By Dr Davin Lim, Procedural Dermatologist, Brisbane & Sydney
The Acne Scar Repair Series
The Acne Scar Repair Series
This program is designed to globally improve acne scarring using the very best lasers at an affordable price point.
Summary
3 laser sessions are performed
Treatments are typically spaced 4 to 8 weeks apart
Recovery can be tailored according to your skin type & recovery, typically 2 to 8 days
We use a variety of lasers including CO2, non-ablative & pico fractional devices
Treatments are done by my experienced procedural nurses
This the most cost effective method of reducing acne scars
Some scar signature may require further treatment methods
What kinds of acne scars does the Acne Scar Repair Series treat?
This series is intended to improve acne scars, making it a general treatment for the majority of acne scar forms, including rolling, boxcar, and atrophic variations (dips and divots).
With the acne scar repair series, there will be some treatment bias; for example, some acne scarring types will react to laser treatment better than other scar types. This program’s objective is to offer a 40–80% global improvement. Other lasers can be used for acne scars that are coloured, such as red scars and brown marks.
*Scar focused treatments frequently result in better outcomes, but they come at a higher cost & with additional complexity. For precise scar signature treatment, dermatologists are involved.
How many treatments are in this series?
Three laser sessions, spaced 4 to 8 weeks apart. Treatments are spaced to ensure you heal fully from each session. The intervals are chosen for maximal collagen stimulation, whilst taking into account skin recovery & skin color. For darker skin types, we recommend spacing appointments 6 to 8 weeks apart.
What is the cost for the Acne Scar Repair series?
This laser series is designed to provide access to the best lasers used in dermatology, at a cost-effective price, hence it is performed by our experienced nurses at Cutis Dermatology.
Single treatment (with any fractional laser/s): $890
Laser series of 3 sessions (with any fractional device) $2135
*Selection of fractional lasers we use include CO2 fractional laser, eCO2, Ultrapulse, Mixto, CO2RE, erbium fractional lasers, Fraxel, 1440 laser, & Alma Hybrid lasers. The same applies to high pass pico lasers including Picoway & Picosure Pro.
Please contact my team at Cutis Dermatology to book a consultation.
Who performs the Scar Repair program?
My senior nurses at Cutis Dermatology provide the Acne Scar Repair Series treatments. Our nurses have extensive experience on scar correction using a variety of methods, such as lasers, TCA CROSS, RF microneedling, pico & vascular lasers, dermal fillers, and injectables.
*You can ask for a consultant dermatologist to provide this treatment; however, the cost each session is significantly more. This package, delivered by nurses, is intended to deliver outcomes while still being affordable for patients.
When will I see the outcomes?
Results are visible within two weeks, although they are at their peak three to six months following your last treatment. This is due to the fact that your body needs time to produce collagen and reconstruct scarring. Your gains will be amplified if you eat healthily and keep your acne completely under control.
How long does it take to perform?
Numbing gel application (in clinic): 1 hour.
Procedure time: 20 to 25 minutes, depending on the area treated.
Total time: One & a half hours.
How long after laser treatment does it take to recover?
Recovery times depend on the settings & ranges from 48 hours to 8 days. We will discuss projected recovery prior to the treatment.
3-4 day recovery: Pico lasers, CO2 light fractional laser
4-6 day recovery: CO2 & Non-ablative fractional medium power
6+ day recovery: Fractional CO2 high power & density
*Note: the higher the setting, the better the outcomes, the longer the downtime. Recovery is proportional to the projected results.
Is laser treatment for acne scarring painful?
Treatments are comfortable. We use specialist strength numbing gel & skin cooling. For more involved procedures, we prescribe laughing gas.
With state of the art laser systems, such as the new Ultrapulse & Alma Hybrid, these deliver laser beams in a specific pattern to minimize discomfort, whilst optimizing outcomes.
What lasers do we employ for scar removal?
We are fortunate to have access to 42 lasers & energy devices. Your clinician will pick from a selection of fractional devices including-
Our nurses & dermatologists can mix & match various combinations of lasers. This ensures that you are getting the best treatments & are not ‘locked in’ to one type of laser. The combinations are infinite.
What is the best laser for this job?
Our preferred laser is the Alma Hybrid as it is 2 lasers in one. The CO2 component of the Hybrid provides the best method for collagen stimulation, whilst the 1570 component provides deep dermal remodeling. It is twice as powerful as the Fraxel laser (which is really good for treating sun damage, but a crap laser for acne scars).
We can control many parameters with the Hybrid, including the power, pulse duration, density & relative ratios of CO2 vs 1570 non-ablative. This means we can tailor treatments based upon scar type, depth, downtime, & skin type. This translates to highly effective treatments with minimal downtime & side effects. All skin colors can be treated with the Hybrid.
SOP or standard operating protocols with CO2 & erbium glass 1570, ALMA Hybrid, treatment of atrophic acne scars, skin type 3+
.
👉The challenge: to produce a reproducible outcome WITHOUT me getting involved in the treatment
.
How? 🔫Alma Hybrid, 1570 + CO2 fractional, standard protocol treatments by Lara @cutis_dermatology , Brisbane
.
👉Additional improvement: with HA hybrid injectables, provides hydration, collagen remodeling with no downtime, another option is with CAH hyper dilute. 1-2 sessions, spaced 4-12 weeks apart
.
🎬Action: Consult my nurses at Cutis Dermatology. Nurse initiated treatments start at $711, 2-4 sessions recommended💯
.
👍🏻End point of scar revision: barely perceivable scars at conversational distances under normal lighting conditions
.
😎Davin Lim
Dermatologist
Brisbane / Sydney🇦🇺
.
#almahybrid #acnescars #scars #co2laser #fractionallaser #drdavinlim #sydneydermatologist #sydneydermatology #dermatologistsydney...
Difficult case as there are numerous factors contributing to acne scars
.
👉Scarring itself; severe atrophic acne scars, with atrophy in multiple levels, namely superficial & deep dermis in addition to subcutaneous layer
.
👉Contributing skin laxity; due to age & weight loss
.
👉Contributing fat atrophy; age & BMI related
.
👉Photodamage; increases the apparent severity of acne scars- think ‘rust’ on ‘dings’ on the car door. Clear up photodamage & it improves light reflex & luminosity, improving the appearance of scars (without volumetric correction of atrophy)💯
.
👍🏻This patient: was challenging. Subcision released deeper scarring, whilst calcium hydroxyapatite hyper dilute fillers stimulate collagen production, in addition to thickening the dermis & subcutaneous layer. The biggest gain using energy devices was the Alma Hybrid, 1570 + CO2 fractional, 🔫standard protocol treatments by Lara @cutis_dermatology
.
💉Additional improvement: with HA hybrid injectables, provides hydration, collagen remodeling with no downtime
.
😎Davin Lim
Dermatologist
Brisbane / Sydney🇦🇺
.
#almahybrid #acnescars #scars #co2laser #fractionallaser #drdavinlim #sydneydermatologist #sydneydermatology #dermatologistsydney...
The Alma Hybrid laser is great for atrophic acne scars, especially in darker skin types, by Lara @cutis_dermatology
.
🔫Alma Hybrid: combines two wavelengths in the one device. It fires the CO2 & the 1570. The exciting thing about this laser is that the bespoke mix of wavelengths ensures clinical results, but markedly reduces post treatment skin darkening. Secondly it takes the dermatologist out of the equation, which is awesome
.
👍🏻👉More improvement? High and low molecular weight hyaluronic acid injectables can amplify the results
.
😎Davin Lim
Dermatologist
Brisbane/Sydney🇦🇺
.
#almahybrid #hybridlaserresurfacing #fractionallaser #laser #rejuvenation #co2laser #brisbanedermatology #drdavinlim #cutisdermatology #almalasers #acnescarremoval
#acnescars #dermatologistsydney...
Hybrid lasers are the way of the future, and Alma is at the pointy end of R & D. This laser is great for atrophic acne scars, especially in darker skin types as the non-ablative is relatively forgiving in the treatment of atrophic scars
.
👍🏻Alma Hybrid: combines two powerful wavelengths in the one device. It fires the CO2 & the 1570 in an almost infinite number of combinations. This before & after was the result of one session of subcision & focal excision (me), one session of Alma (Lara @cutis.dermatology )
.
👉More on how we rock the Alma at the Alma Academy ASCD next week @ascd.org.au
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#alma #almahybrid #hybridlaserresurfacing #fractionallaser #laserrejuvenation #brisbanedermatologist #drdavinlim...
Combined effort from my nursing team at Cutis Dermatology☄️
.
👉Scar type: ice picks
.
👍🏻Treatment/s: TCA, phenol croton oil, paint. CO2 fractional, wee bit of neurotox to relax the frontalis mm (reduces traction of some scar types)
.
👉Comments: Ice pick scars are quite easy to treat; you only need perseverance. Light laser resurfacing improves the light reflex, skin quality & luminosity of the skin. This aids in reflection of light, thereby improving the look of acne scars. Don’t forget the epidermis, as this makes a significant difference in the perception of scars💯
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#acne #acnescars #icepickscars #icepickacnescars #acnescartreatments #fractionallaser #davinlim #dermatologist #cutisdermatology...
This new injectable has the most robust studies for the treatment of atrophic acne scars with two good papers in the past 2 years. It has recently been TGA approved for cosmetic treatment of the face, with off label indications for the neck, hands, chest &....acne scars. It is now available in Australia
.
👉How is it different from dermal filler? Unlike HA fillers that improve volume, this injectable stimulates your cells to produce collagen, fat & also new skin cells to improve skin quality. This in turn improves the reflectance of light which can add to the perceived improvement of acne scars, without volumetric changes. It can also stimulate ASCs or adipose stem cells to further improve outcomes
.
🤔What types of scars can be treated? Atrophic rolling acne scars with low to medium amounts of tethering do best. If you have lots of tethered scars, subcision should be performed prior or during treatment with this product
.
💉How many treatments are required? 2-3 sessions
.
👉Can I still have it done if I have active acne? Yes, but you will get much better responses if your acne is in absolute remission
.
💵How much does it cost? It is super affordable at $850 AUD for the entire course of treatment; 2-3 sessions. Each session is spaced out by 3-5 weeks. The price gets you 2 mls of highly concentrated hyaluronic acid. For mild to moderate acne scar surface area only one syringe is required (0.7 to 1.0 ml per session).
.
⏱Downtime? About 2-3 hours of redness. In some cases bruising may last 3-6 days, depending on the location of scars. Treatment time? 10 min
.
🔫Does it replace all other treatments? No, but it offers good correction of atrophic scars with minimal cost & downtime, the usual methods apply depending on the signature of your scars
.
📩How to book? Send me a DM for me to triage to my nurses & colleagues. This procedure is primarily performed by our skilled nurses, I do get involved in complex surgical cases or deep resurfacing for objectively severe scars
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
#drdavinlim #davinlim #acnescars #acnescartreatment #acnescartips #profhilo #dermalfiller #collagen #scarremoval #brisbanedermatologist
@profhilo_aunz...
Seen one in the late 90s, never did one…😱🆎🅰️🅾️🩸🩸🩸
.
👍🏻My respect for the senior colleagues who used this method to treat acne scars, sun damage & epic wrinkles. A truly tactile procedure that require a steady hand & b*lls the size of 🥥 coconuts
.
🎥YouTube & Instagram will definitely censor this procedure, its beyond ‘sensitive content’
.
😎Davin Lim
Dermatologist🇦🇺
#dermabrasion #micodermabrasion #dermatology #diamondmicrodermabrasion #skinscience #davinlim #brisbanedermatology #sensitivecontent #sensitif...
Yeah, lighting not quite perfect, by you get the picture😁
.
👍🏻☄️Device: Tixel, B+A courtesy of Jean at Cutis Dermatology
.
🧐What is it?: short contact heating via titanium pins
.
👉How does it work?: Collagen stimulation via heat
.
👁What is it really good at?: Eyes
.
👍🏻What else can it do?: Lots. Improve skin quality, treat early acne scars, stretch marks & even aid in transepidermal delivery of Botox & other ‘ingredients’
.
🙄How many sessions?: 2-4
.
📚More at NSS in 3 weeks time. The company is running a masterclass, my team & I will present our settings & indications. See ya all there💯
.
😎Davin Lim
Dermatologist
Cutis Dermatology🇦🇺
.
#tixel #tixeleyes #tixeltreatment #eyerejuvenation #eyes #wrinkletreatment #eyewrinkles
#tixelrejuvenation...
PIH or post inflammatory inflammation treated with pico laser. 3 sessions over 3 months using the 1064 Zoom of Picoway
.
👩🏽PIH/Grade 1 acne scars: 50% last 12 months or longer, of those 25% last 5 years. More prevalent in darker or ethnic skin types
.
🧴Topicals: give modest improvements; the usual HQ, arbutin, #cysteamine, licorice root extracts, botanicals ascorbic acid
.
🔫Pico lasers: are the game changer. Above all things, control or eliminate the source of inflammation. In the context of acne, aim for absolute control & remission
.
🎬Action: For PIH scars, book in with the nursing staff at Cutis Dermatology, if you have active acne, consult my dermatology colleagues
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
#acne #scars #pih #postinflammatorypigment #picolaser #picoway #picolasertreatment #skinlightening #skinbrightening #drdavinlim #brisbanedermatology...
Rolling, highly atrophic acne scars in skin type 4, Asian. Zero acne activity which makes my job infinitely easier💯
.
👍🏻Treatment: multi-laser sharp subcision, fractional CO2 to remodel scars, followed by super -deep fully ablative erbium laser
.
😩Post inflammatory changes: present for nearly 4 months. I have initiated pico & vascular lasers to normalize skin texture
.
👊🏻Concept: I can treat aggressively, but skin color changes WILL occur in darker skin types, or I can be super gentle & not give color changes. If you choose the later, the job may take 3-6 times longer
.
😎Dr Davin Lim
Dermatologist
Brisbane🇦🇺
.
#scartreatments #acnescar #acnescartips #acnescarrevision #scarremedy #scarring #cureacnescars #acnescarskincare...
Red marks post acne, treated with V BEAM Perfecta by @candelamedicalanz
.
👉Post acne FLAT ‘scars’ (Grade 1) can be classified as red, namely PIE or post inflammatory erythema or macular erythema, or brown, post inflammatory hyperpigmentation
.
😡Red: Treat with vascular lasers, in this case V BEAM
.
🖐🏽Brown: Treat with pico laser, previous posts have demonstrated the efficacy of Picoway💯
.
👊🏻Reality: Esp in darker Ethic skin, there are elements of red & brown clinically. I am sure histologically even in lighter skin types, there are elements of both. Hence I prefer the name PIPA or post inflammatory pigmentation alteration to cover both, leaning towards brown or red, or fence sitting in cases of combined color changes
.
3 pointers how to effectively manage pigmentation in acne
.
1️⃣Above all, control active acne
.
2️⃣Use SPF properly, covered in previous posts
.
3️⃣Apply specific lasers based upon clinical findings, vascular for red, pico for brown
.
👍🏻Follow 1-3, problems solved. Indefinitely
.
🎬Action: for simple acne scars, book an appointment with the nurses @ They will find a cost effective solution to treat your concerts, with predictable results
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#skinscience #acnescars #acnemarks #piescars #PIH #postinflammatoryhyperpigmentation #acnetips #acnetreatment #acnecure #dermatologist #dermatology #drdavinlim #davinlim #cutisdermatology...
Congrats to Tom Sun for helping write up this paper
.
👉The paper: shows that TCA can effectively & safely treat multiple scar types, far extending its use beyond traditional ice-pick scars, in fact box car, linear, & even polymorphic scars can be treated with this novel technique. It shows how to partially treat larger acne scars with multiple edges, some defined, others not
.
🔍We disagree with others regarding extension of scar widths, if applied correctly. This means avoiding midline scars & avoiding gentle sloping scars. We also disagree with some papers reflective of the high post-inflammatory hypopigmentation seen with this procedure. To our knowledge we (I) have only caused one case of hypo in the several thousand cases (though I did see another recent case by a dermatologist 3 months ago. 😁Too high coverage with TCA)
.
👊🏻In the world of lasers & energy devices, my instruments of choice are still old fashioned paint brushes, punches, Toledos, & the odd cannula here & there
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#drdavinlim #dermatoloigstbrisbane #skinscience #tcacross #tca...
What is your take on this?
.
👉Here is mine… my team & I revise scars on a daily basis. Most of our patients exceed the ‘severe’ grade 4 ruling by a factor of ten. A lot of these case can be prevented😞
.
💯Scars play a huge role in the physical & emotional well being of patients, we understand that. Patients travel from around Australia & the other end of the world to get treatments
.
💰💵Look, we get it, business is a commercial venture. There is however, a cross over when it comes to medical ethics. If a patient has a few pimples & would like cleaner skin, yes, there is an argument that they are a sitting target for sales. Heck, #Proactive does it, so does #Kleresca & many other companies. Market away
.
🤬Where I get p*ssed off is when acne is medical. Take for example cystic acne, scarring acne or deep painful hormonal acne. These forms of acne have a high incidence of acne scars. They also frequently give emotional scars that can be lifelong
.
👉In these groups of patients (not clients, not consumers), acne treatments should be managed ethically with remission in mind, not commercially. Tell it like it is, let the patient decide
.
👌🏻I have been supporting Scition for 15 years. I think it’s in the top 3 IPL/BBLs out there. We use their devices daily, we also use their BBL to treat acne, however my team has never had the brief to upsell this treatment, in fact it’s the opposite, we encourage medical therapy over light based modalities. We acknowledge that in some cases, this is the preferred treatment👍🏻
.
👉The name of Forever Clear is not ethically correct. In fact, it is misleading. If it was the name of a drug, the company would have been sued within an hour of launching, or it wouldn’t have gained FDA, CE or TGA approval. Not a chance
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#dermatology #IPL #scitonbbl #foreverclear #bluelighttherapy #acnetips #acnetreatment #drdavinlim #davinlim #acne #brisbanedermatologist #laserclinics #cysticacne #hormonalacne...
Ever wondered how ice pick scars form?
.
🔬Skin Science: Ice picks are part of the classic description of acne scars including boxcar, rolling, (atrophic) & hypertrophic. In reality there are many more scar types including saucer, bridging, hypopigmented, & commonly, polymorphic undifferentiated scars
.
👍🏻Think histology to effectively revise scars: icepicks are a paradox. They are ‘superficial but deep.’ Going under the scar itself with subcision often releases the base of ice picks, hence in some, pathology is in the subcutaneous layers
.
👌🏻Solutions: Contrary to the literature, ice picks are relatively easy to treat. Accurate TCA or phenol placement will improve. It’s a matter of treatment sessions & proper selection.
Faster options include punches. 🔫Small diameter lasers can hit the side walls, causing remodeling in shallower icepicks
.
🚬🔥Smoking & scars: anecdotally this scar type is more common in smokers. I suspect changes in the microcirculation may predispose genetically susceptible individuals to this scar morphology
.
🎬Action: book an appointment with Alison or Katie @cliniccutis They can assess your scar types & come up with a treatment plan. Alternatively I am more than happy to be involved in more challenging cases
.
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#dermatology #icepickscars #acnescars #drdavinlim #davinlim #scars #acnescartreatment #nomorescars #pockscars #laserdermatology #dermatologist
#skinclinic #brisbanedermatologist...
One session pico laser using the 532 nm wavelength by Alison @cliniccutis
.
👉How we employ pico: Post inflammatory hyperpigmentation, general dyschromia in darker skin types, #Ota, enlarged pores in dark skin, early #acnescars with minimal volume loss
.
🔫The device: Picoway, with 532 for #lentigos followed by 1064 for general toning
.
🔬The logic: pico lasers in this skin type reduces unwanted side effects, namely post inflammatory hyperpigmentation. This is based on probability not possibility
.
🧐When I still use nano/ QSL: CALM, #melasma, age spots & lentigines in skin type 1- 2 & some 3 (relative risk)
.
👎🏼What pico is NOT great for: Atrophic acne scars, melasma (I prefer a higher predictability), solar keratosis, one session skin rejuvenation in lighter skin types (fractional laser does a much better job), deep wrinkles, skin laxity
.
🧐Davin Lim
Dermo
Brisbane🇦🇺
@cliniccutis
.
#dermatologist #drdavinlim #picosure #picoway #enlighten #agespots #picolaser #picotoning #skinlightening #skinbrightening #ethnicskin #cosmeticclinicbrisbane #dermatologyclinic...
If you’re not into laser physics, you may not appreciate the marvel of technology that pico lasers represent. This ultrashort pulse duration gives some context as to timelines. A picosecond is the SI unit of time equal to 10 to the -12 of a second.. Crazy eh?
.
🔬Tech vs biology: The latter is the rate limiting factor. Many examples ranging from tattoos, #melasma, hemosiderin stains, Hori’s, Ota’s, Ito’s, even some cases of deep dermal post inflammatory hyperpigmentation. Histology shows that pigment is targeted & fragmented- job done by the laser. The rate limiting part is the innate nature of the human immune system & the variability between individuals (treatment same, clinical findings same, histological findings same, but results vary)
.
🔫Pico vs Nano: I think the big leap was the nano laser, but pico represents a biggish step forward. We have been working with pico for nearly 7 years, starting with gen one Picosure, & now with all the wavelengths of Picoway. I find pico lasers the hardest to work out (with >90% confidence intervals). Nevertheless, pico is my go to for PIH, pores & skin quality improvement in darker skin types. Grade 1 acne scars, early scars in ethnic skin types & mixed pigment in darker skin. As for dermal melanocytosis such as Hori’s / Ota, I am still fence sitting. Possibly the newer gen nano lasers with ultrashort PD of 5 ns or less (and increased power), may get close to picos for deep dermal pathology. In the next decade there will be femto lasers, with PD in the 10 to the -18 sec range. Will eagerly see what these lasers can achieve, however for now I do think the rate limiting step is the human immune system & biology, and not tech.
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#picoway #picosure #enlighten #picosecond #picolaser #picotoning #skinlightening #skinbrightening #skinscience #laserdermatology...
Early & EFFECTIVE treatment of acne prevents or at the very least, markedly reduces acne scars
.
🔬Skin Science: The most predictable index of acne scarring is the time taken to EFFECTIVE management. Other factors include genetics, & picking
.
👉This patient: Was treated by me. Oral retinoid & anti-inflammatories- short, tapering course. One cse places acne into remission in about 60-70% of cases. The before & afters taken 9 years apart💯
.
🤔Recurrence higher in: family history of acne, extensive & severe acne, #bacne & truncal acne, hormonal acne (intracrine & endocrine), incomplete cse, acne excoriee, early onset acne, cystic subtype
.
👊Tips: if you struggle with acne see a dermatologist, they can effectively manage your condition & in most cases place it into remission
.
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
Disclaimer: I do not treat acne, my work is entirely procedural, namely I cut, lase, & inject
.
🎬Action: If you have acne, my colleagues @clinicutis can assist with medical management
.
#dermatology #brisbanedermatologist #drdavinlim #davinlim #hormonalacne #cysticacne #acnetips #acneskincare #acne #acneremedy...
Deep ice pick scars are relatively easy to treat. How so?
.
🔬Skin science: Though the literature suggests that ice picks are the hardest, they are actually the easiest as they follow a predictable algorithm. In fact simple paint brushes, insulin syringes or even a toothpick can do it. Even lasers delivered obliquely can help, as can microneedling for shallow picks. Surgical excision can expedite some cases
.
👉Rolling scars are harder. This is because we don’t know the depth of scars, extent of fibrosis, dermal thickness & the amount of atrophy in the dermis vs subcutaneous tissue. Additionally the patient’s age comes into play as deeper structures support the overlying scars. Add to this the unpredictability of collagen regeneration & the surgical technique required to correct this form of scarring
.
👍🏻💯Tip: Most acne scars are polymorphic. Match the scar type/s to the appropriate treatments for the best results
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#acnescars #scars #acnescar #icepickscar #drdavinlim #dermatologist...
These are hypopigmented / depigmented scars. They are the result of picking acne or acne excoriee, it can also occur with dermatillomania & methamphetamine use
.
.
🔬Skin Science: Picking can lead to acne scars. Hyperpigmentation at best, de-pigmented & atrophic scars at worst. Melanocytes belong on the basement membrane & not under fingernails
.
👊Solution: This type of acne scarring is the most challenging to treat, been struggling to find a reliable solution for over a decade
.
🪡Microneedling can stimulate pigment if there are viable melanocytes left
.
🧴Topicals include PG analogues such as bimatoprost, calcineurin inhibitors such as tacrolimus
.
🔫Lasers such as fractional ablative CO2, erbium & NA. 308 excimer lasers & focused light. nUVB, psoralen & UVA can help some cases. Rate limiting factors include the presence of pigment cells & migration from follicular units (if any left) or the periphery
.
💤Cell transfer including #ReCell & #Regenera In theory a good idea but too many steps involved, in turn compromising the viability of melanocytes. Additionally the use of ‘stems’ placed in the hypodermis to differentiate into functioning melanocytes in adequate numbers which may or may not produce adequate pigment to provide a clinical outcome (cf in vitro demonstration) again, too many variables. For viable cells, one should keep the procedure as simple as possible💯
.
👉What we did>> Transferred pigment via SSG. Todate this is the most predictable procedure for hypopigmentation we have come across. Need 4 more cases + histology till we write up it
.
🎬Who are candidates? White scars with NO active disease, limited stable #vitiligo
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#acne #acnescars #whitescars #pickscars #acnescarrevision #scarrevision #acnescarcure #acnescartreatment #Co2laser #dermatology #dermatologist #drdavinlim #davinlim #dermatologybrisbane #recell #regenera #rigenera #stemcells #pickscars #pickingscars #dermatillomania...
I do love pico lasers, they are great for post inflammatory hyperpigmentation & treating dyschromia in ETHNIC & DARKER Skin types. They are used far too often for treating #melasma, atrophic acne scars & photorejuvenation in lighter skin types
.
📊Data: I suspect the actual satisfaction rate of pico lasers in the context of melasma is much lower than 39.3%, as this data is from my recent algorithmic quiz. It relies on an accurate diagnosis in the first place. I suspect in the context of melasma, it’s probably around the 20-27% depending on variables
.
😀The satisfaction rate may be higher than the efficacy. when pico was applied to acne scarring, the efficacy is extremely low (in the context of volumetric changes), however patients report high satisfaction in other aspects of skin, namely pores & general pigment (including PIH)
.
👊How we employ pico: PIH, resistant forms of #melasma, general dyschromia in darker skin types, Ota, Ito, pore sizing in ethnic skin, early acne scars with little volumetric loss
.
🤓When I still use nano: CALM, melasma, age spots & lentigines in skin type 1- 2 & some 3. Traumatic tattoo (very predictable), drug induced pigmentation (some)
.
😩What pico is NOT great for: Atrophic acne scars, melasma, solar keratosis, one session skin rejuvenation in lighter skin types (fractional laser does a much better job), in fact simple Jessner-TCA will outperform the most expensive pico laser in this context. Any day, any time. Also depends on the company. Enlighten by Cutera has a very long pulse duration, Cynosure Picosure has a good 755 but really dismal 532 & a laughable 1064
.
👉Tips: Based upon this data, you have a higher rate of pico not working for your presumed melama, so think about that. In fact, one in four cases you will be forking out a sh*t load of 💰$ 💰to get worse skin. Roll the dice 🎲🎲
.
.
😎Dr Davin Lim
Dermatologist.
Brisbane🇦🇺
.
#dermatologist #drdavinlim #brisbanedermatologist #picosure #picoway #enlightenpico #picolaser #picotoning #skinlightening #skinbrightening #melasma #melasmatips #melasmasolutions #melasmacure #melasmaskincare #skinbrighteningtips #cosmeticclinicbrisbane #dermatology #skinexpert...
This error message is only visible to WordPress admins
Error: Access Token is not valid or has expired. Feed will not update.
How does laser work?
Scar remodeling and collagen stimulation are accomplished by laser therapy. The dermal layer of skin (the skin’s bottom layer), is the area that laser light targets. Light is transformed into heat, which causes scar tissue to dissolve and is then stimulated to remodel by your body’s natural repair processes. Thus, the outcome is determined by how well your immune system remodels collagen.
Pigmented acne scars, also known as post-inflammatory hyperpigmentation, are treated with fractional pico lasers. Your clinician will walk you through the scar modification procedure and recommend the appropriate laser to address your primary scar signature or signatures.
Why do I prefer lasers over microneedling & RF microneedling?
Lasers can ablate & coagulate, whilst microneedling & RFM do not. The latter can coagulate but not ablate. Translation; CO2 lasers have the ability to plane down the skin’s surface, meaning they are more efficient at removing the epidermis & upper dermal layers of skin. This is especially useful to treat shallow boxcar acne scars as we can treat the ‘shoulders’ of the scar.
Lasers provide heat in a controlled environment, whilst Dermapen & SkinPen microneedling do not. Heat generates heat shock protein (HSP 70, 72 & others). This results in more efficient collagen production, as compared to ‘cold steel’ needling.
I do like & use RFM; namely Infini, Genius RF, Morpheus8 & Potenza RFM. These devices are very good at treating deeper rolling atrophic acne scars, often in combination with surgical subcision.
Why is it crucial to keep acne under control throughout the scar remodeling procedure?
Inflammation, in a single word. Your treatment’s results won’t be as good if your skin is inflamed during it. Absolute control is best, not ‘relative control’ (based on the severity of your acne). Inflammation is not good for collagen production.
If you are still experiencing outbreaks, a medical dermatologist can help you treat your acne.
Can I have laser if I am on Accutane?
Revisions to the Accutane guidelines were published in 2016. Treatments such as fractional lasers, RF, RF microneedling, focal deep peels, & microneedling can be conducted on isotretinoin.
To expedite healing, we often cease isotretinoin the day of the laser, & instruct you to recommence the medication 5-8 days post treatment. Guides will be issued on the day of the procedure.
Are there any side effects of laser treatment?
Although adverse effects are extremely rare with fractional lasers, they can occur. They consist of
Melasma flare-ups are rare and typically treatable when they occur.
Post-inflammatory hyperpigmentation, or PIH. As opposed to the predictable pigmentation observed in darker skin types, unanticipated protracted pigmentation is defined. treated with pigment inhibitors and pico lasers.
Continual redness. Rosacea may flare up when treated with fractional lasers, however vascular lasers and anti-inflammatories are more commonly used.
Infection with fractionated lasers is hardly ever observed. Patients with a history of cold sore virus are prescribed antivirals.
Though RF systems have some advantages over lasers (slightly faster healing times, less skin color changes in general), we find that lasers outperform RF devices when it comes to general improvement of acne scars. Lasers are much better than microneedling, however it is your call.
Can TCA CROSS & subcision be added to this procedure?
Yes, however more complex multi-modality treatments are conducted by myself, usually under sedation. A different fee structure applies if I am involved in the management of acne scars. This Acne Scar Repair series is designed to provide you with a cost effective avenue to non-surgical scar revision by expert nurses.
What are the important points to understand regarding the acne scar treatment series?
Cost vs outcome ratio. This series of laser treatments are designed to improve acne scars whilst keeping down costs. This is why they are performed by my senior procedural nurses.
Downtime vs outcome ratio. The longer the downtime the better the outcomes. Recovery ranges from 2 to 8 days. Short recovery lasers include the Picosure & Alma Hybrid systems, whilst longer recovery times are seen with powerful CO2 lasers such as the Ultrapulse & eCO2 Lutronic devices.
Remainder biased. This refers to the scars that may not respond to this program as this scar series is aimed at globally improving acne scarring. It is not designed to remove individual scars (however our nurses will do their very best to address your specific concerns). For individual scars, a specialist dermatologist may be involved. Target treatments such as TCA CROSS, subcision & surgical intervention may be required for specific scar types.
Treating ethnic skin. Darker skin types are more complex, mainly because high laser parameters will give post inflammatory hyperpigmentation, or skin darkening. Hence it is important to balance the outcomes, with the duration of skin darkening. Our nurses will discuss this with you prior to treatments & may recommend post treatment creams to remove unwanted pigment.
Treat your acne. This is the most important factor to address. Two reasons, firstly it prevents future scarring, secondly, it optimizes the ability to remodel collagen. If you have active acne, a medical dermatologist may be involved.
Additional scar directed procedures. Other procedures may be required to address reminder biased scars. These include surgical revision procedures, dermal fillers, TCA or phenol peels. Complex targeted scar revision is performed by me.
Age & acne scars. After 20, collagen decreases by 1-1.5% per year. Collagen loss adds to the deficit of collagen & fat within atrophic scars. The older you get, the more you play catch up. If you can not replenish collagen, soft tissue dermal injectables such as Profhilo, Sculptra & Radiesse injections can give you a helping hand. Fat transfer is an option, the pros & cons are discussed in this website.
Variable outcomes. The bell curve. It’s reality. Some lie to the right of the curve & can produce & remodel more collagen than others. Ethnicity also plays a role. Darker skin types can remodel collagen more effectively than lighter skin types; at the expense of increased incidence of hypertrophic scars & hyperpigmentation. You can not alter genetics, but eating healthy & controlling skin inflammation gives you the highest chances of efficient collagen remodeling.
General health. Eating & living healthy makes a world of difference. Smokers often require three times more treatments than non-smokers.
What is the next step after the Acne Scar Repair series?
It depends on the acne scar type, remembering this series is aimed at global, not specific treatment of acne scars. Scar directed therapy can be performed on the remaining acne scars, often 2-6 months after the last laser session. As a guide-
Ice-pick acne scars: best treated with TCA or phenol croton oil paint, or CROSS. 2-4 sessions, or surgical excision (by myself).
Rolling & atrophic scars: cannula or sharp dissection, & subcision. In most cases simple cannula subcision with Profhilo can give great results within 1-3 sessions.
Scars on the temples: these are hard. The temporal branch of the facial nerve is in this area. Lasers can improve scars, but these scars often require careful subcision & or dermal fillers.
Scars on the forehead; again, challenging. The skin is only 1.5 mm thick & scars are often tethered to the muscle layer. Vertical manipulation with manual microneedling is useful, in combination with low unit Botox as the later reduces muscle ‘pull down’.
Jawline scars are often hypertrophic. Steroid injections with low density lasers are best. They often require 5 or more sessions.
Red scars are called PIE or macular erythema. 90% of red scars respond to vascular lasers, the remaining 10% are challenging to treat. Brown scars are called PIH, pico lasers are the best, but may require 3-6 sessions. Control of acne is paramount to break the cycle. As a guide; 50% of acne spots in darker skin types will have PIH lasting over a year, 25% over 5 years.