Dr Silvan Lee - Cosmetic Information/Treatment

Background for Dr Silvan Lee:

MBBS, FRACGP, DRANZCOG, Dip Child Health

Cosmetic Physician and Medical Director of Akira Aesthetic Medicine.

Graduated from Medicine at Monash University in 2008 and obtained my Fellowship with the RoyalAustralian College of General Practice in 2013. Throughout my career, I have always enjoyed delicate surgical work and appreciated the finesse required to conduct aesthetic procedures.

7 years experience working with medical lasers, including CO2 laser for skin resurfacing, injectables, dermal fillers and collagen bio-stimulants through my time at one of Sydney’s highly regarded doctors only cosmetic medicine clinic.

Common Concerns 

Sun damage / Skin Ageing

There are many factors which affect our skin. Some of these are intrinsic such as such as hormone levels and chronological or genetic aging, while others are extrinsic, for example sun damage, chronic UV exposure, smoking, vaping, and other pollutants. 

In our earlier years, our skin may be impacted by acne, textural, and pigmentary changes. As we head into our 30’s, signs of sun damage become more evident through loss of elastin and collagen and our skin becomes thinner and more pigmented. With time, there is thinning, increased laxity and decreased skin elasticity, while sunspots and pigmentation become more prominent. The skin develops a leathery texture with the progression of deeper lines and wrinkles. 

By using a daily skin care protective regimen as a base, the addition of collagen stimulating treatments such as fractional laser skin resurfacing, or micro doses of hyaluronic acids in the skin, bio remodelling treatments, PDO collagen stimulating threads and topical Alpha Hydroxy Acids, vitamin C and retinoids, all aim to slow skin aging and start rejuvenation.

Prescription medications are also available to support increased integrity of the skin.  These treatments are often used in combination and synergistically at varied times to optimise their effect. Results take time but will be noticeable within a few months.

Acne scars

The best option is to avoid the scars from forming in the first place.  As well as being painful, acne can significantly affect a person’s self-confidence and self-esteem. A combination of topical and oral medications in conjunction with laser drug assisted devices can be utilised to treat acne and significantly improve scarring from the various forms of acne.  Treatments such as medical subcision, fractional resurfacing lasers as well as hyaluronic acid fillers can further improve some of the scars. A comprehensive medical consult is required to determine which of the available medical treatments would be most suitable.

Melasma

Melasma is one of the most common skin disorders and usually presents as a bilateral, blotchy, brownish facial pigment across the cheeks, forehead and upper lip. It appears more frequently in females than in males, with onset typically between the ages of 20 and 40 years. Melasma is more prevalent in people who tan easily or have naturally brown skin. 

Although there are varying degrees of melasma, not every brown spot or mark is melasma. Melasma is a clinical diagnosis and often does not require a skin biopsy, however, freckles, naevus of Ota, acanthosis nigricans, and post-inflammatory pigmentation are some conditions that can look similar. Some pigmentations are due to underlying medical conditions and others may worsen if treated with particular creams and peels. Sometimes, further investigations are required to aid with diagnosis.

The cause of melasma is complex. There is a strong genetic component which predisposes individuals to develop melasma. The pigmentation results from the overproduction of melanin by melanocytes (pigment producing cells).

Some known triggers are:

1. Sun exposure -ultraviolet and visible light 

2. Hormones such as during pregnancy, the oral contraceptive pill, intrauterine device, hormone replacement therapy

3. Medical conditions such as thyroid disorders 

4. Medications and scented products 

5. Vascular and local hormonal factors

A multi-pronged approach is required, the basis of which is sun protection through the use of SPF 50+ sunscreen with high UVA protection or those containing iron oxides, along with a broad brimmed hat. If possible, avoidance of extreme heat and changing to a non-hormonal form of contraception may reduce the worsening of melasma.

There are a number of agents which can be used, often in combination, to manage melasma. These would include niacinamide, azelaic and kojic acid, ascorbic acid, cysteamine cream, hydroquinone and retinol creams and prescription oral tranexamic acid.

In general, laser treatment is not the first line of treatment for melasma. Some lasers or IPLs can worsen the appearance of melasma, so only certain lasers with special settings are suitable. Laser treatment for melasma requires multiple treatments to see improvement and maintenance treatments will be needed. 

Aging Face - Structural change

As we age, the natural fat pads on our face shifts and the face’s bone compositions slowly recede and shrink. As a result, the facial tissue loses its support structure which leads to progressive sagging as well as volume loss. Strategic placement of fillers can support the tissue; to slow down these changes and reduce the appearance of aging, while carefully placed muscle relaxants in the lower face can help lift the jawline and neck. 

For a cohesive balanced result, often, an approach to address both the upper and lower face with a combination of muscle relaxants, laser therapy for skin rejuvenation and fillers or collagen bio-stimulant treatments are used.

Treatments

Anti-wrinkle Treatments - Cosmetic 

Customised anti-wrinkle treatments are commonly used to improve the lines around the eyes, between the brows and across the forehead as well as on the neck. When used appropriately, these treatments can rejuvenate the face in a natural manner and also be used as preventative therapy. 

Anti-wrinkle injections contain a muscle relaxant which acts on the junction between the nerves and muscles to reduce the muscle’s contractile strength in the treated area. Once the muscles are relaxed, the overlying wrinkles will soften or reduce. Depending on the area of the body, it can also be used as a form of medical treatment to reduce sweating, migraines, teeth grinding, neck pain and for hay fever management. They can also be used to reduce muscle bulk in the jawline as well as along the shoulders and calves for a slimmer physique. 

The effects of anti-wrinkle injections start to occur within 2-3 days post injection, but optimal results are seen after 2 weeks. Factors such as the original condition of the skin, area treated and lifestyle factors can affect the duration of outcome. The extent of effect is also dependent on the dose, but natural looking results usually last 3-4 months. The amount of relaxant required varies from patient to patient but most patients will benefit from having anti-wrinkle treatments 3-4 times per year.

Facial slimming 

Treatment involves reducing muscle bulk in the masseter (jaw) muscle using relaxants 

Calf slimming 

Treatment involves using muscle relaxants to reduce the muscle bulk in the calves

Anti-wrinkle Treatments - Medical 

The muscle relaxants in the anti-wrinkle injections are also used to treat several medical conditions such as: 

Teeth Grinding/Clenching Treatments (Masseter, temple and or pterygoid muscle) 

Dental history will be assessed, but obtaining dental advice to assess bite pattern and the condition of the teeth before treatment is strongly advised.

Sweating Treatments (Hyperhidrosis)

Areas most commonly treated are underarms and along the hairline. Sweating treatments can reduce the amount of sweating significantly for approximately 6 - 9 months. 

Migraine Management

Muscle relaxants can help reduce the severity of migraines by decreasing tension in the forehead, scalp, neck and shoulder muscles. A comprehensive medical history is required prior to any migraine treatment 

Hay Fever Treatment 

Approximately 20% of Australians experience hay fever of varying severity with symptoms ranging from a runny/congested nose, sneezing, itchy or watery eyes to headaches and daytime tiredness. Generally, patients resort to daily antihistamine and nasal sprays to manage their symptoms. 

Another treatment option, which may be able to provide longer term relief, is the use of a muscle relaxant. This can be delivered into the nostril via atomised spray and block the conduction of nerve signals in the nasal passage which triggers the onset of hay fever symptoms. To improve results, nasal/sinus irrigation prior to treatment is used to increase the contact of the medicine to the nasal passage and to increase its absorption. A careful medical assessment is always required prior to the commencement of treatment. 

Filler Treatments

Dermal fillers contain hyaluronic acid, a sugar complex, which also occurs naturally in our body.  Dermal fillers are useful in re-supporting facial structures without surgical intervention. When placed carefully and strategically, natural appearing results can be achieved. Dermal fillers are useful in improving mid face droop and the appearance of jowls, as well as addressing areas of our face which hollow with age. 

Although there are many dermal fillers available on the Australian market, they all integrate differently. Each type of dermal filler has unique properties which allow for its use in different areas or for different purposes. Fillers in general last 12-18 months but imaging studies do show that they can last for longer. The diversity of our facial features means that a guided, tailored treatment plan is required for each patient. 

Please note that due to the risks associated with permanent dermal fillers, no permanent fillers will be used at this clinic. 

Rejuvenation of hands 

Treatments with dermal fillers can be used to rehydrates and improve the volume of the hands. The adjuvant of laser resurfacing treatments can further rejuvenate sun damaged skin.

Skin Rejuvenation Treatments: 

LaseMD™ Ultra 

The LaseMD™ Ultra is one of the latest 1927nm thulium laser which is a non-ablative fractional resurfacing laser for skin rejuvenation.  The 1927nm predominately treats sun damaged skin, pigmentation, uneven skin tone and texture as well as fine lines. It is also excellent in reducing the appearance of pore size and acne scarring. 

The LaseMD™ Ultra thulium laser is most often used to treat the face, neck, decolletage, arms and hands.  

The LaseMD™ Ultra thulium laser provides a gentler, yet still effective treatment that is associated with less downtime and minimal discomfort when compared with the older style resurfacing laser procedures. It has the advantage of faster more accurate laser delivery with a specialised scanner, which allows treatments to be completed at higher densities more quickly and with less discomfort. Laser intensity can be adjusted to address a range of conditions including the use of more aggressive therapy with much reduced post-procedural side effects such as swelling. As such, the downtime with LaseMD Ultra is far less than that of traditional lasers and is well tolerated. 

Treatments with LaseMD™ Ultra usually require 20-30 minutes to complete depending on the areas being treated. The treatment is relatively comfortable especially with the option of using numbing gel. Most patients experience warmth and a tingling sensation over the area being treated. Immediately after treatment, the skin will feel very warm and look red, similar to a mild sunburn, but will not be painful. Over the next few days, the skin will feel dry and resemble sand paper. In most cases, full healing is expected within 5-7 days, although some patients may take longer due to individual differences, settings and the area treated. Sun protection including daily wearing and correct application of sunscreen is mandatory during any treatment course and is strongly recommended long term as part of ongoing skin care and preventative management.

The first change to be seen is a reduction of skin pigmentation and a generalised smoother skin texture. Over the weeks, more collagen is generated and there will be a reduction of wrinkles and number of enlarged pores. The skin will continue to improve over the coming months. A series of rejuvenation treatments are required 8-12 weeks apart for optimal results. 

For ongoing skin maintenance, a gentler maintenance session 3 - 4 times a year is ideal.  With regular renewal of the skin comes increased luminosity, vitality and clarity.

Whilst the LaseMD™ Ultra thulium laser is suitable for a wide variety of skin concerns, as with all medical treatments, a medical consultation is required prior to treatment to ensure that this is the most appropriate treatment for your skin condition, particularly as many skin conditions benefit from combining several treatment modalities. The different treatment modalities will build upon the foundations of good skin care and work synergistically to further improve skin quality and reduce the progression of skin aging over the years. 

Skin Booster (Dermal Hydration)

A slow-release injectable moisturiser allows the skin to rehydrate from the inside, improving texture, fine lines and luminosity. This unique skin booster consisting of hyaluronic acid, can be strategically placed as micro droplets into smaller areas of the skin to further help soften fine lines in areas such as under the eyes, smile lines, neck and décolletage by stimulating collagen production and increasing elastin fibres which improves the skin integrity from within. 

Cost is dependent on size of area required to treat. Often treatments are carried out in conjunction with other skin treatments can further improve specific areas.

Dissolving Filler from previous treatment

There are a number of reasons why filler from previous treatments need to be dissolved.  There may be obvious asymmetry, overfilling of area, persistent lumps, swellings, filler migration (often in lip area) or in the emergency setting of vascular occlusion (emergency filler dissolving of a blocked artery or vein).

If the filler treatment has been performed by another injector and you have concerns, please contact the clinician who originally performed the procedure to discuss the issue. They should be able to assist you and will be the best placed to understand what has been performed. 

To assist with the management of filler dissolvement, a detailed referral from the original clinician is recommended.

Referrals should include the following information:

1. What is the concern/issue?

2. The date of treatment

3. Brand and type of filler used 

4. Volume used

5. What treatment attempts have been used and when

Filler dissolving treatments are complex and requires an in-depth assessment and review.