Dr K K Chew

Melasma is a common skin pigmentation condition that appears as brown to gray patches typically on the cheeks, forehead, nose and chin. It occurs predominantly in females with only 10% of males having this condition. Melasma, also known as chloasma, is common in females after pregnancy giving rise to the term “mask of pregnancy". The causes are multifactorial and include sun damage, hormonal factors, inflammatory (increased mast cell activity), increased vascularity and disruption of the basement membrane and skin barrier function.

Firstly, I would like to emphasise that in patients with recurrent acne it is important to take a detailed history of the problem. I have come across cases whereby the patient had only self medicated with OTC products which did not improve their recurrent acne. In such cases a more conservative approach using topical agents like adapalene, retin A, benzyl peroxide and clindamycin can be considered first. In those cases who have experienced treatment failures with topicals, oral medications in the form of isotretinion and antibiotics like doxycycline and minocycline can be considered.

There are no photos provided so I will be just making an assumption. I presume the fillers were injected in your undereye area to improve your tear trough. The possible reason for this is what is called the Tyndall effect. This is due to hyaluronic acid fillers being injected too superficially into the skin and or in too large quantities. This results in a bluish discolouration due to the light reflecting off the filler particles with increased scattering of the light. Thus, the area treated looks darker due to the discolouration. Hope this helps!

Fillers that are primarily used for the lips are made of hyaluronic acid. This helps in moisturisation and adding volume or augmentation. There are softer versions of Lip fillers on the market now that aim to primarily provide moisture for the lips. So yes they can help to keep your lips moist and reduce the side effects of isotretinion, but it might not be a cost effective option as lip fillers tend to be quite costly. For my patients who do have problems with dry or cracked lips while on isotretinion, I normally would ask them to use a moisturising lip balm or Vaseline cream .

Hi! I can understand your concern as Singapore is a humid country which causes us to sweat easily. A lot of us would prefer to wear a sleeveless top. However, it can be embarrassing when our underarms are dark and discoloured compared to the colour tone of our arms. Topical Whitening Creams Topical whitening creams have been promoted and used for a long time but tend to have limited efficacy. IPL IPL devices can be used for whitening of the underarm areas as well as providing hair removal at the same time.

Trusculpt Flex is a device developed for building and toning muscle by replications of muscle contractions that mimic that of squats, crunch and twist . Cool sculpting is primarily a device for the non invasive reduction of fat . The pros of Coolsculpting are: 1. Well documented efficacy in reduction of subcutaneous fat - average up to 25%. 2. Treatment generally well tolerated although there can be some discomfort during the initial vacuum suction. 3. Usually able to see results after 2 or more treatment. sessions . The cons of Coolsculpting: 1.

Hi, from the photos you submitted I have a few suggestions: Firstly I want to emphasise that you are young and have a nice overall oval shape face. The suggestions listed below are based on augmentation of certain of your features to attain the symmetry and definition you desire1. There appears to be some asymmetry of the midface with the left side looking more projected forward than the right. This is usually due to loss or deficiency of the mid cheek fat pads on the right . I would suggest augmentation of the right cheek with a HA filler to create volume and projection .

HiThere are 2 possible scenarios here. Firstly acne flare-up with isotretinoin has been well documented. These flare-ups are usually mild in nature and the acne actually becomes worse before getting better. In one study done they concluded that males and those with severe grades of acne as well as coexisting truncal acne are more likely to experience these flare-ups. The second scenario is related to what has been termed purging of the acne. This occurs more often in those with long-standing cases of acne.

Dear David,The issue of treating patients with laser and other forms of phototherapy while on isotretinoin has always been the perceived increased risk of poor wound healing and scarring. However, more recent consensus studies have not really shown this to be a factor that would contraindicate the use of lasers while on isotretinoin or within a short period of stopping it. It would seem that the main fear would be that of a medico legal issue if and when complications do arise.

Hi The issue of treating acne scars with lasers or other forms of phototherapy while on Accutane has always been the perceived increased risk of wound healing and scarring. However recent consensus studies on this issue does not seem to indicate that there is an increase risk while the relative conservative approach on this has been the fear of medico legal issues should complications arise. I personally have used both ablative lasers like CO2 and non ablative lasers to treat such patients with no complications .

There are a few ways you can lighten post-inflammatory hyperpigmentation (PIH) on the buttocks. I could suggest the following. I would first suggest using topical hyperpigmentation products that have lightening effects. These include products that contain vitamin c, hydroquinone-based or various combinations of active ingredients. Apart from that, I also use a modified TCA peel. This TCA peel may help to lighten and brighten the skin without leaving any downtime. Lastly, you may choose to use light-based devices such as IPL and Lasers.

Both Trusculpt ID and Vanquish ME are radio frequency devices designed to treat unwanted/excess fat non surgically. Trusculpt ID is a later generation device that uses Monopolar RF with 6 Handpieces each 40 cm sq that are placed in contact with the treated area. There are direct temperature monitoring and feedback of the surface skin that ensures that the desired temperature for fat destruction is achieved without the risk of skin burns. Each treatment only takes 15 minutes and results can be seen after one to two sessions about 8-12 weeks after the session.