藥物與乾眼症 (DED) 和瞼板腺功能障礙 (MGD) Medications DED and MGD

與乾眼症 (DED) 和瞼板腺功能障礙 (MGD) 相關的藥物包括口服避孕藥,由於其含有雌激素和黃體素,可能導致與 MGD 相關的乾眼症。用於治療攝護腺問題的坦索羅辛和特拉唑嗪也與乾眼症有關。某些抗癌藥物,如甲胺蝶呤和西妥昔單抗,會影響淚腺,導致乾眼症。此外,常用於治療胃灼熱的質子幫浦抑制劑 (PPI) 也可能透過維生素 B12 缺乏或影響腸道菌叢而導致乾眼症。

局部用藥時,苯扎氯銨 (BAK) 是一種存在於許多眼藥水中的防腐劑,它與乾眼症和 MGD 密切相關,因為它會破壞淚膜。許多青光眼藥物也含有 BAK,長期使用會加重乾眼症。

其他可能導致乾眼症 (DED) 和瞼板腺分泌障礙 (MGD) 的因素包括配戴隱形眼鏡(這會加劇症狀)以及眼瞼衛生不良(會導致細菌積聚,從而對瞼板腺分泌產生負面影響)。蠕形蟎在這些疾病中的作用仍在研究中,但一些研究表明其與瞼板腺分泌障礙 (MGD) 有關,尤其是在乾眼症 (DED) 患者中。

治療方法包括透過熱敷、眼瞼按摩和眼瞼擦洗來保持眼瞼衛生,以改善瞼板腺分泌。脂質類人工淚液有助於穩定淚膜,而局部或全身性用藥則可根據 DED/MGD 的嚴重程度進行。診室內操作,例如瞼板腺擠壓術或 LipiFlow,可以幫助疏通阻塞的腺體。

Medications associated with Dry Eye Disease (DED) and Meibomian Gland Dysfunction (MGD) include oral contraceptives, which can lead to MGD-related dry eye due to their estrogen and progesterone content. Tamsulosin and terazosin, used for prostate issues, are also linked to DED. Certain anticancer drugs, such as methotrexate and cetuximab, can affect the lacrimal glands, contributing to dry eye. Additionally, proton pump inhibitors (PPIs), commonly used for heartburn, may cause DED through vitamin B12 deficiency or impacts on the gut microbiome.

Topically, benzalkonium chloride (BAK), a preservative found in many eye drops, is strongly associated with DED and MGD as it disrupts the tear film. Many glaucoma medications contain BAK as well and can worsen dry eye with prolonged use.

Other factors that can contribute to DED and MGD include contact lens wear, which can exacerbate symptoms, and poor eyelid hygiene that allows bacteria to accumulate, thereby negatively affecting meibomian gland secretion. The role of Demodex mites in these conditions is still under investigation, though some studies suggest a link with MGD, particularly in patients with DED.

Treatment options include maintaining eyelid hygiene through the use of warm compresses, eyelid massage, and lid scrubs to improve meibomian gland flow. Lipid-based artificial tears can help stabilise the tear film, while topical or systemic medications may be prescribed based on the severity of DED/MGD. In-office procedures, such as meibomian gland expression or LipiFlow, can help clear blocked glands.

乾眼症及瞼板腺功能障礙 Meibomian gland dysfunction (MGD) & Dry eye disease (DED)

乾眼症 (DED) 是一種高度流行的眼部疾病,其特徵是淚膜和眼表穩態的改變。根據香港中文大學 2022 年的一項調查,約有 30% 的人口患有乾眼症。值得注意的是,80% 的乾眼症病例是脂質缺乏性或蒸發過強型乾眼症,是由瞼板腺功能障礙 (MGD) 引起的。因此,瞼板腺功能障礙影響著數百萬人,尤其是在亞洲國家。

瞼板腺功能障礙 (MGD) 患者的眼瞼油脂分泌腺無法分泌足夠或適當的油脂,從而導致乾眼症狀。這些位於眼瞼邊緣的腺體負責分泌瞼脂,這種油性物質可以保護淚膜,防止淚膜過快蒸發,並保持眼部濕潤健康。

瞼板腺功能障礙 (MGD) 可發生在所有年齡層的人群中,尤其是 60 歲以上的人。導致 MGD 的因素有很多,包括老化、荷爾蒙變化、低濕度以及低 Omega-3 脂肪酸或高 Omega-6 脂肪酸的飲食。

其他促成因素包括配戴隱形眼鏡以及某些局部或全身用藥。長時間使用電子設備會導致眨眼頻率降低和眼瞼閉合不全,進而導致淚膜蒸發增加、不穩定,以及淚液滲透壓升高。長時間使用螢幕也可能是兒童和青少年乾眼症 (DED) 發病率上升的一個因素。

在瞼板腺功能障礙 (MGD) 病例中,由眼瞼中的瞼板腺分泌的油性分泌物(稱為瞼脂)分泌份量不足且成分改變。這會導致分泌物增厚、混濁且停滯,更難以擠出。如果沒有足夠的油脂分泌,由黏蛋白、水和油脂組成的健康淚膜層就無法正常形成。

促成因素包括淚膜不穩定、水份蒸發率增加、乾燥、淚液高滲透壓、發炎。眼球表面潤滑不足,導致眼瞼和眼球之間產生摩擦,令眼表細胞受損。這些問題會導致淚液代償性分泌過剩,從而形成乾眼症 (DED) 的持續循環。

乾眼症 (DED) 的眼睛症狀包括乾澀、眼部異物感、眼部疲勞、眼紅、灼熱或疼痛、視力模糊、畏光以及作為代償反應的過度流淚。 DED 也與眼瞼發炎和感染(例如瞼緣炎)以及蠕形蟎蟲感染有關。

總結: 瞼板腺功能障礙 (MGD) 是一種慢性進行性疾病,會危害眼表健康。如果不及時治療,MGD 可能會惡化,導致嚴重症狀、持續不適、角膜損傷、眼部感染以及潛在的嚴重視力障礙。優先考慮有效的醫學治療對於確保您的眼部健康和維持生活品質至關重要。

Dry eye disease (DED) is a highly prevalent ocular condition that is characterised by alterations in the homeostasis of the tear film and the ocular surface. According to a 2022 survey conducted by the Chinese University of Hong Kong, approximately 30% of the population suffers from DED. Notably, 80% of DED cases are lipid-deficient or evaporative dry eye, which is caused by Meibomian gland dysfunction (MGD). As a result, meibomian gland dysfunction affects millions of people, especially in Asian countries.

In patients with Meibomian gland dysfunction (MGD), the oil-secreting glands in the eyelids fail to produce enough oil or produce the wrong type of oil, resulting in dry eye symptoms. These glands, located at the edges of the eyelids, are responsible for creating meibum, an oily substance that protects the tear film. This helps prevent the tear film from evaporating too quickly, keeping the eyes moist and healthy.

Meibomian Gland Dysfunction (MGD) can occur in individuals of all age groups, especially in those over 60. Several factors contribute to MGD, including aging, hormonal changes, low humidity, and diets that are low in omega-3 fatty acids or high in omega-6 fatty acids.

Other contributing factors include the use of contact lenses and certain topical or systemic medications. Extended use of electronic devices can lead to decreased blink rates and incomplete eyelid closure, which results in increased evaporation and instability of the tear film, as well as higher tear osmolarity. Prolonged screen time may also be a factor in the rising rates of dry eye disease (DED) among children and young adults.

In cases of Meibomian Gland Dysfunction (MGD), the oily secretion known as meibum, which is produced by the meibomian glands in the eyelids, is often insufficient in quantity and altered in composition. This leads to a thickened, cloudy, and stagnant secretion that is more difficult to express. Without adequate oil, the healthy layers of the tear film—comprising mucin, water, and oil—cannot form properly.

Contributing factors include tear film instability, increased evaporation rate, dryness, tear hyperosmolarity, and inflammation. Inadequate lubrication of the eye surface causes friction between the eyelid and eyeball, which damages the cells on the eye surface. These problems lead to compensatory overproduction of tears, which creates a perpetuating cycle of dry eye disease (DED).

Ocular symptoms of Dry Eye Disease (DED) can include dryness, a gritty sensation, eye fatigue, redness, burning or pain, blurred vision, sensitivity to light, and excessive tearing as a compensatory response. DED is also associated with eyelid inflammation and infections, such as blepharitis, as well as infestations by Demodex mites.

Summary: Meibomian gland dysfunction (MGD) is a chronic, progressive disease that compromises the health of the ocular surface. If left untreated, MGD can worsen, leading to severe symptoms, ongoing discomfort, corneal damage, eye infection, and potentially serious visual impairment. Prioritizing effective medical treatment is critical to ensuring your eye health and maintaining quality of life.

Clinical studies of the Thermo-Mechanical Action (TMA®) non-surgical periorbital rejuvenation and improvement of meibomian function?

Academic presentation at ADAM Annual symposium 2025
Association of Doctos in Aesthetic Medicine (Hong Kong)
Dr James Chan
2025-06-08
Part 1. Clinical studies (last updated on 2025-06-08)

Sequential thermal pulsations of TMA treat the underlying causes of evaporative dry eye caused by meibomian gland dysfunction (MGD).

For reference only, please refer to the original article for the information.

 

抗衰老食疗20 – NMN膳食補充劑

解釋什麼是NMN之前,先要知道什麼是NAD+?
NAD+的全名是 Nicotinamide Adenine Dinucleotide, 它是所有生物與生俱來的天然生成體內物質。
NAD+擔當身體不可或缺的角色, 作為所有細胞的燃料、負責生產能量、激活長壽基因 Sirtuins 修復細胞基因損傷、協調多個與抗衰老有關的表觀遺傳訊息傳遞渠道、
減少炎症及維持體內所有機制的平衡…等等。


資料參考 Cell Metabolism 27, March 6, 2018

研究表明,小朋友和年青時期體內NAD+維持在非常高的水平, NAD+水準會隨著年齡增長,呈斷崖式減少,引發人體機能衰老質變。恢復體內的NAD+水準可以延長健康壽命,這使得它成為抗衰老研究的焦點。

體內NAD+水平,可以透過口服NAD+的前導體 Nicotinamide Mononucleotide ( NMN ) 來補充。在人體內的NAD+是由 NMN 衍生出來, 服用 NMN 膳食補充劑,是最安全、直接、有效提高體內 NAD+水平的方法。


資料參考 Cell Metabolism 27, March 6, 2018

有臨床報告,應用 NMN 在 COVID-19 新冠肺炎的病患者,對控制病情有正療效。
Robert Huizenga, MD. Dramatic Cytokine Storm Reversal with an Over the Counter NMN Cocktail. COVID-19 Case Report. April 20, 2020.
NMN直接補充體內NAD+水平, 對於減緩衰老相關的組織/器官機能衰退、增強免疫力, 調節免疫細胞過度反應之危險 Cytokine storm, 促進血液循環, 保護腎臟、肝臟、腦部受疾病的影響, NMN表現顯著及正面的臨床療效。

提升身體營養,增強抵抗力,預防疾病,是抗衰老中不可或缺的一環。
NMN 膳食補充劑已發展至第四代技術。

Cosmedical高廸醫學美容 十週年

我為這次活動所製作的Keynote,早前已經跟大家分享過,輕鬆的眼部皮膚的護理。
也分享一些今天在台上的照片,順利快樂的一天。
祝 COSMEDICAL 公司業務蒸蒸日上,生意興隆。







医学美容 課題 (黑眼圏的處理 一 )
医学美容 課題 (黑眼圏的處理 二 )
医学美容 課題 (黑眼圏的處理 三 )
黑眼圈四 (有用眼霜的習慣嗎?)

Keynote on multi-technology platforms by VIORA

I was grateful to be invited to participate in the annual company training of VIORA machine manufacturer from Israel. The meeting was held at lovely ‘Movenpick Resort’ in Phuket, Thailand on May 26 ~ 28, 2016.

This was my first business trip traveling with colleagues of Good Union Company

Stunning scenery from my room

This was an old slide about development of a fractional radio frequency machine. I presented it once in 2012 and used this slide again as the first of my keynote presentation.

 

It was my first time to join VIORA company event and I had prepared a 30 minutes keynote presentation to share with colleagues about design concept, applications and unique features of the latest innovations of multi-technology platform series, e.g. V10 V20 and V30 with interchangeable hand pieces for skin tightening, fractional RF resurfacing with SVC (Switching-Vacuum-Cooling), long pulse 1064nm Nd:YAG laser with PCR (PulseConfiguRythm™ Control), Intense Pulse lights with PCR (PulseConfiguRythm™ Control), e.g. V-ST, V-FR, V-Nd:YAG, V-IPL and the latest developed and my new favorite for non-invasive body contouring (BC) and skin tightening V-FORM hand pieces (HP) with Multi-CORE and ABS (Anti-burn system).


V-FORM BC HP can be connected to large and small size of tips for treatment. Apart from a very unique appearance of hard ware design, the large size V-FORM BC HP has very large area coverage 97×83 mm2. The new Multi-CORE system and Anti-burn system allow RF energy to penetrate deeply and produce large volume of homogeneous warming inside subcutaneous fat layer at 3 cm from skin surface without causing epidermal injury and patient’s discomfort. Total treatment time of whole abdomen of average size Chinese can be as short as 20 minutes. It is very suitable as lunch time procedure.

One of most difficult presentation I have ever made 2 years ago. I wanted to ease our life, limited the scope of aesthetic medicine and suggested an approach on practice of aesthetic medicine.

 

A simplified idea of polymodal balanced approach in combination of aesthetic procedures.

 

I first presented the concept of application of ‘a poly-modal balanced approach’ on aesthetic medicine in 2009. At that time, most of aesthetic treatments are based on a single modality. For example, IPL or 800nm Diode laser for hair removal, fractional non-ablative laser resurfacing for skin rejuvenation. A stand alone machine can provide treatment for a few indications. Combination of different machine treatments or modalities was not common.

There were another type of machines called all-in-one machines. A machine with a few applicators or modules combining together as a unit. More treatment can be provided. However, mostly the size of all-in- one machine was big and its hard ware was not up-gradable. If there was malfunctioning of a module, the whole machine should be sent for repair.

Therefore I purposed a new concept of machine design, multi-technology platforms based on ‘the concept of poly-modal balanced approach’ It was my dream for many years. All applicators can be plugged in and interchangeable for usage.

It is difficult to rely on a single treatment modality to treat a diseased or ageing skin condition in all patients with all skin color types.

As a result, a well designed complete aesthetic platform should consist of multiple modalities to successfully manage any skin conditions within an individual and patients with different skin color I to VI. Therefore, patients can be treated in a rational, ethical and cost-effective way and not subjected to unnecessary side effects of treatments or prolonged treatment duration.

An aesthetic multi-technology platform works as a central unit of energy supply.
For example, it should provide various kinds of energies such as radio frequency energy, lasers and light energy.

All radio frequency energy dependent (RF-dependent) hand pieces (HPs) or applicators are connected to the universal RF connector of the platform. Same as lasers and IPL HPs which are plugged into Laser energy universal connector or IPL connector, respectively.

Newly developed application HPs can be easily add-on to the platform via same universal connectors.

Therefore, multi-technology platform is up-gradable in both hard wares and softwares, functionally expandable and more economical in space and money.

V-series (V10, V20 & V30) Platforms by VIORA are examples of multi-technology platforms.

For example: Unwanted hair removal
Both Nd:YAG 1064nm lasers and IPL with 570nm and 630nm filter are applied
Hand pieces: V-Nd:YAG laser HP and V-IPL HP. Both of them have PulseConfigRythm system which can make the light or laser pulse as single pulse, a train of multiple sub-pulses or rapid pulses of low fluence. More time for heat dispersion is suitable to darker skin type. In addition to very effective water cooling system to keep the glass tip of both V-IPL and V-Nd:YAG HP at 5C, pain, risk of epidermal thermal injury and post-inflammation hyper-pigmentation are minimized.
V-IPL 570nm for average hair on lighter skin
V-IPL 630nm for hair on darker skin type
V-Nd:YAG 1064nm laser for dark hair with hair follicles inside deep dermal region
Modalities are enough to remove unwanted hair thin to thick, sparse to dense, and different skin color type I to VI.

By means of a Multi-technology Platform V30 by VIORA, multiple skin conditions can be managed.

I received a gift from Dr. Inna who is the clinical director of VIORA

 

An official photo from VIORA. I was very grateful to participate in this annual event and made friends with colleagues all over the world. Thank you very much for all arrangement of this wonderful gathering.

 

Uncle Koala said 'Yeah, well done'

 


8th Anniversary is coming.

Machine Wonderland

There were so many machines coming to my clinic in the past 8 years.
They were all stylish, lovely and ‘sexy’ because I invited them to be here.
Some of them were super powerful and the other were gentle and comfortable.
They were all top quality created by genius groups and had the highest safety and clinical proven efficacy.
When we first met, they were all new born babies. Those lucky grew and became superstars but some may silently leave us for different reasons.
However, I knew they were all good babies and have contributed to this Universe and improved the quality of life of human being.
Some of them have stayed with me for long long time but most of them stayed here just briefly.
No matter long or short period of time, I knew the purpose was to teach and inspire me.
Maybe you were one of the lucky people who have been connected with these lovely babies and became ‘baby’ again.
I am grateful and thankful to have all these babies in my life and Machine Wonderland of DR JAMES CLINIC.
I will never forget anyone of them. I will continuously let more people know there are such precious babies in this lovely world.
PS: It is my luxury space to enjoy chocolate with love, gelato with overloaded marshmallow (happiness), cakes with sweet heart.

先來定義,何謂儀器樂園?應該個充滿不同種類,不同功能的儀器,解決各様美麗要求。儀器都有專人照顧。不論為了什麼原因進來,都希望找到自己快樂,並帶著滿足的笑容離開。我是這樣希望的! 在香港中環市中心,但沒有鬧市的嘈吵,也沒有令人不安的痛苦聲。地方不大,但訪客都感覺舒服,這就是多年來,不斷有世界頂尖醫美科技進出的地方。 有些儀器威力強大,有些則温柔舒服。都是由一群群天才發明家和設計家共同創造而成的高科技,以最高標凖的安全性和臨床醫學測試確認的療效。 最初相遇的時候,它們還是剛出生的嬰兒。有些幸運的,一鳴驚人,很快就變成了巨星級。但也有些,因不同理由,在不知不覺間失去了。雖然事實如此,但我絕對相信和明白,它們全部都是有價值的好孩子,曾經盡力貢獻,改善人類自身的生活品質,令世界更美好。 有些儀器陪伴多年,一同成長進步。但大部分,都只是短暫停留,只留下美好的回憶。不論相聚的時間是長是短,目的只得一個,專程來教導和啟發我這個學生。 你可能也是曾經來過這裡的幸運兒,跟它們相遇過,再次找到嬰兒般的美麗和笑容。 很感謝曾在我的生命中出現過,在這個樂園相遇的每一部儀器,它們的教導,我一輩子也不會忘記。 我會保持初見面時的態度和好奇心,繼續學習,令更多人知道,有那麼真貴的寶貝,在這個美好的世界中存在。


鐳射激光,射頻電磁波,脈冲光/彩光,超聲波能量的不同應用

最新到的多極綜合射频能量減脂塑身儀器,初步測試效果不錯

3DEEP TC Shaper 緊膚

靚到唔想放手,全球首個美國FDA確認有效安全的家用緊膚小電器


來自日本的水素水

多兩個月,就是診所八週年紀念。 真的感謝各位貴賓,廠商好友,傳媒朋友和同事多年來的支持。我們會繼續努力,提供最優質的服務和產品。

处理痤疮疤痕 (凹凸洞) 及皮肤松弛 2015 (简体)

暗疮後,遗留一些痘印及疤痕,确实令人烦恼。一点点凹凸洞也不算大问题,皮肤松弛的衰老改变,才真正令人着急。近年面世的美容医学仪器技术,能有效改善痤疮疤痕 (凹凸洞),也是处理皮肤松弛下垂的方法。

皮肤松弛下垂的成因
不用多说,一定跟太阳紫外线有关。较早前的文章已详细说明。
皱纹的成因
美学: 皱纹令人老?

 

 

 

 

 

 

 

 

 

 

 

暗疮粉刺後疤痕的成因,皮脂腺位於皮肤真皮层,在毛孔阻塞 (表皮死皮聚积),油脂分泌旺盛,皮肤细菌增生的状况下,皮脂腺产生化学作用,发炎,便形成了暗疮粉刺。由於是真皮层受损及纤维化,纤维化组织拉扯着表皮,形成了凹陷的疤痕。凹凸洞,一般都属较深层的皮肤问题。若发炎状况严重,也有机会影响皮肤正常色素。

所以要解决三大难题。
一,把拉扯着表皮的纤维化组织分离。
二,填补皮肤真皮层在发炎後收缩 (Volumn Loss)
三,保持皮肤正常肤色

处理疤痕,必须同时改善以上的状况。所以一般的皮肤护理,如护肤品,家用磨沙,甚至浅层的化学换肤,对暗疮粉刺後疤痕的疗效有限。

传统办法:

用针或小手术刀切割 Subcision
把拉扯着皮表的纤维化组织分离。但针孔或手术刀抽入位置,也有机会形成小凹凸洞。

皮层填充 Hyaluronic acid dermal filler
注射较细少分子的填充剂 例如: Restylane Vital 在浅层真皮层,填补真皮体积。可能需隔一段时间,重新注射。

 

 

 

 

 

磨皮 Microdermabrasion/Dermabrasion

专业用磨皮,刺激纤维母细胞,增生真皮层胶原蛋白,对浅层痘疤有疗效。

化学换肤 Chemical Peeling
同样是刺激纤维母细胞,增生真皮层胶原蛋白。要较深层的换肤,和较长的治疗期,才对痘疤有改善。

微针 Microderma-rollers
针刺破坏皮肤,形成有控制的伤口,经发炎及康复後,产生真皮层胶原蛋白。注意:疼痛感较强,较长的治疗期,及必须小心处理伤口。

 

 

 

 

 

 

 

 

 

 

 

 

医学美容仪器 ,如彩光/脉冲光 Intense Pulsed Light, 碳粉镭射 或俗称 Laser Facial 的激光护肤。主要针对较浅层的皮肤问题,对深层痘疤的疗效有限。

 

 

 

 

 

 

 

现今主流治疗,以美容医学仪器疗程为主。

去年九月份在上海的医学会议场上,我就报告了应用在凹凸洞处理的主流医美科技 2014 总结。如何混合使用,达致更明显改善肤质,更短的治疗期和持久效果。

旧式的《激光换肤 Laser Skin Resurfacing》 疼痛感较强,较长的治疗期,及必须小心处理伤口。从2008年起,已逐渐被新一代的《Fractional Skin Resurfacing 分段式技术》或在中国国内称为《点阵技术》所取代。

《分段式技术的换肤 Fractional Skin Resurfacing》 就是疗程时只更换部份的皮肤 (包括真皮和表皮),更换位置旁边的组织快速愈合,缩短治疗後康复时间和减低风险。这样的处理,可使拉扯着表皮的纤维化组织分开,同时在发炎的过程中, 刺激纤维母细胞,增生真皮层胶原蛋白。胶原蛋白经过重新排列後 ( Collagen Remodeling ),令皮肤回复弹性,把凹凸洞填平。是新一代较有效的办法。

 

 

 

 

 

 

 

 

 

市面上有那些选择? 大至可分为激光能量 ( Laser Energy ) 和 射频能量 ( Radio-frequency Energy )。也可分为有表皮伤口《有创伤性 Ablative》 和没有表皮伤口《非创伤性 Non-ablative》。很多不同波长激光也被应用,如 1410nm 丶 1440nm 丶 1550nm 丶 2940nm 丶10600nm⋯

 

 

 

 

 

 

 

 

激光跟皮肤水份作用,产生热力 Photothermolysis,形成有控制的微小伤口。 不同波长激光,对皮肤产生不同程度和深度破坏的微细加热区 Microthermal zones。二氧化碳激光 ( CO2 Laser ) 波长 10600nm 激光产生有表皮伤口的 ( Ablative Fractional Laser Resurfacing ),伤口较深,康复期较长。在外国的研究,如欧美白种皮肤人士,效果较非创伤性技术 (Non-ablative technique) 明显。 可是在东方人,黄皮肤的地区,我们有着疗程後皮肤色素改变的风险,治疗後也要较长时间复元。所以大多采用较温和的 《非创伤性分段式激光换肤 Non – ablative Fractional Laser Resurfacing》,例如 Fraxel (Solta), Affirm (Cynosure)。由於技术已上市一段时间,不少厂商也推出类似激光换肤仪器,冠以类似 Fractional 的名字,但能量控制,疼痛感和精准度,确实有差别。选择时要小心留意!

我自己认为不论是那类激光仪器,使用时必须小心,遵守激光使用安全指引,要医生评估和监察,保护接受者和操作者安全,详细的治疗前後指引,减低风险。

近年还多了 分段式射频能量技术 ( Fractional Radio-frequency Energy ),由於射频能量可达表皮及真皮的浅层位置,可在皮肤修复的过程中,更换皮肤浅层受光衰老破坏受损的皮肤。同样地也可刺激纤维母细胞,增生真皮层胶原蛋白。初期的分段式射频技术,能量分布於浅层位置,对深层一点的面部提升,效果一般。

新一代分段射频能量换肤,技术可分为 《 Surface contact electrode pins 接触式电极针 》及《 Micro-needle radio frequency electrodes 刺穿表皮微针电极 》。後者微针电极,可调节能量输送入皮肤的深度,收紧效果更优胜,但也比较疼痛。

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2013 年面世的技术,《 接触式电极针的分段点击射频能量换肤提升技术 Fractional Radiofrequency Skin resurfacing, Uplifting and rejuvenation, Vtouch by Viora 》。利用专利 《SVC 技术 Switching-Vacuum-Cooling》以能量自动调控丶冷冻及真空技术的互相配合,热能分布更深入,更平均,也减轻治疗时的痛楚。可以在没皮肤表面麻醉下进行。产生细少的表面小点伤口和精准的微细加热区,小点快速愈合,康复期缩短。疗程一般四至六治疗,每隔四至八星期一次治疗,按适应症的严重程度和皮肤质素而有所不同。除改善皮肤暗哑,色斑,收细毛孔,提升面部颈部皮肤,也是有效处理凹凸洞及疤痕的办法。

2014年还推出了另一新的换肤仪器, 《 接触式电极针分段式射频仪器 Venus Viva by Venusconcept 》 ,独有的 《Nanofractional RF》 和 《Smartscan》 技术,治疗时系统控制能量平均输送,在皮肤上产生高密度和只有纳米细小的微细加热区,精准幼细度可比美《分段激光换肤技术》,产生的热能更可渗透入真皮层。自己很喜欢 Nanofractional RF 纳米技术,除了提升效果和安全性外,治疗所产生在皮肤上一格一格一点点深褐色的伤口,若不是近距离观察,也注意不到这些小点。虽然只有数天复元期,但也不能太难看,对吗?
我最欣赏这些细节 Fine details,值得一赞。

以上技术,每次疗程处理约 5 至10%皮肤。处理皮肤粗糙丶 毛孔粗大丶色斑丶皱纹细纹⋯ 一般治疗期需进行多次疗程 (四次以上),隔三至四星期一次治疗,肤质和凹凸洞会在疗程後数月得到明显改善。

另一类也算是分段式技术 ,《Intense Focused Ultrasound IFUS 利用聚焦超声波能量》,穿透及聚焦在不同深度的皮层软组织内,产生热力至摄氏60度,制造一行行小点的微细加热区,刺激自体修复。在不破坏表皮的状况下,增生真皮层胶原蛋白和弹性纤维,改善皮肤松弛,令凹陷位置底层的体积增加速度加快。面部提升的同时,减少面部凹陷的轮廓,增加皮肤光线反射,视觉上也可令凹凸洞变得不明显 (有点像拍照打了灯的脸,看似更加白滑)。

另一类也算是分段式技术 Intense Focused Ultrasound ( IFUS ) 利用超声波能量穿透及聚焦在皮层软组织内,产生热力至摄氏60度,制造一行行小点的微细加热区,刺激自体修复。在不破坏表皮的状况下,增生真皮层胶原蛋白和弹性纤维,改善皮肤松弛,令凹陷位置底层的体积生长速度加快。同时面部提升,减少面部凹陷的轮廓,会增加皮肤光线反射,视觉上也可令凹凸洞变得不明显。

最後,你一定会问,那样治疗最好?
这都是有效的技术,那一样是最好,则要按严重程度,皮肤质素,肤色深浅,痛楚接受度,可容许的修复期⋯不能一概而论。自己较喜欢温和的治疗,简单的疗程前 後护理,可接受的痛楚,合理的修复期 (一到数天),不影响日常工作,不影响社交。虽然治疗期可能稍稍延长,最後仍可获得显着的效果。

在适合的状况下,也会使用合并分层治疗,Polymodal Balanced Approach 综合多种技术分层处理凹凸洞,减少依赖单一技术所引致的风险,增加治疗效率,缩短治疗期。

新科技有疗效,同样也有一定的风险和创伤性,要小心选择治疗的地点,和护理人员的专业程度⋯

紧记,治疗後护理十分重要,保湿修复 Moisturizing and barrier repair 防晒 sun protection。多喝水,注意健康饮食,作息定时,减少烟酒,保持心情开朗⋯才会有好皮肤。

越年轻,越早处理,效果更爲理想,当然是跟新陈代谢的速度有关。

暗疮粉刺後的疤痕,是令人烦恼的,要百份之百根治,确实要多点恒心和耐性,但绝对是值得投资的《身内物》。

希望以上的资料,对大家有所帮助。

凹凸洞及皮膚鬆弛的處理 2015

暗瘡後,遺留一些痘印及疤痕,確實令人煩惱。一點點凹凸洞也不算大問題,皮膚松弛的衰老改變,才真正令人著急。近年面世的美容醫學儀器技術,能有效改善痤瘡疤痕 (凹凸洞),也是處理皮膚松弛下垂的方法。

皮膚松弛下垂的成因
不用多說,一定跟太陽紫外線有關。較早前的文章已詳細說明。
皺紋的成因
美學: 皺紋令人老?

 

 

 

 

 

 

 

 

 

 

暗瘡粉刺後疤痕的成因,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,纖維化組織拉扯著表皮,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,把拉扯著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
把拉扯著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
注射較細少分子的填充劑 例如: Restylane Vital 在淺層真皮層,填補真皮體積。可能需隔一段時間,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/脈衝光 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。

 

 

 

 

 

 

 

現今主流,以美容醫學儀器療程為主
去年九月份在上海的醫學會議場上,我就報告了應用在凹凸洞處理的主流醫美科技 2014 總結。如何混合使用,達致更明顯改善膚質,更短的治療期和持久效果。

舊式的《激光換膚 Laser  Skin Resurfacing》 疼痛感較強,較長的治療期,及必須小心處理傷口。從2008年起,已逐漸被新一代的《Fractional Skin Resurfacing 分段式技術》或在中國國內稱為《點陣技術》所取代。
《分段式技術的換膚 Fractional Skin Resurfacing》 就是療程時只更換部份的皮膚 (包括真皮和表皮),更換位置旁邊的組織快速癒合,縮短治療後康復時間和減低風險。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 ),令皮膚回復彈性,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 ) 和 射頻能量 ( Radio-frequency Energy )。也可分為有表皮傷口《有創傷性 Ablative》 和沒有表皮傷口《非創傷性 Non-ablative》。很多不同波長激光也被應用,如 1410nm 、 1440nm 、 1550nm 、 2940nm 、10600nm⋯

 

 

 

 

 

 

 

激光跟皮膚水份作用,產生熱力 Photothermolysis,形成有控制的微小傷口。 不同波長激光,對皮膚產生不同程度和深度破壞的微細加熱區 Microthermal zones。二氧化碳激光 ( CO2 Laser ) 波長 10600nm 激光產生有表皮傷口的 ( Ablative Fractional Laser Resurfacing ),傷口較深,康復期較長。在外國的研究,如歐美白種皮膚人士,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,治療後也要較長時間復元。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》,例如 Fraxel (Solta), Affirm (Cynosure)。

由於以上技術已在市面一段時間,不少廠商也推出類似激光換膚儀器,冠以類似 Fractional 的名字,但能量控制,疼痛感和精準度,確實有差別。選擇時要小心留意!

我自己認為不論是那類激光儀器,使用時必須小心,遵守激光使用安全指引,要醫生評估和監察,保護接受者和操作者安全,詳細的治療前後指引,減低風險。

2010年起還新加入了另一主流儀器 《 分段式射頻能量技術 Fractional Radio-frequency Energy Rejuvenation 》,由於射頻能量可達表皮及真皮的淺層位置,可在皮膚修復的過程中,更換皮膚淺層受光衰老破壞受損的皮膚。同樣地也可刺激纖維母細胞,增生真皮層膠原蛋白。初期的分段式射頻技術,能量控制略能量分佈於淺層位置,對深層一點的面部提升,效果一般。
新一代分段射頻能量換膚,技術可分為 《 Surface contact electrode pins 接觸式電極針 》及《 Micro-needle radio frequency electrodes 刺穿表皮微針電極 》。後者微針電極,可調節能量輸送入皮膚的深度,收緊效果更優勝,但也比較疼痛。還有一類叫 《Microplasma RF resurfacing with roller electrode pins 滾式微波電漿技術》,但暫時並不普及,所以不在此介紹。

 

 

 

 

 

 

 

 

2013 年中首次曝光, 到2014年才正式上市《 新型接觸式電極針的分段點擊射頻能量換膚提升技術 Fractional Radiofrequency Skin resurfacing, Uplifting and rejuvenation, Vtouch by Viora 》,放棄舊有技術的概念,加入不同元素的協調,提升分段射頻技術的精準度和安全性,處理更多的適應症。利用專利 《SVC 技術 Switching-Vacuum-Cooling》以能量自動調控、冷凍及真空技術的互相配合,熱能分佈更深入,更平均,也減輕治療時的痛楚,可以在沒皮膚表面麻醉下進行治療。產生細少的表面小點傷口及精準的微細加熱區 ablation and coagulation zone,小點快速愈合,康復期縮短。
療程一般四至六治療,每隔四至八星期一次治療,按適應症的嚴重程度和皮膚質素而有所不同。除改善皮膚暗啞,色斑,收細毛孔,提升面部頸部皮膚,也是有效處理凹凸洞及疤痕的辦法。《真空負壓》使痤瘡凹凸洞疤痕位置的皮膚拉開後,才釋放出能量,全面覆蓋隱藏的纖維化組織,加強治療效率。

2014年12月才到香港的換膚儀器, 《 接觸式電極針分段式射頻儀器 Venus Viva by  Venusconcept 》 ,獨有的 《Nanofractional RF》 和 《Smartscan》 技術,治療時系統控制能量平均輸送,在皮膚上產生高密度和只有納米細小的微細加熱區,精準幼細度可媲美《分段激光換膚技術》,產生的熱能更可滲透入真皮層。自己很喜歡 Nanofractional RF 納米技術,除了提升效果和安全性外,治療所產生在皮膚上一格一格一點點深褐色的傷口,若不是近距離觀察,也注意不到這些小點。雖然只有數天復元期,但也不能太難看,對嗎?我最欣賞這些細節 Fine details,值得一讚。

以上技術,每次療程處理約 5 至10%皮膚。處理皮膚粗糙、 毛孔粗大、色斑、皺紋細紋⋯ 一般治療期需進行多次療程 (四次以上),隔三至四星期一次治療,膚質和凹凸洞會在療程後數月得到明顯改善。

另一類也算是分段式技術 ,《Intense Focused Ultrasound IFUS 利用聚焦超聲波能量》,穿透及聚焦在不同深度的皮層軟組織內,產生熱力至攝氏60度,製造一行行小點的微細加熱區,刺激自體修復。在不破壞表皮的狀況下,增生真皮層膠原蛋白和彈性纖維,改善皮膚鬆弛,令凹陷位置底層的體積增加速度加快。面部提昇的同時,減少面部凹陷的輪廓,增加皮膚光線反射,視覺上也可令凹凸洞變得不明顯 (有點像拍照打了燈的臉,看似更加白滑)。

最後,你一定會問,那樣治療最好?這都是有效的技術,那一樣是最好,要按嚴重程度,皮膚質素,膚色深淺,痛楚接受度,可容許的修復期⋯不能一概而論。分段式的激光或射頻換膚,是大部份人的選擇。自己傾向選擇較溫和的治療,簡單的療程前後護理,可接受的痛楚度,合理的修復期 (一到數天),副作用機會較少的,不影響日常工作,不影響社交。雖然治療期可能稍稍延長,最後仍可獲得顯著的效果。

在適合的狀況下,也會使用合併分層治療,Polymodal Balanced Approach 綜合多種技術分層處理凹凸洞,減少依賴單一技術所引致的風險,增加治療效率,縮短治療期。 新科技有療效,同樣也有一定的風險和創傷性,要小心選擇治療的地點,和注意護理人員的專業程度⋯只有這一張臉,要小心保護!

緊記,治療後護理十分重要,保濕修復 Moisturizing and barrier repair防曬 sun protection。多喝白開水,注意健康飲食,作息定時,減少煙酒,保持心情開朗⋯才會有好皮膚。 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。