First Malaysia Singapore Conference for Aesthetic Medicine, July 2012

Here are some photos from the conference jointly organised by the Malaysian Society of Aesthetic Medicine, and the Society of Aesthetic Medicine (Singapore), recently held at the Sheraton Imperial Hotel in Kuala Lumpur. Kudos to the organisers who put together a very illuminating and worthwhile event. Much knowledge was gleaned from experts from Malaysia, Singapore, South Korea, Spain, France, Thailand and many other countries.

The Health Minister, YB Datuk Seri Liow Tiong Lai with the President of the MSAM,
Dr Louis Leh 

The Health Minister enjoying a chat with some of the organising committee members

A photo opprtunity with Datuk Seri and the MSCAM organising committee 

The minister made a very encouraging speech in which he urged aesthetic practitioners
to strive for international excellence in line with the push for medical tourism. 

The HM cutting the ribbon to officiate the opening of the first Malaysia Singapore
Conference For Aesthetic Medicine

A light-hearted moment as the minister is invited to examine some of the tools of the aesthetics trade

I was also honoured to have been invited to speak at this conference. This presentation
is on the Fraxel Re:store Dual, the latest platform in the fractional rejuvenation market

A very interesting talk by Assoc. Prof Chin Sze Piaw on the power of stem cells for
anti-aging and healing

One of the most popular exhibitors - Many attendees grabbed the chance to purchase some very rare  medical books

At the booth of one of the largest exhibitors, Allergan 

The crowd turnout was surprisingly good, given that this was the first such effort
from the organisers. Committee members are already planning for a bigger and better
bash in 2013. 

The good response to the conference pointed to the growing interest in the opportunities in the aesthetic market, and was an excellent chance for many up and coming new practitioners to learn the ropes from the old hands in the field. With technology and globalisation fuelling the growth of the aesthetic practice in Malaysia, we can foresee only positive changes ahead. The growing innovation and sophistication in the aesthetic and cosmetic market can only mean cheaper, more effective, pain-free and best of all, more aesthetic results for everyone.

CosMed, MD

Sun Safety : Is Your Sunscreen Doing Its Job?

Proper sun protection should be of key concern for all people of all walks of life. With the correct sun care, skin whitening lotions, depigmentation treatments and anti-aging creams would probably be much less popular and certainly a lot less necessary.

A main factor in the health and appearance of the skin is its interaction with the sun. Ultraviolet (UV) rays in sunlight can cause skin darkening, accelerate the aging process, cause skin abnormalities and are the number one cause of skin cancer. So much damage is caused by lack of knowledge about the negative effects of the sun, and when the harm is done, it takes a lot of time, effort and often discomfort to reverse it. 

This recent blog post, detailing the damage done to a trucker's face from exposure to the sunlight through his driver's seat window, is compelling evidence of the damaging effects of sunlight.So it goes without saying that sun protection is a topic dear to the heart of any doctor who has any dealings with the skin. As with many skin care products, sun care products can be misleading and poorly understood, and thus are prone to being used improperly.

Proper medical-grade sun care is far more important than collagen drinks
and Vitamin A creams in the fight against premature aging. 

Daily sun care is of course, something that most of us know we must use, but it is easy to ignore the need for this when we are in a rush or when other issues seem more pressing. Despite their tender skin, sun protection for children is often something that is poorly utilised. For those who have undergone laser or other corrective skin care procedures, effective sun protection is of paramount importance. As the skin is healing, it is at its' most susceptible to damage.

Here are a few of my basic rules for proper, effective sun protection, whether you have recently undergone an aesthetic procedure, or even if you are only concerned with staying healthy in the sun.


1. Use a Sunblock With Zinc for Complete Protection. The SPF label on your sunscreen only refers to its UVB blocking components. UVB rays are responsible for burning the skin, but UVA rays are the ones that cause cancer, DNA mutation and cause deeper damage of the skin. UVA rays are only blocked by physical sunblock components that leave a white residue on your skin. This can be considered unsightly by some, and is why many cosmetic sunscreens do not contain it. UVA rays can be minimally blocked by some chemical components including titanium, but only a sunblock containing zinc will give you proper protection against UVA rays. There are formulations available that offer micronized zinc that does not leave an unsightly residue.

2. A Higher SPF May Not Be Necessary. An SPF of 30 blocks 96.5% of UVB rays, and an SPF of 45 blocks 98% of UVB. Therefore, any sunscreen with an SPF of at least 30 is more than sufficient for anyone who spends a moderate amount of time out in the sun. A higher SPF will not give you greater protection or prolong its effectiveness. I also have patients tell me their skin cream is SPF 15, their foundation is SPF15, and the powder is SPF 15, surely it all adds up to SPF 45! Unfortunately, no, different layers of sun protection may seem like more coverage, but in actual fact it does not provide increased protection.

3. Apply Sunblock To The Skin, 30 Minutes Before Exposure, and Reapply Frequently. For it to work effectively, sunblock needs to be applied to dry, cleansed skin, under your make-up or skin creams, where it can create a physical layer. Allow the sunblock to set and gain effectiveness for up to 30 minutes before exposure to the sun. It is also important to note that sunblock needs to be reapplied every 1.5 hours or so for full coverage. No sunblock lasts all day, despite their claims. Sunblock is also never completely waterproof, but some brands have water resistance that allow them to be used at the beach.

4. Look For Additives for Added Protection. If you can find a brand that offers added antioxidants such as Vitamins C & E, these additives have the ability to reduce inflammation and improve overall skin protection.

5. Oral Sunblock Can Be An Effective Tool For Photo-Protection. There are some antioxidant products in the market that act as oral sunblocks, to decrease the damaging effects of the sun. Used in conjunction with topical sun protection, they can be an added layer of protection against the long-term effects of sun damage.

6. Prevention is Better Than Cure. Avoiding exposure to sunlight isn't entirely practical, but minimising exposure when the sun is at its peak between the hours of 10am to 4pm helps. Use curtains and shades to minimise the amount of sunlight into your home, and sun protective clothing can give an added layer of protection when you are outdoors.

7. Darker Skin Is Not Immune To The Effects of UV Rays. Although darker skin types are naturally protected from the sun burning effects of UVB rays, damage can still be caused by UVA that result in melasma, sun spots and even cancer. Melasma, in particular,  is quite common in dark skin types and can be  very pronounced and widespread. It is especially hard to treat as the natural pigmentation of the skin makes it very sensitive to most melasma treatments currently available. The best advice is to use an SPF of at least 15 with zinc at all times, and avoid overt exposure to sunlight during peak sun hours.

Melasma in dark skin types can be very hard to treat 

The proper use of the right medical-grade sunblock can be very helpful in reducing the risks of sun related skin conditions such as cancer, melasma, pigmentation disorders and photoaging. Since sun damage isn't generally evident until years after the worst has been done, often patients come to me in their 40s and 50s lamenting their melasma, pigmentation and wrinkled complexions. In our tropical South East Asian countries, effective sun care must surely be one of the easiest ways to look good even in to maturity.

- Cosmetic Medicine , MD

1st Malaysia-Singapore Conference of Aesthetic Medicine (MSCAM)

What a hectic weekend! I had the privilege and honor to be invited as a speaker at the first Malaysia-Singapore Conference of Aesthetic Medicine (MSCAM), at Sheraton Imperial Kuala Lumpur. This confererence for aesthetic medical practitioners was a collaborative effort by the Malaysian Society of Aesthetic Medicine and our peers in Singapore, the Society of Aesthetic Medicine (Singapore).

This was the first such effort between our neighbouring states, and required a huge amount of back and forth emailing as well as copious hours of leg work on the part of the organising committee. It was a resounding success as the conference not only garnered a greater amount of local interest than was anticipated, but this blogger also heard that some participants made the effort to come all the way from Taiwan and India.

We also got the chance to meet up with the Minister for Health, Datuk Seri Liow Tiong Lai, and he was gracious enough to spend a few hours to have lunch with us and share our thoughts and concerns on the field of aesthetic medicine.

YB Minister for Health, Datuk Seri Liow Tiong Lai (center) officiates the opening of the
1st Malaysia Singapore Conference for Aesthetic Medicine, 14 -15 July 2012
at Sheraton Imperial Kuala Lumpur.

The minister (seated, center) poses for a group photo with Malaysia Society of Aesthetic Medicine
and Society of Aesthetic Medicine (Singapore) committee members. 

The minister was attentive and sympathetic, and assured us that he is working hard to address some of the problems and concerns that impact the aesthetic health sector, for example the problems of errant beauticians who wrongfully advertise and perform injectables, lasers and even surgical procedures. The minister has pledged to serve the rakyat (Malaysian public) by further ensuring all medical practitioners who are vernturing into the field of aesthetic medicine, must have the proper training and credentials, as there have been cases whereby specialists from all walks of medicine such as gynaecologists and cardiologists have begun to offer botox and fillers to their own patients. Unsuspecting patients may not be aware that any treatments including the relatively simple botox, does have a risk factor when the person doing the injecting has not undergone the appropriate training, and may not have the expertise to do the job properly, simply because he or she has a medical degree or specialist credentials.

YB Datuk Seri Liow further stressed the importance of improving sophistication in our aesthetic medical practice, as Malaysia is also opening up channels to boost health tourism as Malaysian medical expertise gains global esteem, due to our well-established and increasingly renowned healthcare, plus the benefits of lower costs and the attractions of Malaysian tourism. A growing number of European, Australian and US tourists are exploring our beautiful tropical shores while taking the opportunity to ensure their holiday isn't just  mentally relaxing, but physically beautifying as well!

This conference gave many doctors the opportunity to rub shoulders and share their personal expertise, while gaining exposure to newly launched products and techniques, such as the latest craze in Korea, thread lifting, as well as the newest skin care products from France, and cutting-edge penile enhancements from our Straits-neighbours, the Singaporeans. Stay tuned to this blog to find out more on there and other exciting new developments, in the next few weeks!

CosMed, MD

Striking Evidence of Damaging Effects of Exposure to Sun

Veteran trucker's face with unilateral dermatoheliosis 

William Edward McElligott was a trucker for 28 years, and you don't have to be Sherlock Holmes to be able to tell. The damage from dermatoheliosis is very pronounced on the left side of his face, from exposure to the sun from his side window. On the right side of his face, he looks not much older than his actual age of 69, but the thickening, sagging and nodules on the other side looks like that of a much older person. 

His case was presented in the April 2012 issue of the New England Journal of Medicine, and is a very convincing piece of evidence of the negative effects of exposure to the sun. This patient's skin condition is consistent with the effects of Favre-Racouchot syndrome, a disorder caused by exposure of the skin to damaging sunlight. 

This kind of damage is typically caused by UVA rays, which are less intense than sunburn-causing UVB rays, but can be up to 50 times more prevalent. Such frequent and prolonged exposure to the sun can also cause DNA mutations that can lead to skin cancer.

This photo is a reminder of the importance of prevention and protection from excessive sun exposure, and the use of at least an SPF 30 sun block at all times is a must. Wearing protective clothing and hats are also important, as is the use of sunglasses to protect the eye and ocular area from photo-aging, especially during the peak sunlight hours of 10am to 4pm. 

CosMed, MD

Understanding Melasma

Melasma

In Asia, melasma is a very prevalent and common problem. It most typically occurs with lightly pigmented skin types such as Asian and Hispanic skin, and also presents more commonly in women. Melasma can be caused by frequent exposure to the sun, but is also known to be caused by female hormonal changes due  to pregnancy or the use of oral contraceptive pills. Some patients are also found to have a genetic predisposition to the condition.

What is melasma?
Melasma typically occurs in three patterns: centro-facial - occurring on the forehead, cheeks, upper lip, nose and chin areas, malar - occurring on the upper cheek areas and mandibular - which is specific to the jaw line and sides of the cheek.

Melasma differs from freckles in that freckles are generally spread over wide areas of the face and occur as small, darkened spots of various sizes. Melasma that occurs in the epiderrmis (top layers of skin) responds better to treatment than dermal melasma. 

As melasma can build up very gradually over a number of years, proper diagnosis and treatment may not be sought until the melasma is at a very advanced or pronounced stage. Early stages of the condition may be only visible with the use of a Wood's lamp or computerised facial analysis system.

Treatment of melasma
Melasma treatment can be very difficult, as the pigmentation can be worsened with the wrong care. Physicians may choose to explore different options as different patients respond to different types of treatment. Epidermal melasma is the easiest to treat, with dermal melasma often recurring very rapidly after cessation of treatment. Hence, identification of melasma type can be a very important factor in  Here are some clinically-tested treatments for melasma that are the best available on the Asian market at the moment.

Tri-Luma
Tri-Luma is an FDA-approved treatment for melasma. It is a topical cream treatment for melasma that is well-tolerated and works well for most patients. It is a combination of hydroquinone - a lightening agent, Tretinoin - vitamin A derivative, and fluocinolone - an anti-inflammatory agent, and can be very effective if properly used.
The cream is applied to the affected areas once daily, and is effective within 6 - 8 weeks of use.



Cosmelan
Cosmelan is a facial mask treatment that works on facial pigmentation by inhibiting tyrosinase, an enzyme in the melanin formation process. The mask is applied by a doctor, and it is left on for a set number of hours depending on each patient's requirements. Peeling of the skin occurs on the second day of treatment, and usually resolves within the next few days to leave the skin clearer, smoother and more refined.
The treatment is combined with a topical skin treatment that the patient applies at home.

Fraxel
The Fraxel Re:store DUAL laser is the only laser that is FDA approved for the treatment of melasma. The treatment for melasma differs from that of other conditions, so it is important that the proper settings for melasma are used when Fraxel is given. In certain cases, the wrong Fraxel settings can result in a worsening of the melasma. Patients may be given a topical treatment such as Tri-Luma for pre- or post-treatment care. Treatments are typically given monthly for a three to four month period, and a few days' downtime as the skin darkens and peels is normal after every treatment.

IPL
IPL or Intense Pulsed Light is a very commonly found therapy that even beauty salons are offering today. While there are many horror stories of botched treatments and intensification of melasma pigmentation after such treatments, studies have shown that melasma can be very effectively treated with the right settings and protocol on an IPL machine. Li, et al. showed in a 2008 study conducted at the China Medical University in Shenyang, China, that 69 out of 89 Chinese women suffering from melasma, obtained a 51% to 100% improvement in their condition after a total of four IPL treatments in 3 week intervals.


Melasma can be successfully treated, but improvement usually takes time and repeated treatments,and may require a combination of different modalities for full effectiveness. Proper sun care, with sun avoidance, usage of hats or covers or high SPF sunscreen is a very important factor for successful resolution of the problem. In many cases, unless exposure to the sun or to hormonal factors can be minimised, melasma will recur after the prescribed treatment.

CosMed, MD