The term retinoids is often the cause of a lot of confusion on social media and in skin clinics. After sunscreen and rigorous sun avoidance, everyone’s skincare should ideally, include a retinoid.  Retinoids are clinically proven to treat and improve acne, fine lines and wrinkles, even out pigmentation (eg pigmentation/ sunspots)  and a host of other skin concerns over time (3-12 months) in large part due to their ability to stimulate collagen and elastin, increase the rate at which skin cells renew themselves and decrease inflammation (eg rosacea and psoriasis)  The most powerful retinoids are available by prescription only, with one exception: Differin (adapalene). Differin is an amazingly potent but well-tolerated acne treatment and the only prescription-strength retinoid to be sold over the counter. People often use the terms retinols and retinoids interchangeably but the two terms are not the same. They are related, but different. So what is a retinoid? A retinoid refers to all derivatives of Vitamin A converted into the active ingredient retinoic acid for use in skincare. Retinoid is also the term used interchangeably to refer to both over-the-counter (OTC) retinols as well as prescription retinoids. They’re available in pharmacies, beauty stores and salons as well as supermarkets and may be as cheap as $10 or cost hundreds depending on formulation and other base ingredients used.  Most retinoids are used topically ie applied to the skin, but some are taken orally eg isotretinoin aka Roaccutane for severe cystic acne, among other things. What is Retinol? Retinol is a type of retinoid available OTC and while still effective, it differs from prescription retinoids such that it needs more steps for retinols to be converted to retinoic acid than for retinoids. More steps for conversion to retinoic acid = weaker retinoid. As such, OTC retinols work more gradually and can be less irritating especially for those with sensitive skin. Can everyone use retinoids? I believe that with adequate preparation and sensible onboarding, almost everyone can tolerate a retinol/ retinoid and reap the benefits, but the secret is in the onboarding.  Some of my top tips when starting out:  start with an OTC retinol and acclimate to using that nightly before considering if you’d benefit from prescription retinoid from a doctor (a minority will not tolerate prescription retinoids ) I generally recommend starting with using it 1-2 times a week then stepping upto 2-3 times a week the following week and then upto nightly if all goes to plan.  keep the rest of your skincare super simple - cut out all other active ingredients such as acids, scrubs and more.  common side effects of onboarding retinoids are dryness, temporary irritation, peeling and flaking - so prepare for them and extra serums and moisturiser will help calm skin down as it acclimates.  less is more when it comes to active ingredients - the lowest concentration of the drug that gives you results is the right dose for you. Higher strengths may cause more irritation causing you to use it less often or worse, abandon your regimen.  rigorous sun avoidance is non negotiable - you are more likely to burn if you are not careful, so daily SPF and sun protection should be an established habit by the time you onboard retinoids.  If you're not sure which one is best for you or want a tailored skin regimen specifically for you, make an appointment and we’d be happy to talk you through it all.  These drugs are not suitable if you're pregnant or breastfeeding; avoid using retinoids altogether once pregnant until after you’ve given birth.  Key take-home tips:  like all skincare, remember that retinoids are a longterm commitment to healthy and beautiful skin. If you stop using them, over time, your skin will return to its pre-retinoid state.  retinoids take around 3 months minimum for you to begin to see results, and as long as upto 12 months if you have significant skin concerns eg acne, pigmentation, rosacea  do not stop-start your prescription retinoids without medical advice. Make an appointment to see your doctor annually to obtain your prescription and to check all remains well with your skin. Being erratic with your prescription may do more harm than good.   

There is no doubt about it. Even in people with good skin, the gradual process of ageing, questionable lifestyle choices and transitions that make up part of life all begin to take their toll, sooner or later.  For some of us, this may begin as early as our 20s, which is when collagen production generally begins to slow down, and the plumpness and glow of youth is gradually lost. For others, if genetics are on our side and we observe some basics such as rigorous sun protections habits, we may get longer, into our 30s, and if we are fortunate, our early 40s.  Alas, for all of us, it is inevitable that over time, collagen will begin to decline, along with other changes - volume loss in the face, loss of plumpness in the skin and overall glow and the gradual etching of fine lines and wrinkles that may eventually make way for deeply etched lines present even at rest.  When I first see patients in clinic, especially if they've let nature take its course for some years, or even a decade or more, it is important to replace volume loss quickly with dermal fillers and to restore some youthfulness to the face. However, it is equally important to recognise that this is not a panacea, and that more and more filler will inevitably risk the dreaded pillowface, or overfilled face, which is a caricature.  Instead once we have optimally replaced lost volume, I encourage patients to shift focus with me to longterm goals, which relay on improving skin quality, inducing collagen and establishing and maintaining lifelong habits that will enable them to age well, for a decade or longer to come. The aim is not to be a one-and-done thing but rather an ongoing investment in oneself and commitment to ageing well, whatever that looks like for the individual.  To that end, skin therapies are the bedrock of any ageing-well regimen because they rely on building habits and maintaining those, no matter how big or small, such that over time, imperceptibly, they pay dividends. They are not the stuff of "wow" or "magic" or instant gratification, but rather a gradual and sustained improvement visible only after some weeks or months, which in the process, teach us the value of prioritising ourselves, investing in ourselves and committing to our stated goals with our time, energy and budget.  Skin Therapies consist of a personalised treatment plan with our team, in conjunction with you and your stated goals. They consist of:  a bespoke skincare regimen addressing your specific concerns, whether based on our cosmeceuticals range or prescription range if there is existing skin disease such as acne, rosacea or pigmentation  support around beginning active ingredients that may cause irritation by our staff until you are comfortably and safely using the regimen nightly  recommendations from monthly in-clinic skin therapies that would complement your skincare regimen, designed with you and your goals in mind, which also hold you accountable to your treatment and skin goals.  as with all skin therapies, skin takes time. Skin diseases take longer to resolve and begin to show improvment, typically 6-10 weeks depending on the concern. During this time, in-clinic treatments may accelerate some of the results  most skin therapies needs a series of initial treatment sessions to jumpstart the process, after which we would recommend a repeat session once or twice a year to maintain results Results are cumulative and worthwhile, the hardest part is finding a clinic and treatment partners who are qualified and who can work with you to help you achieve your goals, and then getting started. 

Where Medicine meets Art, for your best skin ever....

When the COVID19 pandemic hit us and lockdowns began, we were likely expecting to be facing restrictions for much longer than we’d wanted and expected. Months, possibly. Instead, thanks in large part to frontline workers and the efforts of everyone else who has stayed at home and done the right thing, we’ve managed to flatten the curve and to avoid overwhelming the health system- for now. In the wake of this, there are plans afoot to open up certain types of surgery from next week, 27/4/2020 and to see what effect that has, if any, on cases. It’s worrying to see that some others have continued injecting and others will be resuming business from 27/4/2020. I’ve sought advice from my medical defence organisation and while it’s not illegal, their advice remains - they strongly advise against all non essential medical services in view of the risk despite all due precautions and the ongoing shortage of protective equipment for frontline workers including GPs to see actual sick people. I can’t in good conscience open at present so we will delay and wait until May 11 or so to see what the recommendation is. I’d hate to see a second wave because people take it upon themselves to open too soon after all the success we have achieved as a nation, largely due to the hardworking frontline workers who have taken the risk for all of us. We hope to open around May 11th or just after, and all being well, we will have plenty of time to focus on your skin goals this winter in a safe and ethical manner without taking away from frontline workers. Until then, please stay at home, stay safe and keep saving for your treatments. For those observing Ramadan, Ramadan Mubarak, we hope to open up bookings from Monday, May 11th if all remains well, and we look forward to welcoming you in our purpose built clinic just for skin soon. Bookings may be done here. We will post more closer to the date about how we aim to protect you and ourselves while caring for your skin, all being well. Hope to see you in clinic soon.