Thursday, September 26, 2013

Asiatic Aesthetic series 232:Thanks for your visits

Thanks to all of you for the regular visits to my blogs.I appreciate it very much.
Hope the articles on aesthetic cleft surgeries and aesthetic medicine are of some benefit to you guys.
The number of blogs on cleft surgeries will decrease and there will be more regular blogs on newer aesthetic procedures.

here is a song i recorded for you all: "the year of the cat" -guitar solo

Saturday, September 21, 2013

Asiatic Aesthetic Series 231: Sultans of Smiles-folks who make it happen for cleft children

Thanks to Duncan Quirk and all Smile Train US friends who made 940 miracle smiles happen for cleft children in Arabia Felix from Feb 2010- August 2013.
I did this improvised solo of Knopfler's Sultans to let you all know that ,"You guys ROCK".
It was difficult traveling around dangerous zones but we got the smiles across the nation.
Thanks for the smiles.
Here is my video on you tube: 

Thursday, September 19, 2013

Asiatic Aesthetic Series 1:Cellulite -diet and exercise?

Cellulite was described as early as the 17th century. However it was only recently that the pathogenesis of this disorder was better understood as a problem of fat and fibrous tissue accumulation.

Cellulite is a colloquial term for deposits of fat and fibrous tissue causing dimpling of skin
The medical term is "sclerotic fibroadenoma panniculopathy".
It is not the same as  fat accumulation.
Female are affected mostly,in their post pubescent years.80-95 % of females have this problem, Males with hormonal imbalance may also be affected.
The common sites are on the thighs and buttocks
The hormone estrogen plays a primary role. It causes blood vessels to break and leak, as a result of which there is edema, and leakage of peptides,protease enzymens and growth factors which increases fat cells and the inflammation causes fibrous tissue to form with fat trappen in between. As a result one sees dimpling of the skin.
Exercise and diet have been tried many times but they do not help in cellulite reduction.
Therapies used are liposuction,endermologies,mesotherapy(phosphatidyl choline choline) without success.
Retinol addresses fibrobast acivity,caffeine addresses lipolytic acivity,-but are  not effective
Therapy should address blood vessel damage,inflammatory process,wound healing events,lipocyte stimulation.
Vit K has been tried  for vessel damage and leakage secondary to estrogen.
Vascular strength can be improved by grape seed extract which  oligomeric proanthicyanadins, which are powerful antioxidants.Guarana extract of paullina cupana seed from the amazon,has caffeine and theophylline like effects,lipolytic effect and some cellular stabilizing effect ,It is combined with grape seed extract and licorice extract to treat cellulite.The results are encouraging with this treatment.

Asiatic Aesthetic Series 2: Melasma-Asian Nightmare

Asian nightmare=melasma due to sun exposure

One of the worst nightmares for Asian skin Type 4-6 is melasma or hyperpigmentation of the skin. This is made worse by sun exposure,pregnancy,birth control pills,some cosmetics,diabetes,some medications

Superficial or epidermal melasma is easier to treat than dermal melasma which involves the dermis.This is the reason for  recurrence of melasma after treatment when the patient comes back months or two years later to complain of the same problem.Naevus of Ota has both epidermal and dermal melasma.

The skin is usually treated with a bleach like hydroquinone 4%,tretinoin,licorice,chemical peels and IPL . Laser treatment has an increased risk for PIH by 25%,long pulsed laser,fractional lasers, and IPL are ok,
 SKIN CONDITIONING IS ESSENTIAL  when treating this skin condition .If melasma is confined only to the epidermis,it responds well to treatment with superficial peels and lighteners.The deeper lesions take more time to respond to the treatment.

Asiatic Aesthetic Series 3: Here comes the sun..oh,no!

Increased sun exposure was thought to be beneficial in the past ,but today it is  a well known fact that UVA and UVB rays are harmful to the skin. Some common misconceptions in the past were -
a.Darker skin types do not need sunblock,only white skinned people need this protection
b. sunblocks are completely water proof and would last the whole day does not need sunblocks while indoors in an office with windows

Sun protection for whom?  Any ethnic group .
Asian skin may have PIH(post inflammatory hyperpigmentation),skin aging,skin cancers,photodamage.
Nearly 90 percent of photodamage to the skin is by the sun's rays.
 Sunblocks have to be applied every 2-3 hours,and the waterproof sunblock usually lasts for 40 minutes under water.Most people do not apply sunblock correctly. SPF 30 offers protection upto 91% and above this number (SPF 30 plus-100 etc) there is no advantage of the higher number.
UVA rays penetrate glass and cause photodamage and skin cancers;UVB does not penetrate glass but causes photodamage and skin cancers like melanoma.

UV skin damage causes faster collagen breakdown than with chronological aging.The sun damaged collagen fibers leads to accumulation of abnormal collagen and increases metalloproteinases(enzymes) ;this breaks down more collagen,leading to disorganized collagen.As a result we get solar scars and wrinkles.The first line of defence in our skin is provided  by the Langerhans cells in the epidermis and these cells are damaged by ultraviolet rays.

Wednesday, September 18, 2013

Asiatic Aesthetic Series 4:Acid peels for facial rejuvenation

What are superficial acid peels?
Superficial acid peels act on the epidermis-blue peel,GCA and TCA acid peels..
Those that reach the basal cells are blue peel,GA;depending on te concentration TCA can reach the pap and upper ret dermis-blue TCA;phenol is a deep peel.
Phenol is generally not uswed because of it's side effects like permanent hypopigmentation,cardiotoxic,deep peel.
How do acid peels act?
Goals of peeling- exfoliate,remove dead cells from stratum cornuem,stimulate fibroblast activity,remove scars,even skin surface,treat photo damage,treat pigmentary disorders,fine lines/wrinkles.

GCA- for light skin exfoliation,it has to be neutralized with cold water.All other peels are self neutralizing.

Salicylic Acid is  one of the best peels for acne ; goal is deeper exfoliation 30%, uses:mild acne and inflammatory acne/not CYSTIC acne/stubborn excess of sebum production
Miami peelS30 SA 30%,VitC,green tea extracts,antioxidants  self neutralizing, uses:acne,rosacea,photoageing,melasma
Miami Peel TM= LA7%,Sal A 7%,Citric acid 7%,kojic acid 7%,HQ 4%,ethanol(salicylic acid not soluble in water/need ethanol)  no need neutralize/uses:melasma,PIH,acne,photoageing/sun damage
Apothepeel=TCA 7%,SA7%,Phenol 7%,vitamins and microelements,retinoic acid 0.9%  target:deep dermis indications: improvement of skin texture and tone/fine lines wrinkles/age spots and hyperpigmentation  
Jessner peel= SA 14%,LA 14%,Resorcinol 14%,ethanol 100ml  of 94%      uses: superficial acne scars,fine lines and wrinkles,skin ageing  
Modified TCA= BRA biocell rejuvenation activator,Easy peel,Blue peel   BRA- TCA15%,Ascorbic acid 10%,phytic acid 2%,ROS rejuvenating system. Uses-epidermis renewal,skin hydration improvement,collagen and elastin stimulation(open pores,brighten skin,even tone and surface of skin

For epidermal peelings-GCA 35%,50%, Miami s30 peel,Miami peel,Apothepeel
For dermal peels-jessner,modified TCA peels

Blue peel ingredients=TCA30% ,colour blue FDC color no 1,non ionic base made to bind with TCA for slow release-acetyl alcohol,butyl hydroxyl toluene,saponins
For post peel management- regular evaluation 2 wks,oozing ,transudation,scabs-use domeboro astringent (aluminium acetate)
 Prevention and Rx of complications by pre and post peel conditioning,pre peeling adequate information, 
Patients should be advised not pick on scabs,to avoid the sun, and use a customized skin regimen

 Short term complications in the healing process-oozing and scabs,herpes,pain,psychological support

 Long term complications- PIH (post inflammatory hyperpigmentation-use skin conditioning programme as prevention,), recurrence may be due to sun,drugs,pregnancy,hormones , hypertrophic scars

Asiatic Aesthetic Series 5:MY DERMNAYSEUM-taking care of my skin

A healthy skin is smooth,properly hydrated,without scars, and functioning properly. One has to do regular workouts for ones own skin to get results.The goal of a dermnayseum is to achieve a healthy skin that looks and feels good. The normal pH of the skin is 5.5.

Skin conditioning goals are to speed up healing processes,avoid complications, and obtain faster and better results. Skin conditioning regimes target the keratinocytes,melanocytes,fibroblasts,dermis vascularisation
Our peptide units are synthesized in ribosomes ,tropocollagen is assembled in the Golgi complex-tropocollagen molecules aggregate extracellularly to form collagen fibrils

 The first step is to remove the dead cells which accumulate on the surface.exfoliation  of the skin is done with substances called  alpha hydroxy acids(Glycolic Acid and lactic Acid) ;phytic acid is  a light bleacher and exfoliant
Next,the skin is treated with a  bleaching agent like 4% hydroquinone;the other bleaching agents that are used are arbutine,licorice,lumixyl(peptide),kojic acid
The skin is then stimulated with acid using retinoic acid 0.025-0.1% in combination (with HQ=blending agent)Retin A gel acts on fibroblasts  
Skin care is continued using topical antibiotics,aloe vera,antioxidants,sun protection with SPF 30+,and other products like Vit C,and the newer peptides.

There may be some problems with retin A gel -redness,dryness,itching and burning,flaking,worsening;for this,one needs to stop for 3 days and continue about once a week.

Usually the skin is conditioned for 6 wks, before peels and stopped  for 3 days before the peel;after this, skin care is maintained every 2 weeks with moisturizers and lighteners.

Goals of peeling are to exfoliate,remove dead cells from stratum cornuem,stimulate fibroblast activity,remove scars,even skin surface,treat photo damage,treat pigmentary disorders,fine lines/wrinkles

Is it absolutely necessary to condition my skin before peels?

If the skin is treated after proper conditioning,the chances of complications of peelings and lasers will be decreased significantly.This is true especially for darker skin types 4,5 and 6.

Asiatic Aesthetic Series 6:Dry skin blues?

                    Most of us have dry skin problems and want easy solutions to this condition.

           PHYSICAL PEELINGS are not not chemical peels!
Physical peels include cryotherapy, dermabrasion, microdermabrasion, hydrafacial, ablative lasers.

Why do I need physical peels?

The skin renews itself q 20days for 15-25yr olds  ;in the 30s- this is slower @ every 12weeks-the sebaceous or oil producing glands are less active,leading to a dry skin condition.

Physical Peels:
Cryotherapy-utilizes cold to affect superficial epidermis CO2/nitrogen;for warts,granuloma annularis,AK,molluscum contagiosum ;problems of permanent hypo/hyper pigmentation.It is not a popular mode of treatment anymore because of the side effects like hypopigmentation.
Dermabrasion-invasive,bloody, causes hypopigmentation permanent,hypertrophic scars;this is an obsolete method and should not be used anymore.It was used about ten years ago and had many problems.

What is microdermabrasion?

These days we use  microdermabrasion- inert aluminium oxide crystals to abrade skin;safe, used for exfoliation ,and is non invasive .it decreases superficial hyperpigmentation,photodamage,diminish fine lines,wrinkles,shallow acne scars. Better penetration of skin care products by 50%- and can also improve laser and IPL results.The technique of microdermabrasion is easy to learn and gives good results.

Hydra facial is the newest advance in non laser resurfacing;this is a hydra microdermabrasion procedure that combines cleansing ,exfoliation,extraction,hydration,and antioxidant protection simultaneously to improve fine lines/wrinkles/acne scars,hyper pigmentation
It is used for congested pores,uneven skin tone..various serums infused after the suction-peptides,active 4,antioxidant 6,glysal,betaHD skin solution.. an increasingly popular mode of treating the skin and improving the overall appearance.

Tuesday, September 17, 2013

Asiatic Aesthetic Series 7: Laser Hair Removal :permanent removal or permanent reduction?

Laser HR by IPL and Laser-IPL is not ideal for darker skin; diode lasers are better for darker skin

 Types of LHR lasers are
 Ruby 694nm,alexandrite 755nm,diode for darker skin 810nm,NdYaG 1064nm,IPL 600-1200nm

LHR red haired patients do better with the ruby laser,
If one is to chose which laser hair removal machine to buy ,it may be good to invest in the Alexandrite Laser which is the workhorse for LHR ,it is good for  FP 1-3; those with darker skin 4,to be used with caution –better 810nm diode; for Type 5,6 safer with 1064nm Nd YaG
 hair growth cycles include are needed - anagen(growth),catagen(transition),telogen(resting)  LHR works only in anagen.multiple Rx as a result..

Hair looks patchy during Rx because not all hairs are not in the same growth phase.

Will the hair be removed forever by lasers? 

This is the commonest question patients will ask the physician.

LH reduction is not permanent removal ; it considered permanent reduction when a significant amount of hair does not return for a period of time longer than the complete growth cycle
Hair growth cycles-where LHR will work   well are on theface Q4wks,underarm q 4 wks,bikini q 6 wks,lower leg q 6-8wks ( lighter hair=less effective LHR)

LHR works when energy is applied so hair follicle is destroyed by heat (selective thermolysis) ;laser hair removal will not work in grey and white hairs because there is no melanin.Melanin is the target in laser hair removal.

Asiatic Aesthetic Series 8: Non Invasive and minimally invasive body treatments

Non invasive body contouring -is achieved using different radiofrequency machines,some lasers(minimally invasive)

 Zerona or "cold laser" is used for all skin types,it disrupts the cell membrane, relesing  the cellular contents of fat cells-contents enter interstitial space and removed by detoxification, while leaving capillaries and other cells within the interstitial space intact.
Venus freeze-2applicators,octipolar with 8MP synthesizers for large treatment areas(abdomen,buttocks,thighs and arms) ,diamond polar 4MP synthesizers for smaller areas like face,neck and arms.all skin types treated. In Venus Freeze-energy rotates between any 2 synthesizers in an organized matrix,which homogenously raise the temp over the entire treatment area and creates a dense energy matrix that penetrates deep into the different skin layers;magnetic fields increase fibroblast derived collagen production through a non thermal mechanism of membrane stimulation
Vela shape- combines bi polar RF,infrared light energy,plus vacuum and mechanical massage. The heating produces a safe and fast treatment with no downtime-increases metabolism of stored energy,increases lymphatic drainage and reduces or shrinks the size of fat cells
Zeltique-uses cryolipolysis;employs cold to reduce fat cells thereby enhancing shape-cold damages the fat cells causing an inflammatory response,”apoptosis” and shrinkage and digestion by the body then,removed through the liver
Smart lipo –with 1064Nd YaG ,watt 6-18W liquefies fat cells and coagulates small blood vessels-hollow cannula sucks out the ruptured fat cells ;performed with tumesecent anesthesia and 1-2mm cannulae;laser energy causes collagen shrinkage
Cool Touch-1320nm wavelength targets water in the connective tissue for collagen rejuv and skin tightening ;high peak power disrupts and liquefies the fat using short pulse with less collateral damage
Tickle lipo uses low frequency acoustic infrasonic vibration which allows for removal of body fat while respecting surrounding tissues-smooth contour and rapid recovery-there is no heat,less damage to fat and can be used for fat transfer simultaneously;using 10Hz frequency –the vibration interferes with the conduction of painful stimuli by activation of nerves which do not transmit pain signals(non nociceptive fibers)-use tumescent anesthesia
Slim lipo uses 924nm and 975nm wavelengths to selectively target adipose and dermal tissue for efficient fat melting through laser assisted lipolysis.
VASER –small diameter grooved probes deliver ultrasonic vibrating energy at 36kHz-maintains fat cell viability,targets fat cells selectively;pulse delivery of the ultrasonic vibratory energy 50 % less energy cf to earlier US devices

These machines are generally expensive and treatments are not permanent;one has to visit the clinic for maintenance and follow up procedures. But the main advantage lies in their safety and quick results.

Asiatic Aesthetic Series 8: Neo Aesthetic Solutions Part 1 Aesthetic Lasers

Successful aesthetic lasers are used to preserve surrounding skin, but destroy targets viz. blood vessel,pigment,hair follicle
Lasers  are used in cosmetic medicine for hair removal,scar revision,tattoo removal,vein removal,wrinkle reduction,skin rejuvenation. Intense pulse light is not a laser but provides intense light for various treatments.Radio frequency  is high frequency current that is applied to warm tissue,not a laser but produces neo collagen formation and skin tightening
The wavelengths of medical lasers are within the safe limits and do not emit ionizing radiation like harmful
 x rays,gamma raya,microwaves and cellphones.
Ultraviolet Invisible-Eximers 193-351nm
Visible-argon 485,514nm, KTP 532nm,Green HeNe 543nm, PDL 585,595nm,He Ne 635nm,Alexandrite 755nm,Diode 810nm
Infrared Invisible-NdYaG 1064nm,NdYaG1320,NdYag1440, CO2 10,600nm

Common aesthetic lasers and wavelengths-
KTP 532nm green-pigmented,vascular(red)
Alexandrite 755nm infrared for LHR/pigment
Diode 810-1400nm LHR/veins/skin rejuv
Pulsed dye laser 585-595 nm yellow, vascular(red)
Nd:YaG 1064 nm infrared lhr/veins
Er:glass 1540nm infrared fractional
Er:YaG 2900 nm infrared resurfacing
CO2 10,600 nm infrared resurfacing

 The problems of aesthetic laser are-direct viewing hazards as well as reflected hazards.

What about dark skin types for laser treatment?
Radiofrequency is combined IPL –safer for darker skin;enhances skin rejuv and augments hair removal..bipolar RF electrodes are at edges of light crystal
RF leads to dermal heating with collagen stimulation and neogenesis;there is no chromophore INTERACTION -SAFE in all FP types!

 Should the skin be conditioned before laser treatments?
Skin conditioning decreases risk of PIH(post inflammatory hyperpigmentation) ;for hypopigmentation-fraxel lasers may help. 

Asiatic Aesthetic Series 9: 2013

Welcome to this season's new discussions on aesthetic solutions.From now on, most of the blogs will focus on  various aesthetic solutions - from skin pigmentations to scars and cellulite.
Included are  state of the art techniques for treatment of all types of acne,acne scarring ,nutritional cosmetics,antiageing advances and other useful treatment options for melasma as well as RF,Lasers,PDT,PRPM and antioxidants.

Skin management options include exfoliation, stimulation and prevention of problems.
Welcome to the exciting world of "MY DERMAYSEUM- I will go step by step into all the possible ways one can have a youthful  and more attractive appearance".
Image and Experience are everything in today's aesthetic universe. Stay fine tuned to this blog to get the most out of the blogs that are intended to make you LOOK and FEEL good!

Thanks and bon chance,

ASIATIC AESTHETIC ..your step by step solutions to reinventing the fountain of youth