Accessible Aesthetic Treatments for Flawless Skin

The history of beauty is as ancient as time itself. Throughout mankind’s history, people have tried to improve their attractiveness and beauty, while maintaining youth for as long as their methods of treatments could afford them.

Our appearance is the most public part of ourselves – it is only natural that we desire to improve our apparent imperfections or maintain our perceived youthful beauty. Beauty is often perceived along a spectrum of narcissism, but history and modern-day practices have taught us that being good-looking does contribute to a person’s success.

In his book Beauty Pays: Why Attractive People Are More Successful, Professor Daniel Hamermesh, a prominent economist and professor of economics in the University of London, points out:

“…The attractive are more likely to be employed, work more productively and profitably, receive more substantial pay, obtain loan approvals, negotiate loans with better terms and have more handsome and highly educated spouses”.

While Prof Hamermesh’s statement may sound a little far-fetched, other anecdotal evidence do support some of his words. I am sure you may have heard that South Korean parents (read affluent parents) would present their children a graduation gift of plastic surgery so that they would be perceived to be more attractive and hence could gain that extra edge and value in securing their desired jobs.

“When you’re nineteen, all the girls get plastic surgery, so if you don’t do it, after a few years, your friends will all look better, but you will look like your unimproved you,” a college student who’d had a double-eyelid procedure told me. “We want to have surgeries while we are young so we can have our new faces for a long time,” another young woman said.

Patricia Mark. About Face: Why is South Korea the world’s plastic surgery capital?. New Yorker, March 2015.

In this part of Asia, we have a more moderate, if not conservative propensity when it comes to aesthetic treatments and plastic surgeries. A huge majority of my patients are surgery-averse and more than 50 per cent of my patients often ask for non-invasive or minimally invasive treatments mainly to improve their skin quality. The remainder tend to ask for minor augmentations of their appearance with dermal fillers, Botox or collagen stimulator injections.

I often hear about the desire for Korean-superstar-like dewy, pore-free skin. Social media has not only popularised it but has given us unrealistic expectations of skin quality. Models in major cosmetic product ads, for example, set the tone for the perceived default skin quality for us – flawless, glowing and pore-free skin.

The equatorial climate here is perpetually hot and humid – hence, our pores dilate to perspire. While most of us would not have a bone to pick with the climate, the lack of care of the skin can often lead to hardened and permanently dilated pores.

To achieve the putative flawless skin, it takes years of relentless care with reasonably good amount of skin care, regular aesthetic treatments and mandatory sun avoidance, coupled with the cool and drier climates, such as in the Northern hemisphere, and finally, a good sprinkle of Photoshop digital sorcery.

You may ask, then – what is the secret to youthful skin while we age. Remember the following pointers:

Products – Know your ABC’s:

Vitamin A

Vitamin A (Retinoids) exists in two forms: Retinoic Acid (prescription drug) and Retinol (over-the-counter cosmeceuticals). Retinoids improve skin turnover, resulting in less wrinkles and less pigmentation. They also stimulate collagen production and improve blood supply of the skin – these explain the “Retinoid Glow”.

Retinoids are tricky to use because they can potentially irritate the skin – so, my advice is to start with low concentrations and slowly increase. To reduce risk of irritation, apply nightly with only a pea-sized amount of retinoids, apply outwards and upwards, and for beginners, space out its usage, such as using every other night.

Retinoids are not safe for pregnancy and during breastfeeding.

Vitamin B3

Vitamin B3 (Niacinamide) increases skin barrier function by increasing ceramide production, thus allowing the skin to tolerate stronger products (such as Vitamin A) while reducing trans-epidermal water-loss. Vitamin B3 is also anti-inflammatory – it may help with sensitive skin, acne and rosacea. Studies show that Vitamin B3 also reduces risk of cellular dysplasia and cancer rates.

It is safe to use during pregnancy and breastfeeding.

Vitamin C

Vitamin C (L-Ascorbic Acid) is one of the most versatile skin products ever discovered – it reduces UV damage (antioxidant); has anti-inflammatory functions; stimulates collagen; and reduces hyperpigmentation – all these resulting in reduction of pores, fine lines and pigmentation.

Absorption of Vitamin C can be increased by creating microscopic channels on the skin by gently disrupting the very top layer of the epidermis (stratum corneum) with a non-ablative fractional laser or nano-fractional radio frequency device.

Vitamin C is rapidly degraded by sunlight – products containing Vitamin C should be kept in a cool and dark place. It may irritate the skin for some people, so use Vitamin C after consulting your doctor.

It is safe to use during pregnancy and breastfeeding.

Pigmentation

Pigmentation is one of the hardest to treat, particularly the Asian skin. The current consensus is that pigmentation should be treated with low laser fluence (low energy setting) coupled with the use of topical creams (such as Cyspera) and anti-oxidant serum (such as Vitamin C), to lighten pigmentation and maintain the skin at that lightened state.

Nd:YAG Pigment Lasers (Nano- and Pico-second lasers)

Pigment lasers such as the work-horse Q-switched Nano-second Nd:YAG laser or Pico-second Nd:YAG laser – they work by blasting pigments by photoacoustic and photomechanical effects that gradually break pigment molecules into smaller bits.

Graphics (above): The work-horse of most aesthetic clinics - the Q-Switched Nano Second Nd:YAG laser.

What is the difference between the Nano-second and the Pico-second lasers? Imagine the analogy of a large hammer (Nano-second Q-switched laser) to break larger pigment “rocks” into smaller “pebbles” and a chisel (Pico-second laser) to break these “pebbles” into finer sand-like pigment molecules. The differences in outcomes are subtle and may be operator-dependent.

Graphic (above): Monthly maintenance treatment with both Nd:YAG Pigment laser and ProYellow Laser with recommended. Usually, there is no downtime associated with these.

Vascular lasers

Vascular lasers such as the QuadroStar ProYellow Laser or Norseld Dual Yellow Laser are the only vascular lasers available choices in the market that are designed to treat pigmentation. These laser energies in the yellow wavelength (577nm or 578nm) down-regulates the Vascular Endothelial Growth Factors (VEGF) given off by the underlying blood vessels that feed the pigments cells. With treatment, the pigments will appear lighter due to reduced production, while non-pigmented areas appear brighter and lighter.

Vascular lasers also reduce inflammation and skin redness – perfect for those with acne and rosacea. These lasers can also be used to treat fine blood vessels (telangiectasias).

Pores

Large visible pores are the result of pore dilation to allow perspiration in our warm, humid weather. With dilated pores come increased sebum production and oily skin.

Treatments that minimise dilated pores rebalance the water-sebum equilibrium of the skin, reduce sebum production and tightening pores through collagen stimulation and collagen contraction. Some creams, such as Adapalene (Differin) may help in reducing sebum production, too.

Graphic (above): The range of Rejuran Polynucleotide injectables available for treatment of overall skin rejuvenation (black box), infra-orbital rejuvenation (white box; treatment of fine lines and dry skin under the eye), and acne scars (blue box).

I tend to use a combination of Rejuran Polynucleotide micro-injections with a low dose of Botulinum Toxin that reduce sebum production and cause collagen contraction.

Monthly maintenance of the aforementioned lasers not only help with treating pigmentation but also stimulate collagen and tighten pores in the long term. Treatments individually may not give you obvious results, but when combined, the results are more overt.

Production of collagen

All of the aforementioned treatments can stimulate collagen to a certain extent. Contrary to common (unfounded) belief that lasers thin out the skin, lasers actually stimulate collagen. Even a cold laser peel with an Erbium laser can stimulate collagen, while creating micro-dermal channels on the skin for increased absorption of serum, cosmeceuticals and hydratant.

There have been a couple of novel injectable treatments for collagen stimulation such as Ellansé and Profhilo - these have an overall effect of gradual volumisation of the treated areas – overt effect may take weeks.

Graphics (Above): Ulthera uses micro-focused ultrasound energy to make controlled damage of old, worn-out collagen and "tissue-glue". The skin will then rebuild and make newer, stronger collagen that holds tissue better and also holds more moisture.

For clients who request for non-needle treatments, I would suggest Ulthera – a US-FDA approved treatment using micro-focused ultrasound to remodel collagen at specific depths of the skin. Newly formed collagen tends to hold our skin better and hold moisture much more effectively.

There you go – if you have at least three of the above ticked, your skin should be in a happy state of glow. These are accessible aesthetic treatments that will help also allow us to age gracefully – being the best version of ourselves in appearance without going under the knife.

An abbreviated version was published on The Business Times Weekend in the Health Section on Saturday, 28th December 2019 (subscribers only).