Cosmetic medicine trade - story of friends & unscrupulous middlemen

NB: names have been changed to protect the privacy of the people involved.

Alice had just turned 50 & developed pigmentation she was desperate to get rid of. In her vulnerable state of feeling old & ugly (not uncommon with hormonal fluxes during the peri-menopausal period), she fell victim to a "friend" who pretended to do her a favour by introducing her to another friend (let's call her Meegan) who could introduce a doctor "highly skilled in removing pigmentation".

Alice was so happy to find a friend who would unselfishly introduce a good doctor to solve her problem, she immediately signed up for a RM800 "PRP/Fxl" treatment. However, after the RM800 treatment, her pigmentation was still there, as stubborn as ever.

She called the doctor to ask further but the good doctor was too busy. Instead, she got a call from Meegan. Meegan told Alice that the RM800 treatment was to "prepare her skin" for the superior SuperR (name changed) laser treatment that would remove all types of pigmentation & the cost would be RM3000 for a course of 6 sessions. Alice balked at the thought of spending so much beyond her initial budget but she was persuaded by Meegan & the good doctor that SuperR was the magic laser that removes all pigmentation & that there were only 3 such lasers in the whole of Malaysia. Alice was already uncomfortable with the idea of spending more but since SuperR was the latest & best laser, she argued that she wanted to pay half 1st i.e. RM1500 since she did not see any results so far.

After the 1st session of SuperR laser, she went back to the doctor complaining that she still did not see any improvement in her pigmentation. During this 2nd consultation, there appeared to be 3 consultants, namely 1) Dr. Mickey himself 2) Karlos, the laser salesman & 3) Meegan, the friend who introduced. All 3 of them insisted that the pigmentation had lightened so Alice was outnumbered in her opinion. However, Dr. Mickey's naive clinic nurse walked in & commented that there was no improvement in Alice's pigmentation at all. The nurse got some "if looks could kill" stares but Alice had no choice but to proceed with the 2nd laser treatment. During the laser treatment, Dr. Mickey was receiving instructions from Karlos about what laser settings to use. At the time she said she felt uncomfortable with the whole situation but with 3 consultants hovering around in the treatment room, it was 3 against 1.

A week after the 2nd laser session, she found that to her horror, the pigmentation had actually got worse & she frantically tried to contact Dr. Mickey but the clinic nurse told her to call Meegan instead. She did not want to talk to Meegan but Dr. Mickey was uncontactable as well. Anyway, she received a call from Meegan who lashed out at her telling her she was an unreasonable client who complained too much & therefore Alice was no longer wanted as a client. As for the 3rd prepaid laser session, Meegan told her that the doctor had gone 2 rounds on her face during her 2nd laser visit so she was not entitled to any refund or further laser sessions.

At that point in time, Alice was referred to me by another client of mine.

This story ends here. Why am I telling this story & risking backlash from my own kind in my industry? I'm doing it to remind the consumer of the bad apples in this industry. And it's also an appeal to those in my industry & a reminder to myself that we're practising cosmetic medicine here - ultimately, it is still medicine & as doctors we're duty bound to look out for our patients, not rob clients of their wallets. We don't need laser salesmen & middlemen to interfere in our medical practice. If patients are losing trust in doctors, I don't blame them.

Cosmetic medicine is in huge demand & many non-medical entrepreneurs have jumped on the bandwagon to profit from this industry. I'm not saying free enterprise is bad, in fact, I encourage it BUT one should not profit through lies & deceit. For example, there is no such thing as "preparing skin for SuperR laser with a Frxel laser". If one wants to make money from another laser procedure then please just tell the client directly the benefits of that particular laser. Consumers want to look beautiful & are willing to pay top dollar for it - there is no need to pull the wool over their eyes.

As for friends who want to profit from their friends by making referrals, please tell the truth. There is nothing wrong with making a living but don't pretend to be doing it as a good Samaritan. If you are doing it as a business & receiving a commission - just please tell the truth.

As for marketing middlemen in the industry - do it ethically - don't go around recruiting people to lie to their friends & relatives.

As for consumers who don't want to pay doctors' consultation fees - Think for yourself if it's worthwhile saving $30 & falling into the traps of "friends" who will ultimately make you part with thousands you can't afford. Just as an example, Alice probably only needed to spend a few hundred on her pigmentation, instead she is already out-of-pocket $2300 & to make matters worse, her pigmentation is actually darker than when she first started with.

I'm just fed-up with the direction this industry is heading. As I've said before, much financial reward can be reaped in this industry but I know that it can be done in an ethical manner. Don't let bad apples tarnish the image of those who practise it ethically.

Cosmetology – getting away with murder & other horror stories

Aug 2009 - Yesterday, I saw a client who had just undergone her 4th IPL hair removal treatment in BelXX Skincare centre 3 days ago. She was wondering why she was feeling so much pain & itch on her back. On examination, she had >50 rectangular IPL burn marks on her back. I promptly gave her treatment for her burns & told her hopefully there won't be any permanent scars. Unfortunately, she had already committed RM10K to BelXX who promised her complete hair removal. I gave her a letter addressed to BelXX telling them what had happened & why i.e. untrained personnel with no understanding of machine physics operating the IPL machine. IPL should not be performed on someone who has a recent suntan. The BelXX girl had confidently assured this client that her suntan was "1 week ago, so no problem doing IPL". This beautician (assuming she has a basic beautician's certificate) has clearly forgotten that skin cell turnover is 28 days i.e. it takes 1 month for tanned skin to peel off! The client's tanned dark brown skin had absorbed the light & hence the burnt rectangular footprints on her skin! The BelXX girl's response to the doctor's letter was "It's not a burn mark, only crusting which will fall off & take away the pigmentation." She so generously gave this naive client a bottle of serum to assuage her concerns. Some of you are probably thinking - in this great country of ours, you can get away with murder, so what's a few burn marks on a naive client?

There are so many things wrong with this scenario I just don't know where to begin. Firstly, fine lightly pigmented baby hair on one's back cannot be removed by Intense Pulsed Light technology, it's even difficult for some of the more advanced laser systems. So, conning someone of RM10K is the first sin.
Secondly, the burn marks on her back were about 2 cm apart, evidence that the client was being shortchanged on the treatment i.e. only 1/3 the surface area of the back was being treated in a session.
Thirdly, the BelXX girl must be a real moron or thinks her client one to describe a burn as "only crusting" in the face of a doctor's letter stating the fact. The purpose of my letter wasn't to elicit a lawsuit although I personally think this client should have proceeded with one. The letter was an appeal to BelXX to recognise a mistake, admit it & take measures to ensure it doesn't happen again. What do they do? Sweep it under the carpet like what has happened umpteen times before...it's not only BelXX.

Here's another story from another client who also had hair removal (also done at BelXX but I'm not singling them out, I repeat, there are many other stories from other salons. It's just these stories I remember because BelXX advertises heavily with the most celebrities! ). The BelXX girl used a black marker pen to draw a square around where she wanted to perform the hair removal. This client had a nice black square tattooed onto her leg! How IPL works to remove hair is simply that black hair prefentially absorbs the IPL light to get destroyed - that's how you get destruction of the hair follicle. The black ink from the marker pen also absorbs the IPL hence burning the square mark onto the skin! The beautician's ignorance is laughable but the consequences of their ignorance is not.

I wrote the above about 1 month ago. Yesterday, another rip-off report from another client who went to BelXX. She went to BelXX asking about a moustache-like shadow on her upper lip & they promptly told her they could remove her upper lip hair & happily charged her RM1200 upfront for IPL hair removal. 2 weeks after the procedure, her upper lip shadow has now darkened into a stubborn dark brown patch. Even her regular beautician can tell her it was more pigmentation & not hair to start with! I confirmed her beautician’s suspicions – IPL can darken melasma (hormone-related pigmentation) – which is exactly what happened here.

P.S. - 1st case 1 month later - the burn marks healed with some post-inflammatory pigmentation which will hopefully fade with time. The client asked for a refund but they of course refused her.

To be fair, this noble profession of mine has also it's fair share of sinners. A few months ago, an educated Malay lady died in a medical clinic after undergoing her 14th liposuction. Her weight was a mere 53 kg when she died.
Again, there are so many things wrong with this scenario I don't know where to begin.
Dissecting it slowly, firstly, liposuction, under general anesthetic or not, should not be performed in a mere clinic where there is no medical emergency backup should something go wrong. Secondly, liposuction is an invasive procedure that should not be taken lightly. It's not a monthly body massage! Why on earth would someone weighing 53 kg continue to need liposuction?!

How about the client (with body dysmorphic disorder - condition whereby she has a morbid misconception that everything is wrong with her body) who walked into a famous plastic surgeon's office enquiring about a facelift & nose job & walked out having done enough plastic surgery to buy the equivalent of a Ferrari? I'm not exaggerating.

And why do some doctors reduce themselves to the level of unscrupulous beauticians?
Unscrupulous beauticians will skillfully manipulate the measuring tape to give the client "a total of 10 cm loss from your arms ,chest, waist, hips & both thighs!" (Just loosen up the tape 1 cm on each area to give an impressive total of 10 cm loss). A few days ago, a colleague who also practises cosmetic medicine full time proudly told me how many inches she has lost from mesolipo injections but sad to say, she still looked very fat with the spare tyres bulging through the skin-tight jeans. When I asked her what are the ingredients she is injecting into herself, she couldn't even name them! Some doctors actually delude themselves into believing in miraculous results so that they can convincingly con patients to do the same.
Patients trust doctors to know what we are injecting into them. They trust us to do things to them that won't kill or harm them. Of course, there is no such thing as a risk-free medical procedure but as doctors, we are responsible for knowing what we are doing & informing the patient of the pros & cons. Some people may act smart & claim to know everything since they can surf the internet but it is still our duty to impress upon them the true facts.

Eyelash Enhancers Reviewed: How Well Do They Work?

REVITALASH (by Athena Cosmetics) has now hit the shores of Malaysia. This prompted me to do some research on this topic. Below is an article by Nora Richards reproduced below which nicely summarises this topic.
As for other reviews, like all cosmetic products, it works for some & doesn't work for others. I think you have to keep using it continuously to maintain the benefits (like all cosmetics)

Revitalash is retailing in Malaysia for RM550 (on the internet, apparently you can get it for USD150). I won't be stocking up on this product or trying it myself because it's too pricey & I've got nice enough lashes anyway. I'll be happy to place orders for anyone who would like to order it but you'll have to prepay RM400 for the product. I've been caught ordering products for clients before who decided later they did not want it & I'm stuck with the inventory cost.

Happy reading!

Long lashes, a universal symbol of youth and beauty, have been sought after for centuries dating back to ancient Egypt when goddesses used natural paints to enhance their eyelashes. Artificial eyelash enhancement evolved to include the first version of mascara by London's Eugene Rimmel worn by women of substance in the early 19th century to the creation of false lashes in 1916 by film and stage director D.W. Griffith. Unsatisfied with temporary solutions to our physical shortcomings, false lashes and mascara are no longer enough in a society that prefers artificial means to produce natural results. Women don’t want the illusion of longer lashes, they want longer lashes. Long luscious lashes tempt suitors with the promise of a more youthful, glamorous and sexy woman behind those alluring eyes.

Moving from the temporary nature of mascara, false eyelashes and lash extenders to the permanent results eyelash conditioners and growth serums promise a solution to the problem of brittle, weak lashes. Ranging from $30 to over $150, a product that can produce naturally longer, darker, and stronger lashes is more valuable than the fake look of goopy make-up, tarantula-like false lashes and lash extenders.

Eyelash Enhancers The cosmetic industry is recognizing society's need for natural, long-lasting results in its production of eyelash stimulators, serums and conditioners. Many of the products labeled as eyelash conditioners work like hair conditioner in that moisturizing the hair on the head promotes healthy hair that enhances growth with the use of natural botanicals. The promise rests in the fact that moisturized hair whether growing on the head or from the eyelid will grow longer, stronger and healthier if properly moisturized to reduce brittleness and breakage. Strictly promoting eyelash growth, serums and stimulators are formulated with a combination of active ingredients such as:

* Hyaluronic Acid – one of nature's most potent moisturizers and capable of carrying up to 1000 times its weight in water. It also stimulates blood vessels to promote hair growth.
* Arginine – amino acid known for its growth hormone releasing capabilities.
* Glycoproteins – processing "lectin-like" activity which strongly stimulates the growth of hair follicle cells.
* Biotin – a B vitamin which is required for the production of fatty acid and glucose-based energy to prevent hair loss.


Taking advantage of opportunity and understanding the variances in the target market is crucial for companies satisfying the desire for long luxurious lashes. Meanwhile, companies are feverishly working to promote an over-the-counter alternative for those willing to forgo a physician's care and quicker results in favor of a more natural approach and less side-effects.

The Internet lash out has begun revealing the play on words involving the retail eyelash growth alternatives. Natural eyelash conditioners may encourage natural eyelash growth through the reduction of breakage and eyelash fall out.

Due to the wide array of eyelash enhancing products currently sold in traditional retail stores, pharmacies and on the Internet and the confusing assortment of ingredients, we scrutinized the most currently marketed products. We used the most current scientific research in order to assess which eyelash enhancing products available over the counter without a prescription were most effective. While the physiological breakage of our eyelashes can occur due to a variety of causes, our actions and attention can reduce the damage and promote new growth while protecting and nourishing existent eyelashes. Selecting an effective eyelash enhancing product is an excellent way to manage natural eyelash breakage.


During our research, the skin care specialists we consulted provided useful tips that contribute to achieving and maintaining beautiful, healthy eyelashes, including the following:

* Step 1 - Choose an eyelash conditioner. You may have to search various salons or research online. Look for active agents in the ingredients of an eyelash enhancer. These active ingredients are that contain prostaglandin analogues, or similar compounds that have the ability to grow lashes.
* Step 2 - Clean your eyelashes. Before bedtime, make sure that your lash line is free of makeup.
* Step 3 - Apply your lash conditioner. Use your eyelash conditioner daily. Consistency is key when seeking results in an eyelash conditioner.
* Step 4 - Be patient with results. An eyelash enhancer may take a matter of 2-3 weeks for some, while it could take up to 2 months for others.
* Step 5 - Apply false lashes in the meantime. Waiting for your lashes grow can feel a little like watching the grass grow. You may want immediate gratification by applying false lashes. This does not disrupt the eyelash enhancement process.

PS Revitalash was rated 4/5 for product satisfaction

UNIXEL fractional CO2 laser

The old CO2 laser resurfacing had been the standard of skin resurfacing for the past couple of decades as it achieved unparalleled smoothness and reduction of wrinkles. However, it has fallen out of favour because of significant pain requiring general anesthesia and substantial down time.

UNIXEL 40 is a scanner based fractional laser that makes micro holes on the skin layer. It delivers precise matrix of micro-spots that penetrate to the dermis and stimulate the formation of new collagen.

The Fractional CO2 laser removes and eliminates aged and damaged skin without the prolonged downtime and adverse reactions associated with conventional ablative resurfacing lasers and surgical procedures.
It treats a portion of the skin's surface and leaves the surrounding areas intact to allow for rapid healing.

It's good for treating scars (surgical, acne, burns, traumatic), wrinkles, skin tightening, uneven pigmentation & large pores.

Usually at least 3-5 sessions in total are required to achieve the desired result.

Unixel pre-laser instructions

1. If you are on anti-coagulants (e.g. aspirin, warfarin) please stop 1 week before the procedure. If you are on photosensitisers (tetracycline, naproxen, gold, oral contraceptives, cloroquine), please stop 3 days before procedure. Consult your physician first.
2. Avoid peels, scrubs, microdermabrasion & Retin A 1 week before procedure.
3. If you have a history of herpes infection, please start aciclovir 200 mg 4x/day for 3 days before the laser procedure & continue for 5 days after.
4. If you have a history of bad acne breakouts, start oral antibiotics 3 days before laser & continue for 1 week after.
5. If you have a pigmentation problem, please start applying a lightening cream (hydroquinone, arbutin, azeleic acid, vitamin C) at least 10 days before the laser procedure.
6. On the day of laser, please remove all makeup & come with a clean face.


Post procedure downtime:

You'll experience a burning sensation for the 1st 3 hours.
Redness will last about 2 days. Thereafter, a layer of dead skin (like after a suntan) will form in a dot-matrix pattern (looks like sunburnt skin). The dead skin falls off after 1 week.

Radiantmax Light Technology for Skin & Hair Rejuvenation & Acne

"Low level laser (LLLT) triggers biostimulative-regenerative processes inside the cell and subsequently causes revitalisation of the tissue as well. Second effect of LLLT refers to the vasodilatation and neovascularisation of local blood and lymph vessels, thus causing a better removal of waste products and, on the other hand, improved oxygenation and nutrition of damaged tissue. Analgesic and anti-inflammatory effects of LLLT are also significant when irradiating certain dermatological changes." 1Zlatko Simunovic, M.D., F.M.H., 2Tatjana Trobonjaca, M.D. 1Pain Clinic-Laser Center, Locarno, Switzerland 2Laser Center, Opatija, Croatia


Skin Rejuvenation
Pure visible red light increases the metabolic rate of the mitochondria of cells. Mitochondria are the power house of cells & increasing its metabolic rate makes the cell more efficient. Hence, cell activity and blood flow is increased to oxygenate and detox the skin while stimulating collagen production. It gives the skin an instant glow after just 1 treatment. Over a series of treatments, improvements can be seen in skin tone, texture and fine lines.
"LLLT obtains good results in aesthetics due to its three main effects: biostimulative-regenerative, analgesic and anti-inflammatory effect. LLLT can be applied in aesthetics like monotherapy or complementary treatment modality to the topic medications. Frequent indications for LLLT in aesthetics are as follows: - Acne - Cellulite - Striae - Alopecia - Wrinkles - Lentigo senile."
1Tatjana Trobonjaca, M.D., 2Zlatko Simunovic, M.D., F.M.H. 1Laser Center, Opatija , Croatia 2Pain Clinic-Laser Center, Locarno, Switzerland


Hair Loss Treatment
Laser rays are directly applied to the scalp so that the hair follicles are “photo-biostimulated” and the supply of red blood cells is enhanced. This will in turn provide more nutrients and oxygen to the scalp, contributing to hair restoration and a healthy hair-growth cycle. This results in improved hair shaft quality and prolongation of the anagen phase (growth phase), which slows down the rate of hair loss. LLLT treatment results in healthier, thicker, denser, and stronger hairs. The scalp is also healthier; dandruff and scalp irritation is reduced or even eliminated.


Combination Treatment Applications
Can be used stand-alone or combined with other treatments e.g. Botox, fillers, IPL, peels, microdermabrasion, etc
* Combine with RadiantBlue to treat acne
* Combine LLLT with Botox – reduce bruising & enhance results
* Post-surgery – reduce edema, bruising & quicken healing & enhance results
* Post- ablative lasers - reduce redness & enhance healing


RadiantBlue LED activates chemicals called porphyrins (which are produced by the P. acnes bacteria responsible for causing acne inflammation) creating intracellular singlet oxygen – inducing bacterial cell death. This is combined with RadiantRed low level laser which has anti inflammatory properties, minimizing the redness of acne lesions and promoting healthier skin.
Correct wavelengths at optimal intensities ensure optimal results.
This reduces the bacterial colonization of the sebaceous gland, reducing sebum production to normal and reducing the production of proinflammatory cytokines.
Simultaneously, RadiantBlue induces anti-inflammatory cytokines, stimulating specific immunoregulatory pathways.
Studies have shown combination blue & red phototherapy reduces inflammatory acne lesion count by up to 80% 12 weeks from the end of treatment.


Treatment schedules are usually biweekly of 20 minutes duration each. At least a total of 8 sessions are required to get a good result.
For hair rejuvenation, a home use module is available. For acne & skin rejuvenation, in-clinic treatments are required.