hello world!
MOHS Surgery
FEEDBACK
Ablative Carbon Dioxide
Fractional Carbon Dioxide (CO2)
Hair Removal
Intense Pulse Light (IPL)
Pulse Dye Laser
Qs Nd Yag Medlite C6

ABLATIVE CARBON DIOXIDE

What is Carbon Dioxide Laser Skin ReSurfacing?
Using a special scanner attached to a carbon dioxide laser, your dermatologist can delicately exfoliate your skin accurately layer by layer. The superficial layer of the skin is removed and the deeper layer of the skin is exposed. Collagen is then stimulated and a new layer of skin is formed over a period of time. With this precise control over the interaction between the laser energy and the skin, bleeding is eliminated and scarring, which is generally associated with other forms of wrinkle treatment, is significantly reduced.
What are the indications for Laser Skin ReSurfacing?
  • Fine lines and wrinkles around the eyes and mouth,
  • Acne, traumatic, chicken-pox and surgical scars,
  • Photodamaged skin
Is Laser Skin Re-Surfacing suitable for me?
Your dermatologist will take your medical history, age, skin type (including pigmentation) and desired results into consideration to determine whether you are a suitable patient for Laser Skin Re-Surfacing. Be sure to mention any past or present viral infection, sun sensitivity, drug (e.g. isotretinoin) used within the past year, problem with wound healing or prior chemical peel or dermabrasion to your dermatologist.
When can I do my Laser Skin Re-Surfacing?
Your dermatologist will usually schedule a test patch (about 3 em in diameter) for you before conducting the full laser skin re-surfacing.

The reason why a test patch is done is to ascertain the risk of hyperpigmentation and scarring you may have.
How long does it take for the laser wound to heal?
Following the laser re-surfacing procedure you may expect slight swelling and redness on the treated sites.

The initial redness fades in a few weeks to light pink, which can be easily camouflaged with cosmetics. The redness usually disappears completely in 3 -6 months for most patients.

Generally patients enjoy a short recovery time after laser skin re-surfacing.
Are there special precautions to follow after the Laser Skin Re-Surfacing treatment?
Following the laser re-surfacing procedure you may expect slight swelling and redness on the treated sites.

It is important to avoid direct sun exposure for several months following the laser treatment. Some patients may experience transient hyperpigmentation (increased pig mentation) or hypopigmentation (decreased pigmentation) on the laser-treated areas and these resolve in several months.


Generally patients enjoy a short recovery time after laser skin re-surfacing.
What to expect after the Laser Skin ReSurfacing treatment of my "Wrinkles"?
Wrinkles are removed by destroying and removing the top layer of the skin. When the skin laser wound heals, it becomes tightened and the wrinkle lines disappear or become less prominent.
How many times must I come for Laser Skin Re-Surfacing procedure?
This depends on the type and depth of the wrinkles or scars you have. One or more treatment sessions may be required.
When can I do my full Laser Skin ReSurfacing?
If all goes well with the test patch (allowing 8 -12 weeks postoperatively to look for adverse effects), and you remain committed to have the laser treatment, your dermatologists will schedule you for full laser resurfacing. The whole procedure usually takes less than 1 hour. You can expect to go home immediately after the treatment.
When can I return to work?
You can return to work as soon as you feel comfortable. Most patients prefer to wait till their laser-treated areas can be covered with cosmetics (usually by day 7) before returning to work.
What type of anaesthesia do I need?
Lasers DO
  • cause selective destruction of hair follicles.
  • Achieve long term hair reduction after multiple sessions of treatment.
  • Cause some minor side effects such as swelling and pigmentation of skin In a minority of patients. These are more common among patients with darker skin
You can return to work as soon as you feel comfortable. Most patients prefer to wait till their laser-treated areas can be covered with cosmetics (usually by day 7) before returning to work.

1. Local Anaesthesia
  • Usually you will need local anaesthesia for laser skin re-surfacing treatment.
2. Topical Anaesthesia
  • Some patients will need topical anaesthesia only.
  • Topical anaesthesia cream applied under occlusion 1 hour prior to the laser re-surfacing treatment may provide pain relief during the treatment (no injection, is needed).
Precautions to take following your Laser Skin Re-Surfacing treatment
  • Avoid direct exposure to sunlight.
  • DO NOT rub, scratch or pick at the treated skin.
  • Avoid swimming and contact sports before the laser wound heals.
  • If the laser-treated skin shows signs of infection (e.g. presence of pain, redness, swelling or pus), notify your dermatologist or the nurse-in-charge of the Operating Theatre at the National Skin Centre immediately.
What are the side effects and possible complications of Laser Skin Re-Surfacing treatment?
Pain
You may feel mild pain during the laser skin resurfacing procedure.

Laser Wounding Healing
Laser treatment causes a superficial burn on the surface of the skin which takes several days to heal. This is associated with some skin swelling, oozing and crusting on the treated skin. It usually takes 4 -10 days for the skin to heal.

Erythema (Redness)
Redness is usual and should not be regarded as a complication of laser treatment. It typically lasts 3 -6 months and can be camouflaged with cosmetics.

Hyperpigmentation (Increased Pigmentation)
Hyperpigmentation following laser treatment is most often seen in patients with dark skin colour tone but it can also occur in patients with light skin colour tone. Pigmentation may be minimized by applying a bleaching cream prescribed by your dermatologist.

Milia and acne may occur, especially if an occlusive ointment is used after laser treatment.

Herpes Simplex Infection
Herpes simplex infection can occur in patients who have a past history of cold sore. You should report any sign of herpes simplex infection (presenting as blisters and erosions) to your dermatologist immediately.

Scarring
The risk of scarring may be increased in patients who have recently been treated with oral retinoids (e.g. isotretinoin). It may also occur in those who develop secondary bacterial lnfection after laser treatment. Secondary bacterial infection may occur if the laser wound is not properly cleansed and dressed.

Fractional Carbon Dioxide (CO2)

How Fractional C02 Laser Treatment Works


Fractional C02 laser is a new and innovative approach to ablative skin resurfacing to rejuvenate the aging skin and to treat acne scars. This novel laser treatment utilizes the principle of "fractional photothermolysis" by creating multiple small Io.ser­puncture holes into the skin. The procedure injuries only a fraction of the skin leaving lots of normal skin surrounding the laser-puncture holes. These small laser-puncture holes appear as faint tiny spots on the skin after the laser treatment. Because there is lots of normal skin in between the puncture holes, the cells from the normal skin rapidly repairs the holes and the skin heals rapidly. And as a result of this healing process, new collagen is formed and improvements in wrinkles, scars and pigmented spots are seen.
What Conditions May Be Treated With Fractional C02 Laser
  • Acne and other atrophic scars
  • Photoaged skin (fine lines, rough texture, superfi cial pigmentation)
  • Superficial benign skin growths
What Happens After Treatment?
You will experience burning sensation on the skin that will last between 60 minutes and 6 hours on the first day after treatment. If you have discomfort following the treatment, take panadol or ask for a pain-killer prescribed by the doctor (e.g. voltaren, naprosyn or ponstan). Cold compresses over the treatment sites will also help minimize the discomfort.

Treatment to the facial area will result in an appearance similar to a darker tan/ sunburn for the first week. A fine scab will be formed by the skin-do not be concerned. this is part of the normal healing process. Make-up can be used after the scabs have fallen off.

Redness may persist up to 5-7 days. Your skin will get darker and then near the 5th7th day, start to flake off.

More intense treatments may take longer for recovery.

Wash the treatment area using a mild non-abrasive soap everyday, pat gently dry and apply a mild skin recovery ointment / bland moisturizer liberally to the treated sites 3 to 4 times a day.

Avoid hot water.

Rest well.

Avoid strenuous exercise, bending, straining, stooping or lifting heavy objects for 3-5 days after procedure. These activities may cause swelling and pain on your face and slow down your recovery.

Sleep with your face elevated above your heart for the first day after the procedure.

Avoid sun exposure for at least 3 months. A sunscreen SPF 30 or higher should be applied every day after the first week. Use hat and sunglasses. Your skin is extremely vulnerable to the sun after the laser treatment. Protecting your skin and limiting sun exposure ensures the best cosmetic results.

Over the following weeks and months, the skin repairs the deeper dermal tissues that have been affected by the laser treatment, producing longer beneficial changes associated with a healthier, more youthful appearance.
Potential Side-effects of Treatment
Discomfort, redness, swelling, blistering, scarring, pigmentary changes. Post-laser hyperpigmentation may occur in 5-10% of cases and may take several months to clear -sun avoidance will help to reduce the risk of this complication.
Number of Treatments And Treatment Schedule
3-5 treatments spaced 4-6 weeks apart.

Hair Removal

Why do I have excessive hairs?


a) For most people, this is due to genetic or familial factors. There is no underlying medical cause for the excessive hair growth.

b) Rarely, excessive hairs maybe due to underlying medical problems. These conditions are associated with hormonal disturbances resulting in extra hair growth. Besides excessive hairs, these patients may have other signs and symptoms of hormonal disturbances such as weight gain, deepening of voice and menstrual irregularities,

c) Occasionally, excessive hair growth maybe due to medical and surgical treatments. Certain medications, such as cyclosporin A ,which is used to treat various medical conditions, may cause excessive hair growth as part of its side effects. Certain surgeries, such as tissue grafting, may result in excessive hairs at unusual locations due to the use of hairy grafts.

Your doctor will go through the medical history and examination with you thoroughly to rule out underlying medical problems.
Why should I remove those excessive hairs?
The extra hairs can indeed be left alone. Most people want to remove the extra hairs for cosmetic reason. For some people, the extra hairs have also caused much embarrassment and psychological distress.
Do lasers work wonders for hair removal?
Lasers DO
  • cause selective destruction of hair follicles.
  • Achieve long term hair reduction after multiple sessions of treatment.
  • Cause some minor side effects such as swelling and pigmentation of skin In a minority of patients. These are more common among patients with darker skin.
Lasers DO NOT
  • Achieve permanent hair destruction after one single treatment.
  • Work equally well for all patients. In fact, different laser systems may work differently for patients with different skin types. Generally, patients with dark hairs and fair skin respond best to laser hair removal.
What can I expect from my laser treatment?
You will need multiple sessions of treatment to achieve significant hair reduction.

The treated areas may not be completely empty after laser hair removal treatments.
However, the remaining hairs may be lighter in color and finer in texture.

There may be small risk of pigmentation of skin after laser treatment, this will usually resolve with time if you practice proper sun protection.
How can the excessive hairs be removed?
There are various methods available for hair removal, some of them only result in temporary hair loss while some other methods result in more permanent hair removal.

The temporary methods remove the hair shafts but leave the hair follicles and haif roots intact. The commonly used temporary methods Include shaving, waxing, application of depilatory creams and even plucking. There is also a new cream which helps in slowing down hair growth and is used in addition to other temporary hair removal methods. Given time, hairs will grow out from the hair follicles again and the process need to be repeated indefinitely.

The permanent methods remove the hair shafts and also result in destruction on the follicles and hair roots. For a long time. electrolysis was the only permanent method. However, laser hair removal has emerged as a better method in recent years.

Electrolysis involves the application of electric current via a fine electric probe into individual hair follicle. This will result in destruction of individual follicle. However, electrolysis is extremely time consuming and may result in scarring of surrounding skin due to the nonselective destruction of tissue.

Laser hair removal make use of intense light source of specific wavelength to heat up and destroy the hair follicle selectively. The special light is absorbed by pigment within the follicle and the heat generated in the process is enough to "burn" the hair follicle without causing much injury to surrounding tissue.
What are the precautions for laser hair removal?
Before the laser treatment, you should
  • Avoid waxing and plucking of hairs for 2 weeks
  • Avoid excessive sun exposure 4 weeks before treatment. Your doctor will want you to lose the tan if you had prior sun tanning. This is to avoid damage to the overlying skin, as the tanned skin will also absorb the laser light.
  • Shave the hairs short on the day of laser treatment.
  • Consume the medications prescribed by your doctor. Some antiviral medications maybe needed if certain body areas, such as the lips or bikini lines are treated, especially if the patient has prior history of herpes infection. Bleaching agents maybe used for some patients with very dark skin.
After the laser treatment, you should
  • Continue the medications prescribed and complete the course of treatment.
  • Continue to practice sun protection.
  • Take good care of the treated sites to avoid any possible infection. Your doctor may prescribe you with some ointment to sooth the skin and to prevent skin infection.

Intense Pulse Light

What is Intense Pulse Light (IPL)?


Intense pulsed light (IPL) is a recent form of light technology introduced to remove multiple skin disorders, such as pigmentation and fine blood vessels (telangiectasia). It is also popularly known as "photorejuvenation" or "photofacial". The light device is not a laser but a broad band light source with a range of wavelengths, which can target different skin lesions at the same time. Different filters are used depending on the skin type and the predominant target. The improvement is more gradual and subtle than compared to laser therapy.
What is it used for?


IPL is effective for superficial pigmentation such as freckles. Solar lentigines (sun spots) and superficial melasma. It does not work as well for deeper forms of facial pigmentation or certain types of pigmentation e.g. acne marks. It is also effective for redness from fine blood vessels and certain skin conditions e.g. rosacea. IPL may improve skin texture to varying extent but it is not effective for deep wrinkles or movement-related wrinkles such as frown lines and "crow's feet". Deep scars such as those from acne or chicken pox also do not respond to IPL.
What are the IPL devices available?


Presently there are several models of IPL devices available in the market. Some devices are used mainly for hair removal while others are for "photorejuvenation". They have a range of wavelengths from 500 to 1200 nm. Some form of cooling is required to protect the skin surface (epidermis) so that complications such as blistering and burns are minimised.
How many treatments are required?
To achieve significant noticeable results, it has been reported that multiple treatments are necessary. The skin should be treated at intervals of 4 -6 weeks for 4 -6 times.
What are the possible side effects?
The overall risk of side effects is low. The treatment is associated with very little downtime and the patient can resume daily activities almost immediately. Following the IPL treatment, there is usually mild skin redness which lasts one to several hours. Other less common complications include prolonged redness lasting 1 -3 days. blistering and temporary darkening of the skin lasting several months (post-inflammatory hyperpigmentatlon). The risk of side effects is higher in dark-skinned individuals or people who are frequently in the sun.
How effective is it?
The degree of improvement is variable and depends on the severity and depth of the pigmentation/ blood vessels. For people who have a mixture of superficial and deep pigmentation, patchy improvement and incomplete removal of pigmentation may be expected. However. the improvement must be maintained with good skin care such as sun protection and creams. As for redness and fine blood vessels, the results are fairly good. IPL is not the best treatment option if the predominant skin problems are wrinkles and scars. Please see your dermatologist to discuss alternative treatment options e.g. botulinum toxin injection, filler injection or laser treatments for these.
Is it painful?
An anaesthetic cream is applied one hour before the treatment to minimise discomfort. A mild burning sensation may still be felt for some people. Most of the time, it is very well tolerated. There is no need to take painkiller.
What is the skin care regimen after treatment?
There is no special skin care required after IPL. If there is marked redness, the doctor may prescribe a mild steroid cream or moisturiser for a short while. For pigmentary skin conditions, lightening cream and sun protection should be continued in between and after treatment.

Pulse Dye Laser

Certain birthmarks can now be removed using laser treatment :
Portwine stain


This is a blood vessel abnormality affecting up to 0.5% of the population. It looks like a pink patch at birth and will not go away. Instead, as one grows older the birthmark will steadily darken and become larger. By midlife, many of those afflicted with the condition may suffer from cosmetic disfigurement, which can occur on any part of the body. If the birthmark becomes too large or thick it may bleed.
Strawberry hemangiomashemangiomas


These are overgrown or enlarged vessels which grow very rapidly after birth but often go away with time. The birthmark usually resolves by 5-6 years. Some, however, may occur near the mouth or eyes and interfere with eating or vision. They should be treated early before problems set in. Sometimes the birthmark may bleed or become infected.
Spider nevusnevus


Like strawberry haemangiomas, spider naevi are overgrown or enlarged blood vessels. Each spider naevus consists of a central large blood vessel with tiny vessels radiating from the centre, hence the name. They usually do not cause problems except that they look unsightly. These spider naevi may be associated with an underlying chronic liver disease.
Why should I have my birthmark treated?
Many people are uncomfortable with unsightly birthmarks. Young children or infants can be treated before they are subject to the psychological as well as physical blemishes that may be associated with the birthmarks. Sometimes birthmarks may bleed, become infected or interfere with vision, eating or other bodily activities.
What does treatment by the flashlamp pulsed dye laser machine consist of?
The treatment varies from patient to patient depending on the type of birthmark, size of the affected area, colour of the skin and the depth to which the abnormal vessels extend beneath the skin surface.

The steps involved are:

1. The doctor will test your skin reaction to the laser during your first visit to determine the most effective treatment.

2. Because the laser operates at a wavelength that is potentially harmful to the eye, you will be asked to wear eye-protective goggles.

3. Treatment consists of placing a small handpiece or “wand” against the surface of the skin and activating the laser. The flashlamp pulsed dye laser will strike the skin in an intermittent fashion. Each pulse feels, for a small fraction of a second, like the snapping of a small rubber band against your skin.

4. Small birthmarks like spider naevi, will require only a few pulses while others, like portwine stain will require many more. Large birthmarks will require retreatment, necessitating multiple patient visits.
What other concerns should I know about?
Optimal results will be achieved with the flashlamp pulsed dye laser only if you are not sun-tanned. It is also recommended that you avoid exposing the treated area to the sun and cover the area with a sunblock that is approved by your doctor. Of course, this area may be exposed to the sun when your course of treatment is complete.

Patients with tanned or darker skin types will achieve less satisfactory results from this form of treatment.

The cost per treatment ranges from $200 to $2,500 depending on the size of the lesion treated. Most patients will require about 4-6 treatment sessions.
 How safe is the treatment?
The flashlamp pulsed dye laser is able to selectively treat the blood vessels of the birthmark without adversely affecting the surrounding tissues. Thus, it will eliminate many lesions while leaving the surrounding skin and skin pigment intact, thus reducing scarring. This treatment is safe to be used on infants as young as a few weeks old.
What is the skin care regimen after treatment?
There is no special skin care required after IPL. If there is marked redness, the doctor may prescribe a mild steroid cream or moisturiser for a short while. For pigmentary skin conditions, lightening cream and sun protection should be continued in between and after treatment.
Is the treatment painful?
Immediately after treatment, the laser-treated area will turn dark-grey. This will persist up to two weeks until the dead red blood cells are cleared internally by the special cells in your skin. Occasionally, a very thin scab will form on the surface of the skin. This will fall off within two weeks. In the first few hours after treatment, the laser-treated area may feel hot, like a sunburn. You may relieve this by applying cool cloth soaked in cold water, or you can use cloth wrapped around ice cubes or an ice pack. For the next three to four days:
  • avoid hot water contact to the face
  • avoid hot conditions e.g. sauna, spa
  • you can wash the face with tepid water but avoid soaps and rubbing or friction on the skin
  • avoid or minimise sun exposure
  • you may use moisturiser on the face if it is applied gently and not rubbed in
After the first four days, you may use a sunscreen if you are going outside. It is very important that you avoid excessive sun exposure for the first 3 months. Otherwise brownish pigmentation may occur which may take a few months to fade.

Qs Nd Yag Medlite C6

Q-switched Nd: YAG Laser (Pigmentation Laser)


The Q-Switched Nd: YAG Laser is a pigment laser developed to remove black, red and possibly other colours of tattoo pigment and certain brown growths and birthmarks from the skin. Repeated laser treatments are often necessary. The tattoo or pigmentation will be treated at intervals of two months or longer until either the entire pigment is removed or further improvement is deemed unlikely.
Number of treatment sessions required

The number of treatment sessions required is as follows:
Nature of Pigmentation


Freckles/ Lentigines
Eyebrow/ Eyeliner tattoo
Cafe-au-lait macules
Amateur tattoo
Hori's Naevus
Naevus of Ota
Professional tattoo
Estimated Number of
Treatment Sessions


1 - 3
2 - 3
3 - 5
4 - 6
7 - 10 
7 - 10
7 - 10
The above information serves only as a general guide. No guarantee can be made that the specific patient will benefit from the treatment of that the pigmentation/ tattoo will be totally removed at the end of the treatment sessions.
Colour of tattoo and response to treatment



Colour


Black
Red
Green
Other Colours
Response to Treatment


Good
Good
Poor
Variable
Instructions for skin care after Q-switched Nd:YAG Laser treatment

You have been treated with the Q-Switched Nd: YAG Laser. The treated area is very delicate and should be treated with care. Please read and follow instructions given.
Care of the treated area
  • Keep the treated area dry for 24 hours following the Q-Switched Nd: YAG Laser treatment.
  • Remove the dressing after 24 hours.
  • If it is difficult to remove the dressing, soak it in saline solution (salt water) to loosen it.
  • Clean the wound with the prescribed cleansing solution using cotton balls. Apply gentle pressure and clean the wound and the edges.
  • After cleansing the wound, dry the wound.
  • Apply antibiotic ointment with cotton applicators. (Q tips)
  • Cover the wound with non-stick dressing (eg. Melolin). This will prevent the dressing from sticking to the wound. Secure the dressing with tape.
  • Apply antibiotic ointment to the treated area twice a day for 7 days or until the surface is totally healed.
  • Showers are permitted but gently pat the area dry. Do not rub with a towel or washcloth because the area is extremely delicate when a crust is present.
You may experience some discomfort after Q-Switched Nd: YAG Laser treatment. For adults take two tablets of paracetamol (eg. Panadol) every six hours for pain when necessary (if you not allergic to it).
  • If swelling occurs, an ice pack wrapped in a soft cloth can be applied.
Precautions to take following your laser treatment
  • Avoid direct exposure to the sun. Use a sunblock regulary once the crust disappears.
  • Do not rub, scratch or pick at the treated area. A protective dressing should be applied if the area is irritated by clothing or jewellery.
  • Do not apply make-up until the crust disappears. (Usually 3 - 7 days).
  • Avoid swimming and contact sport while crusts are present.
  • If the treated area shows signs of infection (tenderness, redness, swelling or pus), notify your doctor or Nurse-in-Charge.
What are the side effects and possible complications of laser surgery


Pain
You will feel some pain during treatment. The pain is mild and it is similar to snapping the skin with a rubber band. Some areas are more sensitive than others.

Wound Healing
Laser surgery may cause a superficial burn on the surface of the skin which takes several days to heal. This may result in swelling, weeping and crusting of the treated area. This usually takes 4 to 10 days to heal.

Pigmentary changes
In most patients the treated area loses pigmentation (hypopigmentation) and becomes lighter in colour than the surrounding skin temporarily. This type of reaction tends to gradually fade away and return to normal over a period of 2-4 weeks. With repeated treatments the pigment loss may become more persistent and takes longer to resolve (up to 6 to 8 months). There is a risk of permanent pigment loss in the area of treatment, leaving a white area similar in shape to the original tattoo or pigmented lesion being treated. This is rare and is usually minimized by allowing adequate healing time between treatments.

There is a risk of increased pigmentation (hyperpigmentation) as a healing reaction. Post-laser reactive hyperpigmentation is very common in Asian skin. If this should occur, the increased pigment usually fades away over a 6 - 12 month period. This can be minimized by avoiding sun exposure during the first few weeks after laser treatment.

Scarring
Scarring is a very rare occurrence but it is a possibility. To minimize the chances of scarring, it is important that you follow the post-operation instructions carefully.

Persistence of tattoo or pigment
Some tattoo ink or pigment is located too deep in the skin to be removed completely in spite of repeated treatments. Vague spots of colour may remain after treatment. There may be some ink colours that change colour prior to removal and others that simply will not respond to this laser. (eg. green tattoo) It may not be possible to completely remove all tattoo and skin pigmentations with this laser. If this situation arises, there may be other treatment alternative available.


BOOK AN APPOINTMENT

Not sure which treatment is for you? Book your first consultation to discuss your concerns with a member of our medical team.
+65 6881-0028 (Only open for appointment bookings)
Monday - Friday : 8:30am-5:30pm
Saturday : 8:30am-12:30pm
Book Now
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram