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I am currently in a limbo as to whether i should stick to my current doctor from an aesthetic clinic or seek treatment from dermatologist in NSC.
Backstory: I’ve been with this aesthetic clinic for several years now and my main issue is with acne, nothing severe but I wanted to have clear skin so i have been seeking treatment. Initially I got started on Isotretinoin 20mg 5/7 for quite a long period of time (2 year~) and when the doctor finally started tapering my dose, he also left the clinic which left me to abruptly stop the treatment on my own (which i probably shouldnt have). So i got switched to another doctor and i’ve been on spironolactone for approximately 1-1.5 years (albeit rather non-compliant) but not much of an improvement and i was thinking of getting started on Isotretinoin.
When i asked my current doctor about looking for more permanent solution to acne, he told me that there are no permanent solutions to that (i understand that there are no guarantees with ANY treatments as it depends on how individuals respond to the treatment) but that made me hesitate if i should continue going back to seek treatment since i’ve been with them for quite sometime.
For NSC, I managed to speak to a senior consultant (not a consultation session but a quick chat during my dad’s appointment) he mentioned that if i were to go to the polyclinic to get a referral the doctors in the subsidized clinic wouldn’t consider my case serious enough to be started on Isotretinoin which means i’d probably have to go in as a private patient and that means that consultation fees would be on the pricier side (for a student with no income). However, if i do seek treatment at NSC it would seem that medication wise would be cheaper as compared to the aesthetic clinic that i have been going to (generic vs branded drug).
To sum it up:
- Cheaper consultation fees (as compared to NSC with a dermatologist)
- Pricier medications cause they use branded drugs
- Slightly unsure if i should stick with the doctor as i’m not very satisfied with his explanations
- Double the cost of consultation fees of my current clinic
- Cheaper drugs since they use generic drugs
- If i go with subsidized clinic i wouldn’t have the same doctor review my case and if i go as a private patient the cost would be quite a lot (assuming that i’d have to go back for review monthly?)
Really sorry for my long grandmother story but i’d really like to seek some advice from other doctors before deciding if i should switch doctor or go to nsc (i have been having a debate mentally for quite awhile now)
Thank you! (finally reached end of my endless rambles)
I wouldn’t say that either is particularly superior in terms of treatment for acne per se. Everyone has their own practices pertaining to the use of isotretinoin or spironolactone.
For instance, I have a lower threshold for using isotretinoin for cystic acne. My patient had suffered very severe acne and was kept on 6 months of doxycyline by her dermatologist, and finally plucked up the courage to visit me on a friend’s recommendation. Isotretinoin has solved her issue, and she can finally reduce the thick makeup and walk out with her confidence.
It boils down to the doctor you are seeing really, so I would suggest for you to look around for someone you have heard good reviews about. I would also like to entreat you to be compliant to medications to get the maximal effect, as well as for you to use the right products to augment the medications.
PS it’s not true that private clinics use only branded drugs, as I have found that the generic Isotretinoin had less complaints from my patients.
Wishing you the best!
Dr Winston Lee
South Bridge Aesthetics Clinic
I’d suggest for you to read mine and Dr Winston’s answer here for a primer as to our opinions for who and where you should go to in Singapore for acne treatment. We also share some of our personal experiences with battling acne.
In a nutshell, I think that the single most important factor is that the doctor takes a genuine interest in you, and treating your condition. Other considerations are secondary.
Of course, as Dr Winston pointed out, it’s very important that you’re compliant to the treatment regime as well.
From your brief history, I saw that the senior consultant at NSC thinks your case not serious enough for most doctors to start you on oral isotretinoin. I hope to remind you of the undesirable effects of oral isotretinoin, which include dry lips/mouth, skin peeling and itch, as well as risk of birth defects if pregnant while on the drug.
I use oral isotretinoin on male patients fairly regularly, but with ladies of childbearing age I prefer other medication, proper skincare and also laser treatments.
Laser treatments are seldom used in NSC to treat acne, because only the senior doctors there have access to the laser. Laser treatments are also very proven in acne treatment, with the erbium-glass laser shown to clear up to 40% of acne spots in just one treatment, and achieving nearly 100% clearance with long term control after an average of four sessions in one clinical study. This was active inflammatory acne and not just mild acne.
Please note that even spironolactone has possibility of systemic side effects like giddiness and blood potassium level disturbance.
Hence, I would recommend you to seriously consider laser treatments which provide other skin benefits (scar lightening) and which only treat the oil glands on the areas treated (unlike isotretinoin that dries up the entire body).
Hope this helps!