Sunday, June 30, 2019

Hair loss - what you should know.


Hair Loss
Most people normally shed 50 to 100 hairs a day. But with about 100,000 hairs in the scalp, this amount of hair loss shouldn't cause noticeable thinning of the scalp hair. As people age, hair tends to gradually thin. Other causes of hair loss include hormonal factors, medical conditions and medications. Alopecia is a medical term for hair loss.



Types of hair loss (Alopecia):

  • Involutional alopecia is an aging process where the hair gradually thins with age.
  • Androgenic alopecia affects both men and women. It is a genetic condition. In men, this can happen as early as in teens or early 20s whereas in women will notice hair thinning when they are 40s or later.
  •   Alopecia areata causes patchy hair loss. The hair regrows within a few years in about 90% of people
  • Alopecia universalis results in all body hair to fall out, which includes the hair, eyebrows, eyelashes and pubic hair.
  • Trichotillomania is a psychological disorder where a person pulls out his/her own hair. This commonly occurs in children.
  • Telogen effluvium causes temporary hair thinning due to changes in the hair grow cycle. Hair sheds and thins as a large number of hairs enter the resting phase simultaneously.


Causes of alopecia:
  • Genes from both male and female parents predispose to male or female pattern baldness.
  • Hormones changes and imbalances due to pregnancy, childbirth (reduce in oestrogen level), discontinuation of birth control pills or perimenopause can cause temporary hair loss.
  • Stress for example experiencing a traumatic event (death of a loved one or divorce), a major surgery, high fever, burns and injuries can cause hair loss.
  • Medical conditions such as thyroid problems, anaemia, scalp ringworm infections and severe infection can cause hair loss.
  • Autoimmune disease occurs in which the body’s immune system attacks own hair follicles, causing Alopecia areata, other diseases like lichen planus and some types of lupus cause scarring, which then result in permanent hair loss.
  • Drugs such as chemotherapy drugs used in cancer treatment, arthritis, antidepressants, blood thinners, high dose vitamin A, anabolic steroid (to build muscle and improve athletic performance), some antihypertensive medication, and birth control pills cause temporary hair loss.
  • Trichotillomania or hair pulling disorder is a mental illness in which causes people to have an irresistible urge to pull out their hair.
  • Dieting and poor nutrition. Anorexia and bulimia, lack of protein and iron, and too much vitamin A can cause hair loss.
  • Cosmetic procedures for example frequent shampooing, combing, brushing, perm, bleaching and dyeing of hair can make hair weak and brittle and thus contribute to overall hair thinning. Regular and improper use of gels, relaxers, hair sprays, blow dryers, flat irons and curling irons cause hair breakage.
  • Certain hairstyles like tight braiding, hairstyles such as pony tails, cornrows and braids causes traction hair loss. When used to hold hair tightly, hairpins, clips and rubber bands can cause hair breakage.



Diagnosis of alopecia:
1.      Your doctor will take a complete medical history, family history and perform physical examination to determine the type and causes of alopecia.
2.      Blood tests are carried out to determine medical illnesses as the cause of hair loss, such as thyroid disease, diabetes, hormonal studies and autoimmune diseases.
3.      Your doctor may do a pull test, where several dozen of hairs are gently pulled to determine the stage of the shedding process, scrape samples to detect for infection, or perform a scalp biopsy to determine the cause of hair loss.

Treatment for alopecia:
Early treatment of hair loss is essential as hair loss is harder to treat when a person has lost a lot of hairs.
  •  Treat underlying diseases such as anaemia, thyroid problem, malnutrition of iron and protein is the utmost important treatment.
  • Minoxidil is a topical medicine applied to the scalp to stop hair thinning and stimulate hair growth. Tricalgoxyl stimulates hair growth in women whereas tricosaccaride stimulates hair growth in men. Zanthin is a potent anti-oxidant that eliminates free radicals. Complex Vitamin A, B5, C and E improves blood microcirculation and eliminate waste product from hair follicles.
  • Finasteride is an oral medication to treat male-pattern baldness which works by stopping the conversion of testosterone to dihydrotestosterone (DHT). It should be avoided by women of reproductive age as it causes harm to foetus.
  •  Corticosteroid injection into your scalp can halt the inflammation caused by alopecia areata.
  •  Hair transplantation requires removing and transplanting of skin on the scalp with good hair growth to bald areas of the scalp.
  • Scalp flaps is by surgically remove hair bearing segments of scalp and place at bald areas.
  • Scalp reduction removes bald scalp surgically and approximate with hair covered scalp.
  •  Scalp expansion is a procedure which may be performed before a scalp reduction to make the scalp more lax, or performed solely to stretch hair bearing areas to reduce balding.
  •  Wigs and hairpieces can be used to cover either permanent or temporary hair loss.

Prevention of alopecia:
As prevention is always better than cure, tips to avoid preventable types of hair loss are:
  • 1.      Consume a nutritionally balanced diet. Eating more protein including meats, eggs and fish whereas nuts, seeds and beans for vegetarian will stop the hair loss. In addition, good vegetarian sources of iron are iron-fortified cereals, soy beans, pumpkin seeds, white beans, lentils and spinach whereas clams, oysters and organ meats are good animal sources of iron.
  • 2.      Practice good hair care by avoiding tight hairstyles and avoid compulsively twisting, rubbing or pulling your hair. Use hairpins with smooth, ball tipped surface, and hair clips should have spongy rubber padding. Use fabric scrunchies that fit loosely. Too much shampooing and combing and brushing on wet hair will cause hair to break.
  • 3.      Make an appointment to see a dermatologist. A dermatologist can find the cause and tell you what to expect.



Tuesday, July 24, 2018

10 Essential Things Every Gentleman Should Get

So you have finally grown up. You no longer live with your parents, and you now have your own responsibilities. What separates a man from a boy? Here are some handy tips by our very own Doctor Bob:

1. Get insurance
You are starting to accumulate quite a bit of commitment at this point. Make sure you get yourself covered in case of the worst happening. You would not want all your effort to go to waste or even worse, burden your loved ones with your debts should the worst happen. Talk to your insurance provider about a plan that best suits you.
2. Get clear skin
You are no longer hitting puberty. You cannot blame your hormones for acne on your skin. You do not want to look like a prematurely aged secondary school boy.  You have some disposable income, so spend it where it matters. Invest in good skincare products to tackle your skin problems. If nothing else works, talk to your doctor who will be able to recommend medical treatments for you.

Clique Clinic has laser treatments including Dual Yellow laser, fractional laser as well as Pico Genesis laser for treatment of active acne as well as acne scars.

3. Get a car
You do not need to blow your bank account to get a car you cannot afford. Invest in a reliable car that will transport you uneventfully to work, and good enough to fetch your date after hours.

Having a car that does not smell like a garbage truck will increase your chances of scoring a second date. Get your car cleaned at least once a week. Never compromise in safety, make sure you get a car that is ASEAN NCAP safety rated, and always get your car serviced regularly.
4. Get fit
As you outgrow your adolescence phase, you will notice it being easier to accumulate fat especially around the midsection. You may need to put in more work to maintain your physique as your metabolism slows down. If you find it difficult to squeeze in the desired amount of physical activity, you may want to control your diet. A fit physique is 80% built in the kitchen, and 20% in the gym.

If you notice that you have some stubborn fats that are non-responsive to diet and exercise, you may want to consult a body contouring specialist. Clique Clinic is a certified provider and Key Opinion Leader for CoolSculpting that utilises Cryolypolysis to eliminate unwanted fat deposits.

5. Get a signature fragrance
Nothing leaves a more lasting impression than a scent. A scent triggers strong emotions and memories due to the direct connection our smell senses have to the area of the brain in charge of emotion and memory. Invest in several signature fragrances that you can wear in formal settings, and more casual settings. Deodorant sprays do not count. Deodorant is good for keeping body odour at bay, but you should splurge a little bit more for that designer or niche fragrance.

If you notice that you are perspirating more than you should, you may have a condition known as hyperhydrosis. Your doctor may be able to treat your condition with Botulinum Toxin A injections which will reduce your excessive sweating and subsequent body odour.

6. Get a watch
A watch is probably the only jewellery a man can carry without looking like a rapper wannabe. In a time where everyone has a mobile phone, the watch has become more of a fashion statement rather than a necessity. It is also handy for telling the time, as our mobile phones have limited power supply. An automatic watch is powered by your wrist movement.

It is considered less rude to have a quick glance at your wrist than to whip out your mobile phone while engaging in conversation to check the time. Plus, looking at your phone for the time will just create more unnecessary distraction, as you notice that you may have unread text or email notifications. A watch's sole function is to tell you the time.
7. Get well groomed
You may have moved out of your parents’ home, but you should not appear like you are homeless. Get well groomed. A gentleman should get a haircut at least once every few months if not monthly. Find a hairdresser you trust and stick with him or her.

Invest in a good set of shaving razors and shaving gel. You do not want to look like you had an encounter with a giant cat everytime you shave. Apply aftershave lotion to soothe your skin after.

If you notice that you have thinning hair or hair loss (androgenic alopecia), do consult with our doctors at Clique Clinic before it is too late. There are several modalities to treat androgenic alopecia including Platelet Rich Plasma, low-level laser therapy, Minoxidil spray, Finasteride tablets as well as specialised haircare products.

8. Get a credit card
This comes in handy when you need to pay for something expensive. You would not want to carry around a briefcase loaded with cash for obvious safety purposes. A credit card is also a lifesaver for when you realise you do not carry enough cash to pay for that romantic dinner you just had. Nothing kills chemistry more than having to split the bill, or even worse, making your date pay for it.

9. Get a passport
You need a passport to travel out of your own country. Get your passport stamped. Enough said.

10. Get well fitted clothing
Hopefully by now your clothes are no longer bought by your mother. It is time to get a well fitting wardrobe. You may want to consider investing in a nice suit. At your age you are most likely to attend more than a few weddings and corporate events annually. Most off the rack suits will need some altering to fit your body, or if you are willing to spend much more, nothing says you have made it like a bespoke suit made to measure. A bespoke suit is to men what lingerie is to women. Skip the flashy shiny materials or printed fabrics and opt for a classic look when it comes down to formal wear.
Dr Bob Klajo is an experienced and sociable medical aesthetic physician of Clique Clinic. His passion is to make people look their best with the help of state-of-the-art medical technology, specialising in skin lasers and injectology. Dr Bob values genuine relationship with his patients and friends.

Immediate skin rejuvenation with injectables. Rejuran versus PRP versus Skinboosters: Which one is best for me?


Immediate skin rejuvenation with injectables. Rejuran versus PRP versus Skinboosters: Which one is best for me?

An educational article by Attending Physician Dr Bob John

Image may contain: one or more people and close-up

As an Aethetic Physician, I commonly get enquiries on how to improve the skin condition instantly. It could be in preparation for a reunion, a wedding or a special event, but these clients would come in for quick fix and a perk me up, so that they can look their best in the shortest amount of time possible.

Energy based devices such as Q-Switched laser (Medlite C6), Copper Bromide laser (Dual Yellow), Picosecond laser (Cutera Pico Genesis), Microneedling Radiofrequency (Sylfirm), Microfocused Ultrasound devices (Ultherapy) usually requires time to exert the effects.

Therefore, the fastest method to see almost instantaneous results is by using injectables. The downtime is minimal, and the results are immediate.

But between the different modalities that can be injected into the skin, amongst them Platelet Rich Plasma, Skinboosters (Hyaluronic acid) and the newest kid on the block Rejuran (Polydeoxyribonucleotide), which one provides the best results?

In this article, I hope to shed some light on the difference between the different injectables and help you to decide which one suits your condition best.


What is Rejuran Healer?

The active ingredient in Rejuran Healer is Polydeoxyribonucleotide (PDRN) which is a type of polynucleotide (PN) derived from trout (salmon). PN are molecules that are present in all living organisms and are basically the building blocks that make up DNA.

PN in Rejuran Healer is derived from Salmon germ cells and subjected to a very rigorous purification process that removes any antigens or proteins that might cause immune reactions.

PN has been extensively researched and demonstrated to be effective in wound healing.

Rejuran improves your skin via the following

1)         Improving microcirculation via process called angiogenesis.
 2)        Anti-inflammatory effects on tissues.
3)         Improves skin texture and elasticity- collagen synthesis is enhanced by fibroblast activation.
4)         Tissue repair and wound healing- PN salvages DNA and RNA fragments from damaged cells to incorporate them into new DNA for normal cell proliferation and recovery.
5)         Protection from UV damage- PN has been shown to enhance DNA repair and clearance of toxic by-products of UV damaged cells.



What is Platelet Rich Plasma (PRP)?

PRP is harvested from a patient’s peripheral blood by a centrifugation process to concentrate platelets and growth factors. Once processed, the PRP has between five to eight folds the concentration of platelets relative to whole blood.

PRP can promote stem cell regeneration as well as soft tissue healing. The growth factors identified in PRP include platelet-derived growth factor, transforming growth factor-β, vascular endothelial growth factor, epidermal growth factor, and insulin-like growth factor.

PRP improves the skin by the following

1)             stimulate multiple cell types including monocytes, fibroblasts, stem cells, endothelial cells, and keratinocytes

2)             Promote new blood vessels (angiogenesis)

3)             Induce new collagen production (neocollagenesis)

4)             Increase vascular permeability


Aesthetic uses include soft tissue augmentation, skin rejuvenation, hair restoration, wound and skin graft healing, and fat graft augmentation.


What is Restylane® Skinbooster (Skinbooster)?

Skinbooster is a hyaluronic acid (HA) product injected superficially for revitalization of the skin are and have a clinically proven effect duration of up to 12 months.

It improves the signs of skin aging through stimulation of the extracellular matrix (ECM). Our skin contains approximately 50-56% of the total body content of hyaluronic acid. HA is a significant stabilizing component of the ECM, can bind large amounts of water and is essential for hydration homeostasis.

Skinboosters improve the skin by the following

1)             HA is an important functional tissue component, because extracellular substance transport as well as the activity of the immune system are associated with the hydration status of the ECM.

2)             HA is pivotal for cellular processes such as proliferation, differentiation and migration.

3)             HA stimulates fibroblast proliferation and activity with an increased biosynthesis of collagen and other components of the ECM

4)             HA has cell protecting properties against external noxious substances.

Restylane® Skinboosters lead to an improvement of skin quality without significant volume changes. The skin is hydrated, its elasticity increased, the skin surface smoothened, and fine lines and wrinkles are reduced.


So which one is the best for me? 

The functions of Rejuran and Platelet Rich Plasma are very similar. They both share the same mechanism of action via promoting tissue healing and repair. Rejuran does so via Polynucleotides, whereas PRP does the same via growth factors.

The main difference would be the source of the product. PRP is harvested from clients own blood, therefore there is no risk of an immune response (allergy) nor risk of blood-borne infection.  This may be more suitable for clients with concerns of anything foreign injected into their skin.
Rejuran on the other hand is derived from Salmon DNA, as it is very similar to human DNA. The salmon cells are subjected to a rigorous purification process to remove any antigens or proteins that may cause biocompatibility or immune reactions. This treatment may be suitable for clients who find the very thought of applying their own blood products on their face (famously known as vampire lift), or who may face difficulty having their blood drawn to harvest PRP (difficult veins).  However, clients with concerns of animal sources (vegans, PETA) may object to the idea that Rejuran is derived from Salmon.

Skinboosters on the other hand differentiates from PRP and Rejuran, because its main mechanism of action is  hydration of the ECM. The main content of Skinbooster is hyaluronic acid, which is extremely hydrophilic and therefore very hydrating. If skin dryness with poor elasticity is the main skin concern that you are addresing, then skinbooster may be the better choice compared to the either PRP or Rejuran.


References

1.              Squadrito, F., Bitto, A., Irrera, N., Pizzino, G., Pallio, G., Minutoli, L. and Altavilla, D., 2017. Pharmacological activity and clinical use of PDRN. Frontiers in pharmacology8, p.224.
2.              Sand, J.P., Nabili, V., Kochhar, A., Rawnsley, J. and Keller, G., 2017. platelet-rich Plasma for the Aesthetic Surgeon. Facial Plastic Surgery33(04), pp.437-443.
3.              Kerscher, M., Eiben-Nielson, C., Kleine-Boerger, L., Haas, H., Sattler, S. and Sattler, G., 2017. Restylane Skinboosters for improved facial skin quality using two treatment sessions.


Fat reduction treatments: Hot versus cold, which one is better?

A short article by body contouring expert Dr Bob John, Clique Clinic

I recently had the honour to be invited as part of an expert panel at the inaugural Body Aesthetic Conference in Singapore by idsMED. It was held in the prestigious Andaz Hotel, and received overwhelming response and attendance from doctors around the region.

One of the more interesting debate and discussion that came up was a comparison between the different modalities for fat reduction, and the possible advantages of using a combination therapy.
Almost everyone has stubborn fat deposits that they would like to have removed. There is no doubt that the trend for non-invasive fat reduction will continue to rise, while surgical liposuction will slowly be relegated.

The big question is: Between Coolsculpting Cryolipolysis vs Trusculpt 3d Radiofrequency vs Sculpsure low level laser, which would offer the best results?

I am glad to have had the privilege to experience all three different treatments for myself and have seen good results with all of them. However, in this article I would like to delve further into the existing literature to gain a better understanding and share with you the evidence.

Cryolipolysis: Coolsculpting 

Cryolipolysis was introduced in 2007, and worked on the principle that fat cells are more sensitive to cold temperatures compared to other cells. The effects of cold temperature was first noticed among children who received frozen treats resulting in loss of buccal fat, and was reported as cold panniculitis. Coolsculpting has been the most well researched treatment for fat reduction. Studies have shown fat reduction of up to 23% on the treated area1, and the patient satisfaction rate is more than 70%.
Thermal lipolysis: Sculpsure and Trusculpt 3D 

Sculpsure utilizes a hyperthermic diode laser of 1,060nm wavelength, whereas Trusculpt 3D uses Monopolar Radiofrequency to deliver thermal energy to subcutaneous adipose tissue.

Scientific papers have shown that elevation of temperature between 42 to 47 degrees Celsius is proposed to result in adipocyte injury and eliciting inflammatory response. Sculpsure have been shown to be able to result in 25% fat reduction2, whereas Trusculpt treatment advertises up to 24% fat reduction (Although I have not been able to find scientific literature to back this up, I believe the numbers should be similar for both thermal lipolysis).
What is the conclusion?So there you have it. If you are looking for numbers, the percentages are fairly equal, with all technologies being able to provide between 23 to 25% of fat reduction at the treated areas. All treatments are clinically proven to be safe and effective, with minimal adverse affects.

The results of all treatments may take up to three months to be evident, as your body slowly eliminates the fat cells that have been injured through your immune system.

Combination therapy 

There are few, if any at all, evidence available at this time to support the efficacy of combined therapy with both cryolipolysis as well as thermal lipolysis. Combination therapy for body contouring is still a very exciting idea that remains unexplored, mainly because not many centres have access to the different modalities.

As one of the clinics at the forefront of body sculpting treatments in Malaysia, Clique Clinic is always looking for ways to push the limits of body sculpting, including providing you with the latest technologies in body sculpting.
References 

1. Coleman, S.R., Sachdeva, K., Egbert, B.M., Preciado, J. and Allison, J., 2009. Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves. Aesthetic plastic surgery, 33(4), pp.482-488.
2. Katz, B. and Doherty, S., 2018. Safety and Efficacy of a Noninvasive 1,060-nm Diode Laser for Fat Reduction of the Flanks. Dermatologic Surgery, 44(3), pp.388-396.
Dr Bob Klajo is an experienced and sociable medical aesthetic physician of Clique Clinic. His passion is to make people look their best with the help of state-of-the-art medical technology, specialising in skin lasers and injectology. Dr Bob values genuine relationship with his patients and friends.