Hit The Q-switch

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.

I. PIGMENTATION

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.”

II. SAGGING

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.