Adeline Tay

"This occurs more in young to middle-aged females," says Dr Colin Kwok, a dermatologist with the Centre. "A common pigmentation problem is melasma, which not only spreads but causes brownish or grey patches on the cheeks," he says. "It is induced by sunlight and hormonal changes, and occurs in women who have had two children, are on oral contraceptives pills, and who are exposed to ultraviolet rays."

• Chemical peeling

A chemical face peel uses chemicals (glycolic acid, lactic acid, trichloroacetic acid, phenol and/or resorcinol) to burn off the top layer of the skin, thus erasing irregular pigmentation, mild acne scars, crow's feet, fine cheek wrinkles and tiny vertical lines above the upper lip. Essentially, there are two types of chemical peels - superficial and skin deep.
The milder peels, which use alpha hydroxy acids, improve the skin's appearance by speeding up the shedding of dead skin cells. They clear up acne-prone skin, soften tiny lines around the eyes and mouth, and smooth dry skin as well as fading dark spots caused by the sun or hormonal changes (such as in pregnancy). These acids are, however, not deep enough to erase scars or wrinkles.
There is a burning sensation while the chemical is applied, but this soon passes. The skin may remain more pink than normal for several weeks, but this may be camouflaged with tinted sunscreens or make-up. Sun protection is important until the pinkness goes completely.
Phenol and trichloroacetic acid are used in fairly deep peels. These are more painful and complicated. After the peel, a thick crust lasts for a week, and the purple-red skin colour may take a few months to fade away. Though more difficult to endure, the result after the skin heals is a pinker, tighter, smoother and relatively wrinkle- and blemish-free skin.
However, the chemical peel is not for everyone. Those with dark or olive skin may end up with a blotchy appearance.

• Dermabrasion

Instead of an acid, a hand-held, high-speed rotary wheel is used in dermabrasion to remove the epidermis, or top layer of the skin.
Dermabrasion is an effective treatment for deeper imperfections, such as smooth scars left by acne, accidents or previous surgery.
While it is less likely to produce side effects such as changes in skin colour, the procedure involves a certain degree of blood loss and requires greater skill on the part of the surgeon.

• Laser resurfacing

Laser resurfacing of the skin removes medium to fine wrinkles with the use of a laser. It can also resurface edges of acne and chickenpox scars. Laser treatments work best around the eye and the mouth.
This technique employs the use of a pulsed or scanned carbon dioxide laser. The pulsed carbon dioxide laser works by emitting a very brief pulse of high-intensity light that is fast enough to limit heat damage in the skin, yet strong enough to vaporise tissue cleanly. Since the heat penetrates the skin no deeper than half the thickness of a human hair, it can remove the wrinkled skin layer by layer without scarring.
The scanned carbon dioxide laser, on the other hand, uses mirrors to rapidly scan the laser spot in a spiral pattern.
Laser resurfacing allows for better control and safety, and patients have reported little or no pain during the pulsed carbon dioxide treatment. However, there is still a risk of complications, such as prolonged redness, pigmentation and infections.

• Botox

Botox, or botulinum A toxin, is produced by the bacterium Clostridium botulinum and causes muscle paralysis.
Tiny quantities of this toxin are injected directly into the muscles that control frowning and wrinkling. The treated muscles weaken over the following week or so. The effect is a smoother and less furrowed face that lasts for three to four months.
Some people have a slight headache after treatment for several hours. In rare cases, there is a drooping of the eyelid caused by the Botox tracking into the eyelid muscle. It generally lasts just a few days, but more prolonged weakness is possible.
Botox injections cannot be used in pregnancy or when breastfeeding.

• Collagen replacement therapy

Collagen replacement therapy is a safe, non-surgical procedure that quickly softens lines and furrows on the face temporarily.
Tiny quantities of collagen are injected through very fine needles, boosting the skin's natural collagen. The treatment takes around 20 minutes and the effects last between three and nine months.
Side effects can include temporary bruising, redness and swelling. For individuals with an immunological disorder, collagen injections are not advisable.

• Laser treatments

Lasers produce light of specific wavelengths in a nondivergent beam of monochromatic radiation that can mobilise immense heat and power when focused at close range.
A laser contains an active medium that can be made up of a gas (such as carbon dioxide or argon), a solid (such as ruby or neodymium: yttrium aluminium garnet [Nd:YAG]) or a liquid (such as a dye).
Different types of substances in tissue, depending on its wavelength absorb laser light, and it is the absorbed light, which produces the effect on tissue.
The colour of light a laser emits determines what kind of skin problem it can be used to treat. Ruby lasers, which produce red light (694nm), and the Nd:YAG remove some tattoos and pigmented lesions such as liver spots. The pulsed dye laser is best suited for birthmarks.
Small red spots usually disappear with one treatment. More extensive veins on the face usually require additional treatments spaced one month apart. Generally no anaesthesia is required but there is some discomfort. Some bruising and swelling may occur afterwards, but there is usually no crusting or blistering.
However, not all skin problems respond to laser treatment. For example, spider veins are still best treated by sclerotherapy, which involves injections of a saline solution or an agent called aethoxysclerol.

1. Turkington, Carol A. & Dover, Jeffrey S. Dover, M.D., Skin Deep. Facts on File, Inc. New York, USA.
2. Bergfeld, Wilma F., M.D., F.A.C.P., A Woman Doctor's Guide to Skin Care. Hyperion. New York, USA.
3. Dr Gray, Mark, MBChB, Am Bd Cert Path, Am Bd Cert Dermpath, FRCPA, FRCPC, Cosmetic Dermatology, www.dermnet.org.nz

Date reviewed: 13 March 2000