Most males are not that into cosmeceuticals. That is skincare with medical or drug-like benefits to improve skin health. Cosmeceuticals have a more relevant function than coloured cosmetics. Men have traditionally been uninterested in skin appearance, and only think of skincare as necessary when they face a specific skin concern – acne, oily skin, wrinkles or other topical skin conditions. Yes, using targeted skincare products are likely to help with these isolated issues, but having a daily skincare regime in place can avoid them completely.
Most skincare products used by men are likely to be purchased by women, even though most are unaware that male cosmeceuticals are distinct from those that females use. Many of the male products are created to address male facial hair, such as preshave treatments, shaving products and post-shave skin care. Yet, men’s skin is structurally different from females and knowing these differences can be a good place to start your skincare journey.
Oil control
Sebum production is also greater in males, this is mostly due to testosterone secretions. This can mean longer-lasting acne for men. The oil glands on our skin are more receptive towards testosterone, so it is no coincidence that we see males having oily skin more often than females.
Collagen content
We see signs of our skin ageing such as wrinkles and sagging skin as our collagen content decreases as we age. After our thirties, both men and women start to lose one per cent of our collagen each year. But for women, this loss escalates greatly in the first five years after menopause, explaining for why women experience skin ageing faster than men do.
Thickness of skin
Male skin is typically 20 to 30 per cent thicker than that of females. The presence of testosterone accounts for this difference. A man’s skin will continue to thin gradually with age, while a woman’s skin will only thin significantly after menopause. With a higher collagen density which is the ratio of collagen to the thickness of the skin, it explains why men tend to age slower than women of the same age. However, this difference may not be readily noticed as men are less active in protecting their skin from sun damage. The lack of habit in using sunscreen would allow UV radiation to add years to the skin.
That being said, the importance of sunscreen should be emphasized. The skincare product that we should all have is really the sunscreen. We know we are nagging, but please put on your sunscreen.
The skincare regime of male usually fits into either one of these options. They could be either be using soap and water only, or products that are targeted to men, or cherry pick a product from their partner. There are several main concerns with these options. Cherry picking products would likely result in using something that is not suited for men skin. Using gender-focused products may also not be effective as manufacturers typically employ stereotypes to target shoppers. Lastly, common soap and water are never sufficient for facial cleansing, simply because it causes your face to go into an alkaline state that can result in dryness (your skin should ideally be slightly acidic, at about pH of 5.5). Washing with a bar soap can pull all the water out of the skin, leaving your skin dehydrated and a buildup of dead skin cells.
Most men hope to have clean, fresh, clear and smooth skin. And the preferred approach to achieving healthier skin is to have minimal steps in their skincare routine. An ideal skincare routine should begin with a proper cleanser. (No soap and water, please!) Use a pea-sized amount of Miel Honey™ Cleanser and work it into a lather over the entire face. This is to facilitate the removal of sebum and debris. Use cold water as heat can be irritating to the skin. The lather from the Honey Cleanser also doubles up as a “shaving lotion”, lubricating the shave with anti bacterial Honey which thoroughly cleanses the skin without over-drying the jaw line shave areas that could be especially sensitive and prone to acne breakouts!
Sun exposure can damage your DNA, and cause wrinkling and skin cancer. Add SunProtector™ to your routine for daily application. With an SPF value of 50, it is sufficient to safeguard the skin from free radicals and keep it sun damage-free. UV radiation is a common culprit that compromises our skin’s integrity and can lead to sensitive skin or dryness. Developed in a research laboratory, this sunscreen is also formulated in-house for Singapore’s humid climate, so rest assured and lather on.
Keep your face moisturised with Radiancé Fluide™ Hydrating Emulsion. As you age, your skin cells will start losing the ability to retain as much moisture as before, as collagen levels decline over time. Deliver essential nutrients such as amino acids and oligopeptides to your skin with this moisturiser to keep your skin bright and healthy.
Meet with Dr. Teo Wan Lin, consultant dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
The word anti-aging alone turns many heads. Living in a beauty-centric society, we are pressurised to maintain our youth. Although it’s a natural process to age, once we hit the big 3-0, we are told to maintain our youth with an onslaught of anti-aging products that promotes and stimulates collagen production. You can’t really blame yourself for getting sucked into this black hole and there’s nothing really wrong about wanting to look young.
Are you looking for the fountain of youth? Look no further. Fillers are actually becoming a popular option for those wanting a youthful look. In comparison to anti-aging skincare, injectables such as fillers offer an almost instant youthful look and are fairly safe and natural looking when done right at the right place.
Although our skin is remarkable in protecting our bodies from the outside world and repairing itself every day, with age, lifestyle and environmental factors such as sun damage, smoking and poor diet, the condition of our skin deteriorates. This is inevitable. When it comes to giving your skin a refreshing and youthful appearance by giving it definition, firmness and a deep hydration, fillers are an effective method. Done by injecting a gel-like substance into lines and wrinkles, these injectables either fill or add volume to the sunken areas.
Hyaluronic acid is a common component that is used in fillers. Before you shrug at the term acids, know that hyaluronic acid is a component naturally found in the human body. Its sole function is to provide hydration and structure. Since skin hydration and structure depletes as we age, it is quickly removed from the body. By injecting these fillers, we are essentially introducing hydration and structure in the skin. Lasting up to six to twelve months, these temporary fillers plumps up the eyebrow and temporal region, defines and contours the cupid’s bow, cheeks and jawline, smoothens out the under-eye hollows, facial creases and can even minimise the appearance of scars and other depressed creases.
Restylane is one of the many available injectables out there. Using a patented Non-Animal Stabilised Hyaluronic Acid (NASHA) technology, Restylane injectables are generally firmer for a more pronounced lifting capacity and targeted product integration. This delivers a longer lasting skin hydration. Its Optimal Balance Technology (OBT), ensures that the injectable is more evenly diffused in the injected area, creating a softer and more natural look.
Next question in mind would be what to expect before, during and after a filer procedure. First things first, always consult an accredited dermatologist or surgeon when getting a filler or any cosmetic surgery. Avoid going to any aesthetic spas or worse neighbourhood malls to get your fillers done. Hygiene and sanitary is pertinent when it comes to any corrective treatments, to avoid infections and side effects. Make sure you understand the procedure and don’t be afraid to ask any questions. Always remember to inform the dermatologist or surgeon about your present medical condition and allergies. Avoid taking any medications such as panadol that may hasten bruising, or intoxicants such as alcohol, and stay hydrated. Always ask your dermatologist, or trained practitioner what type of filler you are getting injected with. Do some background research of it and make sure you are comfortable with being injected with that particular type of filler chosen for you. Instead of going for a cheaper alternative, choose the type of filler that is recommended by your dermatologist or surgeon, to avoid a botched procedure.
If you feel uncomfortable or uneasy during your filler procedure, voice out your concerns. As for post-procedure, expect minor bruisings. Hydration is key when it comes to healing. So drink up. Avoid using controlled substances such as cigarettes and alcohol immediately after the procedure. To avoid irritating the injected area, minimise makeup or external touch such as facials, pinching or scratching of the skin, high-intensity workouts and even sauna sessions. It is pertinent to abide by the post-procedure instructions given by your dermatologist or surgeon. Although minor bruisings can be expected, always report any signs of abnormality such as bumps, unevenness or unforeseen side effect to your dermatologist or surgeon immediately.
Meet with Dr. Teo Wan Lin, consultant dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
Hair loss (alopecia) can be a major source of distress and is a common problem.
Is my hair loss normal?
We may experience changes to our hair such as hair loss or thinning as we age, so be sure to distinguish the difference between normal changes and alopecia. 100-150 hair strands lost in a day is normal and they usually show up when you brush your comb through or after washing your hair.
Bald patches on your scalp or more than 150 strands a day can be classified as abnormal hair loss.
The hair cycle
Normal hair grows through a hair cycle that has three stages. The growth phase, or the anagen phase, is the longest phase of the hair cycle, with 80 to 90% of the hair on our scalp in this phase. In the next stage called the catagen phase, the hair bulb detaches from the blood supply and is pushed from the scalp. In the last stage, the telogen phase, shedding occurs as the hair is released, leaving behind an empty follicle.
Each hair follicle is independent, going through the cycle at different stages as the other hairs. Hair problems occur when there is a disruption in the hair cycle.
How do I diagnose alopecia?
According to Dr Teo Wan Lin, accredited dermatologist at TWL Specialist Skin and Laser Centre, she says: “There are two major forms of hair loss – scarring or non-scarring alopecia. If follicular orifices are absent on the scalp, and the underlying scalp has a shiny white color, the hair loss is scarring. Follicular orifice is the opening of a hair follicle on the surface of the skin. If follicular orifices are present, it is a form of non-scarring alopecia.”
Non-scarring hair loss is the loss of hair without any presence of scarring in the scalp. Scarring alopecia leaves scar tissues on the scalp and may show signs of inflammation, redness or swelling.
Another common type of hair fall problem is androgenetic alopecia, or female/male pattern hair loss. Patients with androgenetic alopecia have high levels of androgen, a type of steroid hormone. Effects of androgen include miniaturisation of hair follicles by increasing the rate of cell division, shortening the hair cycle and increasing the duration of the telogen phase.
How can I treat my hair fall problem?
A multifaceted approach is recommended, as there are likely to be multiple factors that cause your hair condition.
For topical agents, either a minoxidil solution or ketoconazole shampoo can counter female/male pattern hair loss. Oral ketoconazole has anti-androgen effects, while topical ketoconazole can suppress androgen activity. Minoxidil shortens the telogen phase, and increases the duration of growth phase.
Low-level light treatments, in combination with active ingredients such as minoxidil and copper peptide can encourage hair growth by triggering inactive follicles or increasing blood flow to follicles.
Avoid combing your hair when it is wet, as wet hair is most subject to trauma. Hair should only be combed when mostly dried with a wide-toothed comb. Also, the less that is done to thinning hair, the better. Stay away from bleaching, rebonding or perming your hair to reduce damage done.
Dermatologists also specialize in treating scalp and hair problems, so head to your dermatologist if your hair condition deteriorates.
As a dermatologist, one of the first signs of ageing I observe shows in the eye area, what we call the peri-orbital or peri-ocular region. The commonest complaints I hear from my patients old or young are “Is there anything I can do for my eye bags, dark circles and eye wrinkles?” This is tricky because while so many spas, medi-spas, aesthetics providers and skincare companies confidently brag about their treatments erasing eye wrinkles and waving eyebags goodbye, I often have to burst bubbles in my clinic when I tell my concerned patients their hopes may be misplaced in a single miracle product which probably doesn’t exist.
In my practice, I use a multi-dimensional approach to work the aged eye area— a combination of skin resurfacing (plasma nitrogen over laser for sensitive areas such as the eye region), injectables like botulinum toxins, dysport and Botox. This, in conjunction with an eye cream that I formulate for my patients to use on a daily basis for before and after care, with specific active ingredients to brighten, tighten, moisturise and anti-age periorbital skin, besides being tested for safety and efficacy to complement medical aesthetics treatments around the eye area.
Men and women alike are affected by concerns of ageing and looking older, there’s nothing vain about wanting to look like a younger version of one’s self. In fact, it has been shown that your skin starts to age at around the age of 25. Main areas of wrinkles are at the forehead, nose, mouth and especially around the eyes. Eye wrinkles are often noticed first and more evident as the skin in this area is thinner, making it susceptible to wrinkling. Regardless of gender, you are prone to getting wrinkles so start taking care of your skin to maintain your youthful appearance!
What is Plasma Skin Regeneration?
It is a non-laser treatment that uses a device to convert nitrogen gas into plasma energy, to rejuvenate skin by improving facial lines, wrinkles and pigmentation caused by photoaging. This technology offers a wide variety of single pulse energy levels with different options of frequency that can most efficiently improve the precision of plasma delivery. This function allows accurate temperature irradiation to drastically improve topical drug delivery for a variety of dermatological indicators. Personalisation of settings to cater to different patients is available, as patients’ skin conditions differ in terms of downtime and receptivity to treatments. Through deep tissue re-modelling, the energy delivered by plasma skin regeneration is non-fractionated. This allows for even energy absorption, ensuring the consistency in treatments done to the skin. The high energy also supports significant skin tightening. With deep tissue re-modelling and accelerated healing, plasma skin regeneration usage is versatile and effective.
Plasma Delivery
The handpiece first releases the nitrogen plasma pulses.
This causes it to transfer thermal energy to the skin, allowing for controlled heating of the tissue.
The controlled duration of the pulse and temperature then allows the treatment to happen optimally.
This then leads to the possibility of treatments of many dermatological conditions due to the carefully controlled time frame.
Reliable Technology
Nitrogen plasma technology has been tested and backed by evidence. It has over 3 years of pre-clinical and clinical testing, 16 separate studies conducted, more than 450 clinical study treatments which proved to cause no scarring or pigmentation, and one year of clinical histology. This intense and detailed level of testing is uncommon in the industry, whilst clinically proven to perform skin resurfacing and regeneration using plasma energy.
Drug Delivery Effect
There are many treatable indicators like anti-aging effects, pore size reduction, wrinkle reduction, skin tightening, stretch marks reduction, acne scar reduction and more. However, one key effect is the drug delivery effect. When the skin is exposed to the nitrogen plasma, the permeability of the skin increases. This allows for better absorption of the drug, enhancing drug delivery and making the drug more effective during and after treatment.
Key Specialities
Advanced Technology
Plasma skin regeneration converts nitrogen gas into the fourth state of matter, plasma energy. It then emerges from the handpiece in controlled pulses and causes rapid heating of tissue. This allows for the transmission of thermal energy to the tissue.
Minimal Damage
The treated photodamaged skin layers undergo controlled thermal modification without additional harm. This allows for speedy healing and a natural layer of protection for the skin. At high temperature and energy, the skin epidermis breaks down and sheds, but only after a new healthier skin layer forms beneath. Plasma skin regeneration is non-invasive and will not cause any open wounds.
Treats the Whole Skin Structure
Plasma skin regeneration can treat the entire skin structure. It ensures that the entire skin surface is regenerated and produces conditions favourable for optimal results. It is associated with neocollagenesis and neoelastogenesis. Neocollagenesis is the process of making more collagen while elastogenesis refers to the mechanisms that drive elastic fiber formation for our skin.
Ideal for Eyelids Treatment
The skin around our eyes, our eyelids, are especially sensitive and thinner than the rest of our skin. Thus, not all treatments are suitable to prevent eye wrinkles and eye bags. However, plasma skin regeneration, with its precision safety and efficacy, is suitable for treatment of the eyelids to reduce wrinkles and achieve an anti-aging effect, whereas previous technologies might be less safe for sensitive thin eyelid areas or even deliver inconsistent and ineffective results. In addition, due to the significant skin tightening effect from skin regeneration, deepening of the eyelids (with a look of deeper-set double eyelids) is also achieved.
Long Lasting Effects
Plasma skin regeneration has been proven to show neocollagenesis and reduce elastosis (abnormal elastic tissue in the skin which is a result of excessive sun exposure). Elastosis can cause your skin to have wrinkles and even pigmentation. The nitrogen plasma technology has post treatment effects that can last for more than a year.
With its reliable and advanced technology, plasma skin regeneration can produce anti-aging and long-lasting effects with its non-invasive methods, helping you to achieve a bright and youthful appearance.
Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
People have been increasingly conscious about aging and the effects of aging on appearance. Skin aging will cause facial wrinkles and decreased collagen. Maintaining a youthful appearance seems to be the trend and many have resorted to skin treatments. There are many treatments like chemical peels, fractional laser and more but recently, ultrasound has been used in new treatments. HIFU and ultherapy are examples of ultrasound treatments. It has been introduced as non-invasive and effective in having anti-aging effects on the skin.
What is High-Intensity Focused Ultrasound (HIFU) Sygmalift?
High-Intensity Focused Ultrasound also known as HIFU Sygmalift, is used for rejuvenation, lifting and tightening of the facial skin. Research has been done to demonstrate the efficacy of HIFU Sygmalift. It has been found that HIFU Sygmalift is a safe and effective method for facial skin tightening. It can be used not only to improve skin texture, but also contour the upper arms, knees and thighs. Besides facial skin, it can be used for other parts of your body.
How does HIFU Sygmalift work?
HIFU mainly causes cellular damage and reduces volume of the designated area by coagulation and generating instant microthermal lesions. This is done by using high frequency ultrasound waves targeted at the tissue area without causing any damage to the skin epidermis and surrounding tissues. The targeted skin tissues get heated up which causes cells to be activated, generating new collagen to produce a skin lifting and anti-aging effect.
What is Ultherapy?
Ultherapy is a new Food Drug Administration (FDA) approved treatment that tightens and lift facial skin. The treatment is mainly for the eyebrow, chin and neck area but can be used anywhere where the skin is lacking tightening. Follow up treatments are recommended once a year to maintain the effects. The procedure has been used as it is non invasive and hence does not require anesthetic or sedation. However, it has been said to be painful and it would be better for some to use local anesthetic. It has been said to have no foreign substances or drastic changes but achieves to improve the health of the cells beneath your skin surface to result in a subtle, natural and healthy effect on the outside.
How does Ultherapy work?
Ultherapy is different from the common laser techniques that target the outer layer of the skin. It penetrates the surface and transmits energy to the deeper skin layers. This way, it causes damage to the collagen layers to stimulate more collagen production as the cells are tricked into repairing the collagen. It uses ultrasound technology which has been used in fat burning treatments. With collagen production, it produces skin tightening and anti aging effects.
How are HIFU Sygmalift and Ultherapy different?
HIFU Sygmalift and Ultherapy sound similar in terms of their methodology. Both use ultrasound treatment, a popular choice for non invasive and non-surgical face lifting and tightening treatments. Their main goal is to produce anti-aging effects, helping you to preserve your youthful look. However, there are still some small differences between the two which can impact your decision is choosing the most suitable treatment.
Extent of Pain
One of the main complaints about ultherapy treatment is that it is known to be painful and some people require local anesthetic. However, HIFU Sygmalift is mainly painless because it uses fractionated HIFU. Instead of traditional HIFU techniques which use one concentrated beam, HIFU Sygmalift breaks up the beam into fractions and penetrates the skin at precise extents. People who use HIFU Sygmalift may feel a small sense of tolerable pain but it is definitely less painful that Ultherapy.
Extent of Skin Penetration
HIFU Sygmalift targets the dermis and connective tissues to stimulate collagen production. Meanwhile, Ultherapy can penetrate deeper even into the muscle tissues, which is why some people feel pain. However, both result in skin tightening and lifting effects.
Post Treatment Maintenance
For Ultherapy, most people may see visible results even after the first or second session. To follow-up, they are recommended to go for treatments once a year to maximise the effects. On the other hand, HIFU Sygmalift is used once a month to maintain your skin. Patients of HIFU Sygmalift are recommended to use anti-aging products that contains peptides to complement the treatment, supporting a gentler type of treatment.
Both HIFU Sygmalift and Ultherapy use similar technology and methods with very subtle differences. However, these differences can make a big impact on your comfort with the treatments. Both methods are still safe, striving to produce anti-aging effects on your skin. With the similarities and differences explained, you can now make the best decision for yourself and choose the treatment that suits you the most.
Meet with Dr. Teo Wan Lin, accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
The word anti-aging alone turns many heads. Living in a beauty-centric society, we are pressurised to maintain our youth. Although ageing is considered a natural process, once we hit the big 3-0, we are told to maintain our youth with an onslaught of anti-aging products purportedly promoting rejuvenation and stimulating collagen production.Is the aesthetic and beauty industry just a vicious black hole sucking in the vulnerable and playing on our insecurities? Hey, if you are reading this, there’s nothing wrong about wanting to look good, or a youthful, energised version of yourself.
A myriad of cosmetic procedures are being offered by every aesthetic set up, beauty parlor and medi-spa. If you are looking to look your best this festive season and have decided to get some pampering, do read this article beforehand to educate yourself on what’s out there.
First things first, it’s important to understand, that according to the latest Singapore Medical Council guidelines has clarified its stand on who should and should not perform aesthetic procedures such as lasers, botox, fillers or other cosmetic procedures. Read all about it here. What does this mean? Well,
It’s best to visit an accredited dermatologist or a plastic surgeon who will ensure the safety and efficacy of the treatment, depending on what you are looking for. Non dermatologists who practise “aesthetic medicine” require additional certification of competency conducted by the Dermatological Society of Singapore. Not sure about the qualifications of your doctor? Check your doctor’s accreditation here.
Once you’ve decided on who to see, make a note of the research you’ve done and how you actually feel about yourself. Our take on this? Filler injections are one of the fastest, most dramatic yet natural-looking ( if well done) aesthetic procedures that can instantly rejuvenate a tired face. One of the reasons fillers have sometimes gained a bad- reputation amongst the beauty fans and watchers is that the early nineties were filled with images of Hollywood stars suffering less than ideal( sometimes botched) jobs with unnatural lumps of flesh on their faces or oddly elongated chins. Fast-forward to today, we asked Dr. Teo Wan Lin, a Consultant Dermatologist what her thoughts are on those in their thirties considering facial fillers. “ The benefits to having fillers in the younger age group, say those in their thirties to early forties, as compared to those in their midforties and beyond, is that hyaluronic acid -based facial fillers can provide natural-looking volume to restore areas of the face where fat has been lost or where gravity has taken its toll. Not a lot of product is required to be injected in these women to achieve the desired outcome, but at the same time thit;s a very quick pick-me up to a tired face, when injected at the correct areas, in addition to giving a smooth, radiant look to one’s complexion almost instantly, because hyaluronic acid itself is a water molecule that naturally exists in one’s skin and is depleted as one ages. The pores also end up looking more refined and one also has a smooth youthful contour of the face”.
So it seems indeed, that facial fillers rightfully remain a popular option for those wanting to achieve a youthful look. “Relying on a rigid regimen of filler injections alone is bound to disappoint,” says Dr. Teo, “as the skin itself, like the face structure, is dynamic, different for each individual and requires expert assesment to tailor treatments, all this in order to achieve the desired outcome. For an individual who needs a quick freshening up before the festive period, I start with facial fillers and combine with High Intensity Focussed Ultrasound to target the SMAS layer( Superficial Musculoaponeurotic System), together with cosmeceutical skincare for maintenance of clear radiant and hydrated skin.”
While we don’t need any further reminders that with each passing day, genetics, lifestyle and environmental factors i.e. sun damage, smoking, poor diet, the condition of our skin deteriorates. Before you despair at mankind’s seemingly inevitable fate, here’s some good news. Milennial skincare has extended its technological advances to the field of aesthetic dermatology, and take it from the dermatologists–when it comes to giving your skin a refreshing and youthful appearance, fillers work by giving your ageing face definition, firmness and deep hydration, talk about multi-tasking. No amount of skincare can do that overnight. What to expect?A gel like substance containing a natural water molecule in your skin, known as hyaluronic acid, is injected into parts of your face that has lost volume or sagging, erasing lines and wrinkles at the same time. Talk about getting rid of the tired and pissed look off your face, erase the years away!
Hyaluronic acid is a common component that is used in fillers. With many people reacting to “acid”, probably the last time they have heard of that term was in their chemistry class, where the corrosive substance was definitely not something one would put on their face. Here’s where it’s a fallacy. Hyaluronic acid is a component naturally found in the human body and it is no mean chemical acid! It’s actually really good for your skin, with almost every beauty product these days touting it as its superstar ingredient. According to dermatologist Dr. Teo Wan Lin, “Most commercial brands of hyaluronic acid products contain a concentration ranging between 0.01- 0.1%, simply because of the cost of the molecule. Injecting hyaluronic acid is a totally different story, purity and concentration is important, as it serves to hold up the structure of the face.” Seems like when the creator made hyaluronic acid for the human skin, He also found its sole function to provide hydration and structure, both of which get depleted as we age. So here’s the science of filler injections: one is essentially introducing hydration and structure in the the skin. The next time you see a young girl, notice the fullness of her facial contours. That, is the key to a youthful face. Besides, many who are risk-adverse and into an au-naturale look (who isn’t?) will be pleased to know that hyaluronic acid facial fillers are considered temporary. Lasting up to six to twelve months, these fillers have the ability to plump up the eyebrow and temporal region, define and contours the cupid’s bow, cheeks and jawline, smoothen out the under-eye hollows, facial creases and can even minimise the appearance of scars and other depressed creases.
Restylane is used exclusively at our clinic, for the following reasons. Using a patented Non-Animal Stabilised Hyaluronic Acid (NASHA) technology, Restylane injectables are generally firmer for a pronounced lifting capacity and for targeted product integration. What this means is, it’s now possible to deliver skin hydration that’s longer lasting, giving the dewy, glowy skin look. Its Optimal Balance Technology (OBT), ensures that the injectable is more evenly diffused in the injected area, creating a softer and more natural look.
Finally, know what to expect before, during and after a filler procedure. First things first, always consult an accredited practtioner, such as a dermatologist or plastic surgeon prior to getting a filler. This should be taken seriously, and performed in a accredited medical clinic rather than in a spa or a beauty parlor. He or she will run through which areas are suitable for filler treatment, and what to expect. Hygiene and sterility is pertinent when it comes to any cosmetic treatments, to avoid infections and side effects, and a licensed practitioner will take steps to make sure that all risks of infection are minimised. Next up, during your consultation, make sure that you understand the procedure and don’t be afraid to ask questions. Always remember to inform the dermatologist or surgeon about your present medical condition and allergies. Avoid taking any medications such as panadol that may hasten bruising, or intoxicants such as alcohol, and stay hydrated. Here are more tips: always ask your dermatologist, or trained practitioner what type of filler you are getting injected with. Do some background research and make sure you are comfortable with being injected with that particular type of filler chosen for you. The important thing to know here is, Instead of going for the cheapest deal available, choose the type of filler that is recommended by your dermatologist or plastic surgeon, to minimise risks of any botched procedures. Remember, there is a cost to quality fillers, in addition to the skill of the practitioner injecting it. So if the price or the deal seems too good to be true, it probably is!
Some final words. If you feel uncomfortable or uneasy during your filler procedure, voice out your concerns. Your doctor will reassure you or make adjustments to ensure that the procedure carries on to your comfort level. Post-procedure, minor bruising is expected. Tips for recovery would be staying well hydrated with fluids, avoiding smoking and alcohol as these delay wound healing. Recovery is typically quick and uneventful and one could return to work or activities the same day except for maybe high intensity workouts which are best avoided for a couple of days.
Meet with Dr. Teo Wan Lin, consultant dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
With the term “organic skincare” gaining popularity among the masses, I was recently asked, more than once by different people, what I felt were the benefits relating to organic skincare and why people should be using that. Perhaps my answers would surprise people but I feel that it is time the public gets a honest take on this topic by a dermatologist.
Let me first clarify my position, I am an accredited dermatologist and practice evidence-based medicine, whereby specialist recommendations are always made based on peer-reviewed journal publications or at least on an international consensus of the medical community. The terms “organic skincare”, “all-natural”, “chemical-free”, “pregnancy-safe” skincare are rampant in mass media these days, so I certainly don’t fault the lay person or even beauty writers who get the impression that this is the real thing.
In light of these, I seek to discuss “organic skincare” in this article. You will discover my choice of putting the term in parentheses and hopefully this will open your eyes to what the term really means, and does not, information only your dermatologist would tell you about . Without bias, I personally formulate a cosmeceutical skincare line myself as an adjunct to my cosmetic dermatology practice, with natural ingredients which are also evidence-based for anti-ageing and skin rejuvenation, but by the end of the article you will discover for yourself why I do not label any of the skincare as “organic”, and why “organic” is not exactly my key priority when it comes to skincare.
1.To a dermatologist, organic skincare does not exist
First and foremost, the term “organic skincare’’ itself is not regulated and from a dermatologist perspective, organic skincare does not exist as anything more than a marketing fad. Organic is a term relating to food or farming practices, and is applied correctly to vegetables or other crops which are grown without the use of chemical pesticides. If organic skincare manufacturers are keeping to the above definition at all, what this should mean is that were plant derived ingredients are used in skincare, these are grown in a chemical pesticide-free environment. What would be surprising to the lay person is that neither the FDA or HSA (in Singapore) makes any provision in their regulation of cosmetics for labelling “organic skincare”. As such, any skincare label touting this would be responsible for their own definitions of such and the consumer should be wary of such claims and what it implies.
2.There are no specific benefits to skin of using an organically-derived skincare brand
Contrary to popular belief, there are no specific dermatological advantages of using such a brand over any ordinary skincare. In fact, most of these eco-skincare brands often go untested and unquestioned as well. Often, these organic skincare brands boast plant or nature derived ingredients, without “preservatives” and parabens, also being touted as “home-made”. Despite the seemingly positive branding surrounding these skincare, the associated pitfalls are not different from any other cosmetic skincare — they all have the ability to cause irritation, or allergic reactions in individuals who are susceptible, such as those with sensitive skin i.e. atopic dermatitis.
3. An important factor to consider in anti aging skincare is the effectiveness measured by bioactivity of the active ingredients,as well as the scientific literature surrounding it
Plant-derived ingredients, depending on the source and type, may have anti-oxidant or moisturising properties, but simply including it in the skincare does not guarantee that it is effective. Bioactivity has to be measured by a trained chemist or scientist, which is when the extract is carefully distilled or harvested from the plant in such a way that the effectiveness is proven in the laboratory and can be measured.
4. The safety of organic skincare is not guaranteed, and could be even riskier than normal skincare with chemical preservatives
Brands touting “organic skincare”, especially when home-made, lack the stringent quality controls present in a laboratory setting, which is required for the formulation of dermatologist-grade cosmeceutical skincare. One real danger of certain types of “organic skincare”’ is that they are not regulated for safety, in terms of bacterial contamination. Preservatives such as parabens have gotten some bad press in recent years but the overall consensus in the dermatological community and by the FDA is that they are still regarded as safe and necessary to reduce bacterial growth in applied creams. The lack of “preservatives” is again a questionable label because this means that something else should be added to the product to increase the shelf-life of such a product which is meant for public sale. If not, this product should state the expiry of within 2 weeks to a month maximum of opening, because bacterial contamination will set in and this will cause problems when applied to skin.
Furthermore, the current Singapore Health Sciences Authority — HSA requirements for cosmetic skincare distributed via public sale, requires that the production facility acquires a basic certificate of Good Manufacturing Practices (GMP) before it is allowed approval. Home-made formulas that are sold online or by individual proprietors are hence on a “at your own risk basis”, and as a dermatologist, I do not recommend using any home-made or naturally derived products (from plants etc.) on a DIY basis because the irritation and allergy risk, i.e. phototoxic or photoallergic risks are high. Besides, the benefits of plant ingredients can only be harvested and extracted under a controlled laboratory setting with proper testing, as in the case with cosmeceutical skincare. Anything else, the public would be better off with a simple dermatologist-recommended pharmacy-brand moisturiser that is free from fragrances.
5. Problem-skin can’t be treated with ANY type of skincare but can be worsened with certain products
If you have problem skin, no amount of good skincare can treat medical skin conditions such as acne, eczema (dry sensitive skin) or rosacea (a condition that results in red flushed face with pimples). Such conditions require treatment with prescription medications and can be well controlled. These also do not disappear on their own so waiting to “outgrow” the condition, no matter what age you are at, is not a wise idea. Also, avoid consulting the internet, or beauty forums as suggestions there are not based on medical evidence and could even result in worsening of the condition or create a new problem, such as skin irritation or allergies from these DIY remedies.
I have encountered patients who developed phototoxic or photoallergic reactions from citrus (lemon/ orange juices) applied to their skin. A common misconception is that these DIY home remedies are ‘’natural and organic” but from a dermatologist perspective, this is not true. There are no skin benefits to applying lemon or orange juice such as vitamin C, which is only beneficial when one ingests it as a fruit or a juice. Topically applied vitamin C needs to be in a certain formulation, either ascorbic acid or Sodium Ascorbyl Phosphate — I incorporate a nano-formulated form of SAP in the cosmeceutical Vita C Gold which I prescribe in my practice for it to have brightening and anti-oxidant properties for skin.
Applying orange or lemon juice directly will simply result in skin irritation due to the acidic nature of these juices, worse still, some individuals may react to sunlight (UVA component) with the citrus component and develop a severe skin allergy that can result in scarring or pigmentation.
6. Facials, organic or not, makes no difference to your acne-prone skin
The above also applies to skincare services (e.g. facials) similarly labeled with the “organic” term, that organic skincare does not offer any true differentiation from any ordinary cosmetic skincare. Similar to any individually-applied skincare products, it is pertinent to know what is in the products applied during facials and skincare services. As your skin absorbs whatever you apply on them, it is important to always read through the labels and ingredient list, conduct prior research and then a patch test on the inner part of your arm. This helps to prevent any form of skin allergy and sensitivity you might get from trying such new products.
Besides, most aestheticians and facialists use instruments such as extractors and needles which are not medically sterilised (i.e. autoclaved, there is a difference between a new clean needle vs a sterilised instrument). This may lead to infections and scarring, besides having absolutely no benefit in the treatment of acne. Acne is primarily a inflammatory process, worsened by hormones, genetics and oil production. Treatment of acne by dermatologists involves addressing inflammation using oral or topical medications, as well controlling hormonal and oil production factors, via medications or certain cosmeceuticals. Comedonal extraction is only sometimes performed by dermatologists, as the preferred method of eliminating comedones is by the use of retinoids, which modulate the way skin turnovers, as well as with chemical peels whereby the top layer of skin dissolves with glycolic, lactic and salicylic acids, preventing the accumulation of keratin (read: dead skin cells) which can worsen comedonal acne.
7. Environmentally friendly? Perhaps. Skin-friendly, not necessarily
Most people think organic skincare are either eco-friendly, natural or vegan. Here’s the catch, they can and cannot be. Organic skincare products can have components which are organically farmed and also approved by the FDA (which simply means it does not contain toxic or banned ingredients), but having the HSA or FDA approval does not necessarily mean that these are effective or deliver significant benefits. Organically farmed produce can be friendlier on the environment in general, as less pesticide use means less harmful release of chemicals to the environment which accumulates as waste and potentially harms wildlife. However, these can also come at a greater cost, and by no means does that translate into any real benefits when incorporated into skincare which is not consumed but applied.
In fact, organic skincare often boasts essential oils which can cause both allergic( in susceptible individuals) and irritant contact dermatitis( due to the concentration of most essential oils, it is not medically advisable to apply any type of essential oil directly to skin as it can result in a chemical burning type of reaction).
For patients with otherwise healthy skin, whether they are in their twenties, thirties or beyond and who are interested in maintaining youthful skin in a cost-effective manner, I would suggest getting started on cosmeceuticals, and regular medical grade chemical peels supervised by a dermatologist, who would determine the concentration and type of acid suitable for your skin. A chemical peel treatment is designed to improve the appearance of the skin by gently stimulating the top layer of skin cells (epidermis) by applying a solution composed of fruit derived acids such as alpha-hydroxy acids, glycolic acids, lactic and salicylic acids. This stimulates the skin to regenerate, smoothening out wrinkles.
Rounding up the discussion here, I hope readers have gained some insight on the labelling of skincare as “organic” and what that doesn’t mean. It is not a defined or regulated term in dermatology and can lead to great misconceptions by the public, in addition to brands riding on a fad which delivers no real benefits skin-wise. As a dermatologist, I am all for public education for skin health. Skin health is not about “aesthetics”, the skin is an organ of the body just like the heart, lungs and the liver, and these tend to degenerate due to genetics, age as well as poor lifestyle habits. Healthy skin certainly looks good, but in the pursuit of beauty, one should always be wise, consult a dermatologist if you have a skin issue such as acne or skin sensitivity, rather than trying all sorts of products. While there is no miracle product that exists that can cure your skin woes, non-dermatologist-tested cosmetic skincare can worsen problem skin. If you have healthy skin and desire some radiance and want to preserve your youth, then go for cosmeceuticals, instead of ‘‘organic skincare” or any other type of skincare fad.
Meet with Dr. Teo Wan Lin, consultant dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre
The evolution of beauty treatments seems to have reached its pinnacle in this millennia, since there appears to be a whole new branch of medicine dedicated to “aesthetic medicine”. The regulatory medical council of Singapore worked with dermatologists and plastic surgeons last year to release a set of updated guidelines on the practice of aesthetic medicine in Singapore. It sought to stipulate what aesthetic medicine, was, and it was not, as well as regulations surrounding its practice in Singapore.
As a dermatologist, I am often asked by members of the public, my patients or even my colleagues in other specialties if I practice aesthetic medicine. The short answer is yes, but the long answer is that the question itself was wrong.
Since then, I realised how confusing it was for the layperson to navigate in this medical “specialty” and how I could not blame them for not understanding or asking the wrong question fundamentally. I seek to provide an insider perspective on how aesthetic practice should be regarded by the public.
Fundamentally, and amongst my peers, I do think that we, as as a community of medical professionals still believe (perhaps with some naivete on our part) that public opinion does hold us in an altruistic light. This is why I believe we owe it to the public to tell the truth. At the heart of it, I hope to show an honest perspective in the cut-throat aesthetic industry, advice that I have shared with friends, relatives and patients of mine and along the way enlighten readers on what to expect.
1. Doctors are trained to help people with diseases and aesthetic medicine is not regarded as a medical specialty
The public will be surprised to know that there is no internationally accepted definition of “aesthetic practice”. Aesthetic medicine is also not regarded as a specialty or subspecialty. For conditions relating to plastic surgery, the specialist recognised by the Ministry of Health would be an accredited plastic surgeon. In the same vein, accredited dermatologists specialise in treating both cosmetic and medical dermatology conditions, relating to skin, hair and nail health. The realm of aesthetic medicine encompasses the field of research and development that dermatologists and plastic surgeons specialise in. However, due to the increase in the number of non-specialists practising aesthetic medicine, medi-spas and the overlap with the lucrative beauty industry, it’s easy to get confused. Amongst these are also medical practitioners who have undergone rotations in dermatology or have pursued a family practice diploma in dermatology but are not accredited dermatologists.
The current Singapore guidelines issued refer to the UK Cosmetic Surgery Interspecialty Committee definitions for “cosmetic surgery” as the boundaries of “aesthetic practice”. Precisely, this would refer to procedures or surgeries that alter the appearance, colour, texture, structure, or position of bodily features, which otherwise would be considered to be within the socially acceptable range of ‘normal’ for that individual.
2. I am a dermatologist and practise aesthetic dermatology, but I am not an aesthetic doctor
The term “aesthetic doctor” is not regulated and is actually disallowed under the latest regulations. In the early years of my dermatological training, I spent a good amount of time in the medical dermatology department of a local tertiary hospital, mentored by an inspiring professor of dermatology, whose golden words I remember distinctly till today. In response to my enthusiasm to enter the dermatology specialty training programme, he reminded me, that “Wan Lin, you are training to be a dermatologist, and not a beautician. Dermatologists are not beauticians.”
To begin with, I entered dermatology because I was really fascinated by how the skin manifested all sorts of underlying internal conditions of the body in such a unique way. When my dermatology professors were able to diagnose complex diseases of the kidney, liver and even organ cancers, just by analyzing the skin, seemingly at a single glance, I was floored and was determined to become like them.
This is interesting now, that the word “aesthetics” is linked to the medical profession, and to be exact, dermatologists and plastic surgeons are considered the key opinion leaders in this field, which is increasingly practised by non-specialists such as general practitioners. This leads me to reflect upon what my mentor said to me long ago, that “dermatologists are not beauticians”, which is probably why I react with a certain degree of chagrin whenever someone suggests that I am an aesthetics doctor.
3. What is beauty ?
As a junior doctor several years ago, I rotated through the department of plastic surgery before I entered into my dermatology training. A particularly memorable doctor I met there was a respected plastic surgeon that did exclusively reconstructive surgery, meaning he would not be involved in any surgeries for cosmetic enhancement, due to his personal beliefs. In my time there, I learnt from this surgeon the most about reconstruction, which meant restoring anatomy in patients who have suffered from trauma or tissue loss from cancers/infections. Of all the cosmetic/aesthetic surgeries I participated in throughout my rotation, the ones that left the deepest impression on me were all reconstruction cases, when I saw how true beauty was when one could restore to its original form and function, rather than just changing one’s appearance so you could recreate the same K-POP idol pin-up look. The latter, by the way, is always changing. That’s just my personal take. It led me to reflect on the true calling of a doctor, even in the field of plastic surgery.
My private practice encompasses both medical and cosmetic dermatology cases. I own a variety of laser/aesthetic machines equipped with advanced technology and work with injectables such as fillers and botox. For concerns relating to pigmentation, irregular skin texture, scars, these to me are not mere “aesthetic” concerns because a dermatologist can diagnose each of these as specific conditions due to an underlying problem affecting the skin. Patients are also suffering from poor self-esteem and a lot become withdrawn, depressed and anxious thinking that nothing can be done about their skin. All of these concerns can also be definitively treated.
For patients who come to me for ageing concerns such as face sagging, face-lifting…I always ask them first for a picture of themselves at a time when they felt they looked their best. The last thing I feel any doctor should do is to make a patient feel they are not good enough. As a society, we are already made to feel we aren’t. By the time a patient decides to go to a dermatologist for help, my position is really to offer hope, support and treatment.
I am a strong believer in natural beauty, the definition of which is what is unique and pleasing to the eye, and not what everyone thinks is beautiful( at the moment). My goal remains to restore one’s youth, at the same time maintaining the uniqueness and individuality of one’s facial features. Afterall, your skin, being the largest organ of your body, degenerates with time just like your liver, kidney, heart, bones and joint. With laser technology, light is harnessed to trigger off new collagen formation, re-setting the genetically-programmed cell ageing process. With high-intensity focussed ultrasound (HIFU), this technology goes deep to the SMAS (Superficial Musculo-Aponeurotic System) layers where patients can now have a mini face-lift without going under the knife.
Every patient that comes to me for an aesthetic procedure gets a thorough run-through of how the different layers of skin tissue which make up the face movements interact as one ages. Consequently, each patient’s individual ageing process and treatments will differ. Aesthetic procedures like botox, fillers and lasers are not treatments that can be ordered off the menu like your lunch bento, especially when each comes with a set of its own risks along with its benefits. An accredited dermatologist or a plastic surgeon will analyse your facial anatomy, break down the cause of your ageing face, and correct those elements. Any other method of shopping for aesthetic treatments will at very best give a mediocre result, and at worst it can be outright dangerous.
4. Have problem skin? You don’t have an aesthetic issue, you have a medical condition of your skin that should be diagnosed and treated
Any perceived flaw on one’s skin can be attributed to a dermatological condition. Dark mark on your face after having a pimple? It’s post-infIammatory hyperpigmentation. Uneven skin tone? Take care you don’t actually have a skin pigmentation condition such as melasma. Enlarged pores and irregular skin texture? You could have suffered from acne in your teens and still have seborrhea, which is excessive production of oil from one’s sebaceous glands. Untreated acne over a long time leads to blackheads and open “pores”, as well as acne scars that can be indented, “ice-pick” or “box-car” type. To a dermatologist, every single of these conditions can be broken down to the diagnosis, the cause and medical treatment, which may also include lights and lasers.
All dermatologists advocate gentle skin cleansing, regardless of your skin being oily or dry. It is a myth that oily skin needs to be stripped of its oil in order to be healthy. Au contraire, sodium-laureth sulfate laden foaming cleansers and astringents( read: often alcohol or salicylic-acid-based toners) dehydrate skin, cause eczema and sensitivity in the long term.
However, even though good dermatologist-formulated and tested cosmeceutical skincare delivers the nutrients for healthy skin, can improve acne and mild eczema, along with brightening and tightening skin for anti-ageing concerns, it does not actually treat medical conditions. With my brother, a pharmaceutical engineer, I formulate a brand of cosmeceutical skincare Dr. TWL Dermaceuticals which is an adjunct to the medical treatments I offer in my clinic. Even though I am a strong believer in the effectiveness and safety profile of cosmeceutical skincare, I always emphasise to my patients that no amount of good skincare can actually treat their skin problem (if they have one) since their conditions require medicated treatment. Skin conditions have to be diagnosed accurately before correct medical or laser treatments is administered. The use of cosmeceuticals helps to anti-age, lighten scars and complexion by delivering evidence-based pharmaceutical anti-oxidant ingredients to skin and also prolong/enhance the results of aesthetic treatments.
5. Everyone wants to look young and beautiful, but there’s nothing wrong with the existing you
No one really “needs” aesthetic treatments. Feeling overwhelmed by all the advertisements for fillers, botox, skinboosters, ultherapy and lasers? You probably are. It’s not wise to call up any medical aesthetics provider, check for the cheapest rate and order a botox or filler injection like you would deliveroo. These are all medical procedures which are regulated and comes with its own set of risks in the wrong hands. Do research, check your doctor’s accreditation. If you are concerned with ageing, seek the advice of an accredited dermatologist early from your mid-twenties onwards for prevention. If you are in your thirties, forties or beyond, fret not, your dermatologist would discuss your expectations and treatments and he or she can start you on a regimen including lasers and injectables like botox and fillers. Or refer you to a plastic surgeon if required. If you have a true skin condition such as acne, rosacea or eczema that’s troubling you, your dermatologist will first treat it. Very often, my patients have no more complaints about the look of their skin once its treated and realise that it was not anything “aesthetic” -related in the first place. Thankfully, before they spent a bomb on beautician facials, medi-spas or cosmetic skincare.
Meet with Dr. Teo Wan Lin, consultant dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
What are cosmeceuticals? Cosmeceuticals refer to skincare that has been developed from the combination of cosmetics and pharmaceuticals. They have medical or drug-like benefits, such as improving appearance through its ability to affect the structure and function of the skin and are recognised by dermatologists.
As these types of skincare contain bioactive ingredients, which means it has been laboratory tested and formulated, they ensure effective and proper penetration of skincare onto the skin. Cosmeceuticals differ from normal moisturisers or typical cosmetic formula as they contain anti-ageing, anti-wrinkle, sun-protective, anti-acne and anti-oxidant ingredients that have indeed been backed by dermatological research.
Who are cosmeceuticals for? Cosmeceuticals are for everyone. They are commonly recommended by dermatologists as a complementary treatment for those who are undergoing cosmetic dermatology treatments such as lasers, fillers and botox for anti-ageing. It is also recommended as a form of skincare when treating skin conditions like acne. In addition, they serve as a cost effective option for patients to maintain the beneficial effects of such cosmetic treatments at the comfort of their homes and regular users of cosmeceuticals to maintain their youth and improve the appearance of their skin.
How to find the right type cosmeceuticals for you? As cosmeceuticals are not regulated by the FDA or Health Sciences Authority in Singapore, as a quick rule of thumb, a product recommended by a dermatologist (check your doctor’s accreditation) would be safe bet. The skincare and aesthetics market today is flooded with cosmetic companies and even ‘doctor-designed’ skincare products by aesthetic doctors (who are not dermatologists) to add on to the public’s confusion of who’s the real skin expert.
One would be wise to do thorough brand research, look for the labels ‘dermatologist-tested’, ‘dermatologist formulated/recommended’ or just consult a dermatologist before you buy. As a cosmeceutical product, it should also ideally be formulated in a laboratory rather than in a cosmetic factory. It should also have the approval of a dermatologist. The reason these factors are important are because, one has to bear in mind that even when a correct active ingredient is present, it may lack effectiveness because of an inappropriate drug delivery system, compound instability, poor penetration, inadequate dosing or the ingredient itself may lack good clinical studies to back it up.
Meet with Dr. Teo Wan Lin, consultant dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
If you’ve ever been struck with a pesky wart over your palms or soles at least once in your life, you’ve probably been left wondering what caused it. Nope, it is no longer just a childhood infection, adults are increasingly attending my clinic with concerns about stubborn warts that don’t go away and are plain annoying. In this article, I share my experience with the common concerns of those of you who are troubled by viral warts.
1. What exactly are warts?
Warts, also known as verruca, are growths of the skin due to human papillomavirus (HPV) infection. Several subtypes are known, and they all look different. The initial infection occurs in the top layers of the skin, it reprogrammes the skin to cause excessive growth of the keratinocytes (skin cells), leading to thickening of the skin where the viral wart has started. The most common subtypes of HPV are types 2, 3, 4, 27, 29, and 57. Warts appear first like an area of hardened skin, and when one looks carefully, one may find tiny black dots centrally, which is due to thrombosed(or clotted) tiny blood vessels.
2. Who gets viral warts?
Warts are traditionally more commonly found in school-going children and teenagers but can affect people of any age group. People suffering from eczema, whereby their skin barrier is genetically defective, are also prone to getting viral wart infections from areas of broken skin. Those who are immune suppressed are at high risk of getting larger, persistent and multiple warts. These include patients who are pregnant, on medications such as azathioprine or ciclosporin, or with human immunodeficiency virus (HIV) infection. Nevertheless, it’s perfectly normal to have a healthy young adult to suffer from viral warts as well, especially in areas of friction and contact, such as the palms and soles. The palms and soles of feet are subject to small cuts and wounds due to contact on a day to day basis. HPV virus, which is present on surfaces, then has the potential to infect the skin.
3. Is your gym giving you warts?
Moving on to the causes of viral warts. HPV is contagious and is most commonly spread by direct skin-to-skin contact. Another way it occurs is via scratching or picking warts, whereby the virus may be spread to other areas of uninfected skin. Common places where people pick up the wart virus are at public areas such as pools, bathrooms and gyms. Sharing footwear, slippers and shoes, walking barefoot and handling shared gym equipment that has not been properly disinfected. So yes, a good proportion of adults who visit dermatologists for treatment of their viral warts actually get it from shared gym equipment, especially when small cuts are present.
4. Do I need to see a dermatologist to diagnose viral warts?
Warts are common and have a typical appearance, with painful areas of hard skin, almost like a callus, and black dots centrally. While tests are usually not required to diagnosis viral warts, there are some cases whereby the appearance or the location of the wart is unusual, leading to a missed diagnosis of a potential skin cancer. In such cases, dermatologists usually would perform either a dermatoscopic examination or may recommend a skin biopsy to distinguish viral warts from other growths such as seborrhoeic keratosis and skin cancer. It may be necessary sometimes to perform a skin biopsy for diagnosis, especially to rule out rare infections( in people who are immunosuppressed) and also skin cancers.
5. When to get your wart treated by a dermatologist
Small warts which otherwise don’t hurt or bother in any way can sometimes be left alone. However, once you suspect you may have a wart, do get it checked out by a dermatologist rather than using DIY methods. I have seen several patients who have used corn plasters or DIY freeze kits bought online over their wart, which all became worse after their self-treatment. I do not recommend corn plasters as these typically contain salicylic acid which is a keratolytic, essentially dissolving the thicker layers of skin overlying the wart, often causing irritation and blistering, but does not actually treat the underlying viral wart. Many end up with complications of skin infection. DIY freeze kits or not permitted legally in Singapore, however, I have had patients who purchased such kits online or overseas and ended up having severe blistering and infections, some even requiring drainage after that. The reason is that these freeze kits contain liquid nitrogen, which is meant to kill off the virus-infected skin cells and should be applied by a trained healthcare professional upon the direction and assessment of a dermatologist. Importantly, there are variations of the appearance of viral warts as well, which may lead to misdiagnosis or delayed diagnosis. I have seen cases of squamous cell carcinoma, a potentially lethal form of skin cancer, for example, which had been undiagnosed because of an assumption that it was just a stubborn wart that would not go away.
6. How does wart treatment work?
The truth is, once you get a viral wart infection, the virus affects your skin’s DNA where it has infected, causing all new skin cells to be produced with the HPV virus. What that means is the treatment of viral warts is not like that of a skin growth or cyst, whereby cutting it out fully results in removal and a cure. Viral warts are persistent because they are alive, and in order to eliminate the wart virus one has to rely on stimulating the body’s own immune system to overcome the wart virus. Hence, surgeries whereby the wart is excised does not work because the HPV virus replicates and would grow the wart again.
The location of the wart, the morphology as well as the underlying health status of the patient affects the type of treatment chosen as well. There are subcategories of warts as follows which your dermatologist will diagnose you with:
Common warts and plantar warts are those commonly appearing over the palms and soles, with characteristic pinpoint black dots centrally due to clotted blood vessels, a result of the HPV virus infection. Plane warts as the name suggests, have a plane or a flat surface and are found over areas of the knuckles, the knees and the elbows. Another type known as filiform warts are protuberant with a thread-like elongated stalk and are common in areas such as the face. Mucosal warts affect areas such as the lips, inside the mouth and also the anal/genital region.
7. What treatments are available for viral warts?
First of all, make sure the growth you are dealing with is indeed a viral wart. From there, depending on the type of viral wart, your dermatologist will suggest one or a combination of the following.
Topical treatment
Use of topical treatment alone in the treatment of viral warts is uncommon and is usually used in combination with topical treatment i.e. creams, ointments and lotions formulated for wart treatment usually contain active ingredients such as salicylic acid. Salicylic acid is a keratolytic, which means it works by dissolving dead skin cells. Another anti-viral ingredient used is podophyllin, which destroys skin cells i.e. cytotoxic, but is prohibited in pregnancy.
Cryotherapy
Cryotherapy is the use of liquid nitrogen to freeze areas of infected skin. It is performed every one to two weeks. It is a safe and effective treatment except that it requires multiple sessions, with a success rate of about 60–70% for 3 months of regular treatments. It causes blistering and may subsequently leave a scar after treatment.
Electrosurgery and Laser Vaporisation
Electrosurgery and laser vaporisation would be used for larger or stubborn warts. Surgical paring is performed under local anaesthesia and the base of the wart is burned, destroying both healthy tissues together with the bulk of virus infected tissue. Wound healing is expected within two weeks generally. However, about 20%- 30% of warts do recur within a few months, although the rate of recurrence decreases with proper monitoring by a dermatologist.
Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
