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 Dr. Desmond 

Medical Aesthetics Director

Dr Desmond believes that every individual is unique and takes pride in customising treatment plans for each individual according to their goals and expectations.

He adopts a holistic approach when formulating his treatment plans and is dedicated to help his patients look and feel the best they can.

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Why do we get acne scars and how do we get it?

Acne scars occur as a result of a full thickness injury to the skin from inflammatory lesions such as acne, most notably nodulocystic acne. The injury involves the dermis layer of the skin.

 

In the attempt to repair the damaged skin, scar tissue and collagen is formed in an irregular pattern around the injury that leads to the appearance of acne scars and they can be permanent.

 

The bigger and deeper the acne, the more likely scarring is going to occur. Acne scars are different from post-inflammatory pigmentation, acne marks or blemishes which are temporary and usually resolves with time on its own.

 

There are many different types of acne scars such as, ice pick, rolling, box, atrophic and hypertrophic

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So, how do I prevent Acne Scars and what advice can I share?

I always advise my patients to treat their acne the moment it surfaces. With the right skin care products and medications, you can prevent and manage acne effectively.

 

For mild to moderate acne, they can be treated with topicals such as, topical antibiotics, benzoyl peroxide and retinoid. These can be used independently or together depending on the severity.

 

For moderate to severe cases, I like to treat them with an oral antibiotic, topical BPO and topical retinoid. In the most severe cases, oral isotretinoin can be an option. I also like to complement the  acne treatment with a series of lasers and chemical peels for the best results!

 

Personally, I eat everything. But when my face starts to act up, I try to have a low dairy, oily and spicy diet. I eat lots of fruits and vegetables while exercising and drinking plenty of water! As for skincare, use acne compatible cleanser, moisturizer and sunblock.

 

Do not, and I repeat, do not squeeze and pop the angry looking volcano as it increases the likelihood of acne scarring. If you have an upcoming important event that you need to look good for, consider intralesional steroid injections of the acne by a doctor to speed up the healing process!

What is Co2 DEKA and what have I learned from the training?

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I had the privilege of visiting Florence, Italy, on 20th and 21st May for a DEKA CO2 Laser training session alongside my colleague Dr. Jason Pek. During this trip, we had the opportunity to learn about the specifics of the DEKA SmartXide Punto, a versatile CO2 laser machine, and to visit the factory where the machine is made. It was an eye-opening experience!

 

On the morning of 20th May, we were picked up at our hotel and transported to Villa Donatello Hospital, where our training was held. Our group consisted of about 9 doctors from Singapore and Malaysia. Villa Donatella is a private hospital in the suburbs of Florence with multiple specialties. There is a big garden at the entrance of the hospital, and it was a lovely sight to see the flowers blooming in springtime

The morning started with a series of lectures by Prof Paolo Bonan, a well-known Dermatologist in Italy who has vast experience in using the Deka laser for a variety of dermatological conditions.

 

We went through the fundamentals of laser, the unique characteristics of the Deka laser and Prof Bonan graciously showed us his cases as well as the protocols that he had used to treat his patients.

 

The before and after photos showed really good results! Unfortunately, I am unable to show the photos of the case studies due to confidentiality/copyright issues.

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In the afternoon, we managed to get some valuable hands-on with the Deka laser machine to treat a variety of cases including skin rejuvenation, fine lines, acne scarring, neck skin tightening and seborrheic keratosis. I must say this machine is really user-friendly and easy to handle. ​

 

We also had a visit to the DEKA laser factory on the 21st of May. It was fascinating to see all the heavy machinery used to build and test the lasers. We were able to have a quick tour around the facility to see how the Deka lasers are assembled from their individual parts.

 

Unfortunately, we were not able to take photos inside the laser assembly area due to industry trade secrets and prevention of spying.

Explaining the Co2 DEKA Laser

Being a CO2 laser with a wavelength of 10600nm, the laser primarily targets water in tissues. Depending on the parameters set, it can bring about the effects of Vaporization, Stimulation, and Incision.

 

Due to these modes of action, CO2 lasers are known to be versatile and able to treat a myriad of skin conditions including; skin tags, warts, moles, milia, syringomas, acne scarring, fine lines, skin laxity, and seborrheic keratosis/hyperplasia. It can even be used in surgery to make incisions.

 

Many of the doctors present had used other brands of CO2 lasers before in the past. What impressed us about the Deka CO2 laser machine is the ability to adjust a range of parameters independently that other CO2 machines are not capable of. This gives us more control when we treat our patients and allows us to customize the treatment according to the individual’s skin type and condition. This leads to better outcomes and lower risks of undesirable side effects.

What makes it unique?

  1. Power (Watts) – Controls the ablation depth of the laser

  2. Dwell Time -Controls how much thermal energy (heat) is produced with each laser pulse

  3. Energy (Joules) – Can be adjusted by adjusting the power and/or dwell time independently

  4. Dot Spacing – Controls the density of the treatment dots in a certain area

  5. Stacks – Controls the number of repeated pulses on each treatment dot

  6. Pulse Shape – Ability to choose from different pulse profiles for the desired effect

  7. Scan Pattern – Ability to choose shape/size of scanner based on shape of lesion

When treating skin conditions using a CO2 laser, it is a delicate balance between producing results vs causing side effects, especially when aggressive settings are used on our Asian skin subtype, which is prone to post-inflammatory hyperpigmentation (PIH). It is therefore important to have control over these individual parameters to fine-tune the desired effect.

 

For example, heat is required to stimulate collagen in the skin but too much heat can lead to side effects like PIH.

 

When treating deep acne scars, we want to achieve deeper penetration of the laser while controlling the amount of thermal energy generated in the tissues so that there is enough to stimulate collagen but not too much to cause PIH. The ability of the Deka CO2 machine to have stacked pulse on the same treatment dot allows for greater depth of the laser while reducing the thermal damage as the skin is given time to cool between the stacks. ​

 

For these reasons, the Deka SmartXide is our top choice for a CO2 laser. ​

 

Overall, it was a very fruitful trip. It was a great learning opportunity to listen to Prof Bonan share his experience and to see his clinical cases. He is indeed a laser guru and a fantastic teacher. This intensive training session with hands-on allowed me to understand the specifics and individual characteristics of the Deka SmartXide Punto CO2 laser. This very unique and customizable machine is a game-changer in the industry.

A look at the lighter side of our Italy trip!

As the plane was approaching Florence Airport, you could see the famous rolling hills and plains of Tuscany. ​

 

It wasn't my first time in Florence, but I was so glad to be back. I remember that during my last visit, I was so amazed by all the architecture, art and statues that are all around the city.

 

The statues are really quite a feat. The detail of the anatomy, down to the places where the sun doesn't shine, are so intricately sculpted and carved.

 

See the famous statue of David to see what I mean.

Clearly, the Florentines are very proud of their art and history, as they can be seen in every corner and it makes the stroll around the city centre so intriguing and fascinating.

 

What a pleasure getting lost in the streets of Florence with a Gelato in hand. Got to make the most out of this work trip. And oh, do check out Piazalle Michelangelo for a view of the entire city if you happen to be around the area next time.

 

Don’t get me started on the food. The Florentine steaks, pizza/pasta, calzones, wine and cheese are to die for. No pineapples on the pizzas for all you Hawaiian Lovers though. I don’t think it is a good idea to ask when you order as well (at your own risk)!

 

​Just a fun fact: Do you know that there is actually a psychiatric clinical syndrome that describes a set of symptoms that some tourists encounter when they visit Florence? It is called "Stendhal Syndrome" or "Florence Syndrome", a psychosomatic (a physical symptom that is caused by the mind) syndrome involving, hallucinations, dizziness, fainting spells, rapid heart rate and possibly confusion when individuals are exposed to the great beauty of Florence's art scene.

 

Google it. Legit!

At Astute, we can help to resolve your acne scar problems!

Astute's Ultimate Acne Scar Removal Programme

5 Different Modalities for treatment of Acne Scars

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  • Subcision for Tethered Scars

  • Co2 Fractional Laser Resurfacing

  • Pico Fractional Laser

  • TCA Cross

  • RF Micro Needle 

Many treatment plans of Acne Scars begin with subcision for tethered scars. These are scars that are stuck down to the deeper layers by fibrotic tissue, causing a depression. Our doctors can loosen or break up these scar tissue using a blunt instrument or a fine needle. The mechanical movement under the skin also stimulates collagen production, restoring some volume to the scarred skin.

 

We follow up with a second treatment at least 6 weeks later. When the scars have improved after subcision, we can consider the use of energy-based devices. The Fractional CO2 Laser is one such device. Fractional lasers use targeted high-energy lights to create micro-columns of injury in the skin. Areas of the skin are spared, allowing a faster recovery time and lower complication rate compared to traditional full ablative lasers. The selective damage to the skin caused by the laser allows the skin to remodel itself, improving the appearance of the acne scars over time. Fractional Laser resurfacing works well for rolling scars, enlarged pores, box car scars, and moderately well on deeper, ice pick scars. The downtime for Fractional CO2 laser ranges from half a week to 2 weeks, depending on the intensity of the treatment.

 

If the downtime of the CO2 laser is an issue, the Radiofrequency Micro Needle can be considered. This technology utilises a series of needles to deliver radiofrequency energy into the dermis layer skin where it is needed. The selective damage stimulates remodelling and collagen production in the scarred areas that have been damaged by inflammatory acne while sparing the epidermis. As a result, there is lesser downtime compared to the CO2 laser.

 

We are also able to utilise the fractional picosecond laser for treatment of acne scars. Like the Radiofrequency Micro Needle, this treatment is suitable for those who cannot afford the longer downtime associated with the more aggressive fractional CO2 laser resurfacing. It utilises a special lens to concentrate light energy deep in the skin, breaking up scar tissue in the process and encouraging remodelling where it is needed.

 

Finally, there is the TCA CROSS (chemical reconstruction of skin scars). This is a tried and tested method for treating deep scars such as ice-pick scars and deeper box car scars. It utilises a medium to strong chemical peel (usually 70% to 100% TCA) to damage the bottom of the scars that cannot be reached with lasers. TCA CROSS is a manually intensive procedure requires skill and precision.

 

There are different types of acne scars. Proper diagnosis is very important. Treatment must be individualised as different scars require different types of treatments for success.

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