The ABCs of Great Skin

What makes you glow? Uncover the secrets of beautiful skin.

w Vitamin A strengthens the skin, keeping wrinkles at bay. Get it from liver, spinach, milk, egg yolk, orange-coloured fruits and vegetables. w Vitamin B helps to maintain a healthy skin tone. Get it from chicken, tuna, potatoes, asparagus, black beans and watermelons. w  Vitamin C booses the production of collagen, an essential skin protein. Get it from citrus fruits (like oranges), strawberries, tomatoes, brocolli and cabbage. Clean, Nourish, Protect These three words form the essentials of good skin care. And as we live in the tropics, we need to be especially concerned about sun protection. w Clean - Wash your face at least twice a day and do it gently. The 2 letters to remember are pH, which referes to the balance of acid and alkali on your skin. Certain foods and products upset the pH balance and cause skin problems. Soaps, for instance, may be too alkaline. If you wear makeup, you need a cleanser formulated just for this purpose. w Nourish - Drink 6 - 8 glasses of water a day. It flushes out toxins and keeps skin hydrated, giving it a healthy glow. You also need a moisturiser for day and a heavier-duty cream at night if you're older and your skin is dry. w Protect - Always use a sun protection product with a minimum Sun Protector Factor of 15, and steer clear of outdoor activities from 10am to 4pm. Sunburn should be avoided at any age, but especially during childhood and the teenage years, as this could lead to serious skin problems, even skin cancer, in adulthood. Suncreens - What You Need to Know Apply your sunscreen 15 - 30 minutes before you go outdoors - this gives your skin time to absorb it - and keep reapplying when you're swimming or sweating. Choose a broad spectrum sunscreen that protects against UVA (ultraviolet A) / UVB radiation. UVA contributes to wrinkles and the leathering of skin and can also cause skin cancer. UVB is the main cause of skin cancers. The SPF numeric value indicates how long you can stay in the sun before you get sunburned. If you burn after 20 minutes, an SPF 15 means you can stay our for (20 x 15) 300 minutes without getting sunburned.

Skin Enhancement

In Singapore, among the popular cosmetic operations are facelifts and breast augmentations, while treatment for skin is reliant on technology and creams. Two doctors give their take on what to expect from these procedures; their pros and cons.
Skin EnhancementFor skin laxity: Fillers, available in commercial preparations such as hyaluronic acid, collagen and the like, can fill out furrows such as those between the brows. However, these are not permanent. Alternatively, the doctor may use the patient's natural tissues, which are processed in a way that only fat cells are injected as fillers.
Wrinkles: Botox blocks muscle action. Injections are administered in the facial muscles to relax them in a particular area - for instance, the lines of expression around the lower eyelids, also described as crow's feet.

Procedures to address these include Laser technology, Radiofrequency technology and Intense Pulsed Light (IPL). Broadly speaking, these use either Ablative (destructive) or Non-ablative technology. Ablative technology is useful for vapourising skin blemishes such as moles or milia (tiny cysts). These lasers can penetrate up to 100 to 120 microns into the skin dermis.

Loss of skin texture, pigment changes and lacklustre skin, due to ageing:
Non-ablative technology is more useful in darker skin types, as it is less likely to cause further skin darkening from thermal (heat) injury. Non-ablative lasers penetrate up to 25 to 50 microns of the skin and, being lighter lasers, are more suited to darker skins. Of the three, IPL is the "kindest" as it does not penetrate deep into the skin, but it rejuvenates the skin by exfoliating its outer layer.
Creams• Exfoliants, eg tretinoin
• Moisturisers, eg emollients
• Bleaching agents eg 4% hydroquinoneor the new combination of hydroquinone, fluocortizone, tretinoin.
To date, only a few clinical comparative studies show the effects of this new therapeutic regimen.
Latest Treatments
Fractional technology Fraxel, Mosaic, ProFactional, Pixel
Produces thousands of tiny, deep columns in your skin (MicroThermal Zones) for treatment of scars and rejuvenation. Allows faster healing with minimal downtime.
Ouch factor: 3/5
MicroLaserPeel™Superficial skin resurfacing for the treatment of scars, facial lines and fine wrinkles, and for rejuvenation. Ouch factor: 3/5
PPx:Photopneumatic therapy
Light based therapy with the use of a vacuum for the treatment of pigmentation, rejuvenation, hair removal. Ouch factor: 0/5
Biorevitalisers:Injectables
Injections of naturally-occurring skin substrates (surfaces on which an organism grows or is attached) which intensely hydrate, promote collagen formation and provide long-term skin protection against ageing.
Ouch factor: 4/5
Thermage STC tip
Thermage has been around for some time as one of the foremost monopolar radiofrequency devices. The STC tip for the Thermage is a new development which offers an exquisite combination of both superficial skin tightening and deep tissue lifting in a single no-downtime treatment.
Ouch factor: 3/5
Article Contributed by Dr Colin Song, Singapore General Hospital and Dr Colin Tham,

KK Women's and Children's Hospital

Facelift Surgery

SURGERY
Facelift surgery is designed to rejuvenate the face by re-tensioning skin laxity, the cause of wrinkles (rhytids) and re-suspend the submuscular aponeurotic system (SMAS), the deeper layer of tissue that "suspends" the muscles from gravity.

Surgery also addresses other effectsof ageing, such as nasolabial folds (the deep lines along the sides of the nose, lip and cheeks), jowls (lax skin under the lower jaws) and the loose skin over the neck area.
How it’s done The surgeon makes an incision in front of the natural skin line behind the sideburns, in front of the ear, coursing behind the earlobe up onto the back of the ear and back into the back scalp. Once the skin is raised Lip and freed the deeper SMAS layer is tightened, using anchoring sutures to the ear cartilage. Thereafter the excess skin is excised (cut) but not excessively sutured (stitched) back.
Best candidates
Those with no major medical problems. They need to be fit, healthy, and ideally with no heart, lung or bleeding problems. Very important: They should not be smokers.
What to expect
Immediately after the operation, patients can expect to have a drain (plastic conduit exiting from the wounds to drain off possible residual blood). It's important to have realistic expectations, and to know that no matter how small there is always a risk of possible complications.
Post-operative complications include bleeding, swelling, pain, facial nerve disturbance resulting in facial muscle weakness, wound edge discolouration resulting in further scarring (especially in smokers), infection and salivary leak, among others.
Article Contributed by Dr Colin Song, Singapore General Hospital and Dr Colin Tham, KK Women's and Children's Hospital