HAIR LOSS TREATMENT POWER GUIDE

smiling young Woman face with hair

hair loss treatment

ABCs to hair loss treatment

Hair loss. Yes it’s a pain. But unfortunately, WE ALL go thru it. Recently, after my globe trotting, I noticed a sad truth. That I am balding lol.

So what are the common causes of hair loss?

  1. •       Androgenic ( female and male pattern hair loss)
  2. •       Alopecia areata ( coin shaped hair loss)
  3. •       Telogen effluvium ( stress related)
  4. •       Traction ( tight hairstyles)
  5. .        Vitamin and mineral deficiencies ( Copper, zinc, iron magnesium)

First step is identifying if your hair loss is gradual hair thinning or a sudden fall of >100 strands, which would require medical attention. Next is looking at the pattern of the hair loss. Female pattern hair loss is the loss of hair along the top of the head and is the most common form of hair loss. Male pattern hair loss occurs at the back of the head and along the hairline in front. Treatment is dependent on the cause and can be divided into conservative and surgical.

Please note: hair thinning and hair falling is different! If  you noticed your hair gradually thinning over time, androgenic hair loss is the most likely diagnosis. If however, there is a sudden spurt in the hair fall of  >100 strands, this requires medical attention.

This article is designed to be highly educational. So it comes complete with a quiz haha.

Capture

Hair loss

Can u name the diagnosis?

Essentially, the most common cause is androgenic, meaning hormonal. Hence it is impt to recognise the different grades.

Grading Scales for androgenic alopecia Hamilton Norwood (Males)| Sinclair (Females)

Males tend to lose hair in the back of the head, and in the front along the hairline. Females tend to lose hair along the top of the head. Here are some illustrations.

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HAIR LOSS GRADES

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To understand hair loss, you would first need to appreciate the hair cycle.

HAIR CYCLE

3 main phases exist. Anagen, catagen and telogen phase.

  1. Anagen is the growth phase.
  2. Catagen the intermediate phase.
  3. Telogen is the resting phase.
CYCLE Explained
Each hair follicle lives in a cycle. This consists of a  growth phase termed Anagen, followed by a transition phase, Catagen and finally a short period of rest, Telogen Phase, where growth stops.
After Telogen phase, the hair is lost and  newer hair grows, starting another hair growth cycle.
normal-hair-cycle4

HAIR CYCLE

Key principle of hair loss treatment is to increase the growth phase and reduce the resting phase.

 

HAIR LOSS treatment

Here is my 3 Step Formula to hair loss

Key principle is that once you stop your minoxidil, propecia etc, hair loss tends to return. Hence its for long term use.

  1.           Lifestyle changes – healthy diet and reducing hair trauma
  2.           Medical:  topical minoxidil and oral Viviscal
  3.           Specials: Light therapy and Platelet Rich Plasma injection (PRP)

Medication

  1. • Topical Minoxidil 2-5% New users can start with 2% and gradually work up to 5%.
  2. • Oral | Viviscal, finasteride, dusteride, spironolactone | Treatment for 6 months or more for better results. Viviscal is derived from fish proteins, and has had quite consistent results and is arguably safer than propecia, which can cause impotence, low libido, depression etc.
  3. • Immunosuppressant | intralesional steroid, oral steroid, MTX| – Effective for alopecia areata

How to apply Minoxidil?

  1. Dry your hair and scalp
  2. Apply the prescribed amt twice daily to the affected area, starting from the centre.
  3. Allow natural drying – No hairdryer
  4. If you miss a dose, just continue with your next dose.

What are the side effects of minoxidil?

Minoxidil is generally well tolerated. However, there may be rare instances that you may experience the following side-effects: Localised skin reaction = itch, redness, rash, burning

How long do we need to use minoxidil?

Results take time. You may notice hair shedding as your old hair drops to allow regrowth of new hair. Peak results after a year of continued use. Minoxidil is safe and FDA approved. Need for continued usage.

Finasteride – Propecia and Proscar 

Who is suitable to consume propecia?

This medication is only suitable for males.

How does propecia work?

It contains an enzyme, which inhibits the conversion of testosterone to dihydrotetosterone. DHT in excess causes shrinking of your hair follicles. It comes in a 1mg tablet. If you miss a dose, just continue from where you have left.

When can I notice results?

Results take time. You may notice hair shedding as your old hair falls to make way for regrowth of new hair. Peak results after a year of continued use.

 What are the side-effects of propecia?

In very rare instances, decrease in libido may be experienced, reduced ability to get an erection and breast tenderness.

What are the evidence based treatments for hair loss?

Below are the top 3 FDA Approved products for hair loss. Viviscal, Propecia, Rogaine have been proven in controlled clinical studies to stop hair loss and regrow new hair. Scientists have discovered that men with male pattern hair loss have an increased level of dihydrotestosterone (DHT) in their scalps. Propecia blocks the formation of DHT. As a result, it interrupts a key factor in the development of inherited male pattern hair loss in men.

What is the difference between rogaine and propecia?

  1. •Availability: Rogaine is available without a prescription. Propecia requires a prescription.
  2. Application: Rogaine is applied to the scalp. Propecia is taken as a pill.
  3. Mode of action: Rogaine works locally by reinvigorating the hair follicles. Propecia stimulates hair regrowth by altering male hormones.
  4. Suitability: While Rogaine Extra Strength is approved for men only, Rogaine as a 2% minoxidil solution is approved also for use by women. Propecia is not approved for use by women.

Advanced treatment

  1. Cosmetic camouflages include coloured hair sprays to cover thinning areas on the scalp. Specialized scalp tattoos can also mimic the appearance of a short, buzzed haircut.
  2.  Low level laser therapy is of  ? benefit in pattern balding but one device has been approved by the FDA for marketing.
  3.   PRP, platelet rich plasma is becoming more popular although not everyone is suitable for this procedure.

STUDIES:

Cochrane review

A Cochrane systematic review published in 2012 concluded that minoxidil solution was effective for. Minoxidil is available as 2% and 5% solutions; the stronger preparation is more effective, but may irritate and may cause undesirable hair growth unintentionally on areas other than the scalp.

A combination of low dose oral minoxidil (0.25 mg daily) and spironolactone (25 mg daily) has been shown to be most effective.

PRP

  1. PRP stands for platelet-rich plasma. PRP is blood plasma that has been enriched with platelets. PRP contains several different growth factors and other cytokines that stimulate healing of tissue, as well as hair growth.
  2. Human blood contains mesenchymal stem cells, and autologous blood products that contain essential and specific growth factors that assist in tissue regeneration and healing.
  3. PRP was developed in the 1970′s and first used in Italy in 1987 in an open heart surgery procedure.

What is the evidence for PRP in hair loss treatment?

  1. Medical literature worldwide confirms the safety and use of PRP therapy in medicine. In the past 20 years, 
  2. PRP has been widely used in skin and wound healing, and is now being extensively used in cosmetic surgery, dentistry, sports medicine and pain management.
  3. In the field of hair loss treatment, evidence supports PRP therapy  to promote hair growth. Studies have shown that growth factors released from platelets may act on stem cells in the bulge area of the hair follicles, stimulating the development of new follicles and promoting neo-vascularization. ( Journal of Aesthetic Cutaneous Surgery, 2014).

Can PRP replace medication for hair loss?

However, PRP is in the early stages of scientific research for hair loss therapy,  hence PRP is not meant to replace current FDA approved therapies such as DHT blockers and Minoxidil.

How is PRP Hair Loss Therapy performed?

  1. Your blood is drawn and then spun in a sterile centrifuge system
  2. A topical anesthesia is applied to your scalp to reduce any discomfort during the PRP treatment.
  3. The highly concentrated platelet rich plasma is then injected into your scalp
  4. Your hair will then be washed and you may return to your daily routine. You are able to drive after the procedure.

How many sessions are needed?

Studies for hair loss indicate an average of 3 treatments scheduled 6 weeks apart. This may vary depending on the severity of hair loss and desired result. 

Thats all from me. I wish you a hair raising experience.

Dr Daniel Chang

 


 

To learn more about:

ALL Aesthetic treatments, do click here Ultimate Guide to Korean Medical Aesthetics.

Threadlifts, pls click here Facelift, V-Lift.

Dermal fillers, pls click here ABCs to Dermal Fillers. 

Pigments and pigmentation in skin.  Please click here PIGMENTS

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TO LOOK AND FEEL YOUR VERY BEST 

TO BE SO MENTALLY STRONG THAT NOTHING CAN ROCK YOUR PEACE

TO FORGIVE YOURSELF FOR MISTAKES OF THE PAST AND PRESS ON TO THE WORK FOR A BRIGHTER FUTURE

 

closeup   young  woman face with clean  skin

In society today, 3 groups of people are at their most vulnerable. With the rise of social media, and the use of gadgets to communicate, the generation today is faced with a new set of challenges.

Social media portrays people in the most positive light. Seeing your peers posting beautiful pictures and participating in awesome events creates a notion that ‘the grass is ALWAYS greener on the other side’. This creates the false impression that other people’s lives are so cushy and impressive, while you yourself may be struggling in many ways.

3 at risk groups

The youth: Youths today are under massive pressure to excel in school. They have less face time with parents, and miss the nurturing and guidance that a fully attentive parent can give. Schools today place too much emphasis on academic performance and rote learning and very little on problem solving life-skills. Parents in our current generation tend to be too busy with work, leaving the care of their kids to the school or grandparents. Where kids feel that they can only get their parent’s approval if they get good grades, become a school prefect, break into the national team etc… This creates feelings of poor self esteem in youth, and this follows them through life. They have difficulty coping with stress, and find it tough to handle failures. A study shows that a kid aged between 3 to 6 years of age is at a key developmental stage. Lifeskills learnt during this time sets the foundation for healthy personal development in later years. Hence, please do not neglect your children, be kind to them.

The working adult: Adults are very social media savvy these days. And as mentioned earlier, social media creates the false perception that your neighbour is having ‘the time of their lives’, while we ourselves are struggling with work, bosses, career progression, insecurities etc… Inevitably, there will be comparison with peers and adults often find themselves caught up in the rat race. This creates feelings of anxiety, low self esteem and depression. Hence, be kind to one another.

The elderly: Elderly face the major challenge of loneliness, either because they are single, or their children are too busy with their work or family. Being physically handicapped, many need help for daily activities, and this inevitably creates a dent on their emotional well-being. Hence, be kind to your parents.

I created this blog with the purpose of serving the needs of men and women who are seeking aesthetic treatments for both rejuvenation and enhancement, providing them with useful educational information, helping them look and feel their very best, fulfilling their highest, truest, purest expression of themselves.

Along the way, I realised it is so important in our fast paced society today, to include elements of gratitude, kindness and positive psychology in order to address the primary goal of this blog.


Background

We know that how we think affects how we feel, and how we act. So for today, lets start with little acts of kindness. Kindness does not just relate to cash donations, it includes sharing your time, attention and efforts with the less fortunate.


Little Acts of Kindness – Activities to challenge yourself 365 days of the year – Your 365 days Kindness Challenge

Give up your seat. Hold a door open for someone
Give a (sincere) compliment, telling someone you noticed they are doing an awesome job

Give honest appreciation to an old friend
Make someone laugh
Give YOUR CHILD a hug
Make someone new feel welcome. Take time to really listen to someone

Forgive someone for what they’ve done. Donate your old things to charity
Give food to a homeless person and take time to talk with them
Visit someone who may be lonely
Get back in contact with someone you’ve lost touch with
Have a conversation with a stranger
Read a story with YOUR CHILD
Say sorry (you know to who)


Evidence: 

Research shows that humans long for connection and communication. So it’s not all about the need for success, perfection, approval etc. Society will blossom when people look out for each other.

When we’re kind to people we know it strengthens our connection with them and provides a source of support and this sets off a happiness cum kindness movement, aka paying it forward.

Doing kind things for strangers builds empathy and trust in our communities. This is the cornerstone for looking and feeling your very best. So take up the kindness challenge and go forth and help someone out.


 

So if you wanna feel GREAT, start doing good today!

  1. I wish for you to look and feel your very best.
  2. I wish for you to be so mentally strong that nothing can rock your peace.
  3. I wish for you to forget the mistakes of the past and press on to your greater work for the future.

Dr Daniel Chang


 

To learn more about:

ALL Aesthetic treatments, do click here Ultimate Guide to Korean Medical Aesthetics.

Threadlifts, pls click here Facelift, V-Lift.

Dermal fillers, pls click here ABCs to Dermal Fillers. 

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KYBELLA – DOUBLE CHIN (non surgical) reduction

DOUBLE CHIN |CHUBBY CHEEKS | BUCCAL FAT.

Many people are bothered by chubby cheeks and double chin. To some, it may be a fashion statement.  A symbol of power of and wisdom. To others, it is a curse. Hence some may go to Korea to undergo liposuction to achieve the perfect V shape look.

double chin

double chin

v shape face

v shape face

Today, I will share with you non surgical options available for reducing your double chin and chubby cheeks. The medical term for chubby cheeks and double chin is Buccal Fat and Submental Fat respectively. Now all of us have it, however, in some cases, it is more visible due to a combination of reasons.


What is the cause of chubby cheeks and double chin?

3 key reasons. Ageing, Genetics and Weight gain.

images

CAUSE of double chin

How can you lose and reduce buccal fat?

If you desire to reduce the excess fat and tighten your skin, there are some options available. There is no one size fits all technique. Options are on a case by case basis. Definitive treatment is surgical removal for moderate to severe cases.For mild to moderate cases and a desire for non surgical intervention, combination treatment helps. This is my preferred approach. I call it the TIE approach.

  • T: Threadlift to lift and support the saggy tissue
  • I:  Injection – With microtoxin to firm and tighten excess skin
  • E: Energy based devices – Skin tightening with Energy based devices RF, HIFU, And fat reduction via fat freezing

BUCCAL FAT PAD aka CHUBBY CHEEKS

buccal fat

buccal fat

buccal-faty

buccal fat

Where is our buccal fat?

Here we can see where the buccal fat is located. Notice it is right in front of the jawline, hence contributing to a square jaw in Asians. Depending on the severity, the above options of non surgical vs surgical are available and will give a certain degree of efficacy.

chubby cheeks

chubby cheeks – buccal fat

 

SUBMENTAL FAT aka DOUBLE CHIN and Turkey Neck 

Next lets look at the chin and neckline. Notice a bulge under your chin? That is due to skin laxity and soft tissue accumulation.

saggy neck

saggy neck

For most of us, it is something we prefer not to have. And just for laughs, there is actually a restaurant named Double Chin! Bet the food is so yummy they promise you WILL GAIN weight in all the right places haha.

ls

Now, let me share with you my approach to double chin reduction.

Dr Daniel Chang’s TIE approach to double chin reduction

  • T: Threadlift and Microtoxin to provide skin firming and support
  • I:  Injection – with lipo-dissolve solutions – Deoxycholic acid, Kybella
  • E: Energy based devices – Skin tightening with Energy based devices RF, HIFU, And fat reduction via fat freezing

T: Threadlift and Microtoxin. Pls refer to my link below for further information.

I: INJECTION with lipo-dissolve solution – KYBELLA 

E: ENERGY based devices

Please refer to the article and videos below on Facelift.


 

With Kybella, a US FDA approved product for double chin reduction sweeping the Western world by storm, many see it as the elixir to non invasive fat reduction, and a fantastic alternative to liposuction, for those who do not wish to go under the knife. Kybella has a high patient satisfaction of 80% upwards for permanent fat reduction in this area.

What is KYBELLA® (deoxycholic acid)injection?

Kybella is a Lipodissolve solution, FDA approved and used in the US for a number of years now. KYBELLA® is a prescription medicine used in adults to improve the appearance and profile of moderate to severe fat below the chin (submental fat), also called “double chin.”

How does Kybella work? 

Kybella is deoxycholine solution that acts to dissolve fat cells.

HOW KYBELLA WORKS

How Kybella works

KYBELLA INJECTION

Who is suitable to receive KYBELLA?

People with isolated fat deposits.

Who should not receive KYBELLA®?

  1. You should not receive KYBELLA® if you have an infection in the treatment area, of if your double chin is due to excess, saggy skin only.
  2. If you have thyroid problems, are breastfeeding or pregnant
  3. Have excess jowls, excess skin

What are the possible side effects of KYBELLA®?

The most common side effects of KYBELLA® include swelling, bruising, pain, numbness, redness, and areas of hardness in the treatment area.

How is Kybella done? 

The area of concern is marked, and tiny injections are made into your fat tissues to dissolve your fat cells.

KYBELLA AREA

Kybella for double chin

How does it feel after treatment?

Immediately after kybella treatment, you will experience tolerable burning sensation (discomfort 4/10) during the inital 15min, then swelling, numbness, prickly sensation that can last for 4 days on average. This sensation is due to the fat cells getting dissolved.

I would recommend compression dressing +/- the use of analgesia at night in selected cases.

How long do the results of kybella last?

Kybella dissolves the fat cells in the treatment area permanently. It will take between 3-4 sessions to get your final results. The desired effect will take time but Kybella will cause permanent fat reduction after each treatment.

 


 

Aesthetic treatments, do click here Ultimate Guide to Korean Medical Aesthetics.

Threadlifts, pls click here Facelift, V-Lift. 

Filler injections, pls click here ABCs to Dermal Fillers. 

 


 

So I hope this has been useful. May you lose and reduce your chubby cheeks and double chin this festive season! Take care of yourself .

 

pictminusbk

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3D NOSE-LIFT

3D NOSE-LIFT

nose

NOSE FILLERS:

Nose fillers, to enhance your nose bridge, tip and body. For the perkier, sharper you. Non surgically, with minimal pain, downtime and bruising. Results are instant. Nose fillers can be used to correct a flat nose bridge, a down pointing nose tip, and a dorsal hump, all common in Asians. It cannot be used to make a nose smaller. To do so visually, there are options. In the grand scheme of things, it is important for the nose to harmonise with the rest of your facial features. Keeping things natural, simple and beautiful.

NOSE THREADLIFT:  

( To learn more about the difference between surgical vs non surgical rhinoplasty, please click here) 

Who are Suitable patients?

 The procedure is suitable for anyone who has not had surgical rhinoplasty or permanent fillers. 

What are Possible Results To Expect?

  1. Smoothen the nose profile
  2. Raise the nose bridge
  3. Lift the nose tip

Results of the Nose Threadlift generally last 12 to 18 months.  Number of threads vary and depend on your nasal profile.


What is the benefit of nose threadlift over nose fillers?

  1. No risk of blindness and skin necrosis
  2. Lasts longer compared to fillers
  3. Give you a natural looking, sharp and straight nose profile without the risk of the nose bridge widening

So is it better to do a rhinoplasty, Nose Filler or Nose Threadlift?

  1. This depends very much on your aim and existing nose profile.
  2. For general nose contouring in a straight nose, threadlift is the choice.
  3. For noses with volume deficits for example a dorsal hump, fillers are required.
  4. For an obvious and 3D look, combination of threadlift and filler gives the best results.
  5. For a long term results, go for surgical rhinoplasty, though there is downtime.

 

Why do I have no or minimal results post nose threadlift?

  1. Nose Threads used were the incorrect quality, commonly too thin, lacking cogs, not firm enough etc, hence creating a firming but minimal lifting effect.
  2. Nose Threads quantity was not enough or technique of placement of Nose Threads was not optimum.
  3. Need for Nose fillers to augment certain areas on your nose.

Bottomline: Not all threads are equal. The quality of threads used is important.

Can men undergo Nose Threadlift?

Nose Threadlift is commonly used for nose augmentation in men these days. As males tend to have larger noses with dorsal humps, fillers may be required, and more threads too , compared to an average female.

How many sessions do most people need to achieve a good result?

For most patients, one session is required. For the minority who desire very obvious results, top ups may be needed. For optimum results, a repeat treatment at 6 to 12 months is highly recommended.

What are the side effects? 

  1. Injection marks which will heal with proper care.
  2. Risk of infection, hence it is important to do the procedure in a medical clinic under sterile technique.
  3. Soreness of the nose.

*Please note: As this is a medical procedure, results may vary from individual to individual. Hence it is best to seek a consultation with your physician to understand the treatment further.

Revision1
Nose types
nose shape

 

 

images

 

hiko nose

nose

 


To learn more about:
ALL Aesthetic treatments, do click here Ultimate Guide to Korean Medical Aesthetics.
Threadlifts, pls click here Facelift, V-Lift.
Dermal fillers, pls click here ABCs to Dermal Fillers. 
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ACNE SCARS (atrophic, boxscar, ice-pick, rolling, hypertrophic, keloidal) / PORES / Eczema – dry sensitive skin / 痤疮疤痕

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Adult onset Acne, Pimples 


acne scar

Acne scars

What causes acne scars?

Acne scars are the result of the breakdown of collagen and elastin in your dermis. They frequently occur at sites which were acne prone in the past, namely your temples, cheeks etc.

What are the different types of acne scars?

acne-scarring-terms1

 

 

 

 

rolling-scarsacne-scar1-sacne-scarring-2-s

boxscar                ice-pick                                     atrophic

acne-scar7-s

Hypertrophic and keloidal


How can we treat acne scars?

 

Acne scars are 3 dimensional, hence submitting a photo will not do justice to your scar. It requires real time examination (touch and animation), combined with lighting from various angles. That is why you may notice your scars differently in the bathroom mirror and in the dressing table mirror.

Dr Daniel Chang’s 3 STEP ACNE SCAR Treatment Formula: 

1- Control acne

2- Treatment – Fractional laser + skinboosters ( to promote collagen growth)

3- Maintainence with lasers ( to optimise collagen stimulation)

STEP 1: CONTROL YOUR ACNE. (Refer to this page on acne for more information)

Achieving good control of your acne is the important principle towards helping your acne prone skin. This prevents new scars from forming, which is a big step forward. Dont be too worried about your existing acne scars. Focus on prevention first.

STEP 2: Treatment based on scar type. Below are the 4 main types.

Ice pick scars =>    can be treated with TCA CROSS, Fractional and Microneedling

Rolling and box scars scars => are best treated with a combination of  RF Microneedling, PRP, fractional lasers and subcision

Hypertrophic scars can be treated with

  1.  Microbotox
  2. Intralesional steroid

Atrophic scars -> A combination approach is what I would recommend to improve the appearance of such scars.

  1. Laser Resurfacing +/- RF microneedling 
  2. Subcision
  3. Dermal fillers – Skinboosters – Please refer to my Page on Skinboosters 
  4. Intralesional saline – ( Latest evidence from Journal of Dermatology Sept 2016)

STEP 3: Maintainence with lasers to regulate optimum collagen growth.


Videos:

Here is how the procedure is done.

 

Acne-9.jpg

4.png

 

SKINBOOSTERS

 


What to expect post laser resurfacing (CO2, Erbium) treatment

laser-resurfacing-27second-day-after-peel3412138a00000578-3586090-image-m-49_1463030624677images

The pictures above represent the WORST CASE SCENARIO.
Often times, you can expect the following.
  1. Redness x 2 days
  2. Bronzing of skin x 2 – 3 days
  3. Flaking off – dead tissue x 2 days
Results are take time as it takes 3 months for collagen to grow. Hence it is important to know this is not a once-off treatment. Regular sessions are required.
Your dermatologist should be able to navigate you through the sea of information and customise a programme that suits your skin best. I hope this post has been helpful!
Dr Daniel Chang. 
Be bold and beautiful

 

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ACNE TREATMENT

ACNE-FREE SKIN – The DC Acne Experience – Pimples, Acne scars, Acne marks, red marks / 青春豆 ,痤疮治疗

ACNE

howto getridof-net

Acne, acne scars, pimples, whiteheads, blackheads…(Blackheads are open comedones, whiteheads are closed comedones, below is an example.)
getty_rf_photo_of_open_and_closed_comedones_diagram

(courtesy of web-md)
https://youtu.be/Dd3mEXe279E
We have all battled with acne before. Some more than others, some ongoing, some successfully conquered.Our hot humid climate does not help one bit. This, coupled with our natural tendencies for oil glands to go into overdrive has left notable battle scars.
How many of us have been bothered by these thru our teens? Who amongst us had struggled, tried numerous over the counter cleansers, toners and cosmetic products but to no avail, or worse still, triggering more outbreaks?
This should never be a battle fought alone. This is a battle best fought with the help of your Doctor and his array of treatments.

So what causes acne?

how-acne-develops

Well, to put it simply, it’s the blockage of our pores. And if we dont manage it carefully, it leads to acne scarring.

Most acne medications BOUGHT OVER THE COUNTER are drying to the skin. They work by reducing sebum. Benzoyl peroxide works by killing the P Acne bacteria.

The flipside of course is the triggering of skin irritation and inflammationNever attempt to wage this battle alone. Acne is not rocket science, but there is a complex range of conditions. If over the counter medications do not work after 2 weeks, it is time to enlist the help of your friendly Aestheic Physician to guide you thru the various treatment regimes.

CIMG7289

So the question is- how do we treat acne?

In the latest 2016 guidelines released, the American Academy of Dermatology recommends combination treatment for acne. 

The aim of treatment is to reduce acne outbreaks and minimise the dreaded acne scarring.I believe in the combination of good basic cleansing and toning, topicals+/- medication, chemical peels and laser treatment, to obtain optimum results. Acne should be actively managed to reduce the risk of permanent scarring.

The DC approach to ACNE

My approach is to divide and conquer.

Acne can be divided into non inflammatory, inflammatory and acne scars.

Non inflammatory:  comedones, blackheads, whiteheads

1) Blackheads – extraction BY A PROFESSIONAL

2) Whiteheads – retinoids ( retacnyl, differin), AHA peels and scrubs to remove the gunk and unclog the pore. Retin A based creams work well on long term acne control, and have anti ageing benefits too.

Inflammatory: Angry, red, bumpy  pimples

1) Benzoyl peroxide based treatment, plus minus oral antibiotics

2) Lasers and AHA based medical peels to control the oil, and increase exfoliation.

3) Blue light and antibiotics to kill p.acne bacteria.

Only when active acne is controlled, can we proceed to acne scar treatment.


Dr Daniel Chang’s 3 STEP ACNE Treatment Formula: 

1- Laser/ Light/ Peel

2- Topical medication +/- oral

3- Lifestyle changes ( Pls refer to my lifestyle guide)


 

Treatment: Medical peels + Laser  Light + Blue light therapy ( unclog pores, control oil,kill p. acne bacteria)

Dr Daniel Chang’s GOLDEN rules – 3 steps to acne free skin – DAILY SKINCARE REGIMEN:

  1. Cleanse gently, splashing with warm water and pat dry
  2. Apply moisturiser gently. No rubbing.
  3. Dab anti acne cream, gently, no rubbing, with a cotton bud. Key to effective treatment here are ingredients containing retinoid and benzoyl peroxide. But balancing the side effects require time and careful use. Differin cream, clindoxyl and clindamycin are my top choices for this. (Retin A based creams like retacnyl, differin work best with benzoyl peroxide based antibiotic creams like clindoxyl, but these do cause skin irritation, so its important to learn how best to apply them onto your face.)

AVOID Acne triggers – Lifestyle GUIDE 

  1. Diet. Studies have shown that dairy products, food rich in GI, and fried oily food are a no no. They tend to provoke a hormonal surge, which is the trigger for acne. Thats probably why acne tends to affect people in developed countries, where the diet is so rich.
  2. Lifestyle. Stress is no good. Thats why breakouts tend to occur after frequent OTs, after a flight (as the cabin air is super-drying to your skin), before an important photo-event etc. Keeping a regular exercise regime and sleeping sufficiently helps!
  3. Contact. Minimise contact with your fingers. Dap, and not wipe, your face with a towel. Apply cosmetics sparingly. Use oil-free, non comedogenic products. And when applying acne treatment like benzoyl peroxide, retinoids, adopt a hands-free approach. All these serve to reduce inflammation. As for how to select the right products for your skin, and how to use them appropriately, please speak to your Aesthetic physician for further information.

Now, let me share with you my TOP skincare tips for acne control.

  1.  Cleanse, exfoliate and treat. Gently clean your face 2x a day, using a minimal touch technique. Dont overclean your face. (This is to remove all the old and dead skin that is clogging the pores, but not over irritating your skin.)
  2. Use oil free or ‘non comedogenic’ makeup products. Remember, you use makeup to look more beautiful, not to look worsen your acne.
  3. Never ever squeeze a pimple and minimise touching your face. I know its easier said than done. You risk scarring, darkening and spreading the pimple to other parts of your precious face
  4. Wash your pillowcase, and your pillow on a regular basis. Your pillows otherwise collect all the sebum, makeup and dirt that contribute to pore clogging.

Common pitfalls: Lifestyle mistakes

  1. No moisturiser used OR Mistaking aloe vera gel for moisturiser: – A well moisturised skin will help with sebum control and reduce clogging of pores, which leads to acne. And keep yourself well hydrated. Healthy skin starts from within. Oftentimes, the patients I see having breakouts do not use mositurisers. They may use aloe vera gel (which is NOT a moisturiser). Moisturising helps. The skin takes a month to get used to a new product. 2 months to stabilise. 3 months to gain good control.
  2. Too much makeup. – When you cover your skin with heavy makeup, this becomes a vicious cycle as makeup clogs pores. If u run your fingers over your skin, you may feel mini bumps, common over the cheeks, jawline and forehead.
  3.  Habit of picking their pimples, squeezing them. –  This is a NO no! Scar and pigmentation risk is high.

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(pictures courtesy of dermnetnz)

 

(here is an example of adult onset acne)As a general rule of thumb I find that this laser, which serves to kill the P acne bacteria, shrink pores, and reduce oil production, is a good treatment to undergo. In addition, I would recommend the following coupled with a good skincare regime to get on top of your acne.Now acne can be classified into mild, moderate and severe. Below is a summary and their corresponding treatment.
  1. Mild (comedonal acne or mild inflammatory acne): topicals retinoids +/- AHA, BHAs
  2. Moderate: oral and topical antibiotics for inflamed acne, + benzoyl peroxide, +/- OCPs
  3. Severe (nodular): please speak to your dermatologist    

Many have asked me,

Why do some people get breakouts after a chemical peel or laser? 

 

There are 3 main reasons.

  1. Skin is too dry. Hence not suitable for treatment.
  2. Skin is unstable, and having active breakouts. This can be due to a multitude of reasons. So any treatment during this period acts to purge pimples.
  3. Skin is reacting to the skincare that was used after the treatment. Remember, it takes time to get used to a new product.

Why do people get breakouts after a holiday?

2 main reasons.

1- Stress. This can be in the form of unhealthy sleep habits, unhealthy lifestyle, unhealthy diet, which often happens when we want to ‘live life to the fullest’ during our vacation. =)

2 – Change in humidity. This stresses your skin and oil water balance.

Dr Daniel Chang

To learn more about:
  1. ALL Aesthetic treatments, do click here Ultimate Guide to Korean Medical Aesthetics.
  2. Threadlifts, pls click here Facelift, V-Lift.
  3. Dermal fillers, pls click here ABCs to Dermal Fillers. 
  4. Pigments and pigmentation in skin.  Please click here PIGMENTS
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QUICK GUIDE TO STEM CELL THERAPY

 

ANTI AGEING AND REGENERATIVE MEDICINE

Disclaimer: This is a purely educational article on stem cell, regenerative medicine, the hottest treatment in Korea and Taiwan for anti-ageing.

What are stem cells?

Stem cells are the bread and butter for every tissue, organ in our body.  They possess 2 key properties, the ability to self-renew (make copies of themselves) and differentiate (develop into more specialized cells).

What are the types of stem cells?

  1. Embryonic stem cells
  2. Tissue-specific stem cells (adult stem cells)
  3. Mesenchymal stem cells (adult stem cells)
  4. Induced pluripotent stem cells

 

Embryonic stem cells

Embryonic stem cells are obtained from the inner cell mass of the blastocyst, a mainly hollow ball of cells that, in the human, forms three to five days after an egg cell is fertilized by a sperm. A human blastocyst is about the size of the dot above this “i.” These cells are pluripotent.

The fertilized egg and the cells that immediately arise in the first few divisions are “totipotent.” None of the currently studied embryonic stem cell lines are alone capable of generating a viable embryo (i.e., they are pluripotent, not totipotent).

Adult stem cells – Tissue specific and mesenchymal

Mesenchymal stem cells

Mesenchymal stem cells were originally discovered in the bone marrow, but have since been found throughout the body and can give rise to a large number of connective tissue types such as bone, cartilage and fat.

Tissue-specific stem cells

Tissue-specific stem cells (also referred to as somatic or adult stem cells) are more specialized than embryonic stem cells. Typically, these stem cells can generate different cell types for the specific tissue or organ in which they live. These cells are multi-potent. An example is adipocyte derived stem cell, which is the cell type most commonly used in Regenerative medicine.

Induced pluripotent stem cells

Induced pluripotent stem (iPS) cells are cells that have been engineered in the lab by converting tissue-specific cells, such as skin cells, into cells that behave like embryonic stem cells. Researchers are experimenting with many alternative ways to create iPS cells so that they can ultimately be used as a source of cells or tissues for medical treatments.

 

SUMMARY

The embryonic stem cells and iPS are both unstable cells, and can be likened to a wild horse. They cannot be well controlled, and have high oncogenic potential ( cancer-causing), so they are not used in clinical application.

Clinically,  tissue specific stem cells carry the best indication for clinical application due to its stability.


Where are stem cells derived from?

  • Body Fat tissue
  • Bone marrow
  • Blood
  • Umbilical cord
  • Skin

What can stem cell therapy help with?

Stem cell therapy is still at its infancy, and all treatments are conducted in a clinical trial setting. Areas of interest include the following:

  • Anti Ageing – To rewind the clock, repair damaged cells and regenerate healthy new cells
  • Congenital defects
  • Wound healing and recovery from chronic diseases

 

What are 3 important questions to consider further?

  • How are the stem cells identified, isolated and grown?
  • Are the cells differentiated into specialized cells before therapy?
  • How are the cells delivered to the right part of the body?


 

To learn more about:

ALL Aesthetic treatments, do click here Ultimate Guide to Korean Medical Aesthetics.

Threadlifts, pls click here Facelift, V-Lift.

Dermal fillers, pls click here ABCs to Dermal Fillers. 

Pigments and pigmentation in skin.  Please click here PIGMENTS

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