Plastic Surgery, as we know it today, goes back a long long way. The first known record of plastic surgery was in 1213 BC, when ancient Egyptians tried to preserve the nose of their dead king by surgically inserting bones and seeds into it.
3000 years later, plastic surgery has evolved into a recognized medical specialty, with the numbers undergoing the knife steadily increasing year after year.
The picture below gives us an interesting insight into how the Ancients did it - before Botox and Lasers.
I wrote about peptides in skincare creams for anti-aging - what they are, how they work and what to look out for when considering a peptide product.
Choosing a peptide cream can be a nightmare with so many such creams in the market. The strange way these peptides are named do not make your task any easier either. To make things worse, the names of peptides frequently change, creating more confusion.
New peptides are constantly emerging in the skincare arena, making a comprehensive list difficult. Here, I attempt to list and describe some of the more popular anti-aging peptides which you may come across when browsing for beauty products.
Peptides have a chemical name, such as Pamitoyl Oligopeptide, and a trade name, such as Matrixyl. Either its chemical or trade name may be used in the ingredient list of a product.
SNAP-8 is an elongation of the famous neuropeptide, Argireline (see below). SNAP-8 reduces the depth of wrinkles on the face caused by the contraction of muscles of facial expression, especially in the forehead and around the eyes. SNAP-8 seems to have equal anti-wrinkle properties compared to Argireline: in a 2001 study which compares Argireline, SNAP-8, and Placebo, on forehead wrinkles, SNAP-8 performed fairly better, achieving wrinkle depth reduction of 35% which Argireline achieved about 28%. However, Argireline has been shown to perform better than SNAP-8 in other areas besides the forehead.
It is most commonly found as an active ingredient in eye serums and anti-wrinkle creams that focus on the wrinkles and fine lines on the forehead.
Argireline blocks transmission of nerve signals which cause facial muscles to contract. Like SNAP-8, it relaxes your facial muscles, preventing fine lines and wrinkles from forming along the line of expression.
Dermican is clinically shown to stimulate collagen I and the synthesis of Lumican, a proteoglycan (which decrease with age). Lumican is involved in the organisation of collagen fibres. Hence, Dermican firms the skin and combats skin aging.
Clinically shown to stimulate synthesis of proteoglycans which help wth epidermal cohesion, and Collagen XVII. Demonstrated benefits include increased skin firmness and resistance and increased skin radiance.
A peptide that acts as a sugar trap, binding free sugar that would react with proteins to form Advanced Glycation End-products (AGEs). AGEs accelarate skin ageing.
Dipeptide-2 helps improve lymphatic circulation and detoxifies skin. Of note, it improves drainage of under-eye bags, and hence is used primarily in eye creams.
Copper has been used for years to treat chronic wounds, as research has shown that it is an effective agent in skin healing. It clears away damaged cells, rebuilds the skin's circulatory system, activates the skin's primary antioxidant protein and stimulates the production of new collagen. However, the cationic copper has problems penetrating the skin. Interestingly, when attached to a peptide, copper can be delivered more effectively deep into the dermis. Copper Tri-peptide is a copper bound to a peptide for better skin delivery.
You may or may not have heard of peptides in skincare creams, but you would definitely have come across it. Walk past any departmental store and you will see products like Lancome Genifique, Kinerase Pro+Therapy and countless others, promising to 'activate your genes to give you more youthful skin'. These products, in fact, make use of peptides for anti-ageing benefits.
The Search for the 'Perfect' Collagen
Collagen gives our skin its plumb and youthful appearance. As we age, we lose collagen, causing lines to form and skin to sag. For years, scientists have been trying to deliver collagen into the skin, but the attempts proved futile, as the the collagen molecule was too large to penetrate the formidable skin barrier. In recent years, cosmeceutical companies have started using soluble collagen - collagen molecules which have been broken down into much smaller fragments to facilitate absorption. Unfortunately, these do not do much for the skin, as the collagen fragments are too small to integrate with our skin's own collagen.
What are Peptides?
Peptides are short chains of amino-acids, bound together by peptide bonds. Amino-acids are the building blocks of all proteins in our body, including the collagen and elastin in our skin. Each collagen molecule is, in fact, made of thousands of amino-acids pieced together and wound up in a triple helical network.
Although fragmenting the collagen molecule did not work, scientists found that something else did - peptide chains which resembled the collagen precursors. Amazingly, they found that some peptide chains which are structurally similar to the molecules which forms collagen stimulates the skin to increase the production of the key constituents of the skin matrix: collagen, elastin and glycosaminoglycans.
How do Peptides Work?
Scientists are only starting to realise the wonders of peptides. They have been around for only a few years, but we have discovered more and more different mechanisms in which they exert their beneficial effects.
1. Stimulate Collagen
These were the first peptides used, and are still widely used today. Popular peptides like Matrixyl (Palmitoyl Pentapeptide-4), Matrixyl 3000 (Palmitoyl Oligopeptide + Palmitoyl Tripeptide-7) and SYN-Coll (Palmitoyl Tripeptide-3) work by stimulating fibroblasts in the skin to produce collagen and elastin.
2. Relax Facial Muscles
This group of peptides, also called 'neuropeptides', are known to block the transmission of neurotransmitters in skin cells to relax the facial muscles - very much like Botox. Peptides in this group include Argireline (Acetyl Hexapeptide-3) and SYN-AKE (Dipeptide Diaminobutyroyl Benzylamide Diacetate).
3. Regulate Inflammation
Peptides like Rigin (Pamitoyl Tetrapeptide-7) helps control cytokines (Interluekine 6)
secretion in the skin. Cytokines are responsible for the inflammatory process which contributes to skin ageing, hence, by restoring cytokine balance in
mature skin, Rigin improves skin elasticity and firmness, as it hydrates and protects the
skin.
4. Facilitate Copper Delivery
Copper has been used for years to treat chronic wounds, as research has shown that it is an effective agent in skin healing. It clears away damaged cells, rebuilds the skin's circulatory system, activates the skin's primary antioxidant protein and stimulates the production of new collagen. However, the cationic copper has problems penetrating the skin. Interestingly, when attached to a peptide, copper can be delivered more effectively deep into the dermis. These 'Copper Peptides', found in products like iS Clinical Super Serum, seem to promote collagen production, act as antioxidants and facilitate natural healing and regeneration of the skin.
Promising New Applications
Besides its anti-ageing properties, newer peptides are being produced for skin lightening. These peptides inhibit the
formation of tyrosinase, the enzyme responsible for melanin production. Melanostatine®-5, or example, is a biomimetic peptide antagonist specific for the a-MSH (a- Melanocyte-Stimulating Hormone).
Many physicians have already realised the potential of these lightening agents, and are combining using them with other procedures such as Lasers and IPL for improved cosmetic outcomes.
The Downside- And What to Look Out For
While peptides may sound exciting, there are some points to note before you rush down to the nearest departmental store to pick up a bottle.
Peptides, being break-down products of proteins, tend to be unstable, and need to be stabilized or they will break down further and become useless. They also have to be present in the right concentrations - too low a peptide content and they will not work effectively; and strangely, for some peptides like Argireline, studies have shown that too high a content (more than 10% concentration) causes a reverse effect and for skin to sag!
Unfortunately, many good peptide creams will cost you a small fortune. My favourite peptide cream, Epicuren Ultima Peptide, retails for SGD $250 a bottle, but I still recommend it to my patients confidently, as it is absolutely worth every cent.
It may be extremely confusing to browse through the hundreds of anti-aging peptide creams. Check out my blog post detailing the different peptides, to get an idea on what ingredients to look for; and check out the Top 5 Peptide Creams here. Hopefully, these will give you a better idea on how to choose a better product.
Getting a quick skin tightening fix. Thermage CPT is so painless that I can perform it on myself!
Thermage is no new-comer to the world of non-invasive skin tightening. It was introduced in 1995, and received FDA approval for the treatment of facial wrinkles in 2002. In 2006, it received additional FDA approval to treat wrinkles and rhytides anywhere on the body, including the eyelids. And in 2007, Thermage was FDA approved for the improvement in the appearance of cellulite. It took the world by storm after Oprah Winfrey featured the procedure on her talk show in 2003. Women all over the world, including many celebrities, became fans of this revolutionary procedure.
We have been performing the Thermage procedure since 2003, and until today, it remains a very popular procedure, for a good reason - it is still one of the best skin-tightening procedures available today.
Unique Radiofrequency Technology
Thermage uses monopolar capacitively coupled radiofrequency (RF) energy to tighten and contour skin. The unique monopolar technology enables it to penetrate deeper than lasers, into the dermis and subcutaneous tissue. There, the fibrous septae provide the path of least resistance for the energy, which enables selective heating of septae collagen skin tightening.
This top-down heating profile allows Thermage to treat all the superficial skin problems - wrinkles, pores, texture, and even pimples (though treating acne is an off label use and not FDA approved). Hence, Thermage is excellent for improving skin texture. Its superior heating technology also makes Thermage a one-time procedure, unlike lasers. Amazingly, each treatment lasts up to 2-3 years.
I have tried many other skin tightening procedures, such as infrared light and bipolar radiofrequency devices, but none can heat up the skin as much as Thermage, and hence, none can give similar significant and long lasting results. The deep penetration in the subcutaneous tissue gives the additional benefit of being able to melt away fat and slim down the silhouette, whether on the double chin, cheeks, or abdomen and arms.
A Long Journey - Thermage CPT
Thermage has come a long way. Since its inception in 1995, Solta, the company behind it, has continually improved the system to make it safer and more effective. Many of my patients are very worried of skin dimpling after Thermage - this was a fear complication with the initial platforms, as the heating profile was not as uniform, causing fat necrosis and scarring. With the new Thermage platforms, and latest CPT platform, this complication no longer happens.
Introduction of the larger body tip has also allowed us to perform faster, more comfortable, and more effective treatments.
The newest upgrade is the Thermage CPT platform (Comfort Pulse Technology), introduced a year ago. To be honest, I was not a big fan of Thermage until this new platform came along. Thermage CPT incorporated vibration into its treatment tip, making the treatment much more comfortable. The tip design and software has also been upgraded to deliver even more uniform heating. These changes translate to better results, and more comfortable treatments. Thermage used to be notorious for being excruciatingly painful, but with the CPT platform, treatment is now a walk in the park - virtually painless!
Combination Therapy with Ulthera
Thermage works hand-in-hand with my other favourite skin tightening procedure: Ulthera. Thermage heats the skin from top down, while Ulthera heats the skin from inside out, as shown in the diagram here. Hence, the 2 procedures work synergistically to give a 3-Dimensional non-invasive face lift.
One of the most common questions I get asked is which procedure is better - Thermage or Ulthera? The truth is, both procedures are excellent, and each one is better at different things. Thermage treats all the problems in the dermis - texture, pores, wrinkles, firmness, while Ulthera excels at treating even deeper layers like the SMAS to give lifting against gravity. Hence, my answer : have both procedures done, to reap maximal benefits.
Stopping Ageing in its Tracks - Early
Another big misconception about Thermage is that you should only get it done after your skin sags beyond repair. This is not true at all. Anti-ageing treatments like lasers and Thermage should be done preventively, before the skin loses all its collagen. This way, your youthfulness will be maintained. Once the skin sags and loses its elasticity, it is very difficult to restore it to its former glory. On the other hand, if you start early, and maintain the skin in its youthful state, you essentially stop ageing in its tracks!
Canadian Supermodel Linda Evangelista is a huge fan of Thermage and has it done regularly to prevent ageing, while actress Ellen Barkin is such a believer that she is known to have a mini-Thermage (a partial Thermage treatment, done mainly to prevent ageing) done 3 times a year.
I rushed to have Thermage done on myself before the Chinese New Year after many people commented that my double chin was becoming very obvious.
The procedure was so painless I could do it on myself, with some topical anesthesia. I did get a little headache from the vibrating tip though. What you see on my face in the video below is the treatment grid we apply onto the patient's face to guide our treatment.
Chinese New Year is undoubtedly my favourite time of the year. The streets are bursting with celebration, and even in the wee hours of the night, people are still shopping for food in preparation of the reunion dinner. More than any other time of the year, we get to spend time together with our families and loved ones.
Then there is the food. Pineapple tarts, spring rolls, kueh bangkit, the list of irresistible goodies goes on and on. As we hop from relative to relative, we nibble away constantly at these deceptively harmless little snacks - what harm can one more pineapple tart do?
But by the time the celebrations are over, we will realize that we have piled on the kilos, and perhaps need to buy more clothes because we cannot pull up the jeans zipper any longer!
Remember that prevention is better than cure..
Here are some tips to help you survive, or rather prevent, The Chinese New Year Binge.
1. Have a Big, Protein Packed Breakfast
A good breakfast to start the day, high in protein (eggs, dairy) will help to keep your cravings at bay for the rest of the day. Studies have consistently shown that regular healthy breakfasts help you stick o your diet plans better.
2. Choose Your Snacks Wisely
While sitting around at your relative's place, refrain from instinctively reaching for the glitening Bak Kwa. Instead, munch on melon seeds, or nuts instead. Melon seeds require you to remove the outer covering, hence slowing down your rate of consumption. Nuts are a healthier alternative compared to pineapple tarts. You can also peel some Mandarin Oranges to eat instead.
3. Limit the Servings by Using a Small Plate
One useful trick is to pour the Chinese New Year Goodies out onto a small plate, instead of reaching for the whole tin of Love Letters. For this to work, you need to stop after finishing what is on your plate, of course!
4. Sit Away From the Goodies
Our cravings are very much triggered off by visual cues. Studies have shown that looking at a buffet spread makes you more likely to refill your plate. Similarly, staring at the feast of sweets in front of you will inevitably end up in you reaching for one too many Shrimp Roll.
5. Don't Forget to Include the Drinks
A 250ml packet of Pokka Green Tea, served commonly during visiting, contains 80 calories; A can of beer contains about 150, while a can of Coca Cola, about 140. Try to recall how many packets of green tea and cans of coke you consumed during your visits last year, and you will know what I mean.
Be mindful of the number of sweetened drinks you are consuming. Ask for iced water instead of packet drinks.
6. Don't Neglect the Workouts
We all know that by the 10th house you visit, you will want to take a breather. Take the opportunity to plan your workouts in between your visits. Chinese New Year festivities stretches over a few days. It is good to still continue your gym routine to maintain your energy balance.
7. Start Counting
If you want to beat them, you need to know everything about them, especially how many calories each one of these snacks contain. Remember that it takes 3500 calories extra a week to put on 1 pound, meaning 15 pieces of Bak Kwa, or 22 pieces of Pinapple Tarts is all you need!
Here is a list of some of the commonly found snacks during Chinese New Year for you to start counting, and stop piling on the kilos.
And if this survival guide still fails to keep you from upping a dress size, fret not! You can consider the latest CoolSculpting by Zeltiq to help you lose the flab, or come for a consult with us to find out more about The Sloane Diet.
