Aesthetic Medicine and Aesthetic Practioner

What is Aesthetic Medicine? 

Aesthetic medicine is a branch of medicine focused on satisfying the aesthetic desires and goals of patients. This specialty is primarily focused on the pathophysiology of aging skin, and adheres to scientific based procedures. In another words, I would say aesthetic medicine is about helping the patients to achieve their best outlook and body shape that may boost their self confidence and self-esteem in the effective way, evidence-based and most importantly it is safe to their health.

Doctors practicing Aesthetic Medicine are trained in both invasive and non-invasive treatment modalities, and typically utilize a combination to meet the needs of the patient. So, it is obvious that Aesthetic Medicine practitioners are only for doctors and it is not for beauticians!  

What are the different between an Aesthetic Practitioner and a Beautician? 

Many people think a doctors who is practicing aesthetics has become a beautician and a beautician practice is the same with aesthetic practice. In fact they are different like the sky and the earth! 

Unlike beauticians, aesthetic physicians being a doctor, they obviously have far better knowledge of the skin from anatomy to pathophysiology and it functions and how it responds to various treatment modalities and scientific equipments and they are aware of the complications that might arise from the procedures that they may take anticipatory measures to prevent the complications or at least they can inform the patient first before they decide to undertake the procedure. Aesthetic physician takes full responsibility to explain to the patients what procedure is suitable and what is not suitable for the patient's skin knowing the patient's medical background and they also in a position to treat the complication if it arises. The aesthetic doctor also has basic knowledge to understand the science behind scientific equipments like lights and laser and the products which are beyond the comprehension of the beauticians that they may apply safety precautions and recommend to the patient who has the right indications for that particular equipment or products. So, in another word, the patient is in a safe hand of the adequately trained person to make sure the patients achieve what they desire without compromising their health. 

The law that regulate beauty practitioners are very vague and poorly implemented that there are many errant beauticians out there are crossing the line from their scope of practice. Beautician practices are supposedly to confine within beauty products and doing some minor skin procedure up to epidermis level of the skin, not more than 1 mm depth.  Yet, many are daring enough to give injections and using highly scientific equipments like laser that can be dangerous and are meant only for doctors. That is why almost all the complications and complaints of aesthetic malpractice that were reported and filed to Consumer Tribunal are from the errant beauticians!

When I gave a medical aesthetic talk recently, one of the participant asked me whether they can sue the doctor when there is complication or if the expected result is not achieved? My response to her question was that the doctors are doing what are within their scope of practice  and knowledge; she should sue the errant beauticians instead for doing what they are not qualified to do, for placing the patient at risk of danger, for misleading information and over promise of the result in order to sell the beauty products. However, there are also many doctors nowadays who fail to adhere to profesionalism and code of ethics that they are willing to be hired by the beauticians to do some aesthetic procedure without taking responsibility.  We also know there are many beauty centres that engage foreign doctors from Korea, China and Taiwan illegally to do aesthetic procedures and surgery to their clients in their poorly equipped centre or in the hotel. 

The patients or the clients who are seeking for beauty, most of them however are high risk takers.  People are willing to take whatever risk and spend lots of money just for beauty and satisfaction.  That is the reason why they undertake the procedure secretly so that when something goes wrong, nobody is pointing finger back at their risk taking behaviour or if everything is turned out to be perfect, they're enjoying the comments and wanders from their friends who are not aware that they have done something to their face. Many people are shy to let others know that they have gone for a beauty procedure.

Time has come that people should no longer feel shy to seek for beauty or aesthetic procedure.  There is nothing wrong wanting to look perfect and beautiful, slim and sexy, or looking younger and attractive as long as we don't put our health at risk that we make an informed choice instead of doing it blindly.  It is among the options that are available to the modern society to combat sign of aging from the environmental insults and ageing process.

Abnormal Menstruation

Abnormal Uterine Bleeding

What is abnormal uterine bleeding?

Abnormal uterine bleeding is any bleeding from the uterus (through your vagina) other than your normal monthly period. Having extremely heavy bleeding during your period can also be considered abnormal uterine bleeding. Very heavy bleeding during a period and/or bleeding that lasts more than 7 days is called menorrhagia (say: “men-oh-raj-ee-ah”). Women who have menorrhagia may, for example, bleed enough to soak through 1 or more tampons or sanitary pads every hour.

What causes abnormal uterine bleeding?

Many different things can cause abnormal uterine bleeding. Pregnancy is a common cause. Polyps or fibroids (small and large growths) in the uterus can also cause bleeding. Rarely, a thyroid problem, infection of the cervix or cancer of the uterus can cause abnormal uterine bleeding.
In most women, abnormal uterine bleeding is caused by a hormone imbalance. When hormones are the problem, doctors call the problem dysfunctional uterine bleeding, or DUB. Abnormal bleeding caused by hormone imbalance is more common in teenagers or in women who are approaching menopause.
These are just a few of the problems that can cause abnormal uterine bleeding. These problems can occur at any age, but the likely cause of abnormal uterine bleeding usually depends on your age.

Women in their teens, 20s and 30s

A common cause of abnormal bleeding in young women and teenagers is pregnancy. Many women have abnormal bleeding in the first few months of a normal pregnancy. Some birth control pills or the intrauterine device can also cause abnormal bleeding.
Some young women who have abnormal uterine bleeding do not release an egg from their ovaries (called ovulation) during their menstrual cycle. This is common for teenagers who have just started getting their periods. This causes a hormone imbalance where the estrogen in your body makes the lining of your uterus (called the endometrium) grow until it gets too thick. When your body gets rid of this lining during your period, the bleeding will be very heavy. A hormone imbalance may also cause your body not to know when to shed the lining. This can cause irregular bleeding (“spotting”) between your periods.

Women in their 40s and early 50s

In the years before menopause and when menopause begins, women have months when they don't ovulate. This can cause abnormal uterine bleeding, including heavy periods and lighter, irregular bleeding.
Thickening of the lining of the uterus is another cause of bleeding in women in their 40s and 50s. This thickening can be a warning of uterine cancer. If you have abnormal uterine bleeding and you’re in this age group, you need to tell your doctor about it. It may be a normal part of getting older, but it's important to make sure uterine cancer isn't the cause.

Women after menopause

Hormone replacement therapy is a common cause of uterine bleeding after menopause. Other causes include endometrial and uterine cancer. These cancers are more common in older women than in younger women. But cancer is not always the cause of abnormal uterine bleeding. Many other problems can cause bleeding after menopause. For this reason, it’s important to talk to your doctor if you have any bleeding after menopause.

Pelvic Organ Prolapse Treatments

Pelvic organ prolapse (POP) is a relatively common occurrence for women older than 50. In fact, it is estimated that as many as 50 percent of women in this age group have some degree of POP. Treatment for pelvic organ prolapse can be as simple as dietary changes or daily exercises, or it can include surgical procedures.

One of the most recent developments of surgical treatment of POP has included the use of transvaginal mesh. Even though transvaginal mesh has been declared "high risk" by the FDA, it continues to be used in routine gynecological practices around the nation. It is important that women educate themselves on their treatment options to avoid unnecessary health risks.

What is Pelvic Organ Prolapse?

The organs in a woman's pelvic region — the uterus, bladder and rectum — are connected by muscles and ligaments that hold them in place. These tissues become compromised, usually by pregnancy and childbirth. By the time a woman reaches menopausal age and beyond, the connective tissues can become so weakened that certain organs can shift, or drop.

In some cases, this shifting is so mild that the woman is unaware of it and it is diagnosed by her gynecologist in a routine pelvic exam. For other women, these organs can shift and drop so much that they begin to collapse into the vaginal canal. This can be uncomfortable and/or painful. In worst-case scenarios, a woman's ability to urinate or defecate can become severely compromised.

Treatment for Pelvic Organ Prolapse

There are a variety of treatments available for POP. It is important that women realize that treatment is often unnecessary. If a doctor diagnoses POP in an asymptomatic woman, the condition can continue to be monitored without any treatment as long as there are no negative side effects.

Non-Surgical Treatments

Dietary and Lifestyle Changes - Decreasing caffeinated beverages can reduce the need to urinate. Increasing fiber intake can prevent constipation. As obesity is linked to POP, maintaining a healthy diet and regular exercise routine can also help. A healthy lifestyle can reduce mild symptoms of POP.

Physical Therapy - Kegel exercises should be done regularly to strengthen the pelvic floor. Sometimes doctors will use electrical stimulation to contract the muscles in the vagina and pelvic floor to strengthen the connective tissue and reverse the condition.

Vaginal Pessary - A pessary is used like a diaphragm. It is carefully fitted into the vagina and provides the support necessary to keep organs from dropping further.

Surgical Treatments

Hysterectomy - If the prolapse is concentrated in the uterus, and a woman is through her childbearing years, a hysterectomy can often remedy the symptoms.

Reconstructing Vaginal and Pelvic Organ Support - There are several surgeries that can be used to rebuild the support of the vagina and connective tissues. Sometimes this surgical support is constructed using grafting tissues. A synthetic transvaginal mesh is an alternative to natural grafting tissues in these types of surgeries. Women need be exceedingly cautious before allowing transvaginal mesh to be used to correct POP. There have been serious complications linked to the use of transvaginal mesh.  There are even patients who have started to file a transvaginal mesh lawsuit against the mesh manufacturers because of such complications.

Women should educate themselves on the various treatments for POP and make sure to talk openly with their doctor regarding whether treatment is even necessary, as well as ensuring the treatment that is used will be the safest choice for their situation.

Staying Healthy at 50 and Beyond

How to stay health at 50+

At the age of 50, many women may have menopause while the rest are at the brink of menopause. Women after 50 are at risk of cardiovascular disease like high blood pressure, diabetes mellitus and heart disease especially of those who have positive family history, obese, high cholesterol, smoking and have not been exercise regularly.  The most common cancer affecting women at this age is breast cancer, colon cancer, cervical cancer, uterine cancer and ovarian cancer. In Malaysia, statistic shows that breast cancer is number one cancer killer in women followed by cancer colon.  All over the world number one killer of women after 50 yrs of age is heart disease. 

Get the Screenings You Need 

Screenings are tests that look for diseases before you have symptoms. Blood pressure checks and mammograms are examples of screenings. You can get some screenings, such as blood pressure readings, in your doctor’s office. Others, such as as mammograms, need special equipment, so you may need to go to a different office. After a screening test, it's important to ask when you will see the results and who you should talk to about them. 

Breast Cancer. The recomendation b the College of Surgeon, that women after 45 need to do a mammogram 

Cervical Cancer. Have a Pap smear every 1 to 3 years until you are age 65 if you have been sexually active. If you are older than 65 and recent Pap smears were normal, you do not need a Pap smear. If you have had a total hysterectomy for a reason other than cancer, you do not need a Pap smear. 

Cancer Uterus and Ovary:  Have your doctor do pelvic examination and transvaginal ultrasoundwhen you come for pap smear ever 1- 3 years.  Checking blood tumour marker like Ca 125 is a good complimentary for detection of cancer ovary. Almost all cancer ovary present with symptom at a very late stage.

Colorectal Cancer. Have a screening test for colorectal cancer. Several different tests—for example, a stool blood test and colonoscopy—can detect this cancer. Your doctor can help you decide which is best for you. If you history of colon cancer in your immediate family member, having a colonoscopy done once in every 1-3 years is a recommended.

Depression. Your emotional health is as important as your physical health. Talk to your doctor about being screened for depression especially if during the last 2 weeks: You have felt down, sad, or hopeless. You have felt little interest or pleasure in doing things. 

Diabetes. Get screened for diabetes if your blood pressure is higher than 135/80 or if you take medication for high blood pressure. Diabetes (high blood sugar) can cause problems with your heart, brain, eyes, feet, kidneys, nerves, and other body parts. 

High Blood Pressure. Have your blood pressure checked at least every 2 years. High blood pressure is 140/90 or higher. High blood pressure can cause strokes, heart attacks, kidney and eye problems, and heart failure. 

High Cholesterol. High cholesterol increases your chance of heart disease, stroke, and poor circulation. Have your cholesterol checked regularly if: You use tobacco. You are obese. You have a personal history of heart disease or blocked arteries. A male relative in your family had a heart attack before age 50 or a female relative, before age 60. 

Life-style Modicafication

Although it is easy said than done, living a healthy life style is a hallmark of staying healthy after 50 and beyond. As our body undergo accelerated aging after menopause, healthy life style e.g. exercising regularly helps to slow down aging, improves blood circulation, keeping muscle at work and healthy heart.

 About Body Image

When you look in the mirror, do you like what you see?

Is your body image positive or negative? If your answer is negative, you are not alone. Many women feel pressured to measure up to a certain social and cultural ideal of beauty, which can lead to poor body image. Women are constantly bombarded with "Perfect body " images. By presenting an ideal that is so difficult to achieve and maintain, the cosmetic and diet product industries are assured of growth and profits. It's no accident that youth is increasingly promoted, along with thinness, as an essential criterion of beauty. The message we're hearing is either "all women need to lose weight" or that the natural aging process is a "disastrous" fate.

Other pressures can come from the people in our lives.

• Family and friends can influence your body image with positive and negative comments.
• A doctor's health advice can be misinterpreted and affect how a woman sees herself and feels about her body. 

Learning to love what you see in the mirror

And don't forget your kids!

Parents’ attitudes about appearance and diet can affect their kids' attitudes. 

We all want to look our best, but a healthy body is not always linked to appearance. In fact, healthy bodies come in all shapes and sizes! Changing your body image means changing the way you think about your body. At the same time, healthy lifestyle choices are also key to improving body image.

• Healthy eating can promote healthy skin and hair, along with strong bones.
• Regular exercise has been shown to boost self-esteem, self-image, and energy levels.
• Plenty of rest is key to stress management. 

Your body image plays a role in your children

"On a diet, you can't eat." That is what one 5- year-old girl had to say in a study on girls' ideas about dieting. This and other research has shown that daughters are more likely to have ideas about dieting when their mothers diet. Children pick up on comments about dieting concepts that may seem harmless, such as limiting high-fat foods or eating less. Yet, as girls enter their teen years, having ideas about dieting can lead to problems. Many things can spark weight concerns for girls and impact their eating habits in potentially unhealthy ways:

• Having mothers concerned about their own weight
• Having mothers who are overly concerned about their daughters' weight and looks
• Natural weight gain and other body changes during puberty
• Peer pressure to look a certain way
• Struggles with self-esteem
• Media images showing the ideal female body as thin

Many teenage girls of average weight think they are overweight and are not satisfied with their bodies. Having extreme weight concerns — and acting on those concerns — can harm girls' social, physical, and emotional growth. Actions such as skipping meals or taking diet pills can lead to poor nutrition and difficulty learning. For some, extreme efforts to lose weight can lead to eating disorder such as anorexia or bulimia. For others, the pressure to be thin can actually lead to binge eating disorder: overeating that is followed by extreme guilt. What's more, girls are more likely to further risk their health by trying to lose weight in unhealthy ways, such as smoking.