Dr. Teo Wan Lin is an accredited dermatologist and an expert on cosmeceutical skincare research and development. She is the author of “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare” which was published July 2019 by leading bookstores Barnes & Noble, Baker & Taylor and Apple Books and available in bookstores islandwide from January 2020. She is the founder of Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line with evidence-based active ingredients for anti-ageing and skin health. Dr. TWL Pharmacy is the only full fledged online specialist dermatologist compounding pharmacy in Singapore and is jointly headed by a trained pharmaceutical engineer for strict quality controls. In this series “Dermatologist Talks” she shares her top tips on common skincare topics. In this article, she talks about chemical peels, are they necessary and are there any alternatives for those who wish to do it at home?
What is a chemical peel?
A chemical peel is the application of a high yet safe concentration of a certain acid on the skin. Superficial peels involve the use of acids such as salicylic acid and glycolic acid. They induce epidermal injury and the induced exfoliation is followed by dermal and epidermal regeneration from adjacent epithelium and skin adnexa, which results in improved surface texture and appearance of the skin. Superficial peels are most commonly used for mild skin disorders such as dyschromia, acne, postinflammatory hyperpigmentation, melasma, and actinic keratosis.
What are the benefits of a chemical peel?
Chemical peels exfoliate the dead outer layer of your skin and are mainly used to treat:
Acne (i.e Blackheads, whiteheads & pimples)
Chemical peels reduce inflamed lesions, loosen and reduce open and closed comedones (colloquially known as blackheads and whiteheads respectively). Chemical peels also lighten mild acne and facial scars from past blemishes. It can be used to compliment topical or oral medication to treat pimples and control acne breakouts.
Reduce fine lines under eyes, around the mouth and on the forehead.
Lighten mild acne and facial scars.
Reduce age spots, freckles, and dark patches (melasma) due to pregnancy or taking birth control pills.
Remove the sun-damaged outer layers, leaving you with smoother skin.
Chemical peels also increase the absorption of skincare products into the skin because the removal of the topmost layer of skin ensures that there are no dead cells impeding the penetration of products.
SA has anti-inflammatory, antimicrobial and depigmenting properties. It is safe in skin of all Fitzpatrick phototypes. Because of SA’s lipophilic and comedolytic effects, it is particularly effective for comedonal acne.
What are the side effects of a chemical peel?
The side effects of the treatment tend to be mild and temporary. Most side effects subside after 3 days.
Scabbing of the skin (due to skin cells being removed)
Increased sensitivity to the sun
How is a chemical peel performed at your clinic?
A certified nurse will hand you a consent form for the chemical peel before proceeding to explain in detail what you can expect during the peel and the benefits. The peels we use in our clinic are: Lactic Acid, Salicylic Acid and Glycolic Acid. Before the procedure, your face will be cleansed and eye protection like goggles or gauze may be applied. During chemical peel, the nurse will use a cotton pad or brush to apply the chemical solution to your face. You may feel a slight stinging sensation however the nurse will assess the skin and monitor the reaction to the acid. Once complete, the chemical solution will be removed or a neutralizing solution will be added. The strength and peel times are tailored to individual patients skin type and needs. After the peel, we will apply AMINO ACID 360° MASQUE and leave it on for 10 minutes to soothe the skin. It contains a potent concoction of skin brightening Vitamin C which soothes inflamed acne and lightens scars. LARECEA™ Extract with lifting amino acids penetrate the epidermis to stimulate collagen regeneration, resulting in all round 360 degrees lifting effect for a youthful, smooth contour of face.
If I cannot make it down for a chemical peel at your clinic, would there be alternative treatments that can be performed at home?
Our online specialist skincare pharmacy Dr. TWL Pharmacy supplies custom compounded topicals powered by botanical actives, for various skin conditions delivered to your doorstep. This is also part of a teledermatology service integrated with the specialist skincare pharmacy, a unique service developed for our overseas patients and a current necessity given the healthcare situation worldwide. There is complimentary courier service locally and subsidised international shipping for our prescription medications.
The following are alternatives for home peels:
Our Dr. TWL Home Chemical Peel System– By Prescription via Teledermatology only. This system incorporates active peeling agents suitable for home use formulated by our in house team, with recovery serums and skin healing emollients included in the package. From $80 upwards depending on prescription and need. Please book in here for your consultation.
Home Medi-Facial Aesthetic Treatments with our Custom Mask Bar Service Our on-site skincare pharmacy is manned by trained technicians who compound topical prescriptives for skin concerns such as acne/greasy skin, pigmentation, scars and sensitive/eczema prone skin to be used with our newly launched FDA-approved skin devices for a full home facial experience. The SilkPeel, a state-of-the art microdermabrasion device with copper ion technology, suitable for antiageing and skin resurfacing is used with our prescriptive medifacial solutions and has been proven to have similar benefits as in-office chemical peels. For post-peel skin healing and tightening, the CollagenUP Wand utilises Radiofrequency technology with our MoistureMax Polysaccharide Mask Sheet for the Custom Mask Bar which delivers monthly mask essence vials with a complimentary 4L Beauty Fridge. Find out more about the science of our home medi-facials here
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. Our consultations are now available via teledermatology here . Our online skincare pharmacy is also available for over the counter prescriptives to be delivered directly to your doorstep.
To book an appointment with Dr Teo, book directly here with our integrated online booking system, call us at +65 6355 0522 or email email@example.com for assistance. Alternatively, you may fill up our contact form here.
Wrinkles, sagging and pigmentation of one’s skin are signs of premature ageing. Due to this, skin tightening is a popular cosmetic procedure to improve one’s appearance. However, while surgery has long been able to restore a youthful appearance, many prefer non-surgical face lifting and skin tightening treatment because it provides immediate results with minimal or no downtime.
Dr. Teo Wan Lin is an accredited dermatologist and an expert on cosmeceutical skincare research and development. She is the author of “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare” which was published July 2019 by leading bookstores Barnes & Noble, Baker & Taylor and Apple Books and available in bookstores islandwide from January 2020. She heads up Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line with evidence-based active ingredients for anti-ageing and skin health. Its subsidiaries, the Pi- Cosmeceutical Custom Makeup Lab and the Conscious Mask Bar are part of the Conscious Concept Pharmacy launched in December featuring environmentally sustainable makeup and skincare materials. In this series “Dermatologist Talks” she shares her top tips on common skincare topics. In this article, she talks about non-surgical skin tightening treatments.
What are the alternatives to surgical skin-tightening?
1. Non-invasive skin tightening procedures
Unlike surgical skin-tightening, patients will not incur puncture wounds, incisions or raw skin after the procedure. Temporary redness and swelling, would usually be the only side effects of the procedure. When performed by a board-certified dermatologist, little risk of other side effects is involved. This procedure can be performed on almost any part of your body and the results of the procedure tend to appear gradually. Regarding the details of the procedures, a session takes approximately 1 hour or less. Some patients may face some discomfort during the procedure.
Common procedures include:
Heat produced by ultrasound treatments can stimulate collagen production. After one session, most people see modest lifting and tightening within 2 to 6 months. You may get more benefit from having multiple treatments.
A device is used against your skin to heat the tissue beneath. Most patients feel an immediate effect after the first session. Collagen production in the body takes time, the best results show in about 6 months. Some people benefit from having more than 1 treatment. The results from radiofrequency treatments can last 2-3 years when accompanied with appropriate skin care.
Certain lasers allow heat to penetrate into the skin without damaging the top layer of the skin. These lasers are utilised for skin-tightening treatments all over the body and can be especially helpful for tightening loose skin on the belly and upper arms. 3 to 5 treatments may be needed to get results, which gradually appear between 2 and 6 months after the last treatment.
2. Minimally invasive skin tightening procedures.
Although they are unable to give you the results of a surgical procedure like a facelift, these procedures result in more evident changes than non-invasive procedures. They require less downtime than surgery while carrying less risk of side effects. Patients will be sedated during this type of procedure and will have a few days of downtime.
A thin tube (or needles) is inserted into the skin which provides heat to tighten loose skin at a precise location. This procedure is often used to tighten the skin at the neck or upper arms. Results are noticeable in a month. In some research studies, patients see gradual tightening and lifting for close to 1 year. After the procedure, you’ll need someone to drive you home and you may need to wear a compression garment for 4 or 5 days. You’ll also need to care for the wound.
This is the most effective procedure for tightening loose skin. Unlike the laser treatment, this procedure requires some downtime. You’ll need to stay home for 5 to 7 days. Laser resurfacing gives you the fastest results. After you heal, your skin will appear tighter with less wrinkles within 2 weeks. Laser resurfacing can effectively tighten skin, usually showing more prominent results than any other skin-tightening procedure. Laser resurfacing diminishes fine lines, wrinkles, and dark spots on the skin, such as age spots. The tradeoff is that it requires downtime and has a greater risk of possible side effects, such as scarring.
Do skin-firming creams and lotions work?
Despite their promising claims, face-lift like results from a mere jar are highly unlikely. The result, if any, you see from a skin-firming cream will be subtle. These products tend to be good moisturisers at best resulting in plump skin and less noticeable fine lines and wrinkles. This result is temporary. To continue seeing any benefit, you need to apply the product every day. Dermatologists dispute the claim that a cream or lotion can lift sagging skin as these products are unable to penetrate the skin deeply enough to do this. Still, a small change may occur if the product contains a retinoid, such as retinol, which stimulates collagen production.
Who should avoid skin-tightening procedures?
Skin-tightening procedures should not be done on pregnant individuals, those with skin infections or patients with certain medications.
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 firstname.lastname@example.org. Alternatively, you may fill up our contact form here.
“I am a strong believer that natural beauty reflects honesty and authenticity, an approach I take as a dermatologist— sharing the truth about skin. Our pursuit of beauty should always celebrate individuality over vanity, I always emphasise that beauty starts with an inner consciousness and empowerment, starting with a scientific approach towards skin health, building confidence and finding peace.”
Dr. Teo Wan Lin is an accredited dermatologist by the Ministry of Health and is the medical director of TWL Specialist Skin & Laser Centre, as well as the founder of Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line. Want to know the top aesthetic treatments performed by accredited dermatologists? She shares the top aesthetic treatments in her dermatology practice here.
Once I start doing aesthetic treatments, am I reliant on them forever? Will the results go away after some time?
Optimum Face Lift Results with Accredited Dermatologists
“I find two major pitfalls of aesthetic treatments administered in clinical settings– the first relates to the lack of understanding of the total face structure — each layer of ageing skin needs to be addressed individually and dermatologists are well-positioned as MOH-accredited specialists in skin to ensure that correct treatments are administered and combined to each individual’s specific skin age according to the Glogau Photoageing system, developed and used by dermatologists.” Dr. Teo Wan Lin.
Aesthetic Treatments – The Key to Sustained Face Lift Results
“The second pitfall is the lack of maintenance, a touch and go approach, especially without using cosmeceuticals together with aesthetic treatments, is not scientific. While it is a surefire way to fuel ‘repeat treatment sessions’ when signs of ageing quickly recur, I find it unsustainable as results always taper off. I do not use such an approach with my patients. Our joint goal is always, in-clinic treatments for a specific duration until we meet our target, and then home maintenance to maximise the longevity of the clinical results, ”emphasises Dr. Teo.
The Dr.TWL 360 Degrees Face Lift System
At TWL Specialist Skin & Laser Centre, an accredited dermatologist practice in Singapore headed by Dr. Teo Wan Lin, the favourite of many patients seeking aesthetic treatments is a potent full-face anti-ageing cocktail prescribed by her. All patients undergo a medical consultation and with an objective staging of their ageing process to determine the intensity, duration and maintenance of treatment periods.
What does the Face Lift treatment consist of?
The Dr.TWL 360 Degrees Face Lift System is a full face targeted aesthetic treatment which comprises the following
1. Epidermal/superficial dermal treatment
Beginning with microdermabrasion and an in-house formulated gentle chemical peel) performed by our dermatology staff nurses, lasting 45 minutes including preparation and recovery time.
2. Deep Dermis Stimulation and Muscle Relaxation
The second component is performed by Dr. Teo Wan Lin. It comprises deep laser lifting to stimulate bulk tissue heating and collagen growth. The epidermis is treated for superficial pigmentation and fine lines, wrinkles which are the earliest giveaway signs of ageing. Microinjected muscle toxins are then administered to further stimulate collagen production around the jawline and hairline for a relaxed, natural face lift effect.
“The SMAS is best envisioned as the curtain rail that holds the entire curtain up, it’s what holds up the entire facial structure. It’s important to lift this structure when one is anti-ageing the face because it’s really the support of the facial structure,” shares Dr. Teo. At her dermatology practice, she uses High-Intensity Focussed Ultrasound (HIFU), a Korean technology as well as radiofrequency to achieve a SMAS face lift.
4. Composite Eyelid lifting and Wrinkle removal
The eyes often giveaway one’s age. The reason for this is due to the thinner periorbital skin, as well as the natural facial expressions that cause brow furrows and crows feet. At our dermatology practice, plasma nitrogen technology is used for periorbital resurfacing for undereye wrinkles, sagging, and lid drooping, also known as a soft blepharoplasty.
This maintenance system includes a home medifacial regimen fulfilled by Dr.TWL Pharmacy’s Mask Bar, freshly delivered to your doorstep monthly for a 3-month maintenance regime, with freshly compounded face masks containing oligopeptides to further tighten and lift the dermis. The system includes a full-face set of QRASER lifting patches made of medical grade polymers that mimic the skin barrier and erase wrinkles. The CollagenUP Facial Wand which is a FDA-approved Radiofrequency lifting device is used with the Polysaccharide Mask to increase absorption of Oligopeptides, the star molecule of Dr.TWL Dermaceutical that stimulates collagen production with a tightening face lift effect.
This non-surgical face lift system is designed and tested for proven results by accredited dermatologist Dr.Teo Wan Lin at her practice TWL Specialist Skin & Laser Centre. The number of shots used for each treatment is titrated according to the individual’s specific need. For patients who wish to stay home, they can opt for the home medifacial component which is delivered to their doorstep by the clinic’s specialist skincare pharmacy.
For whom is this aesthetic treatment suited for?
People who want a non-surgical, long lasting approach to a face lift effect with minimal to no downtime. A single clinic session followed by a strict home maintenance regime for 3 months helps boost the efficacy of the treatment. Can be adjusted in intensity and frequency according to individual need.
How long will the treatment results last?
This is the very question the Home Mask Bar treatment was created to address. According to Dr. Teo, “I would like to say, for as long as you are diligent to comply. The in-clinic treatment session is completed in a single day, and results peak at 2 weeks. I have seen patients who have maintained the overall face lift results for as long as 2 years. Inter-individual variability exists, due to lifestyle and genetic factors, some individuals have extremely good responses. For those who are at a more advanced stage of photoageing, more frequent treatments should be instituted before attaining the ideal for maintenance.” The effect of regular use of the Dr. TWL 360 Degrees Face-Lift System is sustained improvement.
How many sessions of this treatment do I require?
The in-clinic full sessions can vary from single session to 3-6 sessions depending on the level of skin ageing. The aftercare home system should be used on a daily basis.
Who should not undergo this treatment?
Components such as deep laser toning will be omitted for individuals with photosensitive (sun-sensitive) skin conditions. It is important to consult an accredited dermatologist as he/she is well equipped to manage these medical conditions simultaneously with your aesthetic treatment.
How much does this cost?
Single in-clinic session (expect half-day, 4 hours including recovery time) $2799, with Home Mask Bar Maintenance at $180.50/month, and CollagenUp Facial Wand at $599. All prices before GST.
Dr.TWL 360 Non Surgical Face Lift was featured by Men’s Folio. Read the full article here.
Do you dream of a slimmer face? Is a V-shape face your ideal face shape? What are the ways you have heard of to achieve your dream face shape? I have been interviewed by several magazines and media on how to achieve your ideal face shape and in the process have debunked many myths. I have written this article to shed some light on safe and effective methods, such as HIFU, to achieve and maintain a V-shape facial structure.
HIFU is for anyone with mild to moderate sagging skin from all skin types and tones. It is for those looking to:
to improve and tighten sagging skin
to reduce wrinkles
to reduce nasolabial fold
to remove stubborn areas of fat that are at least 1 inch in size
for skin rejuvenation
for cellulite removal
for fat cell reduction
What are the benefits of HIFU treatment?
HIFU is a safe, effective and noninvasive procedure for skin lifting and tightening. It’s a cost effective option in comparison to a surgical face life. It is comfortable and painless and results can be seen after just one treatment. HIFU acts on the SMAS (superficial musculoaponeurotic system) layer which essentially functions as a structure that the entire face tissue hangs onto.
To address the lifting of the SMAS, HIFU targets that specific layer of tissue which helps to reduce surface wrinkles as well as induce the lifting of the facial tissues by the stimulation of collagen production. HIFU not only results in facial lifting and improvement of wrinkles but also in improvements in skin tone, facial contour, and subjective symptoms such as tightness or tension on the skin. Another recent study showed that HIFU could also be used safely and effectively to improve the skin texture and contour of the upper arms, extensor knees, and medial thighs.
HIFU is also ideal for fat reduction on the abdomen and the flanks. It works by inducing rapid cell necrosis which results in fat reduction. This is done by ablasting subcutaneous adipose tissues which cause molecular vibrations in targeted areas and increasing the temperature of local tissues.
How does HIFU treatment work?
HIFU essentially causes the skin tissue cells to die based on a physiological process known as cell necrosis. This results in the subsequent reduction of bulkiness of the affected area being treated. Common areas that HIFU is used for treatment would be the jawline, the cheeks which leads to an aesthetically pleasant shaping and lifting effect.
How long do the effects of HIFU treatment last?
The effects of hifu treatment can last up to a year. I employ less painful methods in my clinic which require 3-6 successive treatments for the full effect, building up on initial treatment. Sustained treatment rather than a touch-and-go approach is my personal practice as this tends to have more long-lasting results without necessitating the need for repeat treatments over a long period of time. I also combine this with adjunctive treatments such as botox fillers and cosmeceuticals. Studies have shown that the average wrinkle and skin laxity score decreased most in the jawline and periorbital (around the eye) areas.
Fig.1 Clinical photographs showing before (A, D), 3 months (B, D), and 6 months (C, F) after high-intensity focused ultrasound treatment.
TWL Specialist Skin and Laser Centre helmed by accredited dermatologist Dr. Teo Wan Lin uses HIFU as a painless way to shape and lift your face with evidence based methods. This is sold in a full face bundle and used in conjunction with our cosmeceuticals, which penetrate the skin, and the Qraser polymer patch which helps to draw moisture to the top layer of skin, causing a multidimensional lifted effect.
Is PHA (polyhydroxy acid) suitable for all skin types? How does it compare to AHAs and BHAs?
Polyhydroxy acids encompass gluconolactone and lactobionic acids. It has been reported in medical papers as early as 2004 to be effective and better tolerated by sensitive, aging skin.
PHAs works similarly to AHAs by causing the dead skin cells (keratinocytes) to shed at a higher rate, causing reduction in skin irregularities such as uneven pigmentation and texture. In addition, they fulfil the same function of allowing cosmeceutical ingredients such as hyaluronic acid and vitamin C serums to penetrate deeper into the skin.
Is there a possibility of suffering from a chemical burn using skincare products that contain PHA?
PHAs are not as commonly used as AHAs and BHAs, especially as chemical peels in dermatologists’ office setting mainly because the depth of penetration and effectiveness may be less. However, in skincare, the medical literature seems to report that it is a much gentler and moisturising type of chemical exfoliant than the other acids present in skincare, which translates into a much lower risk of skin irritation. In fact, PHAs are large molecules which function as humectants meaning that they trap water under the skin, prevent trans-epidermal water loss and have moisturising properties.
Is there one form of PHA that’s stronger than the others? eg. Lactobionic acid vs Gluconolactone
Clinical studies to date have grouped the use of gluconolactone and lactobionic acids under PHAs which differ from glycolic acids in the fact that they have a larger molecular structure, penetrate the dermis less and hence is less irritating in addition to having humectant (moisture trapping) properties. I am unaware of any head-to-head study which show whether one form of PHA is stronger than the other.
When should I use PHA? Should I use it in the toner, serum, moisturiser, or cleanser step?
The use of PHAs in skincare has been well-reported to have good exfoliating effects but without the irritation that glycolic (AHA) or salicylic acids (BHA) have. However, I generally do not put in chemical exfoliants in skincare because there is always a risk of skin becoming sensitive after being exposed to it on a daily basis.
There are some studies indicating that compared to glycolic acids which are incorporated in several brands of skincare, those which incorporate PHA are much more suited for people with sensitive, eczema skin. However, I would not prescribe that for my patients with eczema and rosacea in the first place due to the risk of irritation.
What should I be looking out for when I use PHAs?
I would say PHAs seem to be rather novel because it’s a term that hasn’t been used in the recent times but our knowledge of it has stemmed since the 1970s and clinical studies have been done with it since 2004. I think it’s important to prioritise, so the main concern really would be to ask yourself what your skin concern is. If it is anti-aging, then chemical exfoliation itself is not going to give you a miracle result.
Chemical exfoliation can be achieved with glycolic acids, BHAs and in this case PHAs may have the same function but with reduced skin irritation. However, chemical peels alone do not satisfactorily target all skin aging concerns, which lasers in combination with a good cosmeceutical regimen can achieve. It is important to caution that while all anti-aging treatments are aimed at increasing collagen production in the skin, an accredited dermatologist still needs to access the individuals’ problems and side effects before recommending combination treatment.
PHAs should be used in conjunction with cosmeceutical ingredients such as vitamin C as well as phyto which are plant-derived antioxidants that have been proven to fight free radical damage which is the key process in anti-aging. Nevertheless, PHAs are a beneficial form of chemical exfoliation and should be placed in the same category as the use of AHAs and BHAs in chemical peels.
One more thing to add, the clinical results in terms of the depth of skin penetration are likely to be less with PHAs. For patients with other forms of skin concerns, for example acne, they may still find that glycolic acid is much more effective in reducing oil control. If their concern is a medical condition like eczema and rosacea, then certainly I would recommend not using any form of chemical exfoliant at all and rather get treated by a dermatologist.
Stretch marks are extremely common. Yet, those squiggly lines on your skin are never welcomed. While such forms of dermal scarring are not medically dangerous, it can be aesthetically unpleasant to patients, causing distress.
Common occurrence of stretch marks includes the thigh, buttock, lower back, chest, upper arm and knee. Striae rubrae and striae albae are the two recognizable forms of stretch marks. Striae rubrae are flesh-toned scars, often accompanied by redness and ruptured capillaries that cause a subtle violet appearance. They then progress to striae albae – silvery, wrinkled scars that are hypopigmented (lighter than your usual skin colour).
What causes stretch marks
Stretch marks, or striae distensae, occur typically during pregnancy, puberty, obesity or certain medical conditions e.g. Cushing syndrome. Other triggers include endocrine imbalance (a type of hormone), extended periods of mechanical stretch or any structural changes to the skin can lead to stretch marks. Chronic use of oral or topical corticosteroids can also contribute to the development of marks.
Stretch marks are formed via three main mechanisms:
Mechanical disorders/stretching of the skin
No specific gene has been isolated as the cause of marks developing on the skin. However, stretch marks have been identified among identical twins, families and inherited genetic skin conditions. This suggests genetic predisposition, that certain individuals may have a greater tendency of developing stretch marks based on their genes.
A hormonal imbalance can contribute to the development of stretch marks. A hormone called adrenocorticotrophic causes an increased rate of protein breakdown. In turn, this leads to less collagen and elastin fibres being produced. With less collagen and elastin, the skin is less flexible and resilient to withstand stretching, causing marks to form.
This effect is similar to that caused by corticosteroids, which explains why patients on long-term use of the drug are more prone to developing stretch marks.
Rapid expansion or contraction of the skin causes it to stretch beyond its usual elastic ability. Fibres in themiddle skin layer (dermis) stretch to accommodate when growth is slow. But with sudden stretching, the dermis may tear, causing the deeper skin layers to be seen and forming marks.
In pregnancy, stretch marks frequently appear in the third trimester.
How to treat stretch marks
Topical treatments only have mild effects in reducing appearance of stretch marks. Still, many patients prefer non-laser approaches, thus topicals remain as a common approach.
Tretinoin: Boost fibroblast production. Fibroblasts are molecules responsible for the structural support in our cells and synthesize collagen. Best for striae rubrae (for newly developed marks), poor for striae albae (marks that have been around for some time).
It is not recommended to use tretinoin during pregnancy as it carries a risk of birth defects
Phytochemicals: Plant extracts such as Centella Asiatica can boost the cells that produce elastic fibers and collagen. Resveratrol, naturally occurring in grapes and berries, can also boost skin elasticity.Elixir-V™ Total Recovery Serum contains a potent combination of phytochemicals, including resveratrol, to help fight ageing effects
Moisturizers: They can be applied as an adjuvant to treat stretch marks. Look out for moisturizers with active ingredients such as niacinamide. Apart from its brightening abilities, niacinamide stimulates collagen synthesis. You may consider Radiance Fluide™ Hydrating Emulsion, a dermatologist-designed lightweight moisturizer formulated with niacinamide.
While ingredients such as cocoa butter or olive oil are commonly marketed as effective in reducing stretch marks, it has not been scientifically proven to show results.
Microdermabrasion: In this process, physical agents such as aluminium oxide is used for skin resurfacing. A targeted injury is caused to trigger collagen production and to deposit elastin. Topical therapies are also more effective after microdermabrasion, as your active ingredients can better penetrate the dermis layer.
Light therapy: Different types of light treatment are available to stimulate collagen production in the dermis layer. Examples include infrared light devices, intense pulsed light (IPL) and ultraviolet light.
Ablative lasers: Such lasersare effective in reducing scars as they create a deliberate wound to induce healing of the skin.
Stretch marks are not medically dangerous, but if you are seeking for an effective treatment, it is best to consultan accredited dermatologist for best results.
Exfoliation, or the removal of dead skin cells from the outermost layer of the skin, is an important and necessary part of any skincare routine. However, if the word ‘exfoliation’ conjures up to you the action of scrubbing your face with harsh granules, you may be doing more harm to your skin than good.
So what is the right exfoliation technique for your skin?
Benefits of Facial Exfoliation
We shed dead skin cells naturally as new skin cells slowly travel up from the deepest skin layers to the surface. On average, this process takes about 27 days. As we age, this cell turnover process slows down.
When we exfoliate, we remove the build-up of dead skin cells. Regular exfoliation can reveal younger, brighter skin with an even tone.
Types of Facial Exfoliation
Exfoliation can happen in two forms: physical and chemical.
Physical Facial Exfoliation:
Physical exfoliation relies on the rubbing of tiny granules or particles over the face to remove dead skin cells by physical force.
While this kind of exfoliation can leave you feeling refreshed, the technique can be too harsh for the skin, especially for individuals with acne-prone or sensitive skin. Physical exfoliation may even weaken the skin’s barrier function and leave your skin red or irritated.
For those of you without sensitive or acne-prone skin, physical exfoliation can still be an option. However, make sure to look out for exfoliating agents that are not too large.
Chemical Facial Exfoliation:
Chemical exfoliation relies on fruit enzymes and gentle acids to slough off dead skin. This mechanism is much gentler than physical exfoliation and more suitable for acne-prone and sensitive skin types.
Types of acids for chemical facial exfoliation
The two most well-known type of exfoliating acids is alpha hydroxy acids (AHA) and beta hydroxy acids (BHA).
AHAs: Alpha hydroxy acids work by causing skin cells to detach from the outermost layer of skin, making them easier to slough off. Once the dead skin cells are removed, new cells can rise to the surface.
Common AHAs used as chemical exfoliants are lactic, glycolic and mandelic acid.
Glycolic acid: Glycolic acid is the strongest AHA as it has the smallest AHA molecule. As such, it is able to penetrate deeper into the skin and can exfoliate at lower concentrations compared to other acids. However, if you are just beginning to try out chemical exfoliants, a different acid should be considered.
Lactic acid: Apart from exfoliating, lactic acid also moisturizes. Individuals with dry skin can consider lactic acid for this dual function.
Mandelic acid: With a larger molecular structure, mandelic acid is not able to penetrate deeply into the skin. This makes it a gentle AHA and safe to use, especially for people with sensitive skin.
BHAs: Beta hydroxyl acids (BHAs) differ from other AHAs as they are oil-soluble. This property allows them to penetrate deeper into our skin and pores.
BHAs exfoliate by softening the outermost layer of skin cells and dissolving unwanted skin debris. They also have anti-inflammatory and antibacterial properties, making them ideal for individuals with oily and acne-prone skin.
Chemical peels for facial exfoliation
Chemical peels are often done at a dermatologist’s office where the chemical agent used can be much more concentrated. Glycolic, lactic or salicylic acid is commonly used. A certified dermatologist is best able to identify the type of peel for your skin.
With regular use, these treatments exfoliate the surface skin and improve fine lines, wrinkles, skin discolouration and texture.
Chemical facial exfoliation at home
Most patients prefer to do chemical exfoliation on their own. However, this can cause skin sensitivity and redness for certain individuals over time without proper medical supervision.
Over facial exfoliation – what happens if you over exfoliate?
The benefits of chemical exfoliation may make it tempting to use AHAs and BHAs often. However, too much exfoliation can disrupt your skin barrier and cause the skin to become red and inflamed. Some encounter a form skin burns when dabbling into prescription type chemical exfoliators, whilst others may even develop eczema of the facial skin due to repeated unsupervised repeated exfoliations.
If you are a beginner to AHA and BHA, start slow with low doses. If you do not have sensitive skin, you may consider exfoliating every week with mild home use agents. Those with sensitive skin should not attempt self exfoliations. Discuss with your dermatologist to have your underlying skin condition resolved first before thinking how often you should get chemical peels or exfoliations.
Struggling with dark spots? To treat them, you first have to know the kind of pigmentation you have.
Melasma is characterized by irregular brown patches on the skin and can typically be found on the forehead, upper lip, nose and the chin. Melasma is the result of an overproduction of melanin (the pigment that gives colour to our skin, hair and eyes).
Excessive sun exposure is one of the greatest contributors to melasma as melanin-producing cells are easily stimulated by UVA and UVB rays. Pregnancy, hormone treatments and genetic predisposition are other causes.
Postinflammatory hyperpigmentation (PIH)
PIH is the result of your skin’s melanin-inducing response to inflammation or injury, and appears at the injured site as a dark brown macule or patch. Such markings usually fade within a few months with appropriate treatment. However, the brown spots may darken or spread if not addressed. Sun exposure may also worsen PIH.
Skin conditions that can cause the above inflammation include acne vulgaris, atopic dermatitis (eczema) and psoriasis (red, flaky skin patches).
Freckles, also known as ephelides, are harmless small pigmented spots that are frequently found on the face, arms, neck and chest. Freckles are brown due to a diffusion of melanin into skin cells.
In winter, the activity of melanin-producing cells slows down. When exposed to UV radiation in sunlight, melanin-producing cells pick-up. As a result, freckles fade slight in the winter and darken in summer. Often, freckles partially disappear with age.
Genetics contribute to the formation of freckles. They are frequently observed in fair-skinned individuals, especially those with red hair.
Solar lentigines are harmless patches of darkened skin that are generally larger than freckles and have well-defined edges. They are caused by an accumulation of sun damage that leads to an increase in the number of melanin-producing cells and subsequent accumulation of melanin.
Solar lentigines are also associated with increased age. While freckles generally disappear over time, untreated solar lentigines are likely to persist indefinitely.
Dark Spots Treatments
For all dark spots, start by avoiding the sun and applying a sufficient amount of sunscreen every two hours. Use a lightweight sunscreen like Dr. TWL’s SunProtector™, which is dermatologist-formulated for the humid climate.
For melasma, consider a combination of topical therapies (outlined below) and chemical peels. Lasers should be considered last.
For PIH, first treat and prevent the skin condition triggering the inflammation. Then use topical treatments followed by chemical peels and lastly, laser and light treatments.
For freckles, use topical or laser/light therapies.
For solar lentigines, use ablative therapy with cryotherapy. Subsequent treatment options include topical agents and laser therapy.
Bleaching agents are often used to inhibit synthesis of melanin which is the skin pigment that contributes to the formation of dark spots. The most commonly prescribed ones are hydroquinone, azelaic acid and kojic acid.
Hydroquinone inhibits the production of melanin by binding to tyrosinase, the enzyme responsible for the first step in melanin production.
Azelaic acid acts on abnormal melanin-producing cells but leaves the healthy ones untouched, ensuring optimal melanin levels.
Kojic acid binds to copper, which is required by melanin-producing cells.
Topical retinoids are often used in combination with bleaching agents. Retinoids target pigmentation issues by inducing the death of melanin-producing cells, accelerating turnover of new skin cells and inhibiting the enzyme tyrosinase.
Chemical peels refer to the process of applying acids to the skin to destroy the outer skin layers. They accelerate the process of exfoliation by sloughing off dead layers of older skin and promoting smoother layers of new skin.
Superficial and medium depth peels are effective in treating pigmentation concerns. These peels differ in the depth of skin resurfaced. Superficial peels target only the surface skin layer while medium peels target the next layer.
To successfully achieve significant depigmentation, a patient needs to undergo at least 3 to 4 repeated peels. Common acids employed are glycolic acid, salicylic acid and lactic acid.
Laser and light treatments
Lasers are notably successful with solar lentigines, but less so with melasma and PIH. Such treatments damage the skin to stimulate growth of new skin cells.
To treat solar lentigo and freckles, use IPL, Q-switched lasers and fractional lasers.
To treat melasma and PIH (and only after topical therapy and chemical peels), try fractional radiofrequency, Q-switched or picosecond lasers, high-fluence/high-density non-ablative lasers, pulsed dye lasers, IPL, microneedling, and spot liquid nitrogen treatment.
If you are considering laser or light treatment, be sure to first consult an accredited dermatologist to recommend suitable treatments for the skin condition you are experiencing.
Patients who are not ready to commit to prescription treatments like laser can consider cosmeceuticals. These are over-the-counter cosmetic products infused with bioactive ingredients that are scientifically proven to deliver results to the skin. In fact, even with prescription treatments, cosmeceuticals are important adjuncts for the treatment of dark spots. Being very safe on skin, cosmeceuticals are suitable for long-term use in maintenance of the skin condition post-treatment and also during the treatment itself to enhance the effects of prescription treatments. For example, following laser treatments, skin cells are stimulated to rejuvenate and the availability of bioactive raw materials in cosmeceuticals on skin increases rejuvenation benefits during the healing process.
Bioactive ingredients that fight dark spots include vitamin C, niacinamide and oligopeptides. As an antioxidant, Vita C GOLD™ Serum helps fade dark spots on your face and neutralise free radicals that damage skin. Stabilised vitamin C, in the form of sodium ascorbyl phosphate, is particularly potent as an antioxidant (without the pitfalls of raw ascorbic acid that may cause skin irritation in higher concentrations) and found in our dermatologist formulation. Niacinamide and oligopeptides are both important skin-brightening constituents of the Radiance Fluide™ Hydrating Emulsion. They participate in different parts of the metabolic pathway in melanin synthesis to inhibit the pigmentary effects that form dark spots.
Enlarged facial pores are a cosmetic concern that plague individuals with oily skin types. Even though this condition besets a majority of individuals, especially those who live in humid climates, treatment options for large pores are elusive or unreliable.
Large pores may not be health-threatening or a disease symptom, but they can be the reason why we refuse to get up close with a mirror. A skin pore usually refers to an enlarged opening of pilosebaceous follicles. The pilosebaceous unit has the hair follicle, the sebaceous (oil) gland and skin muscles.
The mechanism by which visible facial pores occur remains unclear, but three possible causes have emerged: loss of skin elasticity, hair follicle size and excessive sebum production. Other potential factors that can influence this skin condition include genetics, chronic photodamage, acne and vitamin A deficiency.
Excessive sebum production from pores
Oily skin results from excess production of sebum by the oil glands, which fills the follicles and leaks onto the skin surface. During the menstrual cycle, sebum production levels are higher. Pore size is also larger during the ovulation phase. A surge of three hormones during the ovulation phase triggers the oil glands – luteinizing hormone, follicle-stimulating hormone and progesterone.
Severe acne from pores
Previous cases of inflamed acne can destroy hair structures and leave them susceptible to influence by androgenic stimulation. Androgen is a hormone that exerts a major effect on sebocyte (cells found in oil glands) proliferation and sebum secretion. This means acne inflammation may cause you to be more prone to androgen activity, bringing about change in follicle volume and size.
Loss of skin elasticity
A main feature of skin’s ageing process is the loss of elasticity. Our skin’s collagen and elastin framework that supports skin resilience become less efficient due to ageing and chronic photodamage. A protein, crucial for elastic fiber assembly, called microfibril-associated glycoprotein-1 is also produced less over time. Without it, tissues around follicles provide less structural support and there is a loss of thickness in the skin dermal layer. Such changes lead to skin fragility, sagging and enlarged pores.
The volume of our pores is dependent on the size of the hair follicle. There are dermal papilla cells in our hair follicles that contain androgen receptors. Our pore size is affected by the androgen activity in hair follicles.
Topical retinoids are often considered as first-line therapies to reverse collagen and elastin-associated changes caused by aging and photodamage. Retinoids are vitamin A derivatives and were previously used as anti-ageing therapies before the efficacy for improving the appearance of facial pores were discovered.
Commonly used retinoids are tretinoin, isotretinoin and tazarotene for skin rejuvenation, regulating sebum production, and the reduction of wrinkles and large facial pores. Isotretinoin is the most potent inhibitor of sebum production.
Patients are advised to consult their dermatologist before any use of retinoids as side effects – such as inflammation, burning, redness or dry skin – are common.
Niacinamideis another cosmetic ingredient that can reduce sebum production.
Chemical peelscan also help rejuvenate the skin and improve the appearance of large pores. At the epidermal or dermal level, the application of acids induces the temporary breakdown and regeneration of healthier cells. Glycolic acid, lactic acid and salicylic acid are commonly used for chemical peels.
Common oral therapies targeted at enlarged pores are anti-androgens, such as oral contraceptives, spironolactone and cyproterone acetate. They modulate sebum levels by blocking androgen action.
Lasers and ultrasound devices
Advanced devices have been developed to deliver targeted thermal or ultrasound energy to the skin. Such therapies work by remodelling the collagen fibers near our pores for increased skin elasticity and decreased sebum production. Non-ablative lasers helps with facial pore minimalisation and improved appearance of photoaged skin.
Pore volume may decrease with hair removal, especially so if patients have thick and dark facial hair. Laser or intense pulsed light sources can create photothermal destruction of the hair follicles to minimise appearance of large pores.
Melanin is the culprit behind the dark spots that give us an uneven complexion. It is a brown pigment found in the basal layer of the epidermis.
This pigment is synthesised by melanocytes. The process of melanin synthesis is termed melanogenesis. Melanocytes go through different stages of maturation, becoming more pigmented at each stage.
Certain stimulants trigger a gene to produce more of tyrosinase, a copper-containing enzyme that converts tyrosine into melanin. Stimulants that activate the melanocyte include hormones, inflammation (such as acne) and external environmental conditions (ultraviolet light that causes the production of free radicals).
One simple way to reduce melanin production is to use broad-spectrum sunscreens with zinc oxide, titanium dioxide or iron oxide. These substances help block UVA and UVB light, thus impeding the stimulation of melanocytes.
Pigmentary disordersfrom melanin
Common hyperpigmentation disorders that involve the darkening of an area of skin due to increased melanin include melasma, lentigo, and post-inflammatory hyperpigmentation.
Melasma is usually caused by chronic exposure to ultraviolet radiation or a spike in hormones due to pregnancy or the use of oral contraception. It can be found at the epidermis, dermal layer or mixed, depending on the location of the pigment.
A lentigo is a light or dark brown area of discoloration that can range from 1mm to 1cm across, and is caused by an increased number of melanocytes. Its outline is usually discrete, but can also be irregular. Simple lentigines arise mostly during childhood on areas not exposed to the sun. Solar (or senile) lentigines are found on the backs of hands or on the face, most commonly after middle age.
Post-inflammatory hyperpigmentation (PIH) is the skin’s response to inflammatory skin disorders. Common causes are acne and atopic dermatitis. PIH is caused by the overproduction of melanin caused by skin inflammation.
Treating hyperpigmentation from melanin
Hydroquinone: For 50 years, hydroquinone has been the gold standard treatment for hyperpigmentation. This compound inhibits tyrosinase activity, thus limiting the amount of melanin to be produced. It also alters melanosome formation, possibly degrading melanocytes.
However, prolonged use of topical hydroquinone has shown to have side effects such as ochronosis and permanent depigmentation. Ochronosis is a disorder with blue-black discoloration. As such, hydroquinone is banned in cosmetic formulations and only available through a prescription that should be carefully managed by an accredited dermatologist.
Retinoids are forms of vitamin A that can treat acne, photodamage and PIH. They have various pathways that lead to skin lightening effects, such as accelerating epidermal turnover, reducing pigment transfer and slowing the production of tyrosinase.
With common side effects being erythema, skin irritation, dryness and scaling, it is recommended to use a retinoid only under the supervision of an accredited dermatologist. Corticosteroids (steroid hormones) have anti-inflammatory abilities and are often prescribed along with retinoids to prevent excess irritation.
Arbutin is a botanically derived compound found in cranberries, blueberries, wheat and pears. Though arbutin is a derivative of hydroquinoine, it has shown to be a more controlled way of inhibiting the synthesis of melanin as it does not permanently destroy melanocytes.
Kojic acid is a naturally occurring fungal substance. Its skin-lightening ability works by inhibiting the activity of tyrosinase. However, frequent use can cause side effects of contact dermatitis or erythema (redness of the skin).
Azelaic acid is known to be effective for treating PIH and acne. Azelaic acid depigments the skin in several ways. It can inhibit tyrosinase or reduce levels of abnormal melanocytes. This means that azelaic acid does not influence normal skin pigmentation but only acts on the proliferation of unwanted melanocyte activity. Side effects are mild and only last for a short period of time. Irritation, burning sensation or mild erythema may emerge, taking 2 to 4 weeks to subside.
Niacinamide is a derivative of vitamin B3. It works by decreasing the transfer of melanosome to keratinocytes. Niacinamide is a stable ingredient as it is unaffected by light, moisture or acids. This ingredient is often incorporated into cosmeceuticals due to its safety profile.
Vitamin C or L-ascorbic acid is a naturally occurring antioxidant that helps with skin lightening. It prevents tyrosinase from converting tyrosine to melanin. Vitamin C is also favored for its anti-inflammatory and photoprotective properties. However, L-ascorbic acid is highly unstable and rapidly oxidized. It is not used in the treatment of PIH.
Stable forms of vitamin C include magnesium ascorbyl phosphate or sodium ascorbyl phosphate. For safe and effective results, consider a dermatologist-formulated serum VITA C GOLD™ Serum,a formulation tested for bio-activity in a laboratory.
As seen above, there are various treatment options to treat common hyperpigmentation disorders. Recognizing the underlying cause for pigmentation is critical for proper treatment and choosing the best-suited therapy. Visit an accredited dermatologist for effective and safe treatments catered to your condition.