Saturday, March 31, 2012

Lip Enhancement with Fillers - Part 2

In the right hands, fillers can make your lips look the best they can be. The 3 important rules for lip enhancement with fillers are:

1) Make sure the procedure is safe

Hyaluronic acid fillers are the preferred choice for lip enhancement because of their excellent safety profile. They feel natural, soft, are absorbable and reversible if needed. 

Do avoid permanent fillers as what is considered ideal now might change over time. Permanent fillers such as liquid sillicon has the potential to cause long term side effects such as allergic reactions and lumpiness. 

Lastly, do seek treatment from a registered and experienced doctor. Ensure that the procedure is performed in a sterile environment (clinic or hospital) to avoid risk of infection. 

2) Results are natural looking

Our lips are highly mobile. When we talk or smile, we want it to be undetectably enhanced. The key to natural looking lips is to start with a small amount of filler and touch up with more later, if needed. Too much lip filler can result in blunting of the lip edges and cause a sausage-like appearance. Less is often more and it is best to make the most of our natural lips rather than attempting to over-stuff it.

Award winning actress Nicole Kidman used to have naturally thin lips.
Photo source : New York Post
When photographed recently, Nicole's lips looked undeniably plumper. The upper lip showed signs of over filling and the filler distribution looked unbalanced. Smiling exaggerates the unnatural lip contours. Suggestion - Lips should only be filled enough to return to its natural fullness and shape. Significant changes in lip size may look unnatural. 

Angelina Jolie is probably one of the few who can carry off such huge lips. Interestingly, Angelina’s lips are natural. Not everyone can look fabulous with such lips. Note that the lips taper gently to nothing as it reaches the corners of the mouth.

3) Able to pass the “kiss test” (means the person that you kiss doesn't notice an unnatural lip texture)

With the right injection technique, lumpiness should not occur. A soft filler such as hyaluronic acid filler also helps. Avoid injecting too much filler so the lips does not feel too firm. Apply these tricks and you will be able to fly under the kissing radar!

Lip Enhancement with Fillers - Part 1

Full, pouty lips may hold the secret to looking younger as aging causes atrophy of facial fat including the lips. Since 1960's, various injectables were utilised by doctors to achieve fuller lips. So, what if we are not blessed with Angelina's bee-stung lips? A safe option with minimal recovery time is hyaluronic acid filler for lip enhancement . 

 Photo source : Restylane
Left photo : before lip enhancement ; Right photo : the lips look fuller with better projection after lip enhancement with hyaluronic acid fillers

Photo source : Restylane
Besides adding volume, fillers can also smooth wrinkles adjacent to the lips, such as smoker's lines (vertical lines surrounding the lip border) and Marionette lines (frown lines at the mouth corners).

Most of us have seen photos of celebrities who have received too much lip filler and end up looking unnatural, so the next question will be -how can we ensure that we end up with natural looking lips, and not a “duck pout”?

 Photo source : Make me heal
A example of lip filler overload : This 22-year-old Russian lady is reported to have received multiple silicone lip injections to emulate cartoon character Jessica Rabbit.

Wednesday, March 28, 2012

Non Surgical Nose Job - Nose Reshaping With Fillers

Asians typically have less prominent noses. Many consider a higher nose bridge with a sharp and well defined tip to be more attarctive. While this is possible with the traditional nose job, currently many patients are turning to non-surgical nose reshaping with fillers as a fast and safe option with minimal recovery time.

The goal of nose reshaping with fillers is to sculpt a nose that is proportionate to the patient's face. The procedure is not aimed to create a Caucasian nose, but to enhance the individual’s natural beauty rather than change the appearance of the nose drastically. In addition, fillers can also be administered to camouflage undesirable bulges and bumps on the patient’s nose.

Spectacles with plastic frames and branded sunnies pose a problem for many asians with a flat nose. In the absence of a prominent bridge, it is difficult to wear the glasses comfortably. Injectable fillers are administered to sculpt a higher nose bridge so that glasses don't rest on the cheeks, but on the nose bridge.

Left photo : before nose reshaping with filler ; Right photo : the nose bridge depression disappeared after being filled up with fillers, showing a significant improvement in the facial profile.

Left photo : before nose reshaping with fillers ; Right photo : a higher nose bridge with a more refined tip is achieved after nose reshaping with fillers
How is the procedure like ?

Usually a hyaluronic acid filler is preferred due to its good safety profile. The procedure only takes about 15 minutes and is relatively painless as the hyaluronic acid filler is pre-mixed with an anaesthetic agent.

What are the common side effects of nose augmentation with injectable fillers ?

Swelling and bruising are occasionally encountered but the effects will subside within a few days. It is advisable to seek a skillful and experienced doctor as inappropriate injection techniques could lead to an unnaturally shaped nose bridge or a round and bulky nose tip.

What can I expect after the procedure ?

Immediate results can be seen and effects can last from 6 to 12 months, depending on the type of filler used. Do not massage the treated areas for at least 2 weeks to allow the filler material to set its shape.

What are the limitations of nose reshaping with fillers ?
There are certain limitations - while fillers can reshape and sculpt the nose, it cannot reduce the nose size or make the nose appear narrower. Major corrections to the nose’s actual shape also cannot be done. For such changes, a traditional rhinoplasty or nose job is indicated.

Monday, March 26, 2012

Sunscreen Do's and Don'ts - Part 2

A little sunscreen goes a long way. Make it a habit to wear sunscreen daily and in the future your skin will thank you for it. A few tips to consider while you slather on the SPF.

Apply sunscreen 15 to 30 minutes before going out under the sun.
Since it takes time for the sunscreen to be absorbed by your skin, you should apply it in advance.
Photo source : sophisticated edge
If you only start to apply sun screen when you are already under the sun, your skin will have a longer period of being unprotected and a higher chance of getting sun burn.  

Apply adequate quantities of sunscreen.
Many people only apply 25-50 percent of the recommended amount of sunscreen. Experts recommend using a nickel-size amount (about 1/4 teaspoon) for your face and one shot glass (about one ounce) of sunscreen to cover the exposed areas of your body.

"Help! I was sunbathing when I fell asleep with my sunglasses on and now look at me!
Reality star Kim Kardashian tweeted this picture of her sun burned face. Sun burns are uncomfortable when they occur. Getting sun burns repeatedly can lead to premature skin aging.

Protect the lips with a lip balm that contains SPF.
The lips are also susceptible to harmful UV rays. Do avoid high-shine lip gloss because the product can attract more UV radiation.

Avoid common mistakes : SPF do not add up.
Layering a SPF 30 sunscreen over a moisturiser with SPF 15 does not get you the protection of SPF 45. The SPF protection which is effective in this case is the higher SPF value - SPF 30 only.

Wear sunscreen on a cloudy day
Clouds cannot block UV rays. On a cloudy day, up to 80 percent of the sun’s UV rays can pass through the clouds. UV rays can also be reflected off sand and snow, so you can even get a sunburn in the shade.

To avoid having wrinkly leather-like sun damaged skin, use sunscreen and do not sun bathe.

Choose an oil-free sunscreen that does not clog pores.
Some people shun sunscreen as they think it feels greasy and causes pimples. Gone are the days when sunscreen comes in the form of a thick, sticky goop. Nowadays, sunscreens are formulated to be oil-free and non comedogenic — which make it suitable for our hot and humid climate. 

Finally, there is no sunscreen that offers 100 percent sun protection. To prevent photo-aging and skin cancers, do wear protective clothing such as a wide-brimmed hat, long sleeved shirt and sunglasses whenever possible. If you want your skin to look good, cover it up. Do not walk out the door without protecting exposed skin from UV rays.

Sunscreen Do's and Don'ts - Part 1

Sunscreen is one of the most affordable anti-aging tool. I have mentioned about the necessity of sunscreen in another article. Other than protecting us from premature aging, the long term benefits of sunscreen include reducing the risk of skin cancers and sun burns. But with so many choices on the shelves, how can we choose a sunscreen that is best for us ? Here is what to watch out for when picking a sunscreen.

Photo source : fooyoh
Wearing sunscreen only when we are going to the beach is not enough. Do make a habit of wearing sunscreen everyday.

Choose a broad spectrum sunscreen.

A broad spectrum sunscreen protects against both harmful UVA and UVB rays. Check the label for SPF (Sun Protection Factor) and PA (Protection Grade of UVA).

Photo source : wikipedia
Two photographs showing the effect of applying sunscreen in visible light and in UVA. The photograph on the right was taken using ultraviolet photography shortly after application of sunscreen to half of the face.

What does “SPF” means ?

SPF is an indicator of the amount of UVB radiation required to cause sunburn (for example, if a person normally gets sunburn in a hour without sunscreen, SPF 15 is supposed to allow the person to stay under the sun for 15 hours before getting sunburn). FDA is considering to limit the maximum SPF value on sunscreen labels to "50 +" because there is insufficient evidence to show that SPF values higher than 50 provide greater protection than sunscreens with SPF 50.

What does “PA” means ?

Asian brands, particularly Japanese brands, tend to use the PA system as a measure of UVA protection. There are four levels of protection - PA. PA+, PA++ and PA+++ . It is recommended to wear sunblock with at least PA++ protection.

Sunscreen needs to be reapplied at least every 2 to 4 hours.

A high SPF number might sometimes mislead consumers to stay longer under the sun without reapplying sunscreen. While the SPF formula seems simple enough, it does not necessarily hold true as there are numerous other factors such as the variation of UV intensity throughout the day, contact with water and sweating that can decrease the overall effectiveness of sunscreen. If you are planning to go swimming or doing an activity that involves a lot of sweating, sunscreen needs to be reapplied more often.

Friday, March 16, 2012

Lower Eye Lid Aesthetics : Part 2 – Botox for Eye “Bag” Caused by Muscle Bulk

Some young patients in their twenties complain of having eye bags “all their lives” despite religiously applying eye creams and getting eight hours of sleep every night. But not known to many people, what is perceived as eye “bags” can actually be due to an enlarged muscle (orbicularis occuli) at the lower eye rim. 

Photo source : Medline Plus
Diagram showing the Orbicularis Occuli muscle

The function of orbicularis occuli muscle is to close the eyelids. When the muscle is enlarged (or in medical terms – muscle hypertrophy), a bulge is seen immediately under the lower eye rim, especially when the person smiles. This condition can start from a very early age and is not caused by aging.

Angelina Jolie, who has been voted as the most beautiful woman in the world by Vanity Fair magazine also has mild muscular bulges on her lower eye lids.

The treatment for eye “bags” caused by muscle hypertrophy is simple – the procedure involves injection of a tiny drop of Botox to each affected muscle. Results are visible after 4 to 7 days when the muscle relaxes and the bulge disappears. The Botox effect usually last about 3 to 4 months.

Photo source : Pchome
Right photo : This young patient does not have true eye bags. She used to rely on Photoshop to erase the eye bulges that made her look tired on photographs.
Left photo : After Botox treatment, the eye bulges disappeared and her eyes look slightly bigger.

An added advantage of this procedure is to be able to give the appearance of bigger eyes especially when the patient smiles. There is subtle lowering of the lower eyelid margin (the patient may be able to see slightly more white below the iris).

A tiny drop of Botox under each eye can really make a difference. The best part is - it only takes a few minutes to relax and rejuvenate the eyes.

Thursday, March 15, 2012

Lower Eye Lid Aesthetics : Part 1 – Hyaluronic Acid Fillers to Correct Tear Trough

Tear trough refers to a fold extending from the inner eye corner running downwards and outwards that will look worse when a light is shined from above. The shadow created by this groove is commonly perceived as a dark eye circle. It's a safe bet that tear troughs can make anyone look more tired and older than they really are.

Diagram showing the tear trough, also known as nasojugal fold.

Causes Of Tear Trough

Tear troughs are caused by the lower eye lid skin tethered down to underlying structures by a ligament (the orbital malar ligament). Therefore, even very young people in their early twenties can have tear trough deformity. As we age, progressive soft tissue and bone loss in the lower eye lid area causes the tear trough to appear even deeper.

21-year-old “Twilight” star Kristen Steward seen here with “bags” under her eyes. These are not real eye bags but are actually tear troughs.

Tear troughs are different from eye bags, commonly found in older individuals. True eye bags are caused by the weakening of muscles and soft tissues supporting the lower eyelids due to aging. Fat tissues migrate forward and cause the appearance of puffy lower lids.

An aging patient with true eye bag and tear trough. The protruding lower eyelid fat may cause the tear trough to appear more visible.

Treatment Options
While tear troughs can be corrected surgically, hyaluronic acid filler as a non-invasive treatment option is gaining popularity due to its good safety profile and natural looking results. Hyaluronic acid fillers can be injected to restore loss volume and achieve a smooth contour of the lower eye lid area. In addition to erasing the tear trough, it can also diminish dark eye circles associated with tear trough.

Before hyaluronic acid filler injection (top photo), this young lady has tear troughs that are associated with dark eye circles.

After treatment (bottom photo), her tear troughs disappeared and dark eye circles lightened as if being erased by Photoshop.

How is the Procedure Like?

I normally choose a hyaluronic acid filler containing lidocaine (a local anaesthetic agent) to minimise any discomfort to the patient. The procedure can be completed in about 15 minutes and pain is minimal. Results are visible immediately and may last from 4 to 6 months, depending on the type of fillers used. 

Possible Side Effects

Lower eye lid swelling, bruising and lumpiness are a few common side effects. Swelling and bruising usually take a few days to subside. In order to minimise the risk of bruising it is advisable to discontinue the use of Aspirin or any anti-inflammatory medicines such as Indomethacin, Ibuprofen and Voltaren for at least 2 weeks before the produre (please discuss this with your doctor if in doubt). If a patient is unhappy with the results, the hyaluronic acid filler can also be dissolved with a small injection of Hyalase (an enzyme that breaks down hyaluronic acid).

Monday, March 12, 2012

Top 8 Skin Saving Tips

Here's my top 8 skin tips – tried and tested !
  1. Avoid sunlight exposure as much as possible. Wear sunblock regularly and not just at the beach! UVA and UVB rays can cause photoaging not only to our face but other sun exposed areas such as arms and decolettage. The challenge is in finding a sunscreen that offers enough protection (at least SPF 30) and does not feel greasy.

  2. Don't smoke. In addition to causing multiple types of cancer and bad breath, smoking also leads to premature aging due to loss of skin collagen.

  3. Learn to read skincare product labels. It will help you make an informed decision about which skincare product to buy. Check the expire date, watch out for harmful ingredients and know the “good” ingredients such as tretinoin and Vitamin C that may benefit your skin.

    Which skincare product is right for me ? Being able to read labels enables the consumer to choose wisely.

  4. Be patient when starting a new skincare program. A good anti-aging cream can take up to six weeks to show positive results. The same is true for anti-acne skincare, so do not give up too soon.

  5. Exfoliate regularly (and gently). Think of those dead skin cells on the surface as as barrier and you need to remove them to let skincare products work their way in. Do this once a week to improve the effectiveness of your products.

  6. Remove all make-up before going to bed. Make-up residue can mix with skin oils and dirt to cause acne.

    Photo source : Inquisitr 
    When asked how many nights per week she goes to bed wearing makeup, Lady Gaga said: “Seven. That is not good for your skin, but I’m blessed with good genes”.

  7. Do not forget your neck. The bottom line is - whatever skincare products we are applying to our face, we should also be applying to the neck. We do not want a radiant, beautiful face being held up by a saggy, wrinkled neck. Invest an additional few minutes a day to care for your neck and your future self will thank you for it.

  8. Think positively and take it easy. Stress can wreck havoc on our skin by aggravating conditions such as eczema, acne, hives and psoriasis. In addition, stress can also make it harder for skin diseases to heal.

Sunday, March 11, 2012

Platelet Rich Plasma for Skin Rejuvenation

The beauty world's buzzing about a new anti-ageing treatment that may works wonders for the skin. Platelet Rich Plasma or PRP is an emerging treatment that offers a promising solution to rejuvenate skin naturally.

The science behind Platelet Rich Plasma is to utilize the body's natural ability to heal itself. Blood is made up of red blood cells, white blood cells, platelets and plasma. Platelets play a fundamental role in blood clotting and release healing proteins called growth factors. Platelet Rich Plasma is plasma that has been enriched with platelets via an FDA approved process known as centrifugation. As a concentrated source of platelets, Platelet Rich Plasma contains and releases many growth factors that accelerates tissue and wound healing. When Platelet Rich Plasma is injected underneath the skin, this healing process results in increased collagen synthesis.

 A diagram to show the process of harvesting Platelet Rich Plasma

A study published by Chungnam National University, Korea in 2011 suggest that Platelet Rich Plasma promotes tissue remodelling in aged skin and may be used as adjuvant treatment to lasers for skin rejuvenation.

Photo source : My Cells
6 sessions of Platelet Rich Plasma were administered over 2 years to improve this gentleman's skin. Although the lighting effects are not consistent in the 3 photos, there are obvious improvements seen in the right photo especially around the eyes.

The use and clinical validation of Platelet Rich Plasma is still in the early stages. Due to its healing benefits, Platelet Rich Plasma has also attracted attention for treating various medical conditions such as sports injuries, bone repairs, oral and plastic surgeries.

Saturday, March 10, 2012

How to Lose Weight Effectively - Part 4 : Motivational Quotes

Need a little nudge to get the scale moving in the right direction? Here's a few of my favorite motivational quotes to get you heading on the road to health, fitness and freedom from fat!

"Take care of your body. It's the only place you have to live."
– Jim Rohn

"Your body is a temple, but only if you treat it as one."
– Astrid Alauda

"The secret of getting ahead is getting started."
– Mark Twain

On finding time to exercise :
"You will never find time for anything. If you want time, you must make it."
– Charles Buxton

"Victory belongs to the most persevering."
– Napoleon

Supermodel Kate Moss has been accused of encouraging teenage girls to become anorexic after claiming she lives by the motto: “Nothing tastes as good as skinny feels”. She added: “You try and remember, but it never works.” 

How to Lose weight Effectively - Part 3 : Prescription Diet Pills

Diet pills are a tempting quick fix for losing weight effectively. While there have been serious complications reported, most side effects of prescription diet pills are mild (although unpleasant). The use of prescription diet pills may be appropriate for some patients but do keep in mind that these drugs are not a cure-all for obesity. The use of diet pills should be combined with exercise and diet for successful weight loss and maintenance.

Photo source : Adi News

Do I Need a Prescription Diet Pill ?

Prescription diet pills to treat obesity should be an option for individuals with:
  • A body mass index (BMI) of 30 and above with no obesity-related conditions.
  • A BMI of 27 and above with obesity related conditions such as diabetes or high blood pressure.

Types of Prescription Diet Pills


There are 2 main groups of prescription diet pills - Appetite Suppressants and Fat Absorption Inhibitors.

1) Appetite Suppressants
One common prescription appetite suppressant is phentermine (marketed under the trade name Duromine or Adipex). Appetite suppressants promote weight loss by tricking the body into believing that it is not hungry. They decrease appetite by increasing brain chemicals that affect mood and appetite. The side effects of phentermine include palpitations, elevated blood pressure, anxiety, constipation, dry mouth and difficulty to sleep at night. Most side effects usually improve as our body adjusts to the medication. It is not safe to consume phentermine without consulting a doctor. Indeed, experts are warning that thousands of women are putting their lives at risk by buying diet pills online.

 Photo source : Artiste-e
In 2002, Singaporean TV personality Andrea De Cruz was diagnosed with liver failure after consuming a chinese slimming pill purchased from a colleague. De Cruz was saved after receiving an emergency liver transplant from her husband, who donated half of his liver.

2) Fat Absorption Inhibitors

Fat absorption inhibitors are prescribed to prevent the absorption of fats from the diet, thereby reducing calorie intake. The unabsorbed fat is eliminated via bowel movements. Orlistat (marketed under the trade name Xenical) is FDA approved to treat obesity. Possible side effects from Xenical are oily, loose stools, passing gas and inability to control bowel movements. To minimize these effects, foods with high fat content should be avoided.

Most prescription diet pills are intended for short term use to control obesity (not to be prescribed for more than a few months). After that, our body may develop tolerance to the effects of the pills, and the weight loss plateaus. After that, if we do not also practice healthy eating and follow an exercise plan, the pounds may come right back.

Monday, March 5, 2012

Fillers – A Solution to Look Younger Without Surgey

One of the hallmarks of an aging face is loss of subcutaneous volume. This gives rise to hollow cheeks, sunken temples, thinner lips and deeper nasolabial folds (laugh lines). Fortunately, there is a non-invasive way to combat these changes effectively - with fillers.
A combination of aging and sunlight exposure causes our skin to lose collagen and resulting in a wrinkled, sunken appearance. The effect is like a fruit drying up. 

Types of Fillers
There are many types of fillers in the market. Commonly used fillers are hyaluronic acid fillers (Juvederm, Teosyal and Restylane) and poly-L-lactic acid fillers (Sculptra). The main difference is that after injection, hyaluronic acid fillers can last from 3 to 8 months and results are visible immediately while poly-L-lactic acid fillers last up to 2 years but results are gradually visible over weeks to months.
How do Fillers Work?
Collagen production decreases as we get older and after excessive sunlight exposure. Fillers are injected underneath the skin to plump it up from inside out. The filler material replaces lost collagen. In the case of Sculptra, the filler material actually stimulates collagen synthesis. Areas that are commonly enhanced with fillers for anti-aging purposes include cheeks, nasolabial folds (laugh lines), temples, lips, Marionette lines (frown lines at the mouth corners) and tear troughs (sunken under eye areas).
Photo source :Allergan
Hyaluronic acid fillers can be used to flatten out nasolabial folds (laugh lines), plump up thin lips and fill up Marionette lines (frown lines at the mouth corners)

What are the Possible Side Effects from Fillers?
Filler injection is a safe procedure with mostly temporary side effects if performed by a qualified and experienced doctor. The possible side effects are lumpiness, swelling, bruising and rarely infection and scarring.
Combination Treatment for the Best Results
Fillers are commonly combined with Botox, chemical peels and aesthetic lasers to delay aging from a multidimensional approach. Fillers are administered to restore lost volume, Botox relaxes wrinkles while lasers and chemical peels resurface the skin to improve texture and lighten unwanted pigmentation.

Thursday, March 1, 2012

How to Lose Weight Effectively - Part 2 : Diet Tips

When it comes to healthy eating, a triumphant day one is motivation for day two, and so on. Here is a list of my favouraite diet tips to supercharge your weight loss efforts.

Photo credit : Philip Friedman/Studio D
  • Try not to skip meals, especially breakfast. Eating breakfast helps boost our metabolic rate in the morning. Meal skipping will make us more hungry and may overeat afterwards.
  • Healthy snacks are allowed in between meals. Dieting doesn't mean being hungry all the time. The key is to watch the serving size and try to limit snacks to fruits, vegetables and fibre rich foods.
  • Avoid sweetened drinks, for example, coffee with sweetened condensed milk, teh tarik, soft drinks.
  • Cut down on food gradually. Avoid crash diets. It is extremely difficult to sustain a very low calorie diet for long periods of time.
  • If you really have to eat something unhealthy, do it early in the day or right after a workout.
  • Drink adequate amounts of water.
  • Choose whole grain options, avoid simple sugars.
  • Read labels carefully. A label that reads “low fat ” does not necessarily means that it is also low in calories. The food item might still be high in sugar and loaded with calories.
  • Try not store unhealthy or junk food in our house and office.
  • Eat slowly to allow satiety signals from the stomach to reach the brain.
  • Try healthy cooking methods – steaming, grilling, baking, boiling.
  • Watch out for “hidden calories”, for example, salad dressing, gravy and sweetened drinks.
  • Continue a maintenance diet plan after successfully reaching our target weight to avoid gaining back the pounds

How to Lose Weight Effectively – Part 1 : Introduction

Losing weight is about burning more calories than we eat. A simple strategy it seems. But on the contrary, the National Health and Morbidity Survey in 2006 showed that two out of every five adults (or 43%) were either overweight or obese. This is an alarming situation where the number of obese adults had more than tripled over a decade.

Those who have watched “Extreme Makeover : Weight Loss Edition” (a reality TV programme in which individuals volunteered to receive an life-changing makeovers in Hollywood) will realized that losing weight successfully needs hard work and a commitment to change.

Photo source : Extreme Makeover
 An Extreme Makeover contestant lost massive amounts of weight via diet, exercise and lots of determination

The key to successful weight loss is the ability to make sustainable lifestyle changes. Too often we take drastic measures to see results – crash diets or fitness gadgets that promise instant results. We may lose some weight initially but will likely gain back the kilograms once we stop the diet or worse, become heavier than before.

Photo source : Getty Images
American Idol contestant turned Grammy and Oscar winner Jennifer Hudson shared her weight loss success story on The Oprah Winfrey Show

The fact is - there is no short cut to losing weight successfully. However, if we do manage to just lose about 10% of our body weight, there will be significant health benefits. In the meantime, say no to buffets and start exercising!