Laser resurfacing can give good results. #collagen remodelling can be somewhat predictable, however the ‘lift; in this patient is quite remarkable as collagen contraction has reduced her jowls. This is an exception rather than the rule . . 🔬Skin Science: Ablative lasers are still relevant in #dermatology. They can be used to treat derm conditions including actinic cheilitis, sBBCs, IEC-Bowen Disease, solar keratosis, seb ks, seb hyperplasia as well as shallow acne scars. In this case I used both erbium & CO2 fully ablative lasers . . 👉👀Concept: Lasers can improve skin quality & provide collagen contraction. Lasers do NOT address volume. For best results it is the balance between improving skin quality, skin tightening (energy devices vs surgical), & volume replacement (filler or fat) . . 😎Dr Davin Lim @drdavinlim @cliniccutis Brisbane🇦🇺 . . #laserdermatology #dermatologist #dermatologistbrisbane #skinrejuvenation #laserresurfacing #skinscience #rejuvenation #davinlim #drdavinlim #antiaging #laserrejuvenation #co2lasers #erbiumlaser (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CKLJTpOjMZz/?igshid=hlf6uwzvvsy8

Lasers can stimulate & remodel collagen . . 🔬Skin Science: The type of laser plays a role in the ability to stimulate collagen & improve skin texture/quality. In practice it is far more complex than the laser wavelength or the brand . . 👉🔫Variables: Include wavelength, passes, density, power, pulse duration as well as the make of laser. Gentle methods include #dermaltoning or laser genesis using nano or vascular lasers. Pico lasers are great for fine wrinkles in darker - ethnic skin, non-ablative lasers are best in lighter skin types (high density mode), whilst ablative fractional can be used in most skin types (modulate density accordingly). Fully ablative lasers are still the gold standard. The downside is downtime & prolonged skin colour changes . . 👀Hybrid lasers combine 2 wavelengths. This accounts for well over half the cases we do @cliniccutis. For maximal collagen remodelling we employ both fractional CO2 & 1927 thulium in lighter skin, & Pico lasers with low density CO2 in darker skin. Settings are different for each job . . 😎Dr Davin Lim @drdavinlim @cliniccutis Brisbane🇦🇺 . . #dermatologist #dermatologistbrisbane #skinrejuvenation #laserresurfacing #skinscience #rejuvenation #davinlim #drdavinlim #antiaging #laserrejuvenation #lasergenesis #picogenesis #picosure #picoway #fraxel #laseMD #clearandbrilliant (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CKKLGHYDi4y/?igshid=o0oi7oib7pei

Maskne - the new #acne epidemic in this pandemic. As Brisbane has new mask rules, the incidence of maskne will increase . . 🔬Skin Science: Well known variant of acne called acne mechanica. The cause is friction, occlusion, irritation & high humidity. This can lead to bacterial overgrowth (secondary not primary) . . 👀How to treat? . 1️⃣Minimise friction. Don’t touch or rub your mask (easier said than done). Use a light moisturizer before masking. This reduces friction, aids in skin repair & barrier function . 2️⃣Make up free when you are wearing your mask. This allows your skin to breathe easier . 3️⃣Short breaks when appropriate -lowers humidity under the mask . 4️⃣Pimple patches during the day: #Hydrocolloid dressing reduces friction, promotes healing. Salicylic patches can dry out pimples. Titrate according to skin irritation . 5️⃣Exfoliate: Twice a week. Gentle AHA or #BHA - salicylic acid. Do not over do it . . 6️⃣☀️AM: Option for #nicinamide or azelaic acid as this can reduce inflammation . . 7️⃣🌚PM: Ideally #Differin - #adapalene as tolerated, option for a good formulation of retinol . . 👍🏻Protip: The above topicals are used in various combinations according to your skin’s sensitivity & irritant threshold. Do not over do it, as you may get POD (perioral dermatitis). Simple #maskne cases can be managed at home, more complex cases by a medical dermatologist💯 . . 😎Dr Davin Lim @drdavinlim @cliniccutis Brisbane.🇦🇺 Disclaimer: I am a procedural dermatologist. I cut, laser, peel, inject; I do not treat medical issues including acne. For help with #acne & skincare, see my colleagues @cliniccutis . #skinscience #skincarecommunity #dermatologistbrisbane #skincareroutine #retinol #skincare #skincaretips #drdavinlim #davinlim #instaskincare #acneskincare #masknetreatment #masknecure #acnetreatment #acnecure #adultacne #maskneremedy (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CKFCJDaD0Qd/?igshid=4utzn2cwf40p

The MOST important skill set for the treatment of acne scars is surgical subcision & dermal fillers. Deep scars including rolling acne scars will usually have elements of tethering. The extent can be guessed on examination, but only confirmed intra-operatively . . 🔬Science: All things being equal (procedure, skill level, equipment level) the end result in the context of scar revision is largely based upon one’s ability to remodel scar tissue & regenerate dermal matrix. Everyone lies on a bell curve. Subcision beaks attached scars in the dermis but mostly the hypodermis. I subcise in 2 sometimes 3 levels . . 👀👉Scar types: Superficial #acne scars include boxcar scars, pick scars, isolated #icepickscars, & mild rolling scars. These can be treated with the usual #microneedling, #lasers, #RFmicroneedling, TCA, & phenol peels, those scars respond predictably to treatment . . 👉Deep Scars include rolling scars, atrophic scars & tethered acne scars. With significant atrophy, in some cases your immune system can not stimulate enough #collagen (& or adipose tissue) to replace the divots & undulations, namely rolling + atrophic scars. We can use many techniques to ASSIST YOUR IMMUNE SYSTEM such as energy devices & manual methods. If atrophy persists, you are left with 3 choices, filler, fat or dermal grafts. The later is only suitable for low volume deficits . . 🗡🔪Subcision is important, the needle technique is outdated, cannula, modified instrumentation subcision or limited NOKOR blades yield much better results. Pros & cons or each to be discussed with your #dermatologist or plastic surgeon . . 😎Dr Davin Lim, Dermatologist Brisbane, Australia🇦🇺 @drdavinlim . #nomorescars #dermatologistbrisbane #scarrevision #brisbanedermatologist #acnescartreatments #brisbaneskin #brisbanedermatologist #rollingscars #skinscience #scareraser (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CKA3SxoD2Pj/?igshid=1fcf27bd4glw5

Lasers can treat wrinkles & photoaging . . 🔬Skin Science: Many options for treating wrinkles, however the most predictable outcomes include ablative lasers or hybrid laser resurfacing. The former consist of erbium or CO2 lasers, the latter with a combination of laser wavelengths. Everyone has a different mode of practice, I lean towards effective & predictable results over ‘hit & miss treatments.’ This is why my ‘options list for wrinkles’ in real life is very short . . 📚Options: This patient had conservative erbium laser. Simple 1927 thulium laser, combined with sensible low density but deep CO2 can give great results in only one treatment. Downtime of approximately 5-7 days. I prefer ‘one session’ rejuvenation as the outcomes are so much better than ‘mini Fraxels’. By the time you add up all the downtime & expense, ‘one session’ hybrid laser resurfacing is way, way ahead. Injectables can also give predictable results, as can medium to deep chemical peels . . 👀Less Predictable options for wrinkles include non-invasive heating devices like RF or #HIFU (High Intensity Focused Ultrasound), #PDO threads (barbed or suspension threads more predictable), #microneedling, #mesotherapy & pigment specific lasers like Laser Genesis. #Pico lasers used in the correct skin type & application can give modest results for very fine lines. As for skin care? Best for wrinkle prevention than reversing meaningful established wrinkles (that is why you don’t see many before & afters) . . 😎Dr Davin Lim @drdavinlim Brisbane🇦🇺 . . #skinscience #skinschool #dermatologistbrisbane #dermalscience #laserdermatology #antiaging #treatingwrinkles #wrinkletreatments #lasers #antiaging #davinlim #drdavinlim (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CJzDnw5DbMa/?igshid=1sg30r6pp5juc

Prior to formal revisions, Accutane or isotretinoin was contraindicated if undergoing lasers, microneedling, deep peels & energy devices. A washout period of 6 months was recommended.This was based upon case reports of skin scars secondary to argon lasers & mechanical wire dermabrasion in the 80s & 90s . . 🔬Skin Science: Accutane #oratane #roaccutane - #isotretinoin increases skin fragility, delays wound healing, & has effects on #collagen synthesis. Keloid formation has been reported following certain procedures, & hence the blanket cover on all procedures over the past 4 decades . . 👀Revisions: JAMA 2017 revisions & other publications revised recommendations with evidence based medicine in mind. Obviously recommendations are worded as ‘no increased risk’ not no risk. Excluded procedures include wire or mechanical dermabrasion. This is different from #microdermabrasion. Fully ablative lasers are also not advised . . 👉Caveat: I, along with most other #dermatologist are still mindful of the side effects of #accutane & may modify the dose & timings based upon individual side effects & relevant history such as a personal or family history of #keloid scars, location of scars, density of lasers-energy based devices, considerations with staph carriage & many more. Be guided by your dermatologist as to suitable procedures & timings . . 😎Dr Davin Lim @drdavinlim @cliniccutis Brisbane🇦🇺 . . #accutanejourney #acnescars #nomorescars #dermatologistbrisbane #skinspecialist #acnescartreatment #scartreatment #banishscars #scareraser #microneedling #acnejourney #dermaroller #drdavinlim (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CJwf3MTjJDb/?igshid=1cw69bbhay2cy

Retinol & retinoids are widely prescribed by #dermatologist. I suggest starting off with a good retinol formulation before trying prescription retinoids . 🔬Skin Science: #retinoids increase cell turnover, proliferate blood vessels, reduce tyrosinase activity, decrease inflammation, stimulate #collagen,reduce sebum & many more. Hence their use in the treatment of #acne, psoriasis, #antiaging & a myriad of other skin conditions . 👀👉Here’s how to incorporate retinol into your skin care regime. The best time to use retinol is in the evening as this molecule is sun sensitive. Start every second night for the first fortnight, & increase as tolerated . 1️⃣Step 1: Wash your face with a bland formulation. Do not use skin care acids such as glycolic, lactic or salicylic acids prior to using retinol, as interactions can occur . 2️⃣Step 2: Wait a few minutes until your skin is completely dry. This is important, because if your skin is still damp, the retinol will be able to absorb more deeply into your skin and might cause irritation . 3️⃣Step 3: Take a pea-size amount of your retinol and apply with your fingertips in upward and outward motions. If you are unsure how your skin will react, conduct a test patch. This means to try application of a small amount of retinol to the front or the back of your ear . 4️⃣Step 4: Finish with your moisturizer 30 minutes after application of your ‘actives.’ . 5️⃣Step 5: Remember to rise & clean your face in the morning. You should apply a broad-spectrum sunscreen the morning after, as retinol makes skin more sensitive to the sun . 😎Dr Davin Lim Brisbane🇦🇺, @drdavinlim @cliniccutis . #skinrejuvenation #skinscience #skincarecommunity #dermatologistbrisbane #skincareroutine #retinol #differin #skincare #skincaretips #retinoltips #drdavinlim #davinlim #instaskincare #acneskincare (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CJhBlwujN4Y/?igshid=14yncnukqqcbv

Goodbye 2020, hello 2021 Wishing everyone a Happy New Year.🥳 . . 🙏🏼Thank you all for your support, more content to come . . 😎Davin Lim @drdavinlim Brisbane🇦🇺 #drdavinlim #dermatology #dermatologistbrisbane #davinlim (at Cutis Clinic) https://www.instagram.com/p/CJeUVjdj-CL/?igshid=ciabxqcv43yv

Ice picks can be treated with excision, or punch excision. Lots of ice picks can be treated with TCA CROSS, Paint or even deep croton oil phenol peel. In fact laser beams on the side walls of ice picks can also work- but not as effective or efficient as above . . 🥊Punch with a 1,2 or 3 mm punch, suture. Then resurface a few weeks or months later . . ⚠️Caution: Very atrophic adjacent areas can result in ‘pull through’ of sutures, making the defect worse. Test patch before punching the lot. Suture orientation according to RST lines of the scar, & not Langer’s lines . . 😎Dr Davin Lim @drdavinlim @clinic .🇦🇺 #scars #nomorescars #dermatologistbrisbane #skinspecialist #skinbrisbane #brisbaneskin #brisbanedermatologist #acnescartreatment #scartreatment #banishscars #scareraser #acnescars #icepickscars #drdavinlim (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CJc18O2jM6B/?igshid=f6tqxnpypgrn

One has to understand aetiology & histology in order to effectively manage acne scars . . 🔬Skin Science: Essentially clogged oil glands gives rise to big angry oil glands, eventually 💥exploding, in turn results in deep holes. Or abnormal differentiation of follicular orifice coupled with increased sebum leads to proliferation of the commensal c.acnes. Inflammatory response with massive cytokine release destroys adnexal structures including pilosebaceous unit, eccrine & apocrine glands in addition to dermal matrix consisting of #collagen, elastin & hyaluronic acid. This leads to deep dermal & subdermal fibrosis . . 👉👀Understanding the depth of ice picks can explain why if one performs #subcision under the icepick, you can feel the amount of fibrosis. In some cases it extends into the subcutaneous tissue. Icepicks, by definition are deeper than they are wide. I do think there is a spectrum which goes some like this- enlarged pores (etiology is different, but can be classed here as treatments are very similar), pits, picks, shallow ice picks, & classic ice picks . . 📖👉Treatments: More on how to effectively treat this variant of acne scarring tomorrow . . 😎Dr Davin Lim @drdavinlim @cliniccutis Brisbane, 🇦🇺 . #scars #nomorescars #dermatologistbrisbane #skinspecialist #skinbrisbane #brisbaneskin #brisbanedermatologist #acnescartreatment #scartreatment #banishscars #scareraser #acnescars #icepickscars #drdavinlim #davinlim #scarjourney #acne #icepickscars (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CJZb4ioD0bf/?igshid=1fhjmhqwzihx8

Just did this slide for tonights @Lutronic panel meeting. Only when I did this diagram did I realise that 95% of my work focuses around 4-5 devices . . 👉🔨🪚🔪🔫Devices & Procedural Dermatology: Is no different from any sort of industry including surgical, dentistry, motor mechanics, carpenters & others. We use our favourite tools to get the most frequent jobs done. In some cases we need rarely utilized tools to get other jobs completed. As the saying goes, ‘if you have a hammer, everything looks like a nail.’ In some cases those tools are replaced with better equipment . . ☀️Residing in Brisbane, Australia my work is heavily based upon treating sun damage, pigment & acne scars (not cause I live in Brisbane, but it’s my subspeciality). Hence fractional CO2, thulium 1927, nano lasers, fully ablative erbium & vascular lasers are my go to laser types. Occasionally the job requires pico laser, #Tixel, & others . . 👉👀What I rarely use: Non ablative lasers in the 1400 to 1550 wavelength range. I do think 1927 is fab, I also think short PD, low density CO2 lasers or even insulated radiofrequency micro-needling works better then these wavelengths . . 🔪Non-energy based devices: Account for half of my work- namely a blade of some sort, special cannulas & chemicals. In some cases energy devices are used as adjunctive treatments, in other situations I pick up a dermaroller well ahead of super high tech lasers. It is all about the job, not the technology . . 😎Dr Davin Lim @drdavinlim Brisbane🇦🇺 . . #skinscience #skinschool #dermatologistbrisbane #dermalscience #laserdermatology #lasers #antiaging #davinlim #drdavinlim (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CI6aedtDt1Q/?igshid=ln6gqxdmqj7c

Despite an array of lasers @cliniccutis, peels can often be first line treatment for some skin conditions . . 🔬Skin Science: superficial peels are useful for the management of many dermatological conditions including acne, #melasma, #sundamage, #photoaging, #wrinkles, fine lines, enlarged pores, & even #acnescars (deep peels are better for scars). For patients who have #rosacea, #sensitiveskin or dermatitis, laser & light treatments are far better, & infinitely safer . . 👉🍊AHAs: My favs are #glycolicacid, #lacticacidpeels as well as citric & mandelic acid. The peel solution I use most is Jessner with salicylic acid & resorcinol. Can be good for general rejuvenation. 70% great for solar ks & moderate photoaging . . 👉👀BHAs: salicylic acid 5% to 30%. This solution is great for #acne, #blackheads, #zits & congestion. Home use: 5% sal acid + 2% Thymol + 80% ETOH + 5-10% p. Glycol. Great for #bacne . . 👉🥕Retinoic Acid: 0.5% to 5%. Great peel, superfast to apply, delayed peeling for >24 hours, can peel for 5+days. Probably 1000X stronger than your average OTC #retinol. Fractional laser or microneedle first to enhance peeling for up to 2-3 weeks . . 👉👀Jessner: Classed as deep superficial to medium depth. I find this useful as an agent prior to my deeper TCA peels. Many,many variants of Jessner with concentrations ranging from 12 to 16% . . 👍🏻💯Never underestimate the power of peels. . . 😎Dr Davin Lim @drdavinlim Brisbane🇦🇺 #skinscience #skinschool #dermatologistbrisbane #dermalscience #clinicalpeels #retinoicacid #antiaging #davinlim #drdavinlim (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CI3szxCDhi8/?igshid=4hzqpn0ug7v0

Employ treatments based upon the acne scar type & skin type. Many factors going against scar revision procedures in this case including- darker skin type 4, really deep scars & patient factors (heavy, I mean HEAVY smoker) . . 🔬Skin Science: Raise the deepest scars, remodel collagen . . 👉Modalites: #TCA CROSS & Paint, Fractional lasers. I find that CO2 lasers used appropriately is far far superior to non-ablative laser resurfacing (AKA #Fraxel Dual / 1440 -1550 wavelengths) Even without lasers we can achieve 90-95% improvements with this pattern of scarring using simple chemical peels. Lasers speed up the process. Retrospectively I could have got faster results with shorter pulse duration CO2 lasers. I initially used CORE CO2 (short pulse duration, but less power), I swapped over to eCO2 fractional today . . 👉🔫Final treatment: If his scars come up to a superficial level, is fully ablative downtime. His skin type is the rate limiting factor. I then complete the job with a pico laser for improvement in skin texture. Pico lasers do very little for meaningful scars, but can improve pores & pigmentation . . 🧨Smoking & Scar Revision: NOT too bad a combination (contrary to what you may think). Only means delayed healing of 24 hours. Obviously a more important factor with fully ablative procedures. What is much more rate limiting than smoking is the presence of active acne elsewhere. This has a MAJOR rate limiting process in #acnescar revision. Inflammation, however small, takes away from the process of collagen remodelling. I would much rather have a patients smoke 10 durries a day, compared to one that has 10 #zits. True.🙏🏼🙏🏼🙏🏼 . . 😎Davin Lim @cliniccutis Brisbane🇦🇺 . #scars #nomorescars #dermatologistbrisbane #skinspecialist #skinbrisbane #brisbaneskin #brisbanedermatologist #acnescartreatment #scartreatment #banishscars #scareraser #acnescars #icepickscars #drdavinlim (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CI2IHLWjXVg/?igshid=oxhso61gr7yk

Simple combination for pigmentation & acne . . 🔬Skin Science: Azelaic acid is anti-inflammatory. This #skincare ingredient also has anti-pigment properties. Best formulated in a gel, safe to use in sensitive skin . . 🍊Ascorbic acid: is best in a low pH environment, it can flare up sensitive skin. Not a good solution if you have dermatitis or #rosacea. Nevertheless it can complement azelaic acid, especially for hyperpigmentation & acne . . 👉👀How to? Ascorbic acid in the am as it is an #antioxidant, azelaic acid in the p.m . . 👍🏻Useful for: Treating pigmentation including #melasma & post inflammatory #hyperpigmentation. A sensible option for patients off #hydroquinone . . 👍🏻Also useful in ethnic skin types for management of #acne as azelaic acid can reduce acne spots in addition to pigmentation from spots. Ascorbic acid can aid in repair of skin & complement azelaic acid role in pigment reduction . . 😎Dr Davin Lim @drdavinlim @cliniccutis Brisbane 🇦🇺 #acnetreatment #acnesupport #skinlightening #skinbrightening #skincarescience #skincarecombos #acneskincare #skincaretips #drdavinlim #davinlim #dermatologistbrisbane (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CI1ILLyD7_N/?igshid=1hjgkfz6k4ssp

Red acne marks are not true ‘scars’ . . 🔬Skin Science: Pigment changes due to acne are termed grade 1 acne scars. With time & correct treatment they will completely resolve. PIE stands for post inflammatory erythema, or macular erythema. It is secondary to intense inflammation . . 👉👀Prevention: The most common mistake for patients to make is not controlling their acne. If you want every single mark to go, you must have remission . . 👉🔍Simple things to try: Sunscreen above all, followed by #niacinamide in the pm, & #ascorbicacid in the morning. Azelaic acid is another product to try, 10-20% formulations. Products can marginally speed up resolution. I’d go lasers over the marketing of #kleresca any day . . 👉💯Best Treatment: Simple vascular lasers or even IPL- BBL. Bruising settings of lasers gives the fastest clearance with resolution usually within 2-4 sessions. Laser genesis with 1064 takes longer. Pico or QSL dermal toning can help, microneedling if you are really desperate & don’t have access to lasers . . 👉👍🏻Prognosis: Is excellent. These types of ‘scars’ do not have contour changes (by definition of PIE-PIH) . . 👉☎️Action: You do NOT need to see me for these types of scars. My clinical team @cliniccuits can consult & manage. Super easy, super affordable, super simple. The hard bit is control of your acne. For acne treatments, see my medical colleagues for solutions . . 😎Dr Davin Lim Brisbane 🇦🇺 @cliniccutis @drdavinlim . . #dermatologist #scarrevision #acnescartreatment #scars #acnescarring #fraxel #scareraser #nomorescars #scareraser #davinlim #drdavinlim #redacnescars #redacnemarks #dermatologistbrisbane (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CIghEWejTqg/?igshid=7xe544cjdwus

Combining lasers & volume replacement can give good skin rejuvenation results. The ‘wow’ with this case is not with the laser, but with volume replacement. Laser only improves the skin quality, which is also important . . 🔬Skin Science: Ablative lasers including erbium & #co2lasers target water in the skin. They can be employed in fractional mode, or fully ablative. This patient was treated with a high density fractional CO2 laser, one treatment only with the eCO2 by Lutronic. Though lasers can improve collagen, they do not give a significant increase in volume, unlike dermal fillers . . 🔫Lasers & downtime: The deeper the laser, the higher the coverage the longer the downtime. This ranges from 5 days to 15 days. Downtime for this patient was 6 days . . 💉💉💉Filler: Filled in 3 sessions, last session was 2017. First two sessions were ‘structural’- usual support around the lateral cheeks, zygoma, piriform fossa & lid cheek junction. Final session - tear troughs. My level of placement in the trough in this patient was on bone. Product was #Juvederm #volbella. Despite Allegan’s denial of filler migration, I see lots of my patients I personally injected from 2015 with residual filler & developing tyndall over the years. Most patients don’t notice, so I don’t comment. The bonus is that what was supposed to last 12 months is now pushing 4 years & beyond. Any injectors feel the same way? . . 😎Dr Davin Lim Dermatologist Brisbane Australia🇦🇺 . #dermatologistbrisbane #dermatology #lasersurgeon #lasersurgery #skinscience #secondskin #wrinkleremoval#dermalfillers #restylane #botox #antiaging #skinrejuvenation (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CIY6jKADlZC/?igshid=10gdq3fnlc2cx