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DR.WALTER

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Dr Walter is a strong proponent of evidence based treatments that are safe and effective. As an advocate of lifelong learning, he continues to attend conferences and workshops in his free time to keep up with the latest developments, and to learn from the best in the region and the world.

WHAT CAUSES AGEING?

When we look at an older person, we instinctively know that a person is old. So, what happens to a person’s face as he or she ages? This is a complex issue that can be discussed over several full days, and we have new discoveries and insight from time to time. For the purpose of this article, we will keep it simple and easy to understand.

To start, we need to understand what the face is made up of. There are several layers of tissue on a person’s face. And ageing occurs on all these levels at different speeds and in different ways, depending on a person’s genetics and lifestyle. The layers of a person’s face, starting from the most superficial, are:

  1. Skin – As a person gets older, the skin loses its elasticity, resulting in looseness and lines. Both dark and white spots may also appear. It will also get thinner, resulting in more visible blood vessels.

  2. Superficial Fat – Fat gets redistributed during ageing. Some areas get thicker resulting in saggy jowls, deeper nasolabial folds and marionette lines, while others lose volume, causing a tired and haggard look.

  3. Muscle – The muscular layer loosens as one gets older.

  4. Deep Fat – There is volume loss in this layer during ageing. This causes sagging as the overlying more superficial layers lose their support. It is like how clothes look baggy and unsightly when it no longer fits a person who has grown too thin.

  5. Bone – There is bone loss on some areas of the skull. Like in the deep fat, this will cause sagging in the overlying areas, resulting in an older and more tired look.

 

As you can tell, ageing is a complex issue, and there is no one best way to make a person look younger. We need to utilise different methods to treat different problems for the best outcome. In subsequent posts of this series, we will discuss more about how we can approach these problems.

Running a clinic can be hectic and stressful. Work requires a lot of awareness. Apart from seeing patients, we also must help make sure that things run smoothly for everybody in the clinic. It can get draining overtime. That is why it is important to wind down and recharge on our free days.

For me, exercising is the answer. I enjoy a good run on days that I am not working. I have found numerous benefits to hitting the road.

It complements resistance training well. I often feel more refreshed and alive after a good run. It also boosts my metabolism, allowing me to indulge in culinary delights with less guilt.

There is also a meditative quality to outdoor runs. It is a time when I could be away from my thoughts and worries. After all, it is difficult to think of anything else when you are busy huffing and puffing for oxygen. This allows me to mentally recharge. More than once, I have managed to discover solutions to my problems after a good run.

I tend to favour running outdoors to the treadmill. It gives me the opportunity to be at places that I do not usually go to. While it is hard to argue against the comforts of exercising in an air-conditioned room, I personally think that running on the treadmill can feel like an eternity. There is absolutely no substitute to being under the sky.

TRUELIFT AND DYSPORT DERMALIFT

Galderma, in collaboration with Dr Leo Kah Woon, were generous to organise a couple of sessions to share with us on True Lift and Dysport Dermalift.

True Lift is a technique pioneered by Dr Peter Huang, an established plastic surgeon from Taiwan. To understand what True Lift is, we need to first understand what happens when we age.

1 ) VOLUME LOSS

As discussed in the first post of the series, one of the signs of ageing is volume loss, resulting in sagging. It is very much like a person’s clothes not fitting him anymore after he or she gets thinner.

2 ) RETAINING LIGAMENTS

Throughout our faces, there are structures called retaining ligaments that extend from the bone to the skin. They are short and tough fibrous bands that help to maintain the structures of our faces against gravity. In youth, these retaining ligaments are short and strong and perform their jobs well. However, as we get older, these ligaments become loose and stretched, resulting in laxity. As a result, the tissue that they are supposed to support will sag.

3 ) WHAT DOES TRUE LIFT DO?

When performing True Lift, we inject small amounts of a hard filler (We use Restylane Lyft) strategically under these retaining ligaments to replace the fat that has been lost as a result of ageing. A hard filler like Restylane Lyft will be able to support the weight of these retaining ligaments against gravity, giving the face a more lifted rejuvenated look. The original teaching consists of 5 injection points on each side of the face, using 2 to 5ml of fillers in total. Your physician may customise and vary the number of injection points for you.

I find that one of the greatest benefits of True Lift is it does not use a lot of filler to do the job. On top of being more affordable, it also does not drastically alter the appearance of your facial features. This is key to not looking overdone.

4 ) DYSPORT DERMALIFT

This is a technique that was pioneered by renowned Korean plastic surgeon Dr Lee Young Seob. Diluted Dysport (one of three approved brands of Botulinum Toxin in Singapore) is injected into the skin on the periphery of the face, creating tiny blebs that look like mosquito bites. These blebs fade in a few hours. By strategically injecting botulinum toxin in the right areas, the targeted muscles are relaxed so that other muscles can pull the face upwards, creating a gentle lift. Doing so has also been found to stimulate collagen production in the skin, providing further benefits.

The Dysport Dermalift is great for those who have mild laxity and are looking for a non-invasive and natural lift.

PREVENTING WRINKLES

Everybody develops wrinkles as we get older. How bad it gets depends on our genetics and lifestyle. Wrinkles come in 2 forms, dynamic and static. Dynamic wrinkles appear with facial expressions, whereas static wrinkles are there even when we are not moving our faces. Overtime, areas with dynamic wrinkles can develop static lines too. There are ways to slow down, or even prevent the formation of wrinkles. Prevention is often better and cheaper than the cure.

 

Personally, I have a terrible habit of frowning when I am in deep thought. Like many others with smaller eyes, I have also developed a tendency to utilise my forehead muscles to keep my eyes open. Over time, static lines start to develop, especially on days when my skin is dry.

 

Apart from the essential steps of moisturising and using sunblock, I apply a retinoid cream nightly. The usefulness of retinoids is well established. In addition to controlling acne, lessening oil production, and lightening dark spots, retinoids have also been found to stimulate collagen in the skin and treating wrinkles. Retinoids come in different strength, from the gentler retinol that is available over the counter, to medicated ones like tretinoin. I personally use Stieva A 0.05%, which is tretinoin in the concentration of 0.05%, every night on my entire face. 

Retinoids are not for everyone. Women who are pregnant, or planning to get pregnant, should not use them. For many, retinoids can cause significant dryness, and sensitivity to sunlight, especially within the first few weeks of starting. These symptoms often get better over time. If you have any procedures planned, your doctor may also advise you to stop applying the cream for a few days.

 

I also get the occasional Botox for my forehead lines and frown lines to treat the dynamic lines and prevent them from being etched into the skin as permanent static lines. I do not usually use a lot as I do not appreciate the frozen look and feel. I still want my expressions to be visible. As mentioned earlier, I often utilise my forehead muscles to keep my eyes open, and if these are weakened too much, it would be a challenge to keep my eyes open!

Not everybody will want to get their wrinkles treated. Some find that their wrinkles make them look more endearing. There are also people who find that their dynamic lines help to convey their feelings. This is particularly so for actors and presenters. I've also been told on more than one occasion that crow's feet, that is wrinkles to the side of the eyes, are attractive on many men. As with most topics related to aesthetics, treatment should be individualised.

FACIAL HARMONY PROGRAM

Facial Harmony is a gentle invasive treatment, this is designed specifically to work in harmony on Facial Features and skin tightening to achieve natural aesthetics looking face. In this Program, our Doctors use the True lift Technique with 2 syringes of H.A (Hyaluronic Acid) Fillers to replace to volume loss & Derma-Lift Technique to tighten skin to achieve a natural lifting effect.

 

How does True Lift by Restylane Lyft work?

 

As the face ages, several key things happen:

  • Skin loses its elasticity thins out

  • Superficial fat might increase in volume

  • Deep fat and bone atrophy, resulting in a loss of support for the upper layer of fat and skin

  • Retaining ligaments of the face (that attach overlying fat and skin tautly to bone) loosen and lengthen, worsening tissue droop

The True Lift technique, however, specifically targets the issue of aging and loosening retaining ligaments. This technique involves the use of minimal amounts of filler to lift the face by supporting important ligaments. The ligaments are tauter and the tension to the overlying facial tissue increases, lifting sagging facial skin.

Using 5 key injection points per side, the result is a natural, rejuvenating lift that is noticeable but not overdone, even when the face is in dynamic motion.

The filler is precisely placed below the armpit of the retaining ligament, thereby:

  • Supporting the ligament and lifting the overlying skin

  • Volumizes structures around the ligament lending to long term support

  • Stimulates collagen release to help with tissue regeneration

The following technique will be Dysport Dermalift

This is a technique that was pioneered by renowned Korean plastic surgeon Dr. Lee Young Seob. Diluted Dysport is injected into the skin on the periphery of the face, creating tiny blebs that look like mosquito bites. These blebs fade in a few hours. By strategically injecting botulinum toxin in the right areas, the targeted muscles are relaxed so that other muscles can pull the face upwards, creating a gentle lift. Doing so has also been found to stimulate collagen production in the skin, providing further benefits.

The Dysport Dermalift is great for those who have mild laxity and are looking for a non-invasive and natural lift.

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