first week or so, however. “Sexual intercourse can resume after about 1 week,” he says, adding that the man should use contraceptives such as condoms until follow-up medical appointments show that there are indeed no sperm cells in his semen.


Oh yes. To determine whether a vasectomy is successful, the man will be asked to provide a semen sample for analysis at about 3 months or after 20 ejaculations (whichever is sooner) after the surgery.

While not common, post-vasectomy pain syndrome (PVPS) is a group of bothersome and even painful symptoms that can develop either immediately or later (sometimes even a few years) after a vasectomy. Symptoms can include ache in the testicles, discomfort during sex or after heavy activities and pain during ejaculation. There are ways to relieve these symptoms, but in some men, the symptoms may persist and become chronic—their best solution may be to reverse their vasectomy.



Prof Dr Chris Ho reveals that a vasectomy can be reversed, either by:

  • Reconnecting both ends of the cut vas deferens (vaso- vasotomy), or
  • Reconnecting the cut vas deferens to the epididymis (vaso-epididymostomy).

The choice of procedure is determined after an initial assessment of a fluid sample, called vas fluid, obtained from the vas deferens.

  • If healthy sperm cells are seen in the sample, then vaso- vasotomy will be carried out.
  • If no sperm cells are seen, or if the vas fluids aren’t of sufficient quality to be analyzed, then vaso- epididymostomy will be recommended instead.


Vasectomy reversal is a far more complex procedure than vasectomy. It is best carried out by a well-trained surgeon, and even then, there are no guarantees of success.

Furthermore, Prof Dr Chris Ho explains that the vasectomy process itself may affect the man’s fertility even after a reversal has been carried out.

Epididymal blowout. After a vasectomy, the sperm cells in the epididymis has nowhere to go. As a result, there is mounting pressure in the epididymis, to the point that rupture of the epididymal structure may result.This affects sperm production and the quality of the sperm produced.

Anti-sperm antibodies. The body may produce antibodies that can either outright kill sperm cells or severely reduce the ability of the sperm cells to travel in the womb and seek out an egg cell to fertilize.

“The rate of a successful pregnancy after a reversal vasectomy is about 55% if the reversal is done less than 10 years after the initial vasectomy,” says Prof Dr Chris Ho. “This rate drops to 25% if the reversal is performed more than 20 years after the vasectomy.”

Even if the vasectomy reversal is successful, it may take up to a year before viable amounts of sperm cells are produced in some men.


Prof Dr Chris Ho advises men who wish to have their vasectomies reversed to talk to a urologist. With advances in research and medical methodologies, there are many men who successfully become fathers despite having had vasectomies in their past. These days, there is always a possibility that the door to fatherhood is still open, so it is up to the man to make the first step and explore the options available to him. HT

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