How does body sculpting work?
Let’s get the million-dollar question out of the way: is this the weight loss solution that we have all been dreaming of?
How can body sculpting complement efforts to lose weight, such as eating healthy, balanced meals and exercising?
Are the treatments performed by a medical doctor?
Who would benefit most from body sculpting treatments?
Which parts of the body are the body sculpting treatments usually done on?
What can patients realistically expect from this treatment?
How long do the results last?
Are there risks involved in these treatments? Does it hurt?
Is there any downtime involved after a body sculpting session?
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 www.huffingtonpost.com
Bodeker G, ed. Health and Beauty from the Rainforest – Malaysian Traditions of Ramuan. Kuala Lumpur: Editions Didier Millet; 2009.
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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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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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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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WORDS LIM TECK CHOON
Professor Dr Christopher Ho Chee Kong
Oriental Melaka Straits Medical Centre
GETTING THE SNIP
WHAT HAPPENS DURING A VASECTOMY?
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.
ASIDE FROM THE LACK OF SPERM CELLS IN THE SEMEN, WILL VASECTOMY CHANGE ANYTHING ELSE ABOUT ME?
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.
ANYTHING ELSE THAT I SHOULD KNOW?
“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.
CAN I CHANGE MY MIND AFTER THE SURGERY AND GET THE PROCEDURE REVERSED?
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!
HOW IS VASECTOMY DONE?
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.
WHAT HAPPENS AFTER A VASECTOMY? WILL I NEED A LONG TIME TO RECOVER?
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.
REVERSING THE SNIP
WHAT’S THE GOOD NEWS?
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.
SO, WHAT ARE THE NOT-SO-GOOD NEWS?
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.
DON’T BE DISCOURAGED BY THE NOT-SO-GOOD NEWS, THOUGH!
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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WORDS HANNAH MAY-LEE WONG
Can you believe that zapping your skin with laser beams can vaporize some of your deepest insecurities? This technology has come a long way in the aesthetic industry. Laser therapy for the skin can be used to resurface acne scars, remove freckles and tattoos, lessen wrinkles and more.
HOW DOES IT WORK?
There are different types of lasers out there. Each laser machine emits lasers at a specific wavelength. By tweaking the wavelength of the laser, we can treat different skin conditions.
We use carefully chosen wavelengths, pulse durations, and energy strength to target an area and minimize injury to the surrounding healthy skin. Generally, lasers can be used to improve acne scars, reduce pigmentation, wrinkles, blood capillaries, remove tattoos and rejuvenate the skin.
Laser machines work by emitting light of a single wavelength that is absorbed by target chromophores. In the beauty industry, lasers target chromophores (target cells) such as tattoo pigments, melanin, haemoglobin and water. What happens is that certain light waves would target broken capillaries and vessels, while others target dark spots and pigments. When light energy is absorbed by these targets, the vessels or pigments would break down and get swept away by white blood cells or macrophages in the body. In other words, after being zapped by lasers, these imperfections will disappear or fade.
Some lasers are used for rejuvenation. In these cases, the energy from the laser is absorbed deep within the skin and creates a “controlled injury”. This process would stimulate the inner layers of the skin to produce more collagen. As a result, fine lines would appear less visible and the skin would look firmer.
“By tweaking the wavelength of the laser, we can treat different skin conditions.”
However, this is not a one-size- fits-all kind of treatment. The intensity of each laser therapy depends on what the patient hopes to target, skin type, the age of the skin and the gender of the patient. For example, the skin of a 60-year-old gentleman would be thicker and rougher compared to that of a 20-year-old lady. Hence, the settings of the machine used during each treatment needs to be carefully tuned by the doctor to achieve the best possible results.
With more technological innovation, newer machines now provide faster results, are safer for use and have less risk of complications.
WHAT ARE ABLATIVE AND NON-ABLATIVE LASERS?
By definition, “ablation” means to surgically remove. Ablative lasers work like sandpaper — they “sand away” or “resurface” the top layer of your skin and they may cause peeling. With non- ablative lasers, the top part of your skin remains unharmed, because the wavelength and energy used penetrates deeper into the skin and stimulates collagen production. Non-ablative lasers do not cause any injury to the top layer of your skin.
MUST ALL LASER PROCEDURES BE DONE BY A DOCTOR?
Yes. In Malaysia, laser procedures for the skin are supposed to be done by doctors who are trained and certified to use laser machines. These doctors need to obtain a Letter of Credentialing & Privileging (LCP) from the Ministry of Health before being allowed to practise. This is to ensure patient safety. Improper use of lasers may cause burns to the skin and even damage to the eyes.
ARE THERE CERTAIN GROUPS OF PEOPLE WHO CAN’T GO FOR LASERS?
Pregnant or breastfeeding mothers are advised not to go for lasers. Also, those who have recent sunburn would have to wait for a couple of days for the skin to heal before going for laser therapy.
WHAT IS THE PROCESS LIKE?
The patient would first have to come for a consultation session. The doctor would discuss the patient’s expectations and explain the possible risks and complications. Once the patient is fully informed, treatment can be started.
Before the doctor performs the laser procedure, a nurse would wash the patient’s face to remove impurities and apply numbing cream. It takes 30 to 45 minutes for the numbing cream to set in. After that, the doctor performs the laser procedure, which typically lasts for 20 to 30 minutes. Once that is completed, the nurse would wash the patient’s face, do a post-laser care regime and apply a cooling mask to soothe the treated skin.
The doctor may prescribe some medication to help with the discomfort and inflammation. The patient is usually given some skincare to take home too. Patients are required to protect their skin with sunscreen, daily. Overexposure to the sun after the laser treatment to remove pigmentation may result in the treated skin turning darker.
DOES IT HURT?
It depends on the patient’s pain tolerance and what treatment the patient goes for. If the patient receives more intense treatments like tattoo removal, birth mark removal or vascular lesion reduction, light sedation or local anaesthesia may be given. Generally, ablative laser treatments are slightly more painful, and they also require local anaesthesia or sedation.
Non-ablative lasers tend to hurt less. Don’t worry, numbing cream is usually applied before these procedures to reduce the pain sensation, so it will be tolerable. The sensation is akin to being snapped by a rubber band.
ANY DOWNTIME INVOLVED? FOR HOW LONG?
Again, it depends on what you get treated for. If you do laser treatment for rejuvenation or lessening wrinkles (milder treatments), your face would only appear pinkish for a day. If you go for lasers to remove or reduce the appearance of a scar (a stronger treatment with the use of higher energy lasers), it takes up to a week to recover. In those cases, your face would appear red for some time, followed by some peeling of the skin which normally occurs after day five of treatment.
HOW MANY SESSIONS DOES A PERSON NEED TO SEE RESULTS?
However, for treatment of melasma (patches of brown on the skin), it will be more challenging and would take around six or more sessions to get good results.
HOW LONG DO THE RESULTS LAST?
It depends. The rule of thumb is that the more you take care of yourself, the longer the results last. If you don’t smoke, sleep early, have a healthy diet and drink lots of water, the results remain for a long time.
Also, if you go for laser therapy to remove hyperpigmentation, you’ll need to protect your skin from the sun diligently because exposure to the sun may cause the pigmentation to reappear.
WHAT ARE THE POSSIBLE RISKS AND COMPLICATIONS WE SHOULD KNOW ABOUT?
Lasers are at large, safe for use. However, in inexperienced hands the risk of complication would be much higher. Complications can include damage to the eyes, burns on the skin and pigmentation becoming darker or very much lighter (post-inflammatory hyper/ hypopigmentation). During tattoo removal, if the power of the laser is set too strong, the person might develop blisters, which may lead to infection.
Remember, always get your treatment from a licensed doctor to minimize your risk of complications. Your health and safety are of utmost importance and this should not be compromised. While we all want flawless skin, we need to remind ourselves that the procedures we go for should be done safely and with minimal risk. HT
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WORDS HANNAH MAY-LEE WONG
Dr William Hoo
Botulinum toxin injections and dermal fillers may seem similar, but they are two very different things. Although they are both injectable cosmetic treatments performed by aesthetic physicians, that’s pretty much where their similarities end. An expert in the field answers some frequently asked questions and tells us all we need to know about these two popular non-invasive procedures.
Tell us about the Botulinum toxin.
Botulinum toxin (BTX) is a type of protein produced by the bacterium Clostridium botulinum. There are many different types and brand names of BTX that are registered as medication and are approved by the Ministry of Health (MOH).
In the medical field, BTX can be used to treat chronic migraines, muscle spasms (e.g. in children with cerebral palsy or in stroke patients who have lost control of their muscle movement), hyperhidrosis (excessive sweating) and more. In the medical aesthetic industry however, BTX is mainly used to reduce wrinkles.
How is it used in the beauty industry?
BTX can be used to reduce dynamic wrinkles, which are wrinkles caused by repeated muscle movement associated with facial expressions, e.g. squinting, frowning and smiling. Common areas for injection are the glabella (frown lines), crow’s feet and forehead lines.
A popular procedure in Asia is using BTX for face reshaping—for example, reshaping a square face to a more feminine oval face via size reduction of the masseter muscle. With special injection techniques, BTX can also be used for face lifting.
BTX can help reduce the appearance of a “gummy smile”—a smile that shows gum excessively. This is done by weakening the muscles that strongly pulls up the upper lip. For men, many get BTX injections at the frown lines to get a more approachable, refreshing and “less angry” look.
Does it hurt?
The needles used for BTX injections are very fine. Additionally, the doctor may apply ice packs or numbing cream beforehand, so that you may only feel minimal discomfort during the injection.
However, after the treatment, you might feel a bit heavy in the injected muscle area. BTX works by blocking nerve signals in the muscles where it was injected. As a result, the injected muscle would be temporarily relaxed or “asleep”. Extra effort is needed to move the affected muscle, so that area might feel heavy. Don’t worry, the sensation only lasts about 1 to 2 weeks, and then you’ll adapt to it.
“BTX can be used to reduce dynamic wrinkles, which are wrinkles caused by repeated muscle movement”
What is the after-care like?
There will be a needle injection mark at the injected site, therefore the goal is to prevent contamination and infection in the area. After treatment, avoid swimming and going for sauna sessions or massages. Don’t drink excessive amounts of alcohol, as alcohol causes vasodilation (the dilation of blood vessels). Avoid going for laser or facial treatments for about 3 days.
How long do the effects last?
The effects of BTX lasts around 3 to 6 months.
What are the risks and possible complications?
The toxin effect of BTX may spread. If BTX is injected over the forehead, there is a small chance that the toxin may spread downwards and cause the eyelids to droop (ptosis) or cause the patient to have double vision. There are medications available to treat this if it happens.
Some patients may experience headaches after treatment. BTX can also cause breathing difficulty or difficulty in pronouncing certain words when it is injected around the mouth area.
If the doctor injects unequal doses on the left and right side of the face, it may cause asymmetry, which can become obvious when a person is making expressions. Not to worry, you may go back to your doctor to correct the asymmetry; these effects are temporary and can be reversed after a period of time.
Who should NOT get this treatment?
Pregnant women, those who are allergic or those who have had adverse reactions to BTX before.
Can it become addictive?
BTX in itself is not addictive, but people can get addicted to the beauty effects of BTX. The communication between the patient and the doctor is very important. The doctor needs to know when to advise the patient to stop, as too much BTX may make facial features and expressions to become unnatural (stiff or mask-like).
What are fillers and how are they different from BTX injections?
Fillers are substances used to restore volume loss, whereas BTX is used to weaken the muscles that cause wrinkles. They are entirely different.
There are different types of fillers: hyaluronic acid fillers, synthetic fillers (e.g. calcium hydroxylapatite, silicone, etc.) and autologous fillers (i.e. fat transfer) which is a method of using fats from other parts of the body for reinjecting over the face. Hyaluronic acid fillers tend to be a popular choice in the aesthetic industry because it is the only type of filler which has an antidote, called hyaluronidase. If anything goes wrong during the treatment, it can be reversed quickly by the antidote.
Where in the face are fillers typically injected?
Previously, fillers were mainly used to restore volume, especially in the sunken under-eye area and in the lips. Nowadays, we use fillers for much more than that; fillers can be used to correct certain features on the face.
As we age, our features tend to sag and look tired. Many women experience volume loss in the under-eye area. The corners of the mouth and the lateral canthus of the eyes also tend to point downwards as a person gets older, which may make a woman look angry or sad all the time. Fillers can be used to plump up and restore volume in these areas, and it will overall result in the woman looking refreshed, and more feminine and youthful.
Common areas for filler injections are over the cheeks; under the eyes; at the temples; on the chin and on the lips. Some people who are allergic to BTX can opt for fillers too, as fillers can limit muscle movement and reduce the appearance of wrinkles—we call this myomodulation. Lastly, fillers can also be used to reduce the appearance of acne scars.
How long do the effects last?
Some fillers produce effects, which last around 6 to 9 months, while others for up to 24 months. It all depends on the brand, the method of preparation and the concentration of fillers used.
It’s worth noting that if you get fillers for the second or third time, the amount of fillers needed will be less than before, and the effects will probably last longer. This is because when fillers are injected into an area, it stimulates collagen production.
What are the risks?
The skill of the medical professional performing this treatment is a very important factor. Sometimes, fillers can cause asymmetry if the dose injected is not equal on both sides. Filler injections can cause lumps and bumps in the skin if the level of injection is too superficial. Sometimes, after getting fillers, some people might have redness, rashes, bruising or swelling over the treated area.
The more serious complications arise when the fillers are accidentally injected into a blood vessel—it can cause skin necrosis (cell death) or blindness.
The probability of risk also depends on the type of fillers being injected. Fillers are riskier if injected on the central area of the face—there are more blood vessels connected to the eyes, brain and nerves in the central area of the face. Hyaluronic acid fillers are more popular because it has an antidote to reverse the adverse effects, in case anything goes wrong.
It is highly advisable to consult a trained and certified medical professional from a reputable clinic, which uses good quality products. Regulation by the MOH requires the doctor to have a license to perform these procedures, and the clinic must also have an aesthetics treatment license. Lastly, all products used must be registered and approved by the MOH. HT
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