Experimenting with laser assisted delivery of retinoids AKA: LARI or laser assisted retinoid infusion 2.0
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🔬Skin science: approximately 1-2% of topical retinol is absorbed by the skin. It requires conversion to retinoic acid for activity. Stuff that, too many variables, too many steps before it is biochemically active
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👍🏻The Concept: increase absorption by a factor of 20-50. I have been using small spot super dense, low energy CO2 fractional lasers. They work infinitely better than NA lasers. Last week I nearly tripled the spot size to 300 microns. This week it’s 500 microns, super dense with adjusted joules (due to bigger spot size)
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🧪The molecule: I have been playing around with retinoic acid 1-5%, trifarotene, & today #tazarotene (third gen retinoid). I would have continued with #trifarotene, but it is patented, so I can’t increase my concentration. Solution? Tazarotene at 5 mg/ml (5-10x stronger than prescription, when it was available)
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🧬Hopeful outcome: retinoid bomb topically, MOAR - monther of all retinoids, it’s probably 1000X more acitve than topical retinol. Hopefully peel for 4-8 days
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🔎Aiming to improve: skin quality- wrinkles, pores, pigment, etc…
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💯Stay tuned
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#retinol #retinoids #retinoicacid #retinoltips #retinolskincare #differin #acnetips #co2laser #skincaretips #skincarescience #skinscience ...

Table 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-
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1️⃣Treatment of comedonal acne. Salicylic acid 20-30% is a marvelous agent for blackheads & congestion, as is retinoic acid 1-7%
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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
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3️⃣Ice Pick scars, enlarged pores (like pathologically enlarged, not psychologically), TCA or phenol will beat fractional and even ablative devices
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4️⃣Deep rhytids; severe sun damage/elastosis: Phenol croton oil will out gun ablative lasers, albeit long downtime
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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
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🔫🍌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
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🎬Action: Book an appointment with my nursing team @clinic cutis to see whether peels are right for you
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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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 @cliniccutis
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#peels #chemicalpeels #tcapeels #jesserpeels #jessnertca #AHApeels #retinol #BHA #glycolicacid #lacticacidpeels #skincare #mandelicacid #melasmapeels #cosmelan ...

This table is based on probability and not possibility, as exceptions do occur👉
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Facts💯
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1️⃣Concentrations, formulations (pH, stability) make a difference in tolerability, and efficacy
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2️⃣Rosacea & sensitive skin can tolerate low strength BHAs as it is an anti-inflammatory, esp if combined with sodium sulfacetamide, the rule is not absolute. Same applies to #retinoids & sensitive skin, as careful titration can improve tolerability
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3️⃣Anti-aging: Azelaic acid has some anti-aging properties (example is reduction of pigment and hence dyschromia), but other acids are better
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4️⃣Safety in pregnancy is debated. Most derms won’t rx OTC topical retinol based upon principle, BHAs fine,
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😎Dr Davin Lim
Dermatologist
Brisbane🇦🇺
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#skincare #skincaretips #skincareroutine #skinacids #ahapeels #glycolicacid #BHApeels #chemicalpeels #retinoids #retinol #skincarehacks #skincarescience ...

A Lot of these chemicals have primary and secondary effects. These comments are based upon the intended use / efficacy of the molecule rather than in-vitro properties
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👉Molecules within families: Example of alpha hydroxy acids- there are many examples including glycolic, mandelic, lactic, citric, malic and tartaric acids. Glycolic and lactic acids are favourites for their exfoliative effects, whilst the large molecule size of mandelic can reduce skin penetration and hence be useful for skin rejuvenation in sensitive/rosacea skin (but why would you want to risk putting chemicals on rosacea-like skin when lasers & lights are inherently safer?)
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🎬Powerful science: I think most dermatologists stick to the main three for their own personal skin care, namely retinoic acid, ascorbic acid (as an antioxidant) and alpha hydroxy acids (as an exfoliant, usually in high concentration, low pH in a pulse manner). For those with uber sensitive skin, azelaic acid can be useful. As for hyaluronic acid? ...it works far better under your skin (dermal filler), not sitting on the skin 💉👍🏻
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#skinscience #hyaluronicacid #kojicacid #skincareacids #skinscientist #lacticacid #ahas #glycolicacidpeels #drdavinlim #dermatologist #dermatologistbrisbane ...