By Dr Gerard Ee

In more than 10 years of treating the under-eye area, the single most common problem I see is not eye bags, tear troughs or dark circles. It is a misdiagnosis, usually self-diagnosis.

A patient looks in the mirror, sees shadows or puffiness under the eyes, searches online, and subsequently requests a specific treatment. Approximately fifty per cent of the time, the treatment they are asking for does not match the actual issue they likely have. And the uncomfortable truth of this field is that the wrong under-eye treatment not only fails to help. It frequently makes things look worse.

So before you book anything—at my clinic or anyone else’s—let me walk you through how I distinguish these conditions in the consultation room.

The five conditions that get confused with each other

When someone says “I have eye bags”, the real diagnosis is usually one (or a combination) of these five:

1. True eye bags— protruding lower eyelid fat
2. Tear-trough hollowing— a groove between the eyelid and cheek
3. Mid-cheek deficiency— loss of cheek support under the eye
4. Skin laxity— loose, crepey lower eyelid skin
5. Dark circles— pigmentation or visible vasculature

They can look superficially similar in a photo. Under examination, they are completely different problems with completely different solutions.

True eye bags: the fat is pushing forward

A true eye bag is a convexity: a soft bulge below the lash line. Behind your lower eyelid sit three small fat pads, normally held in place by a thin membrane called the orbital septum. When that membrane weakens with age, or earlier if it runs in your family, the fat pushes forward, and you see a bag.

How I identify it:

• The bulge is present every day, whether rested or tired. Sleep doesn’t change it.
• When the patient looks upward, the bulge typically becomes more prominent: the fat is pushed forward.
• Gentle pressure on the eyeball through the closed upper lid makes the lower lid bulge increase.
• There is fullness first, and often a shadow belowthe fullness.

If the primary problem is protruding fat, the only treatments that work are ones that reduce or reposition the fat. In my practice, AGNES + Secret RF for mild Grade 1–2 bags with firm skin, or surgery for more advanced cases. No cream, no skin tightening, and most importantly no filler removes protruding fat.

Tear-trough hollowing: the valley, not the hill

A tear trough is the opposite problem. It is a concavity in the skin. It is a groove running diagonally from the inner corner of the eye toward the cheek. The shadow cast in this groove reads as tiredness or even as a dark circle.

How I identify it

• The darkness largely disappears when light hits it directly or when the skin is gently stretched; it is a shadow, not pigment.
• In overhead lighting, the groove deepens dramatically.
• There is no bulge to speak of, the eyelid-cheek transition dips inward.

A genuine, isolated tear trough is one of the situations where filler is the appropriate tool. A small amount of volume in the groove softens the shadow. But this is exactly where misdiagnosis gets dangerous, because many patients with true eye bags also have a groove below the bag, and filling that groove under a bulging fat pad usually makes the whole area look heavier. I have written about this separately because it deserves its own article.

Mid-cheek deficiency: the problem is below the problem

Sometimes the under-eye area looks hollow and shadowed, not because of the eyelid itself, but because the cheek below it has lost volume or projection. The lid-cheek junction loses support, and the under-eye area appears to sag into the deficiency.

How I identify it

• The shadowing extends further down the cheek than a classic tear trough.
• The face in profile shows flattening of the mid-cheek.
• Restoring cheek support with filler placed in the cheek, not the eyelid visibly improves the under-eye area, often without touching the under-eye at all.

This is one of my favourite diagnoses to explain, because the treatment surprises patients: we improve the under-eye by treating the cheek.

Skin laxity: the skin itself has aged

In older patients, the dominant problem is often neither fat nor hollowing, but loose, crepey lower eyelid skin. Fine horizontal wrinkles, skin that takes a moment to spring back when gently pinched, a generally deflated texture.

This matters enormously for treatment selection. Loose skin:

• Cannot be fixed with filler, as it adds weight to skin that cannot support it.
• Cannot be adequately fixed with fat reduction alone; removing the fat under loose skin can leave you with deflation and wrinkles.
• Usually needs surgical management; in many cases, a pinch blepharoplasty, which removes a fine strip of excess skin at the lash line, is often combined with fat removal.

This is why, at The Clifford Clinic, we routinely tell older patients that non-surgical eye bag treatment is not their best option. The skin around the eyes cannot be loose if you want a good non-surgical result.

Dark circles: pigment and blood vessels

Finally, true dark circles is an actual discolouration of the under-eye skin from melanin. Its common causes are often hereditary or worsened by rubbing and eczema or from visible blood vessels under thin skin.

How I identify it. I stretch the skin gently or shine light directly on it. If the darkness stays, it is pigment or vasculature. If it vanishes, it was a shadow from a trough or a bag.

One pattern I look for specifically: dark circles associated with allergic rhinitis. Chronic nasal congestion impairs venous drainage under the eyes, and prolonged rubbing of itchy eyes causes darkening of the thin skin—the classic “allergic shiners”. These patients need the allergy treated, not just the discolouration. My approach involves initially confirming the allergy through an allergy blood test and a skin prick test, followed by managing it with sublingual immunotherapy (SLIT). Concurrently, the dark circles are treated with V Beam Eyes which is a vascular laser and Juvelook Eyes, which stimulate collagen production. Treating the discolouration during ongoing rhinitis treatment is crucial, as it explains why the dark circles keep coming back.

For other pigment problems like pigment treatments and no amount of fat removal or filler will lighten melanin.

The quick self-check table

Most patients have a combination. A mild bag plus a mild trough. A trough plus pigment. Loose skin plus fat protrusion. Combination problems need sequenced, prioritised treatment, which is exactly what an examination establishes and a photo on a website cannot.

Why I insist on examining before recommending

I can grade a fat pad, test skin recoil and check how light and pressure change the contour in about five minutes of physical examination. Those five minutes determine whether you should have RF fat reduction, filler, surgery, pigment treatment, or simply more sleep and less salt.

In my experience treating eye bags for over a decade, the patients who end up unhappy at any clinic are almost never let down by the technology. They are failed by the diagnosis.

Frequently asked questions

Can I have both eye bags and a tear trough? Yes, very commonly. The bulge of the bag often makes the groove beneath it look deeper. Treatment usually addresses the fat first; the trough is reassessed afterwards.

How do I tell eye bags from dark circles? Gently stretch the skin in a mirror under good light. Persistent darkness suggests pigment; darkness that disappears suggests a shadow from a trough or bag. A doctor’s examination remains more reliable.

Is morning puffiness the same as eye bags? No. Puffiness that improves through the day is usually fluid retention. True eye bags are constant.

Do tear troughs need surgery? Usually not. An isolated tear trough is typically treated with carefully placed filler. Surgery enters the picture for significant fat protrusion or loose skin.

What happens if a tear trough is filled when the real problem is an eye bag? The area typically looks heavier and puffier, and a lump may show when smiling. The filler often needs to be dissolved before correct treatment.

Who should I see for a proper diagnosis? A doctor experienced in periorbital anatomy who offers or at least honestly discusses the full range of options. If you’d like an assessment, my team at Clifford Clinic offers a dedicated eye bag assessment, including non-surgical eye bag removal in Singapore with AGNES + Secret RF where appropriate.

Dr Gerard Ee is the founder and medical director of The Clifford Clinic, Singapore, where he has performed AGNES and Secret RF eye bag treatments for more than 10 years across over 500 eye bag patients. This article reflects his clinical opinion and is for general information; it does not replace a medical consultation.

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Knee osteoarthritis (OA) is one of most common causes of persistent knee pain in adults in Singapore. While prevalent in adults in their 40s, having knee OA does not automatically mean that you need a knee replacement. For mild to moderate cases, there is a wide range of non-surgical treatment options available.

I have written this guide to explain what knee osteoarthritis is, what are the early signs of OA to look for, how a diagnosis is made, and what non-surgical treatment options you can consider.

What Is Knee Osteoarthritis?

Knee osteoarthritis is the gradual wear of the articular cartilage that lines the ends of the bones in the knee joint. It is often accompanied by low-grade inflammation in the joint lining known as the synovium and changes in the knee’s underlying bone structure.

Cartilage degradation causes stiffness and pain as the cartilage is what allows the joint to glide smoothly and absorb load. As the cartilage thins, the knee loses its smooth movement and the bones start to rub against each other, causing the joint to become more reactive. The resulting swelling and pain from bone friction are also what causes stiffness in the knee.

OA is a progressive disease and its pace of progression is not fixed, varying between patients. Load, body weight, strength, activity patterns and the overall health of the joint environment all influence how quickly knee OA progresses.

Who Gets Knee OA

Several factors can increase the risk of developing knee OA.

• Risk rises with each decade from the 40s onward.
• Body weight.Higher body weight puts more strain on the knee.
• Previous knee injury.A past meniscus tear, ligament injury or knee surgery can change how load is distributed through the joint and accelerate wear.
• High cumulative load.Years of heavy physical work or high impact sport cause the cartilage to wear out faster.
• Muscle weakness around the knee and hip.Weak muscles transfer more load directly into the joint.
• Joint alignment.Varus and valgus knee alignments, also known as bow legs and knock knees respectively, forces load to shift unevenly onto the inner or outer knee compartment, accelerating wear.
• Family history.Genetics can affect how early knee OA develops.

Having one or more of these factors does not mean developing knee OA inevitable, but it does mean that any pain you experience in the knee deserves an examination rather than dismissal.

Symptoms of Knee OA

Symptoms of knee OA usually starts mild and escalate over time. The classic early signs of knee OA includes the following.

• Activity related painthat occurs when using the stairs, after long walks, when squatting, or after sports.
• Stiffness after rest.The knee feels tight after prolonged sitting or after waking up in the morning but loosens with movement.
• Occasional swellingafter demanding activity.
• A sense of grinding, clicking or creakinessin the joint.
• The knee tires more quicklythan it used to.

In more advanced stages of the disease, pain becomes more constant. Pain can be severe enough to be present at rest, disturb sleep, and limit walking distance during late-stage knee OA. By this stage, treatment options are narrow, thus the earlier knee OA is identified the more treatment options are available to you.

How Knee OA Is Diagnosed

In most cases, knee osteoarthritis can be diagnosed clinically by a focused physical examination and an X-ray. Personal and family history is also taken into account to give a more accurate diagnosis.

The history aspect of the examination focuses on the pattern of pain, what triggers it, how it has changed over time, and how it is affecting daily life and sleep. The physical examination looks at your range of motion, presence of swelling, joint-line tenderness, kneecap tracking, ligament stability and muscles strength around the knee.

X-rays are usually the first type of imaging done. X-rays are useful as they can identify joint space narrowing, bone spurs or osteophytes, changes in the underlying bone structure, and overall joint alignment. X-rays are graded using the Kellgren–Lawrence (KL) grading system, with KL 4 being grade that indicates end-stage knee OA.

MRI can be added selectively when symptoms do not match the X-ray results or if the X-ray is in conclusive. An MRI is typically ordered when a meniscus or ligament problem is suspected or when a focal cartilage defect needs to be ruled out.

My opinion

“Routine MRI for every knee OA case is not necessary. I add an MRI only when the symptoms and the X-ray do not match or when I am looking for a focal cartilage defect rather than general cartilage wear. As a focal defect is a different problem from knee OA, the presence of a focal defect will drastically alter the treatment plan I recommend. A focal defect will not respond to a knee injection focused strategy similarly to knee OA, it is thus important to perform an MRI to rule it out to prevent the wrong treatment from being matched to the patient.” Dr Gerard Ee

Non-Surgical Treatments

Non-surgical treatments are the foundation of treating knee OA. Effective non-surgical care for knee OA is layered, the best outcomes are often achieved when a treatment plan is supported these foundational non-surgical measures.

• Weight management. Modest weight loss can meaningfully reduce knee pain and slow OA progression.
• Targeted strengthening and physiotherapy. Exercise therapy is most effective when done with a good physiotherapist. Quadriceps and hip muscle strengthening help by improving shock absorption and knee stability.
• Activity modification. Activity level should be adjusted, not stop. Switching to lower impact alternatives like cycling, swimming and controlled gym work can reduce knee pain. Proper pacing and gradual tolerance-building is also recommended.
• Bracing and footwear. An offloading brace or supportive footwear can reduce joint stress and provide better biomechanical support.
• Medication. Short courses of pain relievers or anti-inflammatories can be taken during flare ups.

Knee Injections for Osteoarthritis

When foundational care alone is not enough, I recommend joint injections as the next step.

Cortisone shots, also known as steroid injections. Cortisone is a strong local anti-inflammatory with a fast onset but short duration. It is best suited for treating acute and  inflamed flare ups. Steroid injections should not be used as a maintenance strategy. Repeated steroid injections into the same knee are discouraged as it can result in accelerated cartilage breakdown and increased risk of infection.Leukocyte-poor platelet-rich plasma (LP-PRP). LP-PRP is a biological treatment derived from the patient’s own blood. PRP therapy for knee OA reduces joint inflammation and reduce cartilage degradation by delivering growth factors and signalling proteins into the joint. Leukocyte-poor preparations, such as RegenLab RegenPRP, are favoured for knee OA treatment because they cause fewer post-injection flares and are associated with slightly better outcomes. Additionally, across multiple randomised clinical trials, PRP therapy outperforms hyaluronic acid for pain reduction and knee function improvement at six to twelve months in mild to moderate knee OA.

Hyaluronic acid (HA) viscosupplementation. HA is a gel like preparation that supplements the joint’s natural lubricating fluid. It is helpful for treating dry and creaky osteoarthritic knees. Synolis VA is patented brand of HA that is used in Singapore. It is a 2% non-crosslinked HA with 4% sorbitol antioxidant injectable that, unlike regular HA, serves as an antioxidant on top of being a lubricant.

Conjuran Knee Injection. Conjuran is a polynucleotide intra-articular injectable. It is used as a polynucleotide viscosupplement alternative to HA, but it is not a PRP equivalent.

Guna Collagen MD. A Class III injectable type-I collagen that is used as an extracellular-matrix bioscaffold. While it has a smaller clinical evidence base than HA or PRP, it is an option when HA, PRP and polynucleotide injectables do not provide enough relief.

My opinion

“Generally, I would use steroid injections for a flared knee. PRP therapy for mild to moderate OA where long term symptom improvement is the goal. And HA or Conjuran when a viscosupplement is needed. Due the smaller number of studies backing the effectiveness of Guna Collagen MD, it is something I use only with informed consent from the patient. And usually only after HA, PRP or polynucleotide have already been tried and found to be lacking in terms of results.” — Dr Gerard Ee

Combination Treatments

Not all cases require a combination of treatments to treat. What treatments I use depends on the results of the patient’s knee examination. But below are some examples of effective treatment combinations.

• Steroid plus HA for an OA flare up with synovitis and effusion. This combination provides fast relief and longer lasting symptom control.
• PRP plus HA via CellularMatrix for mild to moderate OA that is not experiencing an active flare up. This is good when longer duration relief is needed.
• Polynucleotide injectable plus HA when viscosupplementation is viable, or when a non-steroid approach is preferred. Suitable for early to moderate knee OA.
• Steroid shot, followed by PRP. I choose this combination when the knee is too inflamed for PRP therapy. The joint is first settled with a steroid injection, then revisited with a PRP injection a few weeks later.
• Guna Collagen MD plus HA. This is a salvage strategy used when HA, PRP and PDRN do not provide enough relief.

When You Should Consider Knee Surgery

Not all cases of knee OA can be helped with non-surgical treatments or knee injections. In my experience, below are some of the signs that the patient’s knee OA has unfortunately progressed past the moderate stage of the disease.

• Imaging shows bone-on-bone contact with major function loss.
• The pain experienced is severe enough that it disturbs sleep.
• Pain is felt even when the joint is not in use.
• Non-surgical care is starting to yield diminishing returns.

If a patient experiences the above symptoms, I would inform them that knee replacement might be the right choice for them. That being said, I consider surgery a last resort as it is invasive. I will always attempt to proceed via the non-surgical pathway when possible.

My opinion

“Helping patients delay or avoid knee replacement where possible is my main goal. But the non-surgical treatment pathway has limits, and surgery can genuinely be the right answer for advanced, end-stage arthritis. To me, what is most important is being honest with patients about the grade of their knee OA and what treatments are still viable for them.”

When A Knee Injection Is Inappropriate

There are a few situations where knee injections are not the right type of treatment to pursue.

• End stage knee OA with major function loss. Surgical referral should be considered in this case.
• When the patient has an active local or systemic infection, recent skin infection over the knee, certain blood disorders or uncontrolled anticoagulation.
• When the diagnosis is unclear. Reassessment, repeat X-ray or addition of MRI should be done first before deciding on a treatment plan.

Managing Unresponsive Patients

When a patient still sees little benefit twelve weeks after PRP therapy, another injection should not be hastily given. Below is my treatment structure for an unresponsive patient.

First, re-confirm the diagnosis. Review the X-ray, add an MRI if the diagnosis is unclear or to check if the pain is caused by a focal cartilage defect rather than generalised wear.

Next, look at rehabilitation and load. Many patients who appear unresponsive to treatments are actually not doing proper rehabilitation.

Finally, consider a combination of treatments or switching to a different treatment agent.

My opinion

“A non-responsive patients deserves a re-look. I will first review the imaging, often add an MRI, then check the rehabilitation progress of the patient. For some patients, adjusting their rehabilitation plan or switching to a combination plan or a different treatment agent works. However, not all knees will respond to knee injections or non-surgical treatments. If the treatment ceiling has been reached, honest counselling should be given to the patient and they should be told that surgery might be their only option. That honesty is part of my job.”

 

Honest Limitations

The non-surgical injection options for knee OA share some limitations. While they manage knee OA symptoms, improve knee function and influence the joint environment in different ways, none of these injections can regrow cartilage or cure osteoarthritis.

Preparation methods for PRP also vary across clinics, so treatment outcomes may vary depending on the clinic’s technique.

Similarly, HA products vary in molecular weight and crosslinking, which affects duration of effect. How long lasting the treatment is thus depends on what product the clinic is using.

Summary

Knee osteoarthritis is treatable, but not curable. Mild to moderate stages of disease can typically be treated with non-surgical treatments and knee injections. A good treatment plan should be paired with strengthening, weight management and sensible load adjustment.

Surgery is reserved for the end stage of the disease. I will only suggest surgical intervention when all non-surgical care options have been fully exhausted as my goal is always to help patients delay or avoid knee replacement where possible.

Frequently Asked Questions

Is knee osteoarthritis curable? No, but it is highly treatable. Non-surgical treatment in mild to moderate OA can substantially reduce pain, improve function and slow progression, often for many years.

Can knee OA be treated without surgery? Yes. Mild to moderate knee OA is usually managed with a combination of weight management, strengthening, activity adjustment and, where appropriate, knee injections. Surgery is reserved for the end stage of the disease or for patients who no longer respond to non-surgical care.

Which injection is best for knee OA? There is no single best injection. The type of injection used depends on whether the knee is experiencing a flare up, the knee OA grade, prior treatment response and the patient’s preference.

Typically, steroid shots are used for flare ups, PRP for selected mild to moderate knee OA, and HA or Conjuran if the patient prefers a viscosupplement strategy.

Are knee injections claimable through Medisave or insurance in Singapore? Knee joint injections performed in an MOH approved day surgery centre like The Clifford Clinic and Surgery are claimable through Medisave and hospitalisation insurance. Coverage depends on the specific plan.

Will knee OA get worse no matter what the patient does? OA is progressive, but the pace of its progression varies between patients. Body weight, strength, load management and the health of the joint environment all influence how quickly knee OA progresses.

Related Reading

• Knee Pain in Singapore: Causes, Symptoms and Treatment Options
• Knee Pain When Climbing Stairs
• Front, Inner, Outer or Back of Knee Pain

Clinic and treatment pages.

• PRP knee injections for knee pain — Dr Gerard Ee
• Hyaluronic acid knee injections at The Clifford Clinic

Speak to Dr Gerard Ee About Your Knee Pain

If a patient has been told they have knee osteoarthritis, or the knee is telling them something is wrong, the right first step is a proper assessment.

Knee joint injections at Dr Gerard Ee’s practice are performed in an MOH approved day surgery centre and are claimable through Medisave and hospitalisation insurance. The clinic’s team will advise on eligibility during consultation.

The Clifford Clinic and Surgery, 50 Raffles Place, #01-01 Singapore Land Tower, Singapore 048623 (Exit B, Raffles Place MRT) Phone: (65) 6532 2048 | WhatsApp: (65) 8318 6332

About Dr Gerard Ee

Dr Gerard Ee (MBBS UK, MRCS Edinburgh, DP Dermatology Cardiff) is a Member of the Royal College of Surgeons and a senior physician in Singapore. He is trained as an orthopaedic doctor and has years of experience in both operative and non-operative care of knee osteoarthritis. His peer-reviewed orthopaedic research has been published in top-tier journals including The Knee, Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA), the Journal of Bone and Joint Surgery (British) and Clinical Orthopaedics and Related Research. He now works as a senior aesthetic doctor and continues to provide evidence-driven, non-surgical knee care for mild to moderate knee osteoarthritis with a clinical philosophy of using non-invasive treatments first and surgery as a last resort. He believes that treatment should be matched to evidence and to the individual patient.

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Acne treatment is not about choosing one best product for every teenager. It starts with identifying the pattern of the acne and matching appropriate and effective treatments to it. Teenage acne is extremely common and although it is a normal part of growing up, treating it early is what prevents scarring that can last a lifetime.

My quick answer

Teenage acne is driven largely by the hormonal changes of puberty, which increase oil production and lead to blocked pores and breakouts. Treatment focuses on good medical skincare at concentrations suited to younger skin. There are also gentle in-clinic options such as Gold or Platinum Photothermal Therapy where needed. Treating early matters most, because it reduces the risk of permanent scarring. The aim is effective control with a comfortable, age-appropriate experience.

What I look for during the consultation

A teenage consultation begins with the type and severity of the acne, whether it is mostly blackheads and whiteheads, inflamed bumps, or deeper painful lesions and whether it is already leaving marks. The history matters too, covering current skincare, diet including dairy and whey protein, sport and sweat habits  and how much the acne is affecting the young person. I keep the conversation about health and skin rather than appearance and I involve the teenager in their own plan so they feel in control rather than judged.

How I classify teenage acne

Teenage acne is classified the same way as any acne, by type and severity. Comedonal acne is the blackheads and whiteheads driven by blocked pores. Inflammatory acne is the red, tender bumps. More severe nodular and cystic acne, with deep painful lumps, is less common in teenagers but carries the highest scarring risk and needs prompt attention. Grading the severity guides how gentle or active the treatment needs to be.

When I would consider in-clinic treatment

Prescription skincare is the foundation and for mild acne it is often enough. In-clinic treatments are considered when the acne is widespread or inflamed, when products are not helping, or when it is starting to leave marks. Gold and Platinum Photothermal Therapy are particularly suitable for teenagers, because they are gentler than some other options and well tolerated. HydraFacial helps where there is heavy congestion. Treating early, before scarring develops, is the priority at this age.

When I would not recommend stronger treatment

More intensive treatments such as AGNES and AviClear can be harder for very young patients to tolerate, which is one reason the gentler photothermal options are usually preferred for teenagers. Aggressive resurfacing and strong oral medication are not first-line for ordinary teenage acne and oral medication in particular is reserved for severe cases. The aim is to control the acne effectively while keeping the experience comfortable, rather than reaching for the strongest available option.

Common mistakes I see

The most common mistake is squeezing and picking, which is one of the surest ways to turn temporary teenage acne into permanent scars. Another is following acne advice from social media, much of which is paid promotion with before and after results that are not real, setting unrealistic expectations. Stopping skincare too soon, before it has had a few weeks to work, is common too. And waiting too long to treat moderate or severe acne risks scarring that is far harder to fix than the acne itself.

The role of parents

Parents make a real difference, mostly by supporting consistency. Acne treatment only works when the skincare is used regularly, and many teenagers stick to their routine far better with gentle parental encouragement. Helping a teenager keep appointments, choose non-comedogenic products, and avoid squeezing all protect against scarring. Framing acne as a common, treatable medical condition rather than a flaw supports both the treatment and the young person’s confidence.

What you can realistically expect

Teenage acne generally responds well, especially when treated early and consistently, though skincare takes several weeks to show its full effect. The goal is steady control and prevention of scarring. Gentle in-clinic treatments build their results over a series of sessions while medical skincare maintains the improvement. Realistic expectations are set at the first visit so a young person does not give up too soon.

When to see a doctor

It is reasonable to seek help when the acne is widespread or inflamed, when over the counter products are not working, when the lesions are deep and painful, or when the acne is affecting a teenager’s confidence. The single most important reason to act early is to prevent scarring, which is far harder to treat than the acne itself.

Frequently asked questions

What is the best acne treatment for teenagers?

Good medical skincare at teen-appropriate concentrations is the foundation. For in-clinic treatment, Gold and Platinum Photothermal Therapy are gentle and well suited to teenagers. The right plan depends on the severity of the acne.

Is it safe to treat acne at a young age?

Yes, with age-appropriate care. Treating early is actually important, because it helps prevent permanent scarring. Gentler in-clinic options are chosen for younger skin.

Should my teenager see a doctor or just use a face wash?

Mild acne may settle with simple skincare. If the acne is widespread, inflamed, painful or leaving marks, or if products are not helping, a consultation is worthwhile to prevent scarring.

How can I stop my teenager’s acne from scarring?

Treat it early, keep skincare consistent, and discourage squeezing. Habitual squeezing is one of the biggest causes of acne scarring in young people.

A simple skincare routine for teenagers

Teenagers do best with a routine that is easy to keep up. A gentle cleanser, a light non-comedogenic moisturiser and any prescribed treatment when done in a regular and consistent protocol achieves far more than a complicated regimen that gets abandoned after a week. Topical creams for teenagers are prescribed at concentrations suited to younger skin, which helps control the acne while limiting irritation. Patience matters, because skincare takes several weeks to show its full effect. Facial scrubs only adds irritation rather than clearing the acne faster.

Diet, sport and teenage skin

Diet can play a supporting role for teenagers. Dairy, sugar and whey protein are common triggers. Many active teenagers who use protein supplements notice a difference when they review their intake. Sport itself is healthy, but sweat left on the skin after training can clog pores, hence showering and cleansing soon after exercise helps. None of this replaces medical treatment, but these habits make the skin easier to control alongside it, and they are easy for a young person to build into a daily routine.

What to expect at a first teen consultation

A first consultation looks at the type and severity of the acne and takes a history covering skincare, diet, sport and daily habits. From there the options are explained in plain language, including gentle in-clinic treatments such as Gold or Platinum Photothermal Therapy where appropriate, and a simple plan is agreed. Parents are welcome and play an important role in supporting consistency once treatment begins. Keeping the plan straightforward is deliberate, because a routine a teenager will actually follow beats a complex one that gets abandoned after a week.

Supporting emotional wellbeing

Acne can weigh heavily on a young person’s confidence and that is worth taking seriously. Keeping the conversation focused on health and skin rather than appearance helps, as does involving the teenager in decisions so they feel in control rather than judged. Treating the acne effectively is often the most reassuring step of all and a supportive attitude at home makes a real difference. If low mood persists beyond the skin itself, it is worth seeking support from a trusted adult or professional. This often also complicates the matter due to the fact that Isotreintoin or Roacutane can increase the risk of depression and suicidal tendencies.

What the evidence shows

Acne is almost universal in adolescence and the medical literature shows that the great majority of teenagers are affected at some point. The priority at this age is to control the acne while preventing scarring, and the Gold PTT used for young children or teenagers work by selectively targeting the oil glands, an approach supported by clinical research. Topical medical skincare, used consistently remains the evidence-based foundation and dermatology guidelines support combining a topical retinoid with benzoyl peroxide as a mainstay of treatment.

A safe topical routine for teenage skin

For most teenagers, the foundation of treatment is a simple topical routine used consistently. A gentle cleanser twice a day with a light non-comedogenic anti acne moisturiser forms the base. On top of this, a topical retinoid at night helps unblock the pores and prevent new spots and it is introduced slowly. This can limit the dryness and irritation that can otherwise put a teenager off. Benzoyl peroxide is useful where there is inflammation and combining it with the retinoid or a topical antibiotic protects against bacterial resistance. Skincare takes several weeks to show its full effect, so patience matters and scrubbing the skin hard only adds irritation without clearing the acne faster.

Where the acne is more widespread or inflamed, a doctor may add a short course of oral treatment, and gentle in-clinic options such as photothermal therapy can help without being harsh on young skin. The aim throughout is effective control with the least irritation, and prevention of the scarring that is so much harder to treat later.

Help your teenager treat acne early and gently.

The Clifford Clinic, 50 Raffles Place, Singapore Land Tower. Call (65) 6532 2400 or WhatsApp (65) 8318 6332 to arrange a consultation.

Related reading

• Acne Treatment Singapore: How I Choose (Dr Gerard Ee)
• Teenage Acne (Dr Gerard Ee)
• Gold PTT for Acne (Dr Gerard Ee)
• Platinum PTT for Acne (Dr Gerard Ee)
• HydraFacial Deep Pore Cleansing
• Acne Treatment Singapore

References

• HealthHub Singapore. Acne. https://www.healthhub.sg/a-z/diseases-and-conditions/acne
• American Academy of Dermatology. Guidelines of care for the management of acne vulgaris. https://www.aad.org/member/clinical-quality/guidelines/acne
• Acne vulgaris. https://dermnetnz.org/topics/acne
• Selective photothermolysis of sebaceous follicles with gold microparticles for acne. PubMed. https://pubmed.ncbi.nlm.nih.gov/25748556/
• Prospective multicentre study of laser-activated gold microparticles for inflammatory acne. J Drugs Dermatol. PubMed. https://pubmed.ncbi.nlm.nih.gov/37943275
• Teenage Acne (Dr Gerard Ee) https://drgerardee.com/teenage-acne/

Medical disclaimer: This article is for general education and does not replace an in-person consultation. Treatment suitability, results and risks vary between individuals. Please speak with a qualified doctor before starting any acne treatment.

The post Teenage Acne Treatment in Singapore: A Parent-Friendly Guide appeared first on Dr Gerard Ee.

Acne is not one condition, and hormonal acne is one of the patterns seen most often in adult women. It does not behave like teenage acne, which is exactly why the routines that once worked stop working. The approach starts with recognising the hormonal pattern, then deciding whether the driver itself needs to be addressed, rather than treating the surface alone.

My quick answer

Hormonal acne in women typically appears along the jawline, chin and neck, flares before menstruation and is driven by the skin’s sensitivity to hormones. Hormonal acne is not caused by skincare or by hygiene. Treatment starts with an accurate diagnosis and proper prescription topical skincare and may include targeted treatments such as AGNES RF or AviClear. If there are signs of an underlying condition such as PCOS, I would recommend further medical evaluation.

What I look for during your consultation

The history covers the timing of breakouts in relation to the cycle, menstrual regularity, and any other signs of a hormonal imbalance such as excess hair growth or sudden severe acne. Diet matters, including dairy and whey protein, which in my experience trigger breakouts in many people, along with stress and sleep, which both influence hormonal acne. Where the lesions sit and how deep they are is noted. The full picture, rather than any single sign, points towards a hormonal driver.

How I classify hormonal acne

Hormonal acne tends to favour the lower face, particularly the jaw and chin and worsens cyclically around the period. The lesions are often deeper and more tender than simple surface bumps. It is distinguished from comedonal acne, which is mainly blocked pores and from straightforward oily acne because hormonal acne is driven from the inside and frequently resists the products that clear other types.

When a woman tells me her breakouts sit along the jaw and flare before her period and that nothing she tries hellps, I start thinking about a hormonal driver. If there are also irregular periods or other signs of androgen excess, I will suggest looking into PCOS rather than just treating the skin. Treating the surface without addressing the driver is why so many people feel they are running in circles.

When I would consider treatment

Hormonal acne is treated actively, because it carries a real risk of deeper, scarring lesions. Medical skincare is the foundation. Where the acne keeps returning to the same areas, AGNES can shrink the specific overactive glands, and where the skin is generally oily AviClear suits better. Where a clear hormonal driver is present, management of that driver is coordinated as part of the plan. Marks left behind are treated later, with Vbeam for redness and Q-Switch for brown pigment.

When I would look deeper or refer

It would be a mistake to simply keep treating the skin if there are clues of an underlying hormonal condition. Irregular or absent periods, excess hair growth, unexplained weight change and sudden severe acne are reasons to investigate further, which may include blood tests and referral to a gynaecologist or endocrinologist. Addressing an underlying condition such as PCOS often makes the skin much easier to treat and it is not something to overlook.

Common mistakes I see

The most common mistake is months of facials and extractions, which do nothing for a problem driven from the inside. The second is ignoring diet triggers such as dairy, sugar and whey protein, which are worth attention without becoming a source of anxiety. The third is treating the surface for a year while never investigating a possible hormonal cause. And as always, squeezing deeper lesions only raises the risk of scarring.

What you can realistically expect

Hormonal acne rarely clears overnight. Skincare and targeted treatments take several weeks to work, and where a hormonal driver is being managed, improvement is usually gradual over a couple of months before it consolidates. This is normal. The most common reason for failure is stopping too early or switching approaches before any has had time to work, so I set clear checkpoints and adjust if they are not being met.

Treating the marks hormonal acne leaves

Because hormonal acne is often deep and inflamed, it tends to leave marks. These are usually flat red or brown marks rather than true scars, meaning there is no change in skin texture. Once the active acne is controlled, the marks can be treated, with Vbeam for redder marks and sensitive skin and Q-Switch for browner pigmentation. If genuine scarring has developed, I build a separate scar plan once the acne has settled, since active acne is always treated before scars. Protecting the skin from the sun with a light, non-comedogenic product helps prevent brown marks from darkening while they are being treated.

When to see a doctor

See a doctor if your breakouts cluster along the jaw and chin, flare before your period, and resist the routines that work for others, especially if there are signs such as irregular periods. Hormonal acne can persist for years and often does not settle without treatment and because it can scar, active treatment is usually advised rather than waiting.

Frequently asked questions

How do I know if my acne is hormonal?

Hormonal acne typically sits along the jawline and chin, flares before your period, and resists routines that work for other types. A consultation that includes history taking is the most reliable way to confirm it.

Does hormonal acne mean I have PCOS?

Not necessarily. PCOS is one possible cause. Clues such as irregular periods, excess hair growth and sudden severe acne may prompt further evaluation, but only proper assessment can confirm it.

What is the best treatment for hormonal acne?

It depends on the pattern. Medical skincare is the foundation, with AGNES for recurring localised lesions and AviClear for diffuse oily skin. If a hormonal condition is found, treating it makes the skin easier to manage.

Will hormonal acne go away on its own?

It can persist for years and often does not settle without treatment. Because it can scar, active treatment is usually advised.

Why hormonal acne resists ordinary routines

Hormonal acne is driven from the inside, by the skin’s sensitivity to hormones that fluctuate through the menstrual cycle. This is why it behaves so differently from teenage or comedonal acne, and why the cleansers and spot treatments that clear surface acne make little difference to it. The breakouts are often deeper, more cyclical and more persistent and they cluster where the skin is most hormonally responsive, along the jaw, chin and neck. Because the trigger sits below the surface, the most effective control often comes from calming that trigger as well as treating the skin, which is precisely the part that so many over the counter routines miss entirely.

Diet, stress and sleep

Several everyday factors influence hormonal acne and are worth attention. In my experience dairy, sugar and whey protein trigger breakouts in many people, and reducing them can help, without turning eating into a source of fear. Stress raises hormones that worsen acne, and poor sleep does the same, so both are genuinely worth managing alongside treatment. None of these replace medical care, but they make the overall picture easier to control. Ignoring them is a common reason progress stalls even when the clinical treatment is sound.

What the evidence shows

Hormonal treatment of acne in women is well supported by clinical evidence. Spironolactone, an oral medicine that blocks the effect of male-type hormones on the oil glands, has been shown in placebo-controlled research to improve persistent acne in adult women, with the benefit building over several months. The combined contraceptive pill is also an established option, shown to reduce acne over time, and clinical comparisons suggest that while antibiotics may work a little faster at first, hormonal treatment catches up over a few months. Clascoterone, a newer cream that blocks the same hormonal signal directly in the skin, has been shown in trials to outperform its inactive base and can be used in both women and men. Which of these suits a particular person depends on their health, their history and whether they are planning a pregnancy.

How hormonal treatments are used and monitored

Each hormonal option is used a little differently. Spironolactone is usually started at a low dose and increased gradually if it is well tolerated, and because it can affect fluid balance and potassium, blood pressure and simple monitoring are considered, especially at higher doses. It can make periods irregular, which is one reason it is often paired with a contraceptive pill, and it is not used in pregnancy. As an anti-androgen it has been found to work about as well as oral antibiotics for many women, without adding to antibiotic resistance, which is part of its appeal as a longer-term option. The combined pill needs the right formulation for acne and is avoided in women with certain risks, such as a history of clots or migraine with aura, so a proper health review comes first. Clascoterone cream is applied twice a day and is generally very well tolerated, which makes it a useful option for people who prefer to avoid, or cannot take, oral hormonal treatment.

Because hormonal acne can be a clue to an underlying condition, I look for signs of polycystic ovary syndrome, such as irregular periods, excess hair growth or sudden severe acne, and arrange the right tests or referral when they are present. Treating any underlying driver often makes the skin far easier to control, and it is the part of the picture that surface treatments alone can never reach.

Get to the root of jawline and premenstrual breakouts.

The Clifford Clinic, 50 Raffles Place, Singapore Land Tower. Call (65) 6532 2400 or WhatsApp (65) 8318 6332 to arrange a consultation.

Related reading

• Acne Treatment Singapore: How I Choose (Dr Gerard Ee)
• Hormonal Acne in Women (Dr Gerard Ee)
• PCOS and Acne (Dr Gerard Ee)
• Hormonal Therapies for Acne (Dr Gerard Ee)
• AviClear (Dr Gerard Ee)
• Acne Treatment Singapore

References

• HealthHub Singapore. Acne. https://www.healthhub.sg/a-z/diseases-and-conditions/acne
• American Academy of Dermatology. Guidelines of care for the management of acne vulgaris. https://www.aad.org/member/clinical-quality/guidelines/acne
• Acne vulgaris. https://dermnetnz.org/topics/acne
• Spironolactone for acne in adult women: randomised controlled trial. BMJ. https://pmc.ncbi.nlm.nih.gov/articles/PMC10599794/
• Combined oral contraceptive pills for treatment of acne. Cochrane Review. https://www.cochrane.org/evidence/CD004425_effect-birth-control-pills-acne-women
• Antibiotics versus oral contraceptives in acne vulgaris: meta-analysis. J Am Acad Dermatol. PubMed. https://pubmed.ncbi.nlm.nih.gov/24880665/
• Topical clascoterone cream for acne: phase 3 randomised clinical trials. JAMA Dermatology. https://jamanetwork.com/journals/jamadermatology/fullarticle/2765025
• Management of acne vulgaris: a review. JAMA. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2021.17633
• Hormonal Acne in Women (Dr Gerard Ee) https://drgerardee.com/hormonal-acne-in-women/

Medical disclaimer: This article is for general education and does not replace an in-person consultation. Treatment suitability, results and risks vary between individuals. Please speak with a qualified doctor before starting any acne treatment.

The post Hormonal Acne in Women: Jawline Acne, PCOS Clues and Treatment Options appeared first on Dr Gerard Ee.

My quick answer

Accure and AviClear are both 1726 nm lasers that treat acne by the same mechanism, selectively heating the oil glands using sebum as the target. The main practical difference is in cooling and comfort. AviClear uses a contact-cooling system that makes treatment well tolerated without anaesthetic, while Accure has been reported as considerably more painful, which affected how well patients tolerated and completed it. AGNES takes a different route entirely, delivering radiofrequency through fine microneedles directly to the gland. Among the 1726 nm options I prefer to use the AviClear, saving the AGNES RF where a targeted approach is more appropriate.

What I look for during the consultation

When someone comes to me after a disappointing experience with an acne laser, I want to understand what was done and how their skin responded. I look at the type and severity of their acne, whether it is oily and diffuse or recurring in one spot and how much discomfort or downtime they can accept. I also ask whether a previous treatment was completed or abandoned, because a painful treatment that was stopped early was never given a fair chance. This picture guides which oil-targeting approach is likely to suit them best.

How a 1726 nm laser treats acne

The oil gland is central to acne and the 1726 nm wavelength was chosen because it is absorbed particularly well by sebum. When the laser light is absorbed, it heats and selectively damages the oil glands while sparing the surface of the skin, a process known as selective photothermolysis. By reducing the activity of the glands, the laser lowers oil production at its source, which is why this class of treatment can produce lasting improvement rather than just a temporary effect. Both Accure and AviClear rely on exactly this mechanism, which is why their underlying approach to acne is essentially the same.

Accure and AviClear: same wavelength, different engineering

Because Accure and AviClear share the 1726 nm wavelength and the same oil gland as the target, the physics behind both technology that allows both these lasers to treat the acne is common to both. Where they differ is in the technology built around the laser, especially the cooling and the way heat is managed and monitored during treatment. This might sound like a technical detail, but it is the part that decides how a treatment feels and how safely the necessary heat can be delivered. Two devices can use the same physics and still offer very different experiences and that is exactly what has been reported with these two systems.

The lesson I take from these two lasers is that the wavelength alone does not make the treatment. The engineering around it, the cooling, the comfort and the way the heat is controlled, matters just as much. A treatment that is too painful to sit through is one a patient is far less likely to finish, and an unfinished course is one of the surest routes to a disappointing result.

Why cooling and comfort matter

Delivering enough heat to the oil glands to reduce their activity, while protecting the surface of the skin, is a fine balance and cooling is what makes it possible to do comfortably.

AviClear’s contact-cooling system is designed to protect and soothe the skin surface as the deeper glands are heated and in practice its treatments are generally well tolerated without the need for anaesthetic, with only mild, short-lived redness. Accure by contrast, has been reported by many patients as significantly more painful. In the end, physicians end up decreasing the power or energy delivered sacrificing comfort for pain at the expense of results.

Why Accure saw limited adoption

Accure showed encouraging early results and proven technology based on science, but it has not become as widely used as AviClear. This is due to several factors. Its published evidence base is smaller and shorter, whereas AviClear has more substantial data including longer follow-up. The reported discomfort affected how well patients accepted and completed treatment. Beyond the clinical picture, commercial factors, company resources and market competition all play a part in which devices become established. None of this means the underlying idea is unsound, only that a good wavelength on its own is not enough without the engineering and the patient experience to match.

How AGNES works differently

AGNES acne is worth mentioning because it targets the same oil glands but by a completely different route. Instead of a laser, it uses fine, insulated microneedles to deliver radiofrequency energy directly into an individual gland, heating and shrinking it while the insulation protects the surface layers of the skin. This precise, needle-based delivery makes AGNES particularly suited to acne that keeps returning to the same spot, where treating one gland at a time is exactly what is needed. Its discomfort is of a different kind, the brief sharp sensation of a needle rather than the sustained heat of a laser, and it is done with local anaesthetic. For the right pattern of acne, it is a very effective alternative to a laser.

Managing discomfort in laser acne treatment

Discomfort during acne laser treatment can be managed in several ways. Effective surface cooling, as built into AviClear, does much of the work, and a topical anaesthetic cream can be applied beforehand where extra comfort is wanted. The way a treatment is delivered, including how the energy is spaced and monitored, also affects how it feels. The point is that comfort should be planned for rather than simply endured, because a comfortable treatment is one a patient will actually complete, and completing the course is what delivers the result.

What the evidence shows

The science behind these treatments is well supported. Research confirms that the 1726 nm wavelength selectively heats and damages the oil glands while sparing the surface of the skin, which is the basis for its lasting effect on acne. Studies of AviClear show durable improvement in inflammatory acne that builds over months and holds up across a range of skin types, with good tolerability and no need for anaesthesia.

Radiofrequency approaches such as AGNES RF are supported by clinical research showing reduced inflammation around the follicles and shrinkage of the oil glands, with improvement sustained over the following months. The common thread is that treating the oil gland at its source, by whichever route suits the patient, produces meaningful, lasting results.

Which I use and why

Among the 1726 nm lasers, AviClear is the option I use, because it combines the strongest and longest evidence with a level of comfort that lets patients actually complete their course. Where the acne keeps returning to one spot, I reach for AGNES instead, because its targeted, gland-by-gland approach suits that pattern better than any broad laser. This is the same principle I apply to all acne treatment. To choose a treatment for the acne and the patient and choose the option a person can realistically tolerate and finish.

Common mistakes I see

The commonest mistake around these treatments is judging a whole approach by one bad experience with a particular device. A painful, abandoned course does not mean laser treatment cannot help. Another is assuming that because two lasers share a wavelength they are interchangeable, when the engineering around the laser makes a real difference to comfort and completion. And, as with all acne treatment, expecting an instant result from something that works gradually over months leads people to give up too soon.

What you can realistically expect

A well-tolerated 1726 nm laser reduces oil and breakouts gradually over a series of sessions, with the improvement continuing to build over the following months, and the results holding across different skin types. AGNES acne can settle a recurrent stubborn sebaceous gland more quickly for a focused area. Regardless of the treatment, neither replaces a plan that includes good prescription skincare that can help to completement the treatments prescribed. The realistic expectation is steady, lasting improvement from a treatment you can comfortably complete, rather than a dramatic single session.

When to see a doctor

If you are considering a 1726 nm laser for acne, if a previous laser was too painful to continue or did not produce any results because it was not treating the root cause, do seek out a professional opinion from a doctor that is experience in treating acne.

Frequently asked questions

Are Accure and AviClear the same?

They share the same wavelength and mechanism, the 1726 nm laser targeting the oil glands, but they differ in the cooling and comfort technology built around the laser, which is why the experience can differ considerably.

Why is Accure so painful?

Reaching the oil glands requires significant heat, and reports suggest Accure’s cooling was less effective at keeping the surface comfortable, so treatments were often described as considerably more painful than AviClear.

Which acne laser is best?

Among 1726 nm lasers, AviClear has the strongest evidence and best tolerability. AGNES is a different, needle-based approach that suits recurrent same-spot acne. The right choice depends on your acne and what you can comfortably tolerate.

Does laser acne treatment need anaesthetic?

A well-cooled laser such as AviClear is generally well tolerated without anaesthetic, though a topical numbing cream can be used for extra comfort. AGNES is done with local anaesthetic.

Considering an acne laser? Let us match the right one to you.

The Clifford Clinic, 50 Raffles Place, Singapore Land Tower. Call (65) 6532 2400 or WhatsApp (65) 8318 6332 to arrange a consultation.

Related reading

• Acne Treatment Singapore: How I Choose (Dr Gerard Ee)
• AviClear (Dr Gerard Ee)
• AGNES Acne Treatment (Dr Gerard Ee)
• Isotretinoin: How It Works (Dr Gerard Ee)
• Gold PTT for Acne (Dr Gerard Ee)

References

• HealthHub Singapore. Acne. https://www.healthhub.sg/a-z/diseases-and-conditions/acne
• American Academy of Dermatology. Guidelines of care for the management of acne vulgaris. https://www.aad.org/member/clinical-quality/guidelines/acne
• Acne vulgaris. https://dermnetnz.org/topics/acne
• A 1726 nm laser system for the treatment of acne vulgaris. PubMed. https://pubmed.ncbi.nlm.nih.gov/36197599/
• A sebum-selective 1726 nm laser for acne across skin types: multicentre study. J Am Acad Dermatol. https://www.jaad.org/article/S0190-9622(25)02900-7/fulltext
• Selective sebaceous gland electrothermolysis using an insulated microneedle radiofrequency device for acne: randomised controlled trial. PubMed. https://pubmed.ncbi.nlm.nih.gov/31502662/
• Effects of light and laser therapies on the sebaceous gland microecosystem in acne. Photodermatol Photoimmunol Photomed. https://onlinelibrary.wiley.com/doi/10.1111/phpp.70005
• Management of acne vulgaris: a review. JAMA. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2021.17633
• The Clifford Clinic. Why Accure laser did not work for you. https://cliffordclinic.com/why-accure-laser-did-not-work-for-you/

Medical disclaimer: This article is for general education and does not replace an in-person consultation. Treatment suitability, results and risks vary between individuals. Please speak with a qualified doctor before starting any acne treatment.

The post Accure Laser for Acne: How It Compares to AviClear appeared first on Dr Gerard Ee.

The location of your knee pain is a valuable clue that can help point towards a diagnosis even before any imaging is done. Knowing if the pain is specifically coming from the front, inner, outer or back of the knee is thus very useful.

In this guide, I will walk you through the four main locations of knee pain, cover the most common causes of knee pain, the warning signs to watch for, and the clinical reasoning linking the location of the pain to the diagnosis.

Before I start, I would like to caution that while the location of the knee pain can help with identifying the cause, confirming the actual cause still requires a proper knee assessment.

Why Location Matters

The knee is a collection of bones, cartilage, ligaments, meniscus tissue, tendons and a fluid-filled lining packaged into one joint. Issues with any of the components of the knee often manifests as knee pain and the location of the pain can indicate which component is compromised. For example, pain at the front of the knee usually involves different structures from pain originating at the back of the knee.

The location of the pain is thus one of the first filters we use to narrow down the root cause of the pain even before a scan is performed.

Anterior Knee Pain

Pain at the front of the knee, around or under the kneecap, is one of the most common types of knee pain that I see at my practice. Below are some conditions that cause anterior knee pain.

Patellofemoral pain syndrome (PFPS). Dull aching around or behind the kneecap that often worsens when using the stairs, squatting, or after sitting with the knee bent for a prolonged period of time. PFPS is closely linked to quadriceps and hip muscle weakness, training spikes and lower-limb mechanics.

Patellar tendinopathy (jumper’s knee). Pain just below the kneecap that is felt when jumping, squatting or going up stairs. Jumper’s knee is common in runners, court-sport players and gym users.

Quadriceps tendinopathy. Pain just above the kneecap, often felt when straightening the knee against load.

Prepatellar bursitis (housemaid’s knee). Swelling and tenderness in front of the kneecap, often felt after prolonged kneeling.

Patellofemoral osteoarthritis. Cartilage wear specifically in the joint between the kneecap and thigh bone. It causes pain that is usually felt when going down the stairs, squatting, or rising from a low chair.

For a closer look at stair related knee pain in particular, see Knee Pain When Climbing Stairs.

Medial Knee Pain

The inner side of the knee refers to the side that faces the other leg. Pain on the inner side of the knee can be caused by the following conditions.

Medial meniscus tears. The inner meniscus is the more commonly injured of the two menisci. Tears can be sudden, caused by a twist or pivot in younger patients or degeneration due to gradual wear in adults over 40 years old. This kind of pain is often localised to the inner joint line. The pain is sometimes accompanied by knee catching, clicking or a feeling of the knee giving way.

Medial compartment knee osteoarthritis. The inner compartment of the knee is the most common location for osteoarthritic wear. This type of knee osteoarthritis (knee OA) particularly affects patients with slightly bow-legged alignment. Pain is typically activity related with stiffness after rest.

Medial collateral ligament (MCL) sprains. Usually caused by a sideways force on the outer knee. MCL sprains cause pain and tenderness on the inner ligament that is often accompanied by a sense of instability.

Pes anserine bursitis. Also known as tendinopathy. Pain is felt a few centimeters below the inner joint line where the hamstring tendons attach. Tendinopathy is common in runners and adults with knee osteoarthritis.

My opinion

“The location of the pain is a good starting point for deciding how to approach treating the knee, but it should not be the only factor taken into consideration. For example,

Medial-side knee pain and stiffness after using the stairs and prolonged sitting in a 50 year old patient is a classic sign of medial-compartment osteoarthritis.. However, an X-ray is still needed to confirm the diagnosis and how the knee should be treated also depends on if the knee is experiencing a flare.”

Lateral Knee Pain

Pain on the outer side of the knee is less common than pain on the inner side of the knee and has its own distinctive set of causes.

Iliotibial (IT) band syndrome. Pain on the outer aspect of the knee. Classically seen in runners and cyclists. Pain caused by IT band syndrome often comes on a predictable distance into a run and eases with rest.

Lateral meniscus tears. Less common than medial meniscus tears but following a similar pattern. Symptoms include joint-line pain and possible knee catching or locking after twisting the knee.

Lateral collateral ligament (LCL) sprains. Caused by a force pushing the knee inward. Less common than MCL injuries.

Lateral compartment knee osteoarthritis. Less common than the medial type. More associated with knock-kneed alignment, also known as valgus alignment.

Proximal tibiofibular joint problems. The proximal tibiofibular is a small joint just below and to the outside of the main knee. It is occasionally a source of stubborn outer knee pain.

Posterior Knee Pain

Posterior Knee Pain

Baker’s cyst. Also known as a popliteal cyst, it is a fluid-filled swelling behind the knee, usually arising from another joint problem such as osteoarthritis or a meniscus tear. The cyst itself is a symptom, not the root cause of the problem.

Hamstring or calf muscle issues. Strains or tendinopathy of the hamstring tendons or the muscles at the back of the calf can present as posterior knee pain.

Meniscus tears with posterior horn involvement. Tears at the back of the meniscus can produce posterior knee pain that is sometimes accompanied by knee catching.

Posterior cruciate ligament (PCL) injuries. Less common than ACL injuries. Usually, the result of a direct blow to the front of the shin.

Vascular causes. Though rare, persistent posterior knee pain with swelling of the whole leg, calf tenderness, redness or breathlessness needs urgent assessment to rule out a deep vein thrombosis (DVT). DVT is a serious condition caused by a blood clot forming in one or more of the deep veins of the leg.

My opinion

“Posterior knee pain with calf swelling and breathlessness should never be ignored. While 99% of posterior knee pain is caused by benign musculoskeletal issues, I will not rule out the 1% chance of DVT as it is a very serious condition that can cause death.”.

“I approach treating most of the issues listed above, including most Baker’s cysts, by working out and treating the joint problem that produced the symptom rather than the symptom itself as the symptom is likely to reoccur if the root cause is not addressed.” Dr Gerard Ee

Warning Signs to Take Seriously

Regardless of where the pain is located, I highly recommend getting an immediate knee examination if you suffer from any of the following issues.

• A knee that gives way, locks or catches.
• Significant swelling within hours of an injury.
• Inability to bear weight or to fully straighten the knee.
• Fever, redness or warmth in the joint.
• Pain severe enough to wake you at night or pain that is constant and unrelated to activity.
• Back of the knee pain with calf swelling, redness or breathlessness

DVT should never be ruled out, it is better to see a doctor sooner rather than later.

How Location Combines with the Rest of the Assessment

Identifying the location of the pain is the starting point of a knee assessment. The full diagnostic process makes use of the location, type, triggers, and any associated features of the pain to decide which structures of the knee are most likely involved.

• The type of pain experienced can be sharp or an ache, mechanical or constant.
• Triggers are activities that induce the pain or make it worse.
• Features associated with the pain include swelling, knee catching, and knee instability.

A focused knee examination scrutinises the suspected structures further. For example, kneecap tracking and stability testing will be done if anterior pain is present. Meniscus and ligament tests if the patient suffers from medial and lateral pain. Careful examination of the popliteal fossa will be done for posterior pain.

If knee OA is suspected, imaging will be added to the assessment plan. Typically, X-ray will be done for arthritis assessment, ultrasound for tendons and Baker’s cysts, and MRI when soft tissue detail or a focal cartilage defect needs to be ruled in or out.

My opinion

“Treating the pain and not the cause of the pain is the single biggest mistake I see. Knee is a symptom of the problem, thus identifying the location of the pain should not be treated as a full diagnosis. It should be the starting position for a full knee assessment that will allow a suitable treatment to be matched to the root cause of the pain.”

Treatment Follows the Diagnosis, Not the Location of the Pain

Treatment should be matched to the structure that is actually causing the problem, not just where the pain is felt. Using my typical treatment flow for osteoarthritic, inflammatory and degenerative causes of knee pain as an example, below is an example of a decision pathway.

• If the knee is experiencing an acute flare, is swollen and hot, or if fast pain relief is needed, a cortisone steroid injection would be a given first.
• If the patientis determined to be suffering from mild to moderate OA without a flare, and long term symptom improvement is the goal, platelet rich plasma (PRP) therapy is recommended.
• If a non-steroid viscosupplement strategy is preferred, hyaluronic acid (HA), Synolis VA, or Conjuran can be considered. Conjuran is a polynucleotide viscosupplement alternative to HA.
• If HA, PRP or Conjuran do not provideenough relief, Guna Collagen MD, usually paired with HA, can also be considered.

For mechanical problems like a knee locking meniscus tear or true ligament instability, I recommend orthopaedic surgery, not a knee injection.

When A Knee Injection Is Not the Right Move

A few situations make injection the wrong move, regardless of the location of the pain.

• The diagnosis is not confidently established.
• The imaging shows endstage knee OA with major function loss. Surgical referral should be honestly considered at this stage.
• Active local or systemic infection, recent skin infection over the knee, certain blood disorders or uncontrolled anticoagulation.
• The dominant problem is mechanical.

My opinion

“I will not give a knee injection if the diagnosis is not confidently established. Repeated examination and re-imaging should be done if needed. An MRI can also be done if a focal cartilage defect is suspected. Knee injections work best when matched to a clear cause of pain. If done blindly, even what is deemed as the best treatment can be ineffective.”

Clinical Summary

Location of knee pain is a useful diagnostic clue, but not a full diagnosis. Anterior, medial, lateral and posterior pain each have a typical shortlist of causes. A knee assessment that takes into account history and selective imaging can narrow the possible causes down further.

The type of treatment given depends on the structure driving the knee pain. For osteoarthritic and degenerative causes, non-surgical options include steroid for flares, PRP for mild to moderate knee OA, HA or Conjuran for a viscosupplement-focused strategy, and Guna Collagen MD if HA or Conjuran alone is ineffective. My treatment plan aims to keep patients out of the operating theatre for as long as their joint allows.

Frequently Asked Questions

Where is the most common location for knee pain? The front of the knee around the kneecap is the most common location for non-traumatic knee pain in active adults. The inner side of the knee is the most common location for osteoarthritic and meniscus related pain.

Is pain at the back of the knee serious? Most posterior knee pain is benign, typically caused by a Baker’s cyst, or hamstring or meniscus-related causes. However, persistent pain with calf swelling, redness or breathlessness needs urgent review to rule out a blood clot.

Can the location of pain inform the diagnosis? Location points strongly toward certain causes but does not confirm them. A proper knee assessment, sometimes with imaging, is needed to identify the actual cause of the pain.

Is an MRI needed to find out where knee pain is coming from? MRIs are not usually done as a first step. Many cases are diagnosed clinically with the help of an X-ray. An MRI is added when soft tissue detail is needed or a focal cartilage defect is suspected.

When should patients see a doctor about knee pain in a specific location? If the pain has lasted more than a few weeks, is limiting activity, started after an injury, or comes with swelling, knee locking or instability, it is worth getting assessed.

Related Reading

• Knee Pain in Singapore: Causes, Symptoms and Treatment Options
• Knee Pain When Climbing Stairs

Clinic and treatment pages.

• PRP knee injections for knee pain — Dr Gerard Ee
• Hyaluronic acid knee injections at The Clifford Clinic

Speak to Dr Gerard Ee About Your Knee Pain

If knee pain in a particular part of the knee that has lasted more than a few weeks or is starting to limit activity, a proper assessment is recommended to name the cause and match a treatment to it.

Knee joint injections at Dr Gerard Ee’s practice are performed in an MOH approved day surgery centre and are claimable through Medisave and hospitalisation insurance. The clinic’s team will advise on eligibility during consultation.

The Clifford Clinic and Surgery, 50 Raffles Place, #01-01 Singapore Land Tower, Singapore 048623 (Exit B, Raffles Place MRT) Phone: (65) 6532 2048 | WhatsApp: (65) 8318 6332

About Dr Gerard Ee

Dr Gerard Ee (MBBS UK, MRCS Edinburgh, DP Dermatology Cardiff) is a Member of the Royal College of Surgeons and a senior physician in Singapore. He is trained as an orthopaedic doctor and has years of experience in both operative and non-operative care of knee osteoarthritis. His peer-reviewed orthopaedic research has been published in top-tier journals including The Knee, Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA), the Journal of Bone and Joint Surgery (British) and Clinical Orthopaedics and Related Research. He now works as a senior aesthetic doctor and continues to provide evidence-driven, non-surgical knee care for mild to moderate knee osteoarthritis with a clinical philosophy of using non-invasive treatments first and surgery as a last resort. He believes that treatment should be matched to evidence and to the individual patient.

The post Front, Inner, Outer or Back of Knee Pain: What the Location May Mean appeared first on Dr Gerard Ee.

Patients researching stubborn acne often meet two very different options, isotretinoin, a powerful oral medication many know as Accutane, and AviClear, a drug-free laser that reduces oil production. Both target the oil gland, which is central to acne, but they do so in very different ways and suit different situations. The aim is not to sell a preferred treatment, but to match the right one to your acne honestly, with realistic expectations.

My quick answer

Isotretinoin is highly effective for severe, scarring or relapsing acne and remains an important option, but it carries side effects and monitoring, which is why I keep it as a last resort. AviClear is a 1726 nm laser that reduces oil production and helps many patients avoid the side effects of oral medication. It suits milder cases, oily skin and maintenance and can be combined with AGNES RF for moderate to severe acne.

What I look for during your consultation

The decision rests on how severe and deep the acne is. The presence of scarring, the skin type and tendency to pigment, whether a pregnancy is planned, how well the patient tolerates medication, and their own preferences. I also look out for what has already been tried, and how the skin responded. These factors, weighed together, decide whether a more invasive treatment or an oral medication protocol would be more appropriate.

How I classify the two options

Isotretinoin shrinks the oil glands, normalises how skin cells shed and reduces inflammation, addressing several drivers of acne at once, which is why it is so effective for severe nodular and cystic acne. It is a serious medication that requires blood monitoring and strict pregnancy prevention. AviClear uses a 1726 nm laser to heat the oil glands and reduce oil production, drug-free, with a cooling system that keeps it comfortable and with very little downtime.

When I would consider AviClear

AviClear is considered when the acne is mild to moderate, when the skin is oily, when a patient wants a drug-free option, or when they cannot tolerate or would prefer to avoid oral medication. It is also a good maintenance choice. It is often combined with AGNES, so AGNES handles the stubborn recurrent glands while AviClear reduces overall oiliness. One practical point is that AviClear is not ideal on the nose, so the plan works around that area.

When I would consider isotretinoin instead

Isotretinoin is kept as a last resort, but it deserves to be on the table when acne is severe, deeply cystic, scarring, or relapsing despite everything else. The earlier truly severe acne is controlled, the lower the risk of permanent scarring, so that conversation should not be delayed when it is clearly needed. Isotretinoin should not be started lightly and never in pregnancy, given its serious risks and monitoring requirements.

Common mistakes I see

One mistake is hoping the acne would self-resolve or thinking that over-the-counter creams can stop acne. Aviclear and AGNES RF has improved outcomes drastically in the treatment of acne. Patients looking to consume isotretinoin too early, or too casually, when a less harmful path is available that can lead to a more permanent cure. Next is thinking there is an instant fix rather than having some patience when treating acne. Prescription skincare is fundamentally crucial and must not be skipped.

What you can realistically expect

AviClear typically consists of three sessions, with results visible after the second and building over three to four months; many patients maintain their results with ongoing skincare and occasional maintenance. Isotretinoin can clear severe acne over a course of months, but with dryness, sun sensitivity and the need for monitoring. Neither removes the need for sensible long-term maintenance.

What to expect during AviClear

An AviClear session is quick and comfortable, taking around thirty minutes, and the built-in cooling system means most patients do not need numbing cream. You may feel a gentle snapping sensation during treatment, and there is very little downtime, so most people return to their day straight away. Afterwards, swimming is avoided for a short period and prescribed creams are continued. Results usually become visible after the second session and build over three to four months, and one practical point worth repeating is that AviClear is not ideal on the nose, so the treatment is planned around that area.

When to see a doctor

Because these options are so different, this is a decision to make with a doctor rather than from an article. See a doctor if your acne is severe, scarring, or relapsing despite treatment, so the safest, most effective path can be chosen for your skin.

Frequently asked questions

Is AviClear as effective as Accutane?

They suit different situations. For severe, scarring acne, isotretinoin remains the most powerful option. For milder acne, oily skin and maintenance, AviClear is effective and avoids the side effects of oral medication.

Can AviClear replace isotretinoin?

For the right patient with milder or moderate acne, AviClear can be an alternative that avoids medication. For severe nodular and cystic acne, medication often remains first line.

How many AviClear sessions are needed?

Typically three sessions, with results visible after the second and building over three to four months.

Is isotretinoin safe in pregnancy?

No. Isotretinoin must never be used in pregnancy. Pregnancy acne is managed with a careful, separate protocol, and gentler options are preferred.

How each option affects the oil gland

Both treatments ultimately act on the sebaceous gland, the source of the oil that drives acne, but by very different routes.

Isotretinoin works from within the body to shrink the glands, normalise skin cell shedding and reduce inflammation all at once, which is why it is so powerful and also why it needs blood monitoring and strict pregnancy precautions. AviClear works from outside, using a 1726 nm wavelength that is absorbed in the oil and heats the glands to reduce their output, without affecting the rest of the body. This single difference explains why one path requires lab tests and contraception while the other does not, and it is central to how the two are weighed.

Maintenance after treatment

Both paths benefit from a maintenance plan because the skin keeps producing oil throughout life. After AviClear, many patients keep their results with ongoing medical skincare and occasional maintenance sessions, since the glands settle gradually but do not disappear. After a course of isotretinoin, a maintenance routine, often centred on a topical retinoid, helps reduce the chance of relapse, which can otherwise happen in a meaningful number of patients. Whichever route you take, good skincare remains the foundation that holds the results in place, and stopping everything at once is one of the more common reasons acne returns.

What the evidence shows

Both options are supported by clinical evidence. Oral isotretinoin remains the most effective acne treatment available, because it is the only medicine that acts on all the main drivers of acne at once, and studies consistently show that it can bring even severe, scarring acne into lasting remission. It is dosed according to body weight and taken over a course of several months, and the total amount taken across that course influences how durable the result is. Because it can harm a developing baby, it is used with strict pregnancy prevention and regular blood-test monitoring. AviClear offers a drug-free alternative for suitable patients, and clinical studies show that it steadily reduces inflammatory acne over a series of sessions, with results that keep building over the following months and hold up across a range of skin types.

Isotretinoin side effects and how they are managed

Isotretinoin is effective but demanding, and knowing what to expect makes it much easier to take. Almost everyone develops dryness, most noticeably of the lips, but also of the skin, eyes and nose, which is managed with a good lip balm, a gentle moisturiser and lubricating eye drops.

The skin becomes more sensitive to the sun, so daily non-comedogenic sun protection matters. Some people notice a brief flare in the first weeks before the acne settles, and starting at a lower dose can smooth this. Aching after exercise is common, so intense training is usually eased back for a while.

Blood tests are done before and during treatment to check the liver and blood fats, and because the medicine can seriously harm a developing baby, reliable contraception and pregnancy testing are essential throughout and for a short period afterwards. None of this is a reason to avoid isotretinoin when it is truly needed, but it is why it is prescribed carefully and monitored closely, with blood tests focused on the liver and blood fats rather than routine blood counts. Treatment is usually continued for a while after the skin has cleared, which makes lasting remission more likely, and mood is checked at each visit as a sensible precaution.

AviClear, by contrast, is a straightforward in-clinic procedure. Each session takes around half an hour, a built-in cooling system keeps it comfortable, and there is very little downtime, so most people return to their day immediately. The trade-off is that it works gradually over a series of sessions rather than as a single intensive course, which is exactly why the choice comes back to how severe the acne is and what a person is looking for.

Related reading

• Acne Treatment Singapore: How I Choose (Dr Gerard Ee)
• AviClear (Dr Gerard Ee)
• Isotretinoin: How It Works (Dr Gerard Ee)
• AGNES Acne Treatment (Dr Gerard Ee)
• Cystic Acne Treatment
• Acne Treatment Singapore

References

• HealthHub Singapore. Acne. https://www.healthhub.sg/a-z/diseases-and-conditions/acne
• American Academy of Dermatology. Guidelines of care for the management of acne vulgaris. https://www.aad.org/member/clinical-quality/guidelines/acne
• Acne vulgaris. https://dermnetnz.org/topics/acne
• A 1726 nm laser system for the treatment of acne vulgaris. PubMed. https://pubmed.ncbi.nlm.nih.gov/36197599/
• A sebum-selective 1726 nm laser for acne across skin types: multicentre study. J Am Acad Dermatol. https://www.jaad.org/article/S0190-9622(25)02900-7/fulltext
• Oral isotretinoin cumulative dosing and long-term acne remission. PubMed. https://pubmed.ncbi.nlm.nih.gov/26187395/
• Management of acne vulgaris: a review. JAMA. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2021.17633
• Acne vulgaris. N Engl J Med. https://www.nejm.org/doi/full/10.1056/NEJMcp1702493
• AviClear (Dr Gerard Ee) https://drgerardee.com/aviclear/
• Isotretinoin: How It Works (Dr Gerard Ee) https://drgerardee.com/isotretinoin-how-it-works-and-its-side-effects/

Medical disclaimer: This article is for general education and does not replace an in-person consultation. Treatment suitability, results and risks vary between individuals. Please speak with a qualified doctor before starting any acne treatment.

The post AviClear vs Isotretinoin: Laser Treatment vs Oral Medication appeared first on Dr Gerard Ee.

AGNES, AviClear and Gold Photothermal Therapy are three of the most effective acne treatments available, and all three target the oil gland rather than just the surface pimple. Because they sound similar, patients often ask which is best. The choice is about matching the tool to the acne type, the oiliness, the age and the skin tone.

My quick answer

AGNES is best for acne that keeps returning in the same spot, because it shrinks individual problem oil glands. AviClear is best for milder, more diffuse oily congestion and for maintenance, because it reduces oil production across a wider area. Gold and Platinum Photothermal Therapy are best for younger teenagers and for pregnant and breastfeeding mothers, used mainly for gentle oil control and maintenance. For moderate to severe acne, I often combine AGNES and AviClear.

What I look for during your consultation

Choosing between these three starts with how the acne behaves. Does the same lesion keep coming back in one place, or is the skin generally oily with congestion scattered across it? Oiliness, lesion depth and inflammation, age, skin tone and prior treatment decide which treatment I recommend.

How I classify the three treatments

AGNES uses a fine, insulated radiofrequency microneedle to shrink an individual overactive gland, so it is the most targeted. AviClear is a 1726 nm laser that reduces oil production across a broader area. Gold and Platinum Photothermal Therapy use metal nanoparticles, delivered with Bellasonic ultrasound and heated with a long pulse laser, gentler and better suited to younger and pregnant patients. The two photothermal versions differ in the element used.

When I would consider each treatment

AGNES is the choice especially for stubborn cysts and nodules along the jaw or T-zone. AviClear suits diffuse congestion, or a patient who wants a drug-free option. Gold or Platinum Photothermal Therapy suits younger teenagers and pregnant and breastfeeding mothers.

When I would not recommend each

AviClear is not relied on for nodular cystic acne and the nose is avoided with it. I would not choose AGNES for very sporadic, scattered acne, since its strength is precise, localised treatment. I would not push AGNES or AviClear on a young patient who cannot tolerate them, which is where Gold or Platinum PTT fits. And I would not promise any of these as a one-off cure. The skin keeps producing oil, so maintenance matters.

Common mistakes I see

The biggest mistake is a clinic selling a single acne laser as the answer for everyone, since no one device suits every acne type. Patients are also misled by social media, where many dramatic before and after results are paid advertorials and some are simply fake. Judge a clinic by how carefully it assesses your skin, not by its marketing.

What you can realistically expect

AGNES often achieves a great deal in one or two sessions for a targeted area, using a local anaesthetic, with temporary redness, tiny entry points and mild swelling unless the acne is nodular and cystic. AviClear is typically a course of three sessions, with results visible after the second and building over three to four months. A built-in cooling system keeps it comfortable, each session takes around thirty minutes, and most patients return to normal activities straight away. Gold and Platinum PTT are usually done as a maintenance series, gentle and generally well tolerated. Across all three, downtime is short, and medical skincare continues alongside. Marks and scars are treated separately, once the active acne settles.

Prescribed skincare is resumed as directed, with swimming avoided for a short period after AviClear, and protecting the skin from strong sun. Recovery can be supported with measures such as hyperbaric oxygen therapy in selected cases.

When to see a doctor

If you are weighing up these treatments, get assessed rather than choosing from an article. See a doctor if your acne is recurring, oily, inflamed or already leaving marks, so the treatment can be matched properly and, where useful, combined.

Frequently asked questions

Is AGNES better than AviClear?

Neither is universally better. AGNES is better for recurring same-spot acne, while AviClear is better for diffuse oily skin and maintenance. For moderate to severe acne, combining them often works best.

Can I combine AGNES and AviClear?

Yes. In moderate to severe acne I often combine them, with AGNES targeting stubborn recurrent glands and AviClear reducing overall oil production.

Which treatment is best for teenagers?

Younger teenagers often do better with Gold or Platinum Photothermal Therapy, which are gentler, since some teens cannot comfortably tolerate AGNES or AviClear.

Are these treatments safe for darker skin?

AGNES and AviClear are both suitable for darker skin tones, with settings and aftercare adjusted to reduce the risk of pigmentation.

Why combination treatment often works best

For moderate to severe acne, a single treatment rarely does everything. AGNES settles the stubborn recurrent glands while AviClear reduces the overall oiliness that feeds new breakouts. Medical skincare supports both, and where there is heavy congestion a deep-cleansing facial can help clear it. A clinic with only one device can only offer part of the answer, which is why the full range, and the experience to combine it well, matters.

What the evidence shows

All three of these treatments are supported by clinical research. AviClear, the 1726 nm laser, became the first laser cleared by the United States FDA to treat acne on its own in 2022. In its key trial of 104 patients, most with moderate to severe acne, around 87 percent achieved at least a 50 percent reduction in inflammatory lesions by six months, rising to roughly 92 percent at one year, and a 2025 multicentre study found it safe and effective across all skin types. Gold Photothermal Therapy is supported by a randomised controlled trial of 168 patients, in which gold microparticles plus a 1064 nm laser reduced inflammatory lesions by a median of 53 percent, compared with 45 percent for laser alone. AGNES, which delivers radiofrequency through an insulated microneedle, was studied in a prospective randomised controlled trial of selective sebaceous gland electrothermolysis that reported significant lesion reduction with good tolerability. The point is not that one is best, but that each has evidence behind it for a particular role.

Related reading

• Acne Treatment Singapore, How I Choose
• AGNES Acne Treatment
• AviClear
• Gold PTT for Acne
• Platinum PTT for Acne
• Acne Treatment Singapore

References

• HealthHub Singapore. Acne. https://www.healthhub.sg/a-z/diseases-and-conditions/acne
• American Academy of Dermatology. Guidelines of care for the management of acne vulgaris. https://www.aad.org/member/clinical-quality/guidelines/acne
• Acne vulgaris. https://dermnetnz.org/topics/acne
• A novel 1726-nm laser system for safe and effective treatment of acne vulgaris. PubMed. https://pubmed.ncbi.nlm.nih.gov/36197599/
• 1726 nm sebum-selective laser for acne across skin types, one-year multicentre data. J Am Acad Dermatol (2025). https://www.jaad.org/article/S0190-9622(25)02900-7/fulltext
• Selective Sebaceous Gland Electrothermolysis Using a Single Microneedle RF Device for Acne, Prospective RCT. PubMed. https://pubmed.ncbi.nlm.nih.gov/31502662/
• Paithankar DY et al. Selective Photothermolysis of Sebaceous Follicles with Gold Microparticles. PubMed. https://pubmed.ncbi.nlm.nih.gov/25748556/
• AviClear  https://drgerardee.com/aviclear/
• AGNES Acne Treatment  https://drgerardee.com/agnes-acne-treatment/

Medical disclaimer: This article is for general education and does not replace an in-person consultation. Treatment suitability, results and risks vary between individuals. Please speak with a qualified doctor before starting any acne treatment.

The post AGNES RF vs AviClear vs Gold PTT, Which Acne Treatment Is Right for You? appeared first on Dr Gerard Ee.

Climbing the stairs is one of the few activities that can reveal the condition of your knees. If you have healthy knees, going up the stairs is likely something you do without thinking. But the moment something goes wrong in your knee, even mundane things like climbing a flight of stairs can suddenly become painful.

This guide explains the most common reasons for knee pain when climbing stairs, what the pattern of pain suggests, what conservative and physical therapy treatment options you can try out, when you should seek medical intervention, and what type of knee injection treatments are available in Singapore.

Why Stairs Stress the Knee

The patellofemoral joint (PFJ) is a complex structure located between the kneecap and the thigh bone. It serves as a mechanical lever that allows for the straightening of the knee and a force distributor that distributes compressive forces generated during physical activity like walking or climbing stairs. If there is an issue with any of the components that make up the PFJ, such as weak quadriceps, irritated cartilage behind the kneecap, mild osteoarthritis or an inflamed tendon, you will most likely notice it as it will manifest as pain when you use your knee.

Using the stairs particularly stresses the knee, as when you climb stairs, the knee bends and straightens under load with each step. Going down the stairs is even more demanding than going up, as the quadriceps must lower the body slowly under gravity with the kneecap pressed firmly against the underlying bone.

As knee pain indicates something wrong with the PFJ, it is worth paying attention to rather than dismissing.

Most Common Causes of Knee Pain

The same handful of conditions account for most stair-related knee pain.

Patellofemoral pain syndrome (PFPS). Pain felt around or behind the kneecap. Often described as a dull ache. The pain is typically worse when going down stairs, squatting, or after prolonged sitting with the knee bent. PFPS is closely linked to quadriceps and hip muscle weakness, training spikes and poor lower-limb mechanics.

Early to moderate knee osteoarthritis (knee OA). Cartilage wear often first presents as pain when using the stairs. Stiffness after rest, occasional swelling and a creaky feeling in the joint often accompany the pain. The risk of knee OA rises with age, body weight, previous knee injury and high cumulative load.

Patellar tendinopathy (jumper’s knee). An overuse injury that causes pain just below the kneecap. Usually felt when going up stairs, squatting or jumping. This kind of pain is common in runners, court-sport players and recreational athletes.

Meniscus problems. A degenerative meniscus tear can cause pain that is sometimes accompanied by a feeling of popping, clicking, something moving inside the knee, or the knee catching.

Quadriceps or hip weakness without a specific lesion. Sometimes the joint itself is fine and the problem is that the muscles that control the knee are not pulling their weight. Stairs are demanding precisely because they need good quadriceps and hip strength.

Iliotibial band syndrome (ITBS). IT band irritation causes pain on the outside of the knee. This pain is most commonly felt when running and walking downhill, or when on the stairs.

What the Pattern of Pain Suggests

Which part of your knee hurts and when it starts hurting are actually really useful diagnostic clues that can help me gauge what is the underlying cause of the pain.

If you feel pain around the kneecap when going down stairs, that usually points to patellofemoral pain or early patellofemoral osteoarthritis. If the pain is just below the kneecap when you are going up stairs, then you may be suffering from patellar tendinopathy. Mechanical pain with knee catching when going both up and down the stairs is suggestive of a meniscus problem.

A proper assessment with a focused knee examination and an optional X-ray is still needed to confirm the diagnosis, but below are some useful signs you can look out for.

• Pain when going down stairs, particularly around or behind the kneecap. This often points toward patellofemoral pain or early osteoarthritis of the patellofemoral compartment.
• Pain when going up stairs, particularly just below the kneecap. This may suggest patellar tendinopathy.
• Mechanical pain with a popping or locking feeling when going up or down the stairs. This suggests a meniscus problem.
• Deep, generalised pain when going up or down the stairs with stiffness after sitting. This may indicate established knee osteoarthritis.

Non-medical Solutions

If you find that your knee pain is mild and using the stairs is still manageable, or if the pain is a recent development, you may not need a knee injection yet. Below are a few lifestyle changes and conservative at-home treatments you can try out.

Activity adjustment. Reduce, but do not stop, the activity level and load of the aggravated knee. Use the handrail and lead with the stronger leg when going down stairs.

Quadriceps and hip strengthening. Wall sits, sit-to-stands, glute bridges and side-lying hip strengtheners are good evidence-backed exercises for improving stair-related knee pain.

Weight management. Weight loss can reduce the strain placed on the patellofemoral joint when using the stairs. Even modest weight loss can help.

Sensible footwear. Supportive, well-cushioned footwear can reduce discomfort when using the stairs. Good and supportive footwear is especially helpful for patellofemoral and osteoarthritic knees.

Gentle range-of-motion work if the knee gets stiff after sitting.

Do note that these measures may improve milder stair-related knee pain, but they will not fix a torn meniscus or advanced arthritis. I recommend monitoring your knee for a few weeks after implementing any of these lifestyle changes. If the pain persists, you should consider getting a professional knee examination.

My opinion

“A common misconception is that stopping all physical activity will help the knee heal. Avoiding movement or exercise entirely actually weakens the quadriceps that protect the joint, so the knee gets worse, not better. The right thing to do is to modify the activity, not completely stop it.

Many patients I see also have undertrained hips. Glute and hip strength controls how the knee tracks, a good training programme should thus work both the quadriceps and hip.”

When Getting a Knee Injection Is the Right Next Step

Generally, I recommend getting a knee injection when the joint itself is driving the problem and conservative care is unable to alleviate pain. Below are a few treatment options that are available in Singapore.

If the knee is swollen, hot or experiment an active flare, and the patient needs fast pain relief, a cortisone injection, also known as a steroid injection, should be considered. Cortisone is a corticosteroid medication that suppresses inflammation. It rapidly calms the joint and creates a window in which the patient can pursue rehabilitation or physiotherapy.

If the pain caused by knee osteoarthritis (knee OA) is mild to moderate, without an active flare, and the patient wants longer-lasting symptom improvement, Platelet-Rich Plasma (PRP) therapy for the knee may be a suitable treatment. Leukocyte-poor PRP, such as is preferred for knee OA.

If the patient prefers viscosupplementation rather than a corticosteroid or PRP based treatment, hyaluronic acid (HA) injections or Conjuran can be considered. Synolis VA is one example of a HA based viscosupplement, it is composed of a 2% non-crosslinked HA with 4% sorbitol antioxidant. Conjuran is used as a polynucleotide viscosupplement alternative to HA. Both treatments are used to lubricate the cartilage, improve shock absorption, and relieve pain.

Combining treatments is sometimes the right call. For example, a steroid injection is however done alone usually to treat a flare up with synovitis and effusion. However if the patient wants fast relief and longer symptom control, PRP therapy plus HA via CellularMatrix is good for non-flared mild to moderate knee OA if the patient is aiming for the long-lasting symptom relief without surgery.

My opinion

“In my experience,  is steroid injections for a flared knee, PRP for selected mild to moderate osteoarthritis where longer duration symptom improvement is the goal, and HA or Conjuran when a viscosupplement strategy is appropriate. That being said, knee injections should not be the default treatment for every patient.

For example, I would not treat patellofemoral pain in a 30 year old runner with a knee injection. For this patient, strength and load-management is a more appropriate approach. I will always perform a thorough knee examination first to ensure that the patient is matched with a suitable treatment plan.”

Knee Joint Problems Are Not Always the Cause of the Pain

Knee injections are effective only when the crux of the patient’s pain is the knee joint itself. Patellofemoral pain in a younger runner is an example of a situation where I would not jump to using an injection to treat the patient as the pain is usually caused by muscle imbalances, poor form, or excessive mechanical loading.

Another example is tendinopathy in a court-sport player. I would not use an injection as the first line of treatment as the underlying cause of the pain is a load-management problem. My treatment approach for these kinds of cases would be to first perform an assessment, then address the contributing factors of the knee pain. If the patient does not settle with that approach, then I will administer an injection.

When to See a Doctor

It is worth getting the knee assessed if the pain shows any of the following features.

• Has lasted more than a few weeks despite sensible self-management
• Significantly limits your walking distance, activity level, or ability to use the stairs
• Comes with the feeling of the knee catching, locking, or giving way
• Accompanied by significant or recurrent swelling
• Came on suddenly after a twist or leg injury
• Severe enough to wake you at night, or is constant even when you are not moving

If you suspect something is wrong, you should see a doctor as soon as possible. The earlier you identify the reason for the pain, the more treatment options are available for you to choose from.

When Injection Is Not the Right Move

There are situations where a knee injection is not the right solution, even if the patient wants one.

• The diagnosis is not confidently established. Reassessment and re-imaging should be done first.
• The imaging shows end-stage knee OA with major knee function loss. Such severe cases require knee surgery to treat.
• Presence of active local or systemic infection, recent skin infection over the knee, certain blood disorders or uncontrolled anticoagulation.
• The dominant problem is mechanical. A meniscus tear or true ligament instability typically needs orthopaedic surgery.

My opinion

“I often see patients make the mistake of getting stuck in a steroid-injection-only loop when trying to treat stair related knee pain. Cortisone shots provide fast relief when dealing with pain flares, but their effect is short lived. Getting repeated shots without a broader plan is not a maintenance strategy. If the knee needs a steroid injection every few months to stay functional, it means the underlying problem is not being addressed and the treatment plan needs to be re-evaluated, not repeated.”

Summary

Knee pain when using the stairs can be an indicator of problems with the knee joint. Most cases can be diagnosed clinically with a thorough knee examination and an optional X-ray. Most cases of knee pain can also be treated non-surgically if caught early.

For cases where the pain is mild and using the stairs is still manageable, weight management, muscle strengthening and load modification can be enough to stop the pain. For more serious cases where a knee injection is warranted, the type of injection used depends on the nature of the pain and whether or not the patient is aiming for longer term relief.

In general, I recommend a steroid injection first if the patient is suffering from a flare up. For mild to moderate osteoarthritis, I recommend a PRP injection. A viscosupplement strategy with HA or Conjuran can also be considered if necessary. As every patient’s situation and knee condition is different, a proper consultation is always needed to match the right treatment to the patient’s underlying issue.

Frequently Asked Questions

Why does the knee hurt going down stairs but not when going up? Going down stairs loads the patellofemoral joint more than when going up. Pain in this pattern often suggests patellofemoral pain syndrome or early patellofemoral osteoarthritis.

Is stair pain a sign of arthritis? It can be. Knee osteoarthritis often shows itself first as activity related pain when using stairs. However, kneecap issues, tendon problems, meniscus tears and muscle weakness can also cause pain when using the stairs. It is thus important to get a professional diagnosis.

Should patients stop using the stairs if the knee hurts? No, patients are advised to  modify rather than stop their activity. Patients can reduce frequency of activity, use the handrail, lead with the stronger leg when going down the stair, and work on strengthening their muscles. Complete avoidance of physical activity tends to weaken the knee further and make the pain worse.

Can a knee injection help with stair pain? If the underlying problem is osteoarthritis or significant joint inflammation, a knee injection can reduce pain enough to rebuild strength and make using the stairs more tolerable or comfortable. The type of injection used depends on the diagnosis.

When should patients see a knee doctor? It is worth getting assessed if the pain has lasted more than a few weeks, is limiting activity, comes with swelling or locking, or is the result of an injury.

Related Reading

• Knee Pain in Singapore: Causes, Symptoms and Treatment Options

Clinic and treatment pages.

• PRP knee injections for knee pain — Dr Gerard Ee
• Hyaluronic acid knee injections at The Clifford Clinic

Speak to Dr Gerard Ee About Your Knee Pain

If you have been experiencing knee pain while using the stairs for than a few weeks or if the pain is starting to become debilitating, a proper assessment to identify the cause of the pain and match a treatment to it is highly recommended.

Knee joint injections at The Clifford Clinic and Surgery are performed in an MOH-approved day surgery centre, which makes them claimable through Medisave and hospitalisation insurance. The clinic’s team will advise on eligibility and what a specific insurance plan covers the treatment during consultation.

The Clifford Clinic and Surgery 50 Raffles Place, #01-01 Singapore Land Tower, Singapore 048623 (Exit B, Raffles Place MRT) Phone: (65) 6532 2048 | WhatsApp: (65) 8318 6332

About Dr Gerard Ee

Dr Gerard Ee (MBBS UK, MRCS Edinburgh, DP Dermatology Cardiff) is a Member of the Royal College of Surgeons and a senior physician in Singapore. He is trained as an orthopaedic doctor and has years of experience in both operative and non-operative care of knee osteoarthritis. His peer-reviewed orthopaedic research has been published in top-tier journals including The Knee, Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA), the Journal of Bone and Joint Surgery (British) and Clinical Orthopaedics and Related Research. He now works as a director of The Clifford Clinic and The Clifford Surgery, treating primarily dermatology conditions but also provides longevity and orthopaedic treatments for  non-surgical knee care for mild to moderate knee osteoarthritis with a clinical philosophy of using non-invasive treatments first and surgery as a last resort. He believes that treatment should be matched to evidence and to the individual patient.

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By Dr Gerard Ee

If you ever tried researching what the best eye bag treatment in Singapore is, you likely ended up even more confused due to all the conflicting answers floating around online. A clinic that specialises in laser treatments will tell you that laser eye bag removal is the best, while a clinic that happens to be promoting their new radiofrequency (RF) device will say that RF eye bag removal is the superior non-surgical treatment. What is touted as the best treatment is usually whatever the clinic happens to sell.

I want to offer a different perspective on how to decide which type of treatment to pursue, so I will go against the grain and say up front that there is no such thing as a best eye bag treatment. Instead of asking what the best blanket treatment for treating all types of eye bags is, the question should be redirected towards asking what treatment is best suited for dealing with the specific root cause of your eye bags, and what type of eye bags you actually have.

At my practice, The Clifford Clinic, we offer non-surgical RF treatment, fillers, collagen stimulators and surgery. I bring this up to assure you that this is my honest and unbiased review after more than 10 years of treating eye bags and the under-eye area. As my practice offers most of the treatments I will mention throughout this article, I gain nothing from advocating for or against any of these treatments.

Five problems hiding under one name

When a patient tells me they suffer from eye bags, examination usually reveals one or a combination of five different conditions listed below.

1. True eye bags. A constant, soft bulge, present every day regardless of sleep. Caused by lower eyelid fat pads protruding forward through a weakened orbital septum. This is a structural excess of volume.
2. Tear-trough hollowing. A groove from the inner corner of the eye toward the cheek that casts a tired-looking shadow across the under-eye area. This is caused by a deficit of volume.
3. Mid-cheek deficiency. The under-eye looks sunken because the floor beneath it has dropped. This is due to the cheek below losing volume or projection, withdrawing its support from the lower eyelid.
4. Skin laxity. Loose, crepey lower eyelid skin. This is the dominant problem faced by many older patients.
5. Dark circles. Unlike true eye bags, dark circles are caused by pigmentation or visible blood vessels. To test for dark circles, stretch the skin around the under-eye gently. If the darkness persists, it is caused by pigments or visible vessels. If the darkness vanishes, it is a shadow caused by a bulge or groove.

A frequently missed driver of dark circles is allergic rhinitis. Chronic nasal or sinus congestion and eye-rubbing of an untreated allergy results in dark, bruise like and dusky under-eyes. This type of dark circles is also called allergic shiners.

Another cause of puffiness under the eyes is periorbital edema. Also known as fluid puffiness, this type of swelling is not permanent and fluctuates with salt intake, alcohol consumption, allergies and sleep. As this is not a true eye bag, treatments are ineffective on it and it should be fixed by making lifestyle changes.

Why getting a diagnosis matters

All treatments are engineered to target a specific problem. When a treatment is matched to the wrong problem, the effects of the treatment ranges from useless to actively harmful.

For example, using fillers on a true eye bag adds even volume to a problem already caused by an excess of volume. Fat reduction is effective for treating true eye bags, but when used to treat a problem caused by a deficit of volume, it deepens the hollow. Skin heating can be used for tightening skin, but warming a bulge caused by a fat pad does nothing to remove it.

I thus always advise my patients to get a proper diagnosis first, as the diagnosis should be what guides their treatment decision.

My treatment-by-treatment review

The section below is my candid assessment of every treatment commonly marketed for treating eye bags in Singapore. I will judge each treatment using the same two criteria.

1. What the treatment physically does
2. Does the treatment actually affect the protruding fat pads, which are the root cause of true eye bags

Tear trough fillers

Fillers add volume. For a genuine tear trough or mid-cheek deficiency, a conservative and correctly placed filler is an appropriate and effective treatment as it fills the valley.

However, the use of fillers to mask true eye bag is one of the most common correctable mistakes I see in my consultation room. Fillers do not hide the eye bag. In my experience, they usually make the protrusion worse and the area looks heavier as the under-eye now carries the original fat pad plus the filler.

Under-eye filler also attracts water, so the puffiness it causes when used wrongly can worsen over months. While fillers can be reversed using hyaluronidase, the total cost of wrongly injecting fillers, fixing the mistake and then switching to the right treatment can add up. To avoid wasting money, I highly recommend getting the diagnosis right from the start.

My verdict: Fillers are excellent for filling hollows and are the right tool for tear troughs and cheek deficiency. But they should not be used for treating true eye bags.

AGNES + Secret RF

The Clifford Clinic uses a two-step AGNES + Secret RF protocol to treat eye bags. Two devices are used because an eye bag is a two-layer problem involving the fat and skin envelope. The combination of AGNES and Secret RF allows for more accurate targeting and the treatment of both layers of the problem.

AGNES delivers radiofrequency (RF) energy at a fixed depth through micro-insulated needles into protruding fat compartments. The targeted fat is broken down and cleared by the body.  Secret RF then treats the overlying skin with fractional microneedle RF, stimulating collagen production so the skin contracts smoothly over the new contour.

AGNES + Secret RF is my treatment of choice for mild Grade 1 to 2 true eye bags as it targets the fat pads that cause the eye bags and then refines the results by contouring the under-eye skin. The treatment is also quick, has a short downtime and is fairly long-lasting. Expect about 20 minutes of treatment, typically 4 to 5 days of mild bruising and swelling, and possible dry eyes for 1 to 2 days. Results mature over 1 to 2 months, and the longevity of the treatment is typically 3 to 5 years.

But there are limits to the types of skin AGNES + Secret RF can treat. I will not sugarcoat it, patients must have firm skin for the treatment to be effective. Patients with loose skin or severe eye bags should consider surgery.

My verdict: One of the best non-surgical options for correcting mild eye bags, in my opinion. However, AGNES + Secret RF is not suitable for all skin types. Patients with loose skin should consider other treatment options.

HIFU

High-Intensity Focused Ultrasound (HIFU) delivers ultrasound energy into the deeper layers of the skin, heating it and activating the body’s natural wound healing response to induce collagen and elastin production. HIFU is used as a non-invasive and non-surgical option for lifting and tightening skin.

I am regularly asked about HIFU for eye bags because it is heavily marketed for facial tightening. In my experience, while HIFU has a legitimate use for skin tightening elsewhere on the face, its design works against it around the eyes.

The lower eyelid skin is superficial and among the thinnest on the body while HIFU’s energy is built for deeper planes. There is a thus a mismatch between the focal depth and anatomy. Though the more fundamental problem is HIFU cannot melt protruding fat nor can it push the fat back behind the weakened septum. Tightening the surface over an untouched fat pad does not flatten it.

My verdict: HIFU is good technology, but I do not recommend it for eye bag treatment because it cannot address the root cause of the eye bag.

Fotona “4D”, “5D”, “6D”

Fotona laser directs long-pulse Nd:YAG laser at the conjunctiva to heat the tissue from within. Several clinics market multi-step Fotona laser protocols as treatments for eye bags.

The choice of laser is itself revealing: long-pulse Nd:YAG is a tissue-heating wavelength, not fat-selective. Genuine laser lipolysis uses a 1444 nm wavelength precisely because fat absorbs it preferentially. One melts fat; the other warms the eyelid.

In my opinion, Fotona laser is conceptually unsuitable for treating eye bags as heating the eyelid from the outside or inside does not remove or shrink orbital fat. Heating the conjunctiva may produce mild or temporary tightening of the tissue over the fat pad, but the fat itself still remains untouched. In short, while these protocols are often sold as non-surgical eye bag removal treatments, I believe the advertising claims outstrip what the treatment can actually deliver.

My verdict: Not an eye bag treatment as it fails to remove or reduce the fat pads.

Rejuran

Rejuran does not thicken the under-eye skin. It is not a collagen biostimulator nor can it lighten pigmentation. And as it also does not remove the protruding fat, it cannot treat true eye bags.

My verdict: Not useful for eye bags or dark eye circles.

Re20 Fine and Juvelook Eyes

Re20 Fine and Juvelook Eyes are two injectables that I find genuinely useful for collagen stimulation in the under-eye skin. While they are not substitutes for treatments that directly target the problematic fat pad, they are adjuncts that I use in my practice as they are effective at improving skin quality and fine crepiness.

Re20 Fine and Juvelook Eyes target the skin envelope, not the fat directly. Though they cannot flatten a protruding fat pad, they can complement an eye bag treatment plan and are beneficial for patients whose dominant problem is early skin-quality change.

My verdict: Excellent adjunct treatments for certain patients.

Dark circles driven by allergic rhinitis

Dark eye circles are a common problem faced by many Singaporeans that is often mismanaged. Unlike true eye bags, dark eye circles are not caused by a protruding fat pad. They are instead caused by pigmentation or visible blood vessels. Dark eye circles are also associated with allergic rhinitis. Chronic nasal congestion impairs venous drainage around the eyes, and years of rubbing itchy eyes darkens and thins the skin. Lasering or injecting these circles without addressing the allergy is a temporary fix as the dark colour will return because the root cause was not treated.

My personal approach is to treat both ends of the problem at once. First, I will determine the cause of the allergy via a skin prick test. The next step is resolving the allergy with sublingual immunotherapy (SLIT). SLIT is my treatment of choice as it retrains the immune system against the confirmed allergens rather than merely suppressing symptoms with antihistamines.

While the allergy is being treated, I would simultaneously treat the dark circles directly with V Beam Eyes. V Beam Eyes is a vascular laser that targets the dusky, vessel-related discolouration. It can be combined with Juvelook Eyes for collagen stimulation in the thin under-eye skin to further lighten the under-eye skin.

My verdict: For allergy-associated dark circles, the SLIT, V Beam Eyes and Juvelook Eyes combination protocol is particularly effective as it addresses both the allergy that causes the discolouration and the dark circles themselves.

Surgery

I recommended surgery for Grade 3–4 eye bags and for patients with significant loose lower eyelid skin.

Scarless eye bag removal, also known as transconjunctival blepharoplasty, is a good option for patients who are concerned about post-surgery scarring. During a scarless eye bag removal surgery, the protruding fat is removed or repositioned through an incision inside the eyelid, allowing for the surgery to be done with no visible external scar.

In cases where excess skin exists, a pinch blepharoplasty that removes a fine strip of skin at the lash line can also be performed. The presence of excess loose skin is why older patients generally need surgery. Skin laxity accumulates with age, and there will be a point where non-surgical treatments and energy devices can no longer tighten the redundant skin.

I do not believe in letting patients waste money on treatments that cannot benefit them. If I feel the patient will not respond to non-surgical options, I will not hesitate to recommend surgery instead. While at a glance, surgery may seem more expensive, for certain patients, it can actually be the more complete and more economical choice because it solves the problem once and for all instead of partly solving it repeatedly.

My verdict: I recommend surgical intervention for advanced bags and loose skin.

Eye creams and home remedies

Cold compresses, head elevation, consuming less salt, allergy control and caffeine creams can genuinely improve fluid puffiness temporarily. However, they cannot reach or reduce a herniated fat pad.

My verdict: May be suitable for alleviating puffiness caused by fluid retention, but not suitable for treating true eye bags.

The verdict table

What an examination at The Clifford Clinic involves

A proper examination is the first step to diagnosing the underlying problem and treating it. Below is a brief outline of what you can expect.

1. The light test

I, or your attending doctor, will look at your under-eye area under direct and overhead light. I use two different light sources as shadows from troughs deepen dramatically under overhead light while pigments look the same under both light sources.

2. The stretch test

Gently stretching the skin distinguishes true pigmentation from shadows as true pigmentation remains dark even when stretched.

3. Upward gaze test

By asking you to look up, protruding fat pads push forward and a true eye bag will become more prominent while a hollow caused by volume loss will not.

4. Grading the protrusion

The protrusion will be graded from 1 to 4 across each of the three lower fat compartments because eye bags are frequently asymmetrical and compartment-specific.

5. Skin recoil check

By gently pinching the lower eyelid skin and observing if it snaps back briskly or if it returns slowly and crinkles, skin quality can be determined.

Skin that snaps back quickly indicates that the patient is a non-surgical treatment candidate as their skin is still firm. While skin that returns slowly indicates skin laxity. I would recommend surgical treatment for such cases.

Finally, I will ask about lifestyle fluctuations such as salt intake, alcohol consumption, allergies, sleep, or menstrual cycle. I do this to make sure that the under-eye bags are not actually caused by temporary fluid retention.

The entire examination should take roughly five minutes. No machines are necessary.

As I have mentioned, a proper diagnosis is needed to determine the best treatment for your situation. Patients should be wary of clinics that recommend treatments without doing an examination first.

Can treatments be combined?

Yes, combination protocols often produce the best results. Below are a few combinations that I find to be particularly effective.

AGNES + Secret RF, followed by filler later. This is suitable for patients with a true eye bag and a genuine residual trough. The problematic fat is dealt with first, then filler is injected if needed after reassessment at 1 to 2 months.

Fat treatment plus collagen stimulation. Re20 Fine or Juvelook Eyes can be used to improve the skin envelope while the result of another treatment that targets the fat pad matures. I recommend this for patients with early eye area crepiness.

Surgery followed by skin-quality work.  This is ideal for older patients once they have fully healed from the eye bag removal surgery.

I would like to caution again that the treatment is only effective if it addresses the underlying cause of the problem. I do not recommend layering treatments on top of an undiagnosed problem. Stacking treatments without a proper diagnosis multiplies the cost of a potential mistake.

My personal algorithm for choosing the best treatment for each patient

After 500+ cases, this is my decision tree.

1. Constant soft bulge, mild Grade 1–2 eye bag, and firm skin→ AGNES + Secret RF → Collagen stimulation via Re20 Fine or Juvelook Eyes as an adjunct if skin quality warrants it.
2. Deep tear trough or mid-cheek deficiency, no significant bulge→ conservative filler, sometimes in the cheek rather than the eyelid.
3. Bulge and groove present together → treat the fat first then reassess the trough at 1–2 months.
4. Grade 3–4 eye bag bulge, or loose lower eyelid skin→ surgery with pinch blepharoplasty for the excess skin. I recommend this pathway for older patients.
5. Under-eye puffiness that fluctuates→ lifestyle changes, no procedure needed.
6. Darkness that persists even when skin is stretched→ this indicates a dark circle problem, not an eye bag problem. If allergic rhinitis is the driver, I will order an allergy blood test and skin prick test to confirm the d Then SLIT to resolve the allergy, and V Beam Eyes with Juvelook Eyes simultaneously to treat the pigmentation.

The common mistakes I keep seeing

After a decade of medical practice, these are some of the recurring mistakes I see in patients who come to me for advice or help. True bags filled with filler, resulting in smile-lumps. Skin-heating treatments like HIFU or multi-D laser that are unable to target fat are being used to treat true eye bags. Rejuran courses for dark circles. And lastly, older patients with loose skin are being given non-surgical treatment that is not suitable for their skin quality.

In my opinion, none of these patients were failed by the treatments or the medical technology. Their treatments failed because they lacked a proper diagnosis.

So before committing to purchasing any treatment, I advise you to ask yourself what grade your eye bags are? Are your under-eye bags true eye bags? What is the quality and elasticity of your skin? Is the cause of your problem the fat pad, hollowing, laxity, fluid or pigmentation? Does this treatment address the core cause of your problem?

Of course, these questions are hard to answer on your own. Hence why recommend always consulting with a medical professional before making any decisions.

Frequently asked questions

What is the best eye bag treatment in Singapore? There is no best blanket treatment for eye bags. What treatment is suitable for you depends on what the root cause of your problem is.

We recommend always getting a professional diagnosis before committing to any treatment.

Does HIFU work for eye bags? In my assessment, no. HIFU is designed to heat deeper tissue planes while eyelid skin is thin and superficial. HIFU also cannot melt or reposition the protruding fat that causes the eye bag.

Do Fotona 4D/5D/6D protocols remove eye bags? No. They heat tissue, including via the conjunctiva, but do not remove or reduce orbital fat.

What is the best treatment for dark eye circles caused by allergies? It is best to treat the cause and the colour together.

First, confirm the allergy with a blood test and skin prick test, then resolve it with sublingual immunotherapy (SLIT). The pigmentation can be simultaneously treated with V Beam Eyes and Juvelook Eyes.

Is Rejuran good for dark eye circles or eye bags? In my opinion, no. Rejuran does not thicken skin, stimulate collagen, lighten pigmentation or reduce fat. For under-eye skin quality, collagen stimulators such as Re20 Fine or Juvelook Eyes are more useful treatments to pursue.

Can fillers ever be the best option? Yes, for a genuine tear trough or mid-cheek deficiency without significant fat protrusion. On true bags, they typically make things worse by causing a lump to form when smiling.

When is surgery unavoidable? When the patient has Grade 3–4 eye bags or loose lower eyelid skin. This is common in older patients who often also need a pinch blepharoplasty for excess skin.

How much do these treatments cost? At Clifford Clinic, AGNES + Secret RF is $2,500 SGD for the first session and $1,800 SGD for subsequent sessions.

Fillers are priced per syringe. Surgery is quoted after assessment. The full eye bag removal cost comparison is on the clinic site.

How do I find out which treatment fits me? Get examined before getting treated. My team offers a doctor-led eye bag assessment at Clifford Clinic, covering non-surgical AGNES + Secret RF treatment, fillers, collagen stimulators and scarless eye bag surgery — so the recommendation follows your anatomy, not a device list.

Dr Gerard Ee is the founder and medical director of The Clifford Clinic, Singapore. He has performed AGNES and Secret RF eye bag treatments for more than 10 years across over 500 eye bag patients. This article reflects his clinical opinion and is for general information; it does not replace a medical consultation.

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