Aging & acne scars; Davin’s Tips
- Acne scars worsen with age due to skin laxity & volume loss
- Volume can only be replaced with dermal fillers, fat transfer or weight gain
- Dermal fillers provide a predictable correction of volume & last 2-4+ years
- Fat transfer potentially lasts longer than fillers, but is less predictable in the outcomes
- Skin tightening is a highly complex process governed by factors such as age, dermal thickness, degree of skin laxity, level of laxity, ethnicity, & location
- Tightening can be addressed with lasers, fillers, HIFU, radiofrequency & other energy devices
Why do acne scars worsen with age?
Picture your bed. The mattress is the fat & muscle layer that supports the overlying skin. Your doona is the overlying dermal layer of your skin where most of your acne scars lie. The mattress supports the doona, much like the fat layer supports the dermal collagen layer of your skin. Time compresses your mattress, making it more compact & less springy. This loss of support for your skin gives rise to wrinkles, skin laxity, and volume deflation. The result? Scars appear worse.
Hence with maturity, an acne scar patient has to deal with pre-existing scars in addition to the signs of aging. Most patients notice worsening of scars when they reach their late 30s to early 40s.
What causes volume loss?
Age & weight loss are the major contributing factors to volume loss, apart from genetic factors such as low facial volume (which I will talk about later).
- Age: as we age we lose volume in multiple layers of the face. Bone loss is significant after the age of 40. This occurs in key areas such as the jawline & midface. Bone forms the support for the overlying skin. With age our deep fat pads deflate, especially in the midface & temples. This starts to occur in the mid-30s & is significant by the mid-40s to early 50s. Age also reduces collagen production & levels as discussed below).
- Weight loss: contributes significantly to facial volume. A lower body fat composition will affect the amount of facial fat you have. This affects the deep, superficial and subcutaneous fat layers. The relative amount of fat to connective tissue/bone volume is genetically determined. If you lose weight through exercise, dieting or Ozempic, it is going to show on your face.
What is the big deal with collagen levels in our skin?
Collagen supports the upper layers of the skin. It is actually more complex than this as collagen also plays a role in the superficial & deep fascial layers, enveloping the fat & muscle & also plays an important part in the fibroseptal network of the fat layers, but let’s keep it simple.
As we age, we lose between 1-1.5% of collagen a year, after the age of 20. Hence in your late 30s to early 40s, you have 75% of your peak collagen levels. Collagen supports your skin & plays a significant role in dermal volume. Hence the relationship between collagen & acne scarring can be simplified as-
- Acne scars are deficient in collagen as inflammatory acne takes out dermal collagen (& fat in deeper layers).
- Collagen loss is universal with age. With maturity there is a linear reduction of collagen. Hence scar patients are playing ‘catch up’ with collagen. Firstly due to age (universal) & secondly due to volume loss secondary to acne.
Part of the equation is to replace collagen levels in the skin with procedures that will be discussed below.
What solutions are available to address volume loss?
You only have 3 solutions to address volume loss, namely fat transfer, dermal fillers or putting weight on. These methods add volume to different depths of your skin. Dermal fillers support the bone, deep fat, subcutaneous tissue (including fat & fibroseptal network) as well as a limited amount of dermis. Fat & fat transfer can address deep & superficial fat compartments with variable contributions to each, depending on the nature of fat enhancement.
An important concept to understand is that the relative volume replacement is far more efficient when addressing the deep followed by the superficial fat layers, whilst ‘volume’ enhancement of the dermis, though important for collagen induction, plays a minor role in the context of total volumetric replacement. A five minute filling session will give instant volumetric correction, in comparison to a fully ablative laser resurfacing session with a two week recovery. Retinol or fuzzy skin care (in the context of volume replacement)? It does not even rank.
Remember, exceptions do occur👉 This table is based upon intended use, comparisons with other agents and clinical effects.
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.
👌🏻Chemical peels: are great. They are underutilized in the day and age of lasers & devices. Peels, like everything else, are merely tools to get the job done. Clinical scenarios where peels have advantages over lasers include-
.
1️⃣Treatment of comedonal acne. Salicylic acid 20-30% is a marvelous agent for blackheads & congestion, as is retinoic acid 1-7%
.
2️⃣Freckles & superficial pigmentation: A medium depth peel can beat fractional lasers & BBL or IPL. One session of Jessner TCA or TCA will do the trick
.
3️⃣Ice Pick scars, enlarged pores (like pathologically enlarged, not psychologically), TCA or phenol will beat fractional and even ablative devices
.
4️⃣Deep rhytids; severe sun damage/elastosis: Phenol croton oil will out gun ablative lasers, albeit long downtime
.
5️⃣Accelerated melasma treatment: in superficial > dermal pigment, where time is an issue. Remember, high gain, high risk, higher cost, but in some, but not all cases, faster results
.
🔫🍌Combination lasers & peels: LARI or laser assisted retinoid infusion, combines laser & potent retinoids. The former aids in delivery of the latter. It works. Downtime can be tailored from 48 to 96 hours
.
🎬Action: Book an appointment with my nursing team @cutis_dermatology to see whether peels are right for you
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
Disclaimer: My clinical work deals with medium to deep peels only. For superficial peels including lactic, glycolic, retinoic, mandelic, #cosmelan #dermamelan & salicylic acid peels, please consult our nurses @cutis_dermatology
.
#peels #chemicalpeels #tcapeels #jesserpeels #jessnertca #AHApeels #retinol #BHA #glycolicacid #lacticacidpeels #skincare #mandelicacid #melasmapeels #cosmelan
The MOST important predictor of acne scarring is the TIME taken to achieve EFFECTIVE control of acne.
.
🔬Skin Science: There are many factors that can contribute to acne scars including chronicity of the disease, extent, family history, & self manipulation (picking/acne excoriee). There are biochemical markers that can predict the chances of acne scars however clinical features are more practical / relevant. Scars are more common in CHRONIC ACNE, as well as adult jawline hormonal acne. The later is associated with deep, painful & blind ended pimples. Picking is frequently seen in this subtype of acne
.
.
👉Control of acne is important. Dermatologist can prescribe topicals including vitamin A/ retinoids, abs, oral #isotretinoin - #accutane, anti androgens, as well as physical modalities including #photodynamictherapy , #kleresca, LLEDs, & AHAs- BHA #salicylicacidpeels.
.
.
👍🏻The ideal treatment depends on clinical factors, lifestyle factors, family & personal history. Be guided by your #dermatologist. Don’t forget the #acnediet
.
.
🙄Acne, Acne Scars + Topicals: Recent papers have shown that adapelene or Differin - Epiduo can help treat acne & remodel early scars. Note: papers were funded by Galderma
.
.
🔫💉🔪Scar revision & acne: Scar revision can be initiated early, just as long as acne is under control. As per JAMA guidelines, all revision procedures apart from fully ablative lasers can be sensibly employed when patients are on oral isotret
.
.
😎Davin’s Tip: Take a photo & treat your acne. Review in 6-8 wks. If it is not under control / markedly better; see a dermatologist. Longer the inflammation, the higher the chance of acne scarring
.
.
Davin Lim @drdavinlim
Brisbane, 🇦🇺
.
.
Disclaimer: I am a procedural dermatologist, I do not treat acne, my colleagues @cutis_dermatology
Can assist you for medical dermatology concerns
.
#pimples #acnetreatments #blemishfree #hormonalacne #healthskin #blackheads #whiteheads #acnefree #nomorescars #brisbaneskin #skin #acne #retinol
Acne can be distinguished based upon description.
Here is a quick summary!
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.
Caution: Cysts & nodules can scar. Best treat ASAP. One of the predictive factors associated with acne scarring is the time taken to see effective acne treatments.
.
🎬Action: Lesions with a low scarring potential, namely blackheads, whiteheads, papules, and pustules can be managed with BHA peels, vitamin A retinol peels, AHA peels, red & blue LEDs, and photodynamic therapy. Acne cysts and nodules have the potential to cause acne scars, hence it is advisable to see a medical dermatologist.
.
💡Over the counter: acne treatments: Salicylic acid wash from Neutogena, bpo benzacac wash, BPO from Acne Org
.
Dr Davin Lim
@cliniccutis
Brisbane, Australia
.
Disclaimer: I do not treat acne as my work is procedural, 💉🔪💉🔪⚒🔩if you do have active acne and would like an appointment with a medical dermatologist email: admin@cutis.com.au
.
.
A referral is required if acne is managed medically by a specialist dermatologist.
#acne #acneskincare #Skincare #skincaretips #acneremoval #acnesolutions #dermatologistbrisbane #dermatology #dermatologist
This is a general guide to improve acne scars at home. Simple, safe, cost effective👍🏻💯
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🔬 Skin Science: Many acne scars can be improved with targeted treatments, and there are several safe and cost-effective options you can try at home. These methods are most suitable for mild scars, early scars, and non-complex cases. One over-the-counter (OTC) product that is worth considering is #differin or #adapalene, available in the US. If you can tolerate alpha hydroxy acids (AHAs), using a cream with 8 to 15% AHA in your skincare routine can be beneficial. Start with a lower frequency and amount, and adjust accordingly.
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Another option is sensible needling once a week using a derma roller with a needle depth of 0.2 to 0.25 mm at most. I will explain the proper technique in another video. To track your progress, take a baseline picture, follow this regimen for 10 weeks, and then take another picture. You should notice an improvement. If you have active acne, it's important to treat it first, as the inflammation can hinder the skin's repair processes.
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👀👉 Still struggling with acne scars? My team at @cutis_dermatology can assist you. Our skilled nurses and therapists can assess your condition and help develop an effective treatment plan. We offer various treatments including lasers, microneedling, RF microneedling, chemical peels, TCAPaint, TCA cross, fractional and picolaser, as well as Healite and LED therapy for acne scars.
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😎 Dr. Davin Lim
@theformulated @cutis_dermatology
Brisbane, Australia 🇦🇺
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#skinconfidence #skinscars #nomorescars #scareraser #dermatologistbrisbane #skinbrisbane #scarrevision #scartreatment #acnescartreatment #laserscarremoval #lasersurgery #dermaroller #skinneedling #CIT #skinpen #diyscarremoval
Adult acne is a unique subset of ‘acne’. Read more, share if you find this post useful, & comment as to what works for you🙏🏼
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🔬Skin Science: Acne has 4 characteristic features- excess oil, inflammation, bacteria overgrowth & abnormal shedding of cells in the oil gland itself. This is modified by hormones, diet, stress, skincare products & lifestyle
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👧🏻Teenage acne is due to hormones (puberty), genetics & diet. In most cases #pimples are self-limiting & simple products including benzoyl peroxide (main ingredient in proactive) are effective
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👩🏼🦱Adult acne is more challenging to treat as it is multifactorial; lifestyle factors, hormones, stress & diet are all causes. See below for some helpful hints
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📋Make Up: Oil free, mineral, paraben & talc free; non-comedogenic- many choices. Remember to let your skin breathe - always remove makeup before sleeping!
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🩺When to see a dermatologist? Treating #adultacne effectively is super important, as this form of acne is usually persistent. Acne cysts are more resistant to treatment compared to zits & blackheads (more superficial). See a derm early if you have scarring acne, or if OTC products don’t work
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🎬Action: My colleague @dr.hebajibreal is dual Board Certified & will get your acne under control. Appointments @cutis_dermatology
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😎Davin's Protip: The majority of acne scars in adults are the result of delayed action to control acne; especially important if one picks. If you suffer from late onset acne give home therapy a go for 6 weeks, for those who suffer from persistent & resistant acne, see a medical #dermatologist early. Control/prevention = less or no #acnescars
•
Dr Davin Lim
BrisVegas🇦🇺
.
#hormonalacne #healthyskin #skincaretips #nomoreacne #blemishfree #acne #Skincare #dermatologytips #acnescars #acnetreatments #acneskincare
The MOST important predictor of acne scarring is the TIME taken to achieve EFFECTIVE control of acne.
.
🔬Skin Science: There are many factors that can contribute to acne scars including chronicity of the disease, extent, family history, & self manipulation (picking/acne excoriee). There are biochemical markers that can predict the chances of acne scars however clinical features are more practical / relevant. Scars are more common in CHRONIC ACNE, as well as adult jawline hormonal acne. The later is associated with deep, painful & blind ended pimples. Picking is frequently seen in this subtype of acne
.
.
👉Control of #acne is important. Dermatologist can prescribe topicals including vitamin A/ #retinoids, abs, oral #isotretinoin - #accutane, anti androgens, as well as physical modalities including #photodynamictherapy , #kleresca, LLEDs, & AHAs- BHA #salicylicacidpeels.
.
.
👍🏻The ideal treatment depends on clinical factors, lifestyle factors, family & personal history. Be guided by your #dermatologist. Don’t forget the #acnediet
.
.
🙄Acne, Acne Scars + Topicals: Recent papers have shown that #adapelene or #differin - #epiduo can help treat acne & remodel early scars. Note: papers were funded by Galderma
.
.
🔫💉🔪Scar revision & acne: Scar revision can be initiated early, just as long as acne is under control. As per JAMA guidelines, all revision procedures apart from fully ablative lasers can be sensibly employed when patients are on oral isotret
.
.
😎Davin’s Tip: Take a photo & treat your acne. Review in 6-8 wks. If it is not under control / markedly better; see a dermatologist. Longer the inflammation, the higher the chance of acne scarring
.
.
Davin Lim @drdavinlim
Brisbane, 🇦🇺
.
.
Disclaimer: I am a procedural dermatologist, I do not treat acne, my colleagues @cutis_dermatology
Can assist you for medical dermatology concerns
.
#pimples #acnetreatments #blemishfree #hormonalacne #healthskin #blackheads #whiteheads #acnefree #nomorescars #brisbaneskin #skin
Acne can be subtyped based upon description.
Here is a quick summary!
.
.
Caution: Cysts & nodules can scar. Best treat ASAP. One of the predictive factors associated with acne scarring is the time taken to see effective acne treatments.
.
🎬Action: Lesions with a low scarring potential, namely blackheads, whiteheads, papules, and pustules can be managed with BHA peels, vitamin A retinol peels, AHA peels, red & blue LEDs, and photodynamic therapy. Acne cysts and nodules have the potential to cause acne scars, hence it is advisable to see a medical dermatologist.
.
💡Over the counter: acne treatments: Salicylic acid wash from Neutogena, bpo benzacac wash, BPO from Acne Org
.
Dr Davin Lim
@cliniccutis
Brisbane, Australia
.
Disclaimer: I do not treat acne as my work is procedural, 💉🔪💉🔪⚒🔩if you do have active acne and would like an appointment with a medical dermatologist email: admin@cutis.com.au
.
.
A referral is required if acne is managed medically by a specialist dermatologist.
This is a general guide to improve acne scars at home. Simple, safe, cost effective👍🏻💯
.
.
🔬Skin Science: Most scars can improve with precise, directed treatments. Home treatments are appropriate for mild scars, early scars & non-complex cases. If you can get #differin - #adapelene (OTC in the US), it is worth a shot. If you can tolerate #AHAs, use a 8 to 15% AHA cream in your #skincareroutine, obviously titrate the frequency & amount. Once a week SENSIBLE needling with a 0.2 to 0.25 mm max depth can help. Proper technique will be shown in another video. Take a baseline picture, try this program, re take a picture in 10 weeks, & you will notice an improvement. If you have active acne, treat it or the background inflammation will dampen down your skin’s repair processes
.
.
👀👉Still struggling with acne scars? My team @cliniccutis can help. My gun nurses & therapists can assess & help you formulate an effective treatment plan. We employ lasers, #microneedling #RFmicroneedling #chemicalpeels #TCAPaint & TCACROSS, fractional & picolaser as well as #Healite & LEDs to help treat acne scars
.
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💉🔪🔫What I do: The scary stuff, surgical, ablative lasers, bad scars. My wait lists extend to early 2021 however my staff can triage & refer challenging cases. Most cases of mild to moderate scars do not need surgical treatments, be guided by your skin care expert👍🏻
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.
😎Dr Davin Lim
@theformulated @cutis_dermatology
Brisbane🇦🇺
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.
#skinconfidence #skinscars #nomorescars #scareraser #dermatologistbrisbane #skinbrisbane #scarrevision #scartreatment #acnescartreatment #laserscarremoval #lasersurgery #dermaroller #skinneedling #CIT #skinpen #diyscarremoval
Prevention is the best management. If you are prone to getting scars, initiate early treatment with a silicone based product
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💯👉Here are some facts about Strataderm, a silicone based gel
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👍🏻How often: once a day
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👉Types of scars: raised & flat scars, new or old
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🌈Color of scars: Strataderm can reduce redness & pigmentation changes
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🥲It also reduces symptoms such as itch & pain
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🤷🏻♂️How do dermatologists manage hypertrophic & keloid scars?
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1️⃣Inject: with steroids or 5FU
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2️⃣Freeze then inject for compact scars
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3️⃣Lasers include pulse dye & fractional lasers
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4️⃣Botox: is a novel treatment for scars, esp. On the chest/dumbell
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5️⃣Excision: with compression or with radiotherapy
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😎Dr Davin Lim
Dermatologist
Brisbane🇦🇺
.
Post in partnership with Stratpharma
.
#keloids #treatingkeloids #keloidgel #siliconegel #stratamark #scarcream #keloidcream
#davinlim #drdavinlim #scartherapy #strathpharma #strataderm
Tixel for acne scars before & afters via Alison
.
🔬Skin science: Tixel is a fractional thermo mechanical device (treats parts of skin with heat that is powered by a motor). It has 81 titanium tips that delivers super brief pulses of heat to the upper layers of skin
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👉Acne scars & Tixel: we use it to treat early acne scarring, preferably less than 6 months old. Patients on isotretinoin - Accutane are great candidates💯
.
🔫 3-6 sessions are required for best outcomes
.
📅Downtime: 12 to 72+ hours depending on settings, typically we start at 14/800+, 2-3 passes, increase with each treatment cycle
.
🎬Action: To embark on scar revision treatment with Tixel, book an appointment with our clinical team at Cutis Dermatology
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#tixel #acne #acnescars #acnescarcure #acnescartips #acnescarremedies #acnescartreatment #tixelrejuvenation #dermatologistbrisbane #drdavinlim
PRP, the do it all treatment
.
💯Great for: Joints, tendons, orthopedic applications
.
✔️😃Good for: hair loss including androgenetic alopecia
.
😏Marginal for: skin & wound healing
.
😩💩Really crap at: dark circles & acne scars. In this context it has marginal (if any) added benefits over that of the delivery system (usually microneedling). Dermal fillers give much better & more predictable results
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
#acne #prp #vampirefacelifts #prptreatments #plateletrichplasma #skinrejuvenation #drdavinlim #brisbanedermatology #skin #dermatology
There are two issues when treating acne excoriee or picking acne. Firstly acne, & secondly the issue with picking
.
👍🏻Dermatologists deal with acne. We employ topical creams, gels, oral agents, chemical peels, phototherapy & lasers. If we get absolute control, picking decreases; as you don’t have any more pimples to pick. Often the fastest way to gain absolute control is with isotretinoin orally💯
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👩⚕️Psychotherapy can help you with your urge to pick. This can be done without drugs (cognitive behavior therapy) or with drugs 💊(SSRI, Prozac etc..). If you want to get better fast, you see a dermatologist for acne treatments & either a psychologist or psychiatrist for the picking problem. Combined therapy = fast results
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👉Skin care is adjunctive. Choose topicals that establish skin barrier function & are non-irritating. Simple hydrocolloid pimple patches are invaluable. Don’t underestimate them, a cost effective brands include COSRX, NeoGen & The Breakout Choice
.
🔫For acne scarring, our team can provide effective treatments to improve the hypopigmented & often atrophic scars seen with picking acne. The most important prognostic factor that determines the extent & severity of scarring is the time taken to effective control of acne & picking
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
#pickingacne #acnetips #acnetreatments #acnecure #treatingpickingacne #dermatillomania #drdavinlim #brisbanedermatologist #acneproneskin
#dermatologistbrisbane @neogen_us @skin choice
.
Disclaimer: I do not treat medical conditions including acne. My work is entirely procedural. For acne, please see my colleagues at Cutis Dermatology, Brisbane
Salicylic acid is one of my favorite ingredients. This is the only acid in the BHA or beta-hydroxy acid family
.
👍🏻Acne: great for reducing inflammation from #zits, pustules & #pimples. Also reduces #blackheads
.
🛢Oily skin: can marginally help regulate oil production by modulating the activity of the sebaceous or oil gland
.
👩🏽Acne Scars: best for PIH or post inflammatory hyperpigmentation. Nowhere as good as pico lasers, but it’s a cost effective alternative
.
🧴Chemical exfoliation: helps improve the optical properties of skin by removing the outermost cell layers. This in turn increases the turnover of cells
.
💥🥊Potentiates other active ingredients: via exfoliation, it increases the effectiveness of #retinol, ascorbic acid & AHAs
.
🎬Action: To discuss what salicylic acid peels can do for your skin, book a consultation with our nurses at Cutis Dermatology
.
😎Davin Lim
Dermatologist
Brisbane 🇦🇺
.
#chemicalpeels #salicylicacid #salacidpeels #BHAs #Bhapeels #skinrejuvenation #skincaretips #dermatologistbrisbane #dermatology #drdavinlim #acnepeels #skinlightening #salicylicacidpeels
Table based upon intended use, comparisons with other agents and clinical effects
.
.
👌🏻Chemical peels: are great. They are underutilized in the day and age of lasers & devices. Peels, like everything else, are merely tools to get the job done. Clinical scenarios where peels have advantages over lasers include-
.
1️⃣Treatment of comedonal acne. Salicylic acid 20-30% is a marvelous agent for blackheads & congestion, as is retinoic acid 1-7%
.
2️⃣Freckles & superficial pigmentation: A medium depth peel can beat fractional lasers & BBL or IPL. One session of Jessner TCA or TCA will do the trick
.
3️⃣Ice Pick scars, enlarged pores (like pathologically enlarged, not psychologically), TCA or phenol will beat fractional and even ablative devices
.
4️⃣Deep rhytids; severe sun damage/elastosis: Phenol croton oil will out gun ablative lasers, albeit long downtime
.
5️⃣Accelerated melasma treatment: in superficial > dermal pigment, where time is an issue. Remember, high gain, high risk, higher cost, but in some, but not all cases, faster results
.
🔫🍌Combination lasers & peels: LARI or laser assisted retinoid infusion, combines laser & potent retinoids. The former aids in delivery of the latter. It works. Downtime can be tailored from 48 to 96 hours
.
🎬Action: Book an appointment with my nursing team @clinic cutis to see whether peels are right for you
.
😎Davin Lim
Dermatologist
Brisbane🇦🇺
.
Disclaimer: My clinical work deals with medium to deep peels only. For superficial peels including lactic, glycolic, retinoic, mandelic, #cosmelan #dermamelan & salicylic acid peels, please consult our nurses @cutis.dermatology
.
#peels #chemicalpeels #tcapeels #jesserpeels #jessnertca #AHApeels #retinol #BHA #glycolicacid #lacticacidpeels #skincare #mandelicacid #melasmapeels #cosmelan
The OCP or #thepill is often used to treat acne, including hormonal acne
.
🔬Skin Science: Antiandrogens work at the intracrine level, namely reducing androgen modulation in the oil or sebaceous glands. They reduce DHT or dihydrotestosterone.
Anti-androgens include
.
💊Drospirenone: most often in 3mg strength. #Yaz #yasmin
.
💊Cyproterone acetate: include Brenda, Estelle, Diane & Juliet
.
💊Chlormadinone: Avail in US, #Belara, Luteran
.
📆Effects seen: In 2-3 months
.
👀Uses: Female acne, #hormonalacne, #pcos, #hirsutism, oily skin - #seborrhea
.
☹️Caution: Clots, DVT, Stroke, PE, mood swings, weight gain, water retention, cramps.
POP or progesterone only pill, #Implanon, Mirena can all flare acne
.
🎥Action: discuss with your GP or medical dermatologist the risk benefit ratio of the #OCP
.
😎Dr Davin Lim
@theformulated @cliniccutis
Brisbane, Australia 🇦🇺
.
.
Disclaimer: I am a procedural dermatologist, I do not treat acne. If you have acne, please see my colleagues @cliniccutis. Early & effective control of acne will mitigate scars, meaning less work for me !!! This will allow me to write more content, so please treat your acne.
#treatingacne #acne #theOCP #hormonalpimples #acnecure #dermatology #skincarecommunity #skincaretips #skincare
Treating & understanding #acne will prevent #acnescars.If you find this post useful tag someone with acne.🙏
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🔬Skin Science: In scar patients, skin is angrier (inflamed) for longer. To be more accurate scar patients have an genetically altered immune system, modified by picking, products, diet & stress
.
😧The #beforeandafter cover picture is a patient whom I treated with anti-inflammatories & oral vitamin A (Pic is 10 yrs old). Early & effective treatment of acne prevented scars. The second pic is scar revision with #subcision & filler only, no lasers! More in another post
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✔Preventing acne scars: The most important index is the time ⏱taken for effective control of acne. If there is a family history &/or a history of scars- see a dermatologist ASAP. Stop picking- reducing inflicted trauma is equally as important
.
🛒Recommended Products: #differin, #obagi #retinol, #Biretix from @theformulated, #benzoylperoxide, #benzacac, #azclear #azelaicacid & don’t forget the #acnediet 🥣🍎
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🎬Action: Products as above, + #bhapeels+ #retinolpeels + LED #heallite @cliniccutis @theformulated
.
📅How long do you wait before seeing a dermatologist? Give a timeline of 8 weeks, if no better a dermatologist can assist👌
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😎Davin’s Protip: Effective treatment of acne is paramount for patients who scar easily. One of the most common mistakes I see is underestimating the potential of ‘collecting scars’ over time. Eg, if one has 4 #pimples/#zits/#cysts monthly & 50% zits scar, over 2 years that = 50 new scars. The time taken from acne outbreaks to EFFECTIVE control is the number 1 factor in reducing acne scars. Be guided by your #esthetician #dermaltherapist #physician as to when to refer to a derm.
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Your thoughts? 🙄
.
😎Dr Davin Lim
@theformulated @cliniccutis
BrisVegas, AU🇦🇺
.
💬Disclaimer: I am a procedural dermatologist, I do not provide any medical management of acne. Active acne can be addressed by my derm colleagues at Cutis. Obligation FREE consult with our talented therapists & nurses @cliniccutis
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#clearskin #skinscience #skincarejunkie #skincarecommunity
Adult acne is a unique subset of ‘acne’. Read more, share if you find this post useful, & comment as to what works for you🙏🏼
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🔬Skin Science: #acne has 4 characteristic features- excess oil, inflammation, bacteria overgrowth & abnormal shedding of cells in the oil gland itself. This is modified by hormones, diet, stress, #skincareproducts & lifestyle
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👧🏻Teenage acne is due to hormones (puberty), genetics & diet. In most cases #pimples are self-limiting & simple products including #benzoylperoxide (main ingredient in #proactiv) are effective
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👩🏼🦱Adult acne is more challenging to treat as it is multifactorial; lifestyle factors, hormones, stress & diet are all causes. See below for some helpful hints
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📋Make Up: Oil free, mineral, paraben & talc free; non-comedogenic- many choices. Remember to let your skin breathe - always remove makeup before sleeping!
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🩺When to see a #dermatologist? Treating #adultacne effectively is super important, as this form of acne is usually persistent. #acnecysts are more resistant to treatment compared to #zits & blackheads (more superficial). See a derm early if you have scarring acne, or if OTC products don’t work
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🎬Action: My colleague @dr.hebajibreal is dual Board Certified & will get your acne under control. Appointments @cliniccutis
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😎Davin's Protip: The majority of acne scars in adults are the result of delayed action to control acne; especially important if one picks. If you suffer from late onset acne give home therapy a go for 6 weeks, for those who suffer from persistent & resistant acne, see a medical #dermatologist early. Control/prevention = less or no #acnescars
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Dr Davin Lim
BrisVegas🇦🇺
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#hormonalacne #healthyskin #skincaretips #nomoreacne #blemishfree
Microneedling can be useful for many things skin
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🔬Skin Science: Epidermal damage causes cytokine & growth factor release. These molecules stimulate fibroblast to produce collagen. Further collagen remodelling is achieved via dermal stimulation. Another theory is that microneedling changes the electrical polarity of skin cells, in turn causing growth factor release
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👉Uses: Skin rejuvenation, hair loss, #acnescars, #wrinkles, #enlargedpores & many more
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👍🏻How I use it: To deliver drugs into the dermal layer of skin. Can be a useful adjunct to clinical lasers, deep chemical peels & surgical procedures for scars. I do use ‘cold’ microneedling, however in the context of what I treat, I use RFM more often; ie. Radiofrequency microneedling. This gives controlled heating, meaning better results
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😎Dr Davin Lim
@theformulated
@101.skin
Brisbane🇦🇺
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#skin #skinrejuvenation #laserscience #skinscience #drdavinlim #davinlim #skintherapy #dermaltherapy #collagen #dermatologist #brisbanedermatologist #dermapen #CIT #collageninduction #skinneedling #microneedling #rfmicroneedling #skinpen #dermaroller
Simple classification of acne scars based upon Jacob, 2001 JAAD
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🔬Skin Science: You gotta start with baseline classification however in real life scarring is not monomorphic, hence why we use many different treatment modalities in the same sitting
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🥊Ice Pick scars: Can be treated with punch excision, TCA or phenol croton oil, laser to the walls can help
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📦Box car scars can respond to TCA, microneedling & various lasers
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🕳Rolling scars are best treated with subcision, #microneedling RF, microneedling as well as dermal fillers
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🗻Hypertrophic scars are best treated with steroid or 5 FU injections, vascular lasers or low density ablative lasers
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😎Dr Davin Lim
Brisbane Dermatologist🇦🇺
@drdavinlim @cliniccutis @the.formulated
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#subcision #rollingscars #acnescars #acnescarrevision #acnescartreatment #acnescarremoval #acnescarcure #brisbanedermatologist #icepickscars #acnescarring #TCACROSS #acnescarlaser #davinlim #drdavinim #dermatologistbrisbane #co2laser #laserresufacing #acnetreatment #acnecure
This patient was from my isotret & eMartix study 8 years ago. Treating acne (& scars) early & effectively can reduce or in many cases mitigate invasive treatments such as lasers &/or surgery. The challenge is to remodel scars with the LEAST invasive treatments
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🔬Skin Science: The biggest prognostic factor by a long shot for scarring is the time taken to achieve EFFECTIVE control of acne. It is not the time taken to try treatments. Early treatment with anti-inflammatories can markedly reduce scarring. With early scars we have a window of opportunity to use banal treatments such as RF, #Tixel, vascular lasers & even simple #microneedling to remodel scars
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📖👉Acne: Treated with anti-inflammatories early on, with v. low dose retinoid initially. There after escalating to 0.4 mg/kg daily dose. I normally cooked it for 10-12 weeks post the last #zit remaining
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🤔👍🏻Scar mitigation: This patient was treated with good old #eMatrix. Still a handy device. My settings were around 60-80 mj per pin. 2 -3 overlaps. Post treatment EES 7d to reduce inflammation & reduce incidence of staph infection, as patients on that study were on oral #isotretinoin
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🎬Action: My clinical team @cliniccuits can consult & manage early scars. This includes patients on isotretinoin ( Accutane #oratane). For cases of acne, please see my colleagues @cliniccutis as they will discuss effective methods.
😎Dr Davin Lim
Brisbane 🇦🇺
@cliniccutis @drdavinlim
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#acne #acnetips #acnecure #acnescars #scarrevision #scartreatments #drdavinlim #davinlim #dermatologist #brisbanedermatologist #accutane #oratane #freethepimple #pimpletreatment #pimplecure #hormonalacne #cysts #cysticacne #cysticacnecure #blackheads
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Disclaimer: I do not treat acne as my work is surgical, laser, peel, and/or injector based, namely procedural. 🙏🏼
What types of dermal fillers do I use to address volume loss?
The algorithm for volume replacement is complex, however I can simplify this with the concept of layered treatments. It goes something like this-
Bone loss: HA or calcium hydroxyapatite fillers placed deep. This supports the overlying tissue. Longevity ranges from 2 to 4+ years, depending on the product & your metabolism.
Mid tissue loss: fat pads can be treated with HA fillers, PLLA or CAH fillers.
Superficial tissue loss: superficial fat & dermal collagen can be addressed with the usual collagen simulation products. Replacement in this level needs to be carefully considered as HA fillers can accumulate, migrate & or take in water over the years. Algorithm is complex & depends on your facial volume, fat distribution, laxity & age.
What if I am not ready for fillers & would like to try a more natural approach?
You can consider fat grafting. I do prefer this method for larger volumes as it is more cost effective than dermal fillers. As a guide, I advocate fat grafting if volumes exceed 10 ml of dermal fillers. The problem with fat is that –
- The predictability of fat grafting is related to the unpredictability of absorption. This ranges from 20% to 80%, even with minimal trauma fat processing.
- Nano fat is hit and miss. You have a much higher hit rate with SIMPLE laser procedures.
- Fat is not as malleable & does not give the finesse of dermal fillers.
- You are screwed if fat gets into a blood vessel. Google ‘fat transfer face blindness.’
What are effective methods of skin tightening?
The two most effective ways of skin tightening are deep plane facelifts & deep level fully ablative CO2 laser resurfacing. Both treatments should be considered as ‘once in a lifetime’ events.
Other non-surgical methods to tighten skin include-
- Dermal fillers– awesome for volume depleted individuals. In this context tightening is secondary to volumetric displacement.
- Collagen stimulating injections– useful adjunct. Mild tightening with Profhilo, moderate with Radiesse, highest with Gouri PCL.
- RF microneedling– best for adjunctive tightening of the deep dermis & fat.
- Radiofrequency monopolar- gentle, yet effective. Best combined with lasers.
- HIFU– modest tightening, best for off-label fat reduction.
- Threads– require combination treatments to be effective, otherwise you are wasting your money.
Who will respond well to non-surgical skin tightening?
The algorithm on non-surgical skin tightening is complex & highly variable, beyond the topic of this page. As a guide, provided the levels are identified, 60-80% of patients will respond to a combination of treatments outlined above. Factors to consider in writing up a skin tightening program include –
- Age: Contractile potential of collagen is better in younger (<50 yo) patients.
- Ethnicity: Better contraction in darker skin types (collagen thicker, more reactive).
- Degree of sag: Less tissue to lift.
- Degree of ‘heaviness’/fat: As above, especially lower face and jowls.
- Dermal thickness: Thicker dermis means more collagen to simulate.
- Degree of photodamage/sun exposure: The more broken collagen & elastin, the less the chances of contracting. Probably one of the most important factors to consider.
- Health: Smokers have less chances of optimal contraction.
- Expectations: Face lifts are gold standards, followed by deep CO2 or phenol peels.
The concept of skin quality & aging
Say you drive a white car. Picture this on the car door; shopping trolley dings (acne scars), & mud (sun damage). The best outcomes are achieved when the mud is washed off, the dings corrected & the door polished. Same applies to skin. If you have sun damage (pigment, blotchy skin, raised age warts, sunspots etc…), addressing textural changes with lasers & peels will mean a better outcome overall. The volumetric defects of scars do not change (divots, pits, undulations), but the overall appearance of skin dramatically changes. Look beyond scars.
Skin quality is super easy to improve. Lasers & peels target this area. The concept is easy to understand- reduce pigmentation with fractional & pico lasers, reduce redness with vascular lasers, & improve light reflex. 90% of patients do not require deep fully ablative CO2, however more mature patients with photodamage might. Skin care? Knock yourself out, it plays a role in post procedure maintenance, but has marginal effects in comparison to procedural dermatology.
What should I prioritize- treat my scars or treat aging?
Complex question as it depends on the relative contribution of each, both physically and mentally, in addition to your budget. The ideal answer is rhetoric; namely both, but in the real world, here is my guide.
Treat scars: if you are in the younger age group where age related changes are minimal. This means good skin turgor with minimal skin laxity & good volume both in the dermis & fat-deeper layers.
Treat aging: if you are older or more mature, treat aging. You will get a far better bang for your buck outcome, as rejuvenation plays a bigger role than scar revision (*exception below).
It gets far more complex than this ‘simple’ answer. For example, patients with genetically low volume may benefit from structural support of overlying scars. This gives better aesthetic improvements, with the added benefit of scar reduction via volume replacement.
*If you are focused on scars despite objective clinical evidence of skin maturity (age), treating acne scars may be recommended, purely on the subjective feel good factor, in contrast to what others (objectively) perceive as ‘better outcomes.’
What is the go with younger patients with low facial volume (skinny face)?
The bed analogy again. Low facial volume can be genetic. It’s not your fault, it’s in your DNA. This means the mattress you are given is already compact to begin with. Your baseline support is reduced. You have 3 choices to build up this layer. 1. Dermal fillers (most logical) 2. Fat transfer (great for large volume defects), 3. Gain weight & facial fat.
It is far easier to work with a ‘skinny’ face than an over inflated one. I can always add volume, whilst subtracting volume is difficult (can do HIFU off-label, Kybella with risks, buccal fat removal etc..but not ideal). Adding volume in the dermal, subcutaneous & deep fat layers will improve support, reduce scarring & aid in facial harmonics.
What is the go with temple scarring & volume?
Scars on the temples are notoriously difficult to treat as scarring is due to multiple factors, including dermal collagen loss (treated with lasers, TCA or phenol CROSS/paint, RF microneedling, collagen stimulating fillers etc…), however fat loss is more complex.
In cases of fat atrophy due to age, a simple solution is to replace volume with dermal fillers. This simple procedure takes only a few minutes to perform. Addressing volume loss in layers such as the subcutaneous fat, interfascial plane & on bone will support the overlying skin, & inevitably cause a volumetric displacement, which directly & indirectly treats acne scars. Early adopters of this concept will enjoy good gains with little to no downtime.
What is the go with acne scarring around the mouth?
Scars around the mouth, jawline & lower face will worsen with time. It is due to bone loss of the jawline & accumulation of lax skin down low. It accumulates around the jowls & marionette lines extending from the lower border of the jawline to the corners of the mouth. Stretching the skin in this area will reduce scarring due to tractioning & displacement of skin & the underlying tissue. You have only have 4 ways to address this-
- Dermal fillers to replace bone, collagen & fat loss in this area.
- Skin tightening procedures (often in combination with above) to reduce laxity.
- Surgical procedures such as a deep plane facelift or surgical implants.
- Miscellaneous treatments to reduce the action of depressors of your lower face (botox) & or stimulate muscles such as the zygomaticus major, minor & risorius to lift the mid to lower face. High variable success.
If you have poor support due to lack of dentition of both the upper & or lower jawline, the answer often lies in orthodontic or maxillofacial work. If you eliminate surgical options, you have dermal fillers & or skin tightening procedures at your disposal. That’s it.
What is the go with collagen supplements?
If you are naturally inclined to take collagen supplements, knock yourself out. They are safe, cheap & can be good for your joints. Supplements such as glycosaminoglycans can reduce joint disease. They do nothing for age & acne scar related collagen loss. Having said that, placebo can be effective in 25% of cases.
How effective is microneedling & PRP?
I do employ microneedling & PRP for the management of low volume early acne scars, however in the context of other treatments available, this method is mediocre at best. Dermatologists use microneedling for hair loss, as this method has the best evidence.
Other more effective methods for addressing collagen stimulation include dermal fillers, collagen stimulating fillers, lasers, & RF microneedling.
Dermal fillers vs fat transfer- which is better?
I perform both, but use fat transfer in certain situations. The biggest drawback of fat is the unpredictability of absorption.
Dermal fillers: Pros. Highly predictable, reversible. Cons. Expensive per unit volume, last 2-4 years.
Fat transfer: Pros. Cost effective if big volumes are used. Cons. Much less predictable. Harder to reverse, less malleable, less finesse. Fat is best used for highly atrophic acne scars with volumes far exceeding 10 ml.
What is the cost of procedures?
Costs depend on what is required to address the problem. Wherever possible I will refer you to my procedural nurses who have over 8 years of experience working with me as they are more cost effective. They perform lasers, fillers & skin rejuvenation. My work is focused on bespoke treatments & or complex cases.
As a guide, my fees are-
- Dermal fillers: $990 to $1490 per ml, depending on the filler used & complexity.
- Collagen stimulating fillers: $850 to $1700, depending on the injectable chosen. I work with PLLA (Sculptra), HA (Profhilo), CAH (Radiesse) & newer poly-capro-lactone (PCL) fillers.
- Lasers: $1390 to $5550. Variation describes fractional to fully ablative resurfacing.
- RF microneedling from $1290.
- Subcision ranging from $1290 to $3990.
If you are on a budget, consult my nursing team, or advise me during the consultation & I will refer you accordingly. As a guide, the fees for scar revision / skin rejuvenation by my nurses are approximately one-third of my fees.
What is the go with retinol, retinoids & skin care when it comes to collagen stimulation?
In the context of acne scars, topical creams play a role in early management of low volume atrophic scars, early scarring & scars secondary to pigmentation alteration (post acne redness or post acne hyperpigmentation). Creams give marginal gains (if any) for established volumetric defects (divots & holes in the skin). Regardless, placebo can have a good therapeutic effect. If you would like to try topicals, here are a few pointers.
- Best evidence is with adapalene (Differin). You do not need to see a dermatologist to get this. Resourceful patients can obtain this online.
- Tretinoin, tazarotene & trifarotene are other retinoids that can be used
- Retinol can be purchased over the counter. Brands include Skinceuticals, Synergie & many others.
- Creams are best used as prevention of future acne outbreaks. A medical dermatologist (not me) can guide you.
What is the go with Botox, aging & acne scars?
In the context of acne scars, Botox can be highly effective in the following scenarios:
- Reduction of muscle action on the overlying skin. A classic example are scars on the forehead. Reducing the action of frown muscles & muscles that elevate your forehead will reduce the tethering of scars. Muscles insert in the skin, relaxing these muscles will reduce the scar tension. Simple. Effective.
- Manual microneedling & neuromodulation of tissue. Again Botox to key muscles can be effective. I add vertical manual microneedling to break up tissue. I prefer manual over DermaPen or SkinPen as I can feel the scar tissue.
- Reduction of downward pull of muscles, especially in the lower face & neck areas. This can reduce tension of key depressor muscles. This helps scars on the neck & lower face, with an added benefit of jawline sharpening.
Sure, Botox doesn’t last & requires maintenance, but to date there is no other way of reducing muscle action, apart from you taping your skin with duct tape to reduce muscle movement. Your call.
Davin’s viewpoint on treating acne scars in the mature patient
This is probably one of the most complicated algorithms to follow as scars & aging have an intimate relationship as aging affects scars. It is complex for two reasons. Firstly the algorithm for skin tightening & volume replacement is complex- especially for the former as it depends on many factors including clinical findings (sag, laxity, thickness of dermis & fat, background sun damage etc…) as well as age & ethnicity.
Volume replacement is quite straightforward- dermal fillers (predictable, finite longevity), fat transfer (natural, longer lasting, highly unpredictable) or put on a ton of weight (probably not a good idea). That. Is. It. Volume replacement is probably the hardest concept to get through to the patient. Lasers, peels & surgery will not replace deep volume loss- especially bone & deep fat pads. The volume replacement you get from collagen stimulation is probably 1-1.5ml per cheek at most following even the most invasive CO2 lasers. Look well beyond the scars & think volumetric displacement of key areas such as the cheeks, lower face (perioral-marionette lines) & temples. Simple displacement of skin can tighten & support acne scars. Review my before & after photos of mature patients to understand this concept. Think beyond acne scarring.
Skin tightening can be beneficial in mature patients with scars, providing the tether from the deeper fat layer to the more superficial papillary dermis is broken. Tightening follows a complex algorithm & should be tailored to each individual. Methods should be directed at each level of the skin & should never be limited to skill sets (or lack of). HIFU, RF, RFM, threads, collagen stimulating injectables, lasers, & surgery are all possible modalities. Tightening provides traction & counter traction. This has a profound impact on scars. This especially applies to areas of the midface & lowerface. Most patients realize that pulling on the skin just in front of the ear can lead to an improvement in scars. It is often the combination of tightening & volumetric displacement that can give good results.
Skin quality improvements are relatively straightforward, & in the scheme of things can make the biggest difference in the mature patient with acne scars. Lasers & peels address skin quality. The aim is simple- make the color & texture of skin homogenous. One uniform color (with a very slight pink hue on the cheeks) & the job is done. We employ vascular, pigment & fractional lasers for this job. Improving skin quality does not affect the volume of acne scars, but provides a better light reflex. This gives the perception of healthy skin, without addressing acne scar volume deficits.
In summary, mature patients should look beyond their acne scars. Those who see it will have far better outcomes than scar-centric individuals.