Category: BLOG

Cysteamine Cream – a product recently shown to whiten skin and correct pigmentation.

[7 November 2018] A blog post by Dr. Gabriel Wong

What is Cysteamine?

Cysteamine is the simplest natural aminothiol produced in human cells, a metabolite of amino acid L-cysteine. Cysteamine promotes the transport of L-cysteine into human cells, which can be further used to synthesise Glutathione, an antioxidant. Cysteamine inhibits melanin synthesis in skin cells, therefore reducing pigmentation.

Is Cysteamine new?

Oral Cysteamine has already been approved by US FDA for human use for cystinosis, a rare genetic disorder. Cysteamine has been shown by researchers in laboratory studies to have significant de-pigmenting activity, but it has never been formulated into a cream due to its very unpleasant sulphur odour. Recent efforts have enabled a stabilised form of cysteamine cream with reduced odour.

Which pigmentary disorders has it been shown to be effective?

Cysteamine cream has been shown to be effective for:

• Melasma, especially epidermal melasma
• Lentigines (sun spots)
• Post-inflammatory hyperpigmentation
• Lighten skin colour overall

How does it compare with other depigmenting creams?

Clinical studies have shown Cysteamine Cream to be superior to traditional depigmenting creams such as Hydroquinone in treating melasma. It is also safer and gentler on human skin due to the fact that it is naturally occurring in human skin cells, and does not have carcinogenic (cancer-causing) potential in long-term use.

How should Cysteamine be used?

Cysteamine Cream can be applied any time of the year regardless of sun exposure and is suitable for all skin tones. The cream is applied to the desired areas with pigmentation once daily and is washed off after 15 minutes using a mild soap and water. After drying the skin, a moisturizer is applied.

Some other tips on applying Cysteamine

• Cysteamine Cream should be applied once a day on rested, calm skin (evening or morning before a shower) to reduce skin irritation
• Exposure time can be gradually increased after 6 weeks if there are no signs of skin irritation such as redness or dryness
• Sunscreen should still be continued daily
• To maintain its effects, cysteamine cream should be continued at least twice a week indefinitely

How soon should I expect to see results?

A reduction in pigmentation is seen after 6 weeks. Optimal results are seen after 8 – 12 weeks.

Are there any side effects?

As Cysteamine is naturally occurring in human cells, it is a very safe medication. It may cause temporary burning sensation or redness that goes away within 30 minutes. More persistent skin irritation should be treated with moisturisers. To date, no serious adverse side effects has been reported with Cysteamine use.

                  Cysteamine Cream should not be used in those with a personal or family history of Vitiligo, a depigmenting skin disorder. It should also not be used by pregnant or breastfeeding women, as no study has been performed during pregnancy or breastfeeding.

Sources:

• Kasraee B. “Deodorized cysteamine* as a depigmenting agent for the treatment of melasma.”Pigment Cell Melanoma Research. 2017;30:e27–e137
• Farshi S. et al. “Efficacy of Cysteamine Cream in the treatment of melasma.”Journal of Dermatological Treatment July 2017
• Mansouri P. et al. “Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial.”British Journal of Dermatology (2015) 173, pp 209-217
• Hsu C. et al. “Cysteamine cream as a new skin depigmenting product.”Journal of the American Academy of Dermatology (2013) 68:4-1 AB189

Having graduated from the Yong Loo Lin School of Medicine – Dr Gabriel Wong worked in several hospitals in Singapore where he honed his medical acumen.

Fate was at work when he met Dr Kelvin Chua, which sparked his interest in aesthetic medicine.

Growing from strength to strength under the tutelage of Dr Chua, Gabriel developed an eye for detail and beauty – perfectly in tune with aesthetic medicine, a confluence of art and science.

Despite his young age, Gabriel has garnered a following due to his unique photographer’s eye, which he applies in a range of non-invasive procedures such as Botox treatments, soft tissue augmentation (Dermal Fillers with the latest virtually painless Cannula Method), skin rejuvenation with lasers, and effective acne and acne scar treatments (Fractional CO2 Laser, subcision).

In his free time, Gabriel loves to travel the in search of that perfect snapshot. His works of art have won praises by many patients.

For more information, write to contact@slclinic.com.sg.
To contact Dr Gabriel Wong, write to gabriel@slclinic.com.sg.

[13 Aug 2018] A blog post by Dr. Gabriel Wong

Melasma patch on the forehead.
Credits: American Medical Aesthetics

Do you suffer from patchy pigmentation on your cheeks or forehead? Have you tried many whitening products, lasers and even chemical peels without significant improvement? If you do, you may benefit from a treatment which has been shown to help with your pigmentation problem.

Melasma is a fairly common skin condition affecting mostly ladies in their 30s and 40s. It is also prevalent among pregnant women. Melasma appears as patchy brown pigmentation on the cheeks, forehead and nose bridge. These patches of brown pigmentation add a “dirty” look to an otherwise well-kept complexion and can affect the self-esteem of its sufferers.

What’s more, over-the-counter whitening products used to lighten pigmentation show limited results on Melasma, and even topical medications and medical laser treatments can sometimes produce marginal improvements. Melasma is also challenging to treat as it tends to recur with time and sun exposure.

Fortunately, researchers at Singapore’s National Skin Centre found that the oral medical Tranxenamic Acid, commonly used in treating heavy menstrual periods, show significant lightening of Melasma in over 90 per cent of patients it studied. Side effects are minimal with the medication it is generally suitable for those in good health. Contraindications include those with a personal/family history of blood disorders, pregnant women, and ladies on oral contraceptive pills.

Do you suffer from patchy pigmentation and want to know if you’ll benefit from this treatment? Speak to any of our doctors at SL Aesthetic Clinic and we’ll be happy to give you professional advice on the best treatments available.

Source:  Journal of the American Academy of Dermatology, 2016 Aug;75(2):385-392

Having graduated from the Yong Loo Lin School of Medicine – Dr Gabriel Wong worked in several hospitals in Singapore where he honed his medical acumen.

Fate was at work when he met Dr Kelvin Chua, which sparked his interest in aesthetic medicine.

Growing from strength to strength under the tutelage of Dr Chua, Gabriel developed an eye for detail and beauty – perfectly in tune with aesthetic medicine, a confluence of art and science.

Despite his young age, Gabriel has garnered a following due to his photographer’s eye, which he applies in a range of non-invasive procedures such as Botox treatments, soft tissue augmentation (Dermal Fillers with the latest virtually painless Cannula Method), skin rejuvenation with lasers, and effective acne and acne scar treatments (e.g. Fractional CO2 Laser, subcision).

In his free time, Gabriel loves to travel the in search of that perfect snapshot. His works of art have won praises by many patients.

For more information, write to contact@slclinic.com.sg.
To contact Dr Gabriel Wong, write to gabriel@slclinic.com.sg.

[6 August 2018] A blog post by Dr. Mark Lim

From facials, skincare products, to medical aesthetic procedures bearing the Skin Booster name, it’s a wild wild world of skin hydration treatments. Many of such mimic the original Restylane Skinboosters™ treatment, at varying levels of success.

Here, I give you a low-down on three medical aesthetic Skin Booster treatments, the latest being Juvederm’s Volite.

But first. What exactly is a Skin Booster?

Not to be confused with the cosmetic product, medical grade skin boosters are meant to be injected rather than applied. Skin Boosters contain a sugar molecule called hyaluronic acid, or H.A. in short.

H.A. is a naturally occurring molecule in our skin, and one of its functions is to bind water to keep our skin hydrated. However, with the ageing process, the quality of the H.A. in our skin deteriorates. Over time, skin loses its glow and suppleness, and develops fine lines.

Skin Boosters are designed to be injected intradermally either via manual injections or assisted by an injector device. Once in place, it soaks up water like a sponge, and continues to hold it in place.

There are 3 Skin Booster treatments available at the point of writing. Here’s a short summary:

As individual needs, expectations, and concerns vary, there’s no one-size fits all Skin Booster treatment. Speak to your preferred healthcare professional for an individualised assessment to pick the best product for your needs!

P.S. another similar product called Rejuran Healer from South Korea has been making waves in the Skin Booster sphere. But that’s a story for another time!

He may be young, but Dr Mark Lim is definitely not a greenhorn.

As a local graduate of the National University of Singapore, Mark is also a Member of the Royal College of Surgeons, Edinburgh and is also on the Singapore Registry of Family Physicians.

But his need to push himself further saw Mark develop an interest in aesthetic medicine. And it was a fateful encounter with Dr Gabriel Wong that paved the way that grew a mere interest to into a passion to practice aesthetic medicine at SL Aesthetic Clinic.

With vigorous training under Dr Kelvin Chua while maintaining a job as a family physician, Mark honed his skills (and his needles) and proved himself an adept in injectable treatments such as Fillers and Thread Lift, as well as non-invasive facial contouring techniques and treatments such as HIFU (High Intensity Focused Ultrasound).

Further distinguishing Mark from his peers is his innate eye for aesthetics. This is evident in his taste in tailored clothes and suits, which underlines his ability to determine the best proportions for his patients.

For more information, write to contact@slclinic.com.sg.
To contact Dr Mark Lim, write to mark@slclinic.com.sg.

[25 May 2018] A blog post by Dr. Charlene Goh

The Facial Ageing Process

How does one lift a droopy face? A common question I get in my practice, we first have to how our face ages.

The ageing process is not a straightforward one. Ageing takes place in the slow degeneration of multiple layers of our face:
1. Your facial bones shrink and lose volume
2. Facial muscles and ligaments that hold fat compartment in place become lax; these fat compartments shift downwards with gravity
3. Your outer skin becomes thinner and wrinkly.

Therefore, in order to reverse ageing with the aim of creating a more youthful look, there is no one-fits-all treatment. More often, we need a combination of treatments for optimal results. Additionally, what works for one may not work for another. My role as an aesthetic doctor is to examine your face to determine which combination of treatments works best for you.

As we age, our face shape changes from an inverse triangle to an upright triangle due facial bone shrinkage, muscle and ligament laxity, fat migration and thinning of skin.

Here are 5 treatments that can help improve an ageing and sagging appearance.

1. Fillers: As you age, your bone structures change and lose volume. Imagine a table with a fitted tablecloth. This represents your face in your youth. Now picture the table frame (i.e. your facial bone structure) shrinking, while the tablecloth (i.e. your skin) stays the same. Sagging will definitely occur!

With filler injections, these empty spaces are filled to keep the skin taut. Fillers can also be introduced at parts of the face that are sunken such as the tear trough or nasolabial fold. Placing fillers in the right place can help to lift and restore volume, giving you a more youthful look.

There are many different brands and types of fillers on the market with varying longevity and usage. It is important for you to find an experienced doctor to decide which one is suitable for you.

2. High Intensity Focused Ultrasound (HIFU): HIFU delivers focused ultrasound energy into the deeper planes of the face, namely the deep skin (dermis), superficial fat and muscle layer (SMAS layer – Superficial Muscular Aponeurotic System). The SMAS layer is the same site that is tightened in a surgical facelift. By stimulating focal contraction points (as shown in the image below), there is immediate collagen contraction, resulting in SMAS tightness. Delayed wound healing in the next 3-6 months will stimulate new collagen production for even greater results.

The advantage of HIFU when compared to conventional surgical facelift is that the deep structures of the face can be targeted without surgery, and herein without the associated downtime. HIFU is the ideal treatment for needle-phobic patients who want a firmer and more lifted face!

2. Thread Lift: The loss of bone support, shift and fat compartments, ligament laxity are parts and parcel of the ageing process. Thread Lifting involves placing dissolvable surgical threads underneath the skin. These sterile threads are lined with cones/barbs, and introduced into your fat compartments to lift and reposition the sagging fat pads. This effectively reverses the signs of ageing. Immediate lifting is seen. More noticeable results can be seen after a few months as your skin’s production of collagen and fibrosis is stimulated by the threads. This keeps the skin firm and prevents the downward shift of your fats pads.

4. BOTOX (i.e. Botulinum Toxin): Oftentimes, BOTOX injections are thought of as an anti-wrinkle, muscle-relaxing treatment. However, when placed at the right places and in the right dosages, BOTOX can also produce lifting results. Depressor muscles responsible for your frowns can result in the gradual lowering of your brows and the drooping of your eyes. BOTOX injections targeting these muscles can result in what we call a “chemical eye lift”, giving you a fresher, more well-rested look.

Another popular use of Botulinum Toxin is by introducing a diluted concentration into the skin layer. This is called DermaLift. This stimulates the fibroblast cells in the skin cells; tightening the collagen fibres. This gives rise to a more lifted appearance in the skin.

5. Resurfacing Lasers: Now that you’ve done everything to lift your facial structures from within, you’ll need a taut, overlaying canvas (i.e. skin). This is when resurfacing lasers come into use. Contrary to popular belief, lasers do not thin your skin! Resurfacing lasers that are commonly in use are fractionated. This means that only a certain fraction of the skin will be acted upon by the lasers. This stimulates the remaining skin to produce more collagen, thereby strengthening your skin’s dermis layer. When performed at an appropriate frequency and power, your skin will be feel taut and smooth after a couple of treatments.

Moreover, the common worry of long downtime is a thing of the past. I personally recommend the extremely gentle Clear + Brilliant Laser, which offers minimal downtime (i.e. 2 hours to a day or two) with great results.

With a plethora of anti-ageing treatments available on the market, which is suitable for you then? As your skin age in your own way and time, consult a trustworthy aesthetic professional who will be able to make recommendations suited to you.

Having obtained her medical degree in Scotland, Dr Charlene Goh returned home to Singapore, where she practised in several major hospitals and in various departments. But her education did not stop there.

From a young age, Charlene has had a strong interest in skin care and beauty trends. Urged by Dr Kelvin Chua to pursue her passion, Charlene went away to study Practical Dermatology at Cardiff University in Wales.

Not one to rest on her laurels, she returned home and picked up certifications from various aesthetic organisations.

Now armed with the proper certifications and experience, Charlene is adept at a wide range of minimally invasive aesthetic procedures such as laser treatments, dermal fillers, botulinum toxin injections, etc.

A firm believer in presenting one’s best self, Charlene hopes to help others achieve greater confidence through a holistic approach; a wholesome combination of a healthy lifestyle and diet, complemented by clinically proven aesthetic treatments.

Charlene is a self-confessed beauty junkie and fashionista, and will happily discuss the latest trends with friends and patients.

For more information, write to contact@slclinic.com.sg
To contact Dr Charlene Goh, write to charlene@slclinic.com.sg

[10 January 2018] A blog post by Dr. Kelvin Chua

To some, ageing gracefully means carrying the “character lines” with pride and quiet dignity. Others seek the help of Botox and Fillers to maintain their natural youthfulness.

The operative word being natural; many aesthetic practitioners ruefully fail to master the art of minimal injections.

Choose Quality, Not Quantity.

Having practised medical aesthetics for over a decade, I’ve seen and corrected my fair share of sloppy work and botched jobs.

Frozen brows, misshapen cheeks and skewed noses were common sights. Such cases have decreased in numbers over the years. All, except for one – the overuse of Botox and fillers.

I attribute this to one common misconception among many patients. The belief in getting every single drop of product to maximise the money spent. Regretfully, this is where such patients get it wrong. Quantity does not equate to results.

Allow me to explain.

Patients pay for results, not the amount of product used.

In achieving natural-looking aesthetics, the doctor (hopefully) knows what’s best for the patient (in his or her own opinion anyway, which is a different story altogether). A combination of specialised techniques and a measured amount of products is key.

Less is definitely more; especially for skill-intensive procedures such as Botox and dermal fillers.

Botox

A poker-faced finish is just not what you’d want to sport unless you’re spending hours counting out those chips in a casino. You’ll want youthful skin that says “Good genes!” instead of a frozen expression that shouts “Botox!”.

Practices of giving larger Botox doses have become a thing of the past as smaller doses are used to achieve a softer look with a touch up later if necessary.

This is why it’s important to seek out ethical and experienced practitioners who understand the interaction of different muscles so as to allow some of the essential muscles to move and maintain natural facial expression.

You’d want compliments on looking younger than your age and less tired looking rather than questions on the number of Botox units you’ve received.

Volumisation and Liquid Lifting with Fillers

With present-day technology, restoring lost volume on the face is ever easier with fillers. And if done right, you can take years off the face within minutes with virtually zero downtime.

While some doctors may inject several vials of fillers into a face, more refined techniques allow a doctor to create a natural and yet youthful look without excessively plumping out the cheeks that look like you

belong to the unenviable Pillow Face Club.

Moreover, Hyaluronic Acid-based Dermal Fillers come with different degrees of fluidity and hardness. The selection of the appropriate filler for each concern is crucial in attaining the best results, rather than the quantity used.

Experienced aesthetic practitioners have a good grasp on the different layers and depth of skin to be injected.

The depth is important to create different effect instead of using vials of fillers to simply fill the entire face. The position and depth also determine the type of fillers that are best suited.

Your Face is 3D, not a 2D Painting

This is particularly important as the face is not a 2-dimensional structure but rather a 3-dimensional model. This is made more complex from muscle interactions, varying degrees of sagginess resulting from migration of fats in different layers of the skin and the loss of fats in different areas.

Ultimately, it all boils down to a doctor’s training and a natural eye for beauty and proportions. Especially when it comes to such skill-intensive procedures.

Dr Kelvin Chua started his surgical training in Australia, teaching for several years in the hospitals, and spent some time in dermatology and surgical rotations.

Kelvin was fascinated by the boom of aesthetic medicine and has since garnered over 12 years of experience in this field – with over hundreds of liposuction procedures and thousands of Botox and filler treatments under his belt.

Kelvin is well regarded by his peers in the industry. With a strong passion for inspiring others through teaching, he is a certified trainer for several aesthetic institutions as well as cosmeceutical companies. Kelvin is also a mentor to many aspiring aesthetic doctors.

For more information, write to contact@slclinic.com.sg
To contact Dr Kelvin Chua, write to kelvin@slclinic.com.sg