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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

Dog 🐶 gone Sunday. jRT on a motorcycle 🛵 , Have a great weekend. #jrtofinstagram #jrtlove #dogsofbrisbane https://www.instagram.com/p/CKIqMvpjpw_/?igshid=dasoqb8eu6th

Straight forward post on some pigment inhibitors out there . . 🔬Skin Science: Apart from the obvious sunscreen, pigmentation can be treated with topicals. The response to treatment is based upon the DIAGNOSIS OF PIGMENTATION. This is extraordinarily complex. The Gold Standard is a real time examination, often with a Wood’s Light & dermatoscope. Occasionally a biopsy . . 👍🏻Topicals can help reduce melanocyte activity, & or increase cell turnover. The usual acids, hydroquinone, cysteamine etc.. Lasers can be adjunctive mx, my goto include nano, pico, thulium 1927 low density, #IPL or #BBL for lentigines, chemical peels include #TCA, #Jessner, #AHAs & many more, including #dermamelan & novel #cosmelan peels. Retinoic acid peels are also great- probably one of my favs for epidermal pigment . . 😎💯Curated Skins: Curated skin care line from all the best products & formulations. No compromise on skin care products, curated kits to maximise effects, reduce side effects. Powerfully Curated line includes prescription skin care. WIll be online in the future. I am populating the IG Reels section with product reviews- just started yesterday (in case you are wondering). Product lines include #Obagi, #AspectDr, #Ultraceuticals, #Medik8, #mesoaesthetic #LRP, & other European companies. Any skin care companies interested, DM me for tender process🙏🏼 . . 😎Dr Davin Lim Brisbane🇦🇺, @drdavinlim @cliniccutis . #skinrejuvenation #skinscience#skincarecommunity#dermatologistbrisbane #bestskincare #skinlightening #skinbrightening #skincareroutine #skincare #skincaretips #retinoltips#drdavinlim #davinlim #instaskincare #acneskincare #curatedskins (at Singapore) https://www.instagram.com/p/CKHvMzojByN/?igshid=1veiy6mba4scu

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

Find your happy space- it’s your niche. How? 👇🏻 . . 👀What comes naturally to you. As a dermatologist the skin science is the easy bit. It is second nature as we had to complete 2000 hours of pure #skinscience -before entering the training program. The flipside is that an esthetician / dermal therapist has much more finesse than I do when it comes to applying topicals on skin💯 . . 🤔Can you differentiate? Lots of skin experts, from dermatologists to bloggers. Differentiation can be design, clarity of thought,humor, work ethic, consistency, or as many iG influencers do now a day; just hang your jugs out . . 👉❤️What are your passions & skill sets? This should be the super easy bit. Skill follows passion. The #petshopboys saying ‘I don’t like much in life, but what I like I love passionately’ applies to relationships, & work. Apply it, & your #niche is waiting for you . . 😎Dr Davin Lim @cliniccutis @drdavinlim . Brisbane🇦🇺 . #dermatologist #dermatology #drdavinlim #davinlim #skinrejuvenation #skincare #skincaretips #nichememes #personalbranding #nichememers #nichecommunity #findyourniche #niche (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CKDalX6jp0f/?igshid=jsobh6bzgo44

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

Don’t forget your hands . . 🔬Skin Science: Same principles apply, texture, tone volume. Volume replacement is super easy, filler or fat. Latter is not as predictable, but useful if larger volumes are required. I am not convinced over the textural change of ASC (adipose stem cells), a simple low density laser gives better results. . 💉FIllers I use: Radiesse in hyper dilute formulations over HA fillers given volume required . 🔫Lasers: CO2 gives the best tightening. Fractional 1927 gives good blending. I also use QSL nano & pico lasers, often in combination with fractional to blend (or spots will be too noticeable). Rejuvenation of hands - arms is a slower process compared to the face. Healing up times are increased (5 to 10 days), 2-3 sessions ideal . . 👉Skin Care: Simple Urea, AHAs, salicylic acid. A nice formulation is 5-10% Lactic acid in sorbolene with or without 5% olive oil (dermatologists were there before J.Lo). Tretinoin every other night. If you are after OTC formulations, simple #calmurid will do. Don’t forget #sunscreen- it is never too late . . 😎Dr Davin Lim @cliniccutis @drdavinlim . Brisbane🇦🇺 . #handrejuvenation #handcare #dermatologist #dermatology #drdavinlim #davinlim #skinrejuvenation #skincare #skincaretips #dermalfiller #radiesse https://www.instagram.com/p/CJ_zGsBD0j7/?igshid=usesmp5nhthp

Seborrhoea or increased oil production is a common dermatological condition that can lead to breakouts, greasy skin, scalp & hair. . . 🔬Skin Science: The oil gland or sebaceous gland had many receptors, including intracrine as well as endocrine inputs. Hormones including DHEAS, 17 OH progesterone, testosterone & prolactin all play a part. IGF also has a role in sebum production . . 👀What works? . . 👍🏻Simple measures: Diet, low dairy, low sugar, reduce effects on IGF pathway. Wash twice a day, don’t strip. Moisturize frequently. Sounds counterintuitive but reduces positive loop feedback. Dab, don’t wipe . . 📝What dermatologists prescribe: Pharmacological solutions include- . 👉Retinoids. Try topical, often does not work well, esp. In severe cases. Vvv low dose isotretinoin orally does the trick . 👉Antihormones: The usual. Cyproterone acetate, drospirenone, spironolactone, finasteride (off label), dutasteride . 👉Photodynamic therapy can help - ALA selectively concentrated in the oil gland. RF microneedling using the old AGNES system (one gland at a time) is brilliant but takes forever . . 🤔Have I missed anything ? My medical derm is getting really rusty... . . 😎Davin Lim @drdavinlim @cliniccutis Brisbane🇦🇺 . #drdavinlim #davinlim #dermatologist #oilyskin #acnetips #skincaretips #skincarecommunity #oilyskintips #seborrhoea #greasyskin #greasetrapn#breakoutremedies . . Disclaimer: I am a procedural dermatologist, for medical conditions like seborrhoea, please see my colleagues @cliniccutis (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CJ9TLjwDYAN/?igshid=4zeidrjheolh

Seborrhoea or increased oil production is a common dermatological condition that can lead to breakouts, greasy skin, scalp & hair. . . 🔬Skin Science: The oil gland or sebaceous gland had many receptors, including intracrine as well as endocrine inputs. Hormones including DHEAS, 17 OH progesterone, testosterone & prolactin all play a part. IGF also has a role in sebum production . . 👀What works? . . 👍🏻Simple measures: Diet, low dairy, low sugar, reduce effects on IGF pathway. Wash twice a day, don’t strip. Moisturize frequently. Sounds counterintuitive but reduces positive loop feedback. Dab, don’t wipe . . 📝What dermatologists prescribe: Pharmacological solutions include- . 👉Retinoids. Try topical, often does not work well, esp. In severe cases. Vvv low dose isotretinoin orally does the trick . 👉Antihormones: The usual. Cyproterone acetate, drospirenone, spironolactone, finasteride (off label), dutasteride . 👉Photodynamic therapy can help - ALA selectively concentrated in the oil gland. RF microneedling using the old AGNES system (one gland at a time) is brilliant but takes forever . . 🤔Have I missed anything ? My medical derm is getting really rusty... . . 😎Davin Lim @drdavinlim @cliniccutis Brisbane🇦🇺 . #drdavinlim #davinlim #dermatologist #oilyskin #acnetips #skincaretips #skincarecommunity #oilyskintips #seborrhoea #greasyskin #greasetrapn#breakoutremedies . . Disclaimer: I am a procedural dermatologist, for medical conditions like seborrhoea, please see my colleagues @cliniccutis (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CJ9TLjwDYAN/?igshid=4zeidrjheolh

Spent the last 6 months batching together skincare products for a CURATED skincare shop. Will be launched in 4 weeks. I realise how confusing it can be with literally thousands of products & infinite combinations 🤫🤷🏻‍♀️ . . 🔬Skin Science: Niacinamide has many actions in the skin, the anti-inflammatory effects are most useful. This compound can also aid in restoring barrier function, reduces UV immune suppression, as well as decrease sebum production. It has weak pigment reducing effects. Retinol & #retinoids increase cell turnover, increases epidermal & dermal thickness, & acts as a chemical exfoliant. Retinoid side effects are often rate limiting. A complementary combination involves the use of Vitamin A namely retinol & vitamin B, namely niacinamide . . 🙄👍🏻Sensitive skin + Rosacea: For my rosacea patients, I normally start you on niacinamide before other topicals, as this compound is anti-inflammatory. B3 can be combined with other topicals as long as the pH is over 5.0. Add a good retinol formulation after 4 weeks, start every second night & increase as tolerated. If you have normal skin, start with retinol followed by niacinamide, & lastly #ascorbicacid . . 😎Dr Davin Lim, Dermatologist Brisbane. Australia🇦🇺 #dermatologist #brisbanedermatologist #skincare #skincaretips #skincarescience #instaskincare #bestskincare #drdavinlim #davinlim #skincareshop #rosacea #rosaceatips #rosaceaskincare #niacinamide . . Disclaimer: My work is purely procedural however for an in-depth analysis of topicals, discuss your concerns with my clinical team @cliniccutis (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CJ4L7YTjQO4/?igshid=1j8djletqfc3

Dog 🐶 gone Sunday... pre lockdown car ride with one of the JRTs & Elizabeth Jane, hope you’re having a great weekend 👍🏻 . 😎Davin Lim .🇦🇺 #davinlim #drdavinlim #jrtlove #jrtlife#jrtofinstagram #dogsofbrisbaneqld #gt3rs (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CJ2obJ4DN-Z/?igshid=yvixpgl77m2n

Rebound melasma is not infrequently seen post IPL or worse still, microneedling . . 🔬Skin Science: The superbright Koreans found a new way of treating #melasma. It is called subcellular selective photothermolysis, meaning you gently shrink the arms of the melanocyte, without blowing sh*t up. High fluence will aggravate the melanocyte & melasma will flare up, as in this case of IPL - #BBL. Other lasers including incorrect nano or pico settings will also upset the melanocyte. Despite the alarming clinical picture, I find energy device melasma flares relatively easy to treat. What we find much more difficult are cases secondary to #microneedling. I suspect further basement membrane compromise pushes both melanocytes & pigment dermal . . 👌🏻First line: Usual pigmentation inhibitors . . 👍🏻Second line: Vascular modulation Oral > Intradermal > Topical . . 👉Third line: #Picolasers , Vascular lasers, Thulium & Diode fractional lasers, novel peels inc. #dermamelan #cosmelan . . 🎬Pigmentation or Melasma? See my clinical team @cliniccutis. In the majority of cases we can get a MASI (Melasma area severity index) improvement between 50 to 90%. Dermal melasma cases are challenging . . 😎Davin Lim @drdavinlim Brisbane 🇦🇺 . #skinrejuvenation #dermatology #skinscience #skinhealth #healthyskin #brisbaneskin #brisbanedermatologist #spectralaser #skinlightening #skinbrightening #dermaltoning #drdavinlim #davinlim #picotoning #melasmatreatment #melasmapeel (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CJ1k17aj2FP/?igshid=1885293vjwmw7

Tag someone who is a Bulltoxer💩 . . 😎Davin Lim . Brisbane 🇦🇺 . #drdavinlim #davinlim #dermatologist #bulltox #bulltoxer #antibotox #cosmeticmedicine (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CJzjoJTD6l9/?igshid=q285uzyki11p

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

Boxcar acne scars are relatively easy to treat. It just takes time. Two rate limiting factors here- patient’s skin type, & scars on convex areas of the cheeks. This was a 9 month job . . 🔬Skin Science: Treatments should be scar directed. In many cases simple treatments such as focal chemical peels far outweigh even the most technical lasers. #TCA stands for trichloroacetic acid. It can be applied as a true facial peel, or applied focally as CROSS or Chemical Reconstruction of Skin Scars. The later is one of the best treatments for deep #acnescars. Phenol Croton Oil peels deliver similar results . . 👀👉This Patient: Was treated with mainly CO2 laser as adjunctive to TCA. Chase deep enough and you can knock out some melanocytes. PIH can be expected, however was not the case in this patient (I used short PD CO2, she is also brilliant at photoprotection). Erythema will decrease in 3-6 weeks. No downtime lasers like Pico (for pores & pigmentation), or simple vascular lasers can reduce colour change & assist with #neocollagenesis . Possibly one more gentle fractional laser in a few months time will take care of the residual shallow scars. At that depth, simple #microneedling or RFM can also be an option . . 📸Action: For simple scars like these, see my nursing team @cliniccutis. Alison, Katie or Marisa are well versed in these non-surgical treatments💯 . .. 😎Dr Davin Lim, Brisbane Dermatologist🇦🇺 @drdavinlim @cliniccutis Brisbane #chemicalpeels #TCA #TCACROSS#acnescars #acnescarrevision#acnescartreatment#brisbanedermatologist #brisbaneskin#acnescarsnomore #acnescarsbegone#ogscareraser #scareraser#phenolpeels #acnescarlaser #davinlim (at Melbourne, Victoria, Australia) https://www.instagram.com/p/CJuCdpzDXsO/?igshid=1x5nnq5s6ivp7