Urticaria!

Urticaria is a skin condition that can afflict people for many months (to years) at a time. Itchy lumps appear out of nowhere & move from one area to another, causing havoc with work, sleep and social activities. It's not a condition aesthetic doctors deal with, but a topic dear to my heart as I have suffered on & off with this for decades! So when the opportunity arose this week for me to attend a lecture by a world expert from Germany, I jumped at the chance!

Turns out, there can be many causes of chronic urticaria, from infections (teeth, tonsils, gut), to environmental factors (hot, cold, exercise, etc), food intolerances and an inherent tendency towards the condition. And to complicate matters, an affected individual may have 2 causes, or require 2 sets of conditions to co-exist before developing urticaria!

I know I had food intolerance issues: the ALCAT test proved my excessive ingestion of tomatoes caused my incessant itching two years ago. The latest bout seems to have settled down, and I have yet to find a trigger other than "stress".

Which really brings me to treatment. Stopping the cause is ideal, but locating the cause may not be easy. The aim ultimately is for cure and/or stopping all symptoms. Without the cause, we are left with a series of pharmacological interventions. Starting with a non-sedating antihistamine at standard dose, then quadrupling it to maximum dose for another month. If this is insufficient, then other fancy drugs get added.

Anyway, the anti-histamines have been ordered. I'm desperately awaiting their arrival. Not so much for the skin now as for my allergic rhinitis. The joys of being atopic (tendency to allergic rhinitis, urticaria, eczema & asthma)...

How this is related to standard aesthetic practice? By controlling urticaria, we stop skin trauma from excessive scratching. And scratches can cause severe post-inflammatory hyperpigmentation (PIH). PIH is relatively easy to treat on the face (eg after acne), but seems much more stubborn on the body, particularly legs.

Updates on Ultrasonic Cavitation

Some months back, we took delivery of the Lipomax Cavitator, and have been waiting very impatiently for the protocol to arrive from the manufacturers in Italy. Finally, recently, the information we were looking for has come through. Along with these, some photographs of results obtained with this device. The pictures above show the improvement after just one session, 4 days apart.

In summary, each area is treated for 15-20 minutes per session, 2-3 sessions a week, preferably just 1-2 days between each session initially. A loss of 2 cm is common initially. More than one area can be treated at one time. All areas can be treated except face and chest, to avoid damage to the organs within. The treatment is very comfortable, often nothing is felt, at most a gentle warmth. We couple it with lymphatic drainage to remove the fat released from the destroyed fat cells.

So finally, we are ready to begin this service! I anticipate it'll be most useful for small to moderate volumes of fat and areas which are difficult to treat with liposuction.

Melasma Treatment Options

I've been told that Melasma is very common amongst the Asian population. But in my 3 years of Aesthetic practice, I've hardly seen a single case! So although I was always intrigued by how to treat this very common condition, I've never had much opportunity to try it out.

Melasma, also known as Chloasma and "mask of pregnancy" is a hereditary condition that causes the deposition of pigmentation in the face. The brown discolouration has indistinct edges and predominantly affects both cheeks, athough the forehead ad chin can be affected too. It is predominantly seen in women, worsened by hormonal stimulation (pregnancy, oral contraceptive pill) and sun exposure. The pigmentation can be at various leves, from superficial to relatively deep.

The treatment options have been relatively limited, with creams containing Hydroquinone (such as Triluma) being first line. Although it is known that lasers do not improve the condition, it seems people continue to persist trying!

When we obtained the Nano Perfector last year, the treatment of Measma was one of the draws. Apparently, relatively recent onset Melasma could be reversed quite quickly with this device. We have yet to try this. Upon discussion with Dr Xanya Weiss recently, she now says that it can cause a lightening, but it didn't sound hugely dramatic. Perhaps it's as well we've not had any patients to treat in this way?

I'd also been hearing about the success our Thai friends have been havng with soft plasma peeling for Melasma. So when the opportunity came about for me to tag along with our local distributor for training, I jumped on it!

The treatment protocol for plasma peeling Melasma came about because the doctors were treating Melasma with lasers. What started off as superficial Melasma was recurring as deep Melasma. So from a light brown, it was turning very dark. Naturally patients and doctors were distressed, so they started to look for alternative options.

The protocol now involves rather aggressive plasma peeling with iontophoresis and the occasional glycolic peel. The skincare regime has also been documented, including exact quantities for best results. Downtime is minimal.

I met one lady who has been treated for the past year. She started off wth significant melasma over both cheeks. Now it is barely visible and her skin glows. There is still a light hit of the underlying condition, but she is happily continuing treatments in hope that it will one day be gone.

We are also bringing in Estelan, a program that is modified from Cosmelan. This starts off wth the application of a cream in clinic. This is left on for 4 hours, so washed off at home. Then twice daily application of Estelan 2 continues the treatment for the next few months. There is some peeing and redness after the initial peel, but by all accounts the results are pretty decent and provides rejuvenation & lifting as well as de-pigmentation. This is perfect for the person who is able to tolerate a few days of downtime and doesn't want the inconvenience of regular trips to the clinic for pasma peeling.

With the introduction of these two services, it's interesting that I am starting to see some patients with Melasma now. So I'm really looking forward to assessing for mysef which of these is more superior in the long term.

Inaugural Wine & Beauty Extravaganza

It has always been my intention to have informal gatherings with friends, clients and guests on a regular basis. This dream came to fruition last month, with our inaugural Wine & Beauty Extravaganza. It was a partnership between Simply Aesthetic, Divine MedSpa and Rubicon Reserve Wines.

The aim was to showcase some of our signature treatments and wines, get to know the guests, and generally have fun. The $30 cost of entry covered a free flow of 5 premium wines, and the opportunity to try a Hot Stones Massage, non-surgical face lifting with the Nano Perfector our new Cavitator. This was waived with purchase of either spa services or wines.

Our guests included photographer Paul Cypert, who runs the beautiful Accidental Epicurean website. It is with thanks to him that we have the beautiful photos below.

The lucky draw winner walked off with a Mesoceutical Facial valued at $188 from Divine MedSpa.

August Beauty & Wine Extravaganza

Simply Aesthetic, in conjunction with Divine MedSpa and Rubicon Reserve Wines, will be bringing you a series of informal wine and beauty evenings scheduled for the last Wednesday of every month.

Starting August 26th 2009, we plan to bring together a group of 20 people for an evening of fun, aesthetic trials and great wine. This opportunity is not limited to existing clients. All who are keen on finding out about our services and try the featured service without obligation are welcome. The nominal cost of $30 per head is fully refundable upon purchase of either spa services or wines above $100.

For the month of August, Rubicon will be showcasing:

(1) Singapore's best Proseco
(2) A fabulous little Marlborough Sav Blanc at an everyday price
(3) A great Kiwi white for spicy Thai food.
(4) A classic Pinot Noir

On our side, we will be showing off our new ultrasonic cavitation machine. Great for blasting away unwanted fat, this device literally causes the implosion and death of unwanted fat cells! It's a liposuction alternative that we've been looking into for quite a long time now! The plus: no discomfort, no downtime.

Plus, of course, you will get to mingle with the staff from both Simply Aesthetic & Divine MedSpa. Find out what else is in the pipeline or what is best for you! Who knows, we may even bring other machines out for you to play with!

We're still working out the logistics of it all, and aim to bring together a memorable evening for all. Please book early by calling 67325527. We anticipate the places will fill up very quickly indeed! The event will start at 6.30pm and will last for approximately 2 hours.

Surprisingly Effective Puffy Eyes Treatment

I saw my friend Ivan for the first time in ages yesterday. I was horrified to find huge eyebags under his eyes! I don't remember him ever having any problems in that area before. The skin also looked a little dark and water-logged. I was just about to convince him into a little bit of Botox when I remembered that I had a new eyebag treatment.

The new eye mask, in conjunction with Aesthetic Dermal's Meso-K Arnica Solution is primarily used for reducing dark eye circles. The Vitamin K helps to strengthen the blood vessels in the eye area. Leakage in weak blood vessels causes the deposition of pigmentation in the delicate under-eye area, hence dark eye circles.

The treatment is pretty straightforward: 3 drops of Meso-K Arnica solution is massaged under each eye. The mask is applied and moistened with toner. It is left on for 15 minutes before the mask is massaged into the under-eye area.

One hiccup: when the 15 minutes was up, I was the only one free! And I can't massage to save my life, let alone do any fancy lymphatic drainage movements. So poor old Ivan had me rubbing this stuff into his face, until Cha took over. Now Cha's a nurse by training, so although more gentle with facial massage, equally clueless about lymphatic drainage.

After about 10 minutes, the sheet mask turned sticky goop was pretty much all absorbed. We had to wipe off some of the residue so Ivan could open his eyes and see, but otherwise it went pretty smoothly for our little play.

Ivan's eyes looked brighter straightaway. Less puffy. This was even more obvious half an hour later. I have no idea how long the results will last. He didn't get a bottle of Meso-K Arnica to continue the treatment at home. So his results won't be maximised by any means. I guess if he likes it, he could purchase a full kit for home use. These are available by pre-order only as we don't hold any stock at the moment.

I'd say that this was a successful trial of a new product. The dark circles were certainly less apparent, and the puffiness totally gone. Bye bye eyebags! This service will be available at both Simply Aesthetic & Divine MedSpa once we finalise the price.

Last Few Weeks of Nano Perfector

The Nano Perfector has been a fantastic addition to my huge family of machines. It has been my favourite for face lifting and general rejuvenation. The response has mostly been positive. Instant results, painless, relatively long lasting... What's not to love?

But sadly, we'll be giving up this machine in just over a month's time. It'll be an upgrade to an even more powerful machine, that is currently still in the production phase. We've been waiting for this machine for the last 6 months. But they have delayed the production till they were absolutely 100% satisfied with the new machine.

And new machine it is! It started off as a new card within the Perfector casing. Now the engine is housed within a transparent casing, with snazzy LED display. There are 300 programs to choose from, and by all accounts the results are reven more remarkable than the Perfector. How could I refuse???

If everything goes to plan, the new machine will be delivered in early September. The price will increase, to cover the cost of the upgrade. However existing clients will continue to enjoy the current price as long as their packages have not lapsed. The increase will be at least 20% above current prices. We have a number of patients who have pre-purchased their treatments at the current super-low Perfector prices and are waiting (very impatiently) for the new model to come in. Us too!

We've got Ultrasonic Cavitation!

Ultrasound has been used for some years for fat melting. The technology has evolved significantly in the last year or so, with the development of cavitation.

When ultrasound is applied to liquids, compression and decompression waves are created. In the decompression phase, the negative pressure generated produces bubbles within the liquid. These expand and enlarge until the compression phase begins. This compresses the bubbles until they implode. Heat is generated in the implosion process and the fat cell membranes rupture. The fat gets released and is taken into the lymphatic system for metabolism.

This amounts to the targeted destruction of fat cells (ie body contouring) without the need for surgery. This is ideal for small pockets of fat, where long-lasting results are desired without undergoing liposuction. The trade-off is a few treatments, but the lack of downtime makes this feasible.

I was just talking about this to one of the reps last week. When I got back from SNEC this afternoon, I found a box in our pantry... It's arrived!!! Talk about fast! Hopefully the training will be as swift. I believe I have the first unit of this device in Singapore. There's plenty of excess fat amongst us to test this out. It's pretty exciting stuff!

Simply Aesthetic has moved to Robertson Walk

After many months of planning, renovation, inspections and running back and forth, we have finally settled into our new home at Robertson Walk. We moved all our things over last Thursday, then abandoned the girls for a short holiday, so they could tidy up/organise stocks in peace without any interference from me!

I have to say that I am very relieved to have moved in at last. The last month of running back & forth was getting quite frustrating, especially since the new clinic was in a much nicer space than the old one! But the wait is finally over, the licence is ready and we can unveil the beautiful new facilities.

We now have 3 good sized treatment rooms, two with natural sunlight (frosted glass, of course!). The restrooms are still outside, but just next to the clinic (so no more dashing through the shopping mall to get to the ladies!). Parking is even more convenient. The car park entrance is in the lane between Park Hotel Clarke Quay and Robertson Walk. There's ample parking and is very straightforward compared to UE Square, where people often got lost! And getting lost generally should not be an issue anymore: no more confusion between UE Square and United Square!

For those who are not familiar with Robertson Walk, it is a beautiful development at the junction of Mohamed Sultan Road (section opposite Kim Yam Rd) and Unity Street. It is largely F&B and the restaurants are distributed around a courtyard which is pretty happening at night, especially at weekends. There are some services on the second floor, including the DBS Arts Theatre! Our frontage is just off the corner facing the bridge, next to Divine MedSpa.

It is lovely to see sunlight all the time. UE Square was so depressingly grey, both inside & out! The Singapore River is also a stone's throw away. I'm looking forward to my strolls there when things are quiet in the clinic. So appointments by booking only please! It won't be a pretty sight if I have to run back to the clinic to see you!

Judging the Harper's Bazaar Beauty Awards 2009

I received an exciting e-mail from Alli Sim, Harper's Beauty Editor a couple of weeks ago. She wanted to know if I woud be keen on being on the judging panel of Harper's Bazaar's Beauty Awards 2009! She warned me that it would be an intensive month of trying out a variety of the newest products for 90 categories! It was naturally an offer that I could not refuse! Which female would?!!! My brief was to give the medical take on which products were best in each category.

The products arrived yesterday. I had a phone call from my very excited 13 year old daughter (and self-elected co-judge), exclaiming that she was "traumatised" at the number of products to try! Fortunately she changed the term to "overwhelmed". Hmmmmmm................

I didn't get home till after 10pm, and all hopes of a decent "early night" were dashed immediately. Six of the largest plastic containers from IKEA were waiting for me. In them was a myriad of products, spanning cosmetics, skincare, hair products, nail care, scrubs, body washes, perfumes, even 2 eyelash curlers! My jaw dropped as it looked like over 1000 items to try in just one month! No wonder Alli said her hair almost dropped out with trying out the hair products last year!

My daughter was bouncing off the wall with glee, proclaiming she now officially has more makeup than any of her friends. The dogs were going crazy trying to get into the boxes. All I could think of was "Oh My God!" and "Thank God I have help!". My daughter is definitely better with makeup than I am. Her beady eyes were already on the eyelash curlers and she'd tried on one of the nail polishes already. One of my friends has extremely dry skin and is desperate for a tan, so anything vaguely oily and in the self tan range will be palmed off to her. The scrubs and hand/foot spa things will be brought into Divine MedSpa for the girls to try on me. Nothing like an expert opinion!

I managed to try a shampoo and conditoner last night. A common high street brand that my daughter has purchased before. Cannot make it. Neither could the face wash I tried. I was intrigued by another sample which had a strange plastic tool and capsule of cream. I have to say that it was the tool that really grabbed my attention! After fiddling about, pulling & twisting it, it broke! Then I realised that the fancy "tool" was nothing but a spatula to scrape out the cream. What a joke!

At this point, I have to say that I gave up on trialling the products & decided to try something "simple": choose the lipstick with the most compelling design. The age gap then surfaced with the little princess going for something hip and the old mother insisting on something classy. The real judge won that battle and we decided on a lipstick with a beautiful shape and unique matt black finish. Settled one item out of 90.

Tonight's task will be an attempt at sorting out the products into the correct categories, choosing some to bring on holiday with me this weekend, and packing the ones for the spa. Then slowly trying out the makeup one by one. If I can find eye makeup that is resistant to my compulsive rubbing, that'll be a miracle!