Acne Scar Treatment Sydney
Dr Davin Lim, Dermatologist | Woollahra, Sydney
I will be consulting & performing acne scar revision procedures in Sydney as of March 2024. My joint rooms are located in Woollahra, Eastern Suburbs. Read more to understand what is possible & the time lines of services that my team & I will be providing.
What types of acne scar revision will I be offering in Sydney?
As of March 2024, I will be conducting scar revision procedures in Sydney. Initially, treatments are limited (see below) however this will build up over 2024 to offer class leading therapies using the very latest lasers & energy devices.
Stage one (March to mid 2024) services include- cannula subcision, soft tissue injectables, RF microneedling, pigment & vascular lasers & superficial non-ablative lasers for scarring. We will also be performing TCA or phenol CROSS/Paint technique for scarring.
Stage two (from mid 2024) our plan is to introduce hybrid lasers, pico lasers for PIH-dark acne scars, as well as third generation RF microneedling & vascular lasers (with cryogen cooling).
How to book?
As my resources are limited in Sydney at the moment due to construction of our new premises we can only see 2 new acne scar patients per week, with the aim of increasing to 10 new patients per week in the second half of 2024.
If you are keen to see us for a treatment plan you can –
- Fill out the expression of interest form.
- Arrange a virtual consultation with myself.
Will my current Sydney patients be able to book immediately?
If you reside in Sydney-Canberra or NSW & have already seen me, send your information to info@drdavinlim.com * & I will take a look at your file. If your scars are amenable to treatment in my Woollahra office, I will undertake the remainder of your sessions in office.
Acne scar revision techniques are limited to subcision, RF microneedling, TCA Paint, dermal soft tissue injectables, QS laser & vascular lasers only. Our non-ablative lasers are limited in Sydney, with the aim of getting the latest hybrid lasers mid-2024.
*For existing patients only, please go through the virtual consultation portal if you are a new patient. Please do not use this email for advice. Much appreciated.
I am in Sydney or NSW, can I have an appointment?
Absolutely, however my consultation appointments are limited at this moment, with more slots available over the upcoming months. You can see me in real time at my Woollahra rooms, or ideally book a virtual consultation.
Expression of interest form for Sydney here.
Virtual consultation form here.
What is the address of the Sydney practice?
The current practice is located in Woollahra, in the Eastern Suburbs of Sydney. The exact location will be given when your appointment is confirmed.
Please note, parking (& traffic) is atrocious in the Eastern Suburbs, please arrive at least 30 minutes before your scheduled appointment. It can take this long to find a car park.
What about international patients?
Sydney is an international designation (as compared to Brisbane which is where I currently practice). The Sydney to Brisbane flight is just over one hour, however it is much easier to fly into Sydney. Additionally, Sydney is much bigger than Brisbane, with more things to see & do.
If you are planning to see me in Sydney, please book a virtual consultation as I can ascertain if your pattern of scarring is amenable to revision in my rooms. Until July 2024, my acne scar revision repertoire of treatments is limited in Sydney.
What types of acne scar lasers are currently in Sydney?
There are plans to have a laser & energy device selection in Sydney to equal that to my current practice at Cutis dermatology in Brisbane. We currently have the following devices to treat acne scarring-
Vascular lasers: including the Cutera Excel V, 532 & 1064. Laser genesis can be useful to treat active acne, & also remodel early acne scars, especially with gentle dermal heating using the longer wavelength. Red acne scar or macular erythema can be effectively treated with this laser. Vascular laser treatments are provided by Dr Vee Mang or our dermal therapists.
LLED or Healite by Lutronic: best employed for active acne lesions in addition to remodeling early acne scars. Collagen stimulation is minimal, however this treatment is useful as a healing low-level laser post scar revision.
RFM by Secret RF: RF microneedling is most useful for rolling acne scars in darker skin types, however it can also provide scar improvement in lighter skin types who do not have the downtime. In late 2024 we will update our RFM devices in Sydney to the latest generation 3 RF microneedling devices such as Potenza RF.
Thulium 1927 (LaseMD Ultra/Fraxel): thulium laser is only useful for very superficial scars & enlarged pores in lighter skin types. It can be used to treat enlarged pores in lighter skin as well as pick scars (not ice pick) & pits. Darker skin types can also be treated, however it does require 5-6 sessions more – purely because of the physics of the wavelength.
Q switch nano lasers: are good for treating PIH or post inflammatory hyperpigmentation. 5-8 sessions are recommended over a period of 10-14 weeks. The dermal toning setting can marginally improve collagen production- the word is ‘marginal’.
What types of lasers are planned for Sydney?
Lots, with the aim of making this one of the premier laser centers in Sydney- New South Wales. Lasers & energy devices will be introduced to the clinic in stages.
Stage one (Mid 2024)
Picosure Pro: pigment laser used to treat post inflammatory hyperpigmentation & macular pigmented acne scars (flat dark scars). This laser is useful to reduce pore sizing in darker skin types.
Hybrid non-ablative lasers, generation 3 planned for mid 2024. This will replace the current CO2 systems at Cutis dermatology. Sydney will be the home of the very latest hybrid non-ablative laser with super short pulse duration for darker skin types). This laser has both fractional & fully ablative functions. Involved cases of CO2 will be performed in a day surgery hospital off site.
Stage two (end 2024)
New vascular lasers including the DermaV- cryogen cooling, super fast, super reliable & super comfortable vascular laser. This will provide dermal remodeling as well as the treatment of red acne scars or macular erythema.
RF Microneedling, generation 3 devices will replace older generation RFM. My device of choice is the Potenza RFM by Cynosure. It is better than the generation 2 Morpheus8 as it is more comfortable, effective & it has a delivery system to enhance penetration of topicals.
Erbium fully ablative & fractional laser planned for Sydney toward the end of 2024. This wavelength enables safe & effective treatment of superficial as well as rolling acne scars in skin types 1-5. It has less recovery than CO2 laser resurfacing, in addition to less post-inflammatory hyperpigmentation. Ablative work will be performed off site in a day theater.
What forms of subcision will I be doing?
Effective March 2024 we will be offering cannula & limited subcision. As the Sydney rooms are limited in capacity for larger or more involved surgery, blunt subcision with cannulas, often with soft tissue injectables is the mainstay of treatment.
More involved procedures such as fully ablative lasers combined with sharp subcision will be offered in July 2024 however these procedures will be performed off site at a day surgery hospital.
What types of injectables & fillers are offered in Sydney?
This is where the clinic excels. The Woollahra clinic offers one of the largest selections of soft tissue fillers in Australia as we work with all classes of soft tissue augmentation. Our physicians are noted for their work with soft tissue injectables ranging from HA, CAH, PLLA, Rejuran & more.
Dermal filling is useful in the following scenarios-
- Treatment of superficial scars such as boxcar scars, low volume atrophic scars where the defect is in the dermal layer of skin. The types of injectables employed for these scar signatures include- Rejuran S, high and low molecular weight HAs as well as lactic acid derived collagen stimulating injectables. These are best combined with energy devices. 2-5 sessions are required depending on the scar type & depth.
- Medium to high volume atrophic scars. This type of acne scarring involves a deficit of collagen & in most cases fat. If you can not remodel collagen (or generate new fat), the atrophic areas will be void of volume. Rolling scars, especially in more mature patients, are classified as medium to high volume atrophy. Soft tissue augmentation can be treated with CAH, PDLLA, PLLA as well as hyaluronic acid injectables. 2-4 sessions are required depending on age & depth of acne scars.
- Augmentation of neocollagenesis (collagen stimulation) from other acne scar revision modalities. Bioremodelling can be accelerated using soft tissue fillers & agents. The initial treatment can be energy based devices such as RF microneedling, lasers or even chemical peels- mechanical (subcutaneous subcision, intradermal subcision), followed by compounded collagen stimulation using bioremodelling agents as described above.
- Addressing dermal & subcutaneous support in mature acne scar patients. Two scenarios- firstly (& most commonly), age related loss of collagen, fat, bone. Focusing on collagen itself, there is a 1-1.5% loss of collagen in the skin after the age of 20. If you are in the mid 30s, factor in a 25% deficit in collagen due to aging. Collagen provides SUPPORT for the overlying skin & scar tissue. The same applies to the other layers of the face including the subcutaneous fat, muscle & bone. Support can be provided by various type of dermal injectables & soft tissue augmentation. Our most commonly used products include hyaluronic acid & calcium hydroxyapatite.
Dermal augmentation with injectables are provided by Dr Davin Lim, Dr Van Park & Dr Vee Mang. Cost varies between $990 to $1490 per syringe, factor in 1-4 sessions, depending on your age, level of atrophy & expectations.
More on the use of dermal soft tissue injectables
Will TCA CROSS be offered in Sydney?
Absolutely. Our team & I will be offering TCA (& or phenol) CROSS & Paint for the management of deep ice pick or boxcar acne scars.
TCA CROSS is a predictable method to reduce certain forms of scarring. A series of 3-6 sessions are required for optimal results. TCA can be combined with lasers, energy devices as well as subcision & surgical excision of scars. Costing starts from $790 per session, conducted by our therapist or physician.
*As this treatment requires multiple sessions, I tend not to conduct TCA CROSS (as it is more cost effective if it is performed by our physicians – therapists). For deeper icepick scars my treatment of choice is FUE excision of scar tissue. This yields faster results, but is associated with a slightly longer healing time. Scar selection is critical for results. This is a surgical procedure.
What are the current limitations I have in Sydney for acne scar revision?
Our practice in Woollahra does not have an operating theater which is useful for sedation cases, namely fully ablative CO2 & or erbium laser resurfacing, in addition to multi-level wide subcision & acne scar excision. A theater environment is ideal for these cases as conscious sedation can be used to ensure patient comfort levels & to optimize efficiency of procedures.
I have plans to operate from a day surgery in Sydney, however I will need to coordinate the logistics of lasers etc. In reality only 10% of acne scar patients will require this.
What is the cost of acne scar removal?
I will mirror the fee structure offered in Brisbane, here is a guide-
- Virtual consultation with planning $490
- New consultation $340
- Ablative lasers/subcision/excision from $3490, ranging to $5990. Medicare rebates apply, conducted off site.
- Fractional lasers/RFM ranges from $790 (therapist) to $1390 (physician).
- Vascular & pico lasers $400 to $800. Medicare rebate in some cases.
- Dermal soft tissue injectables; from $990 per syringe
- Rejuran S; $950 per syringe
- Dermal soft tissue injectables + cannula subcision; from $1790 per syringe
- TCA CROSS/Paint; from $790
Can treatments be performed on the day?
Hard call, as some treatments require pre-planning, namely numbing cream, setting up of equipment as well as a suitable time slot. The only treatment that can be predictably performed during the time of consultation is injectable treatment with soft tissue fillers (collagen stimulating fillers, Rejuran S).
For a more time efficient way to plan, a virtual consultation can be arranged. This allows me to pre-plan your visit, so that you visit me in Sydney for treatment, not planning (as planning can be conducted virtually).
Do you need a referral?
A referral can give a rebate of $81, however this can only be applied if your acne scarring is considered medical & not cosmetic in nature. It is not my rule, but Medicare.
Dermatologists will provide an objective scar rating based objectively, namely the Goodman Baron severity scale. Scars that are non-distensible at distances of 50 cm or more are considered or classed as grade 4, severe. This is the rule of which I follow, measured objectively with photography.
What if I have active acne, do we treat acne in Sydney?
For Sydney patients with active acne (something I know about, but do not practice), patients have 2 treatment options. Firstly, management of acne without the use of Accutane by our cosmetic physician, Dr Vee Mang, secondly consideration of Accutane or isotretinoin by an external dermatologist.
Non-Accutane management include the use of: topical retinoids (not fluffy retinol), salicylic acid washes, chemical peels, low level laser LEDs, AviClear laser***, anti-hormonal treatments, anti-inflammatory medications & others.
*Disclaimer: I do not get involved with acne management purely due to time constraints. Management of acne requires timely appointments at regular intervals. In some cases testing is conducted to exclude hormonal acne in addition to monitoring of therapy.
**Accutane management is provided by dermatologists at the Skin Hospital in Darlinghurst, Sydney.
***AviClear laser is a novel 1726 nm laser that may be offered in Sydney. It is TGA approved as of February 2024 after a long delay. It has been shown to be effective in the treatment of all types of acne including cystic acne, hormonal acne, teenage acne & can be employed in areas of the face, neck, & trunk. Though not as effective as oral isotretinoin, it does not have the side effect profile of retinoids. Three treatments are required, with optional outcomes at the 6 to 9 month mark.
The end goal of AviClear is to provide clinically & statistically significant acne improvement & not absolute clearance. Patient selection & expectations are critical. For patients with acne & acne scarring, AviClear laser may not be the best choice, as often acne lesion count has to be ZERO if one has the propensity to scar. Collect one acne scar every 2 months, & you can expect to have 6 in one year, over 10 years, you may collect over 60 new scars. Factor in acne at 15 years of age till 35, & you may collect 120 new scars. In this patient subgroup, medical management with the aim of absolute remission may be the best avenue.
The role of AviClear & active acne in the patient with a genetic propensity to scar has not been investigated. I suspect studies will be available in the next decade. My gut feeling is that in these subgroups of patients, medical management will be the primary method to treat acne & to gain early / effective control. AviClear may be used as an adjunct to provide further reduction in sebaceous gland activity.
Do I perform Exosome treatments in Sydney?
Yes, if you would like to upsize your treatment, we do offer exosomes. Exosomes provide a warm & fuzzy feeling when it comes to ‘natural’ solutions for acne scars as they may upregulate genes that transcript DNA. The end result is a theoretical increase in collagen remodeling.
As of 2024, there are no split face blinded studies to confirm (or deny) the efficacy of exosome therapy in scar treatments. If your Google research has shown otherwise, flag it with me & I can upsize your treatment at your request. We charge an additional $490 for exosomes on top of your revision price.
Do I use Rejuran or Rejuran S in Sydney?
Yes. Rejuran or the higher viscosity Rejuran S is a polynucleotide DNA derived product that has value in the treatment of certain types of acne scars. The scars which are amenable to Rejuran include shallow boxcar scars, pick scars (not icepick), saucer scars & low volume atrophic polymorphic (mixed scars) in addition to post inflammatory hyperpigmented macular acne scars.
This is how we use it-
- As a treatment for the above described scar types.
- As an adjunctive treatment to aid in healing of the primary procedure (usually lasers).
- As an adjunct to improve skin quality- pore sizing, texture, reduce inflammation.
2-4 sessions are required for optional results. Costs range from $850 to $990, depending on who performs the procedure.
Do I do PRP for acne scars (in Sydney)?
Much like exosomes, if you would like to upsize your scar revision flag PRP with me. PRP for acne scars can marginally accelerate wound healing from procedures such as laser resurfacing & RF microneedling. I can also safely inject PRP when performing subcision. PRP does not correct volumetric defects anywhere near what dermal soft tissue collagen stimulating injectables can achieve.
We charge an additional $990 for PRP on top of your revision price.
What scar revision packages do we offer in Sydney?
If you are on a budget we offer SOP ‘packages’, SOP stands for standard operating protocols that are performed by our dermal therapists. An example is RF microneedling treatments. Sessions start from only $790* per session *Total package $2370 for 3 sessions.
We will add other packages throughout the year, including CO2 fractional acne scar laser packages. Package treatments are designed as an entry level treatment for acne scars. They can globally reduce scarring by 40-70%. They are not designed to address specific scar signatures such as ice-pick, box car or rolling scars.
Who does the actual work – me or another clinician?
I work on challenging cases (not challenging personalities). If you have objectively severe scarring (scars seen at beyond 2 meters in non-angled lighting), I will most likely be the clinician working on your scarring.
If you have milder scars, our cosmetic physician, Dr Vee Mang, & or dermal therapist will take up your job. I am happy to take on treatment, but you will not get a Medicare rebate for non-surgical work. I do not work on body dysmorphic patients (subjectively ‘severe’ scars, but objectively mild).
Do I treat keloid or hypertrophic acne scars in Sydney?
Yes. I employ lasers, corticosteroid injectables & surgical methods to revise keloids. Most cases will require 3-6 sessions over a period of 6 months or more. A Medicare rebate applies.
Do we perform microneedling for acne scars in Sydney?
Yes, the clinic performs microneedling, however this is performed by our dermal therapist. Microneedling is an entry level treatment for acne scars that is non-specific. Our work is primarily on focused scar treatments based upon the scar type. RF microneedling is a better option as this provides controlled heating.
What RF microneedling devices do we have available in Sydney?
We currently have the Secret RF microneedling device with a view to upgrade to the latest third generation RF devices shortly. As a guide-
- Generation one devices: Intracel, Intensif RF
- Generation two devices: Infini, Secret RF, Morpheus8
- Generation three devices: Genius RF, Potenza RF, Matrix Candela RF
Do I perform dermal grafting or fat transfer in Sydney for acne scarring?
I do not offer dermal grafting or fat transfer for acne scars in Sydney due to limited theater resources. These treatments are offered in Brisbane for suitable cases.
Do I treat white or hypopigmented scars in Sydney?
Hypopigmented scars are secondary to picking, hence your condition must be in absolute remission before treating. The treatment algorithm goes like this-
- Trial of microneedling or RFM plus pigment stimulators for a period of 8 months.
- Option for trial of low density laser plus pigment stimulators.
- If unsuccessful, you may be a candidate for melanocyte transfer. This procedure is involved & will be performed in an operating room in Sydney (off site) or in Brisbane.
What other services are we offering in Sydney?
The Sydney clinic is very different from my Brisbane practice. It is a boutique clinic located in Woollahra, a beautiful suburb with almost impossible parking!
The clinic (have not thought of a name yet, open to suggestions!), will provide other cosmetic & procedural services that includes-
Anti-aging treatments
- Laser resurfacing for wrinkles, pores, improved skin quality, wrinkles
- Soft tissue injectables & neurotox injectables
- Solutions for melasma & pigmentation
- Asian & ethnic skin rejuvenation
Chemical peels
- AHA, retinoic acid peels, Cosmelan, salicylic acid peels
Pigmentation treatment in Sydney
- Pico laser (mid 2024)
- QS laser
- Fractional lasers
- Cosmelan peels
Skin tightening
- TriLift
- RF microneedling
- Ultraformer MPT-HIFU
PRP (Dr Kate in Sydney)
- For skin rejuvenation
- Dark circles- eye rejuvenation
- Hair growth
