The Atlas ART Aesthetic Dermatology services aims to treat and improve common skin concerns. For even better results, some conditions may require combination treatments with ART Aesthetic Surgery procedures.
Useful information on common conditions (Not exhaustive and not meant to be a replacement for a visit to your aesthetic doctor).
Freckles, Lentiges, melasma and Pigments
Pigmentary changes on our skin is something nobody wishes to have. But unfortunately in our Asian population, hyperpigmentation (increase in pigment in our skin) is a common and sometimes distressing problem.
Much of the root of the problem comes from our tendency to sun exposure (UV radiation), and when coupled with factors like genetic predisposition, drugs and pregnancy, we can develop a variety of skin pigmentary changes.
In order to have optimal treatment, it is important to ascertain if the pigmentary lesions are epidermal or dermal. Many patients have a combination of both types of pigmentation. Examination under a Wood's lamp can help in our clinical assessment.
Freckles and Lentiges
These are by definition, epidermal lesions on skin. (The epidermis is the outermost layer of our skin, as opposed to the layer beneath the epidermis which is called the dermis)
What are freckles and lentiges?
Freckles (or Ephelides) are very common and can be easily treated. They are small brown macules (flat lesions) on the face or other sun-exposed areas.
Lentiges are similar to freckles but are a different entity. They tend to be a darker shade than freckles. Solar lentiges can be found on the back of the hands, and face. There are usually associated sun related changes like wrinkling and dryness, and in combination are sometimes referred to as signs of photoaging.
How can freckles and lentiges be treated?
We use the REVLITE Q-switched Nd:YAG laser system to treat freckles and lentiges . This laser targets epidermal melanin via the concept of selective photothermolysis.
Post procedure, the pigmentation will darken, develop a "scab" and eventually fall off in a few days to a week's time. Sometimes, a second session may be required for complete clearance. The use of a short wavelength pigment laser in darker skinned individuals with higher epidermal melanin content can pose challenges (increased risk of pigmentation worsening), hence the importance of skin conditioning.
With a smaller laser spot size, we can avoid stimulating normal skin around the pigmented areas and hence manage (and lower) the risks of new (and unwanted) pigmentation occurring post treatment. The only downside of 532nm settings is the small risk of post treatment hypopigmentation (less pigment) which may be transient and improve by itself. This risk can be minimized by keeping energy levels (or fluence) at moderate levels, avoiding unnecessary sun exposure post treatment, and adhering to our prescribed post treatment skin and wound care.
Topical lightening agents can also be used in combination with laser treatment.
How many sessions are needed?
Usually 1-2 session are sufficient. Post pigment removal, laser toning using 1064 wavelength is essential to facilitate good recovery.
Is there downtime?
No. There may be slight redness over the treated areas post laser but this will subside within a day. We may prescribe some mild steroids, healing creams, and antibiotics to speed up healing and prevent infection.
Melasma has been historically referred to as the "mask of pregnancy" because it was thought to occur as a result of pregnancy. However, we now know that it can happen to sun-exposed skin of both males and females. We still do not know the exact cause of Melasma but use of the oral contraceptive pills, hormone replacement therapy and other drugs have been associated with the condition. There may be a mixture of epidermal and dermal components in Melasma. Based on present evidence, epidermal melasma can be treated with a combination of topical creams. The dermal component of Melasma is more difficult to treat.
We use a combination of prescription lightening creams and an intensive laser toning programme to reduce, control, and improve Melasma.
Is it true it is "pointless" to treat Melasma?
No. Nothing in medicine is "pointless" to treat. Melasma is difficult, but not impossible to treat. It is important to develop a logical treatment plan in order to combat Melasma effectively.
Acquired Bilateral Nevus of Ota-like Macules (ABNOM)
ABNOM are also know as Hori's nevus (brownish or grayish in colour) and usually occur symmetrically over the upper cheek regions (what we call the malar region), just below and around the lower eyelids. Many people mistake this as freckles but they should not be confused with each other as the treatment is different.
These predominantly dermal pigmentation is best treated with a REVLITE Q-switched Nd:YAG laser at 1064nm. This longer wavelength allows heat from the laser to penetrate deeper into the dermis (which IPL or a 532nm wavelength laser cannot effectively reach), and via selective photothermolysis, breaks up melanin.
We combine laser treatments with a treatment regime consisting of lightening agents like hydroquinone, arbutin and tretinoin for optimal results.
Is there downtime?
No. The treated skin may be slightly reddish for a few hours post treatment but should subside readily.
How effective is treatment and how many sessions are required?
Some patients can get very good clearance while some may see reasonably significant lightening. Multiple sessions are usually needed.
It is very important to follow a strict home care treatment and the use of sunblock, lightening agents and moisturizers are absolutely essential.
With discipline and patience, good results are possible.
Ageing skin is a common complaint among patients seeking aesthetic treatments. Many non medical treatments are largely ineffective and many patients end up very disappointed. We make it a point to discuss with our patients about what can be achieved with anti-ageing treatments, how we can go about achieving their goals, and what are realistic results we can expect after an anti-ageing programme.
What is the main problem in ageing skin?
The crux of the problem can be attributed to collagen depletion, which leads to sagging skin, lines and wrinkles. Many products and "revolutionary" treatments out in the market today promise much, but often deliver little. More correctly, many treatments and products "over promise" and "under deliver".
In our local context, because of sun exposure, patients with ageing skin may also display changes like uneven skin tone (colour), pigmented spots, and other surface blemishes. (we sometimes call this photo-ageing).
What are the signs of ageing?
Fine Lines, Wrinkles, Sagging Skin, Pigmentation, Droopy Eyelids.
Why does dull skin look "dull"?
Dull skin arises when the surface of our skin is uneven and littered with dead skin cells and debris.
In order for your skin to be "not dull", the skin needs to be "radiant". Radiant skin is skin that has a smooth surface texture and without any dead stuck down skin cells.
This "radiance" is no difference from the bright and reflective surfaces that we see on mirrors and glass. The skin behaves the same way too – smooth skin reflects light better than rough skin, and hence smooth skin is always "radiant".
What can be done to improve dull skin?
Several things need to be sorted out:
Dry skin is an often misunderstood, misquoted and misguided topic among beauty circles.
Let us get a few basic facts right.
Dry skin implies that the epidermis (surface layer) of the skin has low water content. This is why people with dry skin often get flaking, peeling and coarseness – this is because the epidermis is not healthy and not well organized and structured.
Dry skin can be a sign of a more serious underlying medical disorder hence you should always consult your doctor for advice.
Dry skin is not always a problem with "lousy moisturizers".
How do we improve dry skin?
Acne is a chronic disease and it affects many of us – physically, psychologically and socially.
Fortunately, there are modern techniques and potent pharmaceutical solutions to treating acne. The success rate is high, provided we embark on treatment early and maintain good compliance and follow-up during the treatment program.
What is Acne?
Acne is caused by inflammation and secondary infection of an obstructed pilo-sebaceous unit. This is usually contributed by factors related to androgen mediated stimulation of sebaceous glands, abnormal keratinisation of hair follicle epithelium (cells lining the follicle), activity of the bacteria propionibacterium acnes, and inflammation secondary to sebum extrusion from the follicle.
Naturally, treatment is aimed at each of the above factors. There are several grades of acne ranging from comedonal acne (no inflammation), to inflammatory acne (with papules and pustules), and to the severe nodular cystic acne.
What are the aims of treating acne?
What treatments are available?
Acne treatment can be broadly divided into:
We usually like to combine several modalities for optimal results. If you have mainly comedonal acne, treatment with a drug that contains a retinoid (like Retin A or Differin) is very useful.
However most patients will have a combination of comedones and inflammatory acne and using a retinoid by itself may not be good enough. In such circumstances, our experience is that a combination of a topical retinoid such as Tretinoin (trans-retinoic acid; Vitamin A acid) together with potent home care products containing a variety of actives such as salicylic acid, benzoyl peroxide and Azelaic acid can show dramatic results. A course of oral antibiotics may be added if there are many red papules and/or pustules seen.
However such a combination while being synergistic, has the potential for side effects such as peeling, flaking, irritation, itch and redness. The good news is that theses unpleasant effects are easily controlled by using these products tactically, specifically and purposefully. Another manner in which we find very useful to prevent such side effects is to use a really good moisturizer. And when we say good, we mean really good ones – not just any run of the mill "keep moist cream". We only use our Rose-2 range of moisturizers because they are manufactured to the strictest quality standards and are non-comedogenic, and have minimal fragrance, colouring and preservatives. This makes this range of products very suitable for acne treatment.
VPL Light based treatment and Silk Peel
This is an exciting treatment area that continues to give impressive results regardless of acne type. VPL (Variable Pulsed Light, similar to IPL) works by using heat and light of the correct wavelength to destroy the bacteria proprionibacterium acnes which is responsible for acne. Silk peel is an innovative and revolutionary concept of microdermabrasion (which we are all familiar with) combined with dermal-infusion.
Our experience has demonstrated that patients can get good improvement of acne just by using VPL and Silk Peel. When combined with the topical treatments highlighted above, results can be further enhanced.
Oral antibiotics and oral retinoids may sometimes be prescribed in conjunction with our treatment. This will vary from patient to patient.
In general, we do not like to use oral retinoids (such as Ro-accutane) unless absolutely necessary.
Probably the biggest concern of acne patients must be the sight of the scars on their face. Depending on the type of scars, several treatment methods can be utilized.
It must be remembered that scar removal is an extremely difficult and long process with non-ablative methods. Ablative methods can give excellent results but they are associated with too much pain, discomfort and post-procedure down time to be of any relevance to most patients in this day and age.
Many patients focus all their energies on planning and preparing for their in-clinic treatments but neglect the importance of home care.
This is not ideal.
Home care – do not ignore its importance!
A good home care range that is potent enough to complement the efforts of a medical procedure in stimulating scar lightening, collagen regeneration and textural improvement of skin surface is the key to successful scar improvement.
With a good home skin care regime, your skin is also well nourished and protected so that more aggressive treatments like laser resurfacing can be done. We have noticed that by using non-invasive treatments like REVLITE laser rejuvenation or minimally-invasive treatments like Fractional CO2 laser resurfacing , significant improvement in scarring can be achieved.
Needless to say, combining such lasers treatment programs with a collagen-stimulating and nourishing home care will further augment the degree of improvement seen. Results will vary from patient to patient and the types and depths of scars also affect the eventual result. Most patients however, will see some definite improvement in their scars in terms of overall look and texture.
Excessive Hair Growth
Permanent hair reduction can be achieved by either using VPL or laser.
Can hair be permanently removed?
No. There is no such thing has permanent hair removal.
Can hair be permanently reduced?
Yes. Hair reduction is one of the most popular treatments in modern times. It is safe, effective and good results are easily reproducible amongst a wide range of patients and skin types.
What areas can hair growth be controlled?
Face, Trunk, Back, Arms, Legs, Armpits, Bikini lines, and even the upper lips can all be safely treated.
How many sessions will I need?
Monthly sessions for a period of 4-6 months is the ideal treatment duration. However, do note that subsequently, follow up maintenance sessions are essential too but these can be done at intervals spaced further apart eg. once every 3 months.
Do also note that different regions of the body respond differently to hair reduction treatment. Some areas may improve faster and better than others.
What can I expect after undergoing a hair removal treatment programme?
Your hair will grow slower, be less dark and finer.
What method do we use for hair reduction?
We like the Energist VPL system as it is painless, very very effective and it gives the treated area a glowing and fair look which most ladies love!
Can I return to work and carry out my normal activities post treatment?
Yes! There is absolutely no downtime at all.