#AskADerm: Q&A with Dr. Angeline Yong on Cosmetic Treatments

Updated: Dec 13, 2020

We all have our favourite go-to skincare products, but you may be curious about whether your skin needs the occasional pick-me-up to really glow! From chemical peels to skin boosters, there are a plethora of beauty clinics now dedicated to helping you give your beauty regime an additional boost.

To find out more about cosmetic treatments, injectables, and other non-surgical offerings, we chat with Dr. Angeline Yong, a Singapore-based dermatologist accredited by the Ministry of Health, from Angeline Yong Dermatology. Known for her signature personalised care, Dr. Yong provides advice and knowledge in a tell-all sharing!

Q1: Is it safe to have chemical treatments when pregnant?

Dr. Angeline Yong: "I would generally avoid chemical treatments when pregnant. Ultimately the answer to this question hinges on what exactly is meant by chemical treatments and what is being applied to the skin. Many things that are not harmful to women who are not pregnant may potentially be absorbed transcutaneously and get into the bloodstream where it can affect the unborn baby.

This is absolutely crucial to avoid in the organ development stages where some chemicals may have potentially known and unknown effects on the development of the baby. Other than that, pregnancy brings about a lot of hormonal changes, and this change in the hormonal milieu and skin quality/texture may potentially also affect the response of the skin to the chemical treatments. As such, the outcomes and the results may not be as expected in a woman who is not pregnant. Hence, I would generally avoid chemical treatments when pregnant as it can not only have effects on the unborn child but may also have less ideal effects and outcomes on the mother, as treatment response may not be optimal. Generally, most pregnant mothers are very careful with what they use during pregnancy and I think to a very good cause!"

Q2: Can Skin Hydrating Boosters help to stimulate collagen? How long does a booster last?

"Skin hydrating boosters are hyaluronic acid-based and therefore serve mainly to plump up the skin and improve hydration levels by attracting and binding water to themselves. They are usually injected in tiny microdroplets into the superficial layers of the skin, and by doing so, serve to improve hydration levels as a primary goal. This is therefore most useful for improving skin that is dry and dehydrated.

They have been reported to increase collagen production and improve skin elasticity to some extent as they are known to also help boost fibroblast activity under the skin, however, this effect is not as pronounced as its skin hydration effect which is the primary aim of a skin hydrating booster.

If I was looking more at the effect of stimulating collagen, there are other injectables that may serve to help stimulate collagen and elastin better, and these are known more as bio- remodeling injectables such as Profhilo.

Profhilo is a hyaluronic acid-based injectable but has the unique properties of being able to stimulate collagen and elastin formation, helping to not only boost hydration levels but also improving skin elasticity and improving laxity issues. It is however better known by definition as a bio-remodeling injectable rather than a pure skin hydrating booster.

Again the choice of treatments really hinges on the primary goals of the patient, if I was looking at stimulating collagen and elastin to improve laxity, I might consider other options such as energy-based devices which may have greater results than skin hydrating boosters. But if my patient was primarily concerned with dry, lacklustre, dehydrated skin, then skin hydrating boosters would be an absolute go-to treatment of choice.

A skin booster typically lasts between 6-9 months. The longevity of the skin booster depends on the type of hyaluronic acid used and varies across different brands due to the technology used in manufacturing the hyaluronic acid skin hydrating booster (ie cross-linked, non-crosslinked, chemically or thermally cross-linked). As such, the duration that it can last really depends on the type of skin booster used. The treatment schedule also varies across the different brands, some are a single treatment, others require two treatments one month apart, and yet others may be best done as a series of 3 one month apart."

Q3: Botox vs Dysport vs Xeomin: Is there a difference between these injectables?

"They are all various forms of botulinum toxin, and work towards the same goal – which is usually to reduce muscle activity in the treatment area. This will lead to reduced dynamic rhytides and prevention of the formation of static rhytides and is particularly popular as an anti-ageing cosmetic treatment for the upper face and in Asia, to reduce the activity of masseter muscles which can slim the face and also reduce symptoms like grinding of the teeth. They are also very useful for the treatment of palmar and axillary hyperhidrosis and have other treatment indications in other fields of medicine such as the treatment of chronic migraine.

The three brands mentioned however have different chemical constitution – Botox is “onabotulinumtoxinA”, and Xeomin is “incobotulinumtoxinA”. Botox and Xeomin have a similar dilution, and they are approximately equivalent in a 1:1 ratio. Xeomin however only contains pure botulinum toxin A and does not contain any additives, which means that the patient is less likely to develop antibodies to it and lead to downstream resistance. Dysport on the other hand is “abobotulinumtoxinA” and has a different dilution from both Botox and Xeomin, hence the units of measurement are different between Dysport and the other two brands mentioned, and should not be directly compared."

Q4: What treatments do you recommend for milia?

"I usually recommend using an exfoliant in your daily routines such as a facial wash containing AHA/BHA, and a weekly gentle facial scrub. Using a leave-in toner that contains AHA/BHA also helps to keep the keratin in your skin from overproducing and causing trapping. Topical retinoids used in a skincare routine may also help to reduce the occurrence of milia. It is also equally important to avoid the use of thick creams or oil-based products which may lead to the formation of more milia."

Should the milia be persistent, I will typically help to extract the milia gently by using a tiny needle to manually deroof the milia, which would then allow the milia to be removed as gently as possible with a comedone extractor. — Dr. Yong  

Q5: Is there an age recommendation for HIFU treatments?

"I personally do not feel that there is a specific age recommendation or minimum age for HIFU treatments because HIFU will be an excellent treatment option as long as there are signs of laxity and the primary goal of treatment is to treat the laxity non-surgically. The response to treatment however depends very much on the patient’s pre-existing condition, and patients who are much older and have extensive age-related laxity may need several treatments before seeing results.

There are also some older patients who would probably benefit more from a surgical facelift procedure but for various personal and health reasons would rather not go under the knife, and would opt for non-surgical lifting procedures such as HIFU. Due to the extent of pre-existing severe laxity and volume loss in these much older patients, results may not be as optimal as in the younger age group (30s to 40s) with mild-moderate severity, and this is especially if only monotherapy with HIFU is carried out."

Q6: Will the skin be more sensitive to sunlight after a HIFU treatment?

"There is typically no surface damage or change after a HIFU treatment. As the surface of the skin is intact and unaffected, the skin is typically not more photosensitive after a HIFU treatment. The skin may however be transiently red after treatment, but this typically does not last more than a day."

Q7: Is there a difference between PicoWay or PicoSure for melasma removal? How many sessions minimally to see results?

"Yes, there is definitely some difference between using either the PicoWay and PicoSure lasers for melasma removal. This is fundamentally because of the different laser physics and characteristics for both lasers, hence their effect on the skin is going to be different.

PicoWay is a picosecond Nd:Yag laser, and its primary wavelengths are 532nm and 1064nm. They also have additional handpieces that allow you to use the Picoway with a 785nm wavelength and a new 730nm wavelength. The Picoway is also the picosecond laser with the shortest pulse duration on the market, and this is very useful in generating a photoacoustic effect that does not overheat the surrounding tissue — particularly useful in the treatment of melasma which tends to be very unstable.

Picosure on the other hand is a picosecond laser with a primary 755nm alexandrite wavelength, and is also useful for the treatment of melasma given its likewise short pulse duration in the picosecond domain which reduces any photothermal effect. It also targets the deep dermal layer of the skin very effectively, and the focused lens array of the Picosure laser is particularly useful at creating laser-induced optical breakdown (LIOBs) which helps to clear out the pigment and also remodel the skin which typically leads to the improvement of melasma as well.

Melasma is also not straightforward in the sense that it could have a predominant epidermal component, predominant dermal component, or could have both. As the two different lasers have different primary wavelengths that target different levels of the skin, I find that the suitability of one over the other hinges largely also on where the melasma pigment lies in the skin.

I oftentimes combine both lasers in the same session and use a blend of lasers in order to harness what I need to treat the melasma pigment and textural irregularities in the same patient. — Dr. Yong

Then again, do note that melasma requires treatment over a few sessions, and may require downstream maintenance treatment to prevent relapse in patients who are less stable as melasma is oftentimes multifactorial – hormones, sun exposure, heat, genetics, and vascular factors all can play a part. Therefore, melasma is best treated with a combination approach which would include proper photoprotection and efficacious topical agents as well for maintenance."

Q8: What treatments do you recommend for dark eye circles?

"The treatments I recommend for dark eye circles really depends on whether it is primarily a pigmentary sort of problem (pigmentary dark eye circles), or whether there is a predominantly vascular problem with ensuing edema and congestion.

Textural irregularities and crepey skin in this area also contribute to a worsened appearance, as the light reflection from an irregular surface is dispersed and makes the skin in the area appear darker and duller. In addition, dark eye circles in many individuals are oftentimes caused by a mixed picture with both a pigmentary and vascular component contributing to the dark eye circles.

Structural and anatomical reasons may also be behind a shadowing effect which gives the pseudo-appearance of “dark eye circles” but this is actually more structural in nature, and is due to either deep-set eyes or protruding eyelids. As a result, treating dark eye circles is more challenging and requires not only the right diagnosis but also often requires a combination approach as there is often a mixed-component to this.

If the dark eye circles are predominantly pigmentary in nature, I find that using picolasers like the Picosure laser with its Focused Lens Array for non-ablative fractional remodeling, or the Picoway laser with its non-ablative Fractional Resolve handpiece very useful for the treatment of pigmentary dark eye circles. This is because these picolasers are able to clear out pigment more effectively and with less downtime given the photoacoustic effect, which is important in this area where the skin is thinner and more prone to pigment alteration-related side effects in individuals in darker skin tones especially when using ablative lasers.

Of note, these lasers can not only improve and clear out pigment, but can also improve the textural irregularities in this area which are commonly associated with dark eye circles, and overall improve the texture and pigment in this area with minimal to no downtime.

On the other hand, if there is a vascular component to the dark eye circles, it may require treatment with a vascular laser such as a pulsed dye laser or long-pulsed Nd-Yag laser. Structural issues such as prominent tear troughs that contribute to the appearance of “dark eye circles” should be treated with a filler as this will correct any anatomical “step deformity”. Again, remember that a single modality approach almost always certainly fails because the majority of dark eye circles have a combination of causes, and will require more than 1 type of treatment.

Finally, good eye skincare is also very important, and I personally like using products with high antioxidants and peptides in this area which will help improve the skin texture and brighten the skin in the area. I caution against using strong lightening agents in this area as the skin is very sensitive, and will not tolerate more traditional lightening/bleaching agents. I would also caution against using products that are very rich in nature as they may lead to trapping and formation of milia around the periorbital area which is more prone to this."

Q9: What are your top 3 skincare tips?

Use a great antioxidant serum that packs a punch. I typically love products with a high amount of antioxidants especially vitamin C. This quenches free radical damage and reduces the oxidative stress it causes on the skin, and by doing so, helps to slow down the photoageing process. It also helps to brighten the skin, evens out skin-tone and makes skin more supple and radiant, whilst also reducing the formation of blemishes and pigmentation. A great antioxidant serum is really an all-in-all skin superfood and is what I will put on my face every day! Then again, not all antioxidant serums with vitamin C are created the same because it also depends on whether this is in a stabilised formulation, as some unbuffered formulations may also sting when applied to the skin.

I also believe that less is more – fundamentally, I believe in a minimalist skincare routine and not in something that is too complicated.

For most people with a normal skin type and without other existing skin conditions such a pigmentation or acne issues, keeping to a minimalist skincare routine that is 3-4 steps, not only keeps things simple and improves complexion, but also reduces the risk of occlusion and trapping if too many layers of creams are applied. This is absolutely pertinent at this point in time as daily mask-wearing becomes the new norm. I really have seen a lot of patients of late with mask-related issues such as 'maskne' and skin dermatitis/irritation from prolonged mask-wearing, and I usually advice avoiding the use of occlusive products underneath the mask, keeping to very lightweight serums, gel-based or light cream-based moisturisers underneath those masks. Where possible, avoid heavy foundations underneath those masks, as this will lead to greater occlusion and trapping.

Lastly, avoid polypharmacy and switching between different products too often. There is always the potential risk of developing unnecessary complications such as allergic contact dermatitis to unnecessary skincare ingredients that might be potentially harmful or irritating, or the skin could be unnecessarily stressed from the sudden switch between different skincare products. Remember that less is more sometimes, and in general, as a full-time working mother-of-two with a busy hectic life, I personally really prefer to keep things simple as well!

Enjoyed reading Dr. Yong’s comprehensive sharing? Find out more about the cosmetic, surgical, and medical treatments Angeline Yong Dermatology offers on their website. To take the first step in transforming your skincare regime to something minimalist but effective, like what Dr. Yong shared, spend 2 minutes on our Smart Skin Analysis to find the products best suited for your skin.

In her 15 years of medical practice, Dr. Yong has also been awarded numerous accolades and titles. She is also committed to giving back to society and has embarked on medical humanitarian mission trips, receiving the Healthcare Humanity Award by the late President S.R. Nathan for her work in Bangladesh and Sri Lanka. She is also committed to nurturing the next generation of aspiring dermatologists, a regular contributor to medical journals, speaker at conferences, and key opinion leader for various aesthetic dermatology products and laser services.


About us: We are Skintelligence, a team focused on a 'skin-first' approach to beauty through artificial intelligence. We match products to you based on your unique skin type and needs. Results are highly accurate and personalized with AI and machine learning. It's fun, convenient, and it works. Try it here.

As featured in Her World, CLEO, FEMALE, Shape, Nuyou, Singapore Women’s Weekly, Daily Vanity, Layers of Skins.

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