第四屆國際抗衰老研討會

剛過去的週末,參加了在泰國曼谷會議中心 Bangkok Convention Centre 舉行之第四屆國際抗衰老研討會 (2012年9月7-9日)。
今年是自己第二次參與這會議,還記得去年,發表了自己對亞洲人面部的衰老變化的文章,也參加了專家討論,跟各國專家在台上,分享討論美容抗衰老醫學,也在活動中結交了不少專家朋友。

這是去年,第三屆國際抗衰老研討會

今年當然要有進步,發表了兩篇全新的文章。第一個是多國參與的美容醫學研究,是我自己創新的透明質酸 (玻尿酸) 皮層注射技術 ,針對亞洲人面部和填充物料的特質,塑造出自然年青的輪廓。

今年六月份,自己特別前往了以色列,參與一項美容醫學儀器研發,也在這次會議,分享了此行的收穫。第二篇文章是綜合各類型最新的分段式射頻膚質改善技術,全面提升面部處理粗大毛孔,暗瘡凹凸洞的處理
自己對今次的表現也十分滿意,可以跟數百醫生專家分享, 也吸收了在場專家的意見。 從最基本的美容醫學注射技術,到最先進的美容醫學儀器研發。這算是,繼美容醫學護膚品研發後的突破。
希望日後,可在不同的地區,跟更多同業分享。
進步的不只是演講內容,不少醫生向我說:「Dr. James ,Why are you younger than last year?」,稱讚自己比去年更年青,哈哈,有嗎?
在此,要多謝我的團隊,有您們的協助和支持,我才可順利把任務完成⋯
Q Med Galderma Hong Kong (Restylane)
Great China Technology Development Limited ( Hong Kong )
Dr Sirem-on Thienthai (Clinical Director, Maxx Aesthetic Clinic, Thailand)
Dr Cissy Choi (Hospital Authority)
Owen Chan
Seabie Chan (DR JAMES CLINIC)
Ms Jessica Mok (American Academy of Aesthetic Medicine)
Angel Chan
Junichi Ishimoto (Hair Stylist, Private-I luxe )
Chris Chau (Makeup Artist, Zing Makeup school)
and You (my friends)
I can’t complete this mission without your support. You are the best!

曼谷 Centara Grand Hotel 酒店房間外看的晨曦。給我100%的能量,把任務完成。

演講廳,演講前的準備

同場,兩個完全不同的課題

第四屆國際抗衰老研討會

第四屆國際抗衰老研討會

第四屆國際抗衰老研討會

努力後的成果,又多一張 !

Centara Grand Hotel 頂樓 Lounge

皮膚凹凸洞的處理 (2012)

要處理暗瘡粉刺後疤痕,先要了解它的成因。皮脂腺位於皮膚真皮層,在毛孔阻塞 (表皮死皮聚積),油脂分泌旺盛,皮膚細菌增生的狀況下,皮脂腺產生化學作用,發炎,便形成了暗瘡粉刺。由於是真皮層受損及纖維化,纖維化組織拉扯着表皮,形成了凹陷的疤痕。凹凸洞,一般都屬較深層的皮膚問題。若發炎狀況嚴重,也有機會影響皮膚正常色素。

所以要解決三大難題。
一,把拉扯着表皮的纖維化組織分離。
二,填補皮膚真皮層在發炎後收縮 (Volumn Loss)
三. 保持皮膚正常膚色
處理疤痕,必須同時改善以上的狀況。所以一般的皮膚護理,如護膚品,家用磨沙,甚至淺層的化學換膚,對暗瘡粉刺後疤痕的療效有限。

傳統辦法:

用針或小手術刀切割 Subcision
把拉扯着皮表的纖維化組織分離。但針孔或手術刀抽入位置,也有機會形成小凹凸洞。

皮層填充 Hyaluronic acid dermal filler
填補真皮體積。需隔一段時間,重新注射。

磨皮 Microdermabrasion/Dermabrasion
專業用磨皮,刺激纖維母細胞,增生真皮層膠原蛋白,對淺層痘疤有療效。

化學換膚 Chemical Peeling
同樣是刺激纖維母細胞,增生真皮層膠原蛋白。要較深層的換膚,和較長的治療期,才對痘疤有改善。

微針 Microderma-rollers
針刺破壞皮膚,形成有控制的傷口,經發炎及康復後,產生真皮層膠原蛋白。注意:疼痛感較強,較長的治療期,及必須小心處理傷口。

醫學美容儀器 ,如彩光 Intense Pulsed Light, 碳粉鐳射 或俗稱 Laser Facial 的激光護膚。
主要針對較淺層的皮膚問題,對深層痘疤的療效有限

醫學美容儀器 ,一般激光換膚 Laser Resurfacing
疼痛感較強,較長的治療期,及必須小心處理傷口。現已被新的分段式技術取代。

醫學美容儀器 , 分段式技術的換膚。Fractional Resurfacing
就是療程時只更換部份的皮膚 (包括真皮和表皮),這樣的處理,可使拉扯着表皮的纖維化組織分開,同時在發炎的過程中, 刺激纖維母細胞,增生真皮層膠原蛋白。膠原蛋白經過重新排列後 ( Collagen Remodeling ),把凹凸洞填平。是新一代較有效的辦法。

市面上有那些選擇?

大至可分為激光能量 ( Laser Energy )射頻能量 ( Radio-frequency Energy )
也可分為創傷性 Ablative 和非創傷性 Non-ablative。
很多不同激光波長也會被使用,如 1410nm 、 1440nm 、 1550nm 、 2940nm 、10600nm⋯

激光會跟皮膚水份作用,而產生熱力 Photothermolysis,形成有控制的傷口。 不同波長激光,對皮膚產生不同程度和深度的破壞。二氧化碳激光 ( CO2 Laser ) 波長 10600nm 是較深和有傷口的激光 ( Ablative Fractional Laser Resurfacing ),傷口較深,康復期較長。在外國的研究,如歐美,這些白種皮膚人士,效果較非創傷性技術 (Non-ablative technique) 明顯。 可是在東方人,黃皮膚的地區,我們有着療程後皮膚色素改變的風險,所以大多採用較溫和的 非創傷性分段式激光換膚 Non – ablative Fractional Laser Resurfacing。

近年還多了 分段式射頻能量技術 ( Fractional Radio-frequency Energy ),由於射頻能量可達深層皮膚,同樣地可刺激纖維母細胞,增生真皮層膠原蛋白。 也是有效處理凹凸洞的辦法。

從2011年起,也新加了 分段式微針射頻能量技術 (Fractional Radio-frequency Energy with Microneedle)。研究證實,以微針電極技術,直接把射頻能量傳入真皮層,製造微細的加熱區,增加膠原蛋白和彈性纖維製造,有效填補凹凸洞,收緊皮膚和撫平皺紋。雖然技術還是很新,要更多臨床證據。但理論上,也是合理的做法。

再有更多新的研究結果,會在這裡跟網友分享。

暗瘡粉刺後的疤痕,是令人煩惱的,要百份之百根治,確實要多點恆心和耐性。希望以上的資料,對大家有所幫助。

皮膚凹凸洞的處理 (2012)

要處理暗瘡粉刺後疤痕,先要了解它的成因。皮脂腺位於皮膚真皮層,在毛孔阻塞 (表皮死皮聚積),油脂分泌旺盛,皮膚細菌增生的狀況下,皮脂腺產生化學作用,發炎,便形成了暗瘡粉刺。由於是真皮層受損及纖維化,纖維化組織拉扯着表皮,形成了凹陷的疤痕。凹凸洞,一般都屬較深層的皮膚問題。若發炎狀況嚴重,也有機會影響皮膚正常色素。

所以要解決兩大難題。
一,把拉扯着表皮的纖維化組織分離。
二,填補皮膚真皮層在發炎後收縮 (Volumn Loss)
三. 保持皮膚正常膚色
處理疤痕,必須同時改善以上的狀況。所以一般的皮膚護理,如護膚品,家用磨沙,甚至淺層的化學換膚,對暗瘡粉刺後疤痕的療效有限。

傳統辦法:

用針或小手術刀切割 Subcision
把拉扯着皮表的纖維化組織分離

皮層填充 Hyaluronic acid dermal filler
填補真皮體積。需隔一段時間,重新注射。

磨皮 Microdermabrasion/Dermabrasion
專業用磨皮,刺激纖維母細胞,增生真皮層膠原蛋白,對淺層痘疤有療效。

化學換膚 Chemical Peeling
同樣是刺激纖維母細胞,增生真皮層膠原蛋白。要較深層的換膚,和較長的治療期,才對痘疤有改善。

微針 Microderma-rollers
針刺破壞皮膚,形成有控制的傷口,經發炎及康復後,產生真皮層膠原蛋白。注意:疼痛感較強,較長的治療期,及必須小心處理傷口。

醫學美容儀器 ,如彩光 Intense Pulsed Light, 碳粉鐳射 或俗稱 Laser Facial 的激光護膚。
主要針對較淺層的皮膚問題,對深層痘疤的療效有限

醫學美容儀器 ,一般激光換膚 Laser Resurfacing
疼痛感較強,較長的治療期,及必須小心處理傷口。現已被新的分段式技術取代。

醫學美容儀器 , 分段式技術的換膚。Fractional Resurfacing
就是療程時只更換部份的皮膚 (包括真皮和表皮),這樣的處理,可使拉扯着表皮的纖維化組織分開,同時在發炎的過程中, 刺激纖維母細胞,增生真皮層膠原蛋白。膠原蛋白經過重新排列後 ( Collagen Remodeling ),把凹凸洞填平。是新一代較有效的辦法。

市面上有那些選擇?

大至可分為激光能量 ( Laser Energy )射頻能量 ( Radio-frequency Energy )
也可分為創傷性 Ablative 和非創傷性 Non-ablative。
很多不同激光波長也會被使用,如 1410nm 、 1440nm 、 1550nm 、 2940nm 、10600nm⋯

激光會跟皮膚水份作用,而產生熱力 Photothermolysis,形成有控制的傷口。 不同波長激光,對皮膚產生不同程度和深度的破壞。二氧化碳激光 ( CO2 Laser ) 波長 10600nm 是較深和有傷口的激光 ( Ablative Fractional Laser Resurfacing ),傷口較深,康復期較長。在外國的研究,如歐美,這些白種皮膚人士,效果較非創傷性技術 (Non-ablative technique) 明顯。 可是在東方人,黃皮膚的地區,我們有着療程後皮膚色素改變的風險,所以大多採用較溫和的 非創傷性分段式激光換膚 Non – ablative Fractional Laser Resurfacing。

近年還多了 分段式射頻能量技術 ( Fractional Radio-frequency Energy ),由於射頻能量可達深層皮膚,同樣地可刺激纖維母細胞,增生真皮層膠原蛋白。 也是有效處理凹凸洞的辦法。

從2011年起,也新加了 分段式微針射頻能量技術 (Fractional Radio-frequency Energy with Microneedle)。研究證實,以微針電極技術,直接把射頻能量傳入真皮層,製造微細的加熱區,增加膠原蛋白和彈性纖維製造,有效填補凹凸洞,收緊皮膚和撫平皺紋。雖然技術還是很新,要更多臨床證據。但理論上,也是合理的做法。

再有更多新的研究結果,會在這裡跟網友分享。

暗瘡粉刺後的疤痕,是令人煩惱的,要百份之百根治,確實要多點恆心和耐性。希望以上的資料,對大家有所幫助。

化妝品和暗瘡 的概念

這是一篇很值得閱讀的文獻。(我已經為大家記下要點,看以下中文字便可。)

化妝品與暗瘡 Facial Cosmetics and Acne

What exactly does a patient mean when reporting that a certain cosmetic causes her face to "break out?" This phrase may refer to formation of a comedone, papule, pustule, nodule, cyst, or red rash. In addition, patients often have difficulty establishing a cause-and-effect relationship. From a dermatologic standpoint, the term that is still used to refer to cosmetic-related acne is acne cosmetica.

化妝品引發的暗瘡
Acne cosmetica is a concept that was developed many years ago when cosmetics could indeed cause comedone formation. The issue of comedogenicity in relation to cosmetics arose in 1972 when Kligman and Mills described a low-grade acne characterized by closed comedones on the cheeks of women aged 20-25. Many of these women had not experienced adolescent acne. The authors proposed that substances present in cosmetic products induced the formation of closed comedones and, in some cases, a papulopustular eruption. Presently, personal communication with Dr. Kligman indicates that he no longer believes currently marketed cosmetics cause comedone formation, yet acne related to cosmetics remains a problem.

這是源於 1972 年 Dr. Kligman 認為 化妝品的成份,可引致暗瘡。可是這個概念,對現在的化妝品 (指有一定質素的),已不太合用了。

The literature reports lists of ingredients that supposedly cause acne, but finding a formulation that possesses none of these substances is practically impossible. The list contains some of the most effective emollients (eg, octyl stearate, isocetyl stearate), detergents (eg, sodium lauryl sulfate), occlusive moisturizers (eg, mineral oil, petrolatum, sesame oil, cocoa butter), and emulsifiers found in the cosmetic industry. A product line that avoids all of these substances would not perform well on the skin and would possess low cosmetic acceptability.
There are many myths regarding cosmetics and cosmeceuticals and the acne that they may or may not cause. Examining these myths to determine the medical truth is worthwhile.

以下是一些沒有事實根據的觀點

The first myth is that cosmeceuticals do not produce acne if labeled noncomedogenic and nonacnegenic. Similar to the term hypoallergenic, labels that describe products as noncomedogenic and nonacnegenic are marketing claims carrying no implied regulation. They were developed to create a new consumer image for cosmetic lines designed to minimize acne.

一些標榜 ‘不引致暗瘡’ ‘不引致毛孔阻塞’ 標語 ,跟 ‘低敏配方’一樣,都是沒有標準的市場學字句,只在於建立消費者對產品的信心。看到這些字句,購買時才有信心?

In order to market a product as noncomedogenic, rabbit ear or human comedogenicity testing should be undertaken. Both the animal and the human model are based on the presence of new comedone formation after the exposure of skin to the finished cosmetic. Human testing is considered to be more accurate, but the results are highly dependent on the skill of the contract testing laboratory. Acnegenic claims are based on human use testing and the evaluation of volunteer subjects who report any increased acne following product use. Many manufacturers, however, make noncomedogenic and nonacnegenic claims based on the safety profiles of the individual ingredients in the formulation. This is inaccurate. Noncomedogenic and nonacnegenic claims should be made based on clinical testing of the finished formulation. Therefore, dermatologists should still consider all products labeled noncomedogenic or nonacnegenic as potentially problematic.

廠商在產品研發時,會在動物和人類皮膚上測試,是否阻塞毛孔,引致暗瘡。優質的化妝品,會以完成後的配方作測試。只以產品中的個別成份作測試,即使是沒有引致阻塞毛孔和暗瘡,也是不可靠的。
(只看着那成份表,用產品中個別成份的功效,作為分析該產品的理據,也是不對的。 要考慮各成份互相作用,互相影響,穩定性和吸收度,光破壞和氧化分解⋯等等。這個跟給你食材表,就以爲可以煮出美餸菜一樣的道理!不是天真了一點嗎? Dr James)

The second myth is that mineral oil is comedogenic. Mineral oil is one of the most common ingredients in skin care products and colored cosmetics. It is a lightweight inexpensive oil that is odorless and tasteless. One of the common concerns regarding the use of mineral oil is its presence on several lists of comedogenic substances. These comedogenic lists were developed many years ago yet remain frequently quoted in the dermatologic literature.
Several points are important to consider. First, different grades of mineral oil are available. Industrial grade mineral oil is used as a machine lubricant and is not of the purity required for skin application. Cosmetic grade mineral oil is the purist form without contaminants. Industrial grade mineral oil may be comedogenic, but cosmetic grade mineral oil is not. Quality manufacturers only purchase quality products from quality suppliers who guarantee the standards of the materials they provide. This author considers cosmetic grade mineral oil noncomedogenic based on findings from testing performed for the skin care industry.

礦物油會引致毛孔阻塞和暗瘡? 礦物油以不同的純度分成多個等級,有工業用,也有最潔淨的和沒有用污染物的。後者是不會引致毛孔阻塞和暗瘡,現在的化妝品,都是用它作成份。

The third myth is that sunscreens produce acne. Many patients note the occurrence of breakouts following the use of sunscreens. These patients typically present with perifollicular papules and pustules in a random distribution over the face. Eruptions appear within 24-48 hours after wearing a facial sunscreen. This author has not performed biopsies on patients who develop sunscreen-related acne, but presented below is a hypothesis based on how sunscreens function.
Most sunscreens available today are based primarily on UVB-absorbing ingredients, such as octylmethoxycinnamate, oxybenzone, and homosalate. Many also have UVA-absorbing ingredients, such as avobenzone, titanium dioxide, or zinc oxide, as secondary sunscreens. All of the UVB sunscreens and avobenzone function by transforming ultraviolet radiation to heat energy through a process known as resonance delocalization. This heat energy is appreciated by many patients who state that they do not like wearing sunscreens because the gels or lotions make them feel hot.
In some patients, the increased sweating induced by the sunscreens and the sunny weather may cause increased activity of the eccrine glands. This may cause miliaria rubra that may be magnified by the occlusive nature of the water-resistant, rub-proof sunscreen product. Thus, much of the problem with sunscreen-induced acne is the formation of papules or pustules around the eccrine duct ostia without the sebaceous gland involvement that characterizes true acne.

防曬用品可引致毛孔阻塞和暗瘡,是沒有證實的。有些人對皮膚溫度上升,會有較大反應,引致流汗增加,形成汗腺出口發炎。這跟一般因皮脂腺阻塞引起的暗瘡不一樣。

Myth Four is that a complex skin care regimen of multiple cleansers, moisturizers, and ancillary skin care products is necessary for clear skin. There are many different approaches to skin care, from the no-nonsense soap-and-water approach to the 20-step skin care routine. No routine is established as better. In Japan, skin care is a complex ritual of multiple cleansers, toners, and moisturizers. The Japanese are also considered to have the most sensitive skin of all races, and the incidence of atopic dermatitis is dramatically rising in Japan. Perhaps this due to the use of extensive skin care products. However, without doubt, the more the skin is manipulated, the more opportunity there is for problems to arise. The best advice may be to recommend moderation in skin care.[22 ]

複雜的護膚程序,不單沒有改善皮膚質素,反而引致更多皮膚炎,濕疹⋯等皮膚狀況。建議用溫和簡易的護膚程序。

Myth 5 is that acne breakouts after age 30 years in women are rare and benefit from special skin care. Acne after age 30 years is actually becoming more and more common in women. The cause of this trend is not known, but it appears to be related to fluctuating hormones and the onset of premenopause and perimenopause. This supposition is based on the observation that the acne is not characterized by open and closed comedones, but rather inflammatory papules and pustules. Because these lesions are in the lower epidermis and dermis, special skin care routines cannot have a dramatic effect. Thus, the use of oral antibiotics and hormonal therapies, such as birth control pills or estrogen replacement therapy, are the best options for acne control in this population. Cosmetics and skin care products have little effect on this type of acne. Many mature patients mistake this cyclic hormonal acne for acne related to cosmetic product use.

三十歲以上的女性,因生理週期的影響,較多機會有暗瘡的煩惱。有時會誤以為是化妝品的影響。這些激素轉變引致的皮膚炎,大多是發炎膿皰和丘疹,跟一般毛孔毛孔阻塞的暗瘡不一樣。處理的辦法,不是加強清潔,而是用激素類的治療。

Summary
For all purposes, acne cosmetica is a concept of the past, which the industry has done its best to remedy. Skin care manufacturers are keenly aware of the need to test and formulate products without skin side effects. Yet, many acne myths persist. This article has posed possible answers to some of the most common acne myths submitted by several dermatologists.

結論
化妝品引發的暗瘡 ,是舊概念了。現在的護膚品和化妝品生產商, 利用正確的測試, 致力改善產品質素,令使用者用得放心。

Acknowledgement:  Zoe Diana Draelos, MD, Primary Investigator, Dermatology Consulting Services; Private Practice Updated: Apr 30, 2009

暗瘡粉刺 二 (形成暗瘡的元素)

從前已討論過,在身體健康的情況下,暗瘡形成,以下三種狀況必須同時存在:
1. 皮膚油脂分泌 sebum secretion
大家有沒有見過手掌腳掌長暗瘡粉刺?因為那裡根本沒有皮脂線 (sebaceous glands),暗瘡粉刺又怎長來!
皮膚油脂分泌旺盛,會較容易長暗瘡粉刺。但不一定是油脂分泌過多,有些成熟型皮膚,沒有過多油脂,也有暗瘡的煩惱。若洗臉或潔膚次數過多,保護皮膚的正常油脂便失去平衡,引致缺水,皮膚便會產生更加多的油脂作保護,令毛孔變得粗大和不暢通。
對成熟型皮膚,過份的頻密的潔膚程序,只會令更多問題出現,乾紋,皺紋,鬆弛,皮膚變得失衡脆弱。

2. 毛孔阻塞 Blockage of skin pores
皮膚油脂分泌,角質層細胞積聚,暗瘡細菌,白血球..等,把正常的毛孔阻塞。正常程況下,皮膚更新時,舊的角質會脫落。當皮膚失衡或新陳代謝減慢,角質層的更換會減慢而變厚,令皮膚變得暗瓦,亦會阻塞皮脂線分泌的出口。

3. 暗瘡細菌增生,引致皮膚發炎 bacterial overgrowth (暗瘡細菌 propionibacterium acnes/p. acnes 是存在於我們的正常的皮膚上,保護皮膚免受有害的細菌入侵。一般情況下,是不會引致問題,不必要把這細菌清除。但當皮膚失衡,如皮脂不能正常排出,變會形成一個無氧狀態,暗瘡細菌便會在皮膚內無氧的環境下 (anaerobic environment)過份增生,產生引致發炎的物質,形成暗瘡粉刺。

以上都是形成暗瘡最基本的元素。

待續…

暗瘡粉刺 一 (序)
暗瘡粉刺 二 (形成暗瘡的元素)
暗瘡粉刺 三 (常見的原因)
暗瘡粉刺 四 (暗瘡處理 一)
暗瘡粉刺 五 (暗瘡處理 二)
暗瘡粉刺 六 (暗瘡處理 三)
暗瘡粉刺 七 (暗瘡處理 四)

粉刺暗瘡的形成

暗瘡粉刺 一 (序)

很久沒有寫這麼長的文章了,這是我想了多時,要跟大家分享的課題。太多人有這樣的困擾了,自己也是其中之一。
小時候不懂處理,即使用盡辦法,現在面上還是殘留着這些青春的印記。年輕時真的很介意,面上長過不停的「青春痘」,不知有多少青春歲月,是爲了這個困擾,失去自信,呆在家裡!
可是到這個年紀,也不算什麼了。它反而令我更努力鑽研這方面的知識,自己亦親身體驗,處理這個問題的新科技。希望幫自己之餘,也對我的客人讀者有所益處。
由於內容太多,又不想破壞完整性的關係,就一次過分享一系列八篇有關的文章,全都是我的原創。雖然不一定跟大家的想法一樣,但是根據很多不同專家的意見,醫學證據 (Evidence Based Medicine),綜合而成。
不是要把大家訓練成專家,也不是教大家怎樣去自行處理問題。只想跟大家討論一些要點,讓大家日後有智慧的選擇 (wise decision)。
還記得什麼是智慧的選擇 (wise decision)嗎? 不要盲目跟從或相信,了解現有的選擇,經過思考,分析利弊,作最合適的決定。
您們不一定要一次過把它們看完,慢慢閱讀亦可。
歡迎在我這裡發出提問,或留言跟大家分享您們的經驗,我會盡量回應。

暗瘡粉刺 一 (序)
暗瘡粉刺 二 (形成暗瘡的元素)
暗瘡粉刺 三 (常見的原因)
暗瘡粉刺 四 (暗瘡處理 一)
暗瘡粉刺 五 (暗瘡處理 二)
暗瘡粉刺 六 (暗瘡處理 三)
暗瘡粉刺 七 (暗瘡處理 四)

Fata morgana1 2009 by Michael Lam

Fata morgana1 2009 by Michael Lam


由於資料太多,不能詳細盡錄,若有遺漏了一些大家想知的內容,可在這給我電郵。
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