Skin & Laser Treatments

TYPES OF SKIN ANOMALY: CITY COSMETIC CLINIC HAS 14 LASER MODALITIES TO TREAT YOUR PROBLEMS.

	FACIAL VEINS Facial veins also known as Telangectasias, are fine, little red veins on the nose, chin or cheeks that appear both in men and women as a normal part of aging. These can also result from pregnancy, childbirth, birth-control pills, estrogen-replacement therapy, sun damage, Rosacea and even corticosteroids. These are not broken blood vessels, only permanently dilated and visible fine veins. Laser treatments for facial Telangectasias depend on the quantity, size and depth of veins. Most patients need between one to four sessions that are 4-6 weeks apart. The appearance of the treated area immediately after the laser session will vary from patient to patient and they may include redness, tenderness, crusting and blistering, all of which disappears in short time.
	POIKILODERMA OF CIVATTE It is a mottled pigmentation on the neck, mostly considered to be a reaction pattern of the skin and not a disease. It is a combination of atrophy, telangectasias and changes in pigments (both hypo pigmentation and hyperpigmentation), more common in females than in males affecting middle-aged or elderly women but can be seen in other age groups. Occasionally, patients report mild burning and itching. The causes of Poikiloderma are unknown but many factors are implicated: chronic exposure to UV light rays, photosensitizing chemicals in perfumes or other cosmetic products, possibly hormonal changes related with menopause and low estrogen level as well as genetic predisposition.
	SOLAR LENTIGINES Are multiple dark-brown macules on the face, ears, forearms, hands, chins, upper back and chest and scalp in bald men due to chronic exposure to sunlight. Solar Lentigines are not the same as freckles. These do not fade in the winter as freckles do, these may disappear spontaneously but in general these will remain for years. The laser targets the brown pigment - melanin and the number of sessions may vary from patient to patient.
	PORT-WINE STAIN A port-wine stain (PWS) is of irregular shape red or violaceus vascular malformation that is present at birth and never disappears spontaneously (except for the salmon patch). In adulthood, PWS's usually becomes raised and the cause of significant and progressive cosmetic disfigurement. The laser targets the red pigments in the blood vessels and several sessions may be required along with a maintenance program as these can reappear.
	ROSACEA Is a chronic acne form disorder of the facial pilosebaceous units, coupled with an increased reactivity of capillaries to heat leading to flushing and ultimately to telangectasias. Although, this disease was previously called acne rosacea, it is unrelated but may coexist with acne, which may have preceded the onset of rosacea. Rosacea is the cause of significant cosmetic disfigurement.
	SOLAR KERATOSIS Appears on the scalp, face and dorsal of the hands. It is most common in Caucasians and Asians, usually at people older than Solar keratosis may disappear spontaneously but in general they remain for years and sometimes they can develop in squamous cell carcinoma.
	SEBORRHEIC KERATOSIS It is the most common of the benign epithelial tumors. These lesions which are hereditary do not appear until age 30 and continue to occur over life time. They are isolated or generalized lesion on the face, trunk and upper extremities. The lesion is round or oval in the form of a plaque with brown, black or skin color with warty and "greasy" surface. Larger pigmented lesions are easily mistaken for basal cell carcinoma or malignant melanoma, therefore, a histopathologic examination will rule them out.
	NEVUS OF OTTA This pigmentary disorder is very common in Asian population and is said to occur in 1% of outpatient visits in Japan. It has been reported in East Indians, in blacks and rarely in Caucasians. This pigmentation which can be quite subtle or markedly disfiguring consists of mottled, dusky mixture of blue and brown hyperpigmentation of the skin. It may be congenital but is not hereditary. More often it appears in early childhood or during puberty and remains for life. Treatment with laser is an effective new mode for this disorder.
	BECKER NEVUS It is a pigmented hematoma that is a developmental anomaly comprising of changes in pigmentation, hair growth and most importantly a slightly elevated smooth veracious surface. It occurs mostly in males in all races. It appears NOT in birth but usually before 15 years of age and sometimes after age 15. It is light brown in color with sharply demarcated borders. Common locations are the shoulders and the back with increased hair growth in the pigmented area. The lesions extend for a year or two and then remain stable, only rarely fading. Coarse hair may develop.
	HYPERPIGMENTATION Synonymous with Chloasma or mask of pregnancy is an acquired, light or dark hyperpigmentation that occurs in the exposed areas, most often on the face and results from exposure to sunlight. It may be associated with pregnancy, ingestion of contraceptives or possibly with certain medication. The pigmentation usually evolves quite rapidly over weeks, particularly after exposure to sunlight. Melasma is more apparent or more frequent in persons with brown or black skin color (persons from Asia, Middle East, India and South America). It may disappear spontaneously over a period of months after delivery or after cessation of contraceptive hormones.
	AGE SPOTS Also known as solar keratosis these are single or multiple, discrete; dry, rough, adherent scaly lesions on the habitually sun-exposed skin of adults, which are removed with difficulty and with pain. Most commonly are skin coloured, or yellow-brown and are situated on the face, ears, neck, forearms and hands, shins and on the scalp in bald males. Solar keratosis may disappear spontaneously, but in general they remain for years and sometimes may develop in squamous cell carcinoma (cancer). The target for the laser is the pigment melanin and from case to case 2-6 sessions are required for treatment.

 

 

CHEMICAL PEELS

Chemical peels can improve the appearance of fine lines, hyperpigmentation (skin discoloration or age spots), enlarged pores due to an improper daily skincare regimen, and light sun damage, freckling and scarring.

Many types of chemical peels are on the market today. They may include just one chemical, such as glycolic acid or trichloroacetic acid, or a combination of chemicals. These chemical solutions come in various strengths, and chemical peels are often classified as either a light or superficial peel, medium peel or deep peel.

The number of treatments varies among individuals with results lasting up to several months.

Other treatment options include facelift, brow lift and facial implants.

Laser skin resurfacing, fat transfers, Botox and Restylane can be incorporated into your treatment. For deep scarring, laser scar removal may help.

How is it done?
During the procedure, the chemical solution is applied to the affected area. The chemical agents then work to separate and "peel" the outer surface layers of the skin. These layers often contain dead skin, which is removed during the process. The chemical agents stimulate the generation of new skin cells through the healing process.

During the application, you may experience a cool, warm or hot sensation that can last for 10 minutes or more. You may also feel a stinging sensation.

How long does the procedure take?
The procedure takes about 15 minutes, then one to three weeks of recovery.

What should I expect after treatment?
You should avoid all makeup and stay out of the sun for up to two weeks. You will need sunblock with an SPF of 15 or higher before you go outside.

Your skin's reaction to a chemical peel depends on many factors, including skin type and peel strength. During the first two weeks the skin may break out until it is renewed at the end of recovery. Additional reactions can be similar to sunburn.

Lighter peels can produce redness and skin peeling for a few days. Deeper chemical peels can result in blisters that burst, scabs or skin peeling for up to two weeks. This may be accompanied by swelling.

The treated skin is highly susceptible to injury, so take care of it.

The aging process, including new fine lines and age spots, will continue over time. A maintenance program of chemical peels may be part of your long-term plan.

What are the costs involved?
Prices start from $176* including GST.

*The cost of cosmetic surgery can vary (higher or lower), depending on the complexity of the procedure, the required results, cost of implants, aftercare treatment and the area of the body where the surgery is being performed. Further costs may be incurred for anaesthetist and hospital fees if applicable. For specific pricing information, please arrange a consultation with Dr. Tiong.

 

ADULT ACNE

Adult acne is a common condition affecting adults of all ages, including 50 percent of women and 25 percent of men. Whether you are 22 or 62, you may be prone to adult acne. The good news is City Cosmetic Clinic provide many new treatments and procedures to you.

Dr Tiong will explain to you  the pathogenesis of acne such as  hormonal changes as well as many contributing factors can include side effects from certain medications, cosmetic products with high oil contents, excessive sweating, stress, pregnancy, and menopause.

Blockages of bacteria and oil can build, leading to adult acne problems including pimples, inflammation, cysts, and scarring. Adult acne most often appears on the face; however, it can appear on the arms, legs, buttocks, and torso.

Adult acne can be physically painful and it can interfere with everyday life. Adults who are concerned about the first impression they make with others will be especially interested in facial acne treatments and remedies.

How is it treated?
The appropriate treatment for acne varies depending on the individual. Some of the products currently on the market include ingredients such as benzoyl peroxide, salicylic acid, retin-a, cleocin-t, accutane, sulfur, erthythromyicin, doxycyline and tetracycline. But there's more than medicine to treating adult acne.

A multifaceted approach of treatments, behaviors, and diet is often most effective. Here are a few simple strategies to help you combat adult acne:

• Consult your doctor about hormonal changes.
• Protect skin from pollution with toners and moisturizers.
• Limit exposure to high humidity.
• Do not touch or scrub your face or the blemishes on your skin.
• Do not wear apparel that is tight on the face or skin, including tight collars or helmets.
• Follow a daily skincare regimen.
• Avoid exposure to sun and excessive cold.
• Select non-oily cosmetic products.
• Eat a well-balanced diet.

Skin procedures can be used for the prevention, onset, or aftermath of adult acne:City Cosmetic Clinic provides all these services.

• microdermabrasion
• chemical peels
• laser skin resurfacing (for acne scars)
• laser scar removal (for deeper acne marks on the face)

 

FRACTIONATED LASER:

New Generation of Laser is delivery of fractionated laser beam to the dermis while preserving the integrety of many skin appendages structures that helps the healing process of laser treatment . This process is called micro-thermal injury , helps to minimised the incidence of complications such as PIH or scaring.

A protein found in connective tissue, collagen maintains the skin's integrity, but breaks down with advancing age. The breakdown of collagen can lead to the development of wrinkles, lines and folds in the skin. Regenerating collagen, however, can improve skin elasticity, tone and appearance.

Fractionated laser therapy is used for a variety of rejuvenating treatments, including the shrinking of large pores. It is the first and only laser approved for treatment of melasma (the mask of pregnancy), a condition marked by brown patches on both sides of the face, including the cheeks, bridge of nose, forehead and upper lip. Fractionated laser  therapy can be used to treat the neck, chest and hands.

How is it done?
A topical anaesthetic will be applied approximately one hour before treatment . When the procedure begins, you will likely feel slight pressure with each pulse of the laser. It may feel like a rubber band snapping against your skin. Depending on your pain threshold, other medicine or gas may be used . This will be discussed during consultation with Dr Tiong.

How long does the procedure take?
The treatment takes approximately an hour  to complete, depending on the size of the treated area.

What should I expect after treatment?
Following  treatment, your skin will be pink or brown for a 3-4 days. This treatment involves little down-time. You may feel like you have a sunburn. Some people develop a slight tan a few weeks after treatment. This procedure is NOT an office procedure. Although lower energy can be use , which may produce minimal down time, but it is a costly process.

There are many more laser combination Dr Tiong can use. For example, micro-laser peel with low energy can close your skin pores;  Skin Tighten laser combined with IPL to smooth the skin texture as well as improving skin laxity.

Multiple treatments are frequently necessary and are done once a month, but the exact number of  treatments needed to achieve your desired results will vary depending on your skin problems.

It's wise to have a pre treatment  skin program before laser treatment and a program afterwards to keep the skin moisturized after treatment with the  laser. Sun protection with a sun protection factor of 30 or above that is re-applied as much as possible during the day. You can wear makeup to hide some of the redness. The full results will usually evolve over several months post treatment.

What are the costs involved?
Prices start from $2,200* including GST.

*The cost of cosmetic surgery can vary (higher or lower), depending on the complexity of the procedure, the required results, cost of implants, aftercare treatment and the area of the body where the surgery is being performed. Further costs may be incurred for anaesthetist and hospital fees if applicable. For specific pricing information, please arrange a consultation with Dr. Tiong.

 

MICRODERMABRASION

Microdermabrasion is a popular skin treatment that may improve signs of aging and sun exposure. It's a non-invasive, one hour procedure for the skin on your face, neck, or arms, with virtually no recovery time.

While microdermabrasion is most effective for patients in the early stages of aging, teens have also benefited from this technique. Microdermabrasion can reduce mild acne scarring and hyperpigmentation, and improve the appearance of poorly textured skin, fine lines, and large or clogged pores. The procedure is considered effective for both dark and light skinned patients.

How is it done?
During the microdermabrasion treatment, a device is pressed against your skin, which causes a gentle abrasion through a fine crystal spray that breaks up dead skin and other imperfections. There are many materials that may be used, including aluminum oxide crystals, sodium bi carbonate crystals, diamond-tipped crystals, or salt crystals.

Manufacturers have also developed technology that does not require the use of crystals. In this case, a vacuum-type device removes the dead skin. The treatment works much like an exfoliation with vacuum action that removes imperfections, buffs the skin, enhances skin texture, and improves circulation and lymph flow. The treatment does not cause discomfort or skin laceration.

You'll need a daily skincare regimen and follow-up treatments to maintain the benefits.

How long does the procedure take?
The procedure usually takes around 30-60 min. to complete. Usually done by Trained Nurses and Beauticians.

What should I expect after treatment?
Your face may be slightly red for an hour after treatment. You are to avoid sun exposure for a number of days after treatment.

Multiple treatments may be required in order to achieve the results you're looking for.

What are the costs involved?
Surgeon fees start from $154* including GST.

*The cost of cosmetic surgery can vary (higher or lower), depending on the complexity of the procedure, the required results, cost of implants, aftercare treatment and the area of the body where the surgery is being performed. Further costs may be incurred for anaesthetist and hospital fees if applicable. For specific pricing information, please arrange a consultation with Dr. Tiong.

 

LASER SKIN RESURFACING

One of the most popular anti-aging remedies is ablative laser skin resurfacing, which improves the appearance of fine lines or wrinkles, scars and hyperpigmentation, primarily around the eyes and mouth. It can also be used to treat large areas of the face.

Ablative laser skin resurfacing holds advantages over alternative approaches that may cause discomfort, bleeding and bruising, all of which equate to a longer recovery time. This  treatment remove a layer of skin so that the new skin can flourish and fill in the wrinkles and crevices.

New Generation  of ablative Er:YAG. By contrast, non-ablative lasers do not burn off the skin surface in experience hands.

 

How is it done?
Typically you would receive topical anaesthesia, local anaesthesia, and intravenous sedation so that you are awake, but not fully aware. You might even receive general anaesthesia for treatment of deeper layers of the skin. The type of anaesthesia is based on the laser that is used and the level of your treatment.

The laser is moved precisely over the treatment area. Depending on the depth of the wrinkle, scar or discoloration, the laser may be moved over the area repeatedly.

The laser penetrates and removes the number of outer skin layers necessary to uncover the layer not affected by imperfections. It feels like a rubber band is being gently snapped against your skin. Once that layer is exposed, healing can begin to rebuild new skin that looks younger and does not have the imperfections.

The procedure may be performed in two or more sessions to penetrate deeper areas, but one procedure is usually enough. You may need a series of such treatments before you achieve the desired results. Multiple lasers may be used at the same time depending on your condition.

How long does the procedure take?
Treatment time ranges from a few minutes to an hour-and-a-half, depending on the amount of resurfacing you need.

What should I expect during recovery?
You may experience some temporary side effects, including swelling and mild discomfort. This can be controlled with ice packs and medications. There is rarely any bleeding.

You may develop a red, crusted appearance on the treated area for three to ten days. Do not pick at the crusts or you could develop scars.

Your skin may look bright pink for weeks. Avoid sun exposure until all skin color has returned to normal. A sun protection factor of 30 or more is recommended to be worn. You are usually allowed to wear make-up one to two weeks after the treatment.

What are the costs involved?
Prices start from $2,200* (nonablative) including GST and $4,950* (ablative) including GST.

*The cost of cosmetic surgery can vary (higher or lower), depending on the complexity of the procedure, the required results, cost of implants, aftercare treatment and the area of the body where the surgery is being performed. Further costs may be incurred for anaesthetist and hospital fees if applicable. For specific pricing information, please arrange a consultation with Dr. Tiong.

 

LASER SCAR REMOVAL

Laser scar removal is another popular use of laser technology. Laser treatment reduces the appearance of scars by 50 to 80 percent and helps prevent recurrence.

The wound-healing process begins with inflammation, progresses to tissue formation and ends with modifying specific factors in the anatomy – such as collagen, the main protein found in connective tissue that supports the skin, bone, cartilage and blood vessels.

Scarring occurs when the wound-healing process is disrupted by certain factors such as too much or too little collagen. For example, a keloid scar is a mass of collagen.

Today's laser scar removal techniques can reduce the appearance of several types of scars, including:

• Keloid Scarring: Firm, raised and reddish-purple scars that extend beyond the initial wound area and build over time.
• Hypertrophic Scarring: Firm, raised and pink scars that remain within the initial wound area and may fade over time.
• Atrophic Scarring: Depressed pin-like pockets in the skin that can result from skin conditions or diseases such as acne.

Not everyone is a candidate for laser scar removal. People with skin disorders such as psoriasis, cystic acne and dermatitis may not be ideal candidates. Those using certain medications such as isotretinoin for acne must stop using the medication for six months prior to the procedure.

How is it done?
During laser scar removal, the laser is moved along the scar. This can vaporize or remove a layer of skin and expose a more natural-looking skin layer, which heals over time to minimize scar appearance. Other lasers may target lower layers of the skin, stimulating new collagen growth and correcting scars from the inside out.

Many types of lasers are available, each of which has unique benefits for scar removal.

The CO2 and Er:YAG lasers are best suited for acne scarring. The CO2 is an ablative laser that basically sandblasts the skin away; resulting in some substantial downtime. The Er:Yag is also ablative, but less so than the CO2; meaning that it is less damaging.

Fractionated  Er:YAG lasers is very helpful for acne scarring, but they require multiple treatments. Fractionated lasers work by treating a fraction of the skin's surface. These lasers create tiny wounds in the deeper layer of the skin. Each wound is surrounded by untreated skin, helping to repair the treated area via a controlled wound-healing process.  Erbium YAG lasers as well as radiofrequency treatments can be fractionated.

The 585-595-nm pulsed dye laser technology which includes Cynosure and Candela lasers, is often used to treat hypertrophic and keloid scars. These lasers may be used with or without steroid or five percent 5-fluorouracil (5-FU) injections, both which can help flatten scars.

These lasers are considered non-ablative because they do not burn off the skin surface. Instead, they target the tissue under the skin surface and stimulate new collagen growth. There is little downtime with these lasers.

How long does the procedure take?
The surgery takes anywhere from a few minutes to an hour-and-a-half.

What should I expect after treatment?
Your skin's regeneration process can begin as early as four days after treatment. Speed of regeneration depends on the type of laser used and individual skin characteristics. You can typically resume normal activities immediately after laser scar removal treatment.

Medicated creams can help the scar fade. A cool mask may also be recommended. You can take oral medication to treat any pain and discomfort.

What are the costs involved?
Prices can start from $300  including GST.

*The cost of cosmetic surgery can vary (higher or lower), depending on the complexity of the procedure, the required results, cost of implants, aftercare treatment and the area of the body where the surgery is being performed. Further costs may be incurred for anaesthetist and hospital fees if applicable. For specific pricing information, please arrange a consultation with Dr. Tiong.

 

LASER TATTOO REMOVAL

Laser tattoo removal is a growing trend among people who had "ink" done in their youth, but now view it as outdated or as detrimental to their career. Others may be dissatisfied with a tattoo that was poorly done.

Whatever your reason may be for removing a tattoo, laser procedures are the most common and effective method for erasing the ink.

The best candidates are people with a fair to medium-light complexion who have darker ink tattoos applied sparsely and close to the skin surface. The laser light seeks contrast to target the appropriate pigments, so the greater the contrast (dark ink on light skin), the more effective the removal process and the fewer sessions needed.

Also, darker ink happens to be more easily fragmented, as is less dense ink that is closer to the surface. However, laser treatments may also be effective on people with darker skin and with varied ink colors.

How is it done?
The laser device fragments the ink with short pulses of intense, concentrated laser light. The method of delivery and the wavelengths used are designed to target only the tattooed pigments, without affecting the surrounding pigments and layers of skin. Different laser lights are used for different ink colors. Black ink is easiest to remove, because black absorbs the full spectrum of light, while green, blue, red, and other colors require more targeted laser pulses.

Passing through the surface layers of your skin, the light is absorbed by the tattooed pigments, causing them to break into smaller particles. Your body's immune system then removes the fragmented tattooed particles. And because your immune system works best in areas of greater blood circulation, ink can be removed faster in those areas. Thus, it's more difficult to remove tattoos in the hands and feet, where there is less circulation.

Tattoo removal may require anywhere from one to ten laser treatment sessions, each treatment lasting only a few minutes, with four- to eight-week intervals between each session. Each treatment penetrates a little deeper, removing more ink and leaving the tattoo progressively lighter.

How long does the procedure take?
Tattoo removal only involves a few minutes of treatment each session.

What should I expect after treatment?
After the procedure, you'll be given anti-bacterial ointment and bandaging on the treated area. You should avoid the sun, as your skin will be extra sensitive to sun damage. You may feel a slight sunburn sensation for a couple of days and have redness for a few weeks.

What are the cost involved?
Prices start from $200* including GST.

*The cost of cosmetic surgery can vary (higher or lower), depending on the complexity of the procedure, the required results, cost of implants, aftercare treatment and the area of the body where the surgery is being performed. Further costs may be incurred for anaesthetist and hospital fees if applicable. For specific pricing information, please arrange a consultation with Dr. Tiong.