Tag Archive: skincare

A Dermatologist Explains Under-Eye Care: Are Under-Eye Sunscreens Necessary?

April 30, 2019

It is not necessary to use a specific sunscreen dedicated to the under eye area if the sunscreen you’re using is already a medical grade sunscreen that has been dermatologist-tested and ophthalmologist-tested. Nevertheless, sunscreen should not be applied too close to the eye area such as the lid margin because the very nature of effective sunscreens means that it would contain chemical and physical components that may be irritating to the eye.

If you are worried about sun exposure to skin around the eyes, you may consider using the SunProtector™, a lightweight soothing sunscreen that is dermatologist-tested and formulated to be suitable for use on the entire face including the under eye area.

The question remains: Why does the under eye area require extra protection?

The difference between the under eye area and the rest of the skin is that the under eye area has much more delicate and thinner skin. This explains why we tend to get dark eye circles from those areas, which is due to genetic factors such as the blood vessels being seen much more prominently in areas of thin skin. In addition, with certain practices such as applying eye makeup over many years as well as wearing contact lenses, the process of dragging and pulling the areas of skin around the eye can make it much more susceptible to wrinkling and laxity. Natural facial expressions, such as smiling can also cause natural creases at the periorbital area, known as crow’s feet, or when one is laughing in the area near the nose known as bunny lines.

It is much more necessary to eliminate bad practices in handling of the skin around the eye area, and to advocate good eye moisturising and antioxidants in the form of an eye cream and daily sun protection. One eye cream product you may opt for is the Elixir-VTM Eyes, which is a dermatologist-formulated eye cream that targets regeneration and repair of skin around the eye area with pharmaceutical-grade bioactive ingredients. Also, as a tip, use your ring finger instead of the index finger to apply any sort of eye cream or makeup, in order to avoid exerting repeated high pressure (from the index finger) over the delicate eye area, which drags down the skin and may cause or worsen eye bags and wrinkles. More importantly, to fight aging effects on the skin and in general, one should have an overall healthy lifestyle, with frequent exercise, adequate sleep, a diet filled with antioxidants, reduced alcohol intake and should stop smoking habits.

If someone were to look for additional protection for the under eye area, would an under eye sunscreen benefit in any way?

The premise overall is that there is no need for a specific under eye sunscreen, other than a sunscreen that is formulated for the face and tested by a dermatologist in a laboratory environment. If one is to experience irritation with such sunscreens, it may help to look for a pure physical sunblock made up of Zinc Oxide and Titanium Dioxide, rather than chemical sunscreen components, as these tend to be less irritating although conferring less broad spectrum protection compared with one that is a combination of physical and chemical components.

It is more important that one re-applies sunscreen regularly, rather than to apply an additional type of sunscreen. This is because layering different sunscreens one on top of the other does not increase the efficacy beyond the time period that the sunscreen is effective for. Conventional wisdom is to reapply sunscreen every 3 to 4 hours, especially when outdoors. However, there are many aspects to aging around the eye area and one of the reasons is actually not due to sun exposure, but rather due to the fact that skin around the eye area is much more delicate, hence more prone to daily tugging for example for people who wear eye make-up and contact lens wearers. For these individuals, it is much more advisable to use a good eye cream which can be applied both day and night, to moisturise the eye area and packed with antioxidants to reverse free-radical damage caused by sun exposure and environmental pollutants, and also to get adequate sleep at night. Having a pair of good sunglasses is also helpful to protect the cornea from UV damage.

Can exposure to the sun make the under eye area more susceptible to dark spots or lead to other undesirable effects?

This is not a very realistic scenario as when someone has excessive exposure to sunlight, it happens over the entire face and is never just localized to one area. Someone who has extensive sun damage in their life will find that they are more prone to get pigmentation as well as dark spots as well as the entire face including the eye area. It is far more common to notice such pigmentation at facial areas of more prominence such as the cheek bones rather than the under eye or say the under the chin area which are relatively protected from sun due to the facial bone structure. In addition, if you have been undergoing treatments such as phototherapy for other skin conditions, it is always advisable to wear protective eyewear.

Will sunglasses work as well as an under eye sunscreen would?

Sunglasses are a good way to block out UV radiation and it is a form of physical protection. It is advisable to wear sunglasses primarily within the context of preventing excessive harmful UV exposure to the eyes for example the cornea. At the same time, when one applies a good quality medical-grade sunscreen together with physical measures such as a broad-rimmed sun hat and a pair of sunglasses, the amount of UV exposure to the face as well as the under eye area can be reduced.

How can you take extra care of the under eye area?

As mentioned, the eye is a very delicate area. It is well-said that the eyes are the windows to one’s soul and are very often the first feature that one notices. For someone who actively looks after their skin and does treatments such as lasers and peels, ageing in the eye area starts to become more obvious because these lasers and peels do not target the eye area and are often the top giveaway signs of a person’s age. So it is indeed very important to take extra care of the eye area, where prevention is key as well as using a good eye cream. In terms of physical treatments that can be done for the eye area, you may consider treatments such as CO2 laser resurfacing, as well as plasma nitrogen treatment which is very safe and uses ionic plasma nitrogen to help to resurface and tighten skin around the eye area.

© 2019 TWL Specialist Skin and Laser Centre. All rights reserved.

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Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may book an appointment online by clicking here.

Sleep Deprivation and The Skin

September 6, 2018

 

Have you ever woken up groggy from less than six hours sleep and felt your skin is looking unwell? Ever wonder why?

How lack of sleep impacts your skin

Dehydrates the skin

The skin barrier works as a shield against environmental threats and prevents excessive water loss. When you don’t get enough sleep, your skin barrier can weaken and your levels of transepidermal water loss (TEWL) can be higher. TEWL is the amount of water lost to external environments via evaporation. Increased water loss dries out our skin, which can cause skin scaling and increased desquamation or the shedding of the skin’s outermost cells.

Imagining your skin cells as bricks and the lipids/fats in between as mortar, dehydrated skin has a more ‘disorganised’ brick and mortar structure; this causes more light to bounce off the surface. In comparison, hydrated skin has an ‘organised’ structure, allowing more light to penetrate the skin and giving off a translucent appearance.

Your pores can also appear larger with lack of sleep. While you will not have an increased number of pores if you sleep less, increased skin scaling causes a coarser skin texture and can make pores appear enlarged.

Reduces immune system function

Sleep also plays a role in restoring the body’s immune system function. Any change in the immune response may affect collagen production and lead to impaired skin integrity.

Inflames the skin

Sleep deprivation also triggers increased levels of inflammatory cytokines, which in turn modify the structures of collagen molecules. Collagen gives the skin its elasticity and flexibility. Assembling into a dense network of fibres, collagen holds the dermis layer together and protects the skin from external sources such as bacterial agents or ultraviolet radiation. Lower collagen levels manifest as thinner and wrinkled skin.

Ages your skin

Poor sleepers may experience uneven pigmentation, fine wrinkling, skin laxity, loss of facial fat and benign skin growths.

Chronic poor quality of sleep is also associated with accelerated intrinsic ageing. Intrinsic ageing results from factors inherent in chronological ageing such as metabolic oxidative stress.

Stress is also a likely factor inherent in the lack of sleep. In response to stress, your brain releases an excess of stress hormones called glucocorticoids. This hormone causes negative effects on nearly all body tissues and accelerates the aging process. Glucocorticoids also inhibit lipid production, which eventually weakens skin integrity.

Regain your skin’s well-rested radiance

If you covet a seemingly translucent, pore-less look, it’s no surprise that we suggest you catch up on your sleep.

However, while you’re trying to change your sleep habits, providing rich hydration to your skin can also help compensate for some of your sleep loss. Apart from a moisturizer, a good boost of hydration also can come from an effective hyaluronic acid serum.


© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.

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Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

 

 

 

 

 

Dermatologist Tips: Most Stable Vitamin C Derivative

February 2, 2018

 

The benefits of Vitamin C are well-known – an efficient collagen booster, and an amazing ability to treat effects of photoageing and hyperpigmentation. A favoured ingredient in skincare products, this vitamin helps to gently brighten and smoothen the skin.

Whilst Vitamin C is a naturally occurring antioxidant in the botanical world, humans do not possess the enzyme L-glucono-gamma lactone oxidase for the production of Vitamin C. When administered orally, Vitamin C is not efficiently delivered to the dermis. The concentration of the vitamin when introduced into the body is not sufficient to allow an activated effect. In the practice of dermatology, topical vitamin C is frequently recommended as an adjunct to treatments, which results in a drive towards newer advanced delivery forms of the vitamin into the dermis or discovery of more stable Vitamin C compounds.

Vitamin C exists in two forms – L-ascorbic acid and D-ascorbic acid. L-ascorbic acid is the chemically active form of Vitamin C, but it is not stable in nature. When exposed to light, Vitamin C may get oxidized to Dehydro Ascorbic Acid for example, which loses the beneficial activity of the vitamin. This gives rise to the interest of stable ascorbate molecules for dermatological uses.

What are the common Vitamin C derivatives?

Not all forms are physiologically effective as some will not be delivered to the dermis in sufficient quantity, or will not convert to a chemically active form in the skin.

Some stable derivatives of L-ascorbic acid are Magnesium Ascorbate, Magnesium Ascorbyl Phospahte, Sodium Ascorbate, Sodium Ascorbyl Phospate, and Calcium Ascorbate, with varying effectiveness.

What is the most stable Vitamin C derivative?

Sodium ascorbyl phosphate is a stable and effective derivative of Vitamin C. It is significantly more stable than magnesium ascorbyl phosphate and ascorbyl palmitate. The stability is attributed to the introduction of a phosphate group into the second position of the cyclic ring.

How does sodium ascorbyl phosphate work?

At our skin’s pH of 7, ascorbic acid is present in a form called ascorbate anion. This form has poor penetration ability into the skin and is unable to prevent effects of photodamaging due to low antioxidant concentrations.

With sodium ascorbyl phosphate, antioxidant levels are substantial and can be absorbed into deeper skin layers and allow effective photoprotection. With ongoing research on this stable derivative, it is understood that sodium ascorbyl phosphate is absorbed in the skin and converted by enzymes into ascorbic acid, increasing the intracellular concentration of ascorbic acid.

Skin cells continuously take up sodium ascorbyl phosphate and convert it into ascorbic acid by the process of dephosphorylation, with the help of the enzyme acid phosphatase in the skin layer. This process allows elevated levels of ascorbic acid in the skin long after the introduction of sodium ascorbyl phosphate to the skin.

How does sodium ascorbyl phosphate help acne?

As a potent antioxidant, sodium ascorbyl phosphate can help improve acne conditions by combating oxidation of sebum and comedogenesis.

According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, she said: “Patients with acne are found to have a higher concentration of polar lipids, which are by-products of squalene oxidation. Squalene is most abundant lipid in our skin and is highly susceptible to oxidation due to its structure. It has six carbon double bonds, allowing atmospheric oxygen to bind. This produces squalene oxides that are highly comedogenic, as it causes inflammatory reactions that further depletes the level of antioxidants in our skin and leads to acne. Sodium ascorbyl phosphate is useful in acne treatment as it prevents sebum oxidation.”

How does sodium ascorbyl phosphate prevent sebum oxidation?

Sodium ascorbyl phosphate works as an antioxidant to neutralise free radicals, reducing oxidative stress. When exposed to UV light, reactive oxygen species such as the superoxide ion, peroxide and singlet oxygen are generated. Sodium ascorbyl phosphate works to protect the skin from oxidative damage to sebum by donating electrons to neutralise the free radicals.

How does sodium ascorbyl phosphate fight ageing?

Sodium ascorbyl phosphate is an oxygen species scavenger, protecting against UV damaging and enhancing properties of sunscreen. Photodamage such as sunburn cell formation, DNA fragmentation and lipid peroxidation can be prevented. The protective effect of sodium ascorbyl phosphate comes from the maintenance of a healthy ascorbic acid level in the skin tissue.

Sodium ascorbyl phosphate reduces UV susceptibility and protects against damage from UV exposure.

Are there any side effects of sodium ascorbyl phosphate?

Formulations containing sodium ascorbyl phosphate are considered safe and has shown no side effects in multiple clinical studies conducted.

Which Vitamin C serum should I use?

Although sodium ascorbyl phosphate boasts many desirable benefits, it is important to choose a Vitamin C serum that is well-formulated to allow its benefits to be realised. Avoid concocting your own serum of Vitamin C, as it may lead to phytophotodermatitis if you include ingredients such as lemon, lime or bergamot oranges.

For a reliable and effective serum, you may consider Vita C Gold™ Serum. Dermatologist-formulated and tested for bio-activity in a laboratory, it is completely safe for use. It is a concentrated serum containing nano-formulated sodium ascorbyl phosphate as a powerful and stable antioxidant.

 

© 2017 TWL Specialist Skin and Laser Centre. All rights reserved.

Dermatologist Guide to Choosing A Body Moisturizer

January 26, 2018

 

With Singapore’s humid weather, most of us fall back on body lotions and moisturizers to keep our skin smooth and hydrated all year round. Yet, faced with a multitude of choices for body moisturisers, we may never know where to begin – here are some quick tips to help guide the choice of body moisturisers.

Read the product’s ingredient list

This is no easy feat, but it pays to know what is in your product. You need not know all the ingredients in detail, a simple trick would be to scrutinise the order in which the ingredients are presented. Right at the top would be the ingredient with the highest percentage, and the concentration of each ingredient decreases with a descending order of mention in the ingredient list.

The first five ingredients or so usually make the bulk of your product. Given that, it does not necessarily translate that an ingredient has to be in greatest concentration for the most impact. Certain ingredients work well at low concentrations.

One tip would be to watch out for creams or lotions that have the highest concentration of water or plain silicones. While these constituents may give the instant feel of moisture, they quickly disappears and do not repair our skin barrier.

How do moisturizers work?

The most essential feature is to increase the water content of the stratum corneum. The ‘valleys’ between skin contour ridges smoothen with hydration, allowing the skin to be more soft and supple.

Ingredient you want in your moisturizer: ceramides

Ceramides are an essential lipid component of the stratum corneum, the outermost layer of our skin that is largely recognized as the skin barrier. Preventing unwanted materials from entering, it can be seen as our skin’s first line of defense. Ceramides contribute to the permeability of the skin barrier by mediating with cell signaling and with processes such as cell growth, differentiation, proliferation and cell death as a lipid messenger.

A deficiency of ceramides in our skin causes a decrease in water-holding capacity and barrier function. Conversely, with a topical application of phytoceramides, barrier abnormalities are improved and impaired skin barrier function can also be repaired. Thus, if you are looking for a good body lotion or moisturizer, phytoceramides definitely should be on your ingredient check list.

Phytoceramides: What are they?

Phytoceramides are derived from plant-oil and it mimics the lipid component of our skin barrier. With an equivalent function of restoring the skin integrity, we can rely on moisturizers with phytoceramides to repair our skin barrier as do synthetic ceramides do.

Ingredient you want in your moisturizer: glycerin

Glycerin is a natural humectant found in our skin and contributes to normal hydration levels of our skin. Topical glycerin helps to correct the hydration abnormality in our skin, causing glyercol to be included in topical dermatological preparations.

Humectants are hydrophilic compounds that hydrate the stratum corneum when they form hydrogen bonds with water molecules. Glycerin is a typical, yet effective water-binding agent. Humectants draw water to our skin from two difference sources: from a humid environment or from deeper layers of our skin. By absorbing water from these sources, it locks in the moisture in our skin.

According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, she said: “Glycerin may accomplish more complex mechanism beyond water absorption. It may interact with the skin lipid structure and alter their water-binding properties. This effect causes an expansion of skin cells on the outermost skin layer, and between those cells, leading to a visible full thickness of the skin layer. With an improvement of water-holding abilities, it results in more effective moisturization of the skin.”

Repeated applications of lotions with high glycerin content have been found to improve skin hydration.

Ingredient you want in your moisturizer: squalane

Found in certain fish oils such as shark liver oil, squalene is a polyunsaturated hydrocarbon. As squalene is unstable and oxidizes easily, squalane has gained more attraction in the area of cosmetics. As a saturated derivative of squalene, squalane’s inert properties and low toxicity have paved its way into the cosmeceutical industry, favoured over its unsaturated analog, squalene. Although squalane is produced naturally by the body, we experience a slower production of this hydrocarbon when we hit thirty.

Squalane has high emollient properties, being absorbed easily by the skin without leaving an oily residue. An emollient helps keep our skin hydrated and supple by reducing water loss from the epidermis. Squalane increases skin hydration due to skin surface occlusions. Occlusives provide a layer of oil on the skin surface to reduce water loss from the stratum corneum.

These properties accentuate the moisturizing effect of squalane and coupled also with its stable nature, have contributed to a continual rise in demand for squalane in cosmeceutical approaches.

To round things up, make a mental note to check the ingredient list before you purchase your moisturiser. A good moisturiser would contain at least one of these ingredients: squalane, glycerin or ceramides. With this in mind, a good moisturiser can be easily differentiated from the plethora of options out there.

© 2017 TWL Specialist Skin and Laser Centre. All rights reserved.

HIFU Sygmalift vs Ultherapy

December 15, 2017

People have been increasingly conscious about aging and the effects of aging on appearance. Skin aging will cause facial wrinkles and decreased collagen. Maintaining a youthful appearance seems to be the trend and many have resorted to skin treatments. There are many treatments like chemical peels, fractional laser and more but recently, ultrasound has been used in new treatments. HIFU and ultherapy are examples of ultrasound treatments. It has been introduced as non-invasive and effective in having anti-aging effects on the skin.

 

What is High-Intensity Focused Ultrasound (HIFU) Sygmalift?

High-Intensity Focused Ultrasound also known as HIFU Sygmalift, is used for rejuvenation, lifting and tightening of the facial skin. Research has been done to demonstrate the efficacy of HIFU Sygmalift. It has been found that HIFU Sygmalift is a safe and effective method for facial skin tightening. It can be used not only to improve skin texture, but also contour the upper arms, knees and thighs. Besides facial skin, it can be used for other parts of your body.

How does HIFU Sygmalift work?

HIFU mainly causes cellular damage and reduces volume of the designated area by coagulation and generating instant microthermal lesions. This is done by using high frequency ultrasound waves targeted at the tissue area without causing any damage to the skin epidermis and surrounding tissues. The targeted skin tissues get heated up which causes cells to be activated, generating new collagen to produce a skin lifting and anti-aging effect.

 

What is Ultherapy?

Ultherapy is a new Food Drug Administration (FDA) approved treatment that tightens and lift facial skin. The treatment is mainly for the eyebrow, chin and neck area but can be used anywhere where the skin is lacking tightening. Follow up treatments are recommended once a year to maintain the effects. The procedure has been used as it is non invasive and hence does not require anesthetic or sedation. However, it has been said to be painful and it would be better for some to use local anesthetic. It has been said to have no foreign substances or drastic changes but achieves to improve the health of the cells beneath your skin surface to result in a subtle, natural and healthy effect on the outside.

How does Ultherapy work?

Ultherapy is different from the common laser techniques that target the outer layer of the skin. It penetrates the surface and transmits energy to the deeper skin layers. This way, it causes damage to the collagen layers to stimulate more collagen production as the cells are tricked into repairing the collagen. It uses ultrasound technology which has been used in fat burning treatments. With collagen production, it produces skin tightening and anti aging effects.

 

How are HIFU Sygmalift and Ultherapy different?

HIFU Sygmalift and Ultherapy sound similar in terms of their methodology. Both use ultrasound treatment, a popular choice for non invasive and non-surgical face lifting and tightening treatments. Their main goal is to produce anti-aging effects, helping you to preserve your youthful look. However, there are still some small differences between the two which can impact your decision is choosing the most suitable treatment.

Extent of Pain

One of the main complaints about ultherapy treatment is that it is known to be painful and some people require local anesthetic. However, HIFU Sygmalift is mainly painless because it uses fractionated HIFU. Instead of traditional HIFU techniques which use one concentrated beam, HIFU Sygmalift breaks up the beam into fractions and penetrates the skin at precise extents. People who use HIFU Sygmalift may feel a small sense of tolerable pain but it is definitely less painful that Ultherapy.

Extent of Skin Penetration

HIFU Sygmalift targets the dermis and connective tissues to stimulate collagen production. Meanwhile, Ultherapy can penetrate deeper even into the muscle tissues, which is why some people feel pain. However, both result in skin tightening and lifting effects.

Post Treatment Maintenance

For Ultherapy, most people may see visible results even after the first or second session. To follow-up, they are recommended to go for treatments once a year to maximise the effects. On the other hand, HIFU Sygmalift is used once a month to maintain your skin. Patients of HIFU Sygmalift are recommended to use anti-aging products that contains peptides to complement the treatment, supporting a gentler type of treatment.

 

Both HIFU Sygmalift and Ultherapy use similar technology and methods with very subtle differences. However, these differences can make a big impact on your comfort with the treatments. Both methods are still safe, striving to produce anti-aging effects on your skin. With the similarities and differences explained, you can now make the best decision for yourself and choose the treatment that suits you the most.

 

© 2017 TWL Specialist Skin and Laser Centre. All rights reserved.

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Meet with Dr. Teo Wan Lin, accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

Organic Skincare Truths by a Singapore Dermatologist

November 23, 2017

With the term “organic skincare” gaining popularity among the masses, I was recently asked, more than once by different people, what I felt were the benefits relating to organic skincare and why people should be using that. Perhaps my answers would surprise people but I feel that it is time the public gets a honest take on this topic by a dermatologist.

Let me first clarify my position, I am an accredited dermatologist and practice evidence-based medicine, whereby specialist recommendations are always made based on peer-reviewed journal publications or at least on an international consensus of the medical community. The terms “organic skincare”, “all-natural”, “chemical-free”, “pregnancy-safe” skincare are rampant in mass media these days, so I certainly don’t fault the lay person or even beauty writers who get the impression that this is the real thing.

In light of these, I seek to discuss “organic skincare” in this article. You will discover my choice of putting the term in parentheses and hopefully this will open your eyes to what the term really means, and does not, information only your dermatologist would tell you about . Without bias, I personally formulate a cosmeceutical skincare line myself as an adjunct to my cosmetic dermatology practice, with natural ingredients which are also evidence-based for anti-ageing and skin rejuvenation, but by the end of the article you will discover for yourself why I do not label any of the skincare as “organic”, and why “organic” is not exactly my key priority when it comes to skincare.

1.To a dermatologist, organic skincare does not exist

First and foremost, the term “organic skincare’’ itself is not regulated and from a dermatologist perspective, organic skincare does not exist as anything more than a marketing fad. Organic is a term relating to food or farming practices, and is applied correctly to vegetables or other crops which are grown without the use of chemical pesticides. If organic skincare manufacturers are keeping to the above definition at all, what this should mean is that were plant derived ingredients are used in skincare, these are grown in a chemical pesticide-free environment. What would be surprising to the lay person is that neither the FDA or HSA (in Singapore) makes any provision in their regulation of cosmetics for labelling “organic skincare”. As such, any skincare label touting this would be responsible for their own definitions of such and the consumer should be wary of such claims and what it implies.

2.There are no specific benefits to skin of using an organically-derived skincare brand

Contrary to popular belief, there are no specific dermatological advantages of using such a brand over any ordinary skincare. In fact, most of these eco-skincare brands often go untested and unquestioned as well. Often, these organic skincare brands boast plant or nature derived ingredients, without “preservatives” and parabens, also being touted as “home-made”. Despite the seemingly positive branding surrounding these skincare, the associated pitfalls are not different from any other cosmetic skincare — they all have the ability to cause irritation, or allergic reactions in individuals who are susceptible, such as those with sensitive skin i.e. atopic dermatitis.

3. An important factor to consider in anti aging skincare is the effectiveness measured by bioactivity of the active ingredients,as well as the scientific literature surrounding it

Plant-derived ingredients, depending on the source and type, may have anti-oxidant or moisturising properties, but simply including it in the skincare does not guarantee that it is effective. Bioactivity has to be measured by a trained chemist or scientist, which is when the extract is carefully distilled or harvested from the plant in such a way that the effectiveness is proven in the laboratory and can be measured.

4. The safety of organic skincare is not guaranteed, and could be even riskier than normal skincare with chemical preservatives

Brands touting “organic skincare”, especially when home-made, lack the stringent quality controls present in a laboratory setting, which is required for the formulation of dermatologist-grade cosmeceutical skincare. One real danger of certain types of “organic skincare”’ is that they are not regulated for safety, in terms of bacterial contamination. Preservatives such as parabens have gotten some bad press in recent years but the overall consensus in the dermatological community and by the FDA is that they are still regarded as safe and necessary to reduce bacterial growth in applied creams. The lack of “preservatives” is again a questionable label because this means that something else should be added to the product to increase the shelf-life of such a product which is meant for public sale. If not, this product should state the expiry of within 2 weeks to a month maximum of opening, because bacterial contamination will set in and this will cause problems when applied to skin.

Furthermore, the current Singapore Health Sciences Authority — HSA requirements for cosmetic skincare distributed via public sale, requires that the production facility acquires a basic certificate of Good Manufacturing Practices (GMP) before it is allowed approval. Home-made formulas that are sold online or by individual proprietors are hence on a “at your own risk basis”, and as a dermatologist, I do not recommend using any home-made or naturally derived products (from plants etc.) on a DIY basis because the irritation and allergy risk, i.e. phototoxic or photoallergic risks are high. Besides, the benefits of plant ingredients can only be harvested and extracted under a controlled laboratory setting with proper testing, as in the case with cosmeceutical skincare. Anything else, the public would be better off with a simple dermatologist-recommended pharmacy-brand moisturiser that is free from fragrances.

5. Problem-skin can’t be treated with ANY type of skincare but can be worsened with certain products

If you have problem skin, no amount of good skincare can treat medical skin conditions such as acne, eczema (dry sensitive skin) or rosacea (a condition that results in red flushed face with pimples). Such conditions require treatment with prescription medications and can be well controlled. These also do not disappear on their own so waiting to “outgrow” the condition, no matter what age you are at, is not a wise idea. Also, avoid consulting the internet, or beauty forums as suggestions there are not based on medical evidence and could even result in worsening of the condition or create a new problem, such as skin irritation or allergies from these DIY remedies.

I have encountered patients who developed phototoxic or photoallergic reactions from citrus (lemon/ orange juices) applied to their skin. A common misconception is that these DIY home remedies are ‘’natural and organic” but from a dermatologist perspective, this is not true. There are no skin benefits to applying lemon or orange juice such as vitamin C, which is only beneficial when one ingests it as a fruit or a juice. Topically applied vitamin C needs to be in a certain formulation, either ascorbic acid or Sodium Ascorbyl Phosphate — I incorporate a nano-formulated form of SAP in the cosmeceutical Vita C Gold which I prescribe in my practice for it to have brightening and anti-oxidant properties for skin.

Applying orange or lemon juice directly will simply result in skin irritation due to the acidic nature of these juices, worse still, some individuals may react to sunlight (UVA component) with the citrus component and develop a severe skin allergy that can result in scarring or pigmentation.

6. Facials, organic or not, makes no difference to your acne-prone skin

The above also applies to skincare services (e.g. facials) similarly labeled with the “organic” term, that organic skincare does not offer any true differentiation from any ordinary cosmetic skincare. Similar to any individually-applied skincare products, it is pertinent to know what is in the products applied during facials and skincare services. As your skin absorbs whatever you apply on them, it is important to always read through the labels and ingredient list, conduct prior research and then a patch test on the inner part of your arm. This helps to prevent any form of skin allergy and sensitivity you might get from trying such new products.

Besides, most aestheticians and facialists use instruments such as extractors and needles which are not medically sterilised (i.e. autoclaved, there is a difference between a new clean needle vs a sterilised instrument). This may lead to infections and scarring, besides having absolutely no benefit in the treatment of acne. Acne is primarily a inflammatory process, worsened by hormones, genetics and oil production. Treatment of acne by dermatologists involves addressing inflammation using oral or topical medications, as well controlling hormonal and oil production factors, via medications or certain cosmeceuticals. Comedonal extraction is only sometimes performed by dermatologists, as the preferred method of eliminating comedones is by the use of retinoids, which modulate the way skin turnovers, as well as with chemical peels whereby the top layer of skin dissolves with glycolic, lactic and salicylic acids, preventing the accumulation of keratin (read: dead skin cells) which can worsen comedonal acne.

7. Environmentally friendly? Perhaps. Skin-friendly, not necessarily

Most people think organic skincare are either eco-friendly, natural or vegan. Here’s the catch, they can and cannot be. Organic skincare products can have components which are organically farmed and also approved by the FDA (which simply means it does not contain toxic or banned ingredients), but having the HSA or FDA approval does not necessarily mean that these are effective or deliver significant benefits. Organically farmed produce can be friendlier on the environment in general, as less pesticide use means less harmful release of chemicals to the environment which accumulates as waste and potentially harms wildlife. However, these can also come at a greater cost, and by no means does that translate into any real benefits when incorporated into skincare which is not consumed but applied.

In fact, organic skincare often boasts essential oils which can cause both allergic( in susceptible individuals) and irritant contact dermatitis( due to the concentration of most essential oils, it is not medically advisable to apply any type of essential oil directly to skin as it can result in a chemical burning type of reaction).

For truly beneficial skincare that has measurable scientific results, I would recommend using cosmeceuticals instead. Cosmeceuticals refer to skincare that is a combination of cosmetics and pharmeceuticals. They have drug-like benefits, such as improving appearance by means of its ability to affect the structure and function of the skin as recognised by dermatologists and research scientists. Read more about cosmeceuticals here.

For patients with otherwise healthy skin, whether they are in their twenties, thirties or beyond and who are interested in maintaining youthful skin in a cost-effective manner, I would suggest getting started on cosmeceuticals, and regular medical grade chemical peels supervised by a dermatologist, who would determine the concentration and type of acid suitable for your skin. A chemical peel treatment is designed to improve the appearance of the skin by gently stimulating the top layer of skin cells (epidermis) by applying a solution composed of fruit derived acids such as alpha-hydroxy acids, glycolic acids, lactic and salicylic acids. This stimulates the skin to regenerate, smoothening out wrinkles.

Rounding up the discussion here, I hope readers have gained some insight on the labelling of skincare as “organic” and what that doesn’t mean. It is not a defined or regulated term in dermatology and can lead to great misconceptions by the public, in addition to brands riding on a fad which delivers no real benefits skin-wise. As a dermatologist, I am all for public education for skin health. Skin health is not about “aesthetics”, the skin is an organ of the body just like the heart, lungs and the liver, and these tend to degenerate due to genetics, age as well as poor lifestyle habits. Healthy skin certainly looks good, but in the pursuit of beauty, one should always be wise, consult a dermatologist if you have a skin issue such as acne or skin sensitivity, rather than trying all sorts of products. While there is no miracle product that exists that can cure your skin woes, non-dermatologist-tested cosmetic skincare can worsen problem skin. If you have healthy skin and desire some radiance and want to preserve your youth, then go for cosmeceuticals, instead of ‘‘organic skincare” or any other type of skincare fad.

© 2017 Dr Teo Wan Lin. All rights reserved.

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Meet with Dr. Teo Wan Lin, consultant dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

Skin Cancer Diagnostics by a Dermatologist

October 29, 2017

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What is dermoscopy?

Dermoscopy is a skin examination technique used to evaluate skin growths as well as pigmented skin lesions, without the need for surgery. The accuracy of the technique is dependent on the operator’s experience, and can help facilitate the diagnosis of potentially fatal skin cancers such as melanoma.

The use of dermoscopy involves advanced lens magnification together with an intense lighting structure incorporated in a portable handheld instrument known as a dermatoscope. This instrument reveals skin structures and patterns and can be attached to computers or smartphones for transmitting images.

Some techniques used in dermoscopic interpretation would include pigmentation colour and structure. In terms of colours, a trained dermatologist will pick up hues in pigmented lesions ranging from black, brown, red, blue, grey, yellow and white. Some tips on patterns and structures that dermatologists specialising in skin cancers would involve determining if a growth has the following features of asymmetry, heterogeny, uniformity. Dermoscopic examination also gives clues to keratin on the skin surface,blood vessels, borders, ulceration which can be signs of skin cancers.

© 2017 twlskin.com. All rights reserved.

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Meet with Dr. Teo Wan Lin, accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

Aesthetic Treatments in Singapore:
Dermatologist Truths

October 27, 2017

By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre

The evolution of beauty treatments seems to have reached its pinnacle in this millennia, since there appears to be a whole new branch of medicine dedicated to “aesthetic medicine”. The regulatory medical council of Singapore worked with dermatologists and plastic surgeons last year to release a set of updated guidelines on the practice of aesthetic medicine in Singapore. It sought to stipulate what aesthetic medicine, was, and it was not, as well as regulations surrounding its practice in Singapore.

As a dermatologist, I am often asked by members of the public, my patients or even my colleagues in other specialties if I practice aesthetic medicine. The short answer is yes, but the long answer is that the question itself was wrong.

Since then, I realised how confusing it was for the layperson to navigate in this medical “specialty” and how I could not blame them for not understanding or asking the wrong question fundamentally. I seek to provide an insider perspective on how aesthetic practice should be regarded by the public.

Fundamentally, and amongst my peers, I do think that we, as as a community of medical professionals still believe (perhaps with some naivete on our part) that public opinion does hold us in an altruistic light. This is why I believe we owe it to the public to tell the truth. At the heart of it, I hope to show an honest perspective in the cut-throat aesthetic industry, advice that I have shared with friends, relatives and patients of mine and along the way enlighten readers on what to expect.

1. Doctors are trained to help people with diseases and aesthetic medicine is not regarded as a medical specialty

The public will be surprised to know that there is no internationally accepted definition of “aesthetic practice”. Aesthetic medicine is also not regarded as a specialty or subspecialty. For conditions relating to plastic surgery, the specialist recognised by the Ministry of Health would be an accredited plastic surgeon. In the same vein, accredited dermatologists specialise in treating both cosmetic and medical dermatology conditions, relating to skin, hair and nail health. The realm of aesthetic medicine encompasses the field of research and development that dermatologists and plastic surgeons specialise in. However, due to the increase in the number of non-specialists practising aesthetic medicine, medi-spas and the overlap with the lucrative beauty industry, it’s easy to get confused. Amongst these are also medical practitioners who have undergone rotations in dermatology or have pursued a family practice diploma in dermatology but are not accredited dermatologists.

The current Singapore guidelines issued refer to the UK Cosmetic Surgery Interspecialty Committee definitions for “cosmetic surgery” as the boundaries of “aesthetic practice”. Precisely, this would refer to procedures or surgeries that alter the appearance, colour, texture, structure, or position of bodily features, which otherwise would be considered to be within the socially acceptable range of ‘normal’ for that individual.

2. I am a dermatologist and practise aesthetic dermatology, but I am not an aesthetic doctor

The term “aesthetic doctor” is not regulated and is actually disallowed under the latest regulations. In the early years of my dermatological training, I spent a good amount of time in the medical dermatology department of a local tertiary hospital, mentored by an inspiring professor of dermatology, whose golden words I remember distinctly till today. In response to my enthusiasm to enter the dermatology specialty training programme, he reminded me, that “Wan Lin, you are training to be a dermatologist, and not a beautician. Dermatologists are not beauticians.”

To begin with, I entered dermatology because I was really fascinated by how the skin manifested all sorts of underlying internal conditions of the body in such a unique way. When my dermatology professors were able to diagnose complex diseases of the kidney, liver and even organ cancers, just by analyzing the skin, seemingly at a single glance, I was floored and was determined to become like them.

This is interesting now, that the word “aesthetics” is linked to the medical profession, and to be exact, dermatologists and plastic surgeons are considered the key opinion leaders in this field, which is increasingly practised by non-specialists such as general practitioners. This leads me to reflect upon what my mentor said to me long ago, that “dermatologists are not beauticians”, which is probably why I react with a certain degree of chagrin whenever someone suggests that I am an aesthetics doctor.

3. What is beauty ?

As a junior doctor several years ago, I rotated through the department of plastic surgery before I entered into my dermatology training. A particularly memorable doctor I met there was a respected plastic surgeon that did exclusively reconstructive surgery, meaning he would not be involved in any surgeries for cosmetic enhancement, due to his personal beliefs. In my time there, I learnt from this surgeon the most about reconstruction, which meant restoring anatomy in patients who have suffered from trauma or tissue loss from cancers/infections. Of all the cosmetic/aesthetic surgeries I participated in throughout my rotation, the ones that left the deepest impression on me were all reconstruction cases, when I saw how true beauty was when one could restore to its original form and function, rather than just changing one’s appearance so you could recreate the same K-POP idol pin-up look. The latter, by the way, is always changing. That’s just my personal take. It led me to reflect on the true calling of a doctor, even in the field of plastic surgery.

My private practice encompasses both medical and cosmetic dermatology cases. I own a variety of laser/aesthetic machines equipped with advanced technology and work with injectables such as fillers and botox. For concerns relating to pigmentation, irregular skin texture, scars, these to me are not mere “aesthetic” concerns because a dermatologist can diagnose each of these as specific conditions due to an underlying problem affecting the skin. Patients are also suffering from poor self-esteem and a lot become withdrawn, depressed and anxious thinking that nothing can be done about their skin. All of these concerns can also be definitively treated.

For patients who come to me for ageing concerns such as face sagging, face-lifting…I always ask them first for a picture of themselves at a time when they felt they looked their best. The last thing I feel any doctor should do is to make a patient feel they are not good enough. As a society, we are already made to feel we aren’t. By the time a patient decides to go to a dermatologist for help, my position is really to offer hope, support and treatment.

I am a strong believer in natural beauty, the definition of which is what is unique and pleasing to the eye, and not what everyone thinks is beautiful( at the moment). My goal remains to restore one’s youth, at the same time maintaining the uniqueness and individuality of one’s facial features. Afterall, your skin, being the largest organ of your body, degenerates with time just like your liver, kidney, heart, bones and joint. With laser technology, light is harnessed to trigger off new collagen formation, re-setting the genetically-programmed cell ageing process. With high-intensity focussed ultrasound (HIFU), this technology goes deep to the SMAS (Superficial Musculo-Aponeurotic System) layers where patients can now have a mini face-lift without going under the knife.

Every patient that comes to me for an aesthetic procedure gets a thorough run-through of how the different layers of skin tissue which make up the face movements interact as one ages. Consequently, each patient’s individual ageing process and treatments will differ. Aesthetic procedures like botox, fillers and lasers are not treatments that can be ordered off the menu like your lunch bento, especially when each comes with a set of its own risks along with its benefits. An accredited dermatologist or a plastic surgeon will analyse your facial anatomy, break down the cause of your ageing face, and correct those elements. Any other method of shopping for aesthetic treatments will at very best give a mediocre result, and at worst it can be outright dangerous.

4. Have problem skin? You don’t have an aesthetic issue, you have a medical condition of your skin that should be diagnosed and treated

Any perceived flaw on one’s skin can be attributed to a dermatological condition. Dark mark on your face after having a pimple? It’s post-infIammatory hyperpigmentation. Uneven skin tone? Take care you don’t actually have a skin pigmentation condition such as melasma. Enlarged pores and irregular skin texture? You could have suffered from acne in your teens and still have seborrhea, which is excessive production of oil from one’s sebaceous glands. Untreated acne over a long time leads to blackheads and open “pores”, as well as acne scars that can be indented, “ice-pick” or “box-car” type. To a dermatologist, every single of these conditions can be broken down to the diagnosis, the cause and medical treatment, which may also include lights and lasers.

All dermatologists advocate gentle skin cleansing, regardless of your skin being oily or dry. It is a myth that oily skin needs to be stripped of its oil in order to be healthy. Au contraire, sodium-laureth sulfate laden foaming cleansers and astringents( read: often alcohol or salicylic-acid-based toners) dehydrate skin, cause eczema and sensitivity in the long term.

 However, even though good dermatologist-formulated and tested cosmeceutical skincare delivers the nutrients for healthy skin, can improve acne and mild eczema, along with brightening and tightening skin for anti-ageing concerns, it does not actually treat medical conditions. With my brother, a pharmaceutical engineer, I formulate a brand of cosmeceutical skincare Dr. TWL Dermaceuticals which is an adjunct to the medical treatments I offer in my clinic. Even though I am a strong believer in the effectiveness and safety profile of cosmeceutical skincare, I always emphasise to my patients that no amount of good skincare can actually treat their skin problem (if they have one) since their conditions require medicated treatment. Skin conditions have to be diagnosed accurately before correct medical or laser treatments is administered. The use of cosmeceuticals helps to anti-age, lighten scars and complexion by delivering evidence-based pharmaceutical anti-oxidant ingredients to skin and also prolong/enhance the results of aesthetic treatments.

5. Everyone wants to look young and beautiful, but there’s nothing wrong with the existing you

No one really “needs” aesthetic treatments. Feeling overwhelmed by all the advertisements for fillers, botox, skinboosters, ultherapy and lasers? You probably are. It’s not wise to call up any medical aesthetics provider, check for the cheapest rate and order a botox or filler injection like you would deliveroo. These are all medical procedures which are regulated and comes with its own set of risks in the wrong hands. Do research, check your doctor’s accreditation. If you are concerned with ageing, seek the advice of an accredited dermatologist early from your mid-twenties onwards for prevention. If you are in your thirties, forties or beyond, fret not, your dermatologist would discuss your expectations and treatments and he or she can start you on a regimen including lasers and injectables like botox and fillers. Or refer you to a plastic surgeon if required. If you have a true skin condition such as acne, rosacea or eczema that’s troubling you, your dermatologist will first treat it. Very often, my patients have no more complaints about the look of their skin once its treated and realise that it was not anything “aesthetic” -related in the first place. Thankfully, before they spent a bomb on beautician facials, medi-spas or cosmetic skincare.

© 2017 twlskin.com. All rights reserved.

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Meet with Dr. Teo Wan Lin, consultant dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

What you need to know about cosmeceuticals

October 23, 2017

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What are cosmeceuticals?
Cosmeceuticals refer to skincare that has been developed from the combination of cosmetics and pharmaceuticals. They have medical or drug-like benefits, such as improving appearance through its ability to affect the structure and function of the skin and are recognised by dermatologists.

As these types of skincare contain bioactive ingredients, which means it has been laboratory tested and formulated, they ensure effective and proper penetration of skincare onto the skin. Cosmeceuticals differ from normal moisturisers or typical cosmetic formula as they contain anti-ageing, anti-wrinkle, sun-protective, anti-acne and anti-oxidant ingredients that have indeed been backed by dermatological research.

Who are cosmeceuticals for?
Cosmeceuticals are for everyone. They are commonly recommended by dermatologists as a complementary treatment for those who are undergoing cosmetic dermatology treatments such as lasers, fillers and botox for anti-ageing. It is also recommended as a form of skincare when treating skin conditions like acne. In addition, they serve as a cost effective option for patients to maintain the beneficial effects of such cosmetic treatments at the comfort of their homes and regular users of cosmeceuticals to maintain their youth and improve the appearance of their skin.

How to find the right type cosmeceuticals for you?
As cosmeceuticals are not regulated by the FDA or Health Sciences Authority in Singapore, as a quick rule of thumb, a product recommended by a dermatologist (check your doctor’s accreditation) would be safe bet. The skincare and aesthetics market today is flooded with cosmetic companies and even ‘doctor-designed’ skincare products by aesthetic doctors (who are not dermatologists) to add on to the public’s confusion of who’s the real skin expert.

One would be wise to do thorough brand research, look for the labels ‘dermatologist-tested’, ‘dermatologist formulated/recommended’ or just consult a dermatologist before you buy. As a cosmeceutical product, it should also ideally be formulated in a laboratory rather than in a cosmetic factory. It should also have the approval of a dermatologist. The reason these factors are important are because, one has to bear in mind that even when a correct active ingredient is present, it may lack effectiveness because of an inappropriate drug delivery system, compound instability, poor penetration, inadequate dosing or the ingredient itself may lack good clinical studies to back it up.

© 2017 twlskin.com. All rights reserved.

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Meet with Dr. Teo Wan Lin, consultant dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

3 Questions About Sensitive Skin Answered By a Dermatologist

October 3, 2017

By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre

Many patients that come to me say: “I have super sensitive skin and I break out easily from using the wrong kinds of products.” However, from a dermatologist’s point of view, skincare or makeup alone (especially if labelled non-comedogenic like most brands on the market are) do not cause breakouts or pimples. These are instead signs of acne-prone skin, which is a medical condition that needs to be treated with prescription medication.

1. How Do I Know If I have Sensitive Skin?

Make a visit to an accredited dermatologist. They will usually ask you the following questions:

Do you suffer from symptoms such as skin redness, flaking, itch or stinging pain? Did you have eczema, asthma or sensitive nose when you were young, or have a family history of eczema or sensitive skin? Does your skin get red and itchy when you use makeup or skincare products, or when you are exposed to a dusty or sweaty environment? Does your skin act up when travelling to a cold or dry climate?

Dermatologists diagnose true “sensitive skin”, with a medical condition known as eczema, where common exposures to the environment or skincare and make up can trigger off flare-ups.

2. What Is Defined As Sensitive Skin Then?

People with sensitive skin are likely to have atopic dermatitis, which is a genetically determined condition where the skin is deficient in certain fats. The skin acts as a barrier to the environment and, without a proper functioning skin barrier, any dust, climate change, pet fur, or even emotional stress can trigger off a flare-up.

 If you have never had any of these symptoms and suddenly experience “sensitivity”, especially soon after using a new skincare or makeup product, it might actually be a form of allergic contact dermatitis to an applied substance. This would be best reviewed by a dermatologist who might suggest a patch test and also receive appropriate medical treatment.

Undiagnosed and untreated skin sensitivity can become chronic and may result in scarring such as post-inflammatory hyperpigmentation which results in dark marks on one’s face.

3. So What Is The Solution To Sensitive Skin ?

RADIANCÉ FLUIDE™ is dermatologically formulated for sensitive skin to provide moisture and hydration, providing a light-weight feel in the day for a radiant makeup base.

Your dermatologist will prescribe you anti-inflammatory creams such as topical steroids of the appropriate strength and ceramide-rich emollients that replenish the skin barrier. In the case of any infection, oral antibiotics to clear the skin infection would also be prescribed. Oral steroids may also be required for severe eczema.

Here are three of the best skincare tips for people with sensitive skin: 

1) Look for “dermatologically tested and formulated” labels that are produced in certified laboratories and that work with dermatologists rather than cosmetic brands.

2) Get your dermatologist to recommend a gentle cleanser formulated for effective cleansing of eczema-prone skin.

3) Get your sensitive skin treated first before using anti-ageing products
Many anti-ageing products contain stimulating ingredients which may worsen sensitive skin. If you do use them, look for a product that’s recommended by your dermatologist.

© 2017 Dr. Teo Wan Lin. All rights reserved.

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Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.