#geniusrf

I had to think outside the box for this case of scar revision . . 🔬Skin Science: One of the most challenging cases of scar revision. Scars are highly atrophic with elastolysis & outpocketing due to lack of support. Additionally there was significant subdermal fibrosis involving the neck & face. Biopsies down to the lower subcutaneous fat shows extension of scar tissue beyond this depth . . 👉🔫💉🔬🔪🔫🩸🪓🧱Previous revision: RFM using #geniusRF & #infiniRF, as well as fractional CO2 lasers, non-ablative lasers, surgical subcision with 12,14, 16, 18G Nokor, 22, G cannula, surgical excision, mini-S-Face lift, dilute Ca OH apatite, PLLA, HA filler, prolonged course of abs, dilute ILCS . . 💯👌🏻What finally worked well: Fractional full thickness excision removing both scar & atrophic tissue . . 💡More to come: Final results from other cases to come, will give a brief outline prior to journal publications . . 😎Dr Davin Lim Brisbane Dermatologist @drdavinlim @cliniccutis AU🇦🇺 . . #nomorescars #healthyskin #scardoctor #acnescars #acnescarrevision #acnescartreatment #skinrejuvenation #beforeandafters #lasersurgery is overrated (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CDZrz0Fjx58/?igshid=a2gdhwiergvt

The concept of atrophy is important to understand . . 🔬Skin Science: Acne scars can be classified as hypertrophic (raised), or atrophic (divot). The latter can be in the dermis, the subcutaneous layer or both. Primarily dermal atrophy is very easy to correct, in the majority of cases. Deeper fat atrophy is harder. The use of dermal fillers or fat transfer is required in some cases. Proper #subcision techniques together with the art and skill of dermal filling are the most important skill sets to master in the context of scar revision. Laser & energy devices can be mastered in a relatively short period of time . . 👉This patient has significant dermal & fat atrophy. This picture shows the placement of the cannula. The aim of treatment is to THICKEN the dermal layer. With the use of a cannula I am able to visualise the DEPTH of the dermis. Without this depth, blindly treating with lasers, RFM or #microneedling would have entirely missed the dermis, with delivery into the fat layer. No good . . 🔍USS & dermal thickness: Dr Steve Weiner @aestheiticclinique has done a lot of work with ultrasound guided cannula methods. We both believe that visualization is the next frontier in scar revision. Wouldn't be great if a device can measure dermal thickness, recognise scar tissue and automatically dial in the settings based upon radiological findings!!! . . 💯Practical aspects: I measure dermal thickness in the majority of cases of scar revision, especially if clinically indicated. I can then dial in the depth of needles for #geniusRF, #infiniRF, #microneedling #dermaroller, erbium laser, #Co2laser, or NA fractional lasers. This way I can reduce overshooting the dermis . . 😎Dr Davin Lim @cliniccutis Brisbane,🇦🇺 #dermatology #dermatologistbrisbane #nomorescars #confidence (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CBJgEWSjTs0/?igshid=bp3f7kbwq14j