Do I do online consultations?
No, I do not offer formal online consultations. The reason is that touch & feel as well as 3D examination is a must for accurate diagnosis. I cannot feel atrophic areas (soft) vs fibrosis (hard) via photos or videos.
I am however active on realself.com, under the acne scars section. I answer questions on this platform on a weekly basis, namely I will give my opinion online, but will not get involved in treatment. Where appropriate I will give an opinion on possible treatments & who to see.
Can I get treatment the same day?
In some cases, yes, in others I would need to coordinate my team of nurses as well as free up theatre space & an allocated time slot. I will attempt to treat interstate & overseas patients within 24 to 72 hours based upon the above factors.
Simple treatments such as steroid injections, & dermal fillers can be performed at the same time of consultation.
What is the average downtime following acne scar revision procedures?
The majority of my work is under the skin. Expect swelling for 3-7 days, depending on the levels I work on. Lasers & deep focal peels take 3-6 days to recover.
What should I consider if I am an overseas or interstate patient?
The majority of international & interstate patients I see have failed to respond adequately with ‘conventional’ scar revision methods. This makes scar revision even more challenging. Time constraints & follow ups also add to the complexity. In many cases you may require several sessions for an optimal outcome.
I will do my best to fit your requirements & revision in a timely manner, considering safety as paramount. It is important to assess scarring in real time, meaning touch of the scar areas to understand the degree of atrophy & or fibrosis (soft vs hard areas). Animation & lighting is also important. Until we have a reliable way to assess scars with ultrasound, I place history & examination as vital steps prior to procedures.
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What treatment will I need?
This really depends on your scar type, skin type & allocated downtime. My usual patient has moderate to severe acne scars. The vast majority of my work is surgical, with the addition of laser procedures.
For milder forms of acne scars, I may refer you to my nurses for less invasive & less costly treatments including gentle microneedling, RF microneedling, spot chemical peels & various lasers.
What lasers do I use?
Lasers are over-rated in the context of scar revision. It is akin to asking a carpenter what brand of hammer he uses. I select lasers based upon the requirements of the job, anyone who says that lasers are the answer to skin concerns & calls themselves a laser expert probably do not have simple skill sets such as the ability to use dermal fillers.
The most common devices I employ to revise scars include–
- Ultrapulse CO2, Deep FX, & Active Fx laser
- eCO2 fractional laser
- Mixto fractional CO2 laser
- CORE CO2 fractional laser
- ProFractional erbium laser
- Juliette Fractional erbium laser
- 1550 Fraxel Dual laser
- Fraxel RePair (retired)
- Vascular lasers (red scars), V Beam Prima, Perfecta, BBL
- Infini RF (retired)
- Genius RF
- Skin Pen, Dermapen, Skin Roller
- Ionnto Plus RF cannula
Lasers are used for remodelling collagen, they require a press of a button. Techniques including multilevel subcision, dermal filling, dermal grafting, fat grafting, nano-fat transfer are skill dependent.
Do I do online consultations?
No. Online consultations are best for medical problems. I prefer the accuracy of real time consultations. A physical examination is best before any procedural work, this includes acne scars, skin rejuvenation & pigmentation disorders.
Are treatments painful?
The majority of treatments that I perform will be done under some form of sedation in theatre. This may be very mild sedation (tablets) or moderate sedation (injections). In some cases, I use gas. This ensures patient comfort levels during the procedure.
Will I treat patients with active acne?
Ideally your acne should be under absolute control before seeing me. Reason? If you have background inflammation, you will not heal up as well, meaning your tissues will not regenerate collagen to the maximum extent.
If you have active acne, I may refer you to a colleague to assist in medical management. Most often we can work in parallel, meaning just as long as you take effective steps to control your acne, revision can be undertaken at the same time. The number one cause of failure to respond to treatment is active acne.
How long does it take to revise acne scars?
One to eight sessions, over one to fifty weeks. This is the variability of acne scarring. Shallow boxcar scars, & or isolated atrophic scars may only take one session.
Deeper rolling acne scars with significant ‘fibrosis’ & atrophy, especially in patients of darker skin type will take much longer. If you have active acne, add another 3 to 9 months to the job.
What is the cost for treatment?
This depends on the complexity of revision. In the majority of cases I perform complex surgical procedures including surgical subcision, excision & ablative laser resurfacing. Medicare rebates do apply to the above procedures. As a guide, out of pocket costs range from $640 to $3,990 per procedure.
What are other cost effective solutions?
My nursing team will provide cost effective & effective solutions for most cases. My nurses are highly skilled & have had over 6 years of experience in specific scar revision techniques, including, TCA – TCA CROSS, Paint, dermal fillers, as well as RF microneedling & lasers.
For acne scars that do not meet Medicare guidelines I may refer you to my team. As a guide, revision procedures start at $390 for a few deep ice pick scars to $990 for laser resurfacing. You can obtain an obligation free consultation & a quote from them prior to treatments. Book with Kate, Alison or Marisa at Clinic Cutis.
Do I treat mild acne scars / dysmorphic patients?
I am probably not the right doctor for you if you have body dysmorphic disorder. This condition is characterized by significant subjective negative views of scarring however objective assessment shows mild scarring. A good way to understand if you suffer from body dysmorphic syndrome is to have a family member or close friend guide you.
For mild scars, I may propose a sensible treatment option that is non-surgical, which may involve lasers by my nursing team. Dysmorphic patients are best seen by a team of psychologists & psychiatrists. Highly invasive surgical procedures & or deep lasers are not advisable.
What is the end goal of scar revision?
The end goal of any revision process is to give you the confidence to know that others do not perceive the same views of scarring that you may have. This end distance can be measured at around 60 to 70 cm (conversational distance).
A goal post of you not seeing any scars is not health. The reason is that you will always find an angle of view to find the remaining scars, as you know where your scars are located. I encourage you to have a healthy outlook on the revision process, guided by your family & friends. If you have body dysmorphic views, I am not the right doctor for you.
Who are other highly regarded experts in the field of scar revision?
This list is based upon who I personally know, & not who is actually out there. You need to do your own research if you would like to find someone close to you.
Victoria, Australia: Prof Greg Goodman, Prof Philip Bekhor
NSW, Australia: Dr Adrian Lim, Dr Shawn Richards
Brisbane, Australia: Dr Rob Sinclair
USA: Dr Steve Weiner, Dr Peter Rullan
Europe: Dr Emil Henningsen
Asia: Prof CL Goh, Dr Joyce Lim
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