Nutrition for

beautiful skin6

Acne in Adolescents 8

Face Creams: Buying

The Genuine Article

Eyelid Rejuvenation

- Eyebags Removal15

Kiat Awet Muda

di Usia 4022

Cara Menghilangkan

Bekas Jerawat21

Obesity: The

Surgical Solution18

Kerutan dan

Keriput23

Indonesian Section:

Nose Shaping Surgery:

A 3-Dimensional Augmentation2

12

We are ISO certified

Certificate No: KLR 0500345

Lasik 13

i-exposure Vol 172

What is Nose Shaping Surgeryor Rhinoplasty?Rhinoplasty is nose shaping surgery to sculpture the nasal bone and cartilage to improve the nose appearance and provide more balance and harmony to the face. This procedure will introduce some additional framework underneath the skin to raise and straighten the bridge-line.

What are the aims and goals of Nose Shaping Surgery?Augmentation is necessary for both aesthetic and functional reasons. The nasal tip may be augmented. In addition, grafts may be placed to camouflage irregularities of the bony dorsum and of the upper or lower lateral cartilages. As the shape of the nose is intimately related to its function, anatomic deformities that cause breathing problems may be addressed at the same time, such as providing structural support for areas deficient of material, such as the upper or lower lateral cartilages.

Figure: The measurements

of ideal nose

120-135o

90-115o

Nose Shaping Surgery

Dr Darren Khoo Teng LyeConsultant Plastic and Reconstructive Surgeon

MD, MS (Plast. Surg.), FADUSM, AM, AAAM(USA), Fellowship in Oculoplastic

and Aesthetic Surgery (Korea).

The nasal dorsum: • Low

More triangular and shorter

The nostril opening• Relatively larger• More widely flared

The tip of the nose:• Inadequate projection• Wider and bulbous• Less angular

The Typical Asian Nose

(cont. page 3)

Our nose is perceived as the most prominent and central structure of the face. It has a major impact on a person’s first impression and determine the attractiveness of the face. A high and 3-dimensional nose is an identity of attractiveness forwomen and a symbol of confidence and sophistication in men. Thus, nose shaping surgery is one of the most popular and commonly requested aesthetic procedures. Commonly, patients describe their desire to achieve elevation of the nasal dorsum, refinement of the nasal tip and narrowing of the nasal base.

What is the ideal nose?Although there are ethnic differences, generally an ideal nose should include:

a) a straight, narrow bridge

b) well-defined projecting tip

c) refined alae

d) a nasolabial angle of approximately 90-115degree, nasofrontal angle about 120-135 degree

However, not everyone has the ideal nose features. Characteristics of the Asian nose include low and less well defined nasal dorsum, foreshortened nose, retracted columella, inadequate projection of nasal tip, and suboptimal alar-columellar relationship. The nostril opening larger and relatively widely flared.

A 3-Dimensional Augmentation

3i-exposure Vol 17

How to do it?A) Nasal dorsum augmentation:

This is a nasal enhancement surgery which elevates bridge of the nose. This could be achieved by using the patient’s own cartilage, taken from the septum or the ear. Often, silicone implants can be used for this purpose.

What can Nose Shaping Surgery Accomplish

Nasal dorsum augmentation

Nose profile correction(Smoothen visible humps or depressions on the bridge)

Nasal deviation or asymmetry correction

Nasal tip refinement and Projection

Nasal base reduction

Short nose lengthening

Figure: Before and after

nasal dorsum and tip augmentation

The overall goals of rhinoplasty to achieve consistent aesthetic results should include:

• Nasal-facial harmony

• A narrower and straight dorsum with increased height

• Enhanced nasal tip projection and definition

• Slight alar flaring

• Normal interalar distance.

Who are best candidates for Nose Shaping Surgery?

One or more of the following conditions may indicate that someone is a good candidate for nose shaping surgery:

• Low nasal dorsum

• Nasal tip is thickened, enlarged or inadequate in projection

• The nostrils flare excessively or nasal base is wide

• The nose is off-center or crooked due to trauma

• There is a bump on the nasal dorsum when viewed in profile

• Previous surgery has created an asymmetric appearance

(cont. page 4)

B) Dorsal hump correction: The hump on nasal bridge can project a stern and unfriendly image and can even make the chin look short and receding. This surgery removes the hump/bump by carefully rasping (shaving off) the protruding bone/cartilage on the bridge of the nose. Sometimes, an onlay implant will serve the same purpose. Although rasping alone can correct the hook nose, silicone and cartilage may be implanted to keep the overall natural balance of the nose.

C) Dorsal deviation correction: This is commonly due to previous trauma and may be associated with nasal septum deviation causing narrowing of nasal airway. Nasal bone osteotomy will be required together to septum deviation correction to achieve both aesthetic and functional improvement.

Dorsal Hump Correction

i-exposure Vol 174

What are the options available for nose augmentation?

A number of materials are available to the rhinoplastic surgeon to augment the nose.

• Alloplastic graft materials (implants): include silicone, Gore-Tex, and porous polyethylene

• Own body (autologous) tissues: nasal septal cartilage, ear cartilage, rib cartilage, iliac bone.

Many surgeons use alloplastic materials for augmentation because of ease of use, minimal operative time required, and lack of donor site morbidity.

Is there any non-surgical ways for nose augmentation?Yes, injectable facial filler such as hyaluronic acid filler could be used to achieve an equivalent results as the surgery especially in nasal dorsum augmentation. This is suitable for those not keen for surgery and do not want to have any down time.

What to expect?If only a small implant or cartilage graft is needed, the surgery is performed under local anaesthesia and no need to stay in hospital. If nasal bone osteomy is needed, general anaesthesia may be needed. The incisions are typically placed inside the nostrils, but may possibly be across the thin strip of skin in between the nostrils (columella). Regardless of the approach, all incisions heal extremely well and are barely visible over time.

After the operation, nasal splint and dressing will be applied for few days. Usually, there should be very little pain in the nose. Some degree of swelling and bruising may be expected and mostly settled down in 1 to 2 weeks. Most patients return to work 1 week after surgery and may resume strenuous activity in 2 weeks. The final sculptured shape of the nose usually will be seen after 6 weeks of surgery.

ConclusionThe rhinoplasty should be tailored and sculptured to the need of each individual’s nasal anatomical dissatisfaction to realize the best aesthetic outcome. This procedure will help those who are suffering from low self-esteem due to an aesthetically undesirable or plain looking nose.

Figure: Before and after nasal

base reduction

Figure: Before and after

hyaluronic acid filler injection (non-surgery method)

END

D) Narrowing of nasal bones:If the nasal bridge appears to be too wide, the nasal bones are narrowed with bone osteotomy.

E) Tip refinement and projection: This nasal tip procedure (tip plasty) raises and narrows the tip of the nose. The tip bulbous appearance, projecting or deprojecting could be solved with restructuring of the nasal cartilages with suturing or onlay cartilage grafts, such as shield grafts. In most cases, when changes to the tip are requested, changes to the other parts of the nose are required as well.

F) Nasal base reduction: It is performed to reduce the width of the nose and the nostrils themselves. When reducing the width of wide nostrils, the tip projection will be improved as well. This could be done by resection a ellipse of tissue at the nostril base on both sides and relocate towards midline with buried sutures, which will result in narrower, less flared nostrils.

i-exposure Vol 176

Go for quality supplements4

Choose your fat wisely3Take more organic and fresh foods1

Reduce meats but increase plantbased protein2

for beautiful skinNutrition Ms Supanee Sararaks

Clinical Dietitian BSc Dietetics (Hons.) (UKM)

You are what you eat. When it comes to your skin, the quality of your appearance in many ways reflects the quality of your diet. Your food across the board will affect your skin, positively or negatively. Nutritional status plays an important role in the maintenance of healthy skin Macronutrients (carbohydrates, proteins, and lipids) and micronutrients(vitamins and nutritionally essential minerals) work together to maintain the barrier functions of the skin in the face of everyday challenges. Changes in nutritional status that alter skin structure and function can also directly affect skin appearance. Unlike many organs, skin nutrition may be enhanced directly through topical applications. Topical application of micronutrients can complement dietary consumption, leading to a stronger, healthier protective barrier for the body.

KEY POINTS TO CONSIDER

Non-organic foods can contain hormones, pesticides, herbicides, fungicides, and waxes. Certain hormones and pesticides have been found to disrupt motor skills, create an inflammatory response and have been linked to a variety of diseases and health conditions. Studies show that organically grown food has two to three times more vitamins, minerals and trace elements than commercially grown food. With more nutrients which are the building blocks of a healthy complexion, the better our skin will look and perform.

Supplementing your diet with foods rich in antioxidants can reduce the impact of toxins introduced to the body. Berries such as blueberries, blackberries, cranberries and dried prunes are especially high in antioxidants. Vitamin C can be found in fruits like oranges, pineapples and lemons; vegetables such as squash, green peppers and broccoli.

Modern industrial farming methods will frequently feed animals a cocktail of steroids, growth hormones and antibiotics in order to make them fatter faster but not healthier. When we eat these animals, by default, we get a dose of their diet –and this chemical cocktail. These compounds can create

hormonal imbalances in our bodies, which can lead to acne and inflammation. Insufficient fluids and fiber in our diets may also expose our digestive system to higher risk of toxicity from high meat intake.

Many dairy cows are fed hormones to keep them lactating year round, in order to double their milk production. When we drink that milk (or eat their yogurt, ice cream, cheese, etc.) we get a dose of those hormones too. Dairy consumption has been linked to acne, and excess estrogen, often found in dairy products which can cause a cascade of health issues in both men and women. Finally, dairy is known to be mucus-forming in our bodies, which contributes to inflammation. Having a variety of other choices to provide calcium such as soya milk, sardines and broccoli will be beneficial.

Avoid consuming more than 2-3 fried food per week as fats in fried food tend to oxidize and form trans-fatty acids which can contribute to heart disease, poor blood circulation and a weakened metabolic process. Since healthy skin requires healthy circulation and metabolism, weak systems can lead to a lack of oxygen in the skin, slowing the collagen and elastin syntheses necessary for youthful radiance.

Omega-6 (n-6) and omega-3 (n-3) play a critical role in normal skin function and appearance. Both n-6 and n-3 PUFAs give rise to potent signaling molecules, called eicosanoids, which influence the inflammatory response in the skin. Dietary supplementation and topical application of certain n-3 PUFAs attenuates UV-induced photo damage, extrinsic signs of skin aging, and inflammatory skin responses.

Results of another study suggest a mixture of tocopherols and tocotrienols may be superior to alpha-tocopherol alone, as the mixture showed reduced sunburn reactions and tumor incidence after UV exposure in mice. However, further trials with dietary tocotrienol/tocopherol mixtures are needed in human subjects.

Many people take supplements on a regular basis, but most of us don’t really know the origin of those supplements – or

(cont. page 7)

7i-exposure Vol 17

what’s really in them. They often contain allergens, fillers or hidden ingredients that unknown to consumers. It’s important to look for supplements that say whole food on the label, reliable bio-availability, RDA requirements and an expiry date. As consumers, we should avoid over-dose in supplements (doses above 100% RDA). As taking too much Vitamin A or Zinc, for example, can dehydrate the skin.

Vitamin C is an essential part of skin health both as a small molecular weight antioxidant and as a critical factor for collagen synthesis. Vitamin C contributes to photo protection, decreases photo damage, and is needed for adequate wound healing. Oral supplementation with vitamin C may help prevent UV-induced damage, especially in combination with supplemental vitamin E.

Topical application of vitamin C appears to be an effective route for delivering ascorbic acid to the skin because ascorbic acid appears to be taken up readily at an acidic pH. Lastly, the greatest effects of vitamin C supplementation are seen when it is combined with other micronutrients, such as vitamin E and zinc.

Collagen, the majority composite of skin, is what grants skin its elasticity. In her book, “Feed Your Skin, Starve Your Wrinkles,” Allison Tannis asserts that promoting collagen production also promotes “plump, smooth skin.” Subsequently, engaging nutrients and behaviors conducive to collagen should result in skin that appears healthier, younger and more attractive. Nonetheless, consult a physician or dietician before assuming any dietary regimens.

Taking high sugar can weaken and suppressed our immune system in fighting off bacteria –a leading cause of acne and other inflammatory skin conditions. Sugar also can contribute to constipation in our bowels, which can lead to congestion in our skin. Excess sugar in the body is acidic and this creates issues in our digestive tract, which establishes a more hospitable environment for the proliferation of bad bacteria in the gut. Thus, more bacteria will create more toxins and have negative impact on the skin.

Processed and packaged foods should be avoided because during processing, living enzymes and nutrients are broken down and lost. These diets always demonstrate nutritional deficiencies, and such deficiencies always show up in the skin. Furthermore, boxed foods frequently have low water

content but high in preservatives and sodium. All foods especially fruits and vegetables in their natural/raw state, are higher in water content and add hydration to the body necessary to proper organ function. This hydration is essential for healthy skin because it assists in skin detoxification and helps to regulate oil production.

Physical exercise can improve skin condition by producingthicker skin with better blood flow and higher oxygenation as well as greater nutrients and growth hormone secretion. The increase in hormone secretion results in greater cell activity and production, also increasing collagen production. A study conducted by researchers Elizabeth Whitmore, M.D., and Michael A. Levine, M.D., of Johns Hopkins University on 146 women showed that women who exercised exhibited thicker skin and a decline in many problems associated with aging, including physical changes to the skin.

Studies have shown that 2-3 cups of caffeinated beverages will stimulate pituitary-adrenocortical response, which leads to increased cortisol levels in our bodies. Excess cortisol (also known as the stress hormone) has been proven to accelerate the aging process and damage our skin, including thinning the skin. The thinner your skin, the more prone it is to fine lines, wrinkles, dehydration and a lackluster appearance. Coffee is also a diuretic and can dehydrate the body. Well- hydrated body will make your skin healthier.

Skin laxity may be accentuated by loss of blood vessels in the dermis. Additionally, smoking and photo damage will increase skin wrinkling. Thus, avoiding these sources of damage would benefit skin tone. Environmental toxins, sun exposure and habits like smoking, can damage collagen while hindering collagen production, thus increasing the skin aging process.

Since UV light exposure depletes antioxidant levels in the skin, please include ascorbic acid (vitamin C) and alpha-tocopherol (vitamin E) to increase antioxidant defenses in the skin cells and to support the cellular repair enzymes to limit photo damage.

In conclusion, higher intakes of antioxidants, fresh food and lower intakes of fats, sugar and processed food are associated with better skin-aging appearance. Promoting healthy dietary behaviors may have additional benefit for skin appearance in addition to other health outcomes in the population.

Be aware of let-downs8

Control your sweet tooth5

Avoid poor quality, packed and processed food6

Get moving7

END

i-exposure Vol 178

Dr. Lo Kang Shang ChitConsultant Dermatologist

MD (USM), MRCP (UK), Dip Derm (Glasgow),Dip STD (COTTISA), Adv M Derm (UKM),

FRCP (Edinburgh), AM (Malaysia).

Figure 4: Hypertrophic scars and

keloidal scars as a result of severe acne.

Figure 1: The Pilosebaceous

Unit.

Figure 2 : Closed Comedones and

Open Comedones

Figure 3 : Pustules and

Inflamed Nodules/ Cysts.

Acnein Adolescents

Acne (Pimple) is an extremely common skin condition. It can affect people of all ages. Approximately 85% of people between the ages of 12 and 25 develop acne. It is a condition that mainly affects adolescents but may sometimes persist or even become more severe in adulthood.

What is acne?

Acne is an inflammatory skin disease which affects the tiny pores covering the face, arms, back and chest and the oil glands (sebaceous glands) attached to them.

What causes acne?

Acne is an abnormal response of the skin to normal levels of the male hormone, testosterone. Both men and women have testosterone circulating in the blood, but in the acne sufferer, this hormone has a profound effect on the skin.

This abnormal response is self-limiting and eventually acne does get better without treatment. However, there is no way of predicting how long this process can take. It may take years or even decades! Acne can also leave scars which are permanent and are easier to prevent than to treat.

In the skin, the disease attacks the “pilo-sebaceous unit”. The two main structures involved are:

1. The pore through which the hairs emerge from the skin - here dead skin cells become more “sticky” and partially block the pore.

2. The oil or sebaceous gland - more oil is produced, which gives rise to an oily complexion.

The partial blockage in the pore restricts the flow of oil onto the skin surface. This results in solidification of the oil which fills the hair channel forming a blackhead. The black of the blackhead is not due to dirt, but a change in pigment in the blockage in the pore. If the partial blockage becomes complete, the oil builds up around the hair and hair root and becomes infected with bacteria (Propionibacterium Acnes) normally present on the skin. The bacteria break down the oil to very inflammatory chemicals which cause redness, pus formation and pain - the “zit”.

If the inflammation is deep and severe, or if the spot is manipulated or squeezed, the pus can burst deep into the skin rather than onto the surface. This deep-rooted inflammation and infection result in scarring and cyst formation.

How does acne affect a sufferer physically? Acne vulgaris may occur on the face, chest, back and sometimes even more extensively. Several types of acne spots occur, often at the same time.

Non-inflammatory lesions:

• Open comedones (blackheads)

• Closed comedones (whiteheads)

Inflammatory lesions:

• Papules (small red bumps)

• Pustules (white or yellow ‘squeezable’ spots)

• Inflamed nodules and cysts (large red lumps)

Secondary lesions:

• Excoriations (picked or scratched spots)

• Erythematous macules (red marks from recently healed spots, mostly in

fair skin)

• Pigmented macules (dark marks from old spots, mostly in dark skin)

• Scars (including depressed scars, hypertrophic scars and keloids)

Individual acne lesions usually last less than two weeks but the deeper papules and nodules may persist for months or even years. (cont. page 9)

9i-exposure Vol 17

Figure 5 : Acne can have profound

social and psychological

impacts.

How does acne affect a sufferer socially and psychologically? Acne can have profound social and psychological effects. These are not necessarily related to its clinical severity. Even mild acne can be significantly disabling. The psychological and social impacts of acne are a huge concern especially because it affects adolescents at a time they are developing their personalities. During this time, peer acceptance is veryimportant to the teenager and unfortunately it has been found that physical appearance and attractiveness is highly linked with peer status.

The following are some of the problems that patients with acne may face.

Self esteem and body image

• Some embarrassed acne patients avoid eye contact.

• Some acne sufferers grow their hair long to cover the face. Girls tend to wear heavy make-up to disguise the pimples, even though they know this sometimes aggravates the condition. Boys often comment, acne is not such a problem for girls because they can wear make-up.

• Truncal acne can reduce participation in sport such as swimming or rugby because of the need to disrobe in public changing rooms.

Social withdrawal/relationship building

• Acne, especially when it affects the face, provokes cruel taunts from other teenagers.

• Some find it hard to form new relationships, especially with the opposite sex.

• At a time when teenagers are learning to form relationships, those with

acne may lack the self-confidence to go out and make these bonds.

They become shy and even reclusive. The main concern is a fear of negative appraisal by others. In extreme cases a social phobia can develop.

Education/work

• Some refuse to go school leading to poor academic performance and possibly future unemployment.

• Some take sick days from work, risking their jobs or livelihood.

• Acne may reduce career choices, ruling out occupations such as modeling that depend upon personal appearance.

• Acne patients are less successful in job applications; their lack of confidence being as important as the potential employers’ reaction to their spotty skin.

• Many young adults with acne seek medical help as they enter the workforce, where they perceive that acne is unacceptable and that they should have grown out of it by now.

How can acne be treated?Acne is a very treatable disease, but in many patients treatment needs to be started early and be aggressive to prevent the scarring.

General principles of treatment

• Where possible, avoid excessively humid conditions such as a sauna or working in an unventilated kitchen.

• Try not to apply irritant oils or cosmetics to the affected skin.

• Abrasive skin treatments can aggravate both comedones and

inflammatory lesions.

• Try not to scratch or pick the spots

• No relationship between particular foods and acne has been proven.

Management of mild acne

Most patients with mild acne can be treated with topical treatment (gels, solutions and lotions) that can be

obtained over-the-counter without prescription. Most people just use topical agents for facial skin as they can be difficult to apply to one’s back. Extra vitamins and minerals have not been proved to help.

• Wash affected areas twice daily with a mild cleanser and water or an antiseptic wash.

• Acne products should be applied to all areas affected by acne, rather

than just put on individual spots.

• A thin smear should only be applied to dry clean skin.

• They often cause dryness particularly in the first 2-4 weeks of use. This is partly how they work. The skin usually adjusts to this.

• Apply an oil-free moisturizer only if the affected skin is obviously peeling.

• Avoid applying oily cosmetics such as foundation or sunscreen.

• It may take several weeks or even months to see convincing improvement with topical treatments alone.

• Discontinue using product if severe irritation results. See your dermatologist for advice.

Suitable topical agents for mild acne that can be obtained without prescription include:

• Mild salicylic acid preparations to exfoliate and unplug the follicles

• Benzoyl peroxide cream / lotion / gel

• Azelaic acid

Topical agents for mild acne which require prescription include:

• Antibiotics, such as clindamycin solution or erythromycin solution and gel are best used with benzoyl peroxide or azelaic acid to reduce the chance of antibiotic resistance.

• Retinoids i.e. tretinoin, isotretinoin, adapalene.

• Combination topicals include clindamycin / benzoyl peroxide and adapalene / benzoyl peroxide gel.

See your dermatologist for advice if your pimples fail to clear up within six weeks or you have severe acne.

(cont. page 10)

i-exposure Vol 1710

Figure 6: Treatment of severe acne with oral isotretinoin, patient’s picture at baseline and 6 months after oral isotretinoin.

Management of moderately severe acne

Treatment for moderately severe acne usually includes topical agents. In addition, a doctor or dermatologist may prescribe an oral medication, usually for at least six months.

Suitable oral medications include: • Antibiotics such as tetracycline,

minocycl ine, doxycycl ine or erythromycin

• In females , oestrogens and antiandrogens such as Diane 35™/

Estelle 35™ or spironolactone

• Some patients are helped by nonsteroidal anti-inflammatory agents such as ibuprofen or naproxen

• For resistant or persistent acne, oral isotretinoin may be more suitable

See your dermatologist for advice if your skin problem fails to improve within three months or you have severe acne.

Management of severe acne Treatment for severe acne requires oral treatment. Patients should be under the care of a dermatologist.

Many patients will be treated with oral retinoids eg. isotretinoin. These drugs are only available from dermatologists in Malaysia. They are very effective anti-acne drugs although they do have few undesirable side-effects. The dermatologist tends to restrict their use to the more severe cases of acne.

If this is not suitable, the following may be used:

• High dose oral antibiotics for six months or longer

• In females, especially those with polycystic ovary syndrome, oral antiandrogens such as oestrogen/cyproterone or spironolactone may be suitable long term.

Physical treatments for acne and acne scars

• Sunlight is anti-inflammatory and can help briefly. However, exposure to ultraviolet radiation results in ageing skin and can eventually lead to skin cancer.

• Cryotherapy (freezing treatment) may be useful to control new nodules.

• Intralesional steroid injections can be used to shrink older nodules or keloidal scars.

• Large unsightly comedones can be expressed or removed by cautery or diathermy.

• Microdermabrasion can help mild acne.

• Lasers and other light systems may be helpful for mild to moderate acne in selected cases. The effect may be enhanced by use of a photosensitising agent (photodynamic therapy).

• Note: X-ray treatment is no longer recommended for acne as it may cause skin cancer.

Figure 7: Acne treatment algorithm

Isotretinoin

Topical retinoidsoral antibiotics

hormonal therapy

SEVERE

or

MILD

Topical retinoids

Benzoyl peroxide or topical antiblotic

Oral antibiotics

Hormonal Therapy

MODERATE

Topical retinoids

Benzoyl peroxide or topical antiblotic

MAINTENANCE

Topical retinoids

Benzoyl peroxide or topical antiblotic

Acne Consensus Meeting, European Academy of Dermatology and Venereology (EADV) 2000, Geneva Switzerland

END

i-exposure Vol 1712

(cont. page 13)

Introduction Face creams, an important component of cosmetics, have been in vogue since ancient times. A Roman philosopher, Plautus, once remarked that a woman without paint is like food without salt. Ancient Egyptians, Roman and Chinese women often adorn their faces with cosmetics, in addition to other whitening products, to enable them to fulfill the ancient definition of beauty. The surge in the usage of cosmetics worldwide started around the turn of the 20th Century due to advancement in chemical sciences and mass production. This resulted in more varieties of cosmetics being available to the population at large. The entry of women into the workforce after the Second World War, as well as the influence of Hollywood movies, probably serve as twin drivers to increase the sales of cosmetics worldwide. As of 2010, there are at least 230,000 types of registered cosmetics in Malaysia.

As with most medical products, it is important to ensure that these face creams come from reputable sources. In 2010 alone, the Malaysian health authorities have seized close to 3,000 counterfeit items from various suppliers, including some face creams which were found to contain dangerous ingredients such as mercury. In addition, these counterfeit products usually

have missing, inadequate or dangerous active ingredients. Some have packaging which is trying to imitate the genuine product. The harm from these products have been well documented in medical literature – usage may result in unwanted allergic reactions, swollen skin or even severe bodily reactions, resulting in hospitalisation and even death.

How Face Creams WorkThere are many types of face creams but essentially they are made up of oil and water with added ingredients such as preservatives, colouring and perfume. Some may contain active ingredients such as depigmentation (whitening) medication or sunblock chemicals, anti-aging ingredients like alpha- and beta- hydroxyl acids and colour pigments which help set skin tone ; most are in fact moisturers (also known as cold creams). In effect, moisturisers work by hydrating the uppermost part of the skin by imparting moisture to it, whilst the oily ingredients in the cream work to prevent the moisture from evaporating into the air. The end result is a smooth and silky appearance of the skin.

Buying the Real Thing

DRUGS YOUDIDN’T

ASK FOR

aminotadalafilhomosildenafilxanthoanthrafil

pseudovardenafilhongdenafilsibutraminehaloperidol

COMMONHOUSEHOLD

ITEMS

road paintwall paintbrick dustfloor waxsheet rock

paint thinner

NO DRUGSAT ALL

dextrose dextrin lactosestarchsalinesalt

ACTUAL POISON

PCBs,benzopyrenes

rat poisonboric acidantifreeze

HEAVYMETALS

mercuryaluminum

leadcadmium arsenicchromeuraniumstrontiumselenium

There are a lot of shady ingredients that go into counterfeit medications that consumers can be exposed to by buying directly from unlicensed drug sellers on the internet, or when medical professionals purchase medications from outside the secured supply chain.

Investigators have found these dangerous ingredients in fake medicine.

Hidden Poisons in Counterfeit Medications

Source: The Partnership for Safe Medicines (http://www.safemedicines.org/)

Face Creams Buying The Genuine Article

Mr LeongPharmacist

BSc (Pharmacy) Hons (S’pore),Diploma in Management (Mal).

13i-exposure Vol 17

RecommendationTo combat this menace, the Ministry of Health of Malaysia has enforced online notification of all cosmetics under the Control of Drugs and Cosmetics Regulations 1984, since 1st January 2008. Additionally, for cosmetics which were registered before 1st January 2008, there should be a registration number which can be found on the packaging or requested from the manufacturer such as: MALxxxxxxxxK or MALxxxxxxxxKE. More information about cosmetics can be found on the Ministry of Health website: www.bpfk.gov.my. In addition, it is also important to ensure that the face cream purchased is of a reputable brand. This in turn will guarantee safety and effectiveness of use. Source: Pharmacy Services Division (www.bpfk.gov.my)

SEIZURES OF UNREGISTERED PRODUCTS (2000 - 2010)

LASIK Miss Venise T’ng Gin Chun Head of iLaser Centre

& OptometristB. Optom. (Hons.) (Reg no. O-0771)

What Is LASIK? LASIK stands for Laser-Assisted In Situ Keratomileusis, commonly referred to as laser eye surgery or laser vision correction. It is a popular refractive surgery for the correction of nearsightedness, farsightedness and astigmatism, an option to reduce the dependency on glasses and contact lenses. LASIK is performed by an ophthalmologist and it permanently reshapes the cornea, the clear covering of the front part of the eye, using an excimer laser. The reshaped cornea helps to focus light directly onto the retina to improve vision.

In LASIK, a thin flap in the cornea is created using a microkeratome blade. A hinge is left at one end of the flap. The surgeon then folds back the flap and then removes some corneal tissue underneath using an excimer laser. The flap is then laid back in place, covering the area where the corneal tissue was removed.

With nearsighted people, the goal of LASIK is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. LASIK can also correct astigmatism by smoothing an irregular cornea into a more normal shape.

LASIK surgery cannot treat presbyopia (lau hua) per se. However, monovision through LASIK is a popular option. In monovision, the dominant eye is fully corrected for distance

vision whilst the non-dominant eye for reading, is under-corrected with residual myopia, in order to offset the presbyopia.

What Are The AdvantagesAdvantages of LASIK over other refractive procedures include:

1. Quick visual recovery

2. Relatively painless

3. Established procedure

4. High patient satisfaction in many studies

5. Low complication rates

6. Affordable

Who Can Have LASIK?To qualify for LASIK, you should be:

1. Aged 18 and above

2. Have shortsightedness of not more than -12.00D (1200 degrees)

3. Have stable refraction with a change of power of less than 1.00D (100 degrees) a year

4. Not pregnant/breastfeeding

5. Free of eye diseases

6. Good health

These guidelines may vary from person to person depending on the status of your eyes. A comprehensive eye examination is required to determine your suitability

for LASIK treatment. If you wear contact lenses, please stop for at least 4 days (soft lenses), 1 week (soft toric lenses) or 2 weeks (semi hard/hard lenses) prior to the eye examination. This is to prevent corneal warpage from affecting the measurements of the cornea.

Comprehensive Eye ExaminationA comprehensive eye examination prior to LASIK includes the following:

1. Refraction (manifest and cycloplegic)

2. Slit lamp microscope eye examination

END

(cont. page 14)

i-exposure Vol 1714

In a LASIK procedure, anaesthetic eye drops are applied and, once the eye is numbed, an eyelid holder is put in place to keep your eye open. A ring-shaped suction device is placed around your cornea, making it easier to keep your eye still.

1. The surgeon then puts the microkeratome in place to create a thin flap in the outer layer of the cornea. A little pressure or tightness may be felt at this stage (lasts for less than a minute).

2. The suction is turned off, and the flap is gently lifted from the central cornea, exposing the treatment area

3. Then the laser is fired. The laser makes a buzzing sound as it fires

4. When the laser is finished, the surgeon puts the flap back in place and then takes 2 to 3 minutes to make sure it is positioned properly before removing the eyelid holder.

LASIK is performed while you are under local anesthesia in the form of eye drops and usually takes about 15 minutes for each eye to complete. LASIK is an outpatient procedure without the need for admission to hospital. Both eyes are routinely operated on the same day (bilateral simultaneous surgery). You should plan to have someone drive you home after surgery.

Postoperative CareAn eye shield will be given to protect the flap for the first day and night. The vision is quite reasonable by the next day and will continue to improve over the next 1 month. Most normal daily routine can be resumed shortly after the treatment. It is not a problem to travel by airplane after the surgery. Swimming and sea sports should be avoided for 1 month.

You will need to use some eye drops or medication (e.g. anti-inflammatory, antibiotics) for 1 to 2 weeks to help the eye heal and to prevent infection and inflammation.

A mild dryness and irritation may persist for several months and during this time lubricating eye drops may be used to ensure comfort.

You may need to come back for a follow up on the first day, first week and first month after the surgery. Occasionally after the procedure a bandage contact lens is placed to aid the healing, and typically removed on the first day follow up.

Can I Go Blind? Is It Safe?LASIK is officially recognized by US FDA since 1999. With over 10 million cases performed worldwide, there are no records of patient becoming blind as a result of the LASIK procedure. At iLaser Centre, the incidence of blindness caused by LASIK is ZERO. Surgeons worldwide have regarded LASIK as one of the safest surgical procedures. However, iLaser Centre has a strict standard of eye evaluation before each procedure to assess patient suitability for LASIK. Moreover, iLaser Centre has an exceptional reputation for quality backed by more than 15 years experience in refractive surgery.

About iLaser Centre, Island HospitaliLaser Centre located in Penang Malaysia is a leading provider of ophthalmological services to patients. It is established in 1997. Procedures performed at iLaser Centre are laser vision correction for nearsightedness, farsightedness and astigmatism and also ocular diagnostics examination. iLaser Centre has had a long and successful track record of being at the forefront of laser vision correction in Northern Malaysia. The latest equipment is used to provide affordable eye care for patients. iLaser Centre forms part of Island Hospital, a leading medical centre in Penang. 3 consultant ophthalmologist and refractive surgeons work together with 2 optometrists to perform ocular diagnostics examination and surgical procedures at the hospital. They are assisted by a specialized ophthalmological nursing and paramedical team. When experience counts, iLaser Centre is the one to choose for.

iLaser Centre

3rd Floor, Island Hospital, 308, Macalister Road, 10450 Penang, Malaysia. Tel: +604-2288222 Ext. 5340 Direct Line: +604-2297286 Email: venisetng@islandhospital.com liliantan@islandhospital.com

3. Intraocular pressure measurement

4. Retinal examination

6. Consultation and counseling with optometrist and ophthalmologist

5. Corneal topography (Orbscan) and wavefront aberrometry (Zywave)

1

2

3

4

LASIK Procedure

END

15i-exposure Vol 17

IntroductionEyes are often considered the window of the souls and important in the daily face to face interaction. They are key features of an attractive face and have big impact and dramatic difference on how we look and feel. Eyelids are the first part of the face to be improved if needed.

Getting older can take its toll on the appearance, particularly to the skin around the eyes. The unavoidable aging process causes the upper and lower eyelid skin to be loose, droopy, wrinkled and puffy in appearance. These result in tired-looking eyes, uninterested or even sometimes angry looks, adding years to the face.

Whats are Eye Bags?Eye bays or bags under the eyes are mild swelling or puffiness under the eyes. With aging, the tissue structures and muscles supporting the eyelids are weakened. Fat pads that are normally confined to the area around the eye (orbit) can now protrude into the lower eyelids, resulting in bulging in one or all of the three fat pocket areas. The second factor is the laxity and redundancy of the lower eyelid skin. Bulging of the fat pads via the lower eyelid skin laxity together with the hollowing of the junction between of the lower eyelids and cheeks (tear trough) demonstrate the typical double-convex deformity in the under eye regions. The dark eye circles make the puffiness or “baggy” appearance even more prominent.

Causes of Eye Bags?Eye bags tend to occur in people in their thirties or older. Contributing factors to these early occurrence include:

• Not getting enough sleep and tiredness

• Fluid retention, e.g. due to hormone levels, eating salty foods

• Underlying medical illness like kidney failure, thyroid disease

• Allergies or dermatitis, especially if puffiness is accompanied by redness and itching

• Heredity — eye bags can run in families

When to see a Plastic Surgeon?Eye bags can give a tired appearance around the eyes that can make you look older than your years. If you’re unhappy about the appearance of your eye bags or sagging eyelids, eyebag removal surgery can correct these common conditions and help to restore youthfulness to the face. See your doctor if the swelling is a) severe and persistent, b) accompanied by redness, itching, pain or c) affects other parts of your body, such as your legs.

What treatment available?Medical and surgical treatments are available if you’re concerned about the appearance of under-eye swelling.

Eye bags Removal Surgery (Lower Blepharoplasty) Without Scars

• Typically, lower eyelid surgery is performed under local anesthesia as out-patient procedure, which means a faster recovery time.

• This takes about 40 to 60 minutes.

• During the procedure, the incision is made below the lower

eyelash, where wrinkly skin, excess muscles and fat are selectively removed. The skin is then lifted and closed with tiny sutures.

• For those with excess fat bulging but without excess or wrinkly lower eyelid skin, the incision will be placed inside the lower lid in a technique called trans-conjunctival lower blepharoplasty. No external scar is visible at all.

Eyelidrejuvenation

Bulging fat pads

TearTrough

Figure: Common aging changes of eyelids

Figure : Excess and bulging fat pads of baggy lower eyelids

(cont. page 16)

Redundantupper eyelid skin

Lower eyelid“bag” and dark circles

Tear Trough

- eyebags removal

Dr Darren Khoo Teng LyeConsultant Plastic and Reconstructive Surgeon

MD, MS (Plast. Surg.), FADUSM, AM, AAAM(USA), Fellowship in Oculoplastic

and Aesthetic Surgery (Korea).

i-exposure Vol 1716

Figure : Incision of lower eyelid surgery

Figure : Before and After Photos of Eye Bags Removal

BEFORE

AFTER

BEFORE

AFTER

BEFORE

AFTER

BEFORE

AFTER

Recovery after eyelid surgery?Immediately after surgery, there will be some mild swelling and possibly some bruising. This will get a little worse over the next 2 days before it gets better. The majority of the swelling usually subsides after 1 week. Blepharoplasty causes very little pain and only mild pain medications is required on the day after surgery. Any sutures are usually removed after 5 to 7 days. Most people go out in public in a week. It’s especially important to avoid strenuous activities for several weeks. The incision will also be slightly pink for a few months, but will fade and ultimately become barely visible.

Will it hurt?The procedure is performed under local anaesthesia which numbs the area around the eyes. You may be awake or feel sleepy during the surgery, but insensitive to pain.

Is the surgery safe?Eyelid surgery is a safe procedure in the expert hands of a plastic surgeon. The complications are infrequent and usually minor. You can reduce your risks by closely following your surgeon’s instructions both before and after surgery. The minor complications that occasionally follow blepharoplasty include temporary swelling and bruising around the eyes; a slight asymmetry in healing or scarring; sensitivity to light; dry and itchy eyes usually clear after a week; watery eyes can last for a few weeks.

Non-surgical Methods?Various wrinkle treatments are used to improve the appearance of puffiness under the eyes. These include laser resurfacing, chemical peels and fillers, which may improve skin tone, tighten the skin, reduce dark eye circles, obliterate the tear trough and rejuvenate the look of bags under the eyes.

A) LASER TREATMENT – The skin tone and fine wrinkles of the eyelids could be reduced with fractional CO2 laser skin resurfacing. Q-switched NdYag laser could reduce the pigmentation and visible fine vessels of dark eye circles.

B) DERMAL FILLER – The hyaluronic acid dermal filler is a safe method which can instantly obliterate the tear trough that contribute the baggy lower eyelids. The hydration of the eyelid skin could be improved as well to reduce fine wrinkles.

C) RADIOFREQUENCY DEVICE – The skin tone and fine wrinkles could be corrected with non-invasive radiofrequency device treatments.

D) MICRO-NEEDLING THERAPY – The stimulation of skin collagen synthesis with micro-needling therapy will improve skin tone and reduce fine wrinkles of the eyelids

E) LIFE STYLE MODIFICATIONS - Get enough sleep at night and reduce prolonged tiredness. Sleep with your head slightly raised, like adding an extra pillow or prop up the head of your mattress, will helpto prevent fluids from accumulating around your eyes as you sleep.

Benefits of having eye bag removal surgery

• Increased overall self-confidence and self-esteem

• Take away the ‘tired look’

• Correct premature ageing

• Improved appearance and look younger

Facts About Eye Bag Removal Surgery

• One of the most popular and initial procedures for men and women to reverse the sign of aging of the face

• Safe and minimally invasive out-patient proceure

• The surgery usually takes about 40-60 minutes to complete

• Hardly noticeable scar under your eyelashes when healed

• No scar method (transconjunctival) is available for excess fat removal

• The upper and lower lids can be operated on either together or separately

END

i-exposure Vol 1718

An estimated 500 million adults in the world are affected by obesity and one billion are overweight. The last two decades has witnessed not only an increase in the number of obese individuals, but also in the severity of obesity. The prevalence of severe obesity has increased by 500 percent and super severe obesity (BMI > 50) increased by nearly 1, 000 percent.

Two thirds of the world’s obese people live in developing countries, though there is a marked variation in the severity of obesity across nations. Malaysia has the unenviable distinction of being the fattest country in Asia, where 44 percent of men and almost 50 percent of women are overweight. Comparatively, 21 percent of men and 30 percent of women in Indonesia are classified as overweight. Nevertheless, unlike other major global risks such as tobacco and malnutrition, obesity shows no sign of decreasing worldwide.

A positive energy balance causes weight gain and occurs when the amount of calories consumed exceeds the amount of calories the body uses in the performance of basic biological functions, daily activities and exercise. This may be caused by overeating or by not getting enough physical activity. Several other conditions

Obesity, a global epidemic, should no longer be considered a cosmetic concern that is caused by overeating and lack of self-control. It is now recognised as a chronic progressive disease resulting from multiple environmental and genetic factors, which will mandate life-long treatment and control. The disease of obesity is characterised by an excessive accumulation of body fat. One of the measures used to define overweight and obesity is the body mass index (BMI). BMI takes into consideration an individual’s height and weight and can be calculated according to the formula:

Weight in kilograms divided by Height in meters squared (BMI = kg/m2)

Body size categories using BMI have been based upon ranges of BMI that is associated with a certain risk for mortality. The categories and respective BMI ranges are:

Obesity The Surgical

Solution

CATEGORY OF BODY SIZE BMI RANGE

Normal Size 18.9 to 24.9

Overweight 25 to 29.9

Class I, Obesity 30 to 34.9

Class II, Serious Obesity 35 to 39.9

Class III, Severe or Morbid Obesity 40 and greater

The disease of overweight and obesity

(cont. page 19)

Dr. Badrul Hisham YeapConsultant Adult & Paediatric Surgeon

MD (USM), MRCS (Edin), FRCS (I)

19i-exposure Vol 17

that promote fat accumulation include low intake of fat-fighting foods (fruits, vegetables, and quality protein), intake of foods high in sugar, fat and processed meats, stress, chronic sleep loss and certain medications.

The disease is considered progressive simply because obesity begets obesity. Weight gain affects hormonal, metabolic and molecular changes in the body that increases the risk of even greater fat accumulation.

Ironically, the primary treatment for obesity disease, a low calorie diet enforced via dieting, can worsen obesity itself. When weight is lost, energy expenditure is reduced to conserve calories, which prompts even lower calorie being consumed. However, eating less is difficult following a diet becausethere are long-term changes in regulators of appetite that increase the desire to eat and the amount of food consumed. Over time, an individual will often not only regain all of their lost weight, but even more. Furthermore, dieting reduces the body’s ability to burn fat whilst increases the capacity of fat to be stored in fat depots. Ultimately, there is a progressive accumulation of fat even if the individual is not overeating, i.e. a vicious weights gain cycle.

Severe obesity is often associated with many conditions and diseases, such as:

1. Type 2 non-insulin dependent diabetes

2. High blood pressure (hypertension)

3. Cardiovascular disease including coronary artery disease, heart failure and irregular heartbeats

4. Respiratory disorders including asthma and obstructive sleep apnea

5. Cancers, including endometrial, cervical, ovarian, breast, colorectal, esophageal, pancreatic, gallbladder, liver, kidney, thyroid, prostate, non-Hodgkin’s lymphoma, multiple myeloma and leukemia. The overall mortality rate from any type of cancer is increased by 50 to 60 percent in the morbidly obese.

6. Cerebrovascular disease and stroke

7. Liver disease such as fatty liver and non-alcoholic fatty liver disease, which can eventually progress to fibrosis and liver failure

8. Musculoskeletal issues including osteoarthritis, disc herniation and spinal abnormalities

9. Kidney disease and failure

10. Alzheimer’s disease

11. Other potentially life-threatening conditions like maternal diabetes, miscarriages, gallstones and pancreatitis

12. Suicide

SEVERE OBESITY: why the need for surgical interventionSevere or morbid obesity is one of the most serious stages of obesity. Individuals are often trap ped in weight gain cycles despite numerous dieting programs. Repeated studies have demonstrated that those with severe obesity are resistant to maintaining weight loss achieved by conventional therapies, whilst acknowledging bariatric (weight-loss) surgery as the only effective solution.

Bariatric surgery work by altering the anatomy of the gastrointestinal tract or by causing different physiologic changes in the body that changes the energy balance and fat metabolism. Certain procedures affect the production of hormones that reduces hunger and appetite and increases feelings of fullness. Interestingly, these surgically-induced changes in hormones are the direct opposite of those produced by dietary weight loss.

The exceptionally high reduction in mortality rates following bariatric surgery is due to the highly significant improvement in those diseases that are caused or worsened by obesity. These include diabetes, high blood pressure, sleep apnea, asthma, arthritis, cholesterol abnormalities and fatty liver.

Perhaps the most striking effects is the improvement and remission of Type II diabetes mellitus (T2DM). Bariatric surgery causes improvement of diabetes in more than 85 percent and remission of the disease in 78 percent. Yet, the causes of improvement or remission have not been completely identified as they occur early after surgery – well before there is significant weight reduction. In 2013, The International Diabetes Foundation released a Position Statement calling for bariatric surgery to be considered early in the treatment of T2DM.

Nevertheless, it must be emphasized that continued weight loss success also depends on other important factors, such as nutrition, exercise and behavior modification.

An individual is considered for bariatric surgery if the following criteria are met:

1. BMI > 40

2. BMI > 35 and at least two obesity-related co-morbidities such as T2DM, hypertension, sleep apnea, non-alcoholic fatty liver disease, heart disease or osteoarthritis

3. Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts

4. Acceptable operative risk

Bariatric surgery proceduresBariatric surgical procedures include those that cause weight loss by restricting the amount of food the stomach can hold, and/ or those that cause weight loss primarily as a result of malabsorption. These procedures also often cause beneficial hormonal changes. The procedures are almost exclusively performed using minimally invasive techniques (laparoscopic surgery).

(cont. page 20)

i-exposure Vol 1720

The commonly performed procedures include:

Sleeve gastrectomyLaparoscopic sleeve gastrectomy involves removing approximately 70 percent of the stomach.

This procedure works by two main mechanisms. First, the new stomach holds a significantly smaller volume and helps to reduce the amount of food and calories that can be consumed. Secondly and of greater impact seems to be the effect the surgery has on gut hormones that influence hunger, satiety and blood sugar control. Recent studies have shown that the sleeve is as effective as the gastric bypass in terms of weight loss and remission of diabetes, minus

the nutritional deficiencies associated with the latter. Patients can expect an

excess weight loss of up to 70 percent. In contrast to the gastric band, there is no implantation of foreign objects. Hospital stay for the procedure is also relatively short.

Gastric bypassDespite its shortfalls, the Roux-en-Y Gastric Bypass remains the most commonly performed bariatric procedure worldwide.

The two components of the procedure are the creation of a small stomach pouch to which is connected the distal end of a divided portion of small intestine, followed by connecting the proximal portion of the divided small intestine to the small intestine further down.

The procedure works by restricting the amount of food and calorie intake significantly, as well as inducing malabsorption via the bypassed segment of small intestine. Most importantly, this rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger and reverses the mechanism by which obesity induces diabetes.

The induced weight loss can be as much as 80 percent of excess weight. However, this complex operation requires a longer hospital stay and could potentially result in greater complication rates. Patients also require strict adherence to dietary recommendations, life-long vitamin and mineral supplementation as well constant follow-up.

Adjustable gastric bandThis procedure involves an inflatable band that is placed around the upper portion of the stomach to create a small pouch above the band. The size of the stomach opening can be adjusted through a port placed under the skin.

The clinical impact of the band seems to be that it reduces hunger, which helps to decrease calorie consumption. As there is no cutting of the stomach or rerouting of intestines, it has the lowest rate of early postoperative complication among the three bariatric procedures. However, this is offset by the comparatively slower and less weight loss, band complications and highest rate of re-operation.

As per international standards and recommendations, bariatric surgery at Island Hospital is performed by a surgeon with specialised experience and training in bariatric and metabolic surgery, supported by a multidisciplinary team comprising of an endocrinologist/ bariatric physician, a plastic surgeon, a gastroenterologist, a nutritionist, and an exercise physiologist.

END

21i-exposure Vol 17

Bagaimanakah cara menghilangkan bekas jerawat? Acapkali jerawat yang telah berlalu di wajah meninggalkan bekas yang kerap permanen.

Perlukaan tersebut tidak hanya menyebalkan, tetapi juga mempengaruhi kepercayaan diri bagi sebagian orang. Bisakah luka bekas jerawat dihilangkan? Jawabnya bisa.

Untuk penanganan menghilangkan bekas jerawat, terdapat beberapa cara. Dan setiap teknik dan cara yang ada tergantung pada beberapa faktor, antara lain:• Luas area bekas jerawat yang hendak dihilangkan. • Dalamnya luka bekas jerawat.

Bekas jerawat dapat dihilangkan dengan beberapa cara, misalnya:• Dengan terapi laser

• Dermabrasi, dan lainnya.

Namun, penanganan bekas jerawat ini sangat tergantung dari luas serta kedalaman bekas jerawat. Kondisi bekas jerawat ringan dan cara memudarkan bekas jerawat:

• Pada keadaan ringan, bekas jerawat dapat memudar hanya dengan pemberian hidrokuinon 2% (termasuk dalam dosis aman) hanya tepat pada daerah bekas jerawat.

• Selain itu, bekas jerawat juga dapat disamarkan dengan cara pemberian krim malam yang umumnya mengandung asam retinoat yang diresepkan oleh dokter spesialis kulit dan

kelamin.

• Kemudian cara lain yang dapat memudarkan atau bahkan menghilangkan bekas jerawat yaitu Procedure Chemical Peeling.

Kedua prosedur tersebut (krim malam yang mengandung asam retinoat dan chemical peeling) bekerja dengan cara mempercepat proses regenerasi kulit, sehingga sel-sel kulit baru akan lebih cepat timbul.

Teknik apa yang paling cocok direkomendasikan dokter?

Namun, sebaiknya sebelum memilih dan melakukan prosedur cara menghilangkan bekas jerawat tersebut, kulit anda akan dianalisa terlebih dahulu seperti kedalaman bekas jerawat, jenis kulit, dan adanya reaksi alergi. Setelah itu, baru dipilihkan jenis cairan kimia dan konsentrasi/ kekuatan yang sesuai untuk kondisi kulit anda.

Untuk hasil cara menghilangkan bekas jerawat yang lebih menyeluruh dan sempurna, konsultasikan terlebih dahulu dengan dokter anda. Namun yang jelas diperlukan kesabaran dan disiplin. Pun sangat dianjurkan untuk tidak berganti-ganti dokter.

Untuk pasca penanganan, penting adanya untuk senantiasa memperhatikan pemicu-pemicu yang dapat menyebabkan timbulnya jerawat agar dapat menghindarinya dan tidak memecahkan jerawat sehingga menjadi bekas jerawat.

Bagi anda yang ingin mengetahui lebih jauh mengenai topik ini, silakan ajukan pertanyaan anda ke e-mel info@islandhospital.com

Bekas Jerawat

Beberapa Cara

Menghilangkan & Menyamarkan Bekas Jerawat

Rekomendasi Dokteruntuk Menghilangkan

Cara MenghilangkanBekas Jerawat

SUDUT INFORMASIUntuk pembaca indonesia kami

END

i-exposure Vol 1722

1. Sarapan setiap hari Para ahli gizi sepakat bahwa sarapan sangat penting untuk

menjaga berat badan. Pada sebuah penelitian, wanita yang rutin sarapan kehilangan 21% dari berat badan mereka setelah 8 bulan, dibandingkan dengan yang tidak.

2. Berpetualang dengan pasangan Tahukah Anda bahwa jatuh cinta merupakan penghilang rasa

sakit yang alami? Hasil dari riset tersebut menunjukkan bahwa mereka yang sedang dimabuk cinta teraktivasi area dopamin pada otaknya, mirip seperti yang terjadi pada pengguna kokain.

3. Kontrol stres Seperti yang sudah diketahui sejak lama, stres dapat

meningkatkan tekanan darah dan menurunkan libido rendah. Akibatnya, stres membuat seseorang menua lebih cepat.

4. Berolahraga Dengan menjalani aktivitas fisik seperti berolahraga, Anda

akan membakar lebih banyak kalori bahkan ketika Anda duduk di sofa. Usahakan untuk meluangkan waktu berolahraga

setidaknya 30 menit dalam sehari.

5. Mengonsumsi kalsium The National Osteoporosis Foundation merekomendasikan

perempuan di usia 40-an untuk mengonsumsi 1.000 mg kalsium, bersamaan dengan suplemen jika diperlukan.

6. Memberikan tubuh protein yang cukup Sumber protein yang baik dapat diperoleh melalui ikan dan

telur. Tapi jangan sekali-kali melewatkan karbohidrat karena karbohidrat terbukti dapat meningkatkan mood.

7. Pergi bersenang-senang dengan sahabat Bersantai dengan teman-teman dapat mengurangi stres,

meningkatkan harga diri, bahkan membuat Anda lebih menyayangi pasangan Anda ketika Anda tiba di rumah.

Cara Awet Muda & Menjaga Kesehatan Usia 40

8. Melakukan check-up secara rutin Sebagai bagian dari gaya hidup sehat, jangan lupa untuk

melakukan tes-tes ini secara rutin: • Pemeriksaan mata: Setiap 2 sampai 4 tahun • Tekanan darah: Setiap 2 tahun • Tes Pap: Setiap 1 sampai 3 tahun • Thyroid: Setiap 5 tahun • Mammogram: Setiap 1 sampai 2 tahun • Glukosa darah: Setiap 3 tahun dimulai pada usia 45

9. Memilih suplemen penunjang kulit yang tepat Pada usia 40, suplemen penunjang kulit sangat diperlukan

bagi kesehatan kulit wajah Anda. Mengapa demikian? Suplemen berguna untuk menutrisi kulit secara optimal, memperlambat proses penuaan, menambah kolagen, serta melembapkan kulit. Pilihlah suplemen kulit wajah yang mengandung soy isoflavone dan astaxanthin. Berdasarkan penelitian, efek pemberian iso flavone pada kulit wajah

selama 4 bulan membantu meningkatkan kekencangan, ketebalan, dan hidrasi kulit. Sementara itu, mekanisme astaxanthin terbukti dapat mencegah dan mengurangi keriput sekaligus menetralkan radikal bebas.

ada usia 40, kadar kolagen pada kulit wajah Anda semakin menurun. Elastisitasnya pun berkurang. Belum lagi, Anda harus mengalami proses penuaan

kulit lainnya seperti warna yang tidak merata, flek, serta kulit yang cenderung kering dan kusam. Jika sudah begitu, jangan pusatkan perhatian Anda hanya pada wajah saja. Ingatlah bahwa gaya hidup sehat secara keseluruhan akan turut mempengaruhi kulit. Jadi, apa saja gaya hidup sehat yang perlu Anda lakukan di usia 40 agar kulit wajah ikut terjaga?

Kiat Awet

P

Muda di Usia 40

SUDUT INFORMASIUntuk pembaca indonesia kami

END

23i-exposure Vol 17

Exfoliating atau luluranBiasanya dilakukan 1 atau 2 kali seminggu, tergantung bagaimana kondisi kulit tubuh anda, apakah kering dan berkeriput, atau masih sehat dan kenyal. Luluran berguna untuk meluruhkan sel-sel kulit mati pada permukaan kulit, serta mencegah kekeringan pada kulit.

Pembersih TubuhAtau yang biasa kita kenal sebagai mandi, berguna untuk menghilangkan kotoran dan keringat yang menempel di kulit sepanjang hari. Sabun yang Anda gunakan saat mandi, juga akan mempengaruhi keadaan kulit. Pilihlah sabun yang memiliki pH balanced supaya kelembaban kulit tetap terjaga. Pemakaian busa atau spons mandi, akan sangat membantu untuk meluruhkan kotoran dan minyak yang menempel.

Pelembab sangat bergunaUntuk membantu menjaga kulit tubuh tetap halus dan lembut. Pelembab sangat baik digunakan setelah mandi, karena pada saat itu kulit tubuh dapat menyerap pelembab dengan lebih baik. Pemakaian pelembab sangat penting, terutama jika usia

anda tergolong sudah tidak muda lagi. Kerana dengan semakin bertambahnya usia, kalenjer minyak yang berfungsi melembabkan kulit mulai berkurang. Bila anda sering berada di ruangan ber-AC, pelembab harus digunakan lebih sering lagi untuk mencegah kekeringan dan dehidrasi. Oleskan pelembab setiap 2 jam sekali, atau saat kulit anda mulai terasa kering. Pilihkan produk pelembab yang diperkaya dengan berbagai vitamin, antioksidan dan tabir surya.

Nutrisi yang baikSeperti buah-buahan dan sayuran yang mengandung vitamin A, C dan E, sangat baik untuk menjaga kemulusan kulit. Vitamin A berguna untuk mencegah kekeringan pada kulit, sedangkan Vitamin C dan E, terkenal karena khasiatnya sebagai antioksidan.

Bagi anda yang ingin mengetahui lebih jauh mengenai topik ini, silakan ajukan pertanyaan Anda ke e-mel info@islandhospital.com.

Berikut ada 4 (empat) langkah mudah untuk perawatan kulit :

Kerutan Keriput

erut dan keriput tidak hanya menyerang kulit wajah anda, tapi juga kulit tubuh. Kulit tubuh yang kendur lebih sering diabaikan karena

tidak terlihat dari luar, tidak seperti halnya keriput di wajah. Proses penuaan pada kulit memang tidak bisa dihindari.

Penuaan ini di mulai saat kolagen dan elastin di kulit dermal mengalami degenerasi. Faktor utama yang menyebabkan degenerasi kolagen dan elastin adalah sinar UV matahari. Bagian kulit tubuh yang terlihat lebih cepat menua adalah talapak tangan bagian atas, paha dan betis.

Proses penuaan biasanya di mulai saat seseorang memasuki usia 40 tahun dan akan semakin cepat

K jika kulit tubuh anda selalu dibiarkan tanpa pelembab yang baik. Dan saat memasuki usia 50 tahun, penuaan kulit akan semakin parah dengan kendurnya otot-otot tubuh jika Anda kurang olahraga.

Menjadi tua merupakan hal alami yang pasti dialami oleh setiap orang. Tapi menjadi tua tidak berarti anda harus tampil dengan wajah yang tua juga. Segala permasalahan kulit seperti keriput, kering, kusam dan flek, dapat diatasi dengan perawatan wajah yang benar.

Memiliki tubuh yang sehat dan bebas keriput, bukanlah suatu hal mustahil. Seperti halnya dengan kulit wajah, kesehatan kulit tubuh akan anda dapatkan jika melakukan perawatan yang baik sejak dini.

SUDUT INFORMASIUntuk pembaca indonesia kami

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Island Hospital Sdn Bhd (Co. No.: 323705 A)

308, Macalister Road, 10450 Penang, Malaysia. T +604-238 3388 F +604-238 3425 Emergency Direct Line (24 Hours) +604-226 8527 E info@islandhospital.com Toll Free No (Malaysia) 1300-880-788 (Indonesia) 007-803-601-5248

The information provided is for educational and communication purposes only and should not be construed as personal medical advice. Information published in these articles are not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. Island Hospital does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this newsletter. Island Hospital disclaims all responsibility for any losses, damages to property or personal injuries suffered directly or indirectly from reliance on such information.

Log on to www.islandhospital.com to download digital copies of our newsletter orsend us your details and comments via e-mail to mktgadmin@islandhospital.com and we’ll send you a copy!

Enjoy reading i-Exposure? Interested in getting future issues?

CHAIRMAN : Puan Nora HamidSECRETARY : Christine Ooi COMMITTEE MEMBERS : Carol Lim, Chuah Chong Chew, Doreen Fong, Grace Lim, Jill Stephanie, Joelle Lee, Leong Kar Hing, Lilian Tan, Regine Lee, Sarah Albert, Matron Khor Gaik Hong, SN Lim Ee Lin, Supanee Sararaks & Vincy Looi

Newsletter Committee

HAPPY NEW YEAR 2015!

CLASS SESSION 1 SESSION 2 SESSION 3

1 17.1.15 24.1.15 31.1.15

2 7.3.15 14.3.15 28.3.15

3 23.5.15 30.5.15 13.6.15

4 8.8.15 15.8.15 22.8.15

5 10.10.15 17.10.15 24.10.15

Herewith is the new Antenatal Classes schedule for year 2015

Mungkin Anda sudah sangat

sering mendengar saran untuk hindari

merokok, selalu gunakan tabir surya, hindari sinar

matahari langsung untuk menghindari penuaan kulit.

Namun sudahkah Anda tahu bagaimana penuaan tersebut tercetus? Untuk mengetahui selengkapnya, ada baiknya kita menelusuri terlebih dahulu bagaimana kulit bekerja di tubuh kita.

SUDUT INFORMASIUntuk pembaca indonesia kami

Inilah yang Menyebabkan Penuaan Kulit

Bagaimana kulit bekerja?

Kulit, organ terluas dari tubuh Anda, terdiri dari 3 lapisan yaitu:• Epidermis: lapisan tipis terluar dimana terjadi pergantian sel kulit paling sering dan konstan• Dermis: lapisan tengah kulit yang tebal yang kaya akan kolagen dan elastin yang memberikan kulit kekenyalan dan elastisitas.• Hipodermis: lapisan paling dalam yang terdiri dari sel lemak dan berhubungan dengan tulang dan otot.

Seiring dengan usia, produksi sel kulit yang baru mengalami penurunan di epidermis dan kolagen serta elastin di dermis mulai mengalami penipisan. Kulit juga dipengaruhi oleh adanya faktor dari luar seperti misalnya kerusakan akibat sinar UV yang berujung pada

pembentukan garis-garis halus, kerutan, pigmentasi dan bintik-bintik penuaan.

Bagaimana rokok dan sinar UV merusak kulit? Berikut penjelasannya:Bagaimana rokok dan sinar UV merusak kulit?

RokokNikotin yang terdapat di dalam rokok dapat menyebabkan penyempitan pembuluh darah pada kulit. Hal ini dapat mengurangi asupan oksigen dan nutrisi penting lainnya.

Zat-zat kimia yang berbahaya di dalam rokok dapat memecah kolagen dan elastin dan menyebabkan penipisan dan kulit menjadi kendur.

Sinar UVSinar UV pada matahari dapat merusak elastin dan jaringan kolagen dan menyebabkan kulit menjadi berkerut dan kendur.

Sinar UV juga mengeluarkan molekul tidak stabil yang disebut dengan radikal bebas. Radikal bebas ini mempengaruhi kemampuan kulit untuk menjaga kelembaban kulit sehingga kulit menjadi kering.

Paparan lama dari sinar UV dapat menyebabkan peningkatan produksi pigmen melanin kulit sehingga kulit menjadi menggelap dan timbul flek hitam.

Sinar UV bersifat karsinogen dan dapat menyebabkan kanker kulit.

Faktor-faktor lain apa sajakah yang juga dapat menyebabkan penuaan kulit? Berikut penjelasannya:

Faktor-faktor lain apa sajakah yang juga dapat menyebabkan penuaan kulit?

Faktor-faktor lain yang dapat menyebabkan penuaan kulit lebih cepat antara lain adalah polusi udara dan toksin lingkungan. Gravitasi juga berkontribusi menyebabkan kulit menjadi kendur. Oleh karena itu pastikan Anda melakukan pencegahan sedini mungkin pada usia 20an untuk mencegah terjadinya tanda-tanda.

Bagi Anda yang ingin mengetahui lebih jauh mengenai topik ini, silakan ajukan pertanyaan Anda di fitur Tanya Dokter Klikdokter.com di laman website kami.

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