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by Dr Shuyan ( RJ CLINIC) Are you frustrated by the stubborn fat that won’t seem to budge, despite your efforts at the gym? Do you find yourself dreading your workouts because they feel like a chore instead of a rewarding experience? If so, we have good news – Aqualyx may be the solution you have been searching for. Aqualyx is an injectable fat dissolving solution that can target areas like chin, abdomen, thighs, love handles, hips, knees and arms to help you achieve a more toned and sculpted appearance. However, it is important to note that Aqualyx does not provide a one-session solution for permanent or complete fat removal. Why? Let’s look into it in details to understand more. How does Aqualyx work? Aqualyx contains a compound called deoxycholic acid, basically a bile acid. It is one of the secondary bile acids that are formed by intestinal bacteria from their metabolism. Naturally, its function is to emulsify and solubilize fats from our diet in the intestine. Research started in 2002 implied that deoxycholic acid is responsible for the lysis of fat cells, and in 2007, Professor Pasquale Motolese developed this preparation and technique to perform this treatment. Aqualyx is injected subcutaneously (fat layer) to disrupt cell membranes in fat cells and destroying them over time- in a process called adipocytolysis. After the breakdown of fat cells, they will be drained by lymphatic system to the liver to be metabolised and then excreted by the kidneys. Before deciding a treatment plan, we will assess your suitability for the treatment and discuss your expectations. Suitability depends on few factors: - Will you be able to accept the downtime? - How much fat do you have? Or is it just loose skin? - Any contraindications? - Can you accept injections and some pain? - Will you be able to stick to post procedure care? Your expectations: - Are you looking for a one-time treatment with immediate result? - Are you aiming to lose just subcutaneous fat or visceral fat as well? Let’s address these questions one by one. 1. Will you be able to accept the downtime? Immediately after treatment, treated areas will appear red, swollen with possible bruising and itching. Do not worry, this is because Aqualyx works by triggering inflammatory response in your fat cells. Noticeable swelling indicates treatment progression and will last for around 5 days. After swelling has gone down, you will return to look normal, but may not feel normal upon touching as there will possibly be small lumps and bumps that are not usually visible under the skin and may take a week or more to resolve. These lumps and bumps may be bruises or dead fat tissues that are still pending to be taken away by your lymphatic system. All these effects also depend on the amount of solution injected. For example, the face only requires a small amount of fat dissolving solution, so side effects are minimal and requires shorter recovery period. It is better to avoid strenuous exercise for the first week while your body is still processing. But overall, downtime for Aqualyx is pretty tolerable and you can still head back to work after treatment. 2. How much fat do you have? Aqualyx is effective in reducing localized pockets of fat. If you have excessive amounts of fat or are significantly overweight, exercise and healthy diet to lose weight should be your main aim, while Aqualyx can be used for stubborn fat that are resistant to diet and exercise. Sometimes, you might mistook loose skin as fat. Loose and flabby skin will not benefit from Aqualyx injection. Instead, Ultherapy will be the choice of treatment for loose skin at face, chin and neck and radiofrequency for the body. 3. Any contraindications? There are few conditions when Aqualyx is contraindicated, which means if you have one of these conditions, you should not go for Aqualyx injection. - Pregnant - Breastfeeding - Autoimmune disease- Treatment may exacerbate the conditions. - Diabetes- Aqualyx is contraindicated in individuals with uncontrolled diabetes because it can potentially increase blood sugar levels from the inflammation and tissue damage. Furthermore, individuals with diabetes may have impaired healing, hence higher risk of infection. - Allergic or anaphylactic reaction to Aqualyx - Skin disease on treatment area- Treatment may exacerbate the conditions. - On blood thinning medications, in particularly warfarin, as there is risk of severe bruising - Severe liver and kidney disease- Deoxycholic acid is primarily eliminated from the body through liver and kidneys. In people with kidney disease, the function of kidneys is compromised, which can lead to build up of toxins and waste products in the body. Extra fat could also overwork the liver, which can be problematic for people with liver disease. 4. Can you accept injection and some pain? Aqualyx treatment involves multiple injections to the target areas. Numb cream and ice pack application before injection can minimize pain and discomfort. Local anaesthesia will also be mixed together with the fat dissolving solution. You may still experience minimal discomfort, more of a burning or stinging sensation upon injection, but most people find it tolerable. 5. Will you be able to stick to post procedure care? After Aqualyx treatment, you should consume low-fat diet to reduce additional stress to your liver by having to cope with processing two sources of fat, which are fat from your usual diet and fat destroyed by Aqualyx injection. As Aqualyx dissolves the fat, manual massage is encouraged not only to ensure even distribution for better result, but also to aid lymphatic system in eliminating the waste products. You should also drink plenty of water after treatment to help flush out the waste products. You should avoid exposure to extreme temperature, including saunas, steam rooms and sunbathing until the initial swelling has resolved, which takes about a week. Strenuous exercise should also be avoided for a week as you may still feel tender and uncomfortable. You can resume gentle exercise when you feel ready. 6. Are you looking for a one-time treatment with immediate result? If you are in a hurry to lose fat or if you prefer a one-time treatment with immediate result, then Aqualyx is not a suitable choice of treatment. Unlike liposuction, in which fats are sucked manually and removed as much as possible, Aqualyx depends on the action of deoxycholic acid that disrupts cell membranes in fat cells and destroying them over time. The action of deoxycholic acid is variable as it can be influenced by multiple factors. You can expect to see a noticeable reduction in size and contour of treated area within a few weeks after treatment, with optimal result typically visible after few sessions depending on areas being treated. Sessions required can range from 3 to 8 treatments, with the least required for smaller areas with lesser fat and vice versa. Hence, if you have just undergone the first Aqualyx treatment and no visible improvement yet, don’t need to feel demotivated. Be patient and continue with the treatment plan and you will see improvement eventually. However, there are ways to help Aqualyx work better. This include massaging the treated areas to allow dispersion and even distribution of Aqualyx throughout the fat tissues, and avoiding anti-inflammatory medication that will counteract the effect of Aqualyx. 7. Are you aiming to burn subcutaneous fat, or visceral fat as well? Subcutaneous fat is the fat underneath you skin, whereas visceral fat is the fat that lies deep within your abdominal walls and wraps around your liver, stomach, intestines and other important organs. The most obvious sign of visceral fat is a growing belly, but it can indicate subcutaneous fat as well. Sedentary lifestyle and poor diet with high intake of saturated fats and carbohydrates increase visceral fat. Surprisingly, stress contributes to the build up of visceral fat too. This is because stress activates cortisol, which is a hormone in your body. High cortisol level activates your body’s fight or flight response that triggers buildup of visceral fat. Some levels of visceral fat are healthy and act as protection to your organs. However, too much visceral fat can be dangerous, and is more dangerous than subcutaneous fat as it can increase the risk of certain health problems, such as heart disease, stroke and diabetes. If you have too much subcutaneous fat, it is often a sign that you have too much visceral fat as well. It is important to note that health is more than beauty. It is true that aesthetic and surgical procedures can help to reduce your subcutaneous fat and achieve your ideal body shape, but healthy diet and exercise should not be forgotten to ensure healthy level of visceral fat. While Aqualyx can be effective at reducing subcutaneous fat, it is NOT designed to target or eliminate visceral fat. If you are looking to reduce visceral fat, it is important to focus on healthy diet and regular exercise. This can help to decrease overall body fat and improve your overall health. Treatment like Redustim can also help to burn up to 8% of visceral fat. Redustim is an aesthetic medical device that uses BioStimology technology, in which low frequency alternating BioEnergetic field stimulates calcium pump in the muscle cells. Calcium pump causes contraction of muscles, and uses energy in the form of ATP that is derived from visceral fat, thereby reducing visceral fat. Treat ment takes 45 minutes per session, and effect is comparable to heavy exercise. On top of that, ReduStim has micropressure that follows the direction of lymphatic drainage. This helps to eliminate toxins and metabolic wastes including broken down fat cells from the body through lymphatic drainage. In short, Redustim helps you to lose weight while improving your health. ReduStim treatment is completely painless. It only involves you slipping into the special suit connected to the device, and relaxing yourself in a lying down position for the entire procedure. However, treatment requires 2 to 3 sessions per week with a total of 12 sessions. Maintenance treatment is advised for continuous improvement. There are also some common questions regarding Aqualyx: 1. Is Aqualyx harmful to the body? Aqualyx is composed of naturally occurring ingredients, deoxycholic acid, which is a secondary bile acid. After it is injected and fat cells are destroyed, the remains are processed and eliminated from the body through the lymphatic system. Therefore, Aqualyx itself is not harmful to the body. However, when there is pre-existing disease that may complicate Aqualyx treatment, such as liver or kidney disease and as mentioned in “contraindications” earlier, Aqualyx should be avoided. 2. Is the result permanent? Not exactly. Fat cells that are destroyed are lost permanently. Results can be maintained as long as you commit to healthy lifestyle alongside treatment. If you have inactive lifestyle and consume diet high in saturated fats and carbohydrate (sugar), fat cells that were not destroyed by Aqualyx will begin to grow with time. In conclusion, Aqualyx is an innovative and effective non-surgical treatment to reduce stubborn fat in specific areas of the body to help you achieve a slimmer and more contoured appearance without the need for surgery or long downtime. However, treatment is a choice and a shared decision making between you and the doctors. The information given above should have more or less covered your doubts on whether you are a suitable candidate for Aqualyx treatment. How about weight loss then? In recent times, there has been a lot of buzz around weight loss injection drugs such as Saxenda and Ozempic. Saxenda contains Liraglutide, whereas Ozempic contains Semaglutide, which are both Glucagon-like peptide 1 receptor agonist (GLP-1 RA). Ozempic is originally used to treat people with Type 2 Diabetes mellitus. They are not insulin injection. They mimic glucagon hormone in our body, and both glucagon and insulin are equally important to manage the body’s blood glucose level. They work by suppressing the hunger centre in your brain responsible for appetite. They also give you feeling of fullness as stomach emptying is delayed, meaning that the food you consumed remains in the stomach for longer period of time before it is digested. This causes people to eat less and lose weight over time. Although it sounds tempting to people who are eager to lose weight, they do cause side effects like nausea, vomiting and diarrhoea. A more serious risk linked to these GLP-1 drugs is hypoglycaemia (low blood sugar level), but higher risk if you are also taking other blood sugar lowering drugs like sulfonylureas or insulin. Though not proven in human, lab studies have linked these drugs with thyroid tumours in rats. Hence, these drugs are not recommended if you have family history of medullary thyroid cancer or multiple endocrine neoplasia. They are also not recommended if you have had pancreatitis. Question is, if you rely solely on the drug to lose weight and continue an inactive lifestyle and unhealthy diet, what happens when you stop taking the drug? There is a high likelihood that you will gain the weight back. It is not sustainable to take these drugs for the rest of your life, nor is it necessarily desirable, given the potential for side effects. Adopting healthy lifestyle can be challenging because it means changing your habits and behaviours, but it is ultimately more sustainable and without side effects.

The face is not only a vital part of our body but also a reflection of our personality, emotions, and overall health. A slim and contoured face is often associated with youthfulness, attractiveness, and confidence. However, factors such as aging, weight gain, genetics, and lifestyle habits can contribute to a fuller and rounder face shape, impacting our self-esteem and confidence. Fortunately, there are various surgical and non-surgical options available to help people achieve a slimmer and more defined facial appearance. In this comprehensive guide, we will explore the different treatments available for face slimming and their potential benefits. Of course, if you are not into any aesthetic treatments, there's always the option of putting daily heavy makeup and contouring... So let's dive into it! Non-Surgical Options for Face Slimming: BTA Injections: BTA injections (more commonly referred to as BOTOX) is a popular injectable treatment containing botulinum toxin, a neurotoxin that temporarily paralyzes targeted muscles. By injecting Botox into the muscles responsible for creating fullness in the cheeks or jawline, a more defined and contoured facial appearance can be achieved. This treatment is relatively painless, requires no downtime, and the results typically last for 3-6 months. Dermal Fillers: Dermal fillers are injectable substances, primarily composed of hyaluronic acid, a naturally occurring substance in the body. By strategically injecting fillers into areas such as the cheeks, jawline, or chin, volume and contour can be added, creating a more defined appearance. The procedure is generally painless, has no downtime, and the results typically last for 6-12 months. Ultherapy: Ultherapy is a non-invasive treatment that utilizes ultrasound technology to stimulate collagen production and tighten the skin. It can be used to lift and contour the cheeks, jawline, and neck, resulting in a more defined facial appearance. With the additional benefit of burning fats at the jowling area too! The treatment typically takes 30-60 minutes, and the results can last up to 2 years. Aqualyx Injections: Aqualyx is an injectable treatment specifically designed to reduce the appearance of a double chin. This treatment involves injecting deoxycholic acid, a naturally occurring substance in the body that breaks down fat cells. By targeting the chin area, Aqualyx injections help reduce fat and create a more contoured jawline. The results can last for several years, and multiple sessions may be required to achieve optimal results. Surgical Options for Face Slimming: Buccal Fat Removal: Buccal fat removal is a surgical procedure that involves the removal of excess fat pads located in the cheeks, especially obvious when you smile. This procedure is ideal for individuals with chubby cheeks, resulting in a rounder or fuller facial appearance. The procedure is performed under local anesthesia, and the recovery time typically ranges from 1-2 weeks. Face Liposuction: Face liposuction is a surgical procedure that removes excess fat from areas such as the cheeks, jawline, and neck, leading to a slimmer and more defined facial appearance. The procedure is usually performed under general anesthesia, and the recovery time is typically 1-2 weeks. The downside is you may need to wear a faceband for 2 weeks to make sure the skin is taut on recovery Chin Implants: Chin implants are a surgical option for individuals with a weak or receding chin. By placing an implant in the chin area, a more defined and contoured jawline can be achieved. The procedure is typically performed under general anesthesia, and the recovery time varies depending on the individual. Surgical Facelift: A facelift is a surgical procedure that addresses sagging skin, wrinkles, and jowls on the face and neck. It involves lifting and tightening the skin, resulting in a more youthful and contoured appearance. The recovery time for a facelift can vary, but patients typically observe the final results after several weeks. Downside? A long scar that is visible at the hairlike and near the ears. A slim and contoured face is highly desirable, and advancements in medical aesthetics offer various options to achieve this goal. Whether you choose non-surgical treatments like Botox, dermal fillers, Aqualyx injections, or non-invasive procedures like Ultherapy, or opt for surgical options such as buccal fat removal, facelift, face liposuction, or chin implants, it's essential to consult with qualified professionals to determine the most suitable approach for your specific needs. By considering the available options and understanding their benefits and limitations, you can make informed decisions and take steps towards achieving a slimmer and more defined facial appearance.

There is a confusion and misinformation among the general public regarding aesthetic injections, often incorrectly referred to as “botox”. This misnomer has led to the association of botox with images of unnatural, overly inflated faces. It is important to recognize that various injection-based treatments exist, each serving distinct purposes and delivering different outcomes. This widespread misconception can be attributed, in part, to a lack of understanding about the true nature of botox and its mechanism of action. So, let’s delve deeper into the topic and explore botox and its diverse range of applications. What is botox and how does it work? Botox, or botulinum toxin, is a neurotoxin that is produced by the bacteria Clostridium botulinum. When injected into a muscle, it blocks the release of acetylcholine, a neurotransmitter responsible for muscle contraction. This prevents the muscle from contracting and causing wrinkles or other unwanted movements. Another common injection, filler, on the other hand, is injected to add volume and plumpiness, filling in hollow areas and smoothing out wrinkles. Uses: While it is often known for its ability to diminish wrinkles and fine lines on the face, botox offers a broader range of cosmetic and even medical uses beyond that. Treat dynamic lines Botox is most commonly used to treat dynamic wrinkles, which are caused by repetitive muscle movements, such as frowning, squinting or raising eyebrows. These wrinkles can create an older or fatigued appearance. By temporarily paralyzing and weakening the muscles involved for these movements, botox helps smoothen the skin and rejuvenate the face, resulting in a more youthful and revitalized look. Face slimming Botox can also be used to contour the face. An increasingly popular treatment is the use of botox injections to target the masseter muscles, aiding in slimming and refining the jawline, ultimately leading to a more feminine and aesthetically pleasing appearance. This treatment is particularly popular in Asian countries, where a V-shaped or heart- shaped face is considered more desirable than a square-shaped face. The masseter muscle, a prominent muscle running along the side of the face, serves a pivotal role in the processes of chewing and jaw clenching. However, in certain individuals, various factors such as teeth grinding or clenching, chronic stress, or even genetic predisposition can contribute to the enlargement of the masseter muscle. This enlargement can lead to a more square-shaped jawline, which is often perceived as a characteristic associated with a masculine aesthetic. To address this concern, botox injections are strategically administered to the masseter muscles, causing a temporary relaxation of the muscle fibers. By doing so, the injections effectively reduce the bulkiness and hypertrophy of the masseter muscles. The treatment helps to sculpt and contour the jawline, resulting in a softer and more feminine appearance. The cosmetic benefits of botox injection for the masseter muscles extend beyond slimming and contouring the jawline. The procedure can also contribute to a more balanced and proportionate facial profile, enhancing overall facial harmony. Moreover, botox injections for masseter muscle reduction are known for their non- surgical and non-invasive nature, making them a popular choice among individuals seeking subtle yet effective facial enhancements. Brow lift Another application of botox involves the enhancement of the brow area, commonly known as a brow lift. By injecting small quantities of botox into the muscles responsible for pulling down the eyebrows, it becomes possible to achieve a lifted appearance and create a more defined, arched shape. This technique proves particularly beneficial and effective for individuals with naturally droopy eyebrows, as it helps to rejuvenate and revitalize their overall facial expression. Treat gummy smile Furthermore, botox offers a solution for those troubled by a gummy smile, a condition characterized by the excessive display of gum tissue when smiling. This aesthetic concern arises from hyperactive muscles that elevate the upper lips, resulting in the exposure of a significant portion of the gums. Thankfully, botox provides an effective treatment option for this condition. By temporarily relaxing the muscles responsible for elevating the upper lips, botox reduces the excessive display of gum tissue, thereby improving the harmony and balance of the smile. Nose tip lift Botox can also enhance the appearance of the nose tip. It is possible to relax the muscle responsible for pulling the nasal tip downward with botox injection, and effectively creating a “lift” for the nose tip. This technique proves advantageous for individuals seeking subtle changes to the shape and projection of their nose, without resorting to invasive surgical procedures. Treat dimpled and receding chin Botox also offers a solution for those with a receding and dimpled chin caused by an overactive mentalis muscle. The mentalis muscle, when hyperactive, can result in a chin that appears dimpled and receded. Botox induces temporary relaxation, hence allowing for increased chin projection and reducing the appearance of dimpling. Nefertiti Lift The Nefertiti Lift is a cosmetic procedure names after Queen Nefertiti, an ancient Egyptian queen known for her elegant and defined jawline. The procedure involves the use of botox injections to rejuvenate and contour the neck and jawline, resulting in a more youthful and sculpted appearance. The Nefertiti Lift primarily targets the platysma muscle, which is located in the neck and plays a significant role in supporting the lower face and neck. When platysma muscles are strong, it can create a downward pull, obscuring the jawline and forming vertical neck bands. This can result in an aged and less defined appearance. Nefertiti lift aims to counteract the downward forces caused by the muscle, thereby providing a lifting effect, creating more defined jawline and improved appearance of the neck. “ Why is it that after multiple botox injections, I no longer see the same improvement that I saw with my initial injections?” There are many brands of botulinum toxin A or botox available, with Dysport, Botox, and Xeomin being the most widely recognised, and then there are newer brands like Daxxify or Jeauveau. The proteins present in botulinum toxin act as antigens, thereby provoking an immune response from the body, which results in the development of antibodies against the toxin. Consequently, with repeated treatments, the efficacy of botulinum toxin injections wanes, owing to the presence of these antibodies, which block the effect of the toxin. There is an exception for this case, which is Xeomin. Xeomin was FDA-approved in 2011 and is often advertised as the “cleanest product” of Botox injections because Xeomin does not contain complexing protein that causes antibody formation. Of course, there are also other factors that can affect the efficacy of botox injections, including changes in the dosage and injection technique. Why is botox not permanent? Botox effects only last 3 to 6 months because of neuronal plasticity, wherein fine nerve fibers emerge and reinnervate the muscle fibers, leading to recovery of muscle strength. On top of that, body can also form new connections between the nerve fibers and muscle fibers, known as motor end plates. Formation of new motor end plates can further aid in the restoration of normal muscle function. Top of Form Microbotox or mesobotox Microbotox is a specialized form of botox injection that involves the use of diluted botox solutions to target a larger area of the skin with multiple injections. This technique allows for a more widespread, subtle effect on the skin’s surface while maintaining natural facial expressions. The microbotox technique is used to reduce sweat, sebum (oil) and minimize pores due to the effect on sweat glands, sebaceous glands (oil glands) and erector pili muscle. Medical uses of botox In addition to its cosmetic uses, botox has a variety of medical applications. It can be used to treat chronic migraines, blepharospasm (involuntary eyelid twitching), cervical dystonia (neck muscle spasms), hyperhidrosis (excessive sweating), and spasticity (muscle stiffness and spasms) Botox or fillers? There are some common misconceptions about botox that need to be addressed. Firstly, it is important to understand that botox and fillers are two distinct treatments. While fillers work by filling in static lines and restoring lost volume, botox is used to relax muscles that cause wrinkles and dynamic lines. Botox works by temporarily paralyzing the muscles that cause wrinkles and fine lines, primarily in the upper part of the face, such as forehead and around the eyes. Results typically last for three to 6 months. Dermal fillers are a popular cosmetic treatment used to address wrinkles and lines that are present even when the face is at rest. These lines, also known as static lines, develop as a result of a combination of factors, including aging, sun damage, loss of collagen and elastin and repetitive facial expression over time. Unlike dynamic wrinkles that appear with facial movement and are treated with botox to relax the underlying muscles, static lines are formed due to the loss of volume and skin elasticity. This is where dermal fillers come into play to help filling in the static lines and reducing their prominence. While hyaluronic acid fillers can be dissolved by injecting hyaluronidase if there are any issues, there is no such solution available for botox. Therefore, if there are any undesirable outcomes from botox treatment, you have to wait for the effects to wear off naturally. Do facial exercise work? Facial exercise is a technique in which specific facial muscles are targeted and exercised in order to improve their tone and strengthen them. The aim is to make the face look firmer and more youthful, and to reduce the appearance of wrinkles and fine lines. Proponents of facial exercise argue that by stimulating blood flow and circulation to the face, these exercises can help nourish the skin and promote a healthy glow. Some also claim that facial exercise can help release tension and stress and improve overall relaxation. Facial exercise can involve a variety of movements and techniques, such as puckering the lips, raising the eyebrows, and performing certain facial expressions. Some people also use tools like facial massage rollers and gua sha stones to enhance the benefits of facial exercise. However, there is currently NO strong scientific evidence to support these claims. In fact, overly vigorous facial movements can actually exacerbate wrinkles and fine lines. One reason for this is that repeated facial movements can cause the muscles in the face to contract and pull on the skin, leading to formation of new wrinkles over time. Additionally, excessive stretching and tugging of the skin can damage its elasticity and contribute to the breakdown of collagen and elastin fibers, which are important for maintaining a smooth and youthful appearance. If you are looking to reduce wrinkles and fine lines at home, it is generally recommended to focus on lifestyle habits like using sunscreen, eating healthy diet and staying hydrated, as well as using skincare products with proven anti-aging ingredients like retinol or retinoids and antioxidants. Your anti-aging skincare Speaking of retinol and retinoids, they are well known and widely used as skincare for their antiaging benefits. However, there can be some confusion about the distinctions between them. Retinol is a specific type of retinoid. Retinoids are a class of compounds derived from Vitamin A, and retinol is one of the forms. In comparison to prescription-strength retinoids or retinoic acid such as tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac), retinol is considered milder and available for purchase over the counter. Retinol is available in various skincare products without the need for a prescription. Retinol is 20 times less potent than prescription-strength retinoids. It serves as a precursor to retinoic acid, which is responsible for the anti-aging effects when it undergoes conversion by the skin. Retinoic acid is the only form of ingredient that is bioavailable to the skin. To put it simply, retinoic acid does not require conversion by the skin to become effective- it starts working instantly. Retinol, on the other hand, takes more time to produce visible results. However, this does not mean that OTC retinol is ineffective. The notion that “stronger is better” is a common misconception. The slow conversion of retinol makes it more tolerable for individuals with sensitive skin, while prescription-strength retinoids have higher potential for side effects such as skin irritation, dryness, and increased sensitivity. Ultimately, both retinol and retinoic acid are effective; the difference lies in the time it takes for visible effects to appear, which varies based on individual tolerance. Along with retinol, retinyl palmitate and retinaldehyde are also considered to be less potent forms of retinoids. These substances offer several benefits for the skin, including: · Reduced wrinkles and fine lines: They stimulate collagen production, which helps improve skin elasticity and reduced the appearance of wrinkles and fine lines. · Improved skin texture: Consistent use of retinol or retinoids can lead to smoother skin by promoting cell turnover and facilitating exfoliation. · Reduced acne: Retinoids possess anti-inflammatory properties and can effectively clear out clogged pores, making them beneficial for treating acne. As previously mentioned, retinol and retinoids can cause skin sensitivity, redness, dryness and flakiness, especially during the initial stages of use. To minimize these effects, it is advisable to begin with a low concentration and gradually increase it as your skin becomes more tolerant. You can also start by applying 2 to 3 times per week and then gradually increase the frequency to daily use, based on your skin’s tolerance. Additionally, it is important to incorporate daily sunscreen use when using retinol or retinoids since they can heighten the skin sensitivity to the sunlight. This precaution helps protect your skin from potential sun damage.

Lip augmentation has become an increasingly popular cosmetic procedure in recent years, with more people seeking to enhance their natural lip shape and achieve a fuller, plumper look. Many people turning to this procedure to enhance their pout and boost their confidence. While many people are satisfied with the results of their lip augmentation, others have experienced horror stories of procedures gone wrong. If you're considering lip augmentations, it's important to do your research and understand what the procedure entails. In this blog, we'll explore some of the most common lip augmentation horror stories, including the potential risks and complications, and the lessons that can be learned from these experiences. What Are Lip Augmentations? Lip augmentations involve the injection of fillers into the lips to enhance their size, shape, and definition. The most common fillers used for lip augmentations are hyaluronic acid fillers, which are made from a substance naturally found in the body. Lip augmentations are typically done on an outpatient basis and can be completed in as little as 30 minutes. The results of the procedure can last anywhere from six months to two years, depending on the type of filler used. What is an ideal lip shape? You will find that as your scour the internet, there are many many different lip shapes. But not one shape fits all types of face and lips. And it also differs by asian and western tastes. In Western culture, the ideal lip shape is often described as full and plump, with a distinct Cupid's bow and a well-defined vermilion border. This ideal is influenced by the cultural norms of beauty and femininity, which prioritize fullness and symmetry in facial features. This preference has led to the widespread use of lip fillers and other cosmetic procedures to achieve fuller lips. In Asian culture, the ideal lip shape is often described as thin and delicate, with a soft curve and a gentle slope. This ideal is influenced by cultural norms of beauty, which prioritize subtlety and understated elegance over boldness and volume. Additionally, many Asian cultures value a more youthful appearance, which can be achieved by maintaining a more natural lip shape. In our clinic, we encounter a mix of requests with clients bringing in pictures of their favourite superstar's lips to follow. Below are samples of what you can achieve with lip fillers. This picture shows a flat, relatively shapeless cupid bow. We were able to enhance the shape and bring back the M cupid bow shape and also provide shapier lip contour while keeping her lip thickness more or less in the same ratio as be original. In this patient, she already has some basic lip shape, but lacks in volume. So our filler lip placement was to bring out the 3d shape of the lip with peaks and valleys on the lips. In this patient, her lips have thinned out significantly with assymetry in her lower lips. Our aim was to volumise, maintain a good shape and also make it more symmetrical. You notice that we were able to make the lips corner "smile" which is favored among asians. The Risks and Complications of Lip Augmentation Before undergoing any cosmetic procedure, it's important to understand the potential risks and complications. Lip augmentation is no exception. In this section, we'll explore some of the most common risks and complications of lip augmentation, including: Infection : Infection is a potential risk of any surgical procedure, including lip augmentation. In some cases, infection can lead to serious complications, such as fever, severe pain, and even sepsis. The other more common type of infection associated with lip augmentations are oral herpes infection. The use of injectable fillers or other surgical techniques during lip augmentation can also trigger a herpes outbreak, particularly if the skin is broken or irritated during the procedure. If you have a history of oral herpes, it is important to discuss this with your healthcare provider and your cosmetic surgeon prior to undergoing lip augmentation. They may recommend antiviral medication or other preventive measures to reduce the risk of an outbreak occurring. Allergic Reactions : Some people may experience allergic reactions to the materials used in lip augmentation, such as fillers or implants. These reactions can lead to swelling, redness, and in severe cases, anaphylaxis. Overfilling : One of the most common horror stories of lip augmentation is overfilling. Overfilling occurs when too much filler or implant material is used, resulting in an unnatural or exaggerated look. Migration : In some cases, the materials used in lip augmentation can migrate, or move, from their original location. This can lead to asymmetry or an uneven appearance. Horror Stories of Lip Augmentation Gone Wrong Unfortunately, there have been many horror stories of lip augmentation gone wrong. In this section, we'll explore some of the most notable examples, including: Kylie Jenner : Perhaps the most famous example of lip augmentation gone wrong is Kylie Jenner. Jenner initially denied having had any lip augmentation, before eventually admitting to having lip fillers. However, the results were often criticized as being overdone and unnatural. Farrah Abraham : Reality TV star Farrah Abraham underwent lip augmentation in 2015, but the procedure left her with a severely swollen and uneven appearance. She later underwent corrective surgery to fix the problem. Amanda Lepore : Model Amanda Lepore underwent lip augmentation in the early 2000s, resulting in an exaggerated and unnatural look. Lepore later underwent corrective surgery to achieve a more natural appearance. Jocelyn Wildenstein : Socialite Jocelyn Wildenstein underwent multiple cosmetic procedures, including lip augmentation, in an attempt to transform her appearance. However, the results were often criticized as being unnatural and cat-like. Leslie Ash: Actress Leslie Ash underwent lip augmentation in 2002, but the procedure resulted in an infection and permanent damage to her lips. She later underwent corrective surgery to repair the damage. Lessons Learned from Lip Augmentation Horror Stories While horror stories of lip augmentation gone wrong can be scary, there are lessons that can be learned from these experiences. In this section, we'll explore some of the key lessons to keep in mind when considering lip augmentation, including: Research Providers: One of the most important lessons is to research providers carefully before undergoing lip augmentation. Look for providers who are experienced, reputable with license, and who have a portfolio of successful lip augmentation cases. In our country, be sure to look for licensed doctors to do your injections. You do not want to risk having unknown product injected and causing trouble later on. Communicate Clearly: Communication is key when it comes to lip augmentation. Be sure to discuss your goals and concerns with your provider, and ask any questions you may have. Don't be afraid to speak up if something doesn't feel right. Bring pictures of lips you like, Be Realistic: It's important to be realistic about your goals for lip augmentation and to avoid overdoing it. Going too far can result in an unnatural or unbalanced look. 4. Follow Post-Procedure Care: Following the proper post-procedure care can help ensure a smooth recovery and reduce the risk of complications. Lip augmentation can be a safe and effective way to enhance your natural lip shape and achieve a fuller, plumper look. However, as with any cosmetic procedure, there are potential risks and complications. Horror stories of lip augmentation gone wrong may be scary, but they also offer valuable lessons to keep in mind when considering lip augmentation. To minimize the risks of lip augmentation, it's important to research providers carefully, communicate clearly with your provider, and follow all pre- and post-operative instructions. By doing so, you can increase your chances of achieving the results you desire while minimizing the risk of complications. Ultimately, the decision to undergo lip augmentation is a personal one that should be carefully considered. By understanding the potential risks and complications, and learning from the experiences of others, you can make an informed decision that is right for you.

Recently the re-emergence of the news regarding the "botox death" which happened in singapore on 23 Mar 2019 havr given Malaysians quite a shock (again). Especially with their clickbait (and misleading) titles. In truth, the autopsy has revealed it was death due to EDTA injection which is commonly used for heavy metals chelation therapies (and not botox, mind you) So what exactly is botox? We have clients who comes very worried they will end up dead or looking like our dear ex-first lady R*sm@h. So let me help enlighten you a little bit. BOTOX is just a popular tradename for a neurotoxic protein produced by the clostridium botulinum bacteria, known as botulinum toxin. There are 8 types but types A and B are most popularly used in medicine. In Malaysia there are 3 main brands namely Xeomin, Dysport and Botox. This treatment have been done for nearly 30 years with almost 3 million injections annually! Of course like any medicine out there, it has risk and benefits. In the right hands (and i do mean right hands like fully certified and trained docs) , we inject only minimal amounts (not enough to reach the fatal dose) to get good cosmetic results. Let me show you a short clip as to how botox works in our body! In simple terms, the toxin works by blocking the nerve pathway so "signals" to move the muscles are blocked. Imagine it like a roadblock. Once these roadblocks are established within 24 to 48 hours of injection, you will see our injected muscles gradually stop moving, lasting results for about 3 to 6 months. Does it travel to the whole face and make the face "hard/frozen look"? Absolutely not. The injection is very localised and will not spread. Awesome science is it not? So back to the question, does BOTOX kill? The answer is ... yes and no. Yes, IF you were given a lethal dose, directly into the bloodstream. And NO, you don't get it when injecting it for cosmetic use. Why? Because the lethal dose is approximately 39units per kg. Which means for botox to kill an average female of about 50kg, it will need = 39x50kg = 1950units of botox, equivalent to almost 20 bottles of botox since each bottle is 100 units. Hence, rest assured that you are pretty safe when you go for your usual anti-wrinkle treatment sessions.

Eyebags are a pain in the ass. Under-eye bags are a common cosmetic concern that can make you look tired and aged beyond your years. No matter how much you try to cover them up with concealer, they always seem to find a way to peek through and ruin your otherwise perfect look. But fear not, my fellow beauty lovers, because there is a new kid on the block when it comes to getting rid of those pesky bags - eyebag laser treatment (let me get back to you on this later as you scroll down). Unfortunately, there are many myths and misconceptions surrounding this issue, which can make it difficult to know how to address it. In this blog post, we'll explore some of the most common myths and misconceptions about under-eye bags, as well as the aesthetic treatments that can help reduce their appearance. Myths and Misconceptions About Under-Eye Bags : Myth: Under-eye bags are caused by lack of sleep. Fact: While lack of sleep can exacerbate under-eye bags, it is not the primary cause. Genetics, age, and fluid retention are all factors that can contribute to the development of under-eye bags. Myth: Eye creams can get rid of under-eye bags. Fact: While eye creams can help hydrate the skin and improve its overall appearance, they cannot eliminate under-eye bags. Aesthetic treatments such as dermal fillers or surgery may be necessary to achieve significant improvement. Myth: Under-eye bags only affect older people. Fact: While under-eye bags are more common in older individuals, they can affect people of all ages due to factors such as genetics, allergies, or fluid retention. Myth: Drinking more water can eliminate under-eye bags. Fact: While dehydration can exacerbate under-eye bags, drinking more water alone is not enough to eliminate them. Other factors such as genetics and age must also be addressed through aesthetic treatments. In fact, some found drinking too much water especially before sleep worsens the eyebags in the morning due to water retention. Myth: Surgery is the only option for addressing under-eye bags. Fact: While surgery is an effective treatment option for severe cases, there are many non-invasive aesthetic treatments available that can help reduce the appearance of under-eye bags without the need for surgery. Aesthetic Treatments for Under-Eye Bags: Now that we've dispelled some of the myths and misconceptions surrounding under-eye bags, let's take a look at the aesthetic treatments that can help reduce their appearance: Dermal fillers: Dermal fillers are a popular treatment option for under-eye bags. They work by adding volume to the area, which can help smooth out the appearance of the skin. Hyaluronic acid fillers are commonly used for this purpose, as they can hydrate the skin and improve elasticity. However, dermal fillers will only help to HIDE those pesky bags, not exactly treating them. It it a great option of course if you have dark eye circles and deep tear troughs. Eyebag Lasers: First things first, what is eyebag laser treatment? Essentially, it's a non-surgical procedure that uses a laser to reduce the eyebag fats bulge, tighten the skin under your eyes and hence, reduce the appearance of those pesky bags. The laser heats up the fats, melting them away and tighetns the skin, causing it to contract and produce new collagen, which helps to firm up the area and give it a more youthful appearance. Now, I know what you're thinking - "a laser near my eyes? That sounds terrifying!" But trust me, it's not as scary as it sounds. The procedure is quick and painless, and you'll be in and out of the office in no time. Plus, the results are seriously impressive without the need for surgery. Not only does eyebag laser treatment help to reduce the appearance of bags under your eyes by 50 to 70%, but it can also help to improve the texture and tone of your skin. And the best part? There's minimal downtime as compared to surgery. But here's the thing - eyebag laser treatment isn't cheap. But hey, you get what you pay for, right? And when it comes to looking and feeling your best, sometimes you just have to invest a little bit of money. So, if you're tired of trying to hide your eyebags with makeup and are ready to take the plunge and try something new, I highly recommend giving eyebag laser treatment a shot. Trust me, your eyes (and your self-esteem) will thank you. And who knows, maybe you'll even be able to ditch the concealer for good. Eyebag Surgery: In severe cases, surgery may be necessary to remove under-eye bags. This procedure, known as blepharoplasty, a surgical procedure that "removes" excess fat and skin from under your eyes, leaving you with a smoother, more youthful appearance. Essentially, it's like hitting the reset button on your under-eye area. The procedure is performed under local anesthesia, so you won't feel a thing. And while there is some downtime involved, the results are seriously impressive. Not only will eyebag surgery treatment get rid of those pesky bags, but it can also help to improve the overall appearance of your eyes. Plus, it's a one-time procedure, so you won't have to worry about going back for touch-ups. Other less effective treatments for eyebags: Laser resurfacing: Laser resurfacing is a non-invasive treatment that uses laser technology to stimulate collagen production in the skin. This can help improve the appearance of under-eye bags by tightening and smoothing the skin, usually helps in the wrinkled skin above the eyebags. Not really to help the eyebag fats itself. Treatments like these are Fotono 4d, CO2 resurfacing laser. Radiofrequency treatments: Radiofrequency treatments use heat to stimulate collagen production and tighten the skin. This can help reduce the appearance of under-eye bags and improve the overall texture of the skin (but not the bags itself). Microneedling: Microneedling involves the use of a device that creates tiny punctures in the skin, which stimulates collagen production and can help reduce the appearance of under-eye bags. Conclusion? Under-eye bags can be a frustrating cosmetic concern, but there are many aesthetic treatments available to help reduce their appearance. By dispelling some of the myths and misconceptions surrounding this issue and exploring the various treatment options available, you can make an informed decision about how to address your under-eye bags. Whether you opt for dermal fillers, eyebag lasers, surgery, laser resurfacing, radiofrequency treatments, or microneedling.

Acne is a common skin condition that affects millions of people worldwide. It is a complex inflammatory condition caused by several factors: - Excessive sebum (oil) production - Cutibacterium acnes ( A type of bacteria previously known as Propionibacterium acnes. It is not the sole cause of acne. Cutibacterium acnes is a natural part of the skin’s microbiome, which consists of a diverse range of microorganisms that help maintain healthy skin. However, when there is an overgrowth of this bacteria, it can lead to inflammation and the formation of acne lesions.) - Alteration in follicular keratinisation ( This means that dead skin cells are not shed at an adequate rate, causing occlusion of pores and microcomedone formation.) - Inflammation These key factors are interrelated and may be influenced by several hormonal and genetic factors. There are many facts about acne that you may not be aware of. Here are some of the interesting facts about acne : 1. Acne can develop at any age People always have the misconception that when you get older, you will not get acne anymore. While acne is most commonly associated with teenagers, it can develop at any age. In fact, adult-onset acne is becoming increasingly common, particularly in women. 2. Acne can be caused by genetics Genetics play a role in development of acne on top of lifestyle and diet. If your parents or siblings have had acne, chances of you getting acne is more likely. 3. Stress can worsen acne Stress can trigger the production of hormones that can increase sebum production and contribute to development of acne. In addition, stress can also weaken your immune system, making it harder for your body to fight off acne- causing bacteria. 4. Acne can be caused by certain medications Some medications, such as corticosteroids, lithium and anticonvulsants, can cause acne. 5. Protein supplement can cause acne Evidence suggests that whey protein may be a contributing factor in acne for some individuals. Whey protein is a popular supplement among gym goers and athletes as it is a high- quality protein and fast-digesting. However, whey protein increases insulin-like growth factor-1 (IGF-1) which can stimulate the production of sebum. Sebum is pro-inflammatory and has the potential to clog pores when it is excessive, thus can worsen or trigger acne breakouts. Moreover, whey protein is often processed with added hormones and often consumed with milk, which are other sources that contribute to acne. If you suspect whey protein may be the cause of your acne breakouts, you can consider to exclude whey protein from your diet for a period of time and see if it makes a difference in your skin. Meanwhile, you can take alternative protein sources like egg whites, almonds, soy, walnuts, plant based protein and bone broth. However, not all individuals who consume whey protein will have acne. Some are more prone to having acne due to other contributing factors such as hormonal changes and genetics. 6. Dairy products can cause acne Dairy products, such as milk, cheese, contain hormones and growth factors that can stimulate the production of sebum, the oily substance that clogs pores and leads to acne. In addition, dairy products can also increase insulin levels in the body, which can trigger inflammation and contribute to acne. Several studies have shown a link between the consumption of dairy products and acne. In one study, researchers found that teenage girls who consumed more milk were more likely to develop acne than those who consumed less milk. Another study found that the risk of acne increased in individuals who consumed more than three servings of dairy products per day. But not all dairy products are associated with acne. For example, yoghurt is acne friendly, as probiotics in yoghurt can reduce IGF-1 level. 7. Sugar intake can cause acne Similarly, sugar, particularly refined sugar and high- glycaemic index carbohydrates, can cause a rapid increase in blood sugar levels, which can trigger the production of insulin and IGF-1, hence leading to inflammation and development of acne. I know it is not easy, especially if you are a sweet tooth person. But hey, think about good skin, it is worth considering reducing your consumption of high- glycaemic index carbohydrates. 8. Exercise and acne Exercise itself does not cause acne, but it can contribute to the development of acne breakouts in some people. This is because exercise causes sweating , which can mix with sebum and dead skin cells on the skin’s surface, leading to clogged pores and later acne breakouts. In addition, exercise can cause friction on the skin , particularly in areas where clothing or equipment rub against the skin, such as the back or chest. This can worsen existing acne or cause the development of new lesions. However, it is important to note that regular exercise and physical activity can have benefits for the skin and overall health. It improves your blood circulation and oxygenation to the skin, and it can also help to reduce stress, which is a known contributor to acne breakouts. Exercising is definitely a must in life to maintain good health. The key is to reduce the impact of exercise on acne by minimising friction to skin and practice good hygiene. These can be achieved by the following measures: - Shower or cleanse the skin as soon as possible after exercising to remove sweat and bacteria from the skin’s surface - Wear loose- fitting clothing that allows the skin to breathe and does not trap sweat against the skin. - Avoid wearing hats or headbands that can trap sweat against the skin. Bottom of Form 9. Menstrual period causes acne Wonder why is there flare up of blemishes and acne before your period? They usually strike about 7 to 10 days before the onset of your period and then subsides as soon as bleeding begins. The average menstrual cycle is 28 days. In the first half of menstrual cycle, estrogen predominates; in the second half, main hormone is progesterone. As bleeding approaches, both of these female hormones levels fall to the lowest, whereas the male hormone, testosterone (exist in smaller amount in female) remain the same level throughout the whole month. This implies that before and during menstruation, testosterone is relatively higher than the female hormones. In mid cycle when progesterone level rises, there is production of sebum. As progesterone level increase, skin swells up, compressing the pores and makes the pores look less visible. When both estrogen and progesterone level decrease and testosterone level is high, sebaceous glands make even more sebum on top of the sebum built up by progesterone. Excessive sebum disturbs the balance of bacteria Cutibacterium acnes, which is the bacteria that forms part of the normal flora of the skin. When bacteria overgrow, acne forms. 10. Acne can be caused by medical conditions Here are some of the medical conditions that can cause acne: - Polycystic ovarian syndrome (PCOS) Polycystic ovarian syndrome is a hormonal disorder that affects women of reproductive age. It is characterised by high levels of androgen (male hormones) in the body, which can lead to acne, hirsutism (excessive hair growth), and other symptoms like irregular periods, weight gain, and difficulty getting pregnant. - Hypothyroidism Hypothyroidism leads to a number of hormone imbalances that could each lead to acne by themselves. In hypothyroidism, there is low progesterone level. This leads to high estrogen levels and estrogen dominance that increase sebum production. Hypothyroidism also influences insulin levels which in turns influence testosterone levels, leading to testosterone-induced acne and oily skin. Acne caused by hypothyroidism is usually cystic that can involve face and other parts of body, not associated with menstrual cycle, but present all the time especially at times of stress. It can also be accompanied by other symptoms of hypothyroidism such as weight gain, cold intolerance, fatigue, menstrual irregularity etc. - Cushing’s syndrome This is a disorder caused by prolonged exposure to high levels of cortisol (a hormone produced by adrenal gland). It can be due to corticosteroid medications intake or by tumour in the pituitary gland or adrenal gland. Other than causing acne, it also leads to weight gain, muscle weakness and high blood pressure. - Congenital adrenal hyperplasia (CAH) and adrenal tumour Adrenal glands are responsible for producing hormones, including androgen such as testosterone. In these two conditions, there will be production of excess androgens, which can stimulate the oil glands in the skin to produce more sebum. In addition to androgen production, imbalance of cortisol also contributes to the development of acne. 11. You should never pop or squeeze your acne Attempts to squeeze or extract whiteheads or cysts can push the sebum and follicular debris deeper thus increasing lesion depth, inflammation, and immune response, creating more aggravated acne flare and increasing the potential to develop postinflammatory hyperpigmentation and scarring. 12. Washing your face a lot will not clear up blemishes Washing your face twice a day is more than enough. Over exfoliating and over cleansing can worsen your acne as it may irritate and dries out your skin, leading to more oil production. 13. There are many reasons why acne can scar Family history is one of the biggest contributor to why you are prone to scarring . However, the most important predictor and an avoidable factor of acne scarring is the time to effective treatment . When there is too much time between initial flaring acne and effective treatment, scars tend to form due to the prolonged inflammation. So, treat your acne as soon as possible to prevent scarring. Self manipulation as mentioned in the previous point will increase the chance of severity of scarring. Severity and duration of your acnes largely determine if or how badly your acne will scar. Jawline hormonal acne also tend to form scars and is associated with deeper, painful and blind ended pimples. 14. Hot showers or baths, saunas or steam rooms can worsen acne People think that going to saunas or steam rooms help to expel toxins and let your pores breathe. But the truth is totally opposite. Heat can increase sebum production thus causing more harm than good to your acne-prone skin. 15. Fungal acne VS common acne Fungal acne, or Malassezia folliculitis, is an infection caused by overgrowth of yeast called Malassezia in the hair follicles on the skin. It is often confused with common acne. The symptoms of fungal acne can be similar to common acne, with small, red bumps or pustules. But unlike common acne, it causes itchiness of the bumps instead of pain. It tends to occur on the chest or back, rather than the face. Fungal acne can be persistent, and worsen with sweating and hot, humid temperatures. Treatment of fungal acne differs from the common acne. There is lack of response to traditional acne treatments like benzoyl peroxide or salicylic acid, instead, its treatment typically involves the use of antifungal medications, such as topical or oral ketonazole in addition to changes to individual’s skin care routine to control the overgrowth of yeast. This includes avoiding heavy or occlusive skin care products, such as oils or heavy creams. Well, acne can be very frustrating and depressing. Do not lose hope, there are treatment options that can help you manage it effectively. Topical therapy available include Benzoyl peroxide, retinoids , antibiotic and azaleic acid. ( Examples of retinoids include tretinoin, isotretinoin, Adapalene (Differin), tazarotene) Retinoids can cause local irritation, so start off slow by applying 2 to 3 times per week and increase frequency to daily as tolerated. Comparing all retinoids, Adapalene is better tolerated. Adding actives like AHA (glycolic acid, lactic acid, mandelic acid) and BHA ( salicylic acid) can help to exfoliate your skin and clear up the dead skin cells that are built up. Salicylic acid is a popular one especially for acne skin as it can penetrate deep into the pores and help to remove dead skin cells and debris. It also has anti-inflammatory properties, making it effective for mild to moderate acne. Moreover, it can help to regulate sebum production, thereby reducing appearance of pores and acne. When there is severe form of acne like nodulocystic acne, oral isotretinoin or antibiotic may be added. Oral isotretinoin, which is more well known as Accutane, can benefit acne with scarring. Combination of topical and oral medications is more effective and reduces the risk of bacterial resistance. For example, combining benzoyl peroxide with oral antibiotic or oral isotretinoin, or topical retinoids with oral antibiotic. Steroids injection into nodulocystic acne lesion can rapidly reduce inflammation, resolve acne lesion and minimise chance of scarring. Physical therapies like acne facial, microdermabrasion and chemical peel can hasten the recovery of acne. Microdermabrasion is a non- invasive treatment that involves usage of tiny crystals or diamond-tipped wand to gently remove the top layer of dead skin cells. This can help to remove debris, excess oil and unclog pores. When dead skin cells layer is removed, skin tone and texture improve and topical treatment get absorbed better into the skin. Chemical peel also works similarly to microdermabrasion, but it involves application of chemical agent on the skin. It can penetrate deeper layer of the skin and stimulate collagen, hence is effective in treating complications of acne like postinflammatory hyperpigmentation and acne scarring. Most of you may be aware of the picture of hormonal acne, which mainly causes breakouts on your jawline or hairline, usually accompanied by oily skin and excess hair growth. If your acne is due to hormonal imbalance, then topicals most likely will not reduce your acne. Hormonal therapy like oral contraceptives and antiandrogen pill like spironolactone help with hormonal acne. However, in certain conditions like hypothyroidism, treating hormonal imbalance is not enough as the main problem is your thyroid. So, in this case, thyroid medication is the key to the cure of your acne. In other words, if your acne is due to underlying medical conditions, treat the underlying cause.

Time flies . Getting into your 60s is unavoidable, and aging is unavoidable . As you approach 4th decades of life, you might start to notice signs of aging, such as: - Fine lines and wrinkles -> due to repeated facial movements and expression. As skin ages, it loses collagen and elastic fibres, leading to loss of flexibility and elasticity. - Dullness of skin -> due to buildup of dead skin cells - Uneven skin tone and hyperpigmentation -> caused by hyperactivation of melanocytes (pigment-forming cells), alteration in the distribution of pigment and turnover - Dry skin -> due to decreased amount of natural moisturizing factors, glycosaminoglycan and impaired skin barrier causing water loss. - Rough skin texture -> caused by dryness and buildup of dead skin cells - Visible pores -> due to reduced skin elasticity around pores - Sunken eyes -> due to fat tissue reduction - Dark circles -> as you age, skin below your eyes loosen and thins out, making colour of blood vessels underneath more visible. Sunken eyes also result in dark circles due to shadow. - Hollowness of cheeks, temper, forehead -> due to superficial fat pads loss - Face sagging -> due to drooping of deep fat pads, alteration of supporting ligaments and loose skin. However, why do some people age like fine wine, but you don’t? There are multiple factors that speed up aging, including: Sleep deprivation Ever notice why people who have sleeping disorders, work night shift, and oncalls like doctors * sigh * tend to age faster? It is because inadequate sleep can accelerate aging process. Here is why: During the first three hours of sleep, growth hormones called somatotropin is being produced, and this hormone helps to repair damaged skin cells. Another hormone, namely melatonin increases during the next two hours of sleep. It helps to protect skin from damaging free radicals that cause aging. During the final stage of sleep, cortisol, which is a stress hormone, along with skin temperature decrease. These cause the muscles to relax and collagen production to increase. In other words, when you do not get enough sleep, the damaged skin cells do not get a chance to repair, thus leading to signs of aging. Blood vessels dilate when you do not get enough sleep. The colour of dilated blood vessels is able to show through the very thin skin of your undereyes, appearing as dark eye circles . Stress Stress raises the level of cortisol, leading to collagen and elastin breakdown and forming wrinkles. So, whoever reading this now, smile and relax :D Lack of Exercise Exercise improves blood circulation which delivers oxygen and nutrients to body’s organs including skin. Exercise also burns fat and tones up muscles, giving you a better body figure and less cellulites. Alcohol Heavy alcohol drinkers age faster because alcohol directly affects DNA. Studies found that heavy alcohol drinkers have shorter telomeres- a part of chromosomes linked to aging. Also, alcohol being a diuretic dehydrates you. Dehydration makes your skin dry and saggy, and wrinkles also appear to be more pronounced. Smoking Tobacco smoke contains reactive oxygen species, which increase matrix metalloproteinase level, leading to break down of collagen. Nicotine also constricts your blood vessels, reducing blood flow to your skin. Unhealthy Diet Processed food can speed up aging of your cells due to the high amount of saturated fats and trans fats that promotes inflammation. Same goes to high-sugar diet that cause inflammation and accelerates the breakdown of cells. Sun Exposure Ultraviolet rays from sunlight breakdown collagen, elastin and hyaluronic acid in our skin, causing premature aging. It also causes melanin overproduction leading to hyperpigmentation. This is why sunscreen is extremely important. If you are too lazy to use other skincare products, at least use sunscreen!! Most people think that sunscreen is only needed when going outdoors, but this is incorrect. UV rays can actually pass through windows. Sunscreen can combat sunburns caused by UVB ray, and also UVA ray that has longer wavelength and is responsible for skin aging by seeping into your skin, breaking down collagen. Blue light emitted by indoor electronic devices can also cause skin damage. *A myth about aging: People with oily skin appear to age more slowly. - Skin aging is not related to the amount of sebum (oil). Instead, the more quality collagen and elastin you have within your skin, the healthier and younger your skin looks. So, for antiaging, look for a treatment that can stimulate collagen and elastin. Back to our main topic, there are tons of skin care available in the market that target aging, but do they work ?? Unfortunately, in the 6th decade and beyond, skin care will not reverse aging , but only helps to PRESERVE your skin. Furthermore, due to aging, there will be fat loss, bone resorption and weakened ligaments causing hollowness and sagging that cannot be resolved by skin care. This is when aesthetic treatments come into play to REVERSE signs of aging. WHAT CAN BE DONE? Ultherapy Ultherapy is approved by FDA as a safe and effective non invasive aesthetic procedure that lifts the neck, chin and brow, and improve lines and wrinkles. It utilizes microfocused ultrasound to target layers of tissues, and stimulate new collagen formation. During treatment, ultrasound gel and probe will be placed on your skin and direct visualization of the layers through ultrasound imaging ensures heat is delivered to areas that benefit you the most. So, for people who are afraid of needles or scalpels, this is the choice for a firming and lifting. BUT, of course, the result won’t be as dramatic as surgical face lift. After ultherapy, you will see improvement gradually as collagen continues to form, and best result can be seen in 3 to 6 months. Result can last 1 year or more and treatment can then be repeated. Thread lift Thread lift is a minimally invasive aesthetic procedure for face lifting. It involves insertion of medical grade sutures to hold onto facial tissues and pull them taut. It gives immediate lifting effect, and further improvement of facial sagging can be seen when the threads inserted stimulate collagen production in your skin. There are different types of thread and the duration for the threads to break down differs depending on the types. But even after the thread has dissolved, collagen stimulating effect continues. Again, thread lift cannot replace facelift surgery given its less dramatic and sustainable results, but it is a more suitable choice for people who cannot take downtime and not fit for general anaesthesia due to medical illness. Dermal fillers As you age, there is redistribution of facial fat. You lose deep fat, and superficial fat becomes droopy. That’s why you get hollowness in certain parts of your face while some areas become saggy. Dermal fillers can be used to replace volume loss, bone loss and to support overlying skin. Certain types of dermal fillers can help to stimulate collagen, E.g. Radiesse, Sculptra, Ellanse, hence able to improve your skin quality and youthfulness on top of volumisation. Static wrinkles can also be improved by dermal fillers. Botulinum toxin (a.k.a botox) Botox works by temporarily relaxing underlying muscles that contract and causes wrinkles. As a result, dynamic wrinkles no longer occur. Effect of botox last about 3 to 4 months, so treatment can be repeated after reoccurrence of wrinkles. FYI: Some brands of botulinum toxin can lead to resistance, in other words, not responding or decreased response to botox after a few treatments due to development of antibodies. It is theorized that antibodies developed because of “complexing proteins” present. Xeomin, which is one of the brands marketed, DOES NOT have this complexing proteins, therefore has LESS RISK of formation of antibodies and resistance. Laser Non ablative laser like Q-switched NdYAG 1064nm when used in low fluence for several sessions can improve hyperpigmentation. 532nm wavelength can treat hyperpigmentation in the epidermal layer, for instance, freckles, solar lentigo, age spots and seborrheic keratosis caused by sun exposure and aging. Skin resurfacing by ablative laser like CO2 laser and Erbium YAG laser can help improving conditions like wrinkles, sun spots, loose skin and scars. Ablative lasers remove the top layer of your skin and part of the second layer of your skin. After this controlled injury, your body responds by making new, healthier skin with less wrinkles and dark spots. This can also be achieved by fractional lasers that delivers laser beam to thousands of microscopic columns with lesser downtime. Ablative lasers are less popular among people with darker skin tone because it tends to leave hyperpigmentation for a longer period of time, which is known as postinflammatory hyperpigmentation, or even hypopigmentation. This happens because people with darker skin tone have more melanosomes, and are larger in size. Lasers may remove too much melanin, causing hypopigmentation. Other possibility is that after injury, your skin produces extra melanin, and melanin may deposit abnormally, resulting in hyperpigmentation. Sublative radiofrequency Using a hand piece placed on the skin, each pulse of the treatment delivers radiofrequency via grid of spots similarly to fractional laser. The radiofrequency heats the skin enough to trigger healing response. The spots surrounding the treated area accelerates wound healing, thereby producing collagen and elastin. Wrinkles, superficial skin pigmentation are reduced and skin texture improves. It is safe and effective with less risk of postinflammatory hyperpigmentation for all skin types and colours as it minimally affects skin’s surface layer. Number of treatment session varies depending on severity and condition, but minimally 3 treatments are needed for better result. Chemical peel Chemical peeling involves application of chemical agent that results in exfoliation of skin followed by regrowth of new skin leading to skin rejuvenation. Different depths of peeling can improve different signs of aging including pigmentation, fine lines, wrinkles and large pores. Good things never come for free. Chemical peel does have downtime for about a week. You will experience redness, tightness and some swelling immediately after peel, dryness on the 2nd day and peeling on subsequent day, lasting for around a week. Similarly to ablative laser, there is risk of postinflammatory hyperpigmentation or hypopigmentation, especially in people with dark skin tone. *For ablative laser and chemical peel in darker skin tone, skin preparation starting 6 weeks before procedure and after procedure care are required to minimize risk of postinflammatory hyperpigmentation. Microneedling+ PRP ( platelet rich plasma) Microneedling involves using device that has multiple tiny sterile needles to make punctures in the skin. It creates controlled injury to the skin, thereby triggering body natural healing response and induce collagen production. Microneedling is beneficial to multiple aging conditions, such as fine lines, hyperpigmentation, and enlarged pores. Combination of microneedling with PRP, also known as Vampire Facial has become a popular treatment for skin rejuvenation. Before treatment, your blood will be taken for centrifugation to produce concentration of platelets above normal value, which is the PRP. What makes PRP different from normal platelet is that PRP contains multiple growth factors and these growth factors are able to augment tissue repair and healing and stimulate collagen formation. Hence, there will be improvement in terms of elasticity, skin tone, complexion, pore size, hydration, skin texture and firmness. PRP together with the action of microneedling from dermapen give even better result. Growing popularity of microneedling has caused an exponential rise in home DIY device, but professionals use more advanced microneedling devices and longer needles for more noticeable results. If falls on amateur hands, long needles can be dangerous. Microneedling at home also has higher risk of infection due to the lack of sterility and proper care. Other than its benefits for skin, PRP injection can also treat hair loss. It is clinically proven to increase hair count, hair thickness and growth phase of hair cycle. Microdermabrasion In elderly, due to slower skin cycle, there is accumulation of stratum corneum (the uppermost layer of your skin), resulting in thick, dull and irregular skin surface. Microdermabrasion produces superficial ablation that removes stratum corneum. Subsequently, new layers of skin with improved complexion and texture replace within 1 to 2 weeks. As it only removes the top layer of your skin, it is not effective for deep wrinkles. If your concern is fine wrinkles, superficial pigmentation, enlarged pores, dry skin, and wants skin rejuvenation, then you can consider microdermabrasion. The above mentioned are some of the treatment options available for signs of aging. Combination therapy often yield better result . For example, combining ultherapy with fillers or ultherapy with thread lift, thread lift with fillers, fillers with botox, laser toning with microdermabrasion and many more. Doctors will carefully assess your face before deciding a treatment plan that suits you. There is always misconception that we cannot do anything about how we age as it is a natural process. Yes, aging is a natural process, BUT we are responsible for how well we age. Although genetic, lifestyle and environment factors play a huge part in aging, good skin care routine, especially sunblock starting from early age are important, and aesthetic procedures will be the icing on the cake. Aesthetic procedures can be a maintenance, and also a treatment when you finally have signs of aging that never go away with skin care alone. Everyone deserves to be beautiful, regardless of your age. So there is nothing to be ashamed of.

In ancient China, there is a proverb saying ‘五官端正’. 五官 means the five features on our face, namely the Brow, Eye, Nose, Mouth and Ear. 端正 means symmetrical straight and harmonious. Today, let us discuss the center of the 5 pillars - The Nose. If eye is the window of the soul, then the nose is the door to one's look. Why would I say so? The nose is located beneath and between the eyes. It is also the connecting feature between the eyes and the lips. Furthermore, it is closely related to the eyebrow (brow arch). The nose itself has close relation three other features on the face. And, it is located most protruded as well as the center of the face. Hence, I call it the center of five pillars. With imperfection of the nose, the aesthetic look of the other three features can be severely affected. The common nose seen in Asian is shorter, flatter compared to our Caucasian counterparts. This is because Asians generally have flatter skull (particularly the nasal bone) and weaker nasal cartilage. This gives a generally 'flat' look on many Asians face. While we want to preserve our ethnic characteristics, it is a wonderful tweak if we enhance the nose slightly to compliment our Asian wonderful lips, brows, and eyes. There are non surgical options available to enhance the nose, ie: with dermafiller and/or nose threads. Both are widely practised worldwide. The results are last generally 12 - 24 months depending on metabolism of one's body. - Dr. Cheok https://www.rjclinic.my/nose-filler-nose-thread-lifting

**disclaimer: I am a medical aesthetic physician that improves human faces. I am not an expert in Feng Shui. However I do believe a more beautiful face does change one’s life. INTRODUCTION Chinese Face Reading has a long history of about 2500 years. It traced all the way back to 500 BC. In ancient times, Chinese emperors did not have technology to help them, they relied upon certain facial features as well as other parameters such as time and date of birth as well as geographical considerations to assist them in predicting certain things. Face reading (面相） is an important part of it. It has guided many emperors and big merchants alike to choose their wives, prime ministers and ministers. FACE FENG SHUI（面相） IN GENERAL In ancient text/diagram (seen below), the face is mark with certain numbers (1 – 99). The designated number represent the age year. For eg: the ear represents the person’s life from age 1 to age 15. The areas must be smooth, clear from any deformities. If the area is filled with impurities, that signifies bad luck or bad event in that year. CERTAIN AREA SIGNIFIES CERTAIN ASPECT OF LIFE WEALTH The Nine Wealth features on the face are namely forehead, middle space above nose and between brow, nose, phoenix (philthrum area), mouth and chin. The Forehead being the celestial dragon. A round, curved and protruding forehead free from blemishes and acne signifies power, wealth and great authority. The forehead being the first wealth spot supersedes all the other wealth spots. The other wealth spots such as the nose, phoenix, mouth and chin must also be moist, clear of blemishes and prominent to signify great wealth and authority. MARRIAGE (夫妻宫） For a good and peaceful marriage, we look at the Marriage palace (夫妻宫) - is beside your eyes and near the ears or in medical terms doctor call it the temple area （太阳穴）. You will find problems with your marriage if it is sunken, bulging or you may see a clear eye socket. ANDY HUI’S FACE Although I am not a facial feng shui expert but it is obvious he is a person of great wealth and authority based on his near to perfect forehead, rounded tip and well defined nose, well balanced and succulent lips as well as a square and protruding jaw and chin. But if we focus on his temple area (太阳穴), we can see that it is very much sunken with an obvious orbital bone seen. This in facial feng shui brings bad luck to marriage. CONCLUSION Well, I am not pin pointing or confirming that the sunken temple area brought his marriage with Sammi Cheng into a failure. But there is an obvious observation in his recent pictures, his temple area has worsened tremendously over the years. But if Andy now decides to fill up his temple (夫妻宫）， will it help the marriage at this current stage? Or is it a little too late?  This we must consult the real facial feng shui expert. I am open to expert opinion.

RJ Clinic’s primary goal is to make everyone feel beautiful. The team provides their clients with top-notch services. The physicians are passionate about their craft. The staff strives to prevent depression and issues of low self –esteem among their clients. FEATURED TREATMENTS Acne Treatment Acne occurs when hair follicles become clogged with dead skin cells and sebum. The bacterium spreads through the pores causing acne. There are other variables that can cause acne such as stress, hormones, poor skin care and not exercising regularly. Acne is often visible on the neck, face, chest, and back. It may become severe at different stages during the healing process. You may develop scars and pigment marks. RJ treats acne using several methods. Common options include oral tablets or laser treatments. The treatments are customized based on the severity of the condition. Treating acne at its earliest stages can prevent permanent damage from happening. Eye Bag Treatment Eye bags are an issue that impacts people of all ages. Generally, eye bags are caused due to fat buildup under the eyeball. The most common way to treat eye bags is through injecting fillers into the cheek area. Surgery is another option. Surgery allows the surgeon to locate the layer of fat and remove it. There may be complications with surgery, such as scarring or a potential infection. Another innovative option is laser eye bag removal, which kills the fat cells and shrinks the eye bag. Skin Treatment RJ treats skin growth before it becomes cancerous and spreads to other places. Non-cancerous skin growth may appear in areas such as the groin, neck, and armpits. Treating your skin now will prevent potential growth. Moles are a common issue. Chin Treatment If your chin sinks into your neck, it can damage your entire face. Your jaw may sag, your nose may appear larger, your mouth may droop and weight gain will become more noticeable. Correcting your chin helps create a better jawline. You can opt for surgery to repair your chin, or you can opt for non-surgical treatment. Non-surgical treatment is possible through the use of dermal fillers. If you opt for non-surgical treatment, you will still have a relatively short recovery time. Jaw Treatment Generally, increased jaw size is caused by fat or muscle in the area. Reducing the tissue will cause you to have a slimmer jawline. Frequent chewing and jaw grinding can cause hypertrophy to your jaw. If you are not comfortable with your jaw’s appearance, seek treatment. Cosmetic jaw treatment is considered safe, and you won’t have to worry about issues related to surgery. The results will take shape over 12 months. The time frame differs based on each individual’s cause of treatment. If there is fat causing your face to become chubby, you can seek treatment to meet the fat. The primary options are buccal fat removal or laser lipolysis. Each treatment option is designed to eliminate fat. If you want to see substantial changes to your jaw area, you may need to undergo constant treatment.

by Dr Shuyan (RJ CLINIC) Hyaluronic acid (HA) has been a very popular ingredient used in the cosmetic industry for many years, and for good reason. Many skin care products in the market contain hyaluronic acid, and being advertised as a holy grail that can moisture and plump up your skin. The use of hyaluronic acid is not only limited to the cosmetic industry, but also used in fillers, skin boosters in aesthetic field, and in orthopedics to treat patients with osteoarthritis or rheumatoid arthritis. (Of course, for therapeutic purposes in orthopedic, HA is not used for the skin. In individuals with osteoarthritis or rheumatoid arthritis, the synovial fluid can become thin and lose its ability to lubricate and cushion the joints. Injection of HA into the affected joint can help to increase viscosity and elasticity of the synovial fluid, improving its ability to cushion and lubricate the joint. This in turn leads to reduced pain, improved mobility, and a decrease in inflammation in individual with osteoarthritis or rheumatoid arthritis.) What is hyaluronic acid (HA)? HA is a naturally occurring substance that can be found in various tissue throughout the body, and richest in the skin, joints, vitreous body of the eyes and umbilical cord. For skin, its primary function is to retain moisture and keep the skin hydrated. HA is highly soluble, and can hold up to one thousand times its weight in water molecules. The cosmetic and aesthetic industries utilize these properties of HA and incorporate HA into products like serums, moisturisers, masks, skin boosters and dermal fillers with some modifications. Why do we need HA? Let’s bust a myth before we talk about why we need HA. Myth: Sebum prevents skin dryness. Wrong! Dryness is due to decreased amount of natural moisturizing factors, glycosaminoglycan and impaired skin barrier causing water loss. HA is a glycosaminoglycan, hence its production is directly linked to skin hydration. As we age, the production of key substances in our skin starts to decline, including HA, collagen and elastin. As a result, our skin become dry, lax and loses volume. Thanks to the advancement in technology, we have solutions to this problem. When it comes to achieving a youthful, refreshed appearance, skin boosters and dermal fillers are two popular options. High molecular weight VS low molecular weight HA Low molecular weight HA simply means a form of hyaluronic acid that has a smaller molecular size compared to high molecular weight HA. The smaller size allows it to penetrate deeper into the skin, which makes it more effective for certain skin care benefits. Some studies have suggested that low molecular weight HA promotes production of inflammatory mediators whereas high molecular weight HA inhibits production of pro-inflammatory mediators. In other words, there is possibility of causing inflammation with the use of low molecular weight HA. In some cases, people may experience skin irritation or redness after using skin care products or treatments that contain low molecular weight HA. However, these side effects are generally considered to be mild and temporary. It is also important to keep in mind that not everyone will react the same to it and that individual skin tolerance can vary. High molecular weight HA has a larger molecular size with low skin permeability, meaning that it has difficulty penetrating the top layer of our skin. As a result, it only moisturizes the skin surface and acts more as a barrier to prevent moisture loss, rather than providing deep hydration. Now that we have discussed about high molecular weight and low molecular weight HA, let’s move on to crosslinked and non-crosslinked HA. In natural state, HA can break down rapidly, which is not suitable to be used for certain circumstances. In order to overcome this problem, they must be chemically engineered to create thicker gel in contrast to the usual liquid form. This can be achieved by crosslinking of polymer chains with chemical such as 1,4-BDDE. The more links created, the firmer the HA molecules and the more difficult it is to be broken down. Both skin booster and dermal filler contain hyaluronic acid, but what makes the difference ? You may know about skin booster by “injection that gives you glowing or glass skin”. It has been around for a long time now but getting more popular because of the influence by KPOP and K dramas where all the Korean celebrities appear to have flawless, glass skin. If you are aiming for similar effect like them, skin booster is one of the treatments that you should try! So, what is skin booster actually? It is a treatment designed to hydrate the skin from within, in which the primary ingredient is hyaluronic acid. Skin booster is typically delivered via a series of injections directly into your skin. Since it is made of non-crosslinked HA that does not stay at the site of injection but spread within your skin, its main function is to provide moisture but not volume. On the contrary, dermal filler is injectable treatment that is designed to add volume to specific areas of the face. For example, to enhance the lips, cheekbones, jawline, fill up sunken areas caused by aging, or to reduce the appearance of fine lines and wrinkles. Dermal filler is able to achieve these because of the crosslinked HA that is firm enough to do so. But, not to say that all crosslinked HA dermal fillers are of the same, as there is a remarkable selection of fillers with unique properties in terms of particle size, degree of cross-linkage and concentration depending on the manufacturing methods. The choice of fillers will be made based on the treatment areas and the desired effect. Effect of HA dermal fillers can also be seen immediately after the treatment, which makes them a great option if you have upcoming events and you want to look good. Result of HA fillers is also long-lasting for up to one to one and a half years, depending on the type of filler used, the area being treated, your skin type, skin condition, lifestyle and age. The effect is also reversible by hyaluronidase, which is an enzyme that breaks down hyaluronic acid into water and carbon dioxide. In our clinic, we offer Belotero HA filler, which is a trusted brand manufactured by Merz Aesthetics. The range has won numerous industry awards a decade later and has expanded to include a series of options. Belotero range offers a choice of options specifically formulated to provide best possible effect depending on the treatment areas, including Belotero Volume, Belotero Balance, and Belotero Intense. Of course, there are many more dermal fillers made of materials other than hyaluronic acid, for instance, Radiesse (calcium hydroxylapetite), Ellanse (polycaprolactone), Sculptra (PLLA), each with their own efficacy and safety profiles. Radiesse is one of our favourite treatments, as it has the ability to help your body produce collagen and elastin naturally, which are the two important components that help keep facial lines and wrinkles at bay. As previously mentioned, these key substances decline as we age, and sun damage makes it harder for our body to produce them. Calcium hydroxylapatite, or CaHA, is what makes Radiesse unique as an injectable aesthetic treatment. Upon injection of Radiesse, CaHA particles integrate into your skin and create a “scaffold” that stimulates collagen and elastin. After a time, the CaHA microspheres are absorbed into your body and collagen continues to build in the skin for as long as two years. Skin Boosters There are many types of skin boosters available in the market. Every advertisement is so attractive that you are tempted to try but at the same time confused on which type is suitable for you. Don’t worry, I’ve got you covered! Here, I have listed the types of skin boosters that we offer and given some brief explanations about them: Profhilo Profhilo is made of 100% pure hyaluronic acid, including high and low molecular weight HA. It uses patented thermal process NAHYCO Hybrid Technology which changes character and behavior of hyaluronic acid resulting in formation of co-operative hybrid complexes (HCC) which modulates the tissues. It is biocompatible and does not contain chemicals that are used as cross-linking agents such as BDDE. HCC reduce the degradation of high molecular weight HA, and low molecular weight HA is slowly released from HCC, thus has less risk of inflammation. It is a powerful biostimulator and the only skin booster in the market that helps to stimulate all four types of collagen, elastin and fat stem cells that were lost through skin aging. With this, there will be improvement of skin laxity, fine lines, and skin hydration, tightening and lifting effect. Therefore, some do not consider Profhilo as a skin booster due to its lifting effect on tissues. Profhilo is one of the least painful procedures as it only needs 5 points of injection into each side of your face, which is known as BAP injection technique designed to avoid blood vessels and evenly distributes the product. Typically, two to three sessions of treatment are recommended, spaced one month apart. Cycle can then be repeated every 6 months as needed to maintain the results. Belotero Revive As mentioned previously, non-crosslinked hyaluronic acid cannot last long under the skin, hence glowing result may only last less than a month. So, in addition to non-crosslinked hyaluronic acid, Belotero Revive included another ingredient known as Glycerol, which stays longer under the skin. Glycerol is mainly responsible for attracting and retaining water molecules, strengthening the hyaluronic acid matrix through hydrogen bonding and enhancing the potency of HA in promoting skin hydration. This results in glowing skin for up to 8 months after completing 3 treatments. Glycerol is also known to have anti-inflammatory and antioxidant properties. Belotero Revive helps to improve skin elasticity, hydration, treat signs of aging like fine lines and sun damage such as uneven skin pigmentation and texture. It is suitable for people of all skin types and ages, and is particularly effective for those with dry, dehydrated, or aging skin. Dermaheal HSR Dermaheal skin booster contains non-crosslinked hyaluronic acid along with other natural ingredients such as amino acids that promote fibroblast formation, vitamins that provide additional nourishment to the skin, a complex of biomimetic peptides that restores skin’s vitality and minerals to support skin’s natural processes, improving skin’s ability to repair and regenerate itself. When injected into skin, Dermaheal Skin Booster results in brighter and more youthful-looking complexion, reduction of acne and enlarged pores and increased skin elasticity. Procedure involves injection of multiple small boluses over the whole face superficially into your skin. Numb cream will be applied first to ensure comfort during procedure and treatment with Dermaheal HSR can be repeated monthly to maintain the good result. Skin booster is the type of treatment that gives subtle, smooth changes that occur continuously over time. So, it is an ideal choice for people who want to improve their skin’s appearance without drastic volume changes. Add this to your bucket list and you will no longer need to edit your photos because of your tired looking skin! How about HA in skin care products? If you read this post carefully, you should already have an answer to this. When it comes to choosing a skin care product, look at the type of HA in the ingredient list. As mentioned previously, larger HA molecules cannot penetrate into skin despite being able to bind water better, whereas smaller HA molecule can penetrate deeper, but binds less water. So, for maximum effect, consider products that contain variety of HA sizes. However, not to forget that due to the proinflammatory properties of low molecular weight HA, there is tendency to cause skin redness. It is also undeniable that topical HA will never be as effective as injectable HA. Preventive measures Now that you know the importance of HA, let’s talk about how to prevent the loss of HA . Hyaluronidase is an enzyme that breaks down HA. It can be activated by reactive oxygen species (ROS), which are the byproducts of cellular metabolism and generated from sources including pollution, cigarette smoke, radiation and UV rays. In other words, UV rays, pollution, smoking and radiation are factors that you should avoid in order to preserve healthy looking skin. Although it is impossible to completely avoid UV rays from sunlight, you can wear protective clothing or apply sunscreen to protect yourself from excessive sun exposure. As solar UV rays and our body’s own metabolic pathways create ROS, constantly depleting our available antioxidants, supplementation becomes essential to replenish our body’s supply of antioxidants. Few examples of antioxidants include Vitamin C, Vitamin E, beta-carotene, curcumin, niacinamide, ubiquinone and grape seed extract. Antioxidants can be found in food, or in the form of supplement and topical skin care products. In conclusion, HA is a naturally occurring substance that functions as a powerful hydrator, but due to external and internal factors that degrade HA, homo sapiens, who have been acknowledged as the most intelligent species on the planet have incorporated this brilliant substance into products like skin care, dermal fillers and skin boosters to benefit the skin, and HA gel injection into joints for orthopaedic use. With these, eventhough reversing the number of our age is impossible, at least we can slow down and reverse the signs of aging. Also, not to forget that on top of the availability of these luxury, it is our role and responsibility to practice healthy lifestyle to “protect” our HA.