What happens to skin as we age?

Skin loses elasticity, looks sallow, duller and develops pigmentation. Wrinkles appear because of the loss of elasticity.

There are also changes to the structures below that support the skin, namely bone, fat and muscle.

Cheek bones start to flatten and fat pads start to move downwards creating hollows under the eyes and in the temple area and a flattening of the brow. The movement of facial fat downwards together with the loss of elasticity cause the formation of jowls and hollows in our faces.

With age, facial muscles become over active causing lines and wrinkles. Lines also develop on both sides of our mouth and corners of our mouth start to droop. All of these not only make a person look older but tired and sad as well.

This aging process is hastened by sun exposure and smoking, which fortunately, are two things that we can do something about.

What can we do to slow down the ageing process?

Smokers are encouraged to quit smoking and everyone should use sunscreen daily and diligently. Limit outdoor activities to the periods before 10a.m. and after 5p.m. will also help to prevent pigmentation and wrinkles.

Eat a balanced diet high in low GI carbs, vegetables, fruit, lean protein and good fat and avoid or decrease the intake of food and drink high in sugar.

We should then tackle the ageing face by layers, starting with the skin and then addressing the supporting structures below.

What can we do for ageing skin besides the diligent use of sunscreen?

Cosmeceuticals or medical grade skin care are imperative for glowing skin and to slow down the effects of ageing. Cosmeceuticals are able to stimulate collagen production, hydrate, improve texture, treat acne and reduce pigmentation. Cosmeceuticals include serums and moisturisers, creams that stimulate the production of collagen and creams that exfoliate the dead cell layer. Using cosmeceuticals regularly turns the clock back by making the complexion look clearer, hydrated and pores more refined.

Pigmentation should be treated if present. A correct diagnosis of the type of pigmentation should be made so that the right treatment can be prescribed. Pigmentation in general is treated with lightening creams, laser and IPL.

Wrinkles like frown lines and crow’s feet caused by our muscles of expression are treated very effectively with BTX-A.
Judicious placement of BTX-A can also cause the brow to be lifted, minimise saggy jowls, relax and lengthen the chin and treat neck lines and bands.

Are cosmeceuticals able to tighten lax skin?

Cosmeceuticals alone are not able to control the loss of elasticity in the deeper layers of the skin. To stimulate collagen formation, regular maintenance treatment with laser, IPL and radiofrequency are recommended.

However even these maintenance treatments are not sufficient to treat saggy skin, hooded eye lids and a droopy jawline. These have to be addressed by skin tightening machines like Thermage CPT and Ultherapy.

How do skin tightening with Ultherapy and Thermage CPT work?

Ultherapy and Thermage CPT are 2 systems designed to help tighten and lift the skin on the face and neck. In fact, Ultherapy is FDA cleared for lifting the eyebrow, resulting in a youthful looking set of eyes. Thermage also has a special treatment just for the eyes.

Ultherapy sends ultrasound waves deep into the skin to heat it up while Thermage uses radiofrequency waves to do so. Heating the deep layers of the skin stimulates and promotes new collagen formation. The skin tightening and lifting continues over the next 6 months as new collagen is laid down.

In addition, Thermage and Ultherapy may also be used to tighten skin on other parts of the body like the underarm skin and tummy.

What about the hollows and folds that develop in the ageing face?

Tightening the skin will not get rid of the hollowed areas in the face caused by the downward migration of fat and changes in our bone structure. Volume enhancing fillers like Voluma can be injected to take the place of bone and fat lost through the ageing process.

Fillers are also used to lift sagging skin, correct saggy jowls and left the brow. Lips that become thinner with age and turn downwards and inwards may also be corrected successfully and naturally with fillers.

What is the inverted triangle of ageing?

A young person has a “V”shaped face. With age, this inverts and the lower face and jaw line becomes squarish while the forehead becomes narrower. This change in facial shape may be addressed by a combination of non-surgical treatments like Ultherapy, Thermage , BTX-A and fillers. There is no down time and the procedures do not take much time to do.


What is it?

Acne is caused by inflammation of the pilosebaceous unit (aka the hair follicle and oil gland). This causes blackheads, whiteheads, pimples and larger lesions called nodules and cysts.

Acne occurs on the face, chest and back and may cause scarring.

What causes acne?

People with acne produce more keratin which blocks drainage of oil from the oil gland. Keratin is a protein made by skin cells.

Acne sufferers also secrete excess oil as they are more sensitive to male hormones in their body. Note that ladies also have male hormones. The excess oil and keratin form plugs called whiteheads and blackheads or comedones.

Acne sufferers also have an acne bacteria called P. acnes which act on these comedones causing inflammation. These inflamed lesions are commonly called pimples, which are red bumps or red bumps with pus. More serious inflammation results in larger bumps called nodules and cysts.

What can we do about it?

Acne must be treated early to prevent depressed scars which will last for life. Treatment targets the processes that cause acne.

Treatment for acne comprise skin care in combination with procedures which speed up clearance and make the skin clear and smooth. Sometimes oral medication is also prescribed.

What type of skin care?

We will recommend an appropriate cleanser that will remove surface oil effectively and gently. Creams will be prescribed to treat and reduce the number of comedones. Excess keratin will be tackled with gentle fruit acids. Antibiotics and antiseptics applied to the skin will clear acne bacteria.

In addition, it is important for acne sufferers to keep their skin moisturised and use sunscreen. We have light and oil free moisturises and sunscreens that will not aggravate acne. They make the skin feel hydrated and not dry and irritated as irritation may cause acne to flare.

What about oral medication?

Those whose acne is not controlled by oral medication may be prescribed a course of antibiotics or isotretinoin tablets.

Do you treat acne with injections?

Large pimple and nodules should be treated early with a small injection of steroids which will reduce the inflammatory process and cause the large lesion to reduce in size within 2 days. This not only helps it to heal quickly, it also prevents scar formation.

What are the procedures that help acne clear up?

The carbon laser peel is very effective in helping acne clear up and making skin smooth and pores look finer.

IPL is also useful as it has a blue light that helps kill acne bacteria, and IPL treatment helps reduce the red spots found in acne sufferers complexions. IPL also results in an instant glow immediately after treatment, makes pores look finer and evens out the skin tone.

Silkpeel is another effective procedure where the surface of the skin is exfoliated and this help get rid of excess dead skin and keratin. Healing lotions infused during the procedure penetrate and help to unplug the oil gland.

There is another procedure which has minimal downtime and that is the chemical peel. A stronger concoction of fruit acid is applied to the skin which will cause the topmost layer to peel. In the process, pimples will dry up and comedones are loosened. The face takes about one week for all the dead skin to peel off, and the result is fresh, clear and hydrated looking skin. Chemical peel is also effective in treating acne on the back and chest.

Procedures not only speed up the healing process, they also make the skin look radiant and glowing, so that not only will you have acne free skin, you will also have beautiful skin.

Can we prevent acne from forming?

As the saying goes, prevention is better than cure. After the acne has cleared, we will recommend a maintenance plan with daily skin care and procedures to prevent new acne from forming and keep the skin clear, smooth and glowing.

Is there any food that we can eat to prevent acne?

In general, one should eat a healthy balanced diet for good skin. For acne in particular, eat low GI carbohydrates (whole grains, beans, lentils) and avoid sugar laden food and drinks. Excessive intake of dairy products may also aggravate acne.

Is there anything else that I can do?

Keep hair away from affected areas.

Do not clean your skin more than twice a day as acne is not caused by dirt.

Do not lean your face on your hands for prolonged periods.

Most important of all, do not pick or squeeze pimples as the resulting inflammation may make it worse and cause scarring.

What causes acne scars?

An inflammation of a pimple may damage the dermis, which is the deeper layer of the skin. Scars form when there is damage to the dermis. Before the treatment of acne, inflammation has to be reduced and this means no squeezing of pimples as it may cause damage to the dermis, leaving an acne scar.

What are the types of acne scars?

Post inflammatory hyperpigmentation (PIH), which is a dark spot left behind by a pimple. This usually fades away after a few months.

Depressed scars of which there are a few types: ice pick scars which are narrow and deep, box car scars which are wider and shallower, rolling scars in which the skin looks like it has ripples.

Hypertrophic scars and keloids which look like lumps on the skin.

Besides treatment and prevention, is there anything else we can do about acne scars?

The removal of dark spots (PIH) left by pimples or acne scars will fade but may take a long time. They can be made to clear earlier with lightening creams and laser toning.

Chemical peels also help with PIH.

It is also important to use a suitable sunscreen to minimise PIH.

Depressed acne scars are may be improved with techniques such as subcision and fractional laser treatment. The fractional laser beams cause a controlled injury to the skin in a pixelated pattern. The healthy tissue in between the injured skin will start the healing process which involves the laying down of collagen. This will repair the scars and make them shallower as less visible.

Is there any downtime for fractional laser treatment?

There is a short downtime period of about 5 days. The skin will look pink or red in the beginning and then turn brownish usually on day 3. By day 5, the treated skin will start to peel, revealing new and fresh looking skin below.

How often should fractional laser be done and what is the interval between treatments?

Treatments can be spaced about 2 months apart, and the number of treatment depends on the severity of the scarring.

What about hypertrophic scars and keloids?

These commonly develop after chest or back acne, but may also occur on the face. They are treated with steroid injections which will cause the scars to flatten.

Take home message?

Laser treatment and topical creams might be a solution for acne scars but it is a process that will require constant and continuous care. Therefore, treat acne well to prevent scarring.


A birthmark is a discoloration on a newborn baby’s skin.

Some appear at birth, some become more obvious as the baby grows older. Most are harmless but some require medical attention as they grow rapidly in size or affect the normal functioning of an organ .

Examples of birthmarks include :

Port wine stain: they are pink-red at birth and grow a darker purple. They are blood vessels that didn’t grow properly.

Hemangiomas: they are raised birthmarks formed by a clump of blood vessels that didn’t grow properly. They can be blue, red or purple.

Cafe au lait spots: they are smooth oval light brown to brown patches that are more common on the torso, legs and sometimes face.

Treatments include Lasers such as Nd-YAG laser, vascular lasers or surgery. Usually a series of treatments are needed.


Dull skin is a common complaint, and it commonly refers to a skin that does not glow, has uneven tone, pigmentation and large open pores.

In essence, the skin does not reflect light correctly and appears tired and unhealthy.

A skin rejuvenation program that involves the combination of IPL, or lasers like clear and brilliant , topical creams and even oral supplements go a long way in restoring the glow that everyone desires for.