The FACE PAGE
This page discusses treatments aimed at creating, building and enhancing your best features. The topics discussed are as follows.
- Non invasive facelift for SAGGY skin – With focus on combination therapy for best results ( Ulthera/ Thermage + Fillers + Microbotox with Laser resurfacing as a maintainence )
- Botox, with emphasis on V-shaping and Microbotox
- Please refer to Korean Aesthetic page
Today, we will discuss how to CONQUER saggy skin.
Saggy, saggy, saggy skin, and how achieve a lifted and tightened effect.
Ageing and gravity leads to sagginess. Of course the easiest way to lift skin is to use good old masking tape. Just kidding!
Now ageing leads to the 3Ds, deflation, damage, descent.
- Descent: The skin loses collagen and elastin, and sags.
- Deflation is when the soft tissue layer loses volume, hence flattening the cheeks, liken to a deflated beachball.
- Damage from sun exposure leads to fine lines and wrinkles.
Let us go deeper into the skin, layer by layer.
Skin diagram
- Epidermis: The skin barrier weakens and loses moisture, and is often dry.
- Dermis: The skin loses its collagen and elastin in the dermal matrix due to sun damage and ageing.
- Subcutaneous layer: Volume is lost in the form of fat tissue, causing the redundant skin to sag.
The overall result is SAGGINESS.
Treatment can be divided into the rule of 3s.
- Lifestyle
- Non invasive
- Surgical.
- 1) Lifestyle changes -> Please look under my SKIN PAGE for further elaboration on this.
- I teach my patients the S.E.A and T.C.S principle, and arm them with the use of medical grade skincare products. T.C.S stands for Time, Cover and Sunscreen.
- T.C.S: Time: 10am – 4pm is the hottest time of the day. Stay indoors! Cover: Use a wide brimmed hat and shades to give yourself that extra cover. Sunscreen: Never leave home without it. All these are really PROTECTIVE measures.
- 2) Non invasively -> REPAIR measures with the use of COMBINATION treatment. Ulthera and liquid facelift. To give you a better understanding, click on the respective treatments for a video of the procedure.
Ulthera
This is the only FDA approved procedure to lift and tighten skin. It targets the SMAS, the same foundation layer addressed in a surgical facelift.
Liquid facelift
Basically, this involves the use of either botulinum toxin or hyaluronic acid to achieve a lifting effect. Here are 2 commonly performed procedures.
Dermalift – This technique utilises a diluted dysport dose to induce tightening of the forehead, cheeks, jawline.
H.A fillers – This technique involves careful placement of hyaluronic acid to anchor, support and lift your face.
In the above diagram, you can see areas for filler enhancement. Commonly performed treatments in Singapore are the Chin, Laugh lines, Cheeks and Nose augmentation
- 3) Surgically, its in the form of a surgical facelift. This addresses the underlying muscles through repositioning. The SMAS layer is also tightened in the process.
So when is the best time to undergo Non invasive skin lifting?
- Ageing – Starting early -at the 1st signs of jowling, is the best time
- Post weight loss
- Post pregnancy -> Commonly, after weight loss or a pregnancy, you can find excess skin, which simply wont go away whatever you do.
Sagginess can be divided into Mild, mod and severe.
- Mild sagging -> The use of Ulthera is suffice
- Moderate sagging -> Combination of Ulthera with Fillers +/- microbotox would yield the best results
- Severe sagging -> Surgical facelift would be the best option
Now, I STRONGLY believe in the use of non invasive therapy for safety, efficacy and minimal downtime.
As the majority of patients who complain of saggy skin have moderate degree of sagginess, for OPTIMUM results, I would recommend combination treatment, combining Ulthera with Fillers and Microbotox. Laser resurfacing can be used as a maintainence to reduce the loss of collagen with time.
The end result is – Lifting, tightening, and cleaning up your neck.
Be skin-smart. Be bold and beautiful. Making Raffles Place more beautiful, one face at a time.
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Non invasive FACELIFT, for a lifted, tightened you.
In my previous post, we discussed about Thermage.
Today I will give you an overview of the modalities available, for non invasive facelift in Singapore.
Non invasive facelift
1) Liquid facelift – This involves the use of botulinum toxin as in microbotox or dermalift, or the careful use of fillers, namely Hyaluronic fillers, injected at key areas on your face, to provide the anchor, support and lift.
2) RF facelift – Thermage
3) US facelift – Ulthera
Here is an elegant diagram comparing Ultherapy to RF and Lasers. As we can see, Ultherapy delivers focussed energy onto the SMAS layer, reaching up to 4.5mm into the skin to tighten the SMAS layer. It also delivers energy up to 3mm to induce collagen production.
Most Radiofrequency devices deliver bulk heating up to 4.3mm, hence inducing collagen and tightening pores, improving tone and texture.
Lasers deliver energy under 3mm of the skin, improving tone, colour and clarity.
Today, I will focus the discussion on Ultherapy.
Ultherapy is an elegant system, and is FDA approved for skin lifting and tightening. Using targeted Ultrasound, it achieves lifting and collagen stimulation. It is particularly effective for…
- Upper face for lifting brows– Lift and tighten loose skin on areas such as the eyebrows ( to give you a freshened look)
- Lower face for a sharper, more defined jawline– Addressing double chin, saggy jawline characterised by jowls (addressing the submental fat in the process)
- Neck for a smoother outline– Addressing saggy skin and wrinkles on the neck
Here is an example of the treatment zones in Ultherapy.
Who is suitable?
Ulthera is indicated for patients 35-60 y.o
How does it work?
Its energy is targeted to the SMAS layer – 
Superficial musculo-aponeurotic system, which is the layer commonly addressed by plastic surgeons in a surgical facelift.
Is it painful?
Well, this is a subjective question but generally, I would cover my patients with analgesia.
Is there any downtime?
For most patients, there is little to no downtime. There is a small risk of mild and transient redness, edema and bumps on the face.
How about liquid facelift?
Basically, this involves the use of either botulinum toxin or hyaluronic acid to achieve a lifting effect. Here are 2 commonly performed procedures.
Dermalift – This technique utilises a diluted dysport dose to induce tightening of the forehead, cheeks, jawline.
8 point lift from Juvederm – This technique involves careful placement of hyaluronic acid to anchor, support and lift your face.
So I hope this mini series on facelift has been helpful. Speak to your Dermatologist for more information.
Happy CNY!
Making Raffles Place more beautiful, one face at a time.
======= Combination therapy Explained===================================
In my opinion, I find that the use of Skin lifting technology, followed by fillers and rounding it off with fractional laser resurfacing will help a person address these 3 key problems of ageing. Allow me to explain.
(Image courtesy of Lifting de la peau – Clinique Thermage Solta Medical ® Bruxelles)
So let me start by sharing with you my 3 step approach to Skin lifting for a glowing, more radiant you.
1) Mini skin lifting technology, using either Thermage or Ulthera focuses on the descent issue of ageing.
– Thermage uses unipolar radiofrequency energy (RF), while Ulthera uses US energy on the SMAS. These in concert work on ‘lifting’ the skin in a needle less fashion, softening the laugh lines, jowls, and saggy neck, and can improve the appearance of your skin texture and pores.
2) Fillers address the deflation issue of ageing, and provide the much needed volume and support to the skin, hence filling flattened cheeks, laugh lines, thus making the jowls and lines appear less obvious.
3) To top it off, the use of fractional laser resurfacing would address the damage portion of ageing, and soften the finer lines and wrinkles giving you a younger, healthier, more radiant you.
On the topic of skin lifting, currently, the 2 big players in this field are Thermage and Ulthera.
Many a patients have asked me which is better?
I personally feel that both are effective. They each work on a different level in the skin, and hence, in my opinion, to achieve optimum results, it is best to schedule both. So I would suggest a Thermage procedure first, followed by Ulthera 6 months to a year’s time.
Recently, given the year end holidays, I have had several patients asking about Thermage. So to help you the reader understand this treatment better, I have summarized the commonly asked questions pertaining to this non invasive, skin lifting treatment in an easy to follow format.
What is Thermage?
Thermage is an innovative, non-invasive radiofrequency procedure for lifting and contouring skin. Thermage CPT system is the latest version of Thermage machines in the market. Thermage CPT offers better results and more patient comfort during the procedure than its predecessors.
Who can do Thermage?
For the young, under 30s, as a peventative measure to slowdown ageing. Thermage works best when there is less sagging.
For the more matured patients – to combat saggy skin.
So what can Thermage do for you?
1. Skin lifting
2. Smoothen and contour skin-> giving you better texture
3. Pore refinement-> giving you radiancy
How is it done?
A comfort tip delivers RF energy which you will feel in the form of heat. The procedure takes roughly an hour.
(Image courtesy of Solta medical)
How long do the effects last?
With 1 time treatment, results last for at least a year.
What are the side effects?
Minimal or no downtime.
May have a little redness that last for a while, depending on skin sensitivity.
Rare to have swelling or blisters.
Who are the patients unsuitable for this?
Patients with pacemaker or electronic implanted device, or stents.
When can you expect to see changes that you would really like?
Maximum results at 3 to 6 months. Some get immediate results.
How long after botox, fillers can you do Thermage?
Generally, they be done in the same sitting.
So I hope this mini series on facelift has been helpful. Speak to your Aesthetic Physician for more information.
Happy Holidays.
Making Raffles Place more beautiful, one face at a time.
=====================Botox and MICRObotox ===================
Fillers, Botox, , MICRObotox, which to do and when to do it? These are the questions on everyone’s mind. To do or not to do, that is the question.
I have had several queries about botox and fillers, hence I decided to compile this mini FAQ for your reading pleasure.
So let me share with you some interesting Botox and filler FAQs to hopefully guide you towards your Aesthetic goal. Be bold and beautiful!
So what is botox?
It is a muscle relaxant.
I dont want the frozen look, so is botox still suitable for me?
A good injector will not give you the frozen look.
Is it true that once you start, you have to continue for life?
The short answer is, it depends on what you want. Botox takes your face to the state when it is relaxed. If you like it,
What can be used used?
A combination of Dysport, Botox, Xeomin can all be used. These are FDA, HSA approved and noted for their efficacy, safety and durability.
Fillers can be divided into natural and permanent. Natural ones contain hyaluronic acid, which is a natural sugar found in the body. Personally, I would choose natural fillers.
What is MICROBOTOX?
It is the use of diluted botulinum toxin to induce 3 endpoints. Note that this is currently an off label use in Singapore. I believe in the use of microbotox with Thermage or Ulthera to enhance the skin lifting properties, hence reducing laugh lines, jowls, fine lines and wrinkles.
- Reduction in oil production
- Tightening of pores to improve skin texture
- Skin tightening to improve sagginess and add to your radiancy and glow
What causes a square jaw?
(Mandible or jawbone- picture courtesy of wikipedia)
The masseters are two muscles found on each side of your jaw. They serve as muscles of mastication, which means they help you to chew. The other muscle groups that perform this function are the temporalis muscles and the pterygoid muscles.
In a condition known as bruxism (excessive chewing or grinding at night), the masseters at the jawline can grow in bulk( making the jaws look square), much like how body builders pump their muscles.
A lifestyle of chewy and hard food can also contribute to masseter growth.
Therefore, injecting Botox to relax the muscles is effective in causing the muscles to reduce in size, hence inducing a slimmer contour to the face.
So how can we achieve a V shaped look?
BTX-A is often used to reduce the size of masseter (jaw muscles). Together with chin fillers, the ideal V-shaped look can be achieved non-surgically.
So how is it done?
Botox is injected into the masseters on each side of the face and spread out at multiple points within the muscle. It is effective, with minimal pain and no downtime. The procedure is non surgical procedure, and the face slimming effect is seen at any time between 4 to 6 weeks.
What are the side effects?
In the first week, there may be a slight ache over the jaw, especially with chewing. This should be transient. You should abstain from massaging the muscles and from lying down for 4 hours after the procedure.
(forever_inject)
Where else can botox be used for?
Wrinkles in the upper face – forehead, frown lines, crow’s feet.
Brow lifting, to enhance a refreshed, brighter look.
Ageing leads to low-set brows which often makes one look dull and tired.