Hi Ching Tan, It is true that freckles are related to genetic factors and can be aggravated by excessive sun exposure. The best way to remove freckles is with pigmentation lasers (eg Q-switched Nd Yag laser). You can expect downtime of redness of 1 day followed by dry scabbing for 5-7 days, with a couple of laser sessions. This downtime can be readily concealed, so you can still resume your daily activities. Sun protection measures before and after the laser sessions are equally important for sustainable results, otherwise the freckles can slowly recur.

With regards to your question: Fractional CO2 lasers generally penetrates deeper than Erbium lasers Fractional CO2 lasers also generally penetrates deeper than Fractional RF devices EXCEPT Microneedle RF machines that can reach a depth of 3. 5mm (only in some machines) which in this case will have a greater penetration depth as compared to Fractional CO2 machines.

Thank you for your question. I agree that laser is still an option for you despite your eczema prone skin. The first question is, how stable is your eczema? If it has been well controlled, then you can consider having laser treatments. The next question is, whats your goal for laser treatments? As this will determine your choice of lasers. Hope this helps.

Thanks for your question. If you have all 4 types of acne scars, you may need a combination of treatment methods which includes chemical peels (like TCA cross), and not just laser treatments.

1. No you cannot do most lasers if you are on isotretinoin. If your acne is not too bad, retinoic cream at night is great to improve your skin. 2. Most pharmacies would carry both in their retail section!

I had asked about accutane but my doctor was hesitant in prescribing to me due to my history with depression. Accutane is usually reserved for severe, recalcitrant, cystic acne or as a last resort. Additionally, Accutane can also affect your liver, cholesterol, causes muscle aches, headaches, cause dryness to the skin/ mouth/ eyes etc. In mild cases of acne, using such a “sledge hammer” option might not be the most appropriate choice. My dermatologist said that the retacnyl will help to clear my acne(very few) and my dark spots and mild acne scars.

I agree with Dr Justin that a combination treatment approach is preferred in treating acne scars. Most patients have a mix of different scar types that will benefit from subcision and energy based devices. The latest Fraxel platform is the Fraxel:Dual which combines the Erbium Glass wavelength in the older Fraxel:Restore (same as Mosaic) with a Fractional Thulium (aka BB laser/Lavieen/LaseMD). The Thulium wavelength actually helps with reducing epidermal pigmentation too, apart from resurfacing scars and uneven texture.

Hello Ter88, I assume that by qswitch laser you are referring to the qswitch nd:yag laser. It is possible and in fact, common, to combine both lasers. They target different chromophores and different layers of the skin when used conventionally. Different physicians have different protocols for their combination and I would leave it to your dermatologist or aesthetic physician to advise you accordingly. Hope this helps!

Thank you for your question! At my clinic, we will first have a detailed assessment to determine the different skin issues faced and the best interval between the treatments. For deeper pigmentation like melasma, I still favour laser toning at a lower energy level, around a 2 week interval, for better results and safety. It will be best for you to discuss the treatment plan with your doctor as each individual’s condition is different 🙂 Hope this helps!

Thanks for your question. I’ll answer the 2nd part of your question first. You may call me biased, but personally I would NEVER trust a beauty salon to do any laser procedures. This is because MOH has clear guidelines which prevent them from using laser settings which are effective, which means if they do have lasers, they are either underpowered or using a higher setting illegally – which would also mean they are completely unfamiliar at dealing with potential side effects. That’s not even mentioning some beauty salons that use counterfeit machines.

I totally agree with Dr Elias Tam that “There is no perfect laser for treatment of pigmentations”. The analogy is like having the fastest sports car alone does not guarantee to bring you the Formula One Championship trophy. In fact, to even have a shot at the trophy, the sports car must be driven by an equally matched professional experienced driver. In my own experience, pigmentation laser with the latest technology can certainly be very useful, but technology alone does not guarantee results.

It seems from your pictures that you have some rolling and box scars. Both Fractional CO2 and Infini will help. Fractional CO2 will be a more effective option, but there can be prolonged downtime and it may also be higher risk for your skin type. The Infini will be much safer for our Asian skin types (especially darker Asian), but results may take longer to show. As the previous doctors have already mentioned, try not to lengthen the time between your treatments too much. Hope this helps!

To address your questions: 1. Generally subcision (I assume with some collagen stimulators) will lead to collagen stimulation, and this is also what CO2 laser aims to do. Some experts suggest that an interval of at least 4 – 6 weeks is kept between each collagen-stimulating treatment for optimal results. There is no real good answer – as social downtime and other considerations have to be taken into account by the doctor in recommending the treatments. My personal preference though is not to stretch the treatment too wide apart – 6 months does seem to me to be a little long.

With regards to your question, The number of sessions really depends on 2 main factors: How your skin reacts to the treatment. For some individuals, good results may be seen after 3 sessions whilst others may require 6 or even more sessions. The depth of penetration of the laser. If mild settings are used then more sessions may be required and results may not be as satisfactory. Additionally, as Dr Chua CY has pointed out, combination treatments usually yield more effective results. I personally do not usually just stick with one kind of treatment modality to treat acne scars.

Thanks for the question. If you have a diagnosis of psoriasis, there is a possibility that certain treatments can aggravate it. With psoriasis, damage or injury to the skin can cause psoriasis to develop at the site of the injury. This is know as the Koebner phenomenon. Therefore, you do have to take care that the treatment is gentle and does not cause any trauma or damage to the skin. Likewise, for eczema, the skin is sensitive and more prone to external insults, so you should avoid treatment if the facial skin is still red or irritated as this can be more easily aggravate by treatment.