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Skin Aging Signs, Fact vs Fad

Episode 9-Part 2: Dermatologist and Plastic Surgeon’s Perspective on Aging

 Dermatologist and Plastic Surgeon's Perspective on Aging

Read Part 1 here.

The 50 year old who looks 25: Chuando Tan

For our international listeners, it’s interesting that just a couple of years back, the internet was awash with news of Singapore’s very own ageless specimen – Chuando Tan. He is a model turn photographer  who is in his 50s and still looks like he is in his 20s. He gives his slower aging credit to his strict diet and exercise regime. But I think regardless of whether he had any cosmetic treatments, it wasn’t something anyone was talking about at that time other than: “wow, he’s 50 and he looks this good?!”

Are dermatologists and plastic surgeons in Asia who work with skin of colour, more convinced about the role that melanin has to play in the photo aging process?

Chris: I’m not sure about melanin, but definitely I mean it does offer some sun protection against UV radiation. In or population here in Singapore, aging doesn’t occur as quickly as in Caucasians in the west. I suppose someone like Chuando, he looks young-ish, and he definitely can pass for someone around 25-30. But I guess it’s not uncommon for Asians to look young. I mean even amongst the 3 of us, our patients always tell us we look young. Like Terence and Zul, they both have baby faces as well. However, Chuando’s body is really amazing for 50, and that is definitely not through surgery. It’s all his own hard work and exercise. But yeah, I guess in general, aging in the Asian population is better than in the Caucasian population. 

Dr. Teo: Yes, so you mentioned something quite pertinent in aging, which is the baby face phenomenon. And it’s something that we talk about in dermatology as well as one of the key determinants of how well you age. I mean, that is just genetics. What do you think Terence? 

Asians and Caucasians do age differently

Terence: Aging does occur a bit differently. If you look at his skin, he definitely puts lot of care into sun protection. He meets a really healthy lifestyle, has a great body, probably doesn’t smoke, and probably has very good genes. I think all that helps, and is to his advantage. 

Dr. Teo: There are certain characteristics that we can directly apply to skin of color which enables it to retain more perceived dermal elasticity. The fullness of the dermis and the fact that skin of color inherently possesses more photoprotective melanin which translates into less photodamage in aging compared to a counterpart of the same chronological age. Like J Lo, who is considered skin of color, that allows us to tolerate UV damage a lot more than our Caucasian counterparts who are individuals of Fitzpatrick type 1 -2. Do you think, Zul, since we work in Asia and our patients predominantly belong to the  skin of color category.

Is there a difference in terms of how Asians and Caucasians age, and how we respond to cosmetic treatments? 

Zul: Yeah, I’ve had the chance to work in Europe during my fellowship, and work with Caucasians patients. And back in Singapore where we predominantly work with Asians. So I get to compare the Asian skin as well as Caucasian skin. I mean, I do feel that caucasian skin is thinner. Compared to Asian skin, aging occurs much faster than us Asians. At say 30s, asians still look young, whereas caucasians might look a little bit older already by then. They tend to develop wrinkles much more easily. Mostly over sun exposed areas such as the décolletage, compared to Asians. It affects us as plastic surgeons surgically, because when you make an incision in the Caucasian patient, they heal pretty well when you close it. But it is not so easy in Asian patients – you’ve got to have a very good tissue handling techniques.

Dr. Teo: I find that there is definitely a difference between Asian and Caucasian skin types in terms of how they tolerate cosmetic interventions as well – specifically lasers. Both ablative and non-ablative lasers require lower energy settings in skin of color for skin rejuvenation, skin resurfacing, and also for hair removal. That’s because we’re much more prone to developing post-inflammatory hyperpigmentation. Therefore, the settings which we use for Caucasian patients won’t be applicable in skin of color. 

Why should botox or any other cosmetic treatment denial be offensive?

Let’s say she really didn’t have botox, what’s wrong with saying that? Unless those dermatologists who came out to comment were her dermatologists saying that J Lo is lying. But I don’t think that’s the case.

Zul: Well we have to respect J Lo as a patient, and respect patient confidentiality. So she can say whatever she wants, and her dermatologist can’t say that she’s had botox or she hasn’t had botox, because that would be revealing something. So it is her right, but whether as a celebrity, she should be saying that, I’m not too sure about that. 

Dr. Teo: That’s actually a very insightful comment. When I was reading that, there was this underlying thread of discomfort. Exactly as what you said – the sentiment of the confidentiality part overall. But the fact that she is a public figure, I guess she has to be held more accountable to what she says. Moving on to scrutinize what she really is trying to convey behind her message of botox denial.

What do you think she’s trying to achieve by denying that she’s had Botox?

Or is this something that only very sensitive individuals, say, us doctors who have a commercial interest in recommending botox to patients, the public who may not even give a second thought to what she’s saying.

Terence: Well, I think  I can understand where she’s coming from. If she’s an individual who’s always been trying to promote being natural and not having gone under treatments like botox, or fillers, then certainly, this is something that will be damaging to her reputation and her image. And of course, she has commercial interest. So I can see where that’s coming from. However, what I don’t get is why the doctors are so riled up about her denying it? Because lots of people deny having done stuff, even surgery, so life goes on right? 

Chris: I think if she really is telling the truth that she never had botox, then she doesn’t really have any angle. She’s just relaying an anecdote that she’s never had any of those treatments that’s all. But if she really did have, and she’s just denying it for the sake of her business, that’s her perogative to promote her business.

But in terms of getting offended, I guess some people just believe that everyone should be honest. That you shouldn’t have anything to hide even if you do have these treatments done. So they’re trying to say that if you have had it done, it’s ok, you don’t have to hide these things. But even if J-Lo did say that she didn’t had botox, she just said that’s she not the type of person. She said there’s nothing wrong with it, and there’s no reason to hide it, but she’s relaying that she hasn’t had it done before. I guess we’ll never know. 

You can still look good with wrinkles

Dr. Teo: I mean, don’t get me wrong. I do perform cosmetic dermatology interventions like botox and fillers, but I always let the patients point out to me what they see and what they want to improve on. Rather than pointing it out myself or suggesting it to them. Like you said, a holistic approach emphasizing overall health of the body is also very important to retard the processes involved in aging and inflammation. Now, it’s my personal opinion that you can still look good with wrinkles, as long as it doesn’t bother you. No one has the right to comment on your wrinkles.

The converse is also true, I mean, if you don’t want to have wrinkles – we are here to help you. But above all, I think what you spoke about, Chris, is really something that resonates with me. There’s enough insecurity going on that as both dermatologists and plastic surgeons experience quite often. We know that at the heart of it, our work is about alleviating patient’s distress right? So whether it’s a physical distress or a medical condition or a cosmetic condition, there is a lot of psychosocial distress as well. The focus at the end of the day, is still on helping the patient. 

It can be difficult to tell if anyone has procedures done

I want to close with some of my personal thoughts on ageing, first as a dermatologist and secondly as a woman. 95% of my patients belong to the skin of color demographic, and I think the science does support that melanin is photoprotective and slows down photo aging in pigmented individuals. I think it is never 100% possible to tell if someone has had botox because ideal injection techniques result in a very subtle and natural appearance.

Chris: No definitely. Nowadays with surgical techniques, as well as injection techniques, the goal is actually to create a natural type of beauty without the telltale signs of having done any procedures. So it can be very difficult to tell if anyone has anything done, even surgery. Unless you really take a close up look at them and can see the scars. But if it’s very well done, you may not even be able to see the scars. So yes, it’s very hard to tell. 

Your lifestyle matters in the quest for good skin

Dr. Teo: To say the converse, that you are sure someone has had botox when they are of a certain age and look that good, is dismissing a lot of evidence that is emerging in the skin exposome concept in dermatological research. Which defines lifestyle factors in addition to genetics that play a key role in inflamm-aging. In the case of Chuando, who has this amazing sculpted body which surgery can’t achieve. Clearly, this is my personal opinion, I feel that my underlying discomfort is really that we are being pressured to look good. To feel that we are only going to be the best versions of ourselves by the advertising that’s going on with cosmetic treatments.

The thing that I find shocking is this. Why should it be that it is seen as them boasting about their superior genetics? Why is that the first thought that comes to your mind when somebody says that they haven’t had botox? Is Botox so ingrained in our society now that in order to look good at 51, you must have had Botox?

What do you think about that, because you and I, we practice these aesthetic interventions. but we each clearly take a different approach in terms of how we explain these treatments to patients. As a plastic surgeon, your core is actually still in reconstructive surgery and in terms of restoring the appearance of say an individual who’s had cancer, and you can see how it helps them in terms of their self esteem and daily functioning.

Read on for Part 3 here.

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