Medical Aesthetics Director
MBBS (NUS), MRCS (Edinburgh),
Pg Dip Pract Derm (Cardiff), (AAAM)
Dr Jason believes in lifelong learning and has attended dozens of conferences both locally and overseas to keep up-to-date in new research findings and techniques which he adapts for use in his own patients. He has also attended hands-on cadaveric dissection courses held locally and overseas in order to improve his anatomy knowledge.
WHY DO WE GET ACNE SCARS AND HOW DO WE GET IT?
Acne scars occurs as a result of a full thickness injury to the skin from inflammatory lesions such as acne, most notably would be nodulocystic acne. This 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 these can become permanent.
The worst part is, the bigger and deeper the acne is, the more likely scarring is going to occur. They are different from post-inflammatory pigmentation (hypo, hyperpigmentation, erythema), acne marks or blemishes which can be temporary and can be resolve with time on its own.
There are many different types of acne scars such as, ice pick, rolling, box, atrophic and hypertrophic.
ITALY TRAVEL DIARY
In this entry, I will be sharing about the DEKA training held in Florence, Italy on 20th and 21st May. But being my first time visiting Florence, I extended my trip so that I would have the opportunity to tour the region as well.
19th May 2019
Touched down in Florence, Italy on Sunday morning. Transferred over to our hotel but it was still too early to check in so decided to head over to do some outlet shopping at The Mall: Firenze. Took a taxi from the hotel to the city centre (this cost 50 euros) and then transferred to a bus that brought to the outlet. Some of the brands there include Prada, Gucci, Moncler, Mont Blanc, Fendi, YSL. Only did some window shopping there though.
Hung around the outlets till mid-afternoon, before taking the bus back to the city centre. Walked around the famous cathedral (Cathedral of Santa Maria del Fiore) for a bit to admire its architecture.
I had booked a tour of the cathedral itself on a separate day in order to avoid the snaking long queues. And then it was time for dinner. One of the good things about the city centre in Florence is that it is rather compact, so all the sights and attractions are pretty close to each other and walkable.
Then walked over to Mercato Centrale, which is sort of their local market. On the first level is the wet market which was closed, on the second was a variety of shops that sold meat, pasta, pizza, wines and beer.
20th May 2019
Breakfast at the hotel and then took the chartered bus to the hospital (Villa Donatello) where the training was held. After the training, we decided to head over to Piazza Michelangelo, which was a lookout point city centre to admire the views of the city centre.
22th May 2019
I had a whole free day in Florence, so it was time to stroll around and explore. First up, did some shopping in the city centre around Piazza del Signoria and Repubblica. After that, went on to explore the area along river Arno and Ponte Vecchio (this is one of the bridges along river Arno that has jewelry and boutique watch shops, and several others selling trinkets and curios)
23th May 2019
Booked a day trip to visit surrounding towns today. Today’s route will take us to Siena, San Gimignano, and Pisa, all of which are designated UNESCO World Heritage sites. Got on tour bus and first stop was Siena. The main sights in Siena included its cathedral, and the Piazza del Campo (the town square).
And the final stop of the day was Pisa, where we visited the famous Leaning Tower of Pisa and its surrounding structures, the Baptistery, the Cathedral and the Campo Santo (graveyard). The leaning tower is actually the bell tower of the cathedral. Our guide informed us that it is also called the Circle of Life, as you are born and baptised in the Baptistery, married in the Cathedral, and buried in the Campo Santo.
24th May 2019
Another day trip today, this time to Cinque Terre (our guide tells us this is probably the most mis-pronounced phrase in Italy, and she is probably correct), which mean Five lands. The Cinque Terre National park is also designated a UNESCO World Heritage site, and comprises five villages: Monterosso al Mare, Vernazza, Corniglia, Manarola and Riomaggiore. The most popular ones are Vernazza and Riomaggiore.
Our route starts off with a two-hour hike from our drop-off point to Corniglia, where we had our lunch and a quick tour of the town before taking a train to our next city, Vernazza.
Found some high ground in Vernazza as suggested by our guide for a good photo opportunity, before heading down into the town itself to explore it. We then headed towards the waiting ferry that would bring us to Riomaggiore, the final town of our itinerary for the day.
25th May 2019
Final day of the trip! Booked a guided tour to visit the cathedral and the dome, allowing us to save time and skip the queues by entering through a different entrance (the queues are really long). That’s it! After a week of pizza, pasta and gelato, it was time to head back.
WHAT IS CO2 DEKA AND WHAT HAVE I LEARNED FROM THE TRAINING?
Some of you would already be familiar with CO2 lasers in the treatment of acne scars and removal of skin tags and milia seeds. But with so many CO2 laser machines in the market, it can be confusing for the consumer and most of the time it is left to the physician to make the decision.
This articles aims to explain some of the important parameters that us physicians use and adjust in order to achieve the intended outcomes. First, a short description of the product. The SmartXide Punto is a CO2 laser (wavelength 10,600nm). This wavelength is selectively absorbed by water in tissue.
The main uses of the SmartXide Punto CO2 laser include;
Vaporization – used in the treatment of skin tags, warts, seborrheic keratosis (a form of pigmentation), moles, oil seeds (milia), syringomas etc. and
Stimulation – whereby collagen remodelling, stimulation, and rejuvenation is used in the treatment of acne scarring and skin laxity
Incision – a cutting mode used more in a surgical setting, such as for double eye-lid (blepharoplasty) creation
Every laser machine comes with a set of parameters that can be adjusted, depending on its intended purpose and application. The SmartXide Punto comes with 2 main handpieces, the freehand and scanning handpieces. The scanning handpiece is used primarily for stimulation, while the freehand hand piece is used primarily for vaporisation and incision. The photographs below show the monitor panel of the SmartXide Punto CO2 in the scanning mode (figures 1 and 2), as well as the freehand mode (figures 3 and 4).
As you can see, there are many adjustable parameters. In this article, I will explain the various parameters as depicted in the figures above, their implications on practice and outcome, to give readers a better understanding of why the ability to control all these parameters is important.
The parameters I will be discussing are
(b) Dwell Time
(d) Smart Stack
(e) Pulse Shape Design (PSD)
(f) Scan Pattern (g) Spray
NOW THE TRAINING
20th May 2019
We were greeted warmly by the DEKA rep and introduced to Prof. Paolo Bonan, MD. The next couple of hours were spent going through the theory and presentation of the DEKA Co2 laser. Prof Bonan also shared with us his clinical before/after photos, demonstrating to us the diversity of conditions the DEKA Co2 machine could treat. During his lecture, Prof Bonan also explained to us how the DEKA Co2 machine gave operators the ability to be in control of every laser parameter, and how this translated into better treatment outcomes and results, as well as a lower risk of side effects and complications.
After lunch, it was time for demonstration and hands-on practice. The hospital had arranged for a few subjects already, and after getting them prepared and numbed, Prof Bonan started with his demonstration. We had a productive discussion with Prof. Bonan about his choice of settings and parameters, and how we could adapt this to the Asian population. Then it was our turn to try out the machine for ourselves.
21st May 2019
The focus today was on a different machine, the DEKA Onda. This machine uses microwave technology to heat up and break down fat. It has also been proven to improve cellulite and skin laxity, making it the only machine that can achieve these 3 functions in a single treatment. After the lectures, we were guided along how to use and adjust the parameters of the machine, before having our own hands-on demonstration.
We were then transferred to visit the DEKA Factory. In this facility, the machines are produced, assembled, and tested rigorously. A representative walked us through the facility and explained to us the various sections and functions of the facility. No photos and videos allowed in the facility apart from their machine range showcase. Although our training focused on the DEKA CO2 and DEKA Onda machine, the DEKA brand does have a range of other products as well.
After the DEKA factory visit, it was free time for the rest of the day.
NOW, AT ASTUTE MEDICAL AESTHETICS & LASER CLINIC, WE CAN HELP YOU RESOLVE ALL YOUR ACNE SCAR PROBLEMS!
Astute Ultimate Acne Scars Removal Program Subcision for Tethered Scars
Co2 Fractional Laser Resurfacing
Pico Fractional Laser
RF Micro Needle
5 different modalities for treatment of Acne Scars
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.