#picolasers

Picolasers

Picolasers

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

The 2008 picture was primarily dermal melasma based upon Wood 365nm light & dermatoscopic findings of grey dots. The 2020 picture shows good spontaneous clearance, most recently over the past 2 years . . 🔬Skin Science: The action spectrum for melasma is UVB, UVA, Visible light (Blue> others), all the way to IR. Sunscreens protect against UVB, good ones most of UVA. All of the visible light & IR goes through (except iron oxides). Dermal melasma is humbling because almost everything fails . . 🔍Why the clearance? NFI. Possibly a genetic signal for the immune system to clear up the pigment? Possibly because hormone input is decreased. Sure as hell not due to tech as she has had the same nano treatments limited to 5 - 8 a year over the past 8 years. Not due to ochronosis as I am pretty vigilant monitoring for caviar spots, plus rotational therapy. I should have taken a biopsy from the beginning . . 🤪Thought I was hot sh*t in 08 reading all the papers on melasma, scholarship to the AAD the year before in Washington, training in South East Asia seeing all dermal toning before it got popular in the West. How little did I know back then. Melasma treatment is humbling for all, most times I win but not in all cases. For 10 years we treated her with lasers & medical therapy with minimal gains, then just like that it improved . . 👊Peels: I looked through my peel notes, back in 08 it was glycolic gentle up to 50% in her skin type. TCA not a sane option in her skin type. Peels plus tyrosinase inhibitors up to 8% did not shift things . . 🌤Sunscreens form the foundation of treating #melasma, from there the aim is to reduce pigment output from your pigment cells with tyrosinase inhibitors. My third tier is to modulate vasculature feeding the pigment cycle (if there are no contraindications), the fourth tier is with suitable lasers & peels . . 🔫Lasers & peels include #spectralaser , #revlite #picolasers, #pastelle #C6 #picoplus #picoway etc… On occasion I do use 1927 Diode #fractoinallaser. Peels include #dermamelan, #cosmelan, #TCApeels & #retinoicacid peels. New LaseMD is here, gonna go vvv slowly in the context of #melasma . . 😎Dr Davin Lim Dermatologist. Brisbane 🇦🇺 (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CHUx_WhD19o/?igshid=15s7yofle83ne

Picolasers are a marvel of laser technology. I do believe that they operate in a narrow therapeutic window cf nano lasers. Having said this Picos are useful for skin rejuvenation, enlarged pores & some forms of pigmentation, especially in #ethnicskin types . . 🔬Skin Science: The most exciting aspect of #picolasers is their ability to provide great results in Ethnic skin types with virtually ZERO downtime. A real WOW laser if used creatively. If used incorrectly (too aggressive, wrong management plan), PIH or flare ups of melasma are not uncommon. The first gen #Picosure laser was pretty good at some forms of pigmentation, however their filtered 1064 2 mm handpiece is useless (no power, too small spot size) . . 👊👉The Bottom Line- I do think that picos DO offer an advantage over other lasers, albeit much higher risks of PIH, or flaring up melasma. If used correctly in treating other causes of pigmentation especially in Asian or Ethnic skin types, pico lasers offer a significant advantage over nano with less thermal injury with shorter pulse durations . . 💯Pico coming in less than a week, so treating Asian skin won’t be so much of a butt clenching moment we usually have with nano lasers. As for melasma- I hope they offer at least a 20% faster improvement. Stay posted , . 😎Dr Davin Lim @drdavinlim Brisbane, Australia .🇦🇺 . #healthyskin #ethnicskin #enlargedpores #picoway #enlighten #picoplus #lutronic #lumenis #skinpigmentation #melasmabeforeandafter #melasmatreatment (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CHMjLB1D2jI/?igshid=1wx0zbybb5mqa

👉WebinarLink:https://us02web.zoom.us/webinar/register/WN_amOEditzRUCHBMi6jvH5Bg . 💯Clinical pigment identification via clinical examination is an important step in the management of #melasma This will give an accurate picture of what types of pigment will respond to the prescribed treatment/s . . 🔬Skin Science: The action spectrum for melasma is UVB, UVA, Visible light (Blue> others), all the way to IR. Sunscreens protect against UVB, good ones most of UVA. All of the visible light & IR goes through (except iron oxides). . . ☀️👊Sunscreens;how to use? Apply 3mls twice a day. Face & neck. Form a habit, first in the morning & re-apply at lunch time. Two rule to be cool- twice a day, 2 finger amount, 2 types of sunscreen (daily & sport/outdoor) . . 🙄Where to go from there? Sunscreens form the foundation of treating melasma, from there the aim is to reduce pigment output from your pigment cells with tyrosinase inhibitors. My third tier is to modulate vasculature feeding the pigment cycle (if there are no contraindications). Note the improvement of erythema pre & post, no vascular lasers were employed . . 🧒🏻This patient: Had one round of QSL using the time tested Spectra laser protocols (subcellular selective photothermolysis) devised by the Korean dermatologists circa 2012-2013. Primary treatment was with the standard tyrosinase inhibitors & VEGF modulators. Note, lesions incl. seb k & banal naevi remain, as expected. Second round treatment should improve the clinical picture even further . . 🔫🍌Lasers & peels are considered ONLY if tier one & two are fulfilled. Lasers include #spectralaser , #revlite #picolasers, #pastelle #C6 #picoplus #picoway etc… On occasion I do use 1927 Diode #fractoinallaser. Peels include #dermamelan, #cosmelan, #TCApeels & #retinoicacid peels . . 😎Dr Davin Lim Dermatologist. Brisbane AU🇦🇺 . #melasmatreatment #melasmacure #dermatologist #brisbanedermatologist #melasmabrisbane #melasmasupport (at Cutis Clinic) https://www.instagram.com/p/CE48CEADHu0/?igshid=1ok0zeeqaapqt

The most amount of time I spend in a melasma consultation is talking about sun protection. If you can not do it, I can not help you, please photoprotect 🙏🏼 . . 🔬Skin Science: The action spectrum for melasma is UVB, UVA, Visible light (Blue> others), all the way to IR. Sunscreens protect against UVB, good ones most of UVA. All of the visible light & IR goes through (except iron oxides). Do what you can to protect the wavelengths that can be attenuated with sunscreens . . 🌤Sunscreens. How to apply? Apply 3mls twice a day. Face & neck. Form a habit, first in the morning & re-apply at lunch time. If you travel to work in a car, bus, train, helicopter, walk or in a boat- you will have incidental exposure to & from work. Do not get hung up over the brand of sunscreen, just use it properly. Hats not caps for adjunctive protection . . ☀️☂️👉Where to go from there? Sunscreens form the foundation of treating melasma, from there the aim is to reduce pigment output from your pigment cells with tyrosinase inhibitors. My third tier is to modulate vasculature feeding the pigment cycle (if there are no contraindications). See previous posts on how to use #hydroquinone & how I employ T.acid . . 🔫Lasers include #spectralaser , #revlite #picolasers, #pastelle #C6 #picoplus #picoway etc… On occasion I do use 1927 Diode #fractoinallaser. Peels include #dermamelan, #cosmelan, #TCApeels & #retinoicacid peels I can improve most, but not all cases of melasma . . 😎Dr Davin Lim @drdavinlim @cliniccutis Dermatologist. Brisbane 🇦🇺 #melasmatreatment #melasmacure (is not possible) #dermatologist #brisbanedermatologist #melasmabrisbane #melasmasupport (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CE2XXQuDOeY/?igshid=161s1elkowrwu

Red marks from acne can be classified as post inflammatory erythema or PIE. 50% of PIE can persist for longer than a year, 23% persist for 5 years or longer. This post illustrates two points; firstly contour changes can improve with superficial no-downtime - low downtime treatments (pulse dye laser). Secondly, PIE or redness can be markedly improved with lasers. In ethnic patients it is NOT uncommon to have pigment changes (PIE or PIH) within areas of atrophic OR hypertrophic scarring . . 🔬Skin Science: PIE or red marks from acne are super common. 50% settle with just TIME & sunscreen. Simple vascular laser or even #IPL can help. Nano or #picolasers can help PIH (post inflammatory pigmentation) . . 🙄👍🏻Treatment options: Control acne. Give time. That is it. Use sunscreen. If needed BBL or IPL with a red filter, many vascular lasers can also help. If there are depressions seen with angled or tangential lighting, (early atrophy), the use of vascular lasers- RFM- BBL- Fractional lasers etc… can help stimulate collagen. Ideally early intervention can prevent scarring, however minor depressions can be corrected with the above . . 👉👍🏻Moderate atrophy can treated with fractional lasers & deep focal TCA or Phenol Croton Oil peels . . ☹️👉Significant atrophy can be treated with surgical #subcision as well as dermal fillers . . 🔫This Patient: Was only treated with VASCULAR LASER, 3 conservative sessions over 3 months. Stay tuned for the #tixel challenge (the aim in this patient is to improve his scars with ZERO downtime/minimally invasive treatment options) . 😎Dr Davin Lim Dermatologist, Brisbane Australia🇦🇺 . #brisbanedermatologist #brisbaneskin #brisbanedermatology #acnescars #scarrevision #acnescar (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CD4j26TDX_R/?igshid=aa88rfw41rio