Science of Aesthetics

  • 1)Filler technology: recent advances
  • 2)Laser technology: recent advances
  • 3)The Cell Cycle
    The skin is the largest organ of the body. It consists of 3 primary layers: the epidermis, the dermis and subcutaneous tissue. Each layer possesses unique characteristics and specialised functions.
  • 4) Facial bone structures.

THE NEED TO TREAT THE 3 PRIMARY LAYERS IS THE KEY TO GOOD SKIN!
The three primary layers of the skin can be compared to a bun. The crust is the epidermis which we can see and appreciate. The dermis and subcutaneous are just under the crust and gives the skin its softness and flexibility, just like the bun.
The three wheels and its cogs remind us that the three primary layers of the skin work in an intimate relationship. Each layer serves and affects each other in many ways. To have young looking skin, we must address the 3 primary skin layers to get the best result.

Recently, fillers technology has advanced again. There is data to suggest that certain FDA approved fillers can integrate into the subcutaneous tissue to encourage fibroblast and collagenesis. The bone structures that support the 3 basic skin structures are also stimulated. We are just starting to appreciate what FDA approved filler can do.

The epidermis, the most superficial layer of the skin is important to us because its the first DEFENCE of the body and of cosmetic considerations. This layer determines the skin texture and contributes to a great extent, its colour. If the epidermis is dry or rough, the skin appears old.

The epidermis is actually a very complicated and well tuned structure. It has 4 main layers as determined by light microscopy. There are the Basal layer, the Spinous layer, the Granular layer and the Horny layer. Although the skin is easily accessible, its research is pretty patchy and is still in its infancy. This is due to lack of precise scientific measuring instruments.

The Basal layers consist of basal cells and the overlying Spinous cells to form the basement membrane. These cells are responsible for maintaining the integrity and functions of the skin. 10 % of basal cells are stem cells, 50 % are amplifying cells and 40 % are post mitotic cells. The stem cells in this layer are responsible for the continuous growth and repair of the skin covering the whole body. These cells follow a well controlled programme of maturation. Skin diseases like psoriasis and many types of xerosis are due to malfunction of this maturation process. In the normal circumstances, as the Basal cells mature, they rise up to the Horny layer. This process is called keratinisation or cell cycle.

The key point to note

The normal cell cycle is 26 to 42 days. In simple terms, it means that some of us have a brand new skin every month. It means that young persons look young because we have a new skin covering monthly. As such, most young people can get away with squeezing pimples and abusing the facial skin with many cosmetics. This is because the skin regenerates and replaces itself regularly. However, do note that real abuse can lead to permanent scarring of the skin.

The bad news

The bad news for many of us is that the cell cycle slows down as one age. The cell cycle may take 84 days to renew itself when one is in the forties. This means that that the cells at the surface are much older. Their functions may be impaired.

These older cells also tend to stick to each other. Moreover, some of us are too gentle with the facial skin. We just dab them and gently wash them. As such, these old skin cells are not removed regularly. The end results are the classical signs of ageing of the face like dry and leathery skin.

The good news

There was an interesting experiment done by my professor of dermatology in Cardiff. The right side of a face was applied regularly with retinoic acid.

A well-known skin rejuvenating agent, and the left side of the face was scrubbed regularly with only a face towel.

After 3 months, the left side of the face looks better then the right! It may imply that regular mild scrubbing is beneficial to keeping the face skin looking young.

Nevertheless, I wish to caution about excessive abrasion of the face. I regularly see patients whose face are traumatised by all kinds of abrasive agents including chemical peels, micro peeling gadgets, cosmetics and even pumice stones.

In my clinic, we can shorten the cell cycle and give you a much younger facial skin.

Disclaimer: results do vary with each patient.

HOW?

We treat the 3 primary layers and add FDA approved fillers simultaneously.

1)We use specialised micro fractional lasers to remove the dead Horny layers. The depths of these lasers are very precisely determined and very superficial. As such, the doctor can remove the dead layers only. You can feel that your skin is smoother.

2) We add another laser to stimulate the Basal layers and the subcutaneous tissue. These new lasers spare the first layer of skin. As such, there is no damage to the skin. As such, there is no downtime. These are called picosecond lasers. We are the first to install Picosure 755 and Enlighten 532/1065.

3) We have acquired a radio frequency system that focuses specifically on the basal membrane.

4) We have also acquired a no downtime 711 /758 yellow-green system. This system can give your skin a glow.

With such a careful combination of technology, we can treat the 3 primary layers of skin simultaneously. shortened the ageing cell cycle and promote collagen production.

As such, we can give you a much younger looking facial skin within 1 t0 3 weeks. Result do vary.

There is also no downtime as only the dead layers are removed. The new underlying skin is intact. Most would agree that pain is minimal.  The above are well-tested treatment protocol in our clinic. Safe and effective.

Common Side effects include skin allergy, skin redness, skin dryness, skin peeling, urticaria and some downtime. Most can go shopping on the same day.

Some will also feel the heat under the skin. It may last 2 hours. The heat will stimulate fibroblasts even more. If one finds the heat a little uncomfortable, one may cool it with a moist cold to down.

Do carry out the post laser advice carefully to enjoy the best results.

Medical laser technology advances

In medical laser, we use laser light

  • Remove red colour in red lesions, we target the haemoglobin
  • Remove dark coloured spots in skin, we target the melanin
  • We target tattoo ink pigments
  • Stimulate the growth of fibroblast to promote collagen growth
  • Remove scars, keloids and to minimise pores
  • Science is still exploring the many immune responses to the laser light stimulation

Safety concerns
and downtime

The great concern is safety. We need to remove the offending lesions, improve the skin and let the patient go home with a smile.

There should be no downtime. Therefore medical laser systems took a long gestation period to be invented.

The BEST NEWS is that the day of safe and effective laser systems for the skin has arrived.

Laser systems in
Aesthetic & Medical Clinic (Dr Joseph Yang @ Orchard)

  • We chose the lasers from the best company: HOYAConBio (www.conbio.com), Candela
  • We chose the lasers because of its safety features.
  • We chose because the laser system can produce pulses of energy at consistent power.
  • We chose because this laser system can produce incredible medical results. Result do vary.
  • We chose because this laser system enables patients to go home with no downtime
  • And we are the first in Singapore to have Picosure 755 and Enlighten 532/1064. This is because picosecond technology is another quantum leap in the field of aesthetics.

Examples of the unique qualities of our laser system

1) Ours is a Q-switched Nd: YAG laser that uses a frequency doubling devise to reduce the 1064 nm wavelength by half to 532 nm. This alone enables the laser to produce 2 wavelengths of light. !064 is invisible while 532 appears as green light. The shorter green light has more energy than photons from the longer 1064. As such, we can have a wider armamentarium to choose from. This will result in a better medical outcome.

2) The laser system has a multiline Dye Laser Handpiece in the solid state. This generates either 585 nm yellow or 650 nm red laser light. All other laser system incorporates liquid dye solutions whose solvent create disposal problems due to their toxicity. These safely produced wavelengths greatly expand our ability to deliver the best results.

3) The Q-switched Nd YAG laser produces pulses at 3-7 nanosecond in length. Yet this laser can measure the pulsed laser energy of a single pulse rather than the average. Moreover, this pulsed laser can produce up to 1.0 joule in a single pulse. Short pulses with high peak powers and longer interpulse times have unique tissue effects such as photo-acoustic properties.

4) Laser light impacts on biological tissue in at least 2 ways. The heat that is generated is only partially responsible for chromophore destruction. The photoacoustic effect is more elegant. The target is heated to its fragmentation temperature before the applied energy is conducted to the surrounding tissue. In this way, the target is destroyed with no collateral damage to the surrounding normal tissue. Therefore our laser system can deliver good clinical outcomes with no downtime.

The current gold standard is picosecond technology. In short, the lasers are about one thousand times more refined. Our patients get better results in a much shorter time. Most would agree that it is nearly painless with even less downtime.

5) We have acquired the Gentle Max by Candela which can remove hair from ALL skin types as it has 755/1064 wavelengths. It is still the current gold standard.

6) We have acquired the 511 and 578 lasers too. As such we can remove red and blue broken capillaries.

7) We can also ameliorate stubborn red lesions like keloid, inflammatory acne, red and white striae (stretched marks), rosacea, fungal nails infection and red plaque psoriasis

Disclaimer: As each patient is unique and the degree of cell or skin damage is different, the result may take longer to appear. Results do differ.

Common side effects: Skin redness, laser-induced urticaria, mild skin peeling and skin dryness, Most are mild. Keep the doctors informed. It is important to follow the post-treatment protocols.