Scar revision is my main expertise and the way I treat scars is through a multimodal treatment approach which means I make use of different treatment modalities at the same time or in steps to achieve the desired treatment outcome for scar improvement. Although ablative fractional laser is our work horse for scar treatment, we also use medical therapies, plastic surgery, subcision, PRP, cryosurgery, fillers, botox, compression, induction of repigmentation, contracture release, micro-needling, injection of chemotherapeutic substances and some other methods as part of our multimodal treatment for scars.

Yes I agree, we have a lot of very anxious patients who are concerned and rightly distressed by their hair loss and we know that more than 30% of the population suffers from alopecia or hair loss. Three main causes include androgenic alopecia, alopecia areata and teleogen effluvium. Seasonal variation, nutritional factors, ageing, hormonal imbalances, inflammatory disorders of scalp, autoimmune hair disorders and psychological factors are also implicated. I would particularly like to highlight telogen effluvium which I believe is the main reason of hair thinning in women of all ages presenting to a dermatologist and this can result from iron deficiency, thyroid disorders,  childbirth, surgery, chronic diseases, dietary changes, high fever and stress. The treatment of course depends on the underlying cause and needs comprehensive assessment and detailed history taking sometimes with investigations like scalp biopsy and blood tests. Treatments that we offer in our clinic include topical and injected steroids, hormone rebalancing, vitamins and nutritional supplements, topical vasodilators, 5-alpha-reductase inhibitors, anti-fungal and anti-parasitic medication. We also sometimes use PRP (platelet rich plasma) especially for female and male pattern hair loss (androgenetic alopecia). Unfortunately we are currently not offering hair transplantation in our clinic but can refer to well qualified and trained hair restoration surgeons.

There are two types of ageing processes: intrinsic and extrinsic ageing. Intrinsic or chronological ageing affects the skin of the entire body, including sun-protected sites whereas Extrinsic ageing can be considered premature ageing and is induced by sun or chronic ultraviolet (UV) radiation exposure, and quite importantly by smoking.

In the context of intrinsic ageing, menopause in women is the prime example in which  signs of ageing begin at around 50–60 years of age which is attributed to a decrease in the protective effects of oestrogen during menopause. The role of nutrition in relation to extrinsic ageing cannot be over-emphasised. Fruits, vegetables, legumes, herbs, and teas contain antioxidative compounds. Vitamin C and increased linoleic acid intake are known to decrease wrinkling, skin thinning and dryness. On the other hand, a higher fat and carbohydrate intake has been associated with an increased risk of wrinkles and skin thinning.

Intrinsically aged skin appears dry and pale, smooth, thin, transparent, and unblemished. It has fine wrinkles and sagging or  laxity may occur with body movement, due to loss of elasticity. Extrinsic ageing, such as photoageing affects habitually exposed areas of the body, such as face, neck, and arms and its features  include roughness, deep wrinkles, dyspigmentation, easy bruising and sallowness.

I have a very holistic approach to treat skin ageing and advise my patients to take care of all components of ageing skin and not just cosmetic cover up with fillers and botox etx. For example, moisturisers will help improve dry and flaky skin, vitamin C, alpha hydroxy acids, retinoid creams applied regularly long term reduce fine wrinkles and dryness and even out pigmentation. Use of sun block creams will prevent further sun damage, drinking plenty of water and fluids will improve general hydration status of skin. As for specific facial rejuvenation, the procedures that we offer include: fillers like hyaluronic acid, botox injections to reduce frowning and lessen deep furrows; resurfacing procedures  for example eg, micro-needling, micro-dermabrasion, chemical peels, and laser resurfacing. We also use the lastest 3D HIFU for non-surgical skin tightening and face lifting including jowls and double chin treatment.

Although not much can be done to prevent intrinsic or biological ageing, I would say protection from sun's UV rays is essential at all ages to prvent extrinsic or photo ageing and this should start at a very early age like young children. There are several steps that can be taken to minimise or avoid UV exposure.  

• Be aware of daily UV index levels and avoid outdoor activities during the middle of the day especially between 10 am and 4 pm.
• Wear sun-protective clothing  such as a broad-brimmed hat, long sleeves.
• Apply very high sun-protection factor (SPF > 50), broad-spectrum sunscreens to exposed skin and this should be repeated every two hours if one stays outside in the sun
• Avoid smoking and including vaping, and where possible, avoid exposure to environmental pollutants.
• Drink plenty of water and fluids like fresh juices and green tea
• Take plenty of exercise — active people appear younger than inactive people.
• Eat fresh fruit and vegetables daily.
• Oral supplements with antioxidant and anti-inflammatory properties can retard skin ageing and  improve skin health including omega-3 fatty acids, aloe vera carotenoids,  polyphenols, chlorophyl,  vitamins B, C, and E and red ginseng.

Melasma is a common problem in Asian and African skins and we receive a lot of patients who have tried multiple over the counter remedies as well as proper medical treatment without any long term improvement . Although the exact cause of melasma is not fully established, it has clear association with increased exposure to sun light (especially ultraviolet rays) and female hormonal activity and in one third of patients there is genetic predisposition.

Melasma and other types of pigmentation can be treated using similar treatment methods and most of the topical treatments used in the treatment of melasma act by inhibiting tyrosinase.  Examples of tyrosinase inhibitors include hydroquinone, kojic acid and arbutin. One important aspect of treatment of melasma to keep in mind is that the results take time to be noticeable and are rarely 100% successful. Even in those lucky patients who get initial good results, pigmentation can re-appear after some time of treatment especially if patients are not particular with strict sun protection or under the influence of female hormones as if a woman gets pregnant.

I personally use a combination approach for quick response to satisfy the patient and long term maintenance to prevent the relapse. I personally do not think laser treatment is the answer to treatment of melsama as there is invalitably always relapse of pigmention after some time. I therefore have a unique method of mesotherapy with special depigmentation products that I use for immediate effect followed by repeated sessions every 3 months along with adjuvent oral and topical treatment and life style advice to minimise  exposure to ultraviolet light and other triggers of pigmentation. I have also lately started to employ a brand new technique which is completely non-invasive and based on current published evidence showing promising results.