words & photo KARMAN TSE
My freckles should bother me more. But I suppose they can be cute. Look at Adwoa Aboah and Bella Hadid. That said, when these harmless little spots start to join forces, threatening to become one big brown conglomerate, it’s time to armour up and save my face.
Dr Rachel Ho is sitting opposite me, vis-à-vis. We meet for the first time at a café in the mall where her clinic, La Clinic, is.
Sometimes I think the universe is like Steve Jobs. Like him, she seems to believe that “people don’t know what they want until you show them”. Think about it—all the things, the opportunities, the people she has sent your way before you realise that’s what’s missing.
Last year, just before I turned 40, she did it again. Through my friend Alli, the universe sent Rachel, an aesthetics doctor, my way. Alli texted me one day out of the blue, and asked if she could introduce us. She thinks we’d really hit it off.
If you know me, you’d know I’m quite allergic to people. Meet new people? It’s the kind of thing that used to give me a deadly migraine. (Which is trés bizarre for someone who has been working in the media as a journalist and magazine editor for more than 15 years. And yet it’s true.) But you know what, I said to myself, it’s a new age. It’s a new decade. I had already made the decision to do whatever it takes to grow and evolve into my next act anyway. The more uncomfortable, the more I should say yes—within reason, of course, and only when the intention is right. (Note: Merely to please is not.) Here is as good as anywhere to start.
So I said yes.
Back at the café, after initial introductions and pleasantries, Rachel (who, Anna Kendrick-sized, soft-spoken and very girl-next-door, is not quite what I had imagined) and I quickly drift into a comfortable flow of conversation. We exchange struggle stories, ideas on how we can better help people through what we do best — she through her impressive knowledge of skin care / health / enhancement (I love how much passion and details with which she speaks of her work and mission), and me through words.
Alli was right. We did hit it off.
The inevitable is bound to happen. When an appropriate amount of time has passed, I ask what has been on my mind all along: “Tell me, Rachel, in your professional opinion, what problems do you see when you look at my face? Be honest, I’m a big girl, I can take it.”
This is my first time meeting with an aesthetics doctor, so naturally, I am curious. When it comes to my own physical imperfections, I have a pretty healthy awareness of what I like and what I don’t about my body and my face. For example, I have broad shoulders, my arms are thicker than I’d like, and that damed ice-cream belly I could never work
hard enough to banish. My eyes are too small, my face too wide, my teeth aren’t Chiclets white and straight as light, and my skin, oh my skin, I wish I had complexion like Ezann Lee or Cate Blanchett. But alas, we get what we get. I know what my physical flaws are, but they have never bothered me in a debilitating way, thank God. The trick, I suppose, is to embrace what you have and find ways of accentuating the good and drawing less attention to the not so good. I like to center-part my hair, for instance, because that frames my face nicely, keeping my shy, severe jaws behind the scenes. Sleeves serve their purpose of keeping my arms on the QT. As for my skin, I have learned that skin care trumps make-up. So I do my best to find the most suitable and quality products and facial treatments for me at every stage. And mask as often as I can.
I must confess at this point—judgement and dropped jaws be damned—that I have never protected my skin with sunscreen until recently. I have kind of always known I should, but I gave up looking for a sunscreen—there was always something that did not agree with me, whether it’s the smell or the texture. So I got what I deserved: A constellation of freckles and sun spots, which, now that I’m past 40, I can no longer turn a blind eye. The funny thing is, people keep saying freckles are endearing. I wonder if they say that only because the spots are not on their faces. It’s like babies are forever cute only because they’re not yours all day, every day.
My freckles should bother me more. But I suppose they can be cute. Look at Adwoa Aboah and Bella Hadid. That said, when these harmless little spots start to join forces, threatening to become one big brown conglomerate, it’s time to armour up and save my face. Enter Rachel.
It is no surprise that it’s the first problem the doctor names in reply to my question. There’s a second and third: Lines (which I am aware of), and sagging (which—gasp!—I am not).
These, I imagine, are not uncommon skin woes. Maybe you have them, too. In my chat with Rachel below, I think you’ll find some really insightful and detailed causes and proposed remedies for each of these issues.
Before we get to that, I want to say one more thing: When it concerns what you do with your body/face, remember that it is 100 percent your decision. When you do eventually decide, I hope you do it for you and only you. Fixing the outside is not going to mend the inside. Get to know yourself, get to love yourself, and whatever you need to do to feel like an even better version of you, do that with the right intentions.
Ok then, while you read on, this leopard is going to check on her spots.
Rachel: You have freckles as well as uneven skin tone. This is caused by chronic sun exposure, and to a small extent, genetic predisposition.
Me: Guilty. I have not been wearing sunscreen all my life, until quite recently.
Rachel: All those years of unprotected sun exposure has the melanocytes in the skin producing melanin—which deposits in the skin as freckles. Because your complexion is fair, these freckles look obvious and contribute to an uneven-looking skin tone.
I’m glad you’re not very bothered by them. But so many of my patients are because of our culture’s emphasis on “flawless” and “clear” skin.
Me: I have noticed lately that the smaller spots seem to be joining forces, so even though they don’t really bother me, I do want to know what my options are—can I still get rid of them? How can I prevent more of them from popping up and merging into one big blob?
Rachel: Other than sun protection, retinoids can be used at night to help mitigate the appearance of freckles. There are also in-clinic treatments like chemical peels and lasers, which can help to peel off these superficial pigmentation and fragment the particles, respectively.
I also noticed that you have irregular darkening in parts of your skin. Again, this is mainly due to chronic sun exposure without adequate protection. Besides sunscreen and nightly retinoids, I would also recommend applying topical Vitamin C in the day—Vitamin C has brightening and pigmentation-lightening benefits. Again, laser and chemical peels work. There is another treatment called Skinboosters, where micro droplets of hyaluronic acid, Vitamin C and glutathione (both are lightening agents) are injected under the skin to treat dull and dehydrated skin. You can expect your skin to look brighter, more radiant and feel more hydrated within two weeks.
Me: Ooh, I really like the sound of that.
“I’m glad you’re not very bothered by (your freckles). But so many of my patients are because of our culture’s emphasis on ‘flawless’ and ‘clear’ skin.”
— Dr Rachel Ho
“Your marionette lines are starting to show, and your jawline is slightly blunted. This is due to aging.”
Rachel: Your marionette lines are starting to show, and your jawline is slightly blunted. This is due to aging.
Me: What happens exactly when your skin ages?
Rachel: Good question. I’ll break it down for you:
1. Skin laxity and sagging due to loss of collagen, which is essential for firmness and structural support.
2. Loss of fats in the cheeks and around the mouth, which leads to relative excessive skin along the jawline.
3. The jaw bone (alveolar bone) thins as we age and contributes to relative excess of skin.
4. There is loss of support from the ligaments that support the facial fats along the jawline which sink down and leads to loss of definition. This is why sagging in the lower face leads to loss of jawline definition and jawline.
Me: OK, this stresses me out more than freckles. I like my jawline. What can you recommend for an aesthetics-treatment virgin like me?
Rachel: There are non-invasive treatments using “lifting creams” that contain peptides, but they only work for very mild cases. Results are very slow, if at all. The gold standard is, of course, a surgical facelift, but it has its own problems like requiring GA, and surgical complications such as infections, requiring a drain, long recovery time, et cetera.
The three main in-clinic procedures are:
ENERGY DEVICES: High-intensity focused ultrasound (or HIFU, such as Ulthera, lifthera and sygmalift), and radiofrequency such as thermage. Both remodel the collagen fibres of the skin to reduce sagging and create a lift. They can be painful with some of the devices. The benefits: These are non-invasive, but results take time (one to three months gradually), and can last approximately a year.
LIQUID FACE LIFT: Small doses of botox and fillers containing hyaluronic acid create a gentle lift on the face and tighten the jawline. Results are gentle and immediate.
THREADLIFT: Dissolvable suture material (used in surgery to stitch up organs/tissues) are fashioned as threads with cones to lift and anchor the tissues. The benefit is two-fold—an immediate mechanical lift, and as the threads dissolve in the face, they stimulate collagen in the skin to grow for sustained results. Out of all three options, this presents the most dramatic results. It is also the most invasive of the three, but the invasiveness is really minimal. You can expect the results to last between one and three years.
Rachel: Lastly, wrinkles.
Me: I know. The lines on my neck are deepening, and these super-fine ones under my eyes. I don’t even know when they happened.
Rachel: Yes, wrinkles are basically creases that form in area of the face where there is perpetual muscle contraction, which show our facial expression—and you are quite expressive. These repeated contractions and relaxations lead to repeated “injuries” in the skin where the collagen and elastin fibres are not replaced. These wrinkles are worsened by perpetual muscle actions and sun exposure. This is why wrinkles usually occur in the forehead and as crow’s feet, as in your case, and the glabella.
Me: Help me.
Rachel: The only modality that works for wrinkles is Botulinum toxin, better known as Botox. The wrinkles that form along our lines of facial expression can be removed by injecting Botox into these muscles of facial expression. The toxin relaxes the muscles so that they do not contract to form the wrinkles.
+ Note: For my first treatment, Rachel and I both agreed to take care of my age/sun spots by way of the Q-switch Laser (light amplified by stimulated emission of radiation) treatment, a versatile laser that treats pigmentation, acne, pores and rejuvenates the skin. Naturally, I have more questions.
Me: What exactly is this treatment good for, and who is it suitable for?
Rachel: 1. Pigmentation. More mature patients with age spots to younger patients with dark acne scars.
2. Acne. Teenagers and adults with adult onset acne can benefit from it.
3. Pregnant women. Pregnancy can cause pigmentation problems like melasma or acne. This is especially helpful because most medications for acne and pigmentation are not suitable for pregnant women due to the risk of fetal abnormalities.
4. Patients looking for rejuvenation of their skin or to age-proof their skin. Patients in their 20s can get this done without incurring any downtime.
“Another common question is whether laser thins the skin. The answer is no, laser in general does not thin the skin. On the contrary, laser can stimulate collagen growth in the skin to improve skin firmness.”
Me: When will I see results?
Rachel: Pigmentation lightening can take approximately two weeks. I would say that for pigmentation, some patients may see lightening after one session, while it may take others three to four sessions. Pigmentation lightening is also not a one-off treatment, with patients usually requiring a treatment plan of anything from six to 10 sessions depending on the type and severity of pigmentation.
+ Note: I noticed a significant improvement within two days of my laser session.
For control and reduction of pimples and acne, you should be able to see results after one to two session, usually between one and two weeks.
Me: For first-timers, what are some concerns or fears around Laser treatments you can allay?
Rachel: I think this mostly pertains to safety and efficacy. People commonly worry about complications and horror stories they may have heard or read about. The risk of complications such as burns, worsening of pigmentation (hyperpigmentation), pigmentation turning white (hypopigmentation) and blindness are low if your doctor is a trained and experienced one, who is capable of customising an appropriate treatment regimen, and to obtain results without compromising safety.
Laser isn’t a one-size-fits-all kind of treatment where the protocol is the same for everyone. Also, as I have emphasised, it’s important to have an appropriate skincare routine and sensible habits, such as wearing sunscreen, avoiding excessive sun exposure and using Vitamin C and retinoids.
Another common question is whether laser thins the skin. The answer is no, laser in general does not thin the skin. On the contrary, laser can stimulate collagen growth in the skin to improve skin firmness.
For the Q-switch laser, there is barely any downtime. There is mild transient facial redness, but this fades in one to two hours and you can resume your usual skincare routine, activities and make-up right after the session.
The one major issue I worry most about is the risk of allergy or urticaria. Typically, this presents as itching and raised wheals. This can appear immediately during the laser treatment or present as a delayed reaction. It is self-resolving, but its recovery can be hastened with topical steroids. Usually the episode resolves within 24 hours with no long-lasting problems for the patients. This is also a self-limiting problem that does not require termination of treatment.
+ Note: A very small percentage of people, according to Rachel, experiences this allergic reaction. As it turns out, I belong to that minority, and had that allergy the night of my treatment. It was exactly as Rachel had described. Because of that, I wasn’t panicked. I saw her the next day at her behest, H-cort was administered, and all was well soon enough.
In case you are wondering, the laser treatment does not hurt. It is a tad peculiar at first, when you feel—and smell—little sparks going off on your face. But you get used to it. I can’t stress enough the importance of being in the skilled, gentle hands of a good doctor who cares and prepares you well pre-treatment. Guess I got lucky. Thanks, universe! And Alli.
The Q-switch Laser treatment at La Clinic is priced from $280 per session onwards, depending on the number of sessions required. Dr Rachel Ho offers a one-time trial for first timers at $200 so you can try it out without having to commit to a plan.
This is not a sponsored story. I was invited to try the treatment as a friend, and all opinions are entirely my own.