Dr Winston Lee

I absolutely agree with Dr Mark Lim. Looking at the mid cheek and nasolabial folds, it suggests significant volume loss in the mid cheek and skin laxity. The judicious use of HIFU and fillers (of which I like Radiesse) in combination should have optimal results. While face threads are an option, I feel that it doesn't have adequate impact on the quality of the skin in general.

Hello, Dermatologists can do it. Aesthetic doctors may also have the know-how.

Well, from the picture, it appears that the left periorbital region has some redness and swelling. Post fillers, there may be a reactive swelling due to the "absorption" of fluids by the filler, this is benign and tends to subside over a few days. If there is an obvious lump felt, then it may be a superficial placement of the filler which made the initial swelling a little more pronounced. Do see your doctor to address this problem, the use of hyaluronidase (melting) can be considered. The main concern would of course be infection.

I personally would put the HIFU technology (be it Ultraformer or Ultherapy or other HIFU machines) together. What I would advise my patient is that if there is significant sagging and laxity for a quick lifting effect, threadlift would be faster, albeit limited in its skin changing properties. Some practitioners would say that the PDO or PCL stimulates collagen etc, but if I consider the area affected by the threads to be minimal.

I don't think its a matter of whether its suitable but the purpose of doing the HIFU and whether pain tolerance is an issue. I think anyone with laxity of skin can do HIFU - but I have found that high energy settings lead to significant volume loss, and in an already skinny face, it would be counterproductive. The solution is to do more shots, but with a lower energy setting. The Ultherapy's initial white paper showed that more shots is beneficial compared to fewer shots with high energy.

Unfortunately, yes. Heat-based treatments including lasers can cause an acne flare for some patients. As such, some patients who have significant comedones or whiteheads/ active acne can experience a temporary worsening of breakouts post treatment. I tend to prepare them first with a chemical peel or topical/ antibiotics before doing laser treatments for them. CO2 lasers would tend to cause a worse flare compared to Q-switch or picolasers. Patients should be aware of this risk.

In my practice, I don't find that it is a problem. However I would be cautious if the Isotretioin dosage is excessively high as the skin would be prone to poor healing. I would rather wait for the dose to be about 40-50 mg a week before i commence the above injectables. Just a personal preference, but practices can differ amongst doctors.

Hmm, this is an interesting question. But my take on it is: ICE PICKI would definitely first start with TCA Cross as it would reduce the depth of the scars significantly, before finishing up the last bit with fractional lasers. I had some pretty happy patients with this methodology. I explained it to them that its essentially, "scarring the scar together" BOXCAR I would actually focus more on fractional laser OR microneedling as the modalities of choice. This would generally improve the texture of the skin as well. Adding on subcision for appropriate scars would be optimal as well.

Melasma is such a dicey topic. Lasers is still quite the mainstay of treatment of melasma. But what does matter, is the a combination of a few factors in my opinion: SUNBLOCK cannot be overly emphasised. No sunblock is virtually asking for trouble. I like using oral supplements. TOMATO EXTRACT and P LEUCOTOMOS together i find works well for my patients. Some think its voodoo medicine - I find that it works well. Keeping your skin well hydrated and healthy with your usual skin care regime is useful. LASERS are drying in nature as they are energy based.

This is a great question. TCA Cross is a treatment not commonly done well. Generally the treatment is completed very quickly but should be done very specific to the scar, and avoid excessive spillage of the acid into the surrounding normal skin. Looking at your picture, it is consistent with the usual recovery phase, and this can take anything from 7-14 days, and despite that, some mild post TCA hyperpigmentation can persist. Wound care wise, it is just about normal skin care, applying adequate moisturiser, sunblock (super important) and waiting for it to settle down.

I would recommend subcision and TCA Cross. I like the results for my patients and frankly, I feel that treatments by your doctors should be recommended based on experience rather than just following the latest fads or machinery. Your tethered scars will only respond well to subcision, and using the blunt cannula subcision, there is virtually NO downtime and is acceptable to most people. Seek an experienced practitioner today!

Can i advise that you discuss with your doctor about subcision and filler placement first? That would help improve the undulating appearance of your scars. TCA Cross can widen scars if done poorly (technique wise) by having excessive spillage into the normal skin, or if the scar selection was done wrongly. Find an experienced practitioner for this treatment modality. Post TCA pigment wise - sunblock is key! and you can use Q switch laser to reduce it 2-3 weeks after the therapy. Hope all goes well and Merry Christmas!

The Carbon Peel Laser has been shown to improve the outcome of cystic acne. It helps to remove the dead skin of the surface, and reduces oil secretion and pigmentation. However as with all heat-based therapies, from experience, including IPL/Co2 Laser, there is a small limited outbreak following the treatment in the initial days. Fortunately, the outbreak tends to be self-limiting and recovers rather quickly. So take heart!