As we age, our body slows downs the regeneration of skin cells, collagen and hyaluronic acid that are essential to keep a firm and elastic skin. The thinner and less elastic skin on the face and body tends to sag and fold; wrinkles and age spots appear and many experience uneven tone and pigmentation. In some cases, when an individual has spent a great deal of time in the sun, UV exposure will contribute to a leathery, unhealthy appearance. Fortunately there is an array of treatments that can help address damaged and ageing skin.

By Chow Ee-Tan & Lily Wong

The Rise Of Medispa Treatments
There has been a huge growth in the field of aesthetic medicine and medispas in the last five years. In Malaysia, more and more doctors are being trained to do aesthetic procedures, as they are relatively safe and simple to do in a normal clinic setting.

“People are earning a higher income and are more aware that it’s about growing old gracefully and live well into their golden years,” says Dr Maryati Maharon, aesthetic doctor at Faceworks Aesthetic Clinic at Starhill Gallery, Kuala Lumpur. “Aesthetics play an important role because they want to look young, stay young. It gives them confidence.”

The average age group of her patients is 35 to 50. Her youngest patient is 16 and the eldest is about 70. Surprisingly, 60 per cent of her clients are male while 70 per cent are foreigners. Men tend to go for treatments for the face more while most body treatment patients are women.

She says according to studies from The American Society of Plastic Surgeons (ASAP) 2008, the top non-surgical cosmetic treatment in the United States is BTA, followed by hyaluronic acid dermal fillers and laser treatments. In her clinic though, the most sought-after treatment is Fraxel laser treatment – which can be used to treat acne scars, accident scars, pigmentation and poor skin texture. “It is important that patients are comfortable and confident with their doctors,” she says. “Before a treatment, I would always talk to my patient and ask if they are doing it for themselves and not anyone else. I would make sure my patients have a solid understanding of what is to be done, the results expected as well as what are some of the side effects that could occur,” she says.

Ageing Face: MEDISPA Solutions

Wrinkles and Fine Lines
Common Signs: Tiny wrinkles form around the lips while permanent crease lines and crow’s feet form on the brow and around the eyes.

Sagging Neck Skin
Common Signs: The tissues of the jaw and neck hang down into jowls and double chins as the skin of the neck droops into folds and wattles.

Droopy Lids
Common Signs: The eyebrows drop, and loose skin folds around the upper and lower eyelids, causing a tired appearance.

Beauty Tip
Post-Treatment Skin Care
Wearing sunscreen immediately after laser or light-based treatments helps protect skin from UV damage and overexposure to the sun. Since the cells will be especially vulnerable to skin damage during the post-treatment phase, you’ll need to find sun protection with an SPF 25 or higher. Also you may not be able to wear makeup or apply chemical-based skincare products for a few days.

Lifestyle Tip
Healthy Nutrition
Increase the levels of protective anti-oxidants in your systems to mitigate the effects of skin damage. This can be achieved through a diet rich in fruits and vegetables (especially those richly coloured, such as berries, spinach and sprouts) which are particularly beneficial to your skin.

1 Solution | Laser Skin Resurfacing Good For | Improvement in fine lines, wrinkles and pigmentation of the entire face A technique which allows skin repair from within, laser skin resurfacing is used for the treatment of fine lines or wrinkles, scars and skin-discolouration, primarily around the eyes and mouth but also on larger areas of the face. There are different types of lasers that work at various layers of the skin. For instance, non-ablative lasers do not burn off the skin surface but target the tissue under the skin and stimulate new collagen growth. Fractionated lasers, such as the FraxelTM, and CO2 fractional lasers are more promising as it shoots the laser beam in multiple smaller spot sizes per area, leaving enough normal tissue surrounding to allow fast and prompt healing. Procedure | The laser penetrates and removes the number of outer skin layers necessary to uncover the layer not affected by imperfections. It feels like a rubber band is being gently snapped against your skin. Once that layer is exposed, healing can begin to rebuild new skin that looks younger, reducing the signs of ageing and sun damage. Treatment Duration | A few minutes to an hour and a half, depending on the amount of resurfacing you need. Number of Treatments Needed | Two or more sessions to penetrate deeper areas. Downtime | Few days to few weeks, depending on type of laser used. Reported Results | Overall treated area looks smoother, tauter, and healthier due to reduced signs of ageing like wrinkles and fine lines. Uneven skin pigmentation also improves during recovery while freckles, sun spots, and other discolouration will begin to fade or disappear. Side Effects | Swelling and mild discomfort; red, crusted appearance on the treated area for 3 to 10 days; skin may look bright pink for weeks. Avoid sun exposure until all skin colour has returned to normal. Not for You If... You have olive, suntanned or black skin (as it will take you 6 to 9 months to regain your normal pigmentation after treatment); you are prone to scarring; you are taking certain medications or you have a skin disorder. 2 Solution | Radiofrequensy Tightening Goff For | firming, defining and enhancing sagging and loose skin Radiofrequency (RF) is a safe and effective cosmetic procedure that is clinically proven to help smoothen, tighten and contour skin for a younger appearance. The treatment delivers natural looking results with little to no downtime by heating the innermost layers of skin. On the face RF can treat sagging skin, loose jowls, lack of definition in the jaw line, sagging neck skin, wrinkles and fine lines. On the body, RF can treat wrinkled, sagging or bulging skin as well as the appearance of cellulite. The most powerful RF machine is the Thermage® where a single procedure shows extremely good results. Radio frequency surgery differs from laser surgery in that the laser treatment tends to scatter or absorb in the upper layers of skin, which make it extremely difficult to work with deeper layers without totally doing harm to the skin’s surface layer. Procedure | Depending on the device being used and your practitioner, a “treatment grid” ink transfer may be applied over your face to assist the practitioner in navigating your face whilst delivering the RF energy; helping to assure an even application of the RF and to prevent inadvertent overlapping of treatment. Treatment Duration | 30 minutes to several hours, depending on the size of the area you are having treated. Number of Treatments Needed | One Downtime | No Reported Results | The skin appears tighter and firmer, with better elasticity and a more youthful overall appearance. Results are subtle, but immediately visible, and may continue to improve over the months following treatment. Side Effects | Mild redness immediately following treatment (similar to a sunburnt look), but this usually disappears quickly. Not for You If... You have a sunburn as you would be more likely to suffer pain from the addition of heat to the already damaged skin. 3 Solution | Intense Pulsed Light (IPL) – Photofacial Good For | Visibly reducing the signs of ageing and sun-damaged and reddened skin A light-based treatment that utilises the latest advances in laser technology, the Intense Pulsed Light (IPL) treatment (sometimes called photofacial or fotofacial) is used to help treat everything from sun damaged skin to rosacea, age spots, premature wrinkles, pigment problems, bags under the eyes, and large pores on the face, neck, and chest. This procedure works by penetrating deep below the skin's surface to help start the production of new collagen and other connective tissues. It also encourages the blood vessels under the skin to constrict skin, reducing lines and facial redness. This process leaves the skin rejuvenated and smooth, starting from the very first treatment. IPL Photofacial is an excellent alternative for anyone seeking a non-surgical procedure with a proven track record for being safe and successful. IPL devices have also been used as methods of hair removal. Procedure | Your skin care specialist will apply brief pulses of bright light to the skin through an IPL handpiece. The number of pulses you receive will depend on the size of the area being treated. This treatment can be somewhat painful for some, as the feeling of the laser beam on the skin is usually akin to that of a snapped rubber band. However, the pain usually subsides very quickly after treatment. Treatment Duration | 15-30 minutes Number of Treatments Needed | 5-8, typically scheduled across three-week intervals. Downtime | Little to no downtime Reported Results | Long-lasting; additional Photofacial treatments may be needed after a couple of years. Side Effects | Temporary redness or swelling; blistering and bruising. Not for You If... You have tanned or naturally dark skin as you may experience changes in skin pigmentation after treatment; you are taking the medication Accutane® (you should not have an IPL photofacial until at least six months after you stop using the drug); you are pregnant (you should postpone treatment until after you give birth).

Visible Ageing Signs: MEDISPA Solutions

What Causes Skin to Age?
Skin ageing can be caused by intrinsic factors or extrinsic factors. Intrinsic, biological or internal ageing is basically the natural ageing of the skin. The way it ages is programmed in the genes and therefore it is inherited. Extrinsic or external ageing is caused by external factors such as the sun and the environment. A third group that may contribute to skin ageing is mechanical factors.

Age Spots
Common Signs: flat, brown discolourations of the skin on the back of the hands, neck, shoulders and face.

Sagging Skin & Cellulite
Common Signs: “cottage cheese” and dimpled appearance on thighs and buttocks, flabs around arms and uneven folds on skin.

Note: This information is intended to supplement, not replace, a consultation with a board certified physician. To find out if you could be a candidate for one of these procedures or to learn more information about these procedures, please contact your doctors for a private consultation.

Lifestyle Tip
Safe Sun
By either avoiding the sun or, more practically, applying an SPF product (in excess of 15), the harmful effects of UV damage can be mitigated. Many women have added an SPF product as part of their daily make-up application regimen.

1 Solution | LPG Endermologie Good For | Minimizing the appearance of cellulite and regaining suppleness of the skin LPG Endermologie is the first FDA-approved machine and procedure to temporarily yet effectively reduce cellulite. It increases circulation, relieves minor muscle aches and pains, and relaxes muscle spasms. The machine has suction and motorised vibrators that massage your skin. Gentle suction mobilizes your connective tissue and the vibrators help to increase circulation, thus facilitating exchange of fluid and clearance of fat. It closes the gap between the two forces that originally created the dimpled appearance, thus reducing the appearance of cellulite. Procedure | Motorised rollers are gently smoothed over the full length of your body and then concentrated on the problem areas. The controlled suction gently lifts and rolls your skin, to deeply massage the affected areas. Only a certified endermologist can provide this service. Treatment Duration | 30 minutes Number of Treatments Needed | 15-24 sessions of treatments are needed for lasting results and monthly maintenance sessions are recommended. Downtime | No Reported Results | Approximately 6 treatments will be necessary to begin seeing results; improved skin tone, and there are reports of weight-loss among users. Side Effects | You may experience tiredness after a treatment due to metabolism being stirred up during treatment and re-hydration is required after and between treatments through regular water intake. Not for You If... You are pregnant, or have given birth within the last 6 months; surgery in the last 6 months; you have conditions like hernia, painful varicose veins, infection/skin rash, cancer, growing tumours, any form of infectious disease, HIV, deep vein thrombosis, phlebitis, anti-coagulant treatment, inexplicable and persistent pain. 2 Solution | Body Microdermabrasion Good For | renewing skin to a thicker, healthier, more youthful appearance Microdermabrasion treatment on the body is a safe, relatively gentle solution to improve the rest of our bodies as it effectively treats stretch marks, fine lines and wrinkles, discolouration, and scarring regardless of where they appear. As microdermabrasion helps produce thicker, healthier skin layers, multiple treatments are vital because they encourage the production of a new layer of skin cells that contains higher levels of collagen and elastin. Both of these components are essential for vibrant, healthy skin, and they will further improve your complexion and the overall appearance of your skin. This, in turn, improves the complexion and gives the skin a more radiant, vibrant glow. LPG Endermologie is the first FDA-approved machine and procedure to temporarily yet effectively reduce cellulite. It increases circulation, relieves minor muscle aches and pains, and relaxes muscle spasms. The machine has suction and motorised vibrators that massage your skin. Gentle suction mobilizes your connective tissue and the vibrators help to increase circulation, thus facilitating exchange of fluid and clearance of fat. It closes the gap between the two forces that originally created the dimpled appearance, thus reducing the appearance of cellulite. Procedure | The clinician directs a stream of tiny (“micro”) aluminium oxide crystals through a hand piece that is placed against the skin. These dermabrasion crystals exfoliate the skin, and the mild suction created by the microdermabrasion system removes the skin debris and crystals. You may experience a slight warming sensation. Treatment Duration | 30-60 minutes Number of Treatments Needed | 5-12 treatments spaced 2-3 weeks apart. Downtime | No Reported Results | Immediate and noticeable. Common results include improvements in the colour, tone, and texture of treated areas. Side Effects | Increased skin sensitivity and risk of sunburn. Not for You If... You have deep scars, active keloids, undiagnosed lesions, a recent herpes outbreak, warts on the face, active acne (stages 3 and 4), an autoimmune system disorder, or unstable diabetes; you are pregnant. 3 Solution | Mesotherapy Good For | Reducing or eliminating cellulite and sagging skin Mesotherapy involves injecting microscopic quantities of natural plant extracts, homeopathy agents, vitamins, minerals and amino acids into the skin to treat a variety of conditions. It is painless when tiny “medicinal bullets” are delivered directly into the mesoderm (middle layer of skin). Among its many applications, Mesotherapy can be used to reduce cellulite, to reduce visible ageing signs and fat spots. Mesotherapy is said to be able to target specific areas or spots where there is excessive fat. To counter cellulite, doctors can create a formula to enhance impaired circulation and repair damaged connective tissue thus smoothening the skin. To reduce signs of ageing on the skin, vitamin and antioxidant can be injected under the skin to rejuvenate the cells, stimulate collagen and elastin production. Mesotherapy can also provide micronutrients to accelerate re-growth and hair quality and density. Procedure | Your doctor will carefully map the treatment area. This stage is particularly important in the treatment of cellulite, as cellulite may only be visible when the body is in certain positions. Then, the doctor will cleanse the area with alcohol and use short, thin needles to provide precise treatment to your specific problem areas. During the procedure you will feel some pricking from the needle; however most patients say this is easily tolerated. Treatment Duration | less than 60 mins Number of Treatments Needed | The number of visits can be anywhere from 5 to 15 or more especially with hair growth where treatment is over 6 months period. Downtime | No Reported Results | Immediate, improvement in 2-3 sessions. Long lasting, but not permanent. Patients do need multiple follow up treatments to maintain desired results. Common mesotherapy results include overall weight loss, the firming and smoothing of skin previously dimpled by cellulite; and spot weight reduction. Side Effects | Bruising or swelling at the injection site and a slight itching lasting only a few hours after treatment. Temporary skin discolouration can also occur and will resolve on its own. Not for You If... You are an insulin-dependant diabetic; you are pregnant or you have a history of stroke, blood clots or heart disease.