Interview Room

Interview with the Doctor

Interview participants

asking questions
Dr. Muhaiyo Bartolo
answers the questions

Alisa from For this summer edition we have Dr. Muhaiyo Bartolo who is going to discuss the ageing process and its prevention through the concept of natural looking outcomes focused on a patient-centred approach and achieved through artistry. Dr. Muhaiyo, I would like to discuss your concept of beautification which as I understand refers to the process of successful ageing. Can you expand a bit on this topic

Dr. Muhaiyo: The basis of beautification is to change the way people view the topic of beauty and ageing. There is an antagonism that exists, and is perpetuated by society, that women should fear and hate ageing and the effect it has on their bodies. With this pressure, they will never find satisfaction with themselves, no matter the amount of products they buy or the treatments they seek to counter the effects of ageing. We believe that to help people achieve happiness, we need to dissuade them of these notions, and introduce a holistic approach to beauty that will leave people fulfilled and satisfied

Alisa from What do you believe are the first steps required to achieve this goal?

Dr. Muhaiyo: The most important step is awareness of what the skin is and how it functions. I would like to discuss this in a bit of detail for people to understand why taking care of our skin from a young age is vital. In other words, prevention is the fundamental answer. Facial skin regeneration is a natural process that our skin performs on its own. However, as we age, this process slows down significantly, and we encounter problems of an aesthetic nature

Alisa from Yes, can you give us a basic description of how the skin functions

Dr. Muhaiyo: The skin is our largest organ and belongs to the group of organs that have the greatest ability to regenerate. It consists of three basic layers – epidermis, dermis and subcutaneous tissue. The role of the epidermis is to protect us from external influences such as bacteria and toxins, and in theory it is renewed every 28 days. We can see that this renewal process for people over the age of 30 slows down

In the central layer of the skin, the dermis, there is collagen, elastin and connective tissues. They are responsible for binding water, so the vitality and volume of our skin is regulated in this layer of the skin. The dermis contains sebaceous and sweat glands, lymph vessels and hair roots. This layer of skin is responsible for the healing of wounds and burns and removal of toxic agents. The third, deepest layer of the skin, the subcutaneous tissue, provides insulation protection to our body, and it consists of blood vessels, fat cells and special collagen fibres that hold fat cells together

As the skin ages, the structure of these layers change, and changes in the epidermis such as wrinkles, freckles and pigmentations become visible. The connective tissue of the skin begins to deteriorate, the fatty tissue becomes thinner, and significant changes occur in the blood vessels and sebaceous and sweat glands. All these changes are accompanied by a decrease in regenerative capacity, which decreases by 7% every 10 years . Regeneration of facial skin is especially important because the changes on this part of the body are most noticeable, and facial skin is more sensitive than the skin on other parts of the body.

Scheme 1.1. Three main layers in the younger skin
Scheme 1.2. Three main layers in the older skin

Alisa from Can you expand a bit on skin regeneration and what can be done to aid it?

Dr. Muhaiyo: Precisely on the basis of skin layers, facial skin regeneration can be divided into surface regeneration, internal regeneration and deep tissue regeneration.

I can explain the process of skin regeneration with the example of wound healing where such damage can be superficial and deep, and leave our skin with or without scars. After the skin injury, the blood forms a membrane that sticks to the wound and protects it from external influences. Dead and damaged cells are then released, and they are dissolved by enzymes, the cells that “eat” the dead cells are activated, and then the lymph fluid is poured into the wound. The last segment of the skin renewal process involves the formation of collagen fibres and connective tissues

Alisa from What are the factors that affect skin regeneration?

Dr. Muhaiyo: After the process of skin regeneration that is activated due to the formation of wounds, we can also discuss how this process applies to minor lesions such as acne, pimples and blackheads. If they are not managed in an adequate way, these imperfections can leave scars on the face and body.

We mentioned the ageing process, which will greatly slow down the normal regeneration of the skin, but also the process of epithelial renewal during wound healing (wounds end up healing up to 4 times slower). Apart from ageing, the regeneration of the skin of the face and body depends on factors such as skin care, diet and other lifestyle habits that include smoking, alcohol consumption and exposure to sunlight. In fact, in scientific circles it is believed that skin ageing caused by external factors account for up to 70% of the ageing process, while only 30% is due to the biological ageing process. So, if you act on external factors in an adequate way, you will reduce the ageing process of the skin, and thus maintain the regenerative ability of the skin. It should be noted that deeply damaged facial skin regenerates much longer, because the surface layer of the skin is primarily damaged, and the body focuses primarily on certain damage, and neglects the regular regeneration process

Alisa from To your point on external factors, what can we do to slow down the process of ageing?

Dr. Muhaiyo: The ageing process of the skin actually begins at the age of 25. This is why we initially mentioned that prevention at a young age is key. The use of moisturiser and appropriate natural, good quality cosmetic products should be used from a young age so that the skin maintains its health and natural glow. However it is important to note, especially nowadays, that we should not exaggerate the use of cosmetic products.

Another consideration that will slow down the process of ageing is a healthy diet that is very important for the health of all organs, including the skin. A diet that limits sugars and dairy products will make a difference to the appearance of one’s skin. Avoid alcoholic beverages and smoking that have an adverse effect on the skin, and cause reactions such as pimples and other imperfections. As we mentioned, imperfections slow down the normal regeneration of facial skin. Proper sleep is required to get rid of toxins to which our body was exposed during the day. Nighttime is the period when the skin regenerates. The better quality of sleep and the longer the sleep, the more time your skin will have to focus on cell renewal and regeneration

An example of the effects of stopping alcohol on the skin
Example of the effect of healthy diet on the skin

Alisa from What are you looking at when you assess a person’s skin and face?

Dr. Muhaiyo: We look at a variety of factors such as the hydration level of the skin, the sebum level, the condition of the pores, melanin and pigmentation, acne, wrinkles, the degree of skin sensitivity and the degree of skin softness, laxity and level of sagging

Alisa from What treatments would you advise to a person who comes to you?

Dr. Muhaiyo: I generally assess the skin around the face and neck area to see if a treatment is needed. The treatments generally include botulinum toxin for the treatment of wrinkles caused by muscle movement, dermal fillers to lift, to contour and to fill. There are dissolvable threads to improve sagging face and skin treatments such as collagen stimulation treatment according to the skin type and the problem of the skin

Alisa from What is your advice regarding skincare for home use?

Dr. Muhaiyo: Some patients like to use something like micellar water to cleanse their skin and then apply a hydrating cream, thinking that is all that is required. A skincare routine needs to be tailored to the specific skin type and age of the individual. Home care is generally a three step process that should include the following

Cleansing as the first step of the process unless executed well, makes all the products that follow useless. Approximately 90% of patients, when it comes to picking out the right products for this step in the process, are unable to correctly select what their skin actually needs. Acids such as alpha and beta hydroxy acid cleansers are important in this first step because unless the skin is well cleansed, all subsequent products that are applied would be rendered ineffective. The strength of these acids also need to be tailored to the specific skin type of each individual.

Patients who want to see results need to use skin care that contains active ingredients, however these also need to be picked according to the need of an individual. For example, Vitamin C in a cream can sound interesting however one needs to take care that the product has the right quantity of the ingredient to be considered effective. Additionally, one product with Vitamin C will not work the same for someone who is attempting to protect their skin as someone who already has photo damage on their skin and needs to treat this issue. Every skincare routine needs to be customised to the skin type of the patient as well as the skin problems being faced.

Protection against the sun is important and certain people will require more protection than others e.g. someone who smokes or who works in certain conditions where a normal day cream is not enough. People are very bad at diagnosing themselves, a lot of people will say that they have dry skin when in fact only approximately 15% of the world population actually suffer from dry skin. Our specialists can provide a cohesive protocol that combines individualised procedures, products and ingredients

Three stages of which, as a rule, Home care consists

Alisa from In your opinion, when should sunblock be used?

Dr. Muhaiyo: In Malta sunblock needs to be used throughout the year as we have approximately 300 sunny days per year. Patients come to us and ask about sunscreen and while they understand it is important, they don’t understand the extent to which they should go to protect their skin. For example, most sunburns happen in the spring time, a period of time that people take for granted and are usually surprised when they do end up with sun burns. May is actually an important month for fighting against various types of skin disease and skin damage.

When you are exposed to the sun, the correct method of sunscreen application is to re-apply the cream every two hours. In instances when you come into contact with anything that can physically remove that barrier that the sunscreen provides, such as swimming or excessive perspiration, reapplication is important, irrespective of the amount of time that has passed. What matters as well is the amount of sunscreen applied, you should generally aim for two tablespoons of sunscreen (2mg/cm2) to cover exposed areas of the skin. It is vital that the cream creates a physical barrier against the sun, therefore it is counterproductive to spend an excessive amount of time rubbing the cream into the skin.

Another thing to take into account is that any cream under Factor 30 does not provide enough protection against the sun. I have had patients that are confident in their knowledge of application and would advise that they apply sunscreen with Factor 15 on a daily basis. This is not strong enough to protect against sun rays. Rather, sunscreen with Factor 30 or 50 needs to be used in order to protect the skin against the damaging effects of the sun. General advice is to use sunblock SPF 30-50 and protect against UV-B and UV-A. UV-B are sun-rays which cause sunburn and skin disease while UV-A are the rays which cause ageing and wrinkles.

Yet another point that needs to be discussed when it comes to sun protection, is that regular sunscreen application is only approximately 97% of the story in the fight against sun damage. Patients have come to me in frustration claiming that they apply sunscreen religiously and yet their skin still has noticeable traces of sun damage. What is crucial to take into account as well is that physical protection, in the form of hats and sun glasses and reducing prolonged periods of time under the full glare of the sun, is vital to ensure that skin remains unblemished and unscarred.

Alisa from Is more expensive sunscreen automatically better in quality and effectiveness?

Dr. Muhaiyo: The answer is no, what is important with sunscreen is to ensure that the right SPF is being used, as well as to apply the right quantity of the product to ensure adequate protection. It is worth noting that nowadays one should also search for creams that protect against blue light caused by electronic devices.