Our skin ages along with the rest of the body over time, but because the skin is exposed to the external environment, different parts of our skin age differently. To understand these differences, we need to look more closely at intrinsic aging and extrinsic aging.
Intrinsic Skin Aging
Intrinsic or normal skin aging usually begins in our mid-20s, although the effects are often not obvious till our 40s and can typically be seen on the skin over areas that are normally not exposed to sun damage, eg, on the buttocks. Common changes include dryness, thinning, generalized wrinkling and an imbalance of hair growth. The normal turnover of new skin cells decreases and the process takes longer, around 4-6 weeks, compared with 3-4 weeks in young skin. These changes are inevitable, increase with the passage of time and are partly determined by genetics.
Extrinsic Skin Aging
Extrinsic skin aging is superimposed on intrinsic skin aging and is a result of chronic exposure to external factors that further damage the skin, including:
Cold winds and low temperatures
The skin becomes leathery and lax, with coarseness, deep wrinkles, irregular pigmentation and increased small blood vessels. Skin elasticity is lost, benign and malignant lesions may appear, the most serious of which are skin cancers.
UV radiation as a result of sun exposure significantly accelerates and increases skin aging, especially in lighter skin types combined with repeated and prolonged sun exposure. Those of us with Skin Types I & II are particularly predisposed to premature ageing (for further information, see the Skin Phototype Classification at the end of this article). In addition to sun exposure, UV radiation received in tanning beds is especially harmful to the skin.
There is ample medical research linking cigarette smoking with increased signs of skin aging. Heavier smokers have proportionately more skin aging and wrinkles than ex-smokers and non smokers. These effects are usually seen when one reaches middle age. The combination of smoking and sun exposure on skin ageing is synergistic and further increases the extrinsic ageing.
Steps to reduce extrinsic skin ageing
Avoid prolonged and repeated sun exposure
Avoid direct sunlight between 10am-2pm
Use adequate sunblock and re-apply regularly when outdoors
Choose a broad-spectrum sunblock that protects against UVA & UVB radiation and with a minimum SPF of 30
Stop smoking and reduce alcohol intake
Avoid the use of tanning beds
Aesthetic treatments for skin aging
1.Fractional lasers to improve skin texture, pigmentation, stimulate collagen growth
2.IPL to improve pigmentation and reduce small blood vessels
3.Botulinum toxin to reduce dynamic wrinkles
4.Fillers to reduce static wrinkles and deep lines
5.Intense Focused Ultrasound (IFUS)/PLLA/PDO Threadlift to lift and tighten lax skin
Fitzpatrick Skin Types
All of us can be broadly divided into 6 different skin types:
Type I--Very fair, always burns, never tans, blue eyes, blonde/red hair
Type II--Fair skin, easily burns, poorly tans, blue eyes
Type III--Medium white skin, sometimes burns, always tans
Type IV--Light brown skin, minimally burns, always tans
Type V--Brown skin, rarely burns, always tans
Type VI--Dark brown or black skin, never burns, always tans
Most modern aesthetic treatments are relatively safe for most skin types and Intense Focused Ultrasound (IFUS) (which uses ultrasound for skin tightening) is ‘colour blind’ and usually safe for all skin types. Most injection treatments, eg Fillers and Micro-threadlifts, are also usually safe for all skin types.
Darker skin types can be at greater risk of potential side effects, eg, Post Inflammatory Pigmentation(PIH) after certain treatments such as lasers and phototherapy. Sun avoidance and sun protection are even more important in darker skin types and it is important to discuss with your aesthetic doctor about your pre and post treatment precautions to reduce this risk to the minimum.
With progressive age and environmental damage, our skin’s collagen gradually decreases from our mid 20’s, resulting in signs of aging and sagging usually appearing from our mid 30’s onwards. This occurs because the skin’s structure weakens as dermal collagen and elastin is lost, gradually leading to laxity and sagging, particularly in the lower half of the face. We lose about 1% of our dermal collagen per year during our adult life. The epidermis becomes hyper or hypotrophic and the number of melanocytes increases, with an irregular distribution.
This manifests outwardly in the upper part of the face as dynamic and static wrinkles, drooping brows and eyelids. In the lower face, this shows up as as deep smile lines, downturned lip corners, increased volume and sagging of the jowls. In the neck, skin sagging results in deep wrinkles, the dreaded ‘turkey neck’ and/or ‘double chin’.
To decrease the rate and severity of skin laxity associated with aging, one should:
Avoid excessive sun exposure
Reduce alcohol intake and stop smoking
Maintain a healthy diet
Exercise regularly and avoid excessive weight gain
There are currently a number of treatment options for skin laxity, depending on age, severity, cost and downtime. I have selected a few of the more effective and well-regarded treatment options for our discussion of the relative strengths and weaknesses of each. After understanding each treatment’s pros and cons, I hope you will be in a better position to decide which, if any, are a good fit with your own personal comfort level.
Non-surgical aesthetic treatments
Many clients may not be ready for and/or may not need surgery, with all the associated risks and downtime. Fortunately, modern advances in aesthetic technology have increased the non-surgical options for skin tightening and lifting, many with little or no downtime, allowing clients to resume their normal lifestyles almost immediately. All these treatments aim to stimulate increased production of collagen in and under the skin, leading to improved skin laxity.
A.Ultrasound Skin Tightening
Intense Focused Ultrasound (IFUS) uses micro-focused ultrasound to heat and stimulate collagen leading to skin tightening and lifting. The ultrasound energy is delivered through the superficial skin to reach deeper levels of collagen than lasers or RF energy devices, leading to tightening from deep within. It is the only USFDA approved non-surgical technology for lifting skin on the face and neck and only 1 treatment session is normally required. Results appear gradually and naturally over 2-3 months and usually last for 12-18 months.
Pros: Totally non-invasive, no downtime, only 1 single session needed, suitable for all skin types
Cons: Requires patience to appreciate full results
B.RF skin tightening
Pros: Non-invasive, only 1 session needed, can treat eyelidsCons: Results more variable (dependent on skill of operator), more painful, requires patience to appreciate full results
Pros: Totally non-invasive, no downtime, only 1 single session needed, suitable for all skin types
Cons: Requires patience to appreciate full results
C.PDO Micro-thread Lift
PDO Threadlift is a Korean FDA approved treatment that uses PDO micro-threads to stimulate collagen leading to skin tightening and lifting. The micro-threads are inserted just under the skin using very fine needles in a specific pattern, resulting in immediate tightening, although best results are seen 2-3 weeks after the procedure. Results can last for 9-12 months.
Pros: Immediate results with instant tightening, only 1 session needed
Cons: Short downtime of a few days(bruising and swelling), minimally invasive
PLLA is a dermal filler composed of poly-L-lactic acid(PLLA), which is injected just under the skin to stimulate collagen, leading to skin tightening and lifting. The PLLA stimulates the surrounding collagen to regrow and it is USFDA approved. Normally, 2-3 sessions are required for best results, which appear gradually and can last for 18-24 months.
Pros: Ideal for skin tightening and volume replacement at the same time
Cons: Multiple sessions required, requires patience to appreciate full results, minimally invasive
Depending on each individual’s needs and preferences (eg, cost, downtime, degree of invasiveness, speed of results, etc), any of the treatments discussed might be a suitable treatment option. The importance of a personalized consultation with an experienced aesthetic professional to discuss and select the most appropriate plan of treatment cannot be over-emphasised.
For those patients with advanced age, severe skin laxity and sagging, this may be the only realistic option for significant improvement. In skillful hands, the results can be dramatic, with highly significant improvement, yet natural-looking results. It is imperative that one chooses the right plastic surgeon and that they are comfortable with the associated factors of: significant costs, infection, bleeding, significant downtime and post-operative recovery.
In our region of the Asia-Pacific, Korean cosmetic surgeons have earned a well-deserved reputation for excellence in this field, with innovative new techniques and a depth of clinical experience that is unmatched in this region. Taiwan and Singapore also have a good reputation for plastic surgery, while Thailand is a good choice for those on a budget, although standards can be more variable. The final results of plastic surgery are semi-permanent, so this is a decision that should be carefully and thoroughly considered.
Pros: Significant change/improvement possible, long-lasting effect(good result)
Cons: High cost, long downtime, long-lasting effect(bad result)
Intense Focused Ultrasound (IFUS) is a USFDA approved, safe and non invasive, micro-focussed ultrasound treatment that stimulates your own collagen to regenerate and counteracts the effects of time and gravity on your skin. Intense Focused Ultrasound (IFUS) is the ONLY USFDA approved non invasive, skin tightening and lifting treatment and has been approved for lifting of the brow and upper neck skin. It is also commonly used for skin lifting and tightening over the cheeks and jowls, lower neck and other body parts such as the chest and décolletage, upper arms and abdomen. Improvement is gradual and natural, best results are usually seen after 2-3 months and the skin tightening and lifting lasts for around 18 months to 2 years.
'Dark circles' can be caused by a number of conditions (or a combination of them), including:
Hollow tear troughs
Blood vessels under the skin
Skin laxity and 'eyebags'
Prominent muscles under the eye
As the solutions differ depending on the exact cause, the most important step is an expert facial assessment to determine which is the primary cause of your dark circles. Hollowing of the face can be treated with dermal fillers and filling the tear troughs requires skill and experience to ensure a good outcome. Pigmentation and dark blood vessels can be treated with appropriate lasers and/or topical medication. Overactive muscles can be reduced with a small amount of botulinum toxin, leading to a pleasing increase in the vertical width of the eyes and a fresher, more energetic appearance.
Wrinkles increase with age due to the combination of progressive skin laxity and repeated contractions of the underlying muscles causing lines to form in the skin. There are 2 types of wrinkles: dynamic wrinkles appear with facial expressions and disappear when the face is at rest, static wrinkles are deeper and persist even when there is no facial expression.
Botulinum toxin is usually the first choice for dynamic wrinkles, especially in the upper face, with predictable improvement and quick results. It can also be used with caution for some wrinkles in the lower face and neck. Static wrinkles are treated with a combination of dermal fillers and/or PDO Micro-thread Lift to tighten and lift the skin in and around the wrinkles/folds. Depending on the site and nature of the wrinkles, chemical peels/laser resurfacing can show improvement and PLLA can give a gradual and natural result.
Skin laxity gradually increases with age and exposure to the elements and the area around the eyes is very susceptible to this. Droopy eyes make one look tired and unhappy. In women, flattening of the eyebrow robs one of the sensual and attractive natural arch of the youthful feminine eyebrow.
Botulinum toxin can lift the eyebrows, correct brow asymmetry, reduce wrinkles and increase the vertical width of the eye. dermal fillers can also be used to volumise hollow temples and lift eyebrows.
This is a difficult question to answer without a detailed facial aesthetic assessment as there are many potential causes of a 'tired looking face'. These include:
Dark circles under the eyes
Prominent hollowing of tear troughs
Generalized skin laxity
Drooping eyebrows and eye corners
Hollowing of cheeks and temples
Since all of us have different facial characteristics, the best solution is a personalised aesthetic consultation to determine the root cause(s) of your problem. You may also like to read some of the answers to other FAQs in this section that address some of the common problem areas mentioned above.
In the past, the only option for altering facial shape was through surgery, with all the associated risks, pain, downtime and high costs. Surgery was also permanent, so if you did not like the result…..you were stuck with it!
Nowadays, there are many non-permanent options for face-shaping, with no downtime and little or no pain. Facial slimming (the V-shape) can be easily achieved with a combination of Botulinum toxin for the jaw muscles and dermal filler to improve the shape and prominence of the chin. Flat and/or wide noses can be made higher, slimmer and pointy with proper use of dermal fillers. Minor changes in the shape of the nose, chin and jawline can have a profound effect on the overall appearance of the face.
Creams and lotions that promise dramatic improvement in face shape, wrinkles, skin texture and tightness, etc. should be viewed with a healthy dose of scepticism. Many lack any real scientific evidence for effectiveness. The truth of the matter is this: if it sounds too good to be true, it probably is!
Loss of lip volume and drooping of the lip corners is commonly seen over time, associated with a general loss of skin elasticity and decreased collagen. This can be more noticeable in women, where full and sensuous lips are a hallmark of youth and beauty. Early thinning is commonly seen in the upper lip and peri-oral wrinkles (or smoker's lines) can exacerbate the perception of aging.
Dermal filler can be used to restore lost volume and definition to the lips, giving a youthful and sensual appearance and can also be used to reduce the prominence of fine wrinkles around the lips. Small amounts of Botulinum toxin can relax muscles in the lower face, giving an upturn to the lip corners and reducing the peri-oral wrinkles. A holistic approach to rejuvenation, using a combination of treatments to achieve a natural and subtle improvement, is always the best approach.
Skin laxity is a common problem all of us face sooner or later and it becomes more noticeable around middle age. In the middle and lower face, this shows up as sagging cheeks, prominent jowls and a heaviness around the jawline. In the neck, the horizontal and vertical lines become more pronounced and the skin under the chin hangs down, giving rise to the dreaded 'double chin' or 'turkey neck' appearance.
Really severe skin laxity can only be improved with surgery. PDO Micro-thread Lift can also be used to tighten and lift the cheek, jowl, along the jawline and under the chin. The lifting and tightening can be seen and felt immediately. PLLA, an 'active filler' can also be used to stimulate new collagen production, resulting in a gradual and natural skin tightening effect over 2-3 months. In certain situations, Botulinum toxin can sharpen the contour of the jawline, reduce neck wrinkles and soften prominent vertical neck bands.
This is the one of the most commonly treated areas and results can be instant and dramatic. dermal fillers are usually the first choice and can fill in part of the line, making it less prominent but still natural looking. Microthreading can also improve this area and lift the cheek and jawline as well. Those desiring a more gradual improvement along with some skin tightening could benefit from PLLA.
At WMA, we value your time and try our best to schedule appointments to ensure waiting time is kept to the absolute minimum. Out of respect for other clients, we encourage all clients to arrive punctually at the scheduled time to assist us in avoiding unnecessary delays.
Of course, we understand that personal and professional schedules can change and that some rescheduling may be unavoidable. For cancellations made more than 48 hours beforehand, there is no penalty and our staff will gladly assist you to reschedule your appointment. Simply call or email us with your request and we will give it our prompt attention.
For cancellations made with less than 48 hours' notice, we reserve the right to charge up to half of the treatment cost. No shows on the day without any prior notice will be charged the full price of treatment. We politely request your understanding and cooperation with this policy, as the ultimate goal is to improve the Wyndham Medical Aesthetics experience for ALL our valued customers and staff.
Yes, we charge a nominal fee for our personalized consultations: $250 (aesthetic consultant) and $500 (medical director), but these fees are waived if you select ANY aesthetic treatment from our wide range of available options. This nominal fee is not designed as a revenue-generating tool. We simply prefer to be completely open and honest about our charges, rather than offering 'free' consultations that actually turn out to be 'hard sell', high pressure sales sessions.
There are many reasons for uneven texture and pigmentation, including sun damage, hormonal changes and previous skin infections. For more significant improvement of texture and pigmentation, a fractional laser resurfacing of the superficial layer of skin will be needed. Improvement will be seen after a single session and best results are usually seen with a series of 3 monthly sessions. Our fractional laser significantly reduces the downtime associated with traditional laser resurfacing and is also safer for darker skin types. Chemical peels can also improve pigmentation and texture.
This is a common problem, especially for those with lighter skin type and thinner skin, and is seen in Rosacea. IPL Phototherapy is useful for these conditions and can improve superficial pigmentation and reduce small superficial blood vessels at the same time. Best results are seen with a course of 4-5 monthly sessions and there is NO downtime.