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.