Davin Lim, MBBS, FACD - Account Suspended

In truth, the primary solution is surgical subcision. Other devices including RF Microneedling & lasers come in a distant second. If your choices are limited to Profractional vs RF microneedling, both are appropriate as second line treatments. It then comes down to settings including power (Joules in the context of erbium), and density. The same applies for RFM however the depth can be controlled independently. The ideal treatment for acne scars will depend on YOUR pattern of scarring. Do not approach scar revision with method in mind, but rather the opposite. Treatment methods are employed to best address your scar pattern. For example, rolling scars are best treated with subcision, atrophic scars with fillers, pick-ice pick scars with TCA or Phenol CROSS/ Paint, box-scar scars with fractional laser/ modified TCA/ phenol chemical peels, hypertrophic scars with steroid injections/modulated fractional delivery. Devices such as lasers, microneedling RF and bipolar radiofrequency are other methods to treat ‘general’ scar types. For example, devices can improve rolling-tethered scars as well as ‘deep - superficial scars’ such as broad ice-pick scars and broad box-car scars. Devices should be viewed as a method of scar revision, and rarely as a sole modality. Exceptions do apply- for example in patients with predominantly shallow/broad box-car scars and or superficial pits. Another factor that will determine the ideal combination of treatment is the skin type of patients. Skin typing used to determine the ‘skin colour’ of patients. Darker skin patients will require modifications to treatment parameters. This includes a lower percentage of chemical peels, conservative protocols for lasers and energy devices and in some cases pre and post treatment of skin to reduce but not eliminate the chances of PIH- post inflammatory hyperpigmentation- skin darkening. The very first step in scar revision is to accurately determine the subset of scars you have. This is best done with a real time examination. Factors such as animation (rather than static photographs) are frequently used to determine the amount of ‘deep scarring’ /anchored scars or tethering. Palpation or touch is also extremely important to determine the presence of dermal and subdermal fibrosis. Scars that have altered ‘texture’ either hard or soft (atrophy) are more challenging to treat compared to scars with ‘normal’ texture. In some cases the use of angled lighting can be employed to accurately map scar types. My answers given in the context of this question is a general plan given the limited information. For an accurate guide, one has to take into consideration factors such as animation, touch, feel, real time examination and most importantly subjective measures, namely patient expectations. A real time consultation with a procedural dermatologist or plastic surgeon is required for the best accuracy- diagnosis. All the best, Dr Davin S. Lim Dermatologist. Brisbane Australia.

The ideal treatment for acne scars will depend on YOUR pattern of scarring. Do not approach scar revision with method in mind, but rather the opposite. Treatment methods are employed to best address your scar pattern. For example, rolling scars are best treated with subcision, atrophic scars with fillers, pick-ice pick scars with TCA or Phenol CROSS/ Paint, box-scar scars with fractional laser/ modified TCA/ phenol chemical peels, hypertrophic scars with steroid injections/modulated fractional delivery. Devices such as lasers, microneedling RF and bipolar radiofrequency are other methods to treat ‘general’ scar types. For example, devices can improve rolling-tethered scars as well as ‘deep - superficial scars’ such as broad ice-pick scars and broad box-car scars. Devices should be viewed as a method of scar revision, and rarely as a sole modality. Exceptions do apply- for example in patients with predominantly shallow/broad box-car scars and or superficial pits. Another factor that will determine the ideal combination of treatment is the skin type of patients. Skin typing used to determine the ‘skin colour’ of patients. Darker skin patients will require modifications to treatment parameters. This includes a lower percentage of chemical peels, conservative protocols for lasers and energy devices and in some cases pre and post treatment of skin to reduce but not eliminate the chances of PIH- post inflammatory hyperpigmentation- skin darkening. The very first step in scar revision is to accurately determine the subset of scars you have. This is best done with a real time examination. Factors such as animation (rather than static photographs) are frequently used to determine the amount of ‘deep scarring’ /anchored scars or tethering. Palpation or touch is also extremely important to determine the presence of dermal and subdermal fibrosis. Scars that have altered ‘texture’ either hard or soft (atrophy) are more challenging to treat compared to scars with ‘normal’ texture. In some cases the use of angled lighting can be employed to accurately map scar types. My answers given in the context of this question is a general plan given the limited information. For an accurate guide, one has to take into consideration factors such as animation, touch, feel, real time examination and most importantly subjective measures, namely patient expectations. A real time consultation with a procedural dermatologist or plastic surgeon is required for the best accuracy- diagnosis. All the best, Dr Davin S. Lim Dermatologist. Brisbane Australia.

See a beautician or aesthetician for milia. Simple solutions that don't require CO2 laser. In fact aggressive CO2 lasers increase the incidence of milia. You can consider small beam NA lasers including diode or thulium 1927. All the best, Davin Lim Dermatologist Brisbane, Australia.

No. Our group did a paper on fillers & energy devices. Filler is placed deeper than 99% of laser settings. Filler is also stable at temperatures over 100 degrees for several minutes. All the best, Dr Davin Lim Brisbane, Australia.

The ideal treatment for acne scars will depend on YOUR pattern of scarring. Do not approach scar revision with method in mind, but rather the opposite. In you case, the scars on the left side are box car and shallow, simple TCA or phenol will do. The ones on the lower face may require subcision, hard to tell with the photos. RFM is not indicated as a primary procedure, but it can be useful for rolling scars. Above all things, treat your acne as the reduction of inflammation can compound your results. Treatment methods are employed to best address your scar pattern. For example, rolling scars are best treated with subcision, atrophic scars with fillers, pick-ice pick scars with TCA or Phenol CROSS/ Paint, box-scar scars with fractional laser/ modified TCA/ phenol chemical peels, hypertrophic scars with steroid injections/modulated fractional delivery. Devices such as lasers, microneedling RF and bipolar radiofrequency are other methods to treat ‘general’ scar types. For example, devices can improve rolling-tethered scars as well as ‘deep - superficial scars’ such as broad ice-pick scars and broad box-car scars. Devices should be viewed as a method of scar revision, and rarely as a sole modality. Exceptions do apply- for example in patients with predominantly shallow/broad box-car scars and or superficial pits. Another factor that will determine the ideal combination of treatment is the skin type of patients. Skin typing used to determine the ‘skin colour’ of patients. Darker skin patients will require modifications to treatment parameters. This includes a lower percentage of chemical peels, conservative protocols for lasers and energy devices and in some cases pre and post treatment of skin to reduce but not eliminate the chances of PIH- post inflammatory hyperpigmentation- skin darkening. The very first step in scar revision is to accurately determine the subset of scars you have. This is best done with a real time examination. Factors such as animation (rather than static photographs) are frequently used to determine the amount of ‘deep scarring’ /anchored scars or tethering. Palpation or touch is also extremely important to determine the presence of dermal and subdermal fibrosis. Scars that have altered ‘texture’ either hard or soft (atrophy) are more challenging to treat compared to scars with ‘normal’ texture. In some cases the use of angled lighting can be employed to accurately map scar types. My answers given in the context of this question is a general plan given the limited information. For an accurate guide, one has to take into consideration factors such as animation, touch, feel, real time examination and most importantly subjective measures, namely patient expectations. A real time consultation with a procedural dermatologist or plastic surgeon is required for the best accuracy- diagnosis. All the best, Dr Davin S. Lim Dermatologist. Brisbane Australia.