Whitening laser and gutatte pigmentation

Happy Halloween!
Did you get scare by this pale face of mine? Hahaha.

But white or fair skin has been recognised as beauty in Asian for years. Top sales of skin care products in Asian? I would imagine it to be one of those whitening products rather than sunscreen.

Is whitening laser safe?

When you mentioned "whitening laser", I assume you are referring to Q-switched Nd-Yag 1064nm laser.

Q-switched Nd-Yag has become very popular nowadays because it offers to treat many pigmentation problem and rejuvenation by stimulation of collagen production at the same time. 1064nm has been said to be the most suitable whitening wavelength for Asian skin as the risk of postinflammatory hyperpigmentation is small. Nowadays, you get to do it everywhere, in beauty saloon, in medispa, in general clinics. And it is often marketed as "lunch time laser" as it usually give very short down time (some redness is what you may get) especially when administered in low fluence using large spot size, or what is also known as toning laser.

As this "whitening and rejuvenation laser" getting more common, some people found instead of getting a homogenous white and fair skin, they get white spots. Some people get this even after just 4-5 times of laser, not necessarily after years of repetitive treatment. (Not all Q-switched Ng-Yag lasers are the same, even if they are of the same 1064nm wavelengths) The "solution"? Some people end up going for more and more whitening laser! Instead of monthly, some started to do it every 2 weeks, and every week, and every other days, and even everyday! (This happened especially for those who bought "packages of laser" to save cost or perhaps some centres who offered free rescue treatments.) The consequences, from one white spots to multiple white spots to lacey and mottled appearance.

We do not know why this happened. Perhaps the cumulative laser has destroyed the melanocytes (pigment producing cells) in the skin. What is horrible with this condition caused by "whitening laser" compared to other types of laser such as CO2 resurfacing laser and ruby laser is that this mottled or guttate pigmentation is very difficult to treat. Doctors have tried using topical whitening cream, steroids, calcineurin inhibitors and phototherapy with narrow band ultrabiolet B and various other modalities but many remained the same after years and probably going to be permanent!

No, I'm not saying Q-switched Nd-Yag laser is all evil and no good. Neither did I say you should not do it at all. It has helped many with pigmentation problems if done in a careful way.

I'm asking you to be just a little more careful. And I am definitely against buying or selling large packages of laser treatments as marketing strategies. Please do go to a good doctor who know what exactly he or she is doing. Go to a doctor who will be honest with you what are the pros and cons and what to expect. Very few treatments under the sun is without a single risk since even doing nothing and just staying under the sun is with skin cancer risk as well. As long as you know what to expect, when to put a stop to it, what remedial measures to be taken, you should be fine, most if not all the time.

If you have bought packages of "whitening laser", (yes, you may be heading for problem) and do not want to "waste" it. What I can advise you to do is that do not do it too frequently and closely monitor your face. If you notice white spots starting to appear, stop the laser treatment. do not go for further laser treatment even if you still have another 5 or 10 more treatments to go.  (What? You still have 20 over sessions? What a big "packages"! You must be kidding me!) Use sunscreen diligently and keep your fingers crossed, perhaps it is not permanent yet.

Read some cases from Singapore here.

Skin Care Routine for Dull and Uneven Skin Tone

My skin is dull and I have uneven skin tone. What can I do about it?

Pigment problem is so common, which is why foundation, concealer, BB cream and CC cream are essential items in most ladies' makeup bag.

Try out this simple yet effective skin care routine to help brighten up your skin and smooth-en your skin tone.

Morning:
1. Gentle cleanser
2. Antioxidant + sunscreen

Re-apply sunscreen 2 hourly throughout the day. (Yes, I know it isn't easy, but good skin doesn't come the easy way for most people after 30 years old.)

Night:
1. Makeup remover / gentle cleanser
2. Retinoids or retinol
3. Moisturiser

A few reminders:

1. Prescribed topical retinoids (common acne medication) is more effective but may cause irritation (dry, red and even skin peeling for some). Start with a pea size and observe your skin reaction for a week or even two before increasing the amount.
2. If you have sensitive skin and are trying out new skin care products, start one by one, a week or two apart, just in case you develop any skin reaction, it's easier to identify the culprit.
3. If "water" is your usual "morning cleanser" and you have no skin problem, go ahead, it makes your routine even simpler. Personally I do not use cleanser except makeup remover and I strongly feel cleanser isn't for everyone, especially if your skin is not too oily. But please do remove your makeup completely.

How to keep your skin hydrated?

Malaysia is a humid country, yet we keep on seeing people, with underlying skin problem or without, coming with dry and even cracked skin.

Here's a few tips on how to keep your skin hydrated.

1. Drink water, whenever you feel thirsty. Sounds dumb but how many of us forget to listen to our body cues when er are too engrossed in our work? We lose water in our sweats, urine, bowel movements and even while we breathe. A standard recommendation is to drink 6-8 glasses a day but really there is no "standard" for everyone because we are all different. Exactly how much water one needs depends on many factors from how much you exercise to your metabolic rate to how dry the environment is. Drinking too much water to the extent of water toxicity can lead to confusion and even coma and death. (But who on the earth in their right minds would drink so much water!?)
2. Talk short cold or lukewarm water shower rather than long hot baths (if you have eczema, keep the shower shorter than 5 minutes).
3. Use gentle cleanser instead of soap bar or antiseptic shower gel.
4. Apply generous amount of moisturiser immediately after baths (well not exactly immediate, within 3 minutes or when your skin is still damp).
5. Use paper mask. Paper mask is a great and yet economical invention of facial skin care. If not properly use, it may over hydrate the skin around the eyes making you look puffy though.
6. Use fabric gloves and socks after putting on moisturiser if you have dry hands or feet. This is a form of occlusion which will help your skin absorbs the moisturiser better, keep the moisture longer besides keeping your bed sheet and blanket clean.
7. Avoid direct sunlight, smoking, sauna.

Facial Mist Spray

"I hate applying cream and I'd rather use facial mist spray to hydrate my skin."

Using facial mist spray to hydrate the skin? You must be kidding me.

Water doesn't stay long on the skin, whatever being added in, hyaluronic acid or essential oil. It stays at best 3 minutes? Or 5 minutes? Depending on the additives and also the moisture in the surrounding air. Whatever it is, it is way too short to give adequate hydration. And nobody is going to carry a spray and spray every 30 minutes throughout the day! I don't.

If you mist your skin with water or a water-based product, IT WILL MAKE THE WATER IN YOUR SKIN EVAPORATE OUT! Yes, and this means it will leave your skin even more dehydrated and dryer than before.

How should facial mist spray or water spray be used?

You should apply a moisturiser when your skin is still damp, preferably an occlusive moisturiser that will prevent the water from evaporating to the environment.  Occlusive moisturiser are usually on the heavier side as they are often more oily. Examples of occlusives include petrolatum, triglycerides, beewax, lecithin, sequalene and various oils. Yes, some of these can be greasy and may not be good for acne prone skin.

Other ways that facial mist spray can be used include

• Set the make-up
• Refreshing stress relief especially after a long tired day
• As a "toner" to clean and soothe irritated skin

What is Epidermolysis Bullosa?

The Star has recently published an interview of a mother with her butterfly child. And Dr. Sabeera talking about what is Epidermolysis Bullosa, a group of rare genetic skin disease which is likely underdiagnosed in this part of the world as the awareness of its presence isn't high, not only among layperson but also among healthcare providers.

DEBRA Malaysia has "hunt down" about 100 families in Malaysia suffering from this condition since its establishment in 2013. I thought this video from DEBRA UK is a very nice illustration of what EB is all about, click play if you are interested to know. :)

Vitamin C for fairer skin?

Lemon lemon on the tree, who's the fairest of them all? Fair skin has long been considered beautiful by many. Can vitamin C lightens the skin?

Vitamin C inhibits tyrosinase enzymes to reduce conversion of tyrosine into melanin which is responsible for skin pigmentation. Vitamin C also boosts the level of glutathione and vitamin E in the blood besides being an antioxidant itself.

However it is difficult to obtain very high dose vitamin C from food alone. And even if you supplements, our body cannot retain the extra vitamin C level beyond a certain point and you will start urinating it out. The amount of vitamin C that can ever reach the skin is likely quite minimal.
 
The solution? Use topical vitamin C! And when you use topical vitamin C, choosing the right concentration (around 15-20%), the right stable form and the right packaging (easily oxidised away) matter!

Dark Eye Circles

Why are dark eye "circles" rather than semicircles? 

Probably because it can affect the upper eyelids in some people, not only the under eyes area.
 
Medical terms used for dark eye circles include periorbital melanosis, periorbital pigmentation, periocular hyperpigmentation, periorbital darkening etc.
Eye drops for glaucoma may cause temporary dark eye circles too. This is usually reversible once the medications are no longer needed.

Can you help me with my dark eye circles? 

As with any other medical concern, we have to first see the cause before discussing on treatment. And in many instances, it is more than just what some eye cream can solve.

There are many types and many ways of classifying dark eye circles. But generally dark eye circles can be cause be actual pigmentation (usually brown in colour), prominent vessels (usually bluish or purplish) and structural (skin colored), and frequently a combination of a few factors.

Aging and skin thinning, excessive sun exposure, fatigue and eye strain are among the most common cause of dark eye circles.

While patients are usually more concerned over the tired look, doctors should always look out for
💉Systemic causes (presence of other more severe medical illness)
💉Atopic diseases (often related with frequent rubbing)
💉Chronic sinusitis
💉Skin diseases
💉Nutritional deficiencies
💉Sleep disturbances
💉Use of hormonal supplements / products 

Certain medications such as glaucoma eye drops may cause dark eye circles too.

Treatment usually involve not a single visit. All contributing factors should be identified and if possible get treated. 

Cosmetic manufacturers often overly optimistic with their promises in dark eye circle treatment. Treatment with over-the-counter eye creams are unfortunately rarely successful. Apart from medical grade topical creams (often include a sunscreen and a bleaching agent, or chemical peels), botulinum toxins, fillers, lasers and even surgeries may be required.