I am Dr Mohammad Khurshid Basra. I am a dermatologist and dermatosurgeon. I am mainly based in the UK and work in the National Health Service of England, currently at a hospital in Surrey. I am also a visiting consultant at my Lahore-based dermatology, cosmetic and laser surgery clinic, based at DHA Sector 1. We started this clinic back in April last year, which I believe is the first facility of its type dedicated to the treatment of scars.

As I indicated above, my area of special interest is the treatment of scars and keloids, such as scars resulting from injuries like burns, surgery and acne. In addition to scar treatment, we see a lot of patients for treatment of pigmentation, acne, hair loss, oily skin and large pores, as well as laser hair removal, cosmetic treatments for skin rejuvenation, and anti-ageing procedures such as Botox, fillers, HIFU, PRP, micro-needling and removal of lumps and bumps. We also offer treatment for general and complex skin diseases.

We have a state-of-the-art medical spa in which we offer a whole range of medical facials using only imported, high-standard skin care products, as well as other services like Hydrafacial and Microdermabrasion, carried out under the direct supervision of qualified doctors and highly trained beauty therapists.

Scar revision is my main expertise, and the way I treat scars is through a multimodal treatment approach — meaning I make use of different treatment modalities at the same time, or in steps, to achieve the desired outcome for scar improvement. Although ablative fractional laser is our workhorse for scar treatment, we also use medical therapies, plastic surgery, subcision, PRP, cryosurgery, fillers, Botox, compression, induction of repigmentation, contracture release, micro-needling, injection of chemotherapeutic substances, and some other methods as part of our multimodal treatment for scars.

Yes, I agree — we have a lot of very anxious patients who are concerned and rightly distressed by their hair loss, and we know that more than 30% of the population suffers from alopecia or hair loss. Three main causes include androgenic alopecia, alopecia areata and telogen effluvium. Seasonal variation, nutritional factors, ageing, hormonal imbalances, inflammatory disorders of the scalp, autoimmune hair disorders and psychological factors are also implicated.

I would particularly like to highlight telogen effluvium, which I believe is the main reason for hair thinning in women of all ages presenting to a dermatologist, and this can result from iron deficiency, thyroid disorders, childbirth, surgery, chronic diseases, dietary changes, high fever and stress. Treatment, of course, depends on the underlying cause and needs comprehensive assessment and detailed history-taking, sometimes with investigations like scalp biopsy and blood tests.

Treatments we offer in our clinic include topical and injected steroids, hormone rebalancing, vitamins and nutritional supplements, topical vasodilators, 5-alpha-reductase inhibitors, and anti-fungal and anti-parasitic medication. We also sometimes use PRP (platelet-rich plasma), especially for female and male pattern hair loss (androgenetic alopecia). Unfortunately, we are currently not offering hair transplantation in our clinic, but can refer patients to well-qualified and trained hair restoration surgeons.

There are two types of ageing processes: intrinsic and extrinsic ageing. Intrinsic, or chronological, ageing affects the skin of the entire body, including sun-protected sites, whereas extrinsic ageing can be considered premature ageing and is induced by sun or chronic ultraviolet (UV) radiation exposure, and quite importantly, by smoking.

In the context of intrinsic ageing, menopause in women is the prime example, in which signs of ageing begin at around 50–60 years of age, attributed to a decrease in the protective effects of oestrogen during menopause. The role of nutrition in relation to extrinsic ageing cannot be over-emphasised. Fruits, vegetables, legumes, herbs and teas contain antioxidative compounds. Vitamin C and increased linoleic acid intake are known to decrease wrinkling, skin thinning and dryness, while a higher fat and carbohydrate intake has been associated with an increased risk of wrinkles and skin thinning.

Intrinsically aged skin appears dry and pale, smooth, thin, transparent and unblemished. It has fine wrinkles, and sagging or laxity may occur with body movement due to loss of elasticity. Extrinsic ageing, such as photoageing, affects habitually exposed areas of the body such as the face, neck and arms, and its features include roughness, deep wrinkles, dyspigmentation, easy bruising and sallowness.

I have a very holistic approach to treating skin ageing, and advise my patients to take care of all components of ageing skin, not just cosmetic cover-up with fillers and Botox. For example, moisturisers help improve dry and flaky skin; vitamin C, alpha hydroxy acids and retinoid creams applied regularly, long-term, reduce fine wrinkles and dryness and even out pigmentation. Sun-block creams prevent further sun damage, and drinking plenty of water and fluids improves the general hydration status of the skin.

As for specific facial rejuvenation, the procedures we offer include fillers like hyaluronic acid, Botox injections to reduce frowning and lessen deep furrows, and resurfacing procedures such as micro-needling, microdermabrasion, chemical peels and laser resurfacing. We also use the latest 3D HIFU for non-surgical skin tightening and face lifting, including jowl and double-chin treatment.

Although not much can be done to prevent intrinsic or biological ageing, I would say protection from the sun's UV rays is essential at all ages to prevent extrinsic or photoageing, and this should start at a very early age, like young children. There are several steps that can be taken to minimise or avoid UV exposure:

• Be aware of daily UV index levels and avoid outdoor activities during the middle of the day, especially between 10am and 4pm.
• Wear sun-protective clothing, such as a broad-brimmed hat and long sleeves.
• Apply a very high sun-protection factor (SPF 50+), broad-spectrum sunscreen to exposed skin, and repeat every two hours if staying outside in the sun.
• Avoid smoking, including vaping, and where possible, avoid exposure to environmental pollutants.
• Drink plenty of water and fluids like fresh juices and green tea.
• Take plenty of exercise — active people appear younger than inactive people.
• Eat fresh fruit and vegetables daily.
• Oral supplements with antioxidant and anti-inflammatory properties can retard skin ageing and improve skin health, including omega-3 fatty acids, aloe vera, carotenoids, polyphenols, chlorophyll, vitamins B, C and E, and red ginseng.

Melasma is a common problem in Asian and African skin, and we receive a lot of patients who have tried multiple over-the-counter remedies, as well as proper medical treatment, without any long-term improvement. Although the exact cause of melasma is not fully established, it has a clear association with increased exposure to sunlight (especially ultraviolet rays) and female hormonal activity, and in one third of patients there is a genetic predisposition.

Melasma and other types of pigmentation can be treated using similar methods, and most topical treatments used for melasma act by inhibiting tyrosinase. Examples of tyrosinase inhibitors include hydroquinone, kojic acid and arbutin. One important aspect of melasma treatment to keep in mind is that results take time to become noticeable and are rarely 100% successful — pigmentation can re-appear after some time, especially without strict sun protection, or under the influence of female hormones, such as pregnancy.

I personally use a combination approach for a quick initial response to satisfy the patient, along with long-term maintenance to prevent relapse. I do not think laser treatment alone is the answer to melasma, as there is invariably a relapse of pigmentation after some time. I therefore use a unique method of mesotherapy with special depigmentation products for immediate effect, followed by repeated sessions every three months, along with adjuvant oral and topical treatment and lifestyle advice to minimise exposure to ultraviolet light and other triggers of pigmentation. I have also recently started using a brand-new, completely non-invasive technique based on current published evidence showing promising results.