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.
They may be small, but we definitely do not want these small, pesky bumps around. Milia, sometimes called ‘milk spot’ or ‘oilseed, are tiny white bumps that are benign, but hard to remove. You may have attempted to squeeze it out, given that they
can be cosmetically unappealing, but that would only worsen it.
If you are hoping to know the causes of those tiny bumps under your eyes, and how to get rid of it, read on.
Understanding what is milia – the white bumps under your eyes
Milia are keratin-filled bumps of 1-3 mm in diameter, arising from the outermost layer of the skin. Keratin is a structural protein that makes up your hair, nails and skin.
They are classified into primary and secondary.
What causes milia?
Primary milia is the most common, occurring spontaneously without a known stimulus. Secondary ones are induced by various stimuli, typically when the skin undergoes some form of trauma. This could be dermabrasion, physical trauma e.g. x-rays, inflammatory skin diseases e.g. acne or use of topical or systemic drugs.
Primary milia are connected to the sheath of our hair follicles, near our oil glands. Secondary milia connect to our sweat glands, rarely to hair follicles or the outermost skin layer. They are formed when there is an obstruction of the hair follicles or sweat glands.
Such forms are common in newborns, typically found on the face or scalp. They tend to disappear within weeks. In adults, benign primary milia occur spontaneously, often randomly distributed across cheeks and eyelids, and sometimes at the genitalia. While milia found on newborns go away in time, those that develop later in life tend to persist.
Rarer forms include milia en plaque, where multiple keratin-filled bumps are found in a cluster. It occurs without any apparent trigger and can arise spontaneously on healthy skin of predisposed individuals. Affected areas are often reddish, found under the eyes, on the ears, head or neck.
Multiple eruptive milia have a wider distribution than simple primary ones. It may be spontaneous or an inherited genetic condition. The bumps can be found distributed over the face, neck, upper chest, back and arms. It often numbers in the hundreds and can develop over a period of weeks to months.
Secondary milia occur anywhere following traumatic stimuli after the skin is damaged in some way. Medications that may trigger them include topical steroids, penicillamine, benoxaprofen and cyclosporine. Other conditions can include contact dermatitis, skin grafts, second-degree burns and radiotherapy. In children, superficial abrasions can also lead to secondary milia.
Treating milia: can it be done at home or by a dermatologist?
Milia is benign and does not have any symptoms, thus treatments are only necessary if requested by the patient. However, all treatments must be recommended by your dermatologist.
Evacuation: For individual milium, the most effective way is to nick it with a scalpel blade, followed by applying pressure with a blunt edge. It is important to only have it done at a dermatologist’s office, as it may result in scarring when done without professional expertise. Any puncture of the skin may also cause infection.
Laser therapy: CO2 laser ablation can treat individual or multiple bumps with minimal complications or recurrences
Oral prescription: Tretinoin or minocycline is often prescribed.
Microdermabrasion: A skin-resurfacing procedure to help gently sand the outer skin layer, causing cell turnover. Skin that grows back is smoother.
Electrolysis: Current is applied through a tiny needle on the milium, piercing through the keratin-filled bump. The contents of the milium are then soften, thus easy to remove.
Patients should not attempt extraction at home on themselves. While the bumps alone do not have any side effects, improper technique can cause skin trauma, leading to scarring or injury. If you would like to remove such bumps professionally, do consult an accredited dermatologist who will be able to assist with comprehensive management including post-treatment skincare to prevent recurrence.
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.
Dermarolling, also known as microneedling, has become popular in treating acne scarsand it can be used safely in a dermatologist’s clinic by an accredited dermatologist, as a simple office-based procedure.
It is a minimally invasive procedure that uses fine needles to puncture the epidermis to create micro wounds that stimulate the release of growth factors and induce collagen production. The procedure is painful and a prescription numbing cream is used to numb the skin before the treatment. Overall, the epidermis remains relatively intact and doesn’t seem to have many side effects when performed by a trained professional and with sterilised equipment. To date, the procedure seems to be generally safe and low-cost method of improving acne scars. However, there are insufficient studies as yet to support the use of microneedling for various conditions as an evidence-based method.
Functions of dermarolling
Dermarolling can be used for enhanced delivery of applied medications, “transdermal delivery” of cosmeceuticals such as vitamin C and vitamin A derivatives (retinoids) but this is best used with caution. In my personal experience, it can cause irritation and there is no conclusive evidence to suggest that it is superior to an optimised topically applied cosmeceutical alone. It has also been used for the treatment of hair loss, with steroids delivered for conditions such as alopecia areata, although it is not preferred over conventional methods of steroid injections for this autoimmune condition.
It lasts 10 to 20 minutes and informed consent is obtained about the expected outcomes, delayed response, and need for multiple sessions. Dermatologists also prepare the skin preoperatively for at least a month with vitamin A and C formulations twice a day to optimise results, such as enhancing dermal collagen formation.
Dermarolling at home?
There has been a proliferation of ‘home-care dermarollers’, which are of shorter needle length less than 0.15 mm for improvement of skin texture such as pore size, fine lines, sebum production and delivery of anti-ageing products. Some have also been developed for coverage of larger surface areas such as legs and buttocks for stretch marks and cellulite. In my view, there is insufficient data supporting the safety and effectiveness of home care dermarollers and is not recommended. For conditions such as acne scars, it is far more effective to recommend ablative fractional resurfacing.
On a related note, dermarollers carry risks which may be far more pronounced in the at-home group including the following.
Infection. Medical microneedles are currently made of medical-grade stainless steel presterilized by gamma irradiation and are for single use only. Home dermarollers are usually made of smaller shorter needles, for multiple uses (other than washing in hot water, but this does NOT eliminate all viruses and bacteria, including a type of tap-water tuberculosis bacteria known as atypical mycobacteria). It is hard to predict how deep a home user may end up traumatising their skin, whereas when it is performed by an accredited dermatologist, sterility of the instrument as well as proper technique is applied.
Dermarollers should NOT be used in patients with anyone with these following problems i.e. keloidal tendency, active acne, skin infection such as Herpes labialis or warts, chronic skin diseases such as eczema and psoriasis. Those with blood clotting abnormalities, or on anticoagulant therapy, chemo/radiotherapy are at high risk of bleeding and suffering rare infections using non-medical dermarollers.
Dermarolling may seem like a ‘less invasive’, easier or more novel option to traditional ways of treating acne scars, but it is definitely less effective than laser therapies. However, it has been used mainly in medical studies as a combination treatment with surgical/laser therapies to enhance results. It is also popular in darker skin types, as these patients can have a higher risk of developing hyperpigmentation as a side effect to ablative laser treatments, whereas microneedling does not seem to carry the same risk in such groups.
Dermarolling is only recommended when performed by an accredited dermatologist. Even then, common side effects are redness and irritation (which usually subside within a few hours) and patients are often informed of the risks of scarring: post-inflammatory hyperpigmentation, worsening of acne and reactivation of herpes, systemic hypersensitivity, allergic granulomatous reactions (such as sarcoidosis) and local infections following the use of a nonsterile instrument, such as home-use dermarollers. In addition, there have been reports of allergies to materials used in the needles. Improper technique, such as when performed by a non-medical professional, can result in worsened acne scars, and injury.
There is not yet clear data available to substantiate the length of time which effects of dermarolling could last. Also, depending on the severity of the condition and what dermarolling is used for, it is important to note that severe conditions such as ice pick or box car acne scars or photoaging will not have dramatic improvement effects from dermarolling alone, but will benefit from a combination of laser/injectables/cosmeceuticals with or without dermarolling. Skin healing goes through different phases and occurs differently at different ages, with individual genetic differences, which will all play a factor in determining how long and how dramatic the benefits of dermarolling and treatments in general will present.
By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre
The evolution of beauty or aesthetic 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 industry of aesthetic treatments, 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 offering aesthetic treatments and 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; I practise aesthetic dermatology and carry out aesthetic treatments 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. In terms of aesthetic treatments, 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 aesthetic treatments or procedures 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 treatments like botox, fillers and lasers are not procedures 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.
Whether you are a local, or an expat that lives in Singapore, one is struck by the stark weather of this equatorial city- constantly humid with temperatures rising above 30 degrees celsius. The cause of our sweaty pimply skin, simply put, Singapore’s weather causes bad skin-acne on the face, pimples on the chest and back. True or false?
Also, too many aesthetic clinics and medi-spas are advertising some sort of acne treatment for our humid climate, how does one know if it’s going to work? Does bad skincare cause problems and what exactly constitutes good skincare?
As many of my patients have asked, I share my top skincare tips on maintaining good skin in Singapore (which you could achieve on your own), and how to get treatment when you really need it.
Skincare Tip #1. If it’s bothering you, you may have a real skin problem. Do see a dermatologist.
Do you suffer from any of these: sensitive skin and break-outs if the products were not right? Constant red face? Having flaky itchy skin whenever you’re traveling? Always having a pimple breakout at that time of the month?
Acne on the chest and back is often actually a fungal infection known as pityosporum folliculitis. This sort of chest and back “acne” requires treatment with specific antifungal lotions and creams. People who are at risk include athletes or those living in a humid country like Singapore, as the constant sweating and the moist environment worsens it. When chest and back acne or fungal infections are left untreated, it leaves bad scars and even develops secondary bacterial infections.
If you always have a red face you may likely suffer from rosacea. Rosacea treatment is with correct oral antibiotics and creams before anti-redness lasers (to eradicate the blood vessels) are used. Rosacea is triggered off by hot climates, spicy foods, emotions in certain people who are at risk. It is likely to be related to increased blood vessel sensitivity as well as certain mites that live on your skin (demodex mites).
If you have any such symptoms, stop all skincare products and promptly seek the care of a dermatologist rather than self-medicate, or adopt a “wait-it-out’ attitude. Some skincare tips: Look for the labels “dermatologically tested and formulated” when it comes to choosing cleansers, moisturisers and cosmeceutical products. Avoid testing many different cosmetic products which have no scientific evidence proving effectiveness. Finally, where possible avoid dust, extremes of temperature and humidity, prolonged contact with sweat as these tend to worsen skin sensitivity.
Skincare Tip #2. Don’t use just any wash on your face, use a dermatologist-tested and formulated cleanser.
It almost feels like because Singapore is so warm we constantly need to keep washing and keeping clean because of the sweat! As a dermatologist, I’ve heard from many patients with acne how they struggle to wash their face 3 times a day and are puzzled that they still have pimples. Cleansers perform one function, they emulsify the dirt, oil and bacteria in the foam which is rinsed off with water. Acne not due to dirt or bacteria, although they both can worsen people who already are prone to acne, such as those who have a family history of acne, so no amount of washing can actually get rid of acne.
There is a difference between normal cleansers and those which are dermatologist-tested/formulated. Cleansers approved by dermatologists are gentle on the skin, due to a good balance of the lathering agent and use of quality ingredients that do not strip the skin dry of it’s natural moisture while cleansing effectively. I personally formulate a honey-based cleanser which is suitable for both oily skin and sensitive skin types in Singapore (honey is a natural emulsifying agent which also has anti-bacterial properties) for my patients. Here’s a skincare tip, cleansers that leave your skin feeling squeaky clean is usually a bad sign. Stop using your supermarket cleanser and start looking carefully for those “dermatologist-tested and formulated” labels.
Skincare Tip #3. Don’t buy more scrubs or clay masks to clean your face better.
It amuses me that most of my patients are shocked when they hear this from me, their dermatologist, almost as if I am wrong to say that. Dermatologists do not agree with a lot of what beauty companies/aesthetics providers (who are not qualified dermatologists) are telling the public. The beauty industry is limited by what they are allowed to use in their salons (none of the prescription medications that would actually work is found in these places) and are are very happy to include more products in your regimen to earn your dollar.
Dermatologists have seen way too many complications because of an incomplete understanding of the actual science of how skin behaves. Scrubbing with harsh beady grains of sand would work if your skin was made of wood, like sandpapering it down. In reality, you do not brighten or “exfoliate’’ your skin with that but rather you are causing damage and irritation to your skin, that’s maybe even the cause of your sensitive skin and red face problems.
Clay masks? Totally unnecessary even for oily and acne-prone skin types. The skincare tip here is to know that it’s actually the salicylic acid content in these masks that causes your acne to get better, but not without really dehydrating your skin after that (these masks are dry out your skin with an astringent). Most of my patients end up with a red itchy flaky face, on top of acne after they go on a clay-mask spree hoping that it would cure their oily face and acne.
Dermatologists do not prescribe clay masks for any skin problem because there are much more effective options for treatment of oily skin and acne. What counts in a skin treatment product is the active ingredient in these masks and products. So the skincare tip here is to start looking down the ingredient list of your next bottle!
Skincare Tip #4. Use cosmeceuticals but do thorough brand research first.
Haven’t heard of cosmeceuticals yet? It has become quite a fashionable word amongst the dermatologists community (for those in the know). It’s a marriage of two words “pharmaceuticals” and “cosmetics”. It’s actually referring to skincare with active ingredients best for skin that’s backed by dermatologists.
Am I too young? Or too old? Do i even need to get started? As a skincare tip for best results, start on cosmeceuticals early, in your twenties for maintenance of your youth. If you are already in your thirties and forties or beyond, fret not, cosmeceuticals are a useful adjunct to the laser/filler/botox treatments recommended by your dermatologist and help to enhance and maintain the effects of such anti-aging treatments.
There are a myriad of cosmetic brands that claim wonders. Unfortunately, cosmeceuticals are not regulated by the HSA and so are not bound to their claims. Hence, it’s difficult for the consumer to know if a given product can do what it claims it can do, contains the ingredients it claims to, or if the ingredients are even active forms?
Moreover, if the ingredients have phototoxic or photo reactive properties when exposed to the sun, among other concerns. What then? There is true evidence for the anti-aging properties of cosmeceuticals, but you are wise to consult a dermatologist before you buy. The HSA does not regulate the effectiveness of anti-aging products available without a prescription.
Skincare Tip #5. Go for a chemical peel or a medi-facial monthly at your dermatologist’s office in your twenties. Lasers in your thirties and beyond.
What is true about acne and the humid Singapore climate is that it all encourages the build up of dead keratin (read: skin flakes) which plug the pores and cause inflammation. Even if you don’t have acne, the build-up of keratin on your face with reduced skin turnover as one grows older, or due to environmental conditions such as exposure to pollutants and to sun. All these cause free-radical damage and accelerated aging, makes one’s face look dull and hence lose the bright complexion of one’s youth.
One of the best skincare tip we can give is a regular chemical peel (salicylic, lactic or glycolic acids as suited for your skin type should be determined by your dermatologist) or a medi-facial (I would use a vacuum handpiece with customised chemical peel solutions for patients), would reduce your chances of having oily acne-skin breakouts and reverse early signs of mild aging. It’s affordable as well. However, this alone will not work for a lot of patients with more severe acne/oily skin, for which they may require laser treatments to shrink oil glands or take oral isotretinoin for control of severe acne.