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Tuesday, March 9, 2010

Secret of cosmetic fillers revealed! (that may get me into trouble)

Today, the word dermafiller is often associated with brand names such as Restylane, Juvederm, Esthelis, etc. These are fillers of non animal based products unlike collagen based used previously.
Each of there products comes in a prefilled 1ml  syringe irrespective of the brands. Market price for filler injections ranges between RM3k-RM5k per syringe, depending upon which area that is being treated, and of course, the "who" factor is determines the cost.
Most plastic surgeons( please note that i don't refer them as cosmetic surgeons as those doctors who attained their Masters degree locally, and overseas do not have "Cosmetic Medicine" as part of their syllabus). Despite of that, most plastic surgeons and dermatologist often claim that the field of aesthetics should belong to them, and not practiced by general practitioners. I did my plastic surgery posting for 6 months in Kuala Lumpur General Hospital, hoping to get some practical experience in cosmetic medicine. I was quite disappointed when i realized that they don't do any cosmetic procedures, only purely reconstructive surgeries, cleft palate correction and orbital fracture surgeries mainly.
I did not waste any time upon completion of my government service when I flew over to Australia to pursue my training in Cosmetic Medicine. (my last day of government service being 31th August, by the 1st of September 2005, i was already in Australia, attending my Laser Safety Officer course.
I had an extensive training especially in techniques of filler injections, botox, sclerotherapy, and skin rejuvenation with IPL(Intense Pulse Light) and laser.(Nd Yag, Co2, Erbium), and liposucution.
By the time I've completed my training, I was well versed with lasers and IPL, Botox, filler injection technique, etc. Well verse enough to question why are there so many doctors locally who uses laser is skin rejuvenation when Asian skin aren't suitable for both IPL and laser as we tend to burn easily.
Hence ladies and gentleman, very often you need to go for a few sessions of laser treatment as they had to power down the intensity of laser to prevent burns. Therefore, the more you visit, the more you pay. Asian skin aren't good candidate for laser or IPL treatment.
Anyway, i will elaborate about this topic later. Back to  fillers.
Yes, market price ranges from RM3k -RM5k per syringe. While I charged only RM1650 per syringe, I was commented by the sales rep that I might affect the pricing of fillers by charging so low.
Ok, I might revise the price later. Perhaps to RM2 k by the end of the month.
As for most Chinese patients that I've had so far, most often done procedures are improvement of nasal profile with filler, increasing the prominence of cheek bones, Marionette  and nasolabial fold correction.
As I had mentioned earlier, these fillers comes in a 1ml prefilled syringe. Very often in increasing the prominence of the cheek bone,  the doctor often need to use more than 1ml. Hence, imagine RM3k per syringe x2.
That's RM6k already. Say then you want a better nasal profile, then another RM3K.
Then you asked for correction of signs of aging particularly Marionette lines and nasolabial lines, another 2ml needed. That's an additional of RM6K. A beautiful and youthful face would be a triangular shape face. In aging, the triangle slowly turns into an inverse triangle, characterized by sagging of the cheeks, lose of facial volume, lose flabby skin under the neck. Doctors would try a combination of botox and filler to maintain the triangular shape.  One effective but subtle way is to injection of filler into the chin are to create a prominent chin, hence maintaining the apex of the triangle.
1ml is needed. Now, do the maths. 2+1+2+1=6ml (6ml= 6syringes x RM3k = RM18K for only the cost of fillers, excluding botox)

These are the fillers that I use. Every patient have their own preference.  Personally, I was fully trained with Restylane, and it being the most widely used filler, it is often considered as the gold standard of fillers.
Restylane is a Swedish product. 
While Juvederm is made in France.
While Esthelis is made from Switzerland, unlike other industries where the word "Swiss made" is often synonym with best quality, I am still more comfortable with Restylane. 
Perhaps it is the first non animal base filler, its pioneering NASHA technology adopted by other filler makers in making fillers of their own. 
I have a patient who is a Datin who comes regularly for filler injection for facial revolumization. After a while, I felt bad as she had spent so much money despite my charges being one of the lowest around KL area! Once in a while, I would offer free botox treatment for her to show her my appreciation. Recently, I felt so bad as she had spent so much (even if she is loaded, that doesn't mean I should encourage her to spend unnecessarily.) hence I offered her a solution what would save her loads of money! 
Instead of using these conventional facial fillers that comes in 1ml, I introduced her Hyacorp. 
A German made product which is meant for body recontouring, particularly for increasing the size of buttocks and breast.
Its made from the same non animal base substance called hyaluronic acid.
It's one of the two approved filler used in non invasive breast augmentation, the other being Macrolane. 
Why do I introduce Hyacorp to her? Because for the same price as 1ml of dermafiller used on face, this comes in a 10ml syringe. 
10 times the amount but same price, produces the same result as the facial fillers, which one would you chose?
I know by revealing this, I anticipate getting phone calls or email from other practitioners condemning my action. 
I guess its my nature to take into consideration from the patient's perspective, and not only about earning the $$. 
But the catch is, you would need to get your procedures (procedureS= multiple sites that you want to be treated) all done up on one the same time. DO NOT ever agree if the doctor ever suggested to do in 2 separate times, as once the balance fillers is stored in the fridge, it's not sterile anymore. You DO NOT want to have something non sterile injected into you.
Even if the doctor decides to charge you RM5k for that 1 single syringe, it's still worth it if you do the maths. 


Monday, March 8, 2010

Reflections.....

As I sat comfortably on my well padded leather office chair, sipping hot coffee, while the sweet, soft, soothing , and heart warming voice of Olivia Ong assails to my senses, I can't help but to reminisce on my childhood, which never fails to bring out a smile in me each time i think about it.
How fast time passes by.Those make believe games I often play as a child, chopping down banana trees in a single slash, reenactment of some Ninja movie I watched where those mysterious figures bring down a tree with a single slash with their  Katana, the amount of eggs I wasted after trying to do what was shown in "Majalah 3" the night prior showing how a Malay traditional medical practitioner(Bomoh) would cure sickness by chanting mantras while rubbing the surface of a growth on a patient's body with an egg, where he would then break the egg revealing red and black foul substance instead of yellow egg yolk. Thinking that perhaps method number 1 did not work, perhaps I'll try with method 2, then 3, 4, and soon enough a dozen... and yet, non of the eggs turned black!
I remember being caned nearly on a daily basis for a period of time. I don't know why, but somehow, my idea of fun would always ended by me getting caned. Call me mischievous, or curious that had a thin line separating it from being naughty. The worse thing that I ever did was playing with my dad's .22 caliber rifle when my parents weren't home. I actually loaded the magazine into the rifle, all lock and loaded, and fired a round before it came to my senses how dangerous it was. Seeing how my dad would empty the round from the firing chamber after taking out the magazine, I did that. At the tender age of 8-9, I fired a rifle. I used to wonder how come my dad's .22 doesn't produce a loud boom as seen on TV action flicks. Later in life, I learned that the .22 is a hunting rifle where it's bullet travels at a distance that exceeds 1 mile.
Boys will always be boys! Most of the time whenever i tell someone that I am the youngest and the only son, very often their reply would be ,"Oh, you must be precious! ", yeah... right!
 
Yes, that's me. Born with plenty of hair! Weighing at 10.2 pounds at birth, considered HUGE even by today's standard.

 
That's my second sister and I. Some said Natalie looks like me when I was young, somehow I agree... but to a certain extent.

 
Learning to walk. I was about 10 months old when this picture was taken. But of course I can't recall anything in regard to my childhood before 4-5 years old.

 
That's me celebrating my 1st birthday with my parents and sisters. As far as I could remember, I am a kid who always play by myself as my sisters will be at school. Hence what do you think a boy who gets bored easily does when he's ....bored? Do something amusing!!! 
Slingshot the squirrel, sit on my German Shepard pretending it to be a horse, chop down the banana tree which took years to grow and bear fruits. I remember how horrified my mother was when she found out her banana trees being destroyed! She complained to my dad about probably some "strangers" who trespassed our 9 acre property and vandalized our stuff, that my dad should beef up the security. All these took place over breakfast, and my anal sphincter is all puckered up. 
I would like my children to experience the same kind of childhood that i did. It's fun! And as I had mentioned earlier, whenever i think about it, it never fails to bring out a smile in me. 
 
 
Isabelle, daddy wants you to be happy, and joyful all the time. It's once in a lifetime experience to be a child.

 
 
Daddy wants you to live life to its fullest.

 
Even up to today, daddy is still goofing around!

 
Why shouldn't you and Mei Mei?

 
 Because at the end of the day, when we reflect upon our life,  we'll surely remember our childhood, the time of innocence, joy, and sweet memories.

Saturday, March 6, 2010

New Data on Cervarix

**This post is written based upon the author's personal view, and not sponsored nor received any form of incentives by the respected pharmaceutical company.**

It has been known to be of utmost significance, at par in my opinion to the landing of the first human on the moon  back in 1969 as in the field of medicine, the discovery of the first ever vaccine against cancer. February 27 2006 marked as a milestone in the history of medicine when the first ever Cervical Cancer Vaccine, Gardasil, was launched. It was advertised as a tetravalent vaccine, which means it provides immunity against 4 subgroups of HPV virus,(Human Papilloma Virus)subunit 6,11,16, and 18. 
There are over 100 subgroups of HPV identified and each is given a number. 
Generally, HPV virus is divided into oncogenic and non oncogenic groups. HPV is transmitted through sexual contact. Based on a study conducted locally, more than 70% of women would have experienced sexual intercourse before the age of 25. While 70% of HPV resolves by the first year and 90% resolves by the second year, the other 10% stays within the skin and lays dormant for years. It does not travel within the bloodstream, hence undetectable by blood investigations. When Gardasil was launch, it was accepted worldwide, but not without controversy.Some school of thoughts claimed with the vaccine it gives a false sense of security that encourage sexual promiscuity amongst young women. 
As mentioned earlier, HPV is classified either oncogenic or non oncogenic. Subgroup 16,18,31,45 being the highest risk, 33,35,39,51,52,56,58,59 being high risk, and 26,53,66,68,73,and 82 being classified as probable high risk. 
The others cause genital,plantar,or anogenital warts.
In 2009, Pharmaceutical Giant, GSK launched Cervarix, a bivalent vaccine, that provides immunity against subgroup 16 and 18. Upon the launch of Cervarix, the cost per dose for Gardasil drastically dropped. 
Both vaccines are administered over a period of 6 months in 3 doses, difference being on the second dose where Cervarix is given 1 month after the first dose while Gardasil being 2 months. 
My personal preference would be undoubtedly Cervarix.
 
Based upon the formulation on which the vaccine are made, you'll notice that GSK's Cervarix is far more superior than Gardasil. Cervarix's formulation includes the use of AsO4 (Aluminum hydroxide) as adjuvant that gives the immune system a boost in formation of antibodies and is maintained at a higher level for a longer period of time. 
To date,a study continues to be conducted and has been 7 1/2 years now. Modeling of Cervarix long term antibody kinetics predicts it's immunity remain detectable for at least 20 years, while immunity by Gardasil  begin to dwindle by the 5th year upon administration. 
 

Study on Cervarix is still ongoing today. 

 
Aluminium Hydroxide as the "key factor" for its rapid and sustainability of high antibody level against oncogenic HPV strains. 
The other important factor being that the latest studies conducted by GSK on more than 18,000 women indicated Cervarix does more than only provide immunity against HPV 16, and 18, but cross protection against HPV 31,33, and 45 as well! 

Hence, it provides immunity against the top 5 oncogenic subtypes of HPV. While Gardasil gives protection against subtype 16 and 18, subtype 6 and 11 aren't oncogenic but instead causes genital warts, which is a curable condition.

Therefore, ladies and gentlemen, in that sense, Cervarix would be a pentavalent  vaccine while Gardasil being a bivalent vaccine. 

Which vaccine then would you chose then?
Insist upon the box to be opened right in front of you, just to make sure you receive the right vaccine since you have paid for it. 

Original packaging comes in a pre-filled syringe of 0.5ml of vaccine. Enclosed are two needles of different sizes. 

It would be unbelievable but as I've worked in a  clinic (a well established clinic in Sri Petaling) which is a panel clinic to many restaurants that regularly sends their workers for typhoid vaccination, and since they've ran out of stock, and to save money, instead of injecting typhoid vaccine, the owner actually pre filled an empty typhoid vaccine ampoule with normal saline, and started injected patient with it. Unbelievable, but its true.
Hence, ladies, please make sure that your doctor opens the box right in front of you, and the plastic container that holds the syringe and needles is sealed. Make sure the doctor opens the seal in front of you!

The colour of the vaccine would be slightly cloudy, and not entirely transparent. 
Being ranked number 2 killer among women in Malaysia, with more prevalence among the Chinese, please go to the nearest clinic to inquire about the vaccine. 
Though the recommended age of vaccination is between the age of 10-45, but since occurrence of Cervical Cancer among the elderly of age between 65-70 form a significant percentage out of the overall number, I would still recommend vaccination even in individual above the age of 45.(Remember that HPV is non detectable from blood investigation, but only through HPV DNA Genotype test that identifies not only the presence of HPV, but it's subtypes as well, upon discovering abnormality in Pap smear. 

Love yourself, ladies. Don't think it won't happen to you. The fact that it is ranked 2nd as the cause of morbidity in Malaysia speaks for itself. 
Current market cost per dose is RM230-250. As part of our effort to promote this life saving 
revolutionary vaccine, Klinik Wan dan Keluarga, Bandar Sri Damansara charges only RM165 per dose or RM480 if paid together for the three doses. 

Call us at 62722678 (working hours Mon-Sat 9am - 7pm) for an appointment. It is part of our clinic policy to create an awareness among community on latest development in medicine that is available today.
Wondering why only RM165? No, we don't use fake or "other substitute". It's original Cervarix from GSK. 
Ever heard of cases where woman who regularly goes for annual Pap smear and was told to be normal, but died few months later of Cervical Cancer? Ever wonder why? Look out for out next post!
   

Friday, March 5, 2010

Poor Kids...

My wife has been a supporter of World Vision, an organization that allows you to adopt a child from any continent whom their parents aren't able to support either due to poverty, war, orphans, basically for whatever reason that needs help financially. She has been actively supporting this organization for the past 7-8 years.
Yesterday, she received a card from World Vision on behalf of a 5 year old African child. They are given a card, and to write or draw something on it before being sent to the sponsors.
 
What would you think a 5 year old would draw? A love? An angel? A bright shining sun? A sparkling twinkling star perhaps? No... 

 
Can't see what is it? Perhaps try a closer look...

 
Yup, a knife, an assault rifle, and a hand gun. How on earth would a 5 year old kid would draw pictures as such when they should be drawing stickman with cape, or laser coming out from the eyes, or dinosaurs, perhaps UFO! But no. He drew weapons, weapons that kills. Is the kid trying to send a message across to his sponsor, or was it done out of his subconscious mind? 
If he were to draw this on purpose, he is risking getting his sponsors revoked. A 5 year old who chose to draw this probably never lived a life as a child should. He probably sees plenty of "these" therefore when being told by the organizer that they are given the liberty to draw anything to show appreciation to their sponsors, this is how he expressed himself. Perhaps that's all he knows. 
Poor kid. 

Save me a place in heaven

Have You heard me plea lately?
The one I asked of you God so dearly
I thank you for the angels You've sent me
A new breathe to my troubled life that would have ended prematurely

Lord I seek for Your guidance daily
Showed me light in darkness that consumed me completely
I am down reaching out to kiss your lotus feet
I know you had never left me

But Lord, I am bleeding, pleading, crying,
Wondering how it would be to see you
right in front of me standing
Would I cry, would I laugh, how it would be
If you were to appear before me

Tried my best to serve you, Father
My unwavering will, my hope never falter
I've wronged many in this lifetime
My previous would be the last time
So long I've never experience peace of mind
Pop the pill, take me from this body
that has never been mine.

Dark and gloomy my world is
Hell on earth is what I'm experiencing
All looks fine from the outside
But hell broke lose on the inside

A battle is fought at this point of time
between the devil and the angels in my mind
take away the pain, can't you see I'm hurting
the suffering never ceases, only increasing
In the event of my demise
only one wish i hope in this life of mine
Give me golden wings to soar the sky

Recognize me Father, before my demise
know my voice, see my face,
memorize my name, while there's time
save me a place in heaven
forever with you in your golden mansion.

But before you take me tonight
allow me to kiss my angels one last time
let me see them sleep is all i am asking
Before take me to your golden mansion.

                                -- WCH-- 5.3.2010
**this poem is purely for artistic expression and not by any means reflect my state of  mind.**

Thursday, March 4, 2010

Its hard to be a parent

I remember vividly the birth of my first daughter, Isabelle. The first time we made eye contact. The first time she uttered "daddy", the first step that she took. It seemed like all of these just happened recently. Those are memories that will never falter in my mind. The feelings of excitement and anticipation each time i bring my wife for antenatal checkup to see her growing with each passing month. That has got to be the happiest moment in my life. Even today, whenever i think about it, it never fails to bring out a smile in me.
However from a cheerful and happy girl, of late i noticed her character seemed to have changed. She is more quiet, reserved, and a little disobedient. It all started after the birth of my second daughter, Natalie. Isabelle's love for her sister is unquestionable, as she longs for her little sister to play with her, hug her every night before bedtime, or even a simple a simple peck on the cheek before leaving for school. Until today, I have not seen any form of jealousy from Isabelle, now that everyone's attention goes to Natalie. Her maternal and paternal grandparents who all these while paid so much attention to her now divert their attention to Natalie. Despite that, she still loves her little sister.
It broke my heart when she asked me why nobody seemed to play with her anymore. Why nobody seemed to concern for her nowadays. She felt neglected. I often ask her to talk to me freely on how she feels, what goes on in her mind, what she likes or dislikes.
I felt pity for her as i can see the contrast on the way she was treated prior compared to present. She needs attention, hence, subconsciously, she does things whether good or not, just to get it. Its normal human psychology.
Since the birth of Natalie, the changes in Isabelle is so marked that at present, she feels insecure and often unwanted. Seriously, I don't blame her for feeling that way. Non of her maternal or paternal grandparents play with her anymore! All attention goes to the cheeky second daughter of mine. Don't get me wrong, I love Natalie too, but I love both of them equally, and I spend equal time between both of them.
 
Isabelle's heart is genuine. Her love for her little sister Natalie is unquestionable. 

 
Isabelle, don't you know that you are the apple of daddy's eye?

 
 The once cheerful, and always happy Isabelle Wan....

 
now has changed so much. It hurts daddy to see you feeling down. Don't you know you have a special place in daddy's heart?

 
Daddy wants to see you being your old self again....

 
You'll always be daddy's little darling baby....

 
Always remember that, Isabelle....

 
You are always daddy's sweetheart.....

Tuesday, March 2, 2010

Happy Day!



This post is a continuation from the previous. My mood took a 180 degree turn when I received a call from the staff nurse in charge of the pediatrics ward. His repeated blood investigation showed lowering of bilirubin level to within the normal range, and that he is able to be discharged by today!
 
The feeling I had after the conversation was overwhelming. It felt like a burden was lifted from me. I felt relieved, happy, and glad that Leo need not stay for several days. 
Isabelle being a loving sister insisted on following us to Sunway Medical Centre to pick Leo up. We reached the hospital around 3.00pm. As we were walking towards the lift, suddenly I realized that I had missed my lunch!
Before going up the ward, we had our lunch at Starbucks. 

Feeling restless, Isabelle kept on pestering me to finish up my lunch fast so that she can see Leo. The moment we reached the 5th floor, we had to walk through the same corridor leading to the ward. But it was such a contrasting feeling compared to yesterday. Prior, my spirit was dampened and depressed, but today, its all happiness and feeling of joy. 
 

That's Isabelle running ahead of me. I just can't wait to see Leo again.We were ushered into the breast feeding room and were asked to wait while they brought Leo over to us. Indeed, upon seeing Leo, my heart was overwhelmed with happiness. He looked so radiant, active, and more expressive, compared to yesterday where he appeared mundane, lethargic, and sleepy.                            
































Spot the difference on the colour of Leo's face compared to the previous post? He was facing Isabelle trying to pin point the voice as their vision is still blur at this stage of life.
Isabelle expressed her feelings to Leo by telling him how much she missed him while he was in the hospital.
I can see the genuine sisterly love Isabelle has towards Leonidas.
 
Leo felt asleep after breast feeding.He looked so serene, so peaceful, emanating a kind of peaceful and calming aura towards people who was there in the room. 
After we settled the bill, we walked towards the car park.As we were walking I told Isabelle that Natalie and herself were born in this hospital. 
"Wow,daddy! This place is AWESOME!"

 
I have never been so glad seeing this "KELUAR"  sign in my life so far. 

As I had mentioned earlier, three children means three times the responsibilities. But its all worth it.