2022 June

Med Spas & Beauty Centres often make promises about quick and cost-effective ways to improve your looks, but there are things their directors would prefer you not to know.

1. Buyers should be aware

Many Med Spas and Beauty Centres, promise a harmless way to enhance your appearance or turn back the clock, with many centres offering treatments to smooth wrinkles, eradicate age spots, dissolve double chins through quick and painless methods. Before you schedule an appointment, do some research on the company; you could really be putting yourself in danger with that suspiciously cheap Groupon/Fave for Botox or lip injections. Find out what else you should be aware of, and what many beauty centres don’t want you to know.

2. Don’t be fooled by white coats

Med Spas and Beauty Centres are required to have doctors serve as medical directors, but those doctors aren’t required to be on site. Med Spas and Beauty Centres may be staffed by beauticians who haven’t completed training in injections and laser treatments, but pose as doctors or nurses. Those who do have medical training may have been trained in completely unrelated specialties. If the spa or centre’s medical director didn’t specialize in a field related to skin care or cosmetic surgery, they might not be able to handle an emergency, adverse effect or undesirable outcome. Protect yourself by always choosing a board-certified physician with a relevant area of expertise.

3. The Doctor may be banned from practicing

Before booking an appointment at a Med Spa or Beauty Centre make sure to do some research, find out with the Doctor is certified and watch out for any red flags.
You can look up the Doctors at Malaysian Medical Council (MMC) at: http://www.mmc.gov.my/index.php/medical-register to see if they are licensed Doctors. Rest assured that all our Doctors in Beverly Wilshire Medical Centre are certified and licensed on MMC.

4. The provider may have just learned the procedure she’s about to perform

It’s fair to assume that if a clinic is advertising a service, they are experience and skilled at it. However, in Malaysia, it’s possible for a provider to attend courses on Botox and dermal fillers and start injecting the patients the next day. Finding a qualified provider means asking about how long ago they were trained, how many patients they treat a week and how they handle complications.

At Beverly Wilshire, we assure our patients on the expertise of our Doctors. With some of our Doctors training other Aesthetic Doctors, we are proud to say that they are Best Doctors in Malaysia, our Doctors are Master Trainers in the Aesthetic Field.

5. Things can go really wrong

You pop into a med spa for a relaxing massage, or a beauty salon to get your hands done, and then on impulse decide to get a few units of Botox to help you look as relaxed as you feel. While the spa setting can make medical treatments seem mild and inconsequential, this is far from the case and can be devastating when things go wrong. Unwanted side effects of Botox can last for three to four months, and include drooping eyelids and reactions to the injection. Incorrect usage of lasers can cause scarring, burns and changes in skin colour. So don’t take things so lightly, make sure you do research on the Medical Spas and Beauty Centres you head to.

The Doctors and Aestheticians in Beverly Wilshire are all highly skilled practitioners licensed in their fields with extensive knowledge on all products and procedures. With regular training our staffs are well equipped to use the Aesthetic machines and injections administered.

6. Cheap things aren’t necessarily good

If there is a cheaper alternative offered in Med Spas or Beauty Centres, you should be wary. Centres may be skimping on products, and giving low quality, non-premium brands.

At Beverly Wilshire, our Doctors are very careful when selecting the right products to use for their clients. Products used at our centre are all premium brands from all around the world and are FDA-approved. The reason why premium products cost more is because those companies tend to do more extensive testing and research before launching it to the market. Therefore, with better technology behind it, the products tends to give a better results and last longer when it is combined with the right technique of skillful doctors.

Now that you are aware of things to look out for, be sure to find licensed and certified Doctors to perform the Aesthetic procedures. Get in touch with our Doctors to find out which treatment is best suited to your needs.

In this series we will share about laser therapies. Laser resurfacing is a technique used for treatment of wrinkles, scarring (acne or surgical), stretch marks, spider veins (telangiectasias) and sun damage (solar melanoma, actinic keratosis (thick, scaly or crusty skin).

What is Laser?

Let’s dive in and try to untangle the mystery that shrouds cosmetic lasers.

Laser is an acronym for “Light Amplification by Stimulated Emission of Radiation” they work by emitting a wavelength of high energy light, which when focused on certain skin conditions (e.g sun spots) will create heat and treat the problem via destruction (e.g. removing the sun spots). There are many different wavelengths (or colours) of lasers because each wavelength treats different things. For the purpose of this exercise we shall split the lasers into 4 categories: ablative laser, non-ablative lasers, fractional lasers and non-lasers.

1. Ablative Lasers:  Focus on the outer layer of the skin by creating micro wounds on the surface.
2. Non-Ablative Lasers: Pass safely through the outer layer of the skin by penetrating the tissue lying beneath. They can treat skin issues without damaging the surface of your skin, non-ablative lasers are considered an improvement as they require less recovery time.
3. Fractional Lasers: Fractional laser beams are split into hundreds of tiny beams (a bunch of dots) instead of a solid beam. When fractional laser penetrates the skin, it penetrates in a scattered way, treating some skin while leaving skin in between alone. The spread-out dosage means that you receive the same benefits minus the downtime. Fractional lasers can be either ablative or non-ablative.
4. Non-Lasers: Pretty much everything else, devices such as Radiofrequency (RF), Intense Pulsed Light (IPL), Infrared, and Ultrasound fall into this category.

Types of Laser

1. Ablative Lasers: Carbon Dioxide Laser (CO2), Erbium Laser
   • Carbon Dioxide Laser (CO2)
     A carbon dioxide laser is very strong and can cut into or vaporize skin tissue. A continuous wave of carbon dioxide laser is not as favourable anymore to treat facial skin conditions because of the long downtime. Instead of CO2 Laser used on skin today are fractional carbon dioxide lasers. CO2 lasers are mostly used for removing moles nowadays.
     • Treats: Moles, Deep Wrinkles, Acne Scars/Scars, Warts, Birthmarks, Saggy Skin, Corns on Feet, Sun Damage
     • Side Effects: Long downtime with high risk of scarring and redness. Asians have higher risk of hyper-pigmentation or hypo-pigmentation.
     • Suitability: Not suitable for those with active acne. Not suitable for stretch marks.
     • Brands: Fraxel re:pair, Smartxide, Mixto Pro and Harmony Pixel Perfect
   • Erbium Lasers
     Like CO2 lasers, Erbium lasers can vaporize the surface of your skin. However, they do not penetrate as deep as CO2 therefore they are best suited to treating wrinkles and photoaging on face, hands and neck.
     • Treats: Fine Lines, Small Wrinkles, Skin Pigmentation, Acne Scars, Sun Damage, Moles
     • Side Effects: Swelling, bruising and redness.
     • Suitability: Darker skin tones can use this laser.
     • Brands: Harmony Pixel Laser
2. Non-Ablative Lasers: Pulsed-Dye Laser (PDL), Nd: Yag Laser, Alexandrite Laser
   • Pulsed-Dye Laser
     As the name suggests, a pulsed laser delivers the laser beams in pulses. Instead of lasing your skin in one continuous beam, the laser pulses and zap your skin in beats. There are varying lengths of zaps for pulsed lasers. The light is converted into heat destroying the blood vessels while leaving the surrounding skin undamaged.
     • Treats: Vascular Lesions, Spider Veins, Port Wine Stains, Rosacea, Broken Capillaries, Fine Lines Around Eyes, Stretch Marks
     • Side Effects: Bruising, temporary pigmentation
     • Suitability: Not suitable for those who have blood disorder, diabetes or certain auto-immune conditions
     • Brands: VBeam, Medlite C6, Revlite
   • Nd:Yag Laser
     Nd:Yag’s very long name is Neodymium-Doped Yttrium Aluminium Garnet. It is one of the most common lasers available with both continuous and pulsed modes. There are a variety of Nd:Yag laser that are used to remove unwanted hair or to treat skin veins (spider veins) and facial redness.
     • Treats: Hair Removal, Spider Veins, Skin Pigmentation, Tattoo Removal, Skin Rejuvenation
     • Side Effects: Low success rate for skin issues. Chance of recurrence when used for vascular lesions.
     • Suitability: Does not remove light/white hair.
     • Brands: GentleYAG, Cool Glide, Laser Genesis, Cool Touch
   • Alexandrite Laser
     The laser source is Alexandrite, it is mainly used for hair and tattoo removal. The Alexandrite laser is specifically good at removing green and black coloured pigments in the skin.
     • Treats: Hair Removal, Tattoo Removal, Leg Veins
     • Side Effects: Redness, swelling and itchiness after procedure may last a few days. Skin Pigmentation (rare). Bruising may affect some.
     • Suitability: Better at removing finer/ thinner hair. Good for removing black/green/ yellow coloured tattoos. Good for pale skin tones.
     • Brands: GentleLASE, EpiTouch Plus
3. Fractional Lasers: Fraxel
   • Fraxel
     Moving onto Fractional lasers, Fraxel is from a family of three cosmetic lasers made by a company called Solta. All three lasers in the Fraxel family use fractional photothermolysis to treat certain skin conditions.There are two non-ablative Fraxel lasers and one ablative laser. The two non-ablative lasers are Fraxel re:fine (used for skin rejuvenation and minimizing fine facial lines, and Fraxel re:store (used for skin resurfacing, treating photodamaged and reducing the appearance of acne scars). The ablative laser is Fraxel re:pair, which uses CO2 laser to treat skin pigmentation and deeper facial wrinkles.
     • Treats: Hyperpigmentation, Sun Damage, Wrinkles and Acne Scarring
     • Side Effects: Redness.
     • Suitability: Not suitable for those who have skin cancer, has broken skin around targeted area or is pregnant/breast feeding.
     • Brands: Fraxel, 3Juce, Pixel
4. Non-Lasers: Intense Pulsed Light (IPL), Infrared, Radiofrequency, Ultrasound Imaging
   • Intense Pulse Light
     IPL is a form of treatment that uses flashlamps (not lasers) to produce a high intensity light from specific flash lamps to selectively destroy pigment cells, capillaries and hair roots on your skin.IPL is a non-invasive, non-ablative method for rejuvenating photoaged skin with minimal side effects. It is often used to treat dyschromia, rosacea, melasma, acne, photodamage, vascular and pigmented lesions, hair removal and rhytides.IPL is best suited for people who have pale skin. Though post-treatment side effects resemblance of sunburn, some people actually experience skin blisters.
     • Treats: Rosacea/ Facial Redness, Broken Blood Vessels, Pigmentation, Skin Tightening (rarely used to treat hair removal, tattoo removal)
     • Side Effects: Redness, swelling, bruising, scabbing and sometimes pigmentation.
     • Suitability: Not suitable for those with darker skin tones
     • Brands: Lumenis, EpiLight, Quantum, PhotoDerm, Aculight
       
   • Infrared
     Another form of cosmetic lasers, it is most often used for non-surgical fact lift. The heat from the infrared energy contracts but does not destroy collagen in your skin. It tricks your skin to increase productivity for collagen to replace “lost collagen” resulting in a lifting effect on your skin.
     • Treats: Skin Tightening, Facial Contouring, Non-surgical face lift, Stimulates Collagen, Saggy Skin
     • Side Effects: Redness, swelling, temporary skin pigmentation
     • Suitability: Not suitable if you have heart issues, metal implants. If you are diabetic, have autoimmune disease or been treated with chemotherapy this treatment is not suitable.
     • Brands: Titan
   • Radiofrequency
     The most common source of radiofrequency is Thermage. Radiofrequency is used to heat (or damage) deep layers of your skin (without damaging the surface) so your body will heal the injury, thus producing more collagen to tighten skin making you look younger.
     • Treats: Skin Tightening, Facial Rejuvenation
     • Side Effects: Contracts Fat cells makes face look thinner due to fat loss
     • Suitability: Not suitable for those who are pregnant/breastfeeding
     • Brands: Exilis, Thermage
   • Ultrasound Imaging
     Ultrasound is considered the newest energy source for cosmetic medical procedures. With ultrasound imaging it allows you to visualize the tissues beneath the surface of the skin. This means that you can see where the damage is located and can target them more accurately. Ultrasound facial procedures rejuvenate the skin and minimizes sagging.
     • Treats: Skin Tightening, Increases Collagen Production, Improves Skin Elasticity, Firming Skin
     • Side Effects: Slight swelling, tingling, bruising, sensitive to touch, temporary numbness
     • Suitability: Great for those who do not want a surgical facelift.
     • Brands: Ulthera
   • Cryolipolysis
     Is an FDA-approved procedure also known as Coolsculpting. The method involves controlled application of cooling within temperature range of -11 to +5 C for the non-invasive, localized reduction of fat deposits, intending to reshape the contours of the body. The degree of exposure to cooling causes cell death of subcutaneous fat tissue, without damaging the overlying skin. It is often used for areas that are hard to lose fat like love handles.
     • Treats: Visible bulges in the thigh, abdomen, flank, areas along the bra line, back fat, underneath the buttocks and upper arm
     • Side Effects: Localised redness, bruising and numbness of skin
     • Suitability: Great for those who do not want Liposuction or Surgery
     • Brands: Coolsculpting

Things to Note:

Aside from lasers, there are other ways for skin rejuvenation to be achieved, these include:

1. Chemical Rejuvenation uses chemical peels (e.g. Fire & Ice)
2. Mechanical Rejuvenation: uses dermabrasion or micro-needling (e.g SilkPeel)
3. Injections for Rejuvenation: uses injectable neurotoxin, fillers and collagen

One of the benefits of using laser is that it allows the aesthetic physician to customize the treatment for each patient to specific areas of their face. Laser can also be combined with Liposuction to help tighten and smooth over the new contours after removal of excess fat.

Myths and Misconceptions about Laser Therapies

Myth: Lasers can make your skin perfect

Truth: Laser can make your skin look younger and better but not entirely flawless. People who undergo treatment will notice a drastic difference but the imperfections will not disappear completely. That’s especially true if you choose a non-ablative or fractional laser treatment. You will often find that non-ablative lasers produce less dramatic results.

Myth: Anyone can get laser resurfacing done

Truth: Laser resurfacing works best on fair-skinned people who don’t have active acne flares or frequent cold sores. People who have darker skin tones will need to be careful and consider other options such as RF or micro-needling. The laser itself could cause acne breakouts on treated skin, so those who have active acne will need to consult with their doctors beforehand about their options.

Myth: Laser treatments can replace surgery

Truth: A laser treatment can be used to complement a facial plastic surgery but since surgery and lasers target different concerns, they can’t be exchanged for one another. The more mature the skin is, the less collagen and elastin it contains, hence the formation of deep lines and wrinkles, lasers are great for improving the texture and tone of the skin. Lasers however cannot remove skin laxity or dramatically tighten skin. For skin that’s suffering from extreme laxity, surgery is the best option.

Myth: Lasers make skin weak or thin

Truth: Laser peels actually make the skin stronger. Although ablative lasers are used to peel the skin and remove the top layer, this action encourages the skin cells to grow and replace the older damaged cells. The treated skin may look rough initially but ultimately will strengthen and thicken by the production of collagen and elastin. Collagen supports the skin structurally and will cause it to become thicker, stronger and more youthful looking.

Myth: Lasers use dangerous radiation

Truth: Laser used for skin treatments emit radiation in the form of light, and they do not expose you to dangerous radiation. The light will only penetrate one to four millimetres into the skin. Laser radiation should not be confused with harmful radiation which comes in the form of radio waves, ionizing, x-rays, or radiation from radioactive elements such as radium. At Beverly our goal is to improve your skin.

Myth: Laser can cause cancer

Truth: The light emitted from laser does not contain the wavelengths which causes or triggers cancer. Therefore, lasers do not cause cancer and actually be used to remove skin cancers.

Myth: Lasers are only for mature skin types

Truth: I’m sure you’ve heard the saying; prevention is better than cure. Likewise, in aesthetic treatments it does not apply only to older generation. Many of us tend to ignore our skin problems in our youth thinking that topical skincare is sufficient to fend the signs of ageing or sun damage. This will intensify the skin problems making it a lot harder for treatments to reverse the damage. Undergoing early treatments can reduce pigmentation and improve the skins collagen production dramatically. You can start doing laser treatments as young as 25, stimulate your collagen while you still have them. If you are mature, you might need more sessions to get the same results for collagen production/stimulation.

What is Melasma?

Melasma is a form of hyperpigmentation, that is quite prevalent in women (men do sometimes get it too). It’s also known as chloasma, or the “mask of pregnancy” as it often occurs in pregnant women. The condition is thought to be triggered by UV exposure, as well as hormonal influences. Hormonal increases such as pregnancy, oral contraceptive usage, and other hormonal therapies play a significant role, and can make the situation worst. Melasma is difficult to treat, as it’s often time consuming, what works for one person doesn’t necessarily work for another, therefore its hard to pinpoint one effective treatment.

What are the symptoms of Melasma?

The sneaky Melasma likes to creep in and typically appears as symmetrical blotchy patches on the face, they are often a darker skin shade and can appear as brown, tan or blue-gray in colour. Melasma is commonly found on:

• Cheeks,
• Bridge of the nose,
• Forehead,
• Chin and
• Upper lip.

Sometimes it appears in less common areas of the body like the neck or forearms, especially in areas that are prone to sun exposure. The skin discolouration doesn’t do any physical harm, but you may feel self-conscious about the way it looks.

Melasma often occurs in women in their mid-30’s and continues to middle age. It may also start during the time of the pregnancy or during the use of oral contraceptives. After childbirth or after stopping oral contraceptives, melasma may improve but it never goes away completely.

What causes Melasma?

It isn’t totally clear what causes Melasma, both dark and fair skin individuals are at risk. The skin condition gets affected by estrogen and progesterone levels, this means that taking birth control pills, hormonal therapy and pregnancy does play a role. Stress and thyroid disease are other factors that could be the cause of Melasma.

If you suspect that you have Melasma, you can get it checked by using Visia Machine (wood’s lamp examination). It’s basically a light that detects bacterial or fungal skin infections, it can also be used to detect skin pigmentation disorders such as Melasma.

Things to avoid

While not all cases of Melasma will clear up with treatment, there are things that you can do to make sure the condition doesn’t get worst and to minimize the appearance of the discolouration. These include:

• Wearing sunscreen everyday with SPF 30
• Wearing a wide-brimmed hat that provides shade for your face
• Wearing protective clothing

Do note that Melasma might return without proper skincare and sun protection, so make sure you slap on plenty of SPF.

Treatment

Melasma is a tricky skin condition to treat, there are creams which only Dermatologist can prescribe which lightens the skin. The dermatologist may also prescribe topical steroids, chemical peels, dermabrasion, or lasers. Even though you get a custom-made plan from a dermatologist, it doesn’t guarantee that Melasma won’t come back. Along with the fore mentioned treatment, it’s important to minimize sun exposure by applying sunscreen daily.

Dr. Joyce personal recommendation:

BWMC VC Essence: Soak facial cotton with VC Essence and apply evenly on skin or dispense small amount on palms and pat directly on skin.

BWMC Brightening Cream: Apply evenly on entire face, use twice daily. Use with sunscreen for best results.

BWMC Pigmentation Cream: Apply on face after cleansing, use twice daily (for 3 months or as directed). Use with sunscreen for best results.

The bottom line is Melasma and hyperpigmentation is common but with proper precaution (lots of SPF), the skin condition can be avoided/ delayed.

For a person who wants to get a nose job, would you recommend a surgical method (rhinoplasty) or a non-surgical option (nose fillers or nose thread lift)? What are the differences? How long does it take for the whole process to be completed? Can they both achieve the same results?

1. Surgical (rhinoplasty):
   • Yes, you have to go under the knife and the process requires few hours with longer downtime. However, the results are long lasting.
   • Helps to correct:
     • Nose size, in relation to the other facial structures
     • Nose width, at the bridge
     • Nose profile, with visible humps or depressions on the bridge
     • Nasal tip, that is large or bulbous, drooping, or too upturned
     • Nostrils that are large, wide or upturned
     • Nasal asymmetry and deviation
     • Types of material for rhinoplasty:
     • Silicone implant
     • Cartilage grafts
       
2. Non-surgical:
   • Lasts approximately 12 months before being slowly absorbed by your body. No cutting and suturing involved, can be done less than 30 minutes with no downtime, often dubbed as “lunchtime procedure”.
   • Nose fillers:
     • Made of hyaluronic acid (HA) and/or collagen, hence the nickname “liquid rhinoplasty” or “liquid nose job”
     • Adds volume to areas injected, sculpts the nose
     • Usually injected to the bridge and tip of the nose to give it height and projection
   • Nose thread lift:
     • Made of Polydioxanone (PDO) or Poly L-lactic acid (PLLA), the same material commonly used as sutures in surgeries
     • Usually used on nose bridge where height and projection are needed (not volume). With thread lift, a slimmer and more defined nose bridge can be achieved
     • Stimulates collagen production for skin tightening effect
3. Differences between rhinoplasty, nose fillers and nose thread lift:
   • eg, dorsal hump:
     • Fillers can “hide” the appearance of a smaller bump by filling the area around the bump, creating the illusion of a straight nose.
     • If the hump is too big, or the nose is too thick, rhinoplasty can shave down the hump, getting rid of it permanently.
   • eg, tip of the nose:
     • Fillers can correct a droopy tip or correct sharp angles by adding volume and lifting it up.
     • However, if the nose is too bulbous or upturned, surgical method is the better option. In the case of wide nostrils, alarplasty can trim the wide flaring and large open nasal for a more aesthetically pleasing nostril.
   • eg, off center nose:
     • Thread lift can correct a slightly off-center nose.
     • However, for a very crooked nose, rhinoplasty is recommended.

What are the factors that should come into consideration? Are there any age restrictions to have a nose job? How old do I have to be?

Rhinoplasty is a good option for you if:

• Your facial growth is complete and you are 13 years of age or older
• You are physically healthy
• You have specific, but realistic goals in mind for the improvement of your appearance

Non-surgical option is good for you if:

• You would like to get a “test-drive” before committing to the permanent method.
• Nose surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.
• Age and physical fitness aside, we need to determine the motives – is it for a promotion, family or relationship issues, ageing, changing a flaw, etc. Half of our job is counselling and managing expectations, ensuring that patients are aware of the complications. We draw a
  line when patients become obsessive or hold unrealistic expectations, as they may not be satisfied with the end result even though it is a successful surgery. As plastic surgeons, we have to moderate the industry so that we don’t get dragged down by trends. Some want to
  look like their idols, yet still aren’t happy after achieving that

How many different types of nose surgery are there? How do I know which type do I need?

Open rhinoplasty

• The incision is made under the nasal tip, across the columella (between the nostrils). Often used for patients requiring more extensive change or a complex case. This technique leaves a small visible scar, an experienced surgeon will position the incision to “hide” the scar in the natural contours of the nose so they are less noticeable.

Closed rhinoplasty

• The more difficult approach, requires very skilled surgeon. Ideal for less complicated cases. Incisions are made inside the nostril, there will be no visible scarring after the surgery. Shorter recovery time compared to open rhinoplasty.

Alarplasty

• To increase or decrease the width of the nostrils. Ideal to correct a bulbous nose.

The surgeon will recommend best suited method based on the patient’s anatomy and desired changes. Don’t be shy about discussing your concerns for a mutually agreeable outcome.

Are the signs of nose surgery visible? Does it leave a scar? Would it be obvious that I have done something to my nose before? What are some of the major differences before and after a nose surgery? How much changes can a nose surgery do to the face as a whole? What are the most apparent changes to the whole complexion?

• Scarring will occur, depending on the incision method used, it can be a nearly invisible scar (open rhinoplasty) or a non-visible scar (closed rhinoplasty).
• It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.
• When it comes to change, the surgeon is able to produce varying level of outcome. Be it “you still look like you, just better” kind of change or a dramatic one, be sure to communicate with your surgeon. You may have to change your passport if the before and after is unrecognisable, however, it’s fine if you want to look different and you’re prepared for it. Some patients that suffered birth defects or deformity after an accident actually anticipated the change.
• The nose is the center of the face. A subtle change like altering your nose tip can change your face as a whole. Instead of “what kind of nose you want”, the surgeon will recommend a suitable nose shape by taking other features into account.

Is a rhinoplasty permanent? How are the before or follow up treatments like?

• The results of nose surgery will be long-lasting. It may take several months for swelling to fully dissipate and up to a year for the outcome of the surgery to fully refine. Note that as we age, cartilage may continue to reshape and that may change the appearance.
• Before nose surgery, during your consultation with the surgeon, be prepared to discuss:
  • Why you want the surgery, your expectations and desired outcome
  • Medical conditions, drug allergies and previous medical treatments
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Any previous surgeries or non-surgical procedure
• The surgeon may:
  • Evaluate your general health status and any pre-existing health conditions or risk factors
  • Examine and measure your face o Take photographs for your medical record
  • Discuss your options and recommend a course of reshaping your nose
  • Discuss likely outcomes of a nose surgery and any risks or potential complications
  • Discuss the type of anesthesia that will be used
• Different procedures will have their own follow-up schedule to monitor your progress. For example, splint removal will be approximately a week after rhinoplasty.

Is nose job safe (surgical and non-surgical)? Does a nose job hurt (surgical and non-surgical)? What are some of the risks of nose jobs going wrong?

• Regarding safety:
  • A hard to swallow fact: All surgeries, including cosmetic procedures, carry risk.
  • The decision to have nose surgery is extremely personal and you’ll have to decide if you’re prepared to face the “new you” and if you’re willing to take the risks and potential complications for it.
  • The results of the nose surgery will be yours for many years to come. Hence, the surgical cost, while important, should be the least of your concern. Don’t ever bargain shop for your nose. Most surgeons are reluctant to repair botched job performed by others as there are many complications and patients might have unrealistic expectations.
  • As for non-surgical counterpart, nose fillers may migrate to a different location away from their injection site; nose thread lift might create visible knots or dimpling; both come with risk of infection.
• Regarding pain:
  • Most patients report little or no pain after nose surgery, antibiotics and pain relief will be provided.
  • For nose fillers and nose thread lift, the procedures are performed under local anesthesia, while there’s no pain involved, you’re awake throughout the procedure, expect some tugging at your skin.
• Rhinoplasty risks include (but not limited to):
  • Infection
  • Poor wound healing
  • Bleeding (haematoma)
  • Nose asymmetry
  • Change in skin sensation (numbness)
  • Sutures may spontaneously surface through the skin, become visible or produce irritation that require removal
  • Possibility of revisional surgery
• Therefore, choosing an accredited and experienced plastic surgeon with attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patients’ experience and surgical outcome.

What are the differences between getting a nose job in Malaysia, Korea or Thailand (3 of the highest popular search)?

When medicine and cosmetic surgery started to become borderless, South Korea became the usual choice for Australians, British and Americans. However, procedures in South Korea are expensive and the strong local demand meant that there was hardly a need to develop medical tourism. Also, because of inadequate information and the language barrier, people started looking beyond, and saw Malaysia and Thailand as the go-to place for cosmetic surgery.

Malaysia and Thailand are members of Asia Medical Travel Council (AMTRAC), the first formal collaboration of Asian medical travel associations to promote medical tourism.

• Malaysia is represented by Malaysia Healthcare Travel Council (MHTC), which was established by the Malaysia Ministry of Health to develop medical tourism strategies.
• In Thailand, the Thai Medical Tourism Association (TMTA) is responsible for developing and overseeing medical tourism.

Thai and Malaysia hospitals selected to offer medical tourism must be accredited by the Joint Commission International (JCI), an international body that reviews and accredits American hospitals. On top of that, selected Malaysian hospitals also met Australian Council on Healthcare Standards. Therefore, those who intend to undergo cosmetic surgery can rest assured knowing that the hospitals are on par, if not better, than those in the US.

Cosmetic physicians of both countries are also members of the International Society of Aesthetic Plastic Surgery (ISAPS). With these strict regulations, medical tourists can feel confident of their safety and well-being as they undergo their procedures in either of these countries.

Malaysia is more culturally diverse and English is widely spoken among its people. Although not a factor that could affect the outcome of the procedure, communication is undeniably important when you are undergoing a medical process in a foreign country. English is already the main language used in the medical line (and other science and technology industries), hence there would be no barriers in understanding your concerns and consultation. Should you speak in other languages, its diversity would be beneficial as you can adapt, integrate and recover comfortably.

Caution: While medical tourism patients tempt to cut cost by asking for multiple procedures in one setting, we do not recommend doing so, as the end result may be a shock to the system. Always seek your surgeon’s opinion if you have multiple concerns.

How is a rhinoplasty carried out? How long does it take for the whole process to be completed? How is the recovery like? How should the patient take care of his or her nose for the best results

Process:

• Step 1 – Anaesthesia: Anaesthesia will be administered for your comfort during the surgical procedure. This procedure can be done under general anaesthesia or local anaesthesia.
• Step 2 – Incision: For closed procedure, incisions are hidden inside the nose. For open procedure, incision is made across the columella, the narrow strip of tissue that separates the nostrils. Through these incisions, the soft tissues that cover the nose are gently raised, allowing access to reshape the structure of the nose.
• Step 3 – Reshaping the nose structure: The surgeon can reduce or augment nasal structures with silicone implants or cartilage grafted from other areas of your body. Most commonly, pieces of cartilage from the septum, the partition in the middle of the nose, is used for this purpose. Occasionally a piece of cartilage from the ear or a section of rib cartilage can be used.
• Step 4 – Correcting a deviated septum: If the septum is deviated, it is now straightened and the projections inside the nose are reduced to improve breathing.
• Step 5 – Closing the incision: Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue is redraped and incisions are closed. Additional incisions may be placed in the natural creases of the nostrils to alter their size.

Duration:

• Average time is around 2 hours but that varies with the complexity of the case.

Post surgery care:

• After your surgery is completed, a splint, internal tubes or packing will likely be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing.
• Splints will be removed around a week after surgery.
• Some swelling and bruising may occur, cold compresses will help to promote faster healing. In most cases, bruising subsides in about 2 weeks after the surgery. Swelling will dissipate over the next few months.
• Keep your head elevated while sleeping.
• It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Please avoid blowing your nose for the first few weeks after surgery. Avoid glasses as well.
• Depending on your condition, the surgeon may provide extra instructions on how to care for yourself.

How can a nose surgery change your voice or the way you sound, especially if it changes your nasal passageway?

Generally, rhinoplasty does not change the voice. Technically, rhinoplasty may narrow or open nasal passageway, hence people who underwent rhinoplasty may sound subtly more nasal or deep, however, it will not interfere with the patient’s lives. After surgery, a splint will likely be placed inside your nose for support during initial healing, therefore, your nose may be stuffy and you may sound a little bit nasal.

How can a nose surgery help with sinus problems or affect breathing in anyway?

Rhinoplasty can repair structural abnormalities in the nose. If you have nasal obstruction or sinusitis that is corrected, you may have more airflow, and therefore able to breathe better.

There’s this popular saying that the nose may “drop” 6 months or a year after any nose surgery. How true is this? Why do you think this has been said widespreadly?

It may take up to a year or more for the swelling to completely subside and see the end result of the nose surgery. While it feels like a “drop”, it is actually reduced swelling. 6 months after a rhinoplasty is not enough to assess your final outcome. Communicate with your surgeon whenever you’re in doubt.

Injectables such as Botox and dermal fillers are a great way to maintain a youthful look for a fraction of what a traditional facelift surgery cost. The procedure usually takes less than 30 minutes and can last between 4 months to 2 years. That being said it’s vital to understand the differences to ensure your expectations are met on what they can and cannot do.

Botox and dermal fillers are part of aesthetic treatments given through injections by doctors in medical centres or clinics. They are considered minimally invasive procedures meaning they do not involve any surgical incisions.

Botox and dermal fillers are quite common procedure and have gained popularity in the recent years. Botox contains a type of toxin that relaxes muscles, in doing so it can minimize the appearance of lines and wrinkles caused by facial expressions. It can also be used to treat migraines and other medical conditions.

Dermal fillers on the other hand contain ingredients that add volume to areas that have depleted collagen due to aging. Areas that are commonly lacking collagen are: cheeks, lips and around the mouth (marionette lines).

There are different types of wrinkles that need to be addressed by different injectables. The least risks and best results come from using the right one. That’s why it is important to have Botox or dermal fillers injected only by a certified aesthetic doctor or plastic surgeon.

What is Botox?

Before we proceed further, it is important to know the difference between Botox and Botulinum toxin. Botulinum toxin is a neurotoxic protein produced by the bacterium Clostridium botulinum, manufactured by a variety of companies, for both therapeutic and cosmetic use. Botulinum toxin A is marketed under the brand names Botox and Xeomin. Botulinum toxin B is marketed under the brand name Myobloc.

Therefore, the phenomenon where people are more inclined to say “Botox” instead of Botulinum toxin A is much like how we are used to say “Panadol” instead of paracetamol.

Botox is used to reduce fine lines and wrinkles by paralyzing the underlying muscles. When injected, Botox works by blocking nerve signals in the muscles. When the signals have been disrupted, the affected muscle becomes temporarily paralyzed. Without the movement of these muscles in the face, wrinkles can be softened, reduced or completely disappear.

People also use Botox to treat excessive sweating, migraines, muscular disorders, and some bladder and bowel disorders.

Botox can be dangerous is large quantities, however, it is approved by the US Food and Drug Administration (FDA) and safe to use in small regulated amounts.

How does Botox work?

Botox only works on wrinkles that are caused by muscle movements, these are known as dynamic wrinkles or expression lines. Botox will not work on fine lines and wrinkles that are caused by sagging or loss of

collagen in the face, these are known as static wrinkles, in which, dermal fillers are recommended. It should also be stated that Botox is not a permanent treatment, it needs to be repeated as necessary for the continued effects. Depending on the area that Botox is injected it can last between 3-4 months.

Botox works best on these dynamic wrinkles:

• Upper Face
• Between the brows
• Horizontal lines on the forehead
• Crow’s feet around the eyes
• Any other muscles that cause facial expressions; smiling, frowning, squinting

Side Effects / Risks of Botox

As Botox wears off over time, most side effects are only temporary. Possible side effects include but not limited to:

• Droopy Eyelid (if injected too near the eye)
• Weakness or paralysis of nearby muscles
• Allergic reaction (hive, rashes, itching)
• Pain, bleeding, bruising, swelling, numbness or redness
• Headache
• Dry mouth
• Nausea

What is a dermal filler?

Dermal fillers are sometimes called soft tissue fillers, they are designed to be injected beneath the surface of the skin to add volume and fullness.

Types of dermal fillers: 

Hyaluronic Acid Fillers
Juvederm, Restylane or Belotero contains Hyaluronic Acid, which is found some fluids and tissues in the body that add plumpness into the skin

Synthetic Fillers

1. Radiesse contains Calcium Hydroxylapatite, which is a mineral-like compound found in bones
2. Sculptra contains Polyactic Acid which stimulates the skin to produce more collagen
3. Bellafill contains Polymenthyl-methacrylate microspheres (PMMA) a semi-permanent filler
4. Polyalkyimide, a transparent gel that is compatible with the body

Autologous Fillers

1. Fat is the most commonly used substance in this category. Your own fat will be surgically removed (from abdomen, thigh, buttocks, etc), it will then be purified and injected back into the skin. This method is semi-permanent and treatment needs to be repeated over time.
2. Platelet Rich Plasma (PRP) is another type of autologous wrinkle filler. Blood is drawn from the arm, centrifuged (spun in machine) and plasma is separated and injected into the face. The effects can last around 1 year plus.

Each of the ingredients are designed to treat different signs of aging and other cosmetic issues. Patients should discuss their expectations with a certified aesthetic doctor to determine on which fillers is suitable for the areas you would like to improve.

How does dermal fillers work?

As we mentioned previously, different types of dermal fillers are designed to treat varying signs of aging. Depending on which filler is selected they can correct:

• Thin Lips
• Shallow arears of the face
• Wrinkles under the eyes
• Scars
• Static wrinkles (around the mouth and along the cheeks, these wrinkles are often caused by a loss of collagen and elasticity in the skin.)

Fillers can last for varying lengths of time depending on where it is injected and what filler is used. Some fillers last up to 6 months whilst others can last up to 2 years.

Side Effects / Risks of Dermal Fillers

Dermal fillers are considered a safe procedure but side effects can occur. Some of the most common problems include:

• Allergic reaction, skin rash, itching or pimple-like eruptions
• Redness, bruising, bleeding or swelling
• Undesirable appearance, such as symmetry, lumps or overcorrection of wrinkles
• Skin damage that causes wound, infection or scarring
• Ability to feel the filler substance under the skin
• Blindness or other vision problems

Key Differences

In summary, the difference between Botox and Fillers are:

Botox: Relaxes the muscles to stop creases and wrinkles caused by facial muscles. They are typically found on the upper face such as forehead and eyes. Botox usually last 3 – 4 months.

Dermal Fillers: Used to fill in or plump areas that has lost volume due to collagen and elasticity loss. They are typically injected around the lower face such as around the mouth, thin lips and cheeks. They may also be injected on forehead wrinkles, scars and other areas that need volume. Filler usually last around 6 months to 2 years depending on the type of filler used.

Dermal fillers might produce more long-term results however these injections also carry more side-effects compared to Botox. You should also keep in mind that since Botox and dermal fillers are made from different substances, they are used to treat different areas of the face. Doctors may suggest that they be combined during one treatment. For example, Botox can be used to correct the wrinkles around the forehead and a filler be used to correct marionette lines (around the mouth).

Things to take note

To minimize the risk and increase a good outcome, there are some things that you can do:

• Don’t let price be your guide. If the injectables (Botox & dermal fillers) cost less than the standard treatment, it is likely something has been compromised such as the skill of the provider or the quality of the product. It’s not worth the risk to take a bargain with your face.
• Injectables should be done in medical setting with sterile conditions and instruments. Never settle for treatments done in homes, spas, hotels or resorts as they are not medically sound, regardless of who is doing them.
• Do not get injectables done from other sources aside from accredited aesthetic doctors and plastic surgeons. You should be aware of what is being injected into your face, ask your doctor for an FDAapproved dermal filler or Botox.

Both Botox and dermal fillers are not suitable for:

• Pregnant women
• Breastfeeding women
• People with certain health conditions
• If you are taking medications/supplements, you need to inform the doctor
• Botox and dermal fillers can only go so far to enhance a youthful look; however, they are not as powerful as having a facelift surgery.

Maintenance

In addition to having injectables, you can add in some laser therapy to improve collagen production and improve skin elasticity. RF therapies such as Exilis and Thermage go far in maintaining a youthful appearance. It’s important to avoid things that cause collagen depletion such as being outdoors in the sun and maintaining a healthy lifestyle (avoid the usual culprits like smoking and drinking). Once, you have started on the injectable journey, it is best to continue and maintain Botox and dermal fillers on a regular basis. Talk to your Doctor about how often you should come back for maintenance.

Dr Jessie Lim obtained her medical degree from University Putra Malaysia with honours. She then went on to pursue her post-graduate certification in Aesthetics in Medical Aesthetic Certification programme and American Academy of Aesthetic Medicine (AAAM). Prior to joining Beverly Wilshire Medical Centre, she was in Plastics, Hand and Microsurgery Department. Both lively and lovely, she emits a welcoming aura to everyone around her. Her warm-heartedness and genuine personality quickly bridges the gap between patients, which is crucial for her in understanding and managing a patient’s concerns and expectations.

Doctor, tell us how did your interest in Aesthetic beauty start or rather why did you decide to venture into the Aesthetics line?

It started when I was in the Emergency department (during my houseman days), and then I moved on to Plastics, Hand and Microsurgery Department. So basically we dealt with trauma patients, patients who got into accidents ended up losing limbs and leaving deep scars.

Scars, they not only leave a defect on our physical appearance, they also go skin-deep, leaving a wound on the victim’s heart, which may or may not be carried around for the rest of their lives. Another reason I stepped into Aesthetic medicine was because it’s still pretty taboo or frowned upon among Malaysians to undergo plastic surgery, so Aesthetics bridges the gap for people who want to look good yet are not ready to go under the knife.

You’ve been in this industry for…

Less than 3 years.  Although it hasn’t been that long, I feel genuinely happy when they come in to seek for treatment and walk out feeling confident and satisfied about themselves.

Where do you see yourself 10 years down the line?

Just like anyone else, I hope to be recognized, I don’t have to be world famous, but I hope to be seen and recognized for being able to make a change in people’s life, keep inspiring others even in the smallest way possible.

How’s a day like in your life? On work days.

Wake up, get ready, have a good breakfast first, because I believe in having a good breakfast, then its work.

So what did you have this morning?

I had Roti Canai. My kind of breakfast are either kopitiam or mamak. I’m very Malaysian.

How do you de-stress? Any hobbies?

I’ve recently picked up a new hobby: hitting the gym.

Does it mean that you’ve never worked out previously?

No, never, and I didn’t like it too. Now I make it a habit to go to the gym daily even if it’s just for 30 minutes. Sometimes I’d also go to the gym late at night. It’s a de-stress activity for me. It’s a new thing, I’m working to tone my body.

In your opinion, what’s a woman’s most powerful asset?

Both beauty and the personality. It’s the beauty that captures people’s eyes and personality that catches the heart. It’s equally important.

What then does beauty mean to you?

Beauty means that you are attractive outwardly as in when people look at you; you make a significant impression on people. You don’t have to have Victoria Beckham or Angelina Jolie’s features, everybody should be confident and beautiful in their own way.

What is your greatest fear?

My greatest fear is the thought of my parents leaving me, I cannot imagine that. I know that there’s a solution to all the problems, except deaths.

Someone who inspires you or someone whom you admire?

I am inspired very easily by little things in life. I’m inspired by great leaders and by the smallest thing like a child, like how innocent and naïve they are, at the same time I look up to a lot of successful entrepreneurs. I learn the good from everything and everyone in life.

So if you weren’t a doctor, you’ll be….

I want to be a personal shopper. I love shopping, be it online shopping or even grocery shopping! Everything! So I wish that one day I can be a personal shopper for someone.

3 words that describes yourself.

I’m joyful, loving and meticulous.

Favourite cuisine.

Japanese, it makes me happy. I crave for it every day.

Childhood nickname.

Yes there is one, they use to call me Jessie James, the character in Pokemon. I had a primary school mate, his name is James, so they used to tease us a lot.

Comfort or style.

Comfort, most of the time, comfort.

Tea or coffee.

Tea definitely.

Sweet or savoury.

Both.

Summer or winter.

Winter.

Would  you rather be someone else for a day or have someone else be you for a day?

Be someone else for a day.

Do you have someone specific you have in mind that you want to be for a day?

No, I just want to try to be in many other people’s shoes.

Keen to get a consultation? Dr. Jessie Lim is available at:

• Beverly Wilshire Medical Centre (Kuala Lumpur) on Tuesdays, Thursdays and Saturday
• Beverly Wilshire Clinic (Petaling Jaya) on Monday, Wednesday and Friday
• Beverly Wilshire Medical Centre (Johor Bahru) fortnightly.

Make an appointment with Dr. Jessie or visit the other professionals today.