Botox Prices Around The World

The price of Botox treatments vary greatly from country to country, so out of curiosity, I decided to do a price comparison to find out how much patients are paying for Botox treatments in different countries. You can see the graphic I created below, with price ranges of Botox injections for each country.

I was very surprised to find that the cost of Botox injections in Malaysia (USD4.90 - USD6.60 per unit) is cheaper even than Indonesia (USD7 - USD9 per unit), Thailand (USD7 - USD12 per unit) and the Philippines (USD8 - USD12 per unit)! Botox is also surprisingly affordable in Europe (USD5 - 12 per unit) and Russia (USD5 - USD10 per unit) , although it seems to be a very premium product in Japan (USD12 - USD25 per unit).

Just as a point of reference, I have also made another graphic which lists the amount of Botox generally needed for different treatment points around the face. 

These infographics refer to the proprietary Botox product by Allergan. Dysport, or abobotulinum toxin A, is another neurotoxin product that is often used in place of Botox, but can be much cheaper. Dysport is also used in different dilutions to Botox, so the number of units needed for each procedure may vary. While these are the only two products available in Malaysia currently, there are other products including Xeomin. Dysport is also marketed under the brand name Reloxin and Azzalure.

- Cosmetic Medicine, MD

Dr. Liow Tiong Sin is an aesthetic practitioner who practices in Kuala Lumpur and Melaka, Malaysia. He has more than 12 years of expertise with non-surgical cosmetic treatments, and  conducts training courses for other doctors from all around Asia. To connect with Dr. Liow, Like Cosmedmd's Facebook page. medical centre website or email. 

护肤101 - 有效的活性成份

护肤品的主要元素-----活性成份，能协助修复皮肤至最佳状态。活性成份有助于提升皮肤的抵抗能力，以便能抑止及修复外在环境对皮肤的损坏和体内代谢对皮肤的伤害。因此，护肤品在我们日常护理程序扮演重要的角色。

现今市场上拥有数以千计的护肤皮品牌，每天都有许多新产品推出。昂贵的护肤品牌投入重金宣传，聘请美丽的名人和模特儿代言。可是大笔的宣传预算是否保证优质的产品呢?？其它的品牌广告宣传较少，可是它们主打不同的利基市场，无论是产品标榜贴近自然、低过敏、或是价格实惠又别致，这些产品都具有不同的成份和口碑，让消费者难以抉择。

哪些产品已证实有效？

那些经过皮肤专科检测，或临床测试的产品，会是您的最佳选择，让您 的金钱花费物有所值。

抗皱纹霜是市场上最受欢迎的产品。每个人都梦想拥有一种霜能一夜之间消除皱纹。然而，只有少数的产品可以达到它们所保证的功效。

一种已被证实的活性成份是维A酸（Tretinoin），这个从维他命A衍生的成份已经通过临床测试，证实可促进皮肤代谢和刺激胶原蛋白的产生。维A酸也被证实可降低皮肤色素沉着，改善肤质及色泽，并促进血液循环让脸色红润。

维A酸必须每日使用，至少为期6个月，才会有显著的成果。它已经过许多短期和长期的临床测试，证实对严重老化及皱纹的皮肤有效。

维A酸对皮肤具有高刺激性，在初期使用阶段会造成长痘及脱皮的现象。因此，应遵照医生的指示使用。在治疗的过程中必须使用高防晒系数的防晒乳，以避免皮肤持续受阳光的伤害。怀孕或哺乳的妇女，以及红斑痤疮（Rosacea）的患者，应避免使用维A酸。

许多医生使用维A酸治疗痘痘，而如今的维A酸可被微粉化（micronized form），以减少其副作用，如皮肤干燥，及对皮肤过度刺激。

专柜售卖含有维他命A的产品具有视黄醇（Retinol）的成份，因此其效果不如经医生处方配置的产品，因视黄醇不容易被皮肤吸收。视黄醇更有助于避免年轻的皮肤老化。市场上还有其他形式的维他命A，例如他扎罗汀（Tazarotene）和阿达帕林（Adapalene），可是他扎罗汀刺激性过强，而阿达帕林过于温和，效果不佳。

含有对苯二酚（Hydroquinone，HQ）的产品可有效减轻色素沉着的问题，例如雀斑（Freckles）、黄褐斑（Melasma）、肝斑（Liver spots）和老年斑（Age spots）。对苯二酚可抑止皮肤的酵素反应，以预防色素沉着。

专柜售卖的HQ产品只有2%的浓度，而医生处方的产品里所含的HQ浓度可高达4%，让效果更好。使用HQ霜期间，防晒是必要的。有些医生也综合使用HQ和维A酸来治疗顽强的黄褐斑，或色素沉着问题。

A氢氧基酸（Alpha-hydroxy acid，AHA），简称果酸，例如甘醇酸（Glycolic Acid）和乳酸（Lactic acid）可去除角质，促进皮肤代谢。它们也有协助疏通毛孔阻塞、改善肤质，以及美白功效。AHA霜非常普遍，可是专柜所售卖的产品酸性成分低，因此效果有限。若要AHA发挥效用，这些产品必须至少含有10%以上的酸性成份，及低酸碱度（pH）介于2。在治疗黄褐斑时，我们也可添加15%的甘醇酸乳液，以及Tri-Luma乳膏，以达到更好的功效。

医生使用的甘醇酸换肤（Glycolic Acid Peel）可有效的修复肤质，经去角质后显现年轻、白嫩、柔滑的皮肤。研究显示综合使用甘醇酸换肤及一些活性成份如维A酸，可提高防皱及美白功效。

B氢氧基酸（Beta- hydroxy acid，BHA），或称水杨酸（Salicylic Acid，SA），易融于油脂，因此较适合用于年轻的油性肌肤。它可软化几丁质（keratin），并有助于疏通毛孔阻塞。BHA也可增加皮肤的保湿及抗炎能力。水杨酸可增加细胞的代谢率及减少色素沉着，因此那些对果酸过敏的人士，可选择使用水杨酸。

抗氧化剂 ( Anti oxidants ) 这种活性成份能对抗体内破坏细胞的自由元素 ( Free  radicals )，因此是日常抗皮肤老化的重要成份。许多抗氧化剂已被证实有很好的效用。绿茶或橄榄的淬取物，如多酚（Polyphenols），在许多医学研究上显示有效让皮肤保湿、抵抗氧化应激（oxidative stress），以及预防肌肤损坏。

硫辛酸（Alpha-lipoic acid）是另外一种抗氧化剂，可抑制细胞老化、消炎和排毒。此外，维他命C、Q10酵素和咖啡因也可抗氧化，预防早衰。

也许唯一最有效能应对早衰和阳光对皮肤的损坏的保养品，还是恰当的防晒措施。我曾发表过一篇文章强调防晒的重要性，“Sun Safety: Is Your Sunscreen Doing Its Job?”。

若您的肌肤每日都受到阳光的伤害，那么它就无法呈现最佳状态，也无法全面吸收活性成份。您等于浪费了一切宝贵的金钱和努力。

 - CosMed, MD

注：我在部落格里发表了许多文章，回应患者所关注的问题。您有任何需要我为您解答的疑问吗？这些文章对您有所帮助吗？欢迎提出您的意见。

Botox or Fillers? For Best Results, You May Need Both

A growing trend in aesthetic medicine is for a combination therapy approach to rejuvenation and correction, and botox and fillers are one such winning combination. The latest research has found that the two procedures have equal applications, but together, they can produce a synergistic effect that last longer and looks better.

Botox, or neurotoxins, work on the underlying muscle structures under the skin. The muscles not only provide movement, but affect our facial positioning and expressions. Certain large muscles such as those in the jawline, around the lips and eyes, as well as the forehead areas, can change the entire facial structure noticeably. Deep frown lines can make a person look permanently angry, while pronounced jaw muscles can give someone a belligerent or argumentative demeanor. Proper usage of botox not only relaxes the facial expression, but also can give a more pleasant, uplifted look.

Dermal fillers work hand in hand with botox to restore fullness to areas that are sunken or lined, and also helps to reshape and redefine the overall facial structure. By combining fillers with botox, the volume of both substances can be reduced to achieve a more natural, harmonious look.

Many patients find that in areas of the face that are in constant motion, such as in the mouth area, fillers do not last very long, as the muscle motion works to break up the fillers faster. A combination treatment including botox decreases muscle activity, so that the fillers are not broken down so quickly.

A combination of botox and fillers can relax and fill out deep frown lines
even better than either product can do alone.

The synergistic effect of botox and fillers is such that the combination of both is better than either treatment alone, and it has been theorized that effects of this dual-treatment lasts longer because the collagen production stimulated by fillers help the skin to form correctly in a way that muscle movement would have disturbed.


- Cosmetic Medicine, MD

Dr. Liow Tiong Sin is an aesthetic practitioner who practices in Kuala Lumpur and Melaka, Malaysia. He has more than 12 years of expertise with non-surgical cosmetic treatments, and  conducts training courses for other doctors from all around Asia. To connect with Dr. Liow, Like Cosmedmd's Facebook page. medical centre website or email. 

The Liposuction Alternative -Why More People Are Exploring Nonsurgical Approaches To Body Shaping and Contouring

Liposuction is currently one of the most popular procedures available at the plastic surgeon's office, with an estimated 1.6 million liposuction procedures performed worldwide in 2010 alone. It is also one of the most highly searched keyword on Google, with over 1.2 million searches worldwide every month, an indication of the growing number of people who are looking for a way to shed those inches.

With obesity at epidemic proportions, battling the bulge is a major concern for many

Liposuction, also known as lipoplasty, can be performed on many areas of the body, including the arms, neck, upper arms, calves, and back areas, with the abdomen and thigh areas being the most popularly treated areas. Although liposuction is a proven and highly effective tool, the decision to undergo such a treatment should never be taken lightly. Liposuction is a major surgical procedure, and the risks are as high as in any other surgery.

Here are some things that any person considering this procedure must know -

Liposuction is not for everyone - 

Many people think of liposuction as the 'weight loss solution for lazy people', but actually liposuction is best suited for people who have pockets of fat that they have not been able to lose through diet and exercise. The patient must be relatively fit and healthy in order to withstand the rigours of the surgery and recovery process.

Severely obese patients are never a candidate for liposuction - they are encouraged to lose the weight through bariatric (weight loss) techniques or surgery such as gastric banding.

Liposuction is not a magic wand for instant weight loss

Besides the cost and discomfort that this major surgical procedure involves, there are also many risks that must be considered. These risks can include damage to surrounding tissue, toxicity, allergy, uneven contouring and infection. The amount of fat that can be removed from any single procedure is also limited, and some patients are disappointed when the procedure doesn't give them the smooth silhouette and shapeliness they were expecting. Expecting to go from a size 16 to a size 8 is also unrealistic, as

Just because the fat is gone doesn't mean you won't put on weight

Liposuction works by the physical removal of fat cells from the body, so it's easy to think that your post-surgical body will stay the same forever. However, a study done at the University of Colorado found that the majority of liposuction patients regained the weight within a year after their surgery, but in different, non-treated areas. Those who had their abdomen treated regained it on their thighs, and others who had their thighs liposuctioned found their upper body area getting larger.

Historically, fat reserves were the body's insurance against starvation, so our fat cells were tuned to reserve as much energy as possible from the food we ingest. The fat stores on a post-liposuction patient are just redistributed to existing fat cells in other areas to make up for the reduced amount in the treatment sites. Having liposuction to reduce your problem areas does not mean diet and exercise are no longer important.

The typical liposuction patient - the procedure can give you a temporary boost, but research shows the weight is usually put
back on after a year, but tends to regrow in different areas than the ones treated.

Liposuction alternatives - what options are available besides the surgical procedure?

Liposuction is still the gold standard and the quickest method for fat loss and body contouring, but it does not address long term weight control, and always needs to be carefully considered due to cost, discomfort, recovery and health concerns. Liposuction should not be performed  repeatedly on the same treatment area due to the formation of scar tissue. Other problems such as skin laxity and lumpy or uneven areas are also common after the surgery. Liposuction also cannot address concerns such as cellulite, and is not practical for slimmer people who have small fatty deposits.

The trend today is for non-surgical procedures such as cryolipolisis, soft laser lipolysis or ultrasonolipolysis as an alternative for or extra treatment option post-liposuction. In Europe, many also swear by carboxytherapy and mesotherapy, and new techniques that employ these methods are being explored and introduced on a regular basis. 

While these are exciting prospects for those who don't want to opt for or don't qualify for surgery, they cannot produce the instant results of a liposuction procedure, but often rely on repeated procedures or take time to show effects. Safety concerns are key with nonsurgical methods, and fat loss is slow to avoid complications such as skin or organ damage. The amount of fatty tissue treated is also limited as a sudden loss of too much fat can cause your body to go into shock. Most nonsurgical lipolysis (fat elimination) treatments are also dependent on the efficiency of the body's metabolic system, as the treated fat is not manually removed as in surgical procedures, but purged from the body as part of it's natural waste elimination process. A drawback of this extended recovery process is that it can be hard to see visible results. 

You can read more about non-surgical body shaping options in my previous blog post. Have you tried any of these treatments and do you think you prefer them to surgery?

Cosmetic Medicine, MD

Dr. Liow Tiong Sin is an aesthetic practitioner who practices in Kuala Lumpur and Melaka, Malaysia. He has more than 12 years of expertise with non-surgical cosmetic treatments, and  conducts training courses for other doctors from all around Asia. To connect with Dr. Liow, Like Cosmedmd's Facebook page. medical centre website or email. 

Skincare 101 - Active Ingredients That Really Work

A key component of skincare products are the active ingredients, the components that help to restore the skin's optimal wellness and appearance. Active ingredients help to boost your skin's ability to combat and reverse the damages of environmental and internal ravages, and are an important part of your daily care routine.

Which skincare? Consumers are spoilt for choice.

There are literally thousands of skincare brands on the market, with many more being launched every day. Expensive skincare brands are often advertised heavily, with endorsements by beautiful celebrities and models, but do big advertising budgets guarantee great products? Other brands are less well advertised but they appeal to different niche markets, whether it be the close-to-nature, hypo-allergenic or chic-but-cheap sectors. they all have different ingredients and claims that make the right choice very hard to make.

Which products have proven efficacy?

Dermatologist-tested products, or those who have been proven through clinical trials and tests, are your best option for products that actually give you your money's worth.

Anti-wrinkle creams are among those that are the most popular in the market. Everyone dreams of creams that can erase lines and wrinkles overnight, but unfortunately there are few products that actually live up to their exorbitant claims. One active ingredient that is proven is tretinoin, a Vitamin-A derivative which has been shown in trials to improve skin exfoliation and stimulate collagen production. It has also been shown to reduce pigmentation, improve skin tone and texture, and give a 'rosy glow' due to increased blood circulation.

Tretinoin must be applied daily for a minimum of 6 months for noticeable results. It has been tested in many short and long term clinical studies, and has been proven to work even on severely aged and wrinkled skin. Tretinoin can be highly irritating to the skin and can cause acne and skin peeling in the initial stages, so it should be prescribed and administered carefully under a doctor's care. A high SPF sunscreen is a must to prevent the skin from continuing sun damage during the treatment process. Pregnant or lactating women should not use tretinoin, and it should also be avoided if you have rosacea (skin redness). Also commonly prescribed for the treatment of acne, tretinoin is also now available in micronized form to help with some of the side effects such as skin dryness and irritation.

Over-the-counter products with Vitamin A in the form of retinol do not have the same efficacy as prescription products as retinol is not as easily absorbed and used by the skin. Retinol can be more helpful as a preventative measure to help younger skin prevent the signs of aging. Other forms of Vitamin A such as tazarotene and adapalene are also available, but most patients find tazarotene highly irritating, and adapalene too gentle and non-effective.

Products containing hydroquinone are also effective for lightening of pigmentation problems such as freckles, melasma, liver spots and age spots. Hydroquinone works by inhibiting enzyme reactions within the skin, thus preventing pigmentation. Hydroquinone creams are available at 2% strength in OTC products, but your doctor can prescribe a cream up to 4% strength for better results. The use of a sunblock is essential during treatment with hydroquinone creams. Some doctors use a hydroquinone and tretinoin combination for stubborn melasma or hyperpigmentation cases.

Alpha-hydroxy acids such as glycolic acid or lactic acid work by exfoliating dead skin cells to allow for growth of new skin. They also help to unclog pores, improve skin texture and have an added benefit of skin lightening and depigmentation. The pore cleansing action of AHA also means it can be helpful in controlling mild to moderate acne. AHA creams are very commonly available, but the low acid content of most OTC products means they have limited effectiveness; for AHAs to really make any difference, they must have at least a 10% acid content or more, and have a low pH of around 2. 15% glycolic acid lotions are a useful additional treatment for melasma, when used in conjunction with treatment creams such as Tri-Luma.

A doctor-administered glycolic acid peel can be useful to restore the skin by exfoliation to reveal the younger, smoother, lighter skin beneath. Research has also shown that glycolic acid peels used in combination with topical active ingredients such as tretinoin, can increase the effectiveness of the anti-wrinkle or skin lightening process.

Beta-hydroxy acids or salicylic acid, is more suitable for younger, oily skin, as it is soluble in oil. It helps to soften keratin and promotes clearance of blocked pores. BHAs are also useful in promoting skin moisture levels and is an effective anti-inflammatory agent as well. Salicylic acid is also prized for it's ability to improve cell turnover and promote depigmentation, and is therefore a great alternative for those who are sensitive to AHA creams.

Antioxidants are active ingredients that help to fight the free radical activity that damages skin cells, and therefore should be an important ingredient in your daily fight against skin degeneration. The good news is that there are many antioxidants that have been shown to have great efficacy. Green tea  or olive extracts, for example, contain polyphenols, which have been featured in numerous clinical studies that show their ability to retain moisture, fight oxidative stress and prevent formation of skin damage. Alpha -lipoic acid is another potent antioxidant that can inhibit cellular aging, help soothe inflammation and promote detoxification of a variety of chemicals. Vitamin C, CoEnzyme Q-10 and caffeine are also antioxidative substances that show promise in the battle against premature aging.

Perhaps the single most effective skin care product that you can use to prevent premature aging and protect your skin against sun damage is proper sun protection and sunblock. I wrote about the importance of proper sun care in a previous article, Sun Safety: Is Your Sunscreen Doing Its Job?. If your skin is being attacked and damaged by the sun on a daily basis, then it cannot look its best and absorb any of the goodness from your active ingredients, and you are essentially wasting your efforts and your money.

Cosmetic Medicine, MD

Dr. Liow Tiong Sin is an aesthetic practitioner who practices in Kuala Lumpur and Melaka, Malaysia. He has more than 12 years of expertise with non-surgical cosmetic treatments, and  conducts training courses for other doctors from all around Asia. To connect with Dr. Liow, Like Cosmedmd's Facebook page. medical centre website or email. 

The Eyes Have It - Younger Eyes Nonsurgically

When you look at a person's face, the eyes are always the focal point. Sadness, joy, delight, disgust, anger, fear, outrage or indifference, the eyes show us emotions, expressions and are a pivotal clue to our body language.

The eyes are not just a window to your soul, but  also  an indicator of your health, stress level and physical well-being

The eye area is also very easily affected by stress, whether from illness, fatigue, emotions or environmental factors. This stress, combined with the constant movements of the muscles surrounding the eyes contributes to wrinkles, crepe-like skin, crow's feet, eye bags and under-eye circles.

Effects of aging and stress on the eye area - 

Addressing the problem - The Madonna Eyelift

The Madonna Eyelift is named after the famous pop star, who had the procedure done to improve her eye area. The results are very dramatic, giving you years off your age, and refreshing and brightening your looks.

Can you believe Madonna is 54 years of age?
Her eyes don't give her age away.

The technique involves a fractional laser procedure in the upper and lower eyelid areas, which leaves skin tightened, lifted and smoothened. The procedure takes only 10 minutes to do both eyes, and about 3 -5 sessions may be necessary for optimal results.

Just as fractional lasers help to restore collagen, smoothen skin surfaces, and erase fine lines on the facial area, it works in the same way on the eye area. It is important to note that the technique has only been proven on certain fractional lasers, and specialized training is required for any doctor who is doing the procedure.





Watch Dr. Bruce Katz, the pioneer of the Madonna Eyelift, do this procedure -

The Madonna Eyelift is a minimally-invasive, low downtime procedure that gives you a refreshed, brightened eye area, with results that are very rarely seen with topical creams and serums, for example.  Botox, fillers, thread lifts and surgery can be used in conjunction with the Madonna Eyelift in severe cases.

Cosmetic Medicine, MD

Dr. Liow Tiong Sin is an aesthetic practitioner who practices in Kuala Lumpur and Melaka, Malaysia. He has more than 12 years of expertise with non-surgical cosmetic treatments, and  conducts training courses for other doctors from all around Asia. To connect with Dr. Liow, Like Cosmedmd's Facebook page. medical centre website or email. 

Facial Symmetry - Do The Two Sides Of Your Face Match?

脸部对称－您左右脸对称吗？

Most people do not realise the importance of facial symmetry. If you draw a line directly down from the middle of your forehead down to your chin, the two sides of your face will most probably have some differences.

Photographer Julian Wolkenstein took pictures of many different people, and created a whole face out of the two sides of each person's face. The difference between the left side face and right side face of these people can be very obvious and pronounced, as you can see in these pictures.

许多人没有发现脸部对称的重要性。如果您从额头至下颚画一条中分线，您很有可能会发现您的左右脸有一些差异。

摄影师Julian Nolkenstein拍摄了许多不同人的脸部照片，将他们脸部划分为左右两边，再将同一边的脸组成完整的头像。她发现许多人左右边脸的样貌有明显的差异。

Some scientists believe that facial symmetry is an indication of the effects of environment and nutrition during their growth and developmental stages. So, the more symmetrical the face, the more we find it to be attractive, because this indicates that the person is healthy and has good genes. 

You can see the symmetry in the faces of these famous people -

一些科学家相信脸部对称是一项指标，显示环境和营养对生长期与发育期的影响。因此，一张脸越对称，我们就觉得越有吸引力，因为这显示了此人拥有健康及良好基因。

您可看看这些人的脸部对称。

就如下图所示：

Scarlett Johanssen

Penelope Cruz

Justin Bieber

Eva Longoria

Do you agree that people who are symmetrical are more attractive? You can examine the symmetry of your own face at Echoism.org.

您赞成越对称的脸，越具吸引力吗？您可在Echoism.org测试自己脸部的对称。

-- Cosmetic Medicine, MD

Dr. Liow Tiong Sin is an aesthetic practitioner who practices in Kuala Lumpur and Melaka, Malaysia. He has more than 12 years of expertise with non-surgical cosmetic treatments, and  conducts training courses for other doctors from all around Asia. To connect with Dr. Liow, Like Cosmedmd's Facebook page. medical centre website or email. 

Collagen Supplements - Do They Really Work? What Does?



Old or young? The difference is collagen

I've had many patients come to me and say they take excellent care of their skin,with a regimen that includes regular beautician visits, expensive skincare and that latest must-have - collagen supplements. Usually available in a drink, and costing up to USD100 per bottle, these supplements are not cheap, but come with a lot of promises for prolonged beauty and general health.

 

Collagen - is it really so important?

Collagen is a natural protein component of the skin that acts like a scaffold and the main building block for cells, tissues and organs. About a third of the protein content in your body is made up of collagen, which is found in the bones, muscles, and tissues of the organs. Collagen, keratin and elastin give the skin its strength, elasticity and structure.

The body naturally produces the collagen that it needs, but this production is gradually disrupted as part of the natural aging process. Women produce less collagen than men, and this collagen is lost at a rate of about 1% per year. This means that a woman has naturally lost almost half of the collagen from her skin by the age of 50.

Collagen is also greatly affected by environmental stresses such as sun exposure, nutrition, skin damage, and exposure to toxins such as pollutants, cigarette smoke and recreational drugs. With decreased collagen, the skin loses its natural elasticity and firmness, and fine lines, wrinkles and sagging appear.

 Poor collagen levels also affect the bones, and this picture (right) shows how collagen loss affects facial shape in extreme age degeneration.

Here's to your youth - anti-aging drinks claim to deliver beauty in a bottle, but do they really work?

 

Collagen supplements claim to offer a range of benefits, including

• reducing wrinkles
• reversing age of skin
• tighter skin
• plumps up skin
• improves skin elasticity

The truth is, however, that there is little to no evidence that beauty supplements, pills and drinks can do what they claim. Collagen is a type of protein which when ingested, is broken down by the digestive system into individual amino acids to be recombined by cells according to their needs.  

So many companies have jumped on the collagen bandwagon that it is very hard for consumers to realise that there is actually no scientific proof that collagen supplements have any effects on skin health and appearance at all. There is no guarantee that drinking collagen drinks would be any more effective than any source of protein such as meat, cheese, eggs or beans at restoring the collagen in your skin.

So if you can't get collagen through a drink, what about collagen in skin care products? Most collagen molecules applied to the skin in lotion, cream or gel forms are far too large to be absorbed into the dermis - they merely lie on the surface and get washed or rubbed off. There are some companies that are selling micronized collagen which are meant to be small enough to be absorbed into the skin, but it is unlikely these micro molecules would be in any form useable by skin cells. It is also highly likely that any collagen that actually manages to penetrate the skin would be challenged by the body's immune system as a foreign body. They would either cause an allergic reaction or simply be destroyed by the white blood cells before they manage to be of any benefit to the skin whatsoever.

What really works?

The abundance of collagen supplements on the market tells us that many people are genuinely concerned about their skin health. So, based on the best dermatological and anti-aging expert advice, what can be done to ensure we show up at our 20-year school reunions with our best faces forward?

Reduce collagen degradation
To ensure sufficient collagen in the skin, first prevent loss of the collagen that you already have. If you are not already on a proper sun care regimen, that should be your first priority. Studies have shown that sun protection is one of the most important ways in which you can combat aging. Cigarette smoke, like sun exposure, has also been shown to greatly degenerate collagen, and there is also evidence that improper and insufficient sleep has a negative effect on skin health. Read more about tips for choosing a good sunscreen in this previous post.

A nutritious diet
Eating the right foods and getting good sources of antioxidants from fruits and vegetables is very important for collagen production. Brightly coloured produce such as tomatoes, grapefruit and watermelon contain the powerful antioxidant lycopene, which helps prevent collagen degeneration. Fruits such as oranges, strawberries and red peppers also contain Vitamin C, something that is key for the optimum condition of the skin. Vegetables such as broccoli, leafy greens and cauliflower provide our skin with glucosinolates, which fight the free radicals that attack our collagen. Also key to skin health is the omega-3 fatty acid known as eicosapentanoic acid or EPA, which has anti-oxidative and anti-inflammatory effects to help protect and heal the skin. Omega-3 is readily available from food sources such as oily fish and spirulina. Avoid starchy foods and sugary substances; this helps
reduce inflammation which interferes with the body's natural collagen production processes.

Proper skin care
The right skin care helps regulate the optimum skin condition so that it is protected from extreme stresses. What works? Regular exfoliation with a gentle exfoliator scrub, or with alphahydroxy acids (AHAs) can help to 'exercise' the skin, and ensure healthy cell renewal. Skin care products that have been proven to help combat aging include products that have antioxidant properties, examples of which include green tea extracts, coffeeberry and DHEA. Try products with retinol, a Vitamin A derivative, sometimes known as Retin-A, which works to both stop collagen degradation from the effects of UV exposure while boosting collagen production.


Collagen Stimulating Dermal Fillers
Hyaluronic acid, a natural water-binding component of the skin, helps to stimulate collagen production by surrounding fibroblasts - the skin cells that produce collagen  - with plenty of water. As the skin ages, this important component of the skin also suffers a decline. 
 
Researchers at the University of Michigan medical school found that Restylane injections (Restylane's key component is hyaluronic acid) not only stimulated the fibroblasts around them to increase collagen output, but also seemed to be protective of the existing collagen in the area as well. The two top hyaluronic acid dermal filler brands are Restylane and Juvederm, and they work by immediately filling the area to plump out lines and wrinkles. The effects of the filler are enhanced by the collagen stimulation, so patients tend to need repeat sessions less frequently. 

Just like hyaluronic acid, poly-L-lactic acid or PLLA, has been shown to stimulate collagen growth. PLLA is a major component in Sculptra dermal fillers, which are injected deep into the dermal layer in a three-session treatment program which lasts up to two years. Sculptra has been proven to correct both collagen loss and fat atrophy, and is also FDA approved for AIDS patients who have severe cheek lipoatrophy (fat loss).

Radiesse, which has calcium hydroxylapatite as its collagen stimulating active ingredient, is another dermal filler that works very effectively in restoring volume in patients with deep lines or sagging skin. The effects of the collagen stimulation allows the volumising effect of Radiesse to last for about 12 months or more. 

Laser and RF collagen stimulation
Collagen production slows with the aging process, but where the skin is injured, collagen production is increased as part of the skin healing process. Aesthetic equipment such as carbon dioxide and Fraxel lasers, and radiofrequency modalities such as Thermage and Ultherapy all work by subjecting the skin to controlled damage, so that collagen renewal can be stimulated. All of these methods work very well to tighten the skin and improve its appearance, although lasers are designed to stimulate regrowth on the surface and epidermal (top layer) areas, and radiofrequency skin tightening works in the deeper dermal areas for greater wrinkle and line rejuvenation.



- Cosmetic Medicine, MD


Dr. Liow Tiong Sin is an aesthetic practitioner who practices in Kuala Lumpur and Melaka, Malaysia. He has more than 12 years of expertise with non-surgical cosmetic treatments, and  conducts training courses for other doctors from all around Asia. To connect with Dr. Liow, Like Cosmedmd's Facebook page. medical centre website or drop him an email at cosmedmd@gmail.com