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We are ISO certified

Certificate No: KLR 0500345

Nose
Shaping
3 -Dimensional
Surgery AAugmentation
Dr Darren Khoo Teng Lye
Consultant Plastic and Reconstructive Surgeon
MD, MS (Plast. Surg.), FADUSM, AM,
AAAM(USA), Fellowship in Oculoplastic
and Aesthetic Surgery (Korea).

Our nose is perceived as the most prominent and central

structure of the face. It has a major impact on a persons first
impression and determine the attractiveness of the face. A
high and 3-dimensional nose is an identity of attractiveness for
women 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:

The Typical Asian Nose

The nasal dorsum:

Low
More triangular
and shorter

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

The nostril opening

Relatively larger
More widely flared

The tip of the nose:

Inadequate projection
Wider and bulbous
Less angular

What is Nose Shaping Surgery

or 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.

120-135o

Figure:
The measurements
of ideal nose

90-115o

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.

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.

(cont. page 3)

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Vol 17

The overall goals of rhinoplasty to achieve consistent

aesthetic results should include:

Nasal-facial harmony
A narrower and straight dorsum with
increased height

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
patients own cartilage, taken from the septum or the ear.
Often, silicone implants can be used for this purpose.

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

Figure:
Before and after
nasal dorsum and tip
augmentation

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

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.

Dorsal Hump Correction

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
Short nose lengthening
Nasal tip refinement
and Projection
Nasal base reduction

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.
(cont. page 4)

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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.

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
could be used to achieve
surgery especially in nasal
suitable for those not keen
to have any down time.

such as hyaluronic acid filler

an equivalent results as the
dorsum augmentation. This is
for surgery and do not want

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.

Figure:
Before and after
hyaluronic acid filler injection
(non-surgery method)

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.
Figure:
Before and after nasal
base reduction

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.

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.

Conclusion
The rhinoplasty should be tailored and sculptured to the
need of each individuals 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.

END

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Nutrition

Ms Supanee Sararaks
Clinical Dietitian

for beautiful skin

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

Take more
organic and
fresh foods

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.

Reduce meats but

increase plant
based protein

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

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Vol 17

BSc Dietetics (Hons.) (UKM)

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.

Choose your fat wisely

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.

Go for quality
supplements

Many people take supplements on a regular basis, but most

of us dont really know the origin of those supplements or
(cont. page 7)

whats really in them. They often contain allergens, fillers or

hidden ingredients that unknown to consumers. Its 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.

Control your
sweet tooth

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.

Avoid poor quality, packed

and processed food

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.

Get moving

Physical exercise can improve skin condition by producing

thicker 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.

Be aware of
let-downs

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. Wellhydrated 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.
END

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Acne

Dr. Lo Kang Shang Chit

Consultant Dermatologist

in 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:

MD (USM), MRCP (UK), Dip Derm (Glasgow),

Dip STD (COTTISA), Adv M Derm (UKM),
FRCP (Edinburgh), AM (Malaysia).

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.

Inflamed nodules and cysts (large red

lumps)

Figure 3 :
Pustules and
Inflamed Nodules/
Cysts.

Secondary lesions:
Excoriations (picked or scratched
spots)

How does acne affect

a sufferer physically?

Erythematous macules (red marks

from recently healed spots, mostly in
fair skin)

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.

Pigmented macules (dark marks from

old spots, mostly in dark skin)
Scars (including depressed scars,
hypertrophic scars and keloids)

Non-inflammatory lesions:
Open comedones (blackheads)
Closed comedones (whiteheads)

Figure 1:
The Pilosebaceous
Unit.
Figure 2 :
Closed Comedones and
Open Comedones

1. The pore through which the hairs

emerge from the skin - here dead
skin cells become more sticky and
partially block the pore.

Inflammatory lesions:
Papules (small red bumps)
Pustules (white or yellow
squeezable spots)

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Vol 17

Figure 4:
Hypertrophic scars and
keloidal scars as a result
of severe acne.

Individual acne lesions usually last less

than two weeks but the deeper papules
and nodules may persist for months or
(cont. page 9)
even years.

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 very
important 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.

Figure 5 : Acne
can have profound
social and
psychological
impacts.

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.

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.

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

How can acne be

treated?

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
aggravate both comedones
inflammatory lesions.

It may take several weeks or even

months to see convincing improvement
with topical treatments alone.

Suitable topical agents for mild acne that

can be obtained without prescription
include:
Mild salicylic acid preparations to
exfoliate and unplug the follicles

General principles of treatment

Acne, especially when it affects the

face, provokes cruel taunts from other
teenagers.

A thin smear should only be applied

to dry clean 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.

Some embarrassed acne patients

avoid eye contact.

Social withdrawal/relationship
building

Acne products should be applied to

all areas affected by acne, rather
than just put on individual spots.

Avoid applying oily cosmetics such as

foundation or sunscreen.

Self esteem and body image

Truncal acne can reduce participation

in sport such as swimming or rugby
because of the need to disrobe in
public changing rooms.

Wash affected areas twice daily with

a mild cleanser and water or an
antiseptic wash.

Acne patients are less successful in job

applications; their lack of confidence
being as important as the potential
employers reaction to their spotty
skin.

Acne is a very treatable disease, but

in many patients treatment needs to
be started early and be aggressive to
prevent the scarring.

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.

obtained over-the-counter without

prescription. Most people just use
topical agents for facial skin as they
can be difficult to apply to ones back.
Extra vitamins and minerals have not
been proved to help.

can
and

Try not to scratch or pick the spots

No relationship between particular
foods and acne has been proven.

Management of mild acne

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.

Most patients with mild acne can be

treated with topical treatment (gels,
solutions and lotions) that can be
(cont. page 10)

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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,
min o c yclin e, d ox yc yclin e o r
erythromycin

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.

MILD

MODERATE

SEVERE

MAINTENANCE

Topical retinoids

Topical retinoids

Isotretinoin

Topical retinoids

Benzoyl peroxide or
topical antiblotic

Benzoyl peroxide or
topical antiblotic

In fe m a les, o estroge n s a n d
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

Benzoyl peroxide or
topical antiblotic

or

Oral antibiotics

See your dermatologist for advice if your

skin problem fails to improve within three
months or you have severe acne.

Hormonal Therapy
Topical retinoids
oral antibiotics
hormonal therapy

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.

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

Figure 7: Acne treatment algorithm

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).

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

Note: X-ray treatment is no longer recommended for acne as it may

cause skin cancer.

END

10

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Mr Leong

Pharmacist

BSc (Pharmacy) Hons (Spore),

Diploma in Management (Mal).

Face Creams

Buying The Genuine Article

Introduction

How Face Creams Work

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.

There 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

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.

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

Hidden Poisons in Counterfeit Medications

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.

12

HEAVY
METALS

ACTUAL
POISON

COMMON
HOUSEHOLD
ITEMS

DRUGS YOU
DIDNT
ASK FOR

NO DRUGS
AT ALL

mercury
aluminum
lead
cadmium
arsenic
chrome
uranium
strontium
selenium

PCBs,
benzopyrenes
rat poison
boric acid
antifreeze

road paint
wall paint
brick dust
floor wax
sheet rock
paint thinner

aminotadalafil
homosildenafil
xanthoanthrafil
pseudovardenafil
hongdenafil
sibutramine
haloperidol

dextrose
dextrin
lactose
starch
saline
salt

i -exposure

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

Vol 17

(cont. page 13)

Recommendation

SEIZURES OF UNREGISTERED PRODUCTS (2000 - 2010)

To 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)

LASIK
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

END

Miss Venise Tng Gin Chun

vision whilst the non-dominant eye for

reading, is under-corrected with residual
myopia, in order to offset the presbyopia.

What Are The Advantages

Advantages of LASIK over other refractive
procedures include:
1. Quick visual recovery
2. Relatively painless
3. Established procedure

Head of iLaser Centre

& Optometrist
B. Optom. (Hons.)
(Reg no. O-0771)

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
Examination

4. High patient satisfaction in many studies

A comprehensive eye examination prior to

LASIK includes the following:

5. Low complication rates

1.
Refraction (manifest and cycloplegic)

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

2. Slit lamp microscope eye examination

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

(cont. page 14)

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13

3. Intraocular pressure measurement

4. Retinal examination

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).

5. Corneal topography (Orbscan) and

wavefront aberrometry (Zywave)

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.

6. Consultation and counseling with

optometrist and ophthalmologist

LASIK Procedure
1

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 Care
An 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.

14

i -exposure

Vol 17

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 Hospital
iLaser 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
END

Eyelid

Dr Darren Khoo Teng Lye

Consultant Plastic and Reconstructive Surgeon
MD, MS (Plast. Surg.), FADUSM, AM,
AAAM(USA), Fellowship in Oculoplastic
and Aesthetic Surgery (Korea).

rejuvenation
- eyebags removal

When to see a Plastic

Surgeon?

Introduction
Eyes 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.

Eye bags can give a tired appearance

around the eyes that can make you look
older than your years. If youre 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.

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.

Redundant
upper eyelid skin
Lower eyelid
bag and dark circles
Tear Trough

Figure: Common aging changes of eyelids

What treatment available?

Bulging fat
pads
Tear
Trough

Medical and surgical treatments are

available if youre concerned about the
appearance of under-eye swelling.
Eye bags Removal Surgery (Lower
Blepharoplasty) Without Scars

Figure : Excess and bulging fat pads

of baggy lower eyelids

Typically, lower eyelid surgery is

performed under local anesthesia
as out-patient procedure, which
means a faster recovery time.

Causes of Eye Bags?

This takes about 40 to 60

minutes.

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

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.
(cont. page 16)

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15

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.

Figure : Incision of lower eyelid surgery

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. Its 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
surgeons
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.

16

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Vol 17

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 help
to prevent fluids from accumulating
around your eyes as you sleep.

BEFORE

AFTER

BEFORE

AFTER

BEFORE

Benefits of having eye bag removal surgery

Increased overall self-confidence and

self-esteem
Take away the tired look

AFTER

Correct premature ageing

Improved
younger

appearance

and

look

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

BEFORE

Safe and minimally invasive outpatient proceure

The surgery usually takes about
40-60 minutes to complete

AFTER

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

Figure : Before and After Photos

of Eye Bags Removal

END

Dr. Badrul Hisham Yeap

Consultant Adult & Paediatric Surgeon

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

The disease of overweight and obesity

Obesity, a global epidemic, should no longer be considered a
cosmetic concern that is caused by overeating and lack of selfcontrol. 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 individuals height and weight and
can be calculated according to the formula:

Obesity

The Surgical
Solution

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:

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

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 worlds 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
(cont. page 19)

18

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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 because
there 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
bodys 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, nonHodgkins 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

SEVERE OBESITY: why the need

for surgical intervention
Severe 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 surgicallyinduced 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

7. Liver disease such as fatty liver and non-alcoholic

fatty liver disease, which can eventually progress to
fibrosis and liver failure

3. Inability to achieve a healthy weight loss sustained for

a period of time with prior weight loss efforts

8. Musculoskeletal issues including osteoarthritis, disc

herniation and spinal abnormalities

Bariatric surgery procedures

9. Kidney disease and failure

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

4. Acceptable operative risk

Bariatric 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).

12. Suicide

(cont. page 20)

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19

The commonly performed procedures include:

Sleeve gastrectomy
Laparoscopic
sleeve
gastrectomy
involves
approximately 70 percent of the stomach.

removing

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 bypass
Despite 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 band

This 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 reoperation.
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

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Cara Menghilangkan
Bekas Jerawat

SUDUT
INFORMASI
Untuk pembaca
indonesia kami

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.

a
r
a
C
a
p
a
Beber
Menghilangkan &
Menyamarkan Be
kas 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.

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?

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.

Rekomendasi Do
kter
untuk Menghilangkan
Bekas Jerawat

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
END

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Vol 17

21

SUDUT
INFORMASI
Untuk pembaca
indonesia kami

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

Muda di Usia 40
1. Sarapan setiap hari

7. Pergi bersenang-senang dengan sahabat

2. Berpetualang dengan pasangan

8. Melakukan check-up secara rutin

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.

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

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
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.

Sumber protein yang baik dapat diperoleh melalui ikan dan

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

END

22

i -exposure

Vol 17

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

SUDUT
INFORMASI

Untuk pembaca
jika kulit tubuh anda selalu
indonesia kami
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.

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

Exfoliating atau luluran

Biasanya 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 Tubuh

Atau 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 berguna

Untuk 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 baik

Seperti 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.

END

i -exposure

Vol 17

23

SUDUT
INFORMASI

Inilah yang Menyebabkan Penuaan Kulit

Untuk pembaca
indonesia kami

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.
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?
Rokok
Nikotin 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.

Faktor-faktor lain apa sajakah yang juga

dapat menyebabkan penuaan kulit? Berikut
penjelasannya:

Sinar UV
Sinar UV pada matahari dapat merusak elastin
dan jaringan kolagen dan menyebabkan kulit
Faktor-faktor lain apa sajakah yang juga dapat
menjadi berkerut dan kendur.
menyebabkan penuaan kulit?
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.

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 tandatanda.

Paparan lama dari sinar UV dapat

menyebabkan peningkatan produksi pigmen
melanin kulit sehingga kulit menjadi menggelap
dan timbul flek hitam.
Bagi Anda yang ingin mengetahui lebih jauh
mengenai topik ini, silakan ajukan pertanyaan
Sinar UV bersifat karsinogen dan dapat
Anda di fitur Tanya Dokter Klikdokter.com di
menyebabkan kanker kulit.
laman website kami.
END

HAPPY NEW YEAR 2015!

Herewith is the new Antenatal Classes schedule for year 2015

CLASS

SESSION 1

SESSION 2

SESSION 3

17.1.15

24.1.15

31.1.15

2 7.3.15 14.3.15 28.3.15

3

Newsletter Committee

23.5.15 30.5.15

13.6.15

4 8.8.15 15.8.15

22.8.15

24.10.15

10.10.15 17.10.15

: Puan Nora Hamid

CHAIRMAN
: Christine Ooi
SECRETARY
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

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