#kligman

Melasma management in a nutshell. Medical forms the foundation, laser & peels are adjunctive . . 🔬Skin Science:Melanocytes are stimulated UV, visible through to infrared light, energy devices or chemical aggressors. The aetiology of #melasma involves an interplay of signaling from epidermal cells, fibroblasts, mast cells, & endothelial cells to the pigment producing cell, the melanocyte . . 👉👍🏻Topical Treatment is with pigment correctors & sun protection. HQ, #Kligman’s, Kojic Acid, #retinoids - #retinol #meladerm #melarase #cysteamine. Botanicals like #licorice,bearberries, #arbutin, can be helpful for rotational therapy. Be guided by your #dermatologist . . 👉🩸If there are no contraindications fibrinogen & VEGF modulators can be considered, namely t. acid po. Topical T. acid can be effective in some, same with intradermal . . 👉🔫Lasers can be helpful. Nano or Pico. Subcellular photothermolysis with low fluence . . 👉👀Treatment success is much higher in primarily epidermal compared to dermal melasma, hence it is important to determine the level/ levels of melasma. IMO limited experience, rebound following IPL is easier to treat cf rebound following #microneedling (epidermal vs dermal) . . 😎Dr Davin Lim @drdavinlim Dermatologist, Brisbane @cliniccutis🇦🇺 . . #skinpigmentation #skincaretips #melasmacure #melasmacreams #melasmatreatments #skinbrightening #skinlightening #drdavinlim #davinlim #brisbaneskin #brisbanedermatology (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CIwCnAPDQ4-/?igshid=1qj3mjsn0vjfc

Picolasers can be helpful in the management of melasma, macular sun spots- seb Ks, & #freckles and post inflammatory hyperpigmentation - 2 sessions only to give this outcome . . 🔬Skin Science: Picolasers is an evolution of nanolasers. They can be useful in the mx of pigmentation, pores, v mild & early #acnescars, #tattooremoval, & in some cases #melasma . . 🔫Nano vs Pico: In my hands, pico lasers give faster clearance of melasma. Flipside? Much higher side effects cf. nano lasers. Off label treatments can give amazing results, on label treatment settings give marginal advantage cf nano in the CONTEXT of melasma . . 📋Topical Treatment is with pigment correctors & sun protection. HQ, #Kligman’s, Kojic Acid, #retinoids - #retinol #meladerm #melarase #cysteamine. Botanicals like #licorice,bearberries, #arbutin, can be helpful for rotational therapy. Be guided by your #dermatologist . . 👎🏼Scars & Pico: #acnescars can improve with #picolasers; my indication? v mild scars, early scars (less than 3 months old), in the correct skin type. I do NOT believe that Pico can beat RFM (RF #microneedling), nor is it better than sensible low density fractional #co2laser for meaningful scars. The early papers comparing #picosure to Co2 fractional lasers is utter crap. I do believe that pico can give a good reduction for #enlargedpores & an improvement in skin quality in the correct skin type . . 🙄👉Current practice: In my current practice I do not pico melasma, my default is nano. Why? Pushing parameters, my PIH rate is 5-10%. Way too high for my method of practice. Been there, done that with picolasers. Your specialist may have far better parameters than mine, I do believe that the rate limiting factor is not the pulse duration of lasers, it is our immune system’s response to remove pigmentation & remodel collagen. Much like the top speed of say a Veyron, the rate limiting factor is how the average punter processes speed; it is a marvel of engineering, limited by human parameters, nevertheless I am all for pushing technology . . 😎Dr Davin Lim @drdavinlim Dermatologist, Brisbane . . #skinpigmentation #skinlightening #melasmatreatments #picoway #skinrejuvenation (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CDH9Y2wDJuK/?igshid=1w6qgb5azx6n7