Friday, June 21, 2019

Why your AGNES acne treatment DID NOT work

Hi Everyone!

I've begun writing on a different platform

So check out this link here and I'll reveal some of the secrets as to why your AGNES acne treatment did not work.

So click the link below to find out more on.

Friday, March 22, 2019

Can Botox cause death? What exactly happened!

It is a sad and unfortunate week for all those practicing Aesthetic & Dermatology. There has been a report of a case of death who was a property agent following Botox in Singapore and there has been much debate and worries regarding this procedure. There also has been any questions arising from some of my current patients. There has also been a few articles from some doctors in Singapore writing on this Botox Death topic so I shall not go though too much technical details.

Although there has been no official report yet on the exact cause of death, let's go through Botox itself as a procedure and drug and if it can really result in death!

Botulinum toxin is the most common cosmetic procedure performed world wide with an estimate of nearly 3 million injections per year. It works by the action on muscle nerve endings to disturb the transmission of information preventing these muscle from contracting resulting in them being temporarily paralysed.

Hence it would be logical based on how Botox works to say that Yes, Botox can cause death.

But of course as with all things, how much Botox do you need to be causing death and was this what was done in this case?
Studies have shown that a dose of of more than 6 U of botulinum toxin/kg used in children and other medical indications may cause death. [1] A female that weights about 50kg needs to receive almost 300U of botox.

A typical total amount of units for the forehead would be either 8 or 16 units. Crows feet? Maybe 4 units per eye or 12 units per eye.

Jaw muscles, the most I usually use is about 80 units.

As Botox's function is to paralyze muscles, less muscle contraction would lead to better wrinkles. Less muscle contraction would also lead to smaller jaw muscles and hence a more V shape face.

Botox can also be used for lifting with a unique technique called Dermalift. But the dosage used in these is also so low. No way even close enough to result in a Botox Death as what the news claimed.

How can anyone possibly be reaching such high levels of above 300U of Botulinum Toxin if this was done only for aesthetic reasons?! So in order for someone to be using THAT much Botox, it has to be done for medical reasons. But was this the case?

There has been reports in 1990s of people actually having consumed or eaten Botulinium Toxin. As this was produced by a bacteria that was living in canned food, the dose consumed was extremely high. 405 cases were reported to the CDC in America with about 40 death cases. But of course this was some time ago and it was not in Singapore.

Botox actually has many other uses in the medical field that isn't done for cosmetic and aesthetic purposes. Eg, Botox can be used to treat limb muscle spasticity associated with cerebral palsy. These cases need almost about 6.25 to 32 U/kg!

In fact a quick literature search and I found this list of different indications where Botox is useful.

Dystonias [2]Cervical dystonia, Oromandibular dystonia, Pharyngolaryngial dystonias, Jaw closure/opening dystonias, Occupational cramps, Limb and axial dystonias
Spasticity[3]Cerebral palsy, Brain injury, Spinal cord injury
Eyelid spasm[4]Blepharospasm, Hemifacial spasm, Eyelid twitch
Exocrine gland hyperactivity[5]Focal hyperhidrosis, Relative sialorrohoea, Crocodile tears syndrome,
Movement disorders[6]Tremors, Bruxism, Tic
Pain syndromes[7]Migraine, Back spasm
Urinary bladder dysfunction[8]Sphincter- detrusor dyssenergia, detrusor hyperreflexia,
Opthalmology[9]Strabismus, Entropion, Protective ptosis
Cosmetology[10]Hyperactive facial lines-brow lines, Frown lines,
Gastroenterology[11]Achalasia, Anal fissures, Anismus
Urology[13]Sterile prostatitis

Was this in fact a case of a patient needing medical treatment which required a large amount of Botox that resulted in a Botox Death?

Was this in fact NOT actually related to Botox but instead due to some other causes?

What may actually kill was it anaesthesia or a sedative agent injected into a vein?

We do not know for sure as details of the case has not yet been revealed. We shall have to await the pathologist results to come out to identify the true cause of death.

1. Early communication about an ongoing safety review botox and botox cosmetic and myobloc. [accessed on 2008 Apr 23]. Available from:

2. Jankovic J. Botulinum toxin therapy for cervical dystonia. Neurotox Res. 2006;9:145–8

3. Simpson DM, Gracies JM, Graham HK, Miyasaki JM, Naumann M, Russman B, et al. Assessment: Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review) Neurology. 2008;70:1691–8.

4. Frei K, Truong DD, Dressler D. Botulinum toxin therapy of hemifacial spasm: comparing different therapeutic preparations. Eur J Neurol. 2006;13:30–5

5. Naumann M, Jost W. Botulinum toxin treatment of secretory disorders. Mov Disord. 2004;19:S137–41.

6. Brin MF, Lyons KE, Doucette J, Adler CH, Caviness JN, Comella CL, et al. A randomized, double masked, controlled trial of botulinum toxin type A in essential hand tremor. Neurology. 2001;56:1523–8.

7. Lang AM. Botulinum toxin type A therapy in chronic pain disorders. Arch Phys Med Rehabil. 2003;84:S69–73.

8. Schurch B, Schmid DM, Knapp PA. An update on the treatment of detrusor-sphincter dyssynergia with botulinum toxin type A. Eur J Neurol. 2007;6:S83–9.

9. Dutton JJ, Fowler AM. Botulinum toxin in ophthalmology. Surv Ophthalmol. 2007;52:13–31.

10.  Flynn TC. Update on botulinum toxin. Semin Cutan Med Surg. 2006;25:115–21 

11. Madalinski M, Chodorowski Z. Why the most potent toxin may heal anal fissure. Adv Ther. 2006;23:627–34.

12. Ghazizadeh S, Nikzad M. Botulinum toxin in the treatment of refractory vaginismus. Obstet Gynecol. 2004;104:922–5

13. Thwaini A, Shergill I, Radhakrishnan S, Chinegwundoh F, Thwaini H. Botox in urology. J Int Urogynecol. 2006;17:536–40.

Sunday, February 24, 2019

Secret RF - Depressed Acne Scars Treatment in Singapore

Secret RF is a Fractionated Microneedle Radiofrequency device that can be used for Acne Scar Treatment

This is the latest addition to The Clifford Clinc's armour of lasers and it is used to complement Clifford's Infini Fractional Microneedle Radiofrequency device for treatment of depressed acne scars.

Secret RF uses radiofrequency energy to stimulate collagen growth in the deep dermal layers of the skin. Similar to Infini in concept, the difference between the Secret RF machine and Infini is the ability to use non-insulated needles in Secret RF and semi-insulated needles in Infini. Also with the ability of RF assisted subscision from the Secret RF device, a larger variety of depressed acne scars can now be addressed in a single setting as compared to before.

Patients undergoing depressed acne scar treatment are often concerned with side effects, post treatment recovery time as well as efficacy. Fractionated microneedle radiofrequency devices (including Secret RF and Infini) have a much shorter down time profile due to minimal damage to the epidermal barrier. They also have a much better safety profile with a much lower post inflammatory hyperpigmentation incidence as compared to ablative lasers like fractional co2 lasers.

Why is the recovery for Secret RF and Infini faster? This is largely due to the finely designed microneedles that do little damage to the epidermis. Radiofrequency energy can induce electrical current which result in heating of the dermal tissue hence improving the acne scars. Lasers on the other hand generate heat by delivering energy to chromophores or pigments within the skin, generating heat through a process called photothermolysis. This may somewhat explain why lasers may have a higher incidence of hyperpigmentation if too high powers are used in an attempt to get more results in acne scar treatment.

Infini vs Secret RF

So one might ask, why have 2 devices that seem to work the same way? The truth is as many with acne scars know is that acne scars is not an easy problem to treat. The concept of Semi-Insulated Needles have proof safe with acne scar remodelling, skin tightening as well as pore refining. Non-insulated Microneedle Fractional RF from the Infini was never a viable option but from Secret RF, this option has now become feasible due to the difference in tip profile both in terms of size, material and duration where the tip can be left into the skin.

Moreover, Secret RF now as a RF assisted subscision tip that cuts through anchoring scar fibers more effectively than the traditional subscision needle. With this new subscision technique, you would expect less bruising, less swelling and less down time for faster recovery with Secret RF for depressed acne scar treatment. Rolling scars that were traditionally treated with subscision or microneedle assisted subscison can now be more accurately targeted with the Secret RF machine.

Monday, July 23, 2018

My review on Regenera Activa - The newest development for Hair Loss and Hair Transplant.

There has been a lot of recent development in terms of hair regeneration / hair transplant and methods to treat hair loss, hair thinning and baldness.

There has also been some very recent editorial coverage on The Clifford Clinic in the Straits Times and Today on hair transplant in Singapore and how this is gaining popularity. I would go on about Follicular Unit Extraction and hair transplant but this post is not about that. This post is about the latest medical breakthrough in hair loss that is non-surgical and non-invasive. This is about a procedure that I did recently on myself for hair loss. Introducing a treatment called Regenera Activa, a procedure specifically designed to treat hair loss and balding due to androgenic alopecia!
That's me doing the implantation during 1 of our FUE hair transplant procedures.

Regenera Activa is a new approach that relies on capillary regeneration technique in combating hair loss, balding and hair thinning. How this process works is using a special device that uses micrografts of progenitor cells ( cells that is able to regenerate more cells ) that are able to repair damage tissue. Think of this progenitor cells like the mother of cells, that is able to produce a lot more other cells. Having that concept in mind, we know that this treatment is used quite commonly now to treat leg ulcers, chronic ulcers, surgical wounds and now also hair loss!

What I really like about this new technique is that there is absolutely no down time from this procedure. It is one of the safest and effective ways to regrow hair without the risk of any complications. This method enables the hair to return to its normal life cycle, hence increasing the density, thickness and quality of the hair. The rate of hair loss also slows down, allowing men and women to reverse the signs of hair loss. All this using the concept of progenitor cells to allow your own body to regenerate new hair follicles for the scalp which will eventually lead to new hair growth.

I'm doing some site marking over the frontal region, planning the hairline with my assistant.

Here is a step by step recount of the procedure:

1) The procedure begins with 3-4 hair follicles being removed from the back of the head after administering local anesthetic.

2) The cells obtained by tissues taken through punch biopsy are afterwards fused with a special solution.

3) These hair follicles retrieved are transformed into a special supercell suspension in the Regenera Activa device. The device helps to divide cell samples into miniature and absorbable portions.

4) The disintegration process is started, which can take about five minutes

5) The solution is then injected into areas experiencing an abnormal loss of hair, also known as Androgenetic Alopecia.

The science behind Regenera Activa to treat hair loss in Singapore is to provide aid to the strengthening of the hair follicles and to support tissue cells from the hair root and skin tissue of the person in order to renew and weaken the weakened hair root.

The whole process of Regenera Activa in the treatment of hair loss and hair thining is quick and efficient taking only 30 minutes. It has never been easier to treat hair loss. With only one treatment needed a year, it has never been easier to treat hair loss.

RegeneraActiva is a great alternative to traditional hair transplantation or Follicular Unit Extraction. I still do a lot of hair transplants using the FUE method in my Singapore clinic, but there is a huge role for a non-invasive treatment like this for male and female patients with early stages of hair loss. Especially those who are experiencing some hair thinning over the parting or just generalized hair thinning are excellent candidates.
Me handing the Artas Robot, useful in the harvesting phase of Follicular Unit Extraction during the hair transplant cases.

It is important that a careful selection of the right candidates is done for this procedure. Men who have severe hair loss will likely not see much results and those group I would choose to perform a hair transplant procedure on them. If the hair line needs to be brought down as well due to the typical M pattern shape developing, then a hair transplant procedure would be the treatment of choice.

Would I be raving this much about this procedure if I had not done this on myself? Of course like many others, I too suffer from Male Pattern Baldness and hair loss issues. It’s slightly over my crown and I can tell from the distribution that its very mild and early Androgenic Alopecia.

You can see from the picture here that Dr Casanova personally came to my clinic to mentor and also to personally perform this treatment on me. I am proud to say that I seen and felt what this treatment can do and is all about and I am ready to offer this to my own patients.

I personally like to try all my own treatments to not only validate the efficacy of the treatments but to also experience it myself so that I know how my patients feel. Male Pattern Baldness or Androgenic Alopecia is an extremely common condition, affecting more than 90% of men to varying degrees of severity and also 30-45% of women. Hence it is not uncommon for one to be worried about hair loss and hair thinning issues.

The Regenera Activa treatment for hair loss treatment was uneventful. It was over in under 30 mins and I was back to seeing patients after that. There was absolutely no down time. No redness, no swelling, no bleeding. Hair loss treatment has never been that simple. I especially like how this treatment only needs to be repeated once a year.

The only down side of the procedure? Injection of the micrograft solution into my scalp hurt a little. It needed about 20-30 micro injections of solution into my scalp, into the areas that experience hair loss and hair thinning. But I'm glad it was over very quickly! Honestly, after the procedure was done, I don't really remember much of the pain.  

Check out the video of the procedure done on me below. You can see I was still laughing during the injection. Not too bad!  

So look's happening after I've done this Regenera Procedure for my partner Dr Chow.

And those who have been following our center, we have recently did a FUE Hair transplant for him for his hairline! This was to bring down his high forehead and bring down his hairline. But we didn't transplant any grafts for his crown.

Glad Regenera managed to restore some hairs that were in the miniaturized phase!

Monday, April 23, 2018

Q switch laser. Why are you NOT getting results?

The Q switch laser is widely used by many doctors for many various reasons. Some doctors use them for acne, some for pigmentation while others use them for pores. Yet on numerous occasions, I get patients who tell me that they had done similar lasers and NOT see any results.  Yet they are somehow able to see a difference when the Q switch laser is performed by others. So what's the difference?
Why are some doctors able to get the desired eradication of pigments and even skin tone while others are unable to do so? What's the real secret?

The Q switch laser is essentially an ND-YAG laser. Being a ND-YAG laser, this means that the clinician has chosen the 1064nm wavelength to treat your skin. The choice of wavelength is dictated by the need for good absorption of the laser or light energy in the target structures deep in the skin, while avoiding unnecessary damage to the epidermis or the top most layer of the skin. For the treatment to be effective, the light energy needs to penetrate deeply into the skin because it is necessary to destroy or thermally affect specific skin structures. Depending on the location of the pigment or the end target in the body, the light energy must penetrate to at least 2-7mm in the skin to be effective.

This is dependent on 2 main properties of the laser. The absorption and the scattering of light.
Absorption of the light energy is dependent on numerous factors like the depth, absorption coefficient and intensity of the laser beam.

The absorption coefficient in real skin also vary from the absorption coefficient isolation. Chromophores do have very specific and selective absorption coefficient yet in real skin, this is influenced by numerous other factors. An example of one of this factors is skin colour. Skin colour affects the melanin concentration and this increase in darker individuals. This consequently results in greater penetration depth. Hence using a non Q-switch ND Yag laser results in increase thermal injury.

Scattering is yet another factor that affects the end result of treatments. Scattering of the laser light substantially influences the beam propagation through tissue and thus affects energy absorption in the skin. Once light penetrates through the skin, the depth of penetration becomes strongly influenced by scattering. The degree of laser light scatter before reaching the target is also dependent on the laser wavelength. It is important to know which laser is being used as this influences the amount the scatter. An example would be, when comparing the Q-switch laser to say an IPL or a ruby laser, a ruby laser would require a larger spot size and energy. This is the same if you are comparing an alexandrite laser to a diode laser.

With scattering, light no longer travels in a straight line. Its direction becomes random and causes the light to bounce back and forth inside the skin until it is absorbed. In order to penetrate deeply and unidirectionally, the wavelength and large spot size is important. The influence of spot size on the penetration depth and the energies require to achieve this is highly dependent on the machine and the experience of the doctor. Every single Q-switch laser in the market has a fixed spot size with a maximum energy and frequency it can be fired yet. So, not all Q-switch are equal! Some are indeed better than others. Each of these factors greatly influence the ability of your doctor to achieve the results you desire. With numerous lasers out there in the market, eg the IPL, Ruby laser, Erbium, Co2 etc etc etc... patients in the end really do need to trust the doctor they are seeing.

Pulse width, ... yet another factor I haven't even begun talking about. But by now, I am certain anyone reading up to this last paragraph is already already confused. And if you are a doctor reading my blog, at least I hope you gained some information reading on the 2 factors mentioned above. Absorption and scattering. Period.

Till then, treatment intervals, fluence and shot count.. more technical terms... keep it coming!

Wednesday, April 11, 2018

Adult acne - Permanent Results. Proven.

It's been a very long time since I've updated this blog. But I thought this was time I release an update on the treatment outcomes and methods that is used to treat Adult Acne.

Its great to see lovely outcomes from my patients with the clearance of their acne and the lack of recurrence especially with the use of the AGNES treatment.

AGNES was previously only exclusively available to my clinic but now I can see it being used widely in Singapore. This is good news as the local distributors have decided to sell his machine now to many other clinics.

AGNES is a treatment used to selectively destroy acne prone oil glands. It is quite common for one to then wonder, if doing AGNES will make the skin less oily or will it make it dry and wrinkled. This will not happen, as only very few oil glands are destroyed in proportion to the millions of oil glands located throughout the entire face. On the contrary, it is very likely that topical creams are the most likely cause of the dry skin. However, even through this is uncomfortable and make up often does not sit well on a extremely dry texture, the side effect is nevertheless temporary.

Why is it that sometimes the performance of AGNES varies? AGNES is a very specialized procedure. Accurate identification of the oil glands including direction of the oil glands and accurate selection of the energy required and number of shots needed for complete oil gland destruction takes experience and patience.

Is AGNES a miracle treatment in the treatment of acne and pimples? There are no miracles in treatment of this extremely difficult condition. Yet improvements in medical technology continuously pushes the boundary and allows us doctors to continuously do our best for our patients.

Acne has indeed multi causes. From hormones to genetics to the environment. Every doctor has their own way of treating acne. It is a constant battle to improve our methods and improve our techniques with research taking place regularly on how best to treat this.

I personally do not perform AGNES on all my patients either. Selection of the right candidate for the best outcomes depends on the expertise of your doctor. And again as mentioned, acne alone because has multiple causes, one really needs detailed and careful evaluation as to the likely cause of the pimple before knowing which treatment would work best.

Lastly, acne also has many different forms. Some are huge giant cystic nodules. Others may come as smaller papules or tiny red bumps. While others may appear primarily as bumps on the skin or commedonal acne. Some people describe their acne as fungal acne when it is really pityrosporum folliculitis. And then combined with Rocasea there is subtype 2 Rocasea with papularpustular rocasea or pimples associated with redness and flushing of the skin.

The diagnosis of acne is often straight forward yet it is really up to your doctor to identify the cause and treat it accordingly.

Sunday, May 7, 2017

Another IMPOSSIBLE case of persistent nodular cystic acne

We have a case here of a patient with one of the worst case of nodular cystic acne. The left side had a huge nodular cystic collection that has been constantly flaring up over the past year. When I first saw him, it was actually his mother that was more bothered about his face than the son himself!
Glad he was convinced to come down anyway and finally receive treatment.
These are the pictures when I first saw him. All pictures posted here are posted with full consent of the patient. He has gladly allowed me to share his journey on how I treat a case of severe pimples or acne vulgaris.

What we are seeing here is evidence of massive nodular cystic acne on both sides of the cheeks. Also presence of multiple papules. If he doesn't receive prompt treatment, I am worried that either the acne may develop into a cheek abscess or he will be left with terrible scaring when it finally resolves by itself. Cheek abscesses can sometimes spread to the inner cheeks as well and may result in full facial infection or cellulitis if this is left untreated.

The nodule on the left side was so big that it required a small incision to drain out all the pus and necrotic debris. A tiny stab incision was made after injection of local anaesthesia and this allowed the rapid drainage of the pus to be expressed.

The wound was packed with gauze and required alternate day dressing. This particular abscess was eventually closed with interrupted stitches. It was a difficult journey that time with every alternate day dressing, but he could come to the clinic after school for a relatively quick procedure. After the wound showed more signs of healing, it was closed with interrupted stitches and for the wound to finally heal.

He was subsequently put on 3 round of AGNES treatment, Q-switch laser and V-beam laser treatment. This helped to resolve most of his other stubborn acne throughout the rest of the face and also with the laser treatment to resolve the scarring and also to suppress any active acne and inflammation. This continued for the next 5 months for him, seeing him at regular intervals.
It is an absolutely pleasure for me to report how happy he is that he has agreed to allow me to use his pictures to document his remarkable journey. With repeated AGNES treatment for permanent control for his acne and using a unique Q-switch protocol developed by myself combined with the V-beam laser.

 The most important aspect is also the prevention of depressed scars. The ice-picks and boxscar scars are very difficult to treat and I am glad early treatment of this case of nodular cystic Acne Vulgaris has resulted in an excellent result.

Lesson to learn. Early visit to the doctor can prevent future scaring, help achieve excellent outcomes for the skin and early resolution of even the most severe cases of acne or pimples.

Friday, February 17, 2017

Is there a permanent cure for Keloid Scars?

Kleoid scaring can be disfiguring and a very prominent keloid scar can cause a lot of distress. Keloids apart from looking aesthetically unacceptable, it also causes itch, pain and some discomfort during the day and sometimes even at night.
A true definition of a keloid scar is a scar that is not only raised but also horizontally larger. They are often also erythematous or pink in appearance. These scars form because of excess collagen growth in that particular area. Hence these keloid scars represent excess tissue growth beyond the orginal margins of theh wound.
Traditional treatment of these keloid scars have always been through steroid injections. This is still the mainstay of the treatment but recently there has been a lot of work done on various lasers that were previously not available or not thought to help these very stubborn scars but now shown to be incredibly effective.

I shall be mainly talking about 2 new lasers that are now available at my practice that can improve any stubborn keloid scars that were previously very stubborn to treat. These lasers can be commenced as early as the first few weeks after injury and also as late as several years post injury.

Before and After Steroid injections and V-beam
Facial Plast Surg 2012;28:518–524.
Sepehr Oliaei, John Stuart Nelson, Richard Fitzpatrick, Brian Wong Laser Treatment of Scars Facial Plast Surg 2012;28:518–524 Laser Treatment of Scars

The V beam laser or Pulse Dye Laser has been shown to improve scaring by destroying blood supply at the level of the dermis, hence stopping the formation of these keloid scars.
Futhermore, V beam laser has also been shown to disrupt the growth cycle of the cells, hence stopping the growth of these keloid scars. This methods of treating the keloid scars were previously not available before the introduction of the V beam.

The V beam laser works on the concept of selective photothermolysis. That means that it selectively breaks down specific particles in the skin. With a wavelength of 595nm, this particle happens to fall across the haemoglobin spectrum. Hence its main indication is treatment of pathologies of the vascular wavelength. Examples of this would be cherry haemangioma, telangiectasia and port wine stains.

Picture of a cherry haemangioma

Picture of telangiectasia over the nose

Picture of a baby with port-wine statins

This makes the V beam also a very good laser for the treatment of red raised and angry looking keloid scars. The V beam hence is able to improve not only the colour but also the bulk of the of the scar tissue.

The use of the Fraxel complements the V beam by induction of collegen remodelling of the scar tissue to improve the appearance of the keloid scar. This works by delivering controlled fractional doses of thermal energy to the keloid scar in controlled pulses and intervals, sufficient to induce collagen remodelling and allows for good contour changes in the scar

Keloids have always been difficult to treat. Surgical excision of these scars were previously performed but the tendency for them to return is higih. With the combination of these 2 new lasers in the market, I am now finally hopeful that there can be a permanent cure for the most stubborn pathologies that have long plagued doctors.

Click here to find out more

Monday, February 6, 2017

Infini Microneedle Fractional Radiofrequency - The treatment for acne scars

We all know our local Mediacorp Artist Mark Lee. Having depressed acne scars since he was young, he was teased and made fun off during his early days of his acting. Having personally treated him for a good couple of years, I have to say that his results are truly good especially with the duel effects of scar improvement and skin tightening, allowing regrowth of collagen for a tighter smoother skin.
Infini uses Microneedle that punctures into the skin at a controlled depth, breaking up scar fibres deep beneath the skin. It also delivers radiofrequency at specific energies including the duration of energy to be supplied. This allows very specific collagen growth remodelling and when done in experienced hands have next to no side effects.

1) Why choose Infini as compared to other laser resurfacing?
One huge advantage of this procedure is the ability to get huge dramatic results without the need for laser resurfacing, hence avoiding the need for a long down time yet still getting the results they desire

2) Is there any risk of fat atrophy?
Although there has been some reports of this, I personally have not had any patients with this particular side effect. The Infini microneedles are of a variable depth, hence allowing the user to select which depth the energy should be supplied. This microneedle should never be placed in the fatty laser of the skin, hence there should not be any risk of fat atrophy in an experienced user

3) How is Edge Fractional CO2 laser different?
Edge Fractional CO2 is an ablative laser that allows for controlled micro-thermal damage allowing for collagen stimulation and hence scar improvement. It uses a different technology as compared to Infini

4) Any risk of Infini?
The risk of post-inflammatory hyperpigmentation is always there, but this risk can be reduced and eliminated completely if your doctor understands the machine well.

The procedure isn't as scary as you think! Will be happy to see anyone who is keen to do this procedure for improvement in depressed acne scars and also for skin tightening.

Monday, December 26, 2016

水光针 Skin Boosters - Get Korean Dewy Radiant Skin

Skin Boosters appears to be the latest craze in Singapore, providing quick and instant radiance to the skin, pore closure and a healthy glow for the Korean Dewy skin texture and skin tone.

Skin Boosters are made up of a combination of Hyaluronic Acid. As the skin undergoes sun damage and ageing, it loses moisture and collagen. Hyaluronic Acid is a naturally occurring compound that can now be directly injected into the dermal layers of the skin, delivering hydration to exactly where it is needed. Unlike creams or serums that contain hyaluronic acid, the absorption of this serum into the deeper layers of the skin is limited.

Skin Boosters can be injected deep into the skin through micro-injections with a delivery gun, allowing precise and accurate micro-partials to be injected evenly throughout the entire face

Skin Boosters are suitable for those who have
1) Dry dehydrated skin
2) Oily skin with big open pores
3) Dull skin
4) Aged skin
5) Sun damaged skin with a combination of the above

Results from the Skin Boosters injection depends on the type of product used and the scheduling technique of your doctor. Some clinics recommend once a month for the first 3 injections followed by a 6 monthly. Others recommend doing it once every 2-3 months.


Restylane Skin Boosters is my product of choice. Although there are many alternative names like AquaShine, Dewdrops, Aqua Boosters, Aqua Shine etc, Only Licenced Medical Clinics are allowed to use Restylane Products. You do not want third party products injected into your skin as you are not sure of firstly the manufacturing process, the sterility of the product and the purity of its claims.

Skin Boosters can be used in both men and women across all age groups. A lot of the times, it is done before a special event like Weddings, ROMs, parties, gatherings etc. However, skin is something that requires continuous care. Although the skin boosters are able to make the skin radiant before your all important event, the process of injecting Skin Boosters into the skin also helps to stimulate our own body to produce collagen, allowing for long term benefits beyond the lifespan of the product which is technically up to 9 months maximum.

Common FAQ
A) How is the procedure done?
1) Numbing cream is first applied onto the face and the cream is left on for about 30 mins
2) You will be brought into the treatment room where you will lie down and the cream is then cleaned off
3) The face should feel numb now and your doctor will use a gun to deliver the product into your skin. The gun used in my clinic has 5 micro-injectors where exactly 0.01ml per injector is delivered precisely into the dermal layers of your skin
4) The process is repeated throughout the entire face, focusing more on the problem areas like the cheeks
5) Lastly, the face will be cleaned after the process is done and some antibiotic cream will be applied on
6) Down time is about 2 days. Some elevated bumps on the first and these gradually will subside on the second day

B) Is there anything else apart for Restylane being injected?
Very often we use a combination of Botox and Restylane in the mixture. There are some clinics that use Vitamin C as well as PDRN (婴儿针) in their mixture. Although this has been postulated to improve wound healing and has been used in the treatment of diabetic foot ulters, it's use in North America and Europe is currently still not widespread. There have been Korean Clinics starting to use this product but while it is still new and undergoing clinical trials, I would advise against using it in the face for now until more literature is released.

C) How fast can I see results?
You can see results from the injection within a week

D) Is it painful?There is some discomfort from the procedure, but the numbing cream makes the procedure much more bearable.

E) Any examples of how my skin will look after the injection?

So head down or ring us up at 6532 2400 for a consultation to learn more about Skin Boosters.

Sunday, August 28, 2016

Protecting Your Skin From The Haze in 4 Easy Skincare Tips

Haze and skincare tips

Is your skin looking dull and your pores getting clogged very quickly these days? I've got bad news for you-the haze is back. Again.


You may already be familiar with the damage that the haze does to our airways and eyes. However, the impact of the haze particles on our skin is not to be negated. Every year, I see an increase in haze-related dermatological problems in  my patients and so I've compiled a simple FAQ on how to protect your skin at home from the haze.



What are some of the common skin problems due to the haze?

·         clogged pores

·         blackheads

·         dry skin

·         skin redness

·         pimple/acne outbreaks

·         eczema flares

·         irritable/sensitive skin

·         rough skin texture

·         dull skin

·         premature skin aging (e.g. fine lines and wrinkles)

·         flare up of inflammatory skin conditions (e.g. psoriasis, eczema...etc)

What is haze?

To understand how haze wreaks havoc on the skin, it is important to understand what exactly haze is.


Haze is a mixture of air pollutants, dust particles and smoke suspended in air. These particles are usually less than 10mm in size. Haze resulting from forest fires has a high concentration of these fine particles and can remain in our atmosphere for weeks.


The air pollutants in haze are often referred to as "smog" and consist of a noxious chemical mixture of ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide as well as other pollutants. Smog is what irritates our eyes and makes us cough.

How does haze affect my skin?

Haze damages our skin in more ways than one.


The toxic particles in the air contain free radicals that exhaust the skin's oxygen supply. Your skin cells need these oxygen molecules for normal functioning and when deprived of oxygen, premature aging results. Collagen and elastin in the skin become depleted and skin loses its elasticity and wrinkles can develop-Think of the discolouration that happens to an oxidised apple after it has been cut. Free radicals also cause DNA damage in cells, affecting their ability to heal. Diseases linked to free radical damage include cancer, heart disease and dementia.

The dust particles are also a major culprit in skin damage. You know that grime that you can wipe off from your face? Those clogged pores and dull skin? That's due to the dirt and dust in the air coming into contact with your skin and building. Unfortunately, this layer of gunk also irritates and destabilises skin, causing acne and pimple flares.

It is a myth that the haze blocks out UV rays. In fact, dust particles are also known to intensify sun damage from UV rays. UV rays bounce off dust particles and become scattered in the atmosphere- meaning that the UV rays are intensified because of the haze.


What can I do at home to protect my skin?

Maintaining good skin hygiene and skincare habits can reverse some of the damage done by the haze. Here are the 4 simple but crucial steps that I personally practice to protect my skin during the season of the haze:


1) Cleanse

Having clean skin vital to having healthy skin. Double cleanse your skin with a makeup remover and gentle facial cleanser to adequately remove all that dirt and grime that are causing your clogged pores and dull skin. Your skin may be more sensitive and irritable during this period, so please remember to be gentle with your skin!


2) Antioxidants

Free radicals in smog rob skin cells of their vital oxygen supply, causing accelerated skin aging and loss of collagen has been well documented in many studies. In recent years, there has a been a revolutionary development to defend against these harmful free radicals- Antioxidants.


There is an comprehensive article on the antioxidants and their mechanisms here


In summary, antioxidants protect our skin at different levels by preventing free radical formation, scavenging free radicals and repairing DNA and cell damage. Some common antioxidants include Vitamin C (Ascorbic acid), Vitamin E, Niacinamide and Resveratrol.


My personal favourite, as you can see from this photo on my table  (excuse the amateur photography!), is Skinceuticals' CE Ferulic. This synergistic combination of antioxidants- 15% pure vitamin C, 1% vitamin E and 0.5% ferulic acid is my preferred choice in the day time to fight free radical damage.


At night, I switch to another potent antioxidant combination- Skinceuticals' Resveratrol B-E. This contains both Resveratrol and Vitamin E and works well for my sensitive skin.

3) Moisturise

Having well moisturised skin is especially important during this period. Moisturiser application acts as a physical barrier  between the skin and the environmental pollutants and free radicals, thereby acting as a double defense.


4) Sunprotection

Diligent sunprotection can minimise the damage by UV rays. Choose a broad spectrum sunblock with SPF above 30 and reapply every 3-4 hours if you can.


What else can I do for my skin?

So if you've done all that and your skin's still dull, dirty and irritable? Pimple and acne flares not getting better? It is worthwhile to consult your doctor to see how your skin can be treated in order to prevent your skin condition from worsening.


Some of the common treatments that I recommend my patients to clean and control their skin conditions are :

1) Hydrafacial

The Clifford Clinic's award winning Hydrafacial consists of a comprehensive, non invasive treatment that combines a patented hydrovortex exfoliation and extraction technique together with delivery of antioxidants and hyaluronic acid in to the skin. This works very well for clogged pores, blackheads and white heads, dull skin and pimple/acne outbreaks.

2) Dermaplaning

I've previously shared about dermaplaning here :
By exfoliating the epidermis and removing the skin of dirt particles, skin is immediately cleaner and brighter. This is ideal for patients who have dull and rough skin. Also, without the dead skin cells and dirt particles, penetration of skincare products is improved.

3) Laser

With pimple and acne flares, laser is very helpful to improve control and prevent scaring.  Laser also promotes collagen rejuvenation, erasing away the effects of premature aging and achieve a more even skin tone.

4) Chemical Peel

You can read about my comprehensive review of chemical peels here. Essentially, problems like pigmentation, clogged pores, dull skin, scars and acne control can be addressed with chemical peels

I hope you have found my tips useful in protecting your skin from the haze. Please stay healthy everyone!

Monday, June 20, 2016

Chemical Peels for Acne and Pigmentation



The history of chemical peels dates back to the time of Ancient Egyptians and Romans; where women used  sour milk and fermented grape juice to rejuvenate the skin. Thankfully, chemical peels have evolved to become more  palatable  and safer to patients today. Although eclipsed in popularity by the wide variety of skin resurfacing lasers, chemical peels still remain a safe and efficacious way of lightening pigmentation such  as melasma, erase fine wrinkles and control acne outbreaks.

What is chemical peel

Chemical peel, or chemoexfoliation, is a non invasive clinic based treatment that is suitable for for individuals with pigmentation, wrinkles, uneven skin tone and acne. By removing damaged skin and promoting collagen rejuvenation, skin looks younger and smoother.  this "younger" skin also tends to be more radiant and receptive to skincare because there are no more damaged and dead skin cells to impede penetration.

There is a wide array of chemical peels available and the selection of the agent will depend on your skin condition and your expectations. Hence, treatment can be personalised for each patient.

The treatment involves the doctor applying the selected solution to your skin and monitoring your progress.  When the endpoint is reached, the solution is neutralised.  The objective of the treatment is to achieve removal of damaged skin to allow skin rejunvation.

How does a chem peel work

Essentially, chemical peels remove the top layer of damaged skin gradually, thereby promoting collagen production and skin regeneration.  This layer of new skin is usually smoother and less wrinkled. Chemical peels have been used to treat conditions such as acne scars, melasma, uneven skin tone and fine wrinkles.

The  mechanism of chemical peels can be classified according to the depth of their action-superficial depth, medium depth and deep peels.

Superficial chemical peels extend to the level of the epidermis and are most well tolerated by patients. A superficial chemical peel can be used to lighten certain types of pigmentation, achieve more even skin tone, lighten scars and improve acne scars.

Medium depth peels extend to the upper reticular dermis and can be used to treat the same conditions as superficial chemical peel. Understandably, the downtime and discomfort may be longer than superficial chemical peels.

Deep peels extend to the  mid reticular dermis and usually require analgesia prior to performing the procedure. Deep peels are useful in treating severe wrinkles and intense pigmentations. These peels are also associated with a higher risk of complications.

What conditions can be treated by chem peel

·         uneven skin colour/ skin discolouration

·         pigmentation (e.g. freckles, melasma, lentigenes, post inflammatory hyperpigmentation)

·         fine lines and wrinkles

·         exfoliation and acne control

·         soften acne scars

·         control oil and sebum secretion

Am I a candidate

Patients with skin discolouration, pigmentation, aged skin and acne are ideal candidates for chemical peels.  By lightening pigmentation, removing dead skin and promoting collagen rejuvenation, skin appearance and texture can be improved.

What can i expect/experience during the peel

After a thorough evaluation and discussion with our doctor; the choice of chemical peel is selected. your face is thoroughly cleansed to remove dirt, sweat and oil. Using an applicator, our doctor then applies the chemical peel to your skin. You may experience a temporary tingly sensation,  itchiness or warmth which will resolve when the peel is complete. Please inform your doctor if you find the sensation to be unbearable.

When the chemical peel has reached its endpoint the chemical peel is neutralised. this is followed by cleaning of the skin. Cooling measures may be employed if necessary.  An antibiotic cream is usually prescribed to prevent skin infections

What to expect after

There is no immediate downtime for chemical peels and the procedure can even be performed during lunch time! Depending on the chemical peel used, you may experience facial redness for 1-2 days followed by flaking or exfoliation for up to 1 week.

The skin flakiness may be fine or slightly larger depending on the type of peel used. It is safe to wear makeup to conceal the flakiness if you choose to do so. you may experience skin dryness and this is easily correctable with a moisturiser. During this phase, it is also important to have adequate sun protection and to be gentle when cleansing your face.

How to care for the skin after

·         Be gentle with your skin- please do not peel off any flaking skin

·         moisturise well

·         strict sun protection and sun avoidance for 2 weeks.

Protocol- how often, combination treatment, how many peels/duration

The number of sessions and treatment programme is depend on your skin condition and our doctors' assessment. Generally, deeper and more stubborn lesions will require more sessions.

Chemical peels can be combined together with other medical treatments such as lasers to accelerate result. A recommended programme would comprise of a chemical peel every 4-6 weeks.


Complications are rare when chemical peels are performed by trained doctors, patients are closely monitored and evaluated and when the appropriate chemical peel is selected.  Some of the complications that have been quoted with chemical peels include hyperpigmentation, skin infection, milia seeds, acneiform dermatitis, persistant wrinkles and scarring

Why enerpeel

As one of the leading aesthetic clinics in Singapore, The Clifford Clinic is committed to performing safe and efficacious treatments. traditional chemical peels have been dependent on skin redness and frosting on the surface of the skin as indicators of skin reactivity to the chemical peel. A more ideal peel would allow less visible skin redness and frosting while achieving deeper skin remodelling and rejuvenation.

Enerpeel (R) employs a breakthrough patented carrier solution which controls the acids' activity until it is absorbed.  bB using desmosome disruption- or more simply, by controlling the acid and then releasing it to penetrate between skin cells, the uptake of the acid is more uniform and enhanced. additionally, the uptake of the acid is increased by 2-3 fold without having to increase the strength of the acid. Talk about achieving better results with greater safety! What our patients can expect from Enerpeel(R) are: faster resolution of skin redness and enhanced skin renewal!