Aesthetic Dermatology

Acne scars form as a result of inflammation in active acne. Treatment for acne scars should take place only after active, inflammatory acne is brought under control. Otherwise, new scars will form while old ones are treated. Management of acne scars depends on the type of scar. Acne scars may be classified as:

1. Atrophic (depressed) scars. These include ice-pick, box car and rolling scars.
2. Hypertrophic (raised or thickened) scars, including keloids.
3. Red scars
4. Brown scars
5. Pale or white scars

Patients may have different types of scars, and a combination of methods and repeated treatments may be required.

Early intervention is important.

Acne scars are not life-threatening but have been linked to depression and loss of self-esteem in adolescents. Generally, it is more expensive and time-consuming to treat acne scars than active inflammatory acne. Patients with active acne should seek treatment early, to minimize the amount of scarring.

The DEKA SmartXide CO2 laser is the latest evolution of the original SmartXide with DOT therapy, combining high degree technical features with the most evolved RF-CO2 laser source technology. The CO2 laser remains the gold standard for photorejuvenation, wrinkle reduction and skin tightening. In fractional mode, SmartXide brings laser resurfacing to new grounds compared to traditional resurfacing, increasing safety and reducing downtime while effectively treating atrophic scars. Fractional CO2 laser works by creating minute columns of heat in the skin, which in turn stimulates the skin's healing mechanism to form new collagen. The result is improvement in acne scars, wrinkles, fine lines and laxity.

Noticeable improvement can be seen after 2 to 4 sessions of treatment at 1- to 2-monthly intervals. Numbing cream is applied before the session to minimize any discomfort. After treatment, there will be redness for around 3 to 5 days, and small amounts of crusting for 1 to 2 weeks. Creams will be provided to enhance the healing process. Sun protection after the skin heals is essential to reduce pigmentation.

The BiAxis Q-switched Nd:YAG laser is a state of the art, professional multi-purpose laser that is made in Germany. It is effective in treating both superficial (epidermal) and deep (dermal) pigmentation problems, including dark acne scars. Numbing cream is applied before the treatment to minimize discomfort. There is usually very little downtime. Sun protection is essential after treatment to enhance the efficacy of the laser treatment.

TCA CROSS stands for trichloroacetic acid chemical reconstruction of skin scars. It is a relatively straightforward and quick office procedure to treat atrophic acne scars that are ice-pick, or boxcar in nature. During treatment, a tiny amount of highly concentrated trichloroacetic acid is applied to the scarred areas of the skin. This controlled injury to the skin stimulates the skin's natural healing mechanism, which fills up the scar. Patients will notice scabs forming at the treated areas a few days after. These scabs will generally fall off in 1 to 2 weeks. There will be some redness initially that will fade over time. TCA CROSS can be repeated every 1 to 2 months and scar improvement can be gradually seen after a few sessions.

A chemical peel uses pharmaceutical grade chemicals to remove the top layers of old and damaged skin cells. This process reveals the deeper layers of fresh and newer skin cells and also stimulates new collagen formation. The result is skin that is brighter and smoother in texture. Chemical peels can help to smoothen atrophic and superficial acne scars. Usually only superficial to medium depth peels are used to reduce the risks of side effects.

Subcision is an office procedure done under local anaesthesia. During subcision, a needle-blade is inserted underneath the surface of the skin and moved back and forth to break up fibrous tissue that is pulling the skin downwards. This helps to release the tethers that give rise to atrophic, rolling scars. The result is less depression on the skin, and new collagen formation will also help plump up the skin.

Some types of scars can be treated by surgery. In these cases, the small, scarred area is cut away, and the normal skin on the sides are stitched together gently. The resultant surgical scar is often less obvious and better than the original acne scar.

Wrinkles are also called rhytides, and are a common feature of aged or sun-damaged skin. Many factors can contribute to the formation of wrinkles, including:

1. Biological aging
2. Sun damage
3. Muscle movement
4. Smoking

Early facial wrinkles are dynamic and appear only when the facial muscles move. With time, these wrinkles may become static and appear even when the face is at rest.

Botulinum toxin A injection is one of the most popular treatments worldwide for wrinkles. It uses a highly purified natural protein derived from the bacteria Clostridium botulinum that blocks the signals between the nerves and muscles. The result is relaxation of the muscle and softening of the wrinkles they cause. The types of botulinum toxin approved for use in Singapore include Botox, Dysport and Xeomin. They are commonly used to treat forehead creases, frown lines and crow's feet (wrinkles around the eyes).

The procedure usually takes around 10 - 15 minutes. A small amount of numbing cream may first be applied to the areas to be injected to reduce discomfort. Using a fine needle, small quantities of botulinum toxin are then injected precisely at the location of the muscles. The effect of the injection may take 3 to 6 days to be visible, and often lasts for 3 to 4 months. With regular injections, wrinkles will appear less severe over time, as the muscles are well-rested, and the overlying skin is not creased or wrinkled.

A chemical peel uses pharmaceutical grade chemicals to remove the top layers of old and damaged skin cells. This process reveals the deeper layers of fresh and newer skin cells and also stimulates new collagen formation. The result is skin that is brighter and smoother in texture.

Chemical peels are excellent treatments for:

1. Mild acne and superficial acne scars
2. Pigmentation such as freckles, lentigines, superficial melasma and post-inflammatory hyperpigmentation (brown scars)
3. Sun-damaged skin with actinic keratoses
4. Aged skin with fine lines and wrinkles

The skin is first cleansed to remove any surface oil. The peeling agent is then applied evenly to the skin and left on for a few minutes. There may be a mild stinging sensation on the skin. The chemical peel is then neutralized or washed off, depending on the peeling agent used.

For superficial peels, you may experience mild facial redness for 1 - 3 days. The effect is similar to a sunburn, and most people can resume normal activities immediately after a peel. A gentle cleanser should be used to wash the face, and moisturizers used frequently. One should try to avoid the sun for the next 1 week and use a broad spectrum sunscreen when going out. Crusting occurs infrequently, and antibiotic ointments can be applied till the crusts fall off. For medium-depth peels, the facial redness and swelling may last longer.

The medical term for mole is melanocytic nevus (plural: nevi). Moles are formed by aggregation of pigment cells called melanocytes in the skin. The majority of moles are benign. Removal may be performed for aesthetic reasons. Moles can be removed by surgical excision (cutting followed by stitches), shave excision (a shaving of the top of a mole) or laser. Our specialists at TSN Dermatology will be able to advise you what is the most appropriate treatment, and the benefits and risks of each technique. We will also advise whether the tissue removed should be sent for histology (laboratory analysis) to determine the character of the mole, whether it is benign or cancerous.

Moles should not be casually removed before they are examined by a doctor, because skin cancers can sometimes be mistaken for moles! Inadequate removal of skin cancers may lead to delayed diagnosis, recurrence and further complications later on.

Pigmentation problems are usually due to increase in melanin pigment (hyperpigmentation) in the skin. Melanin is a natural pigment that gives colour to our skin and hair. Pigment producing cells (melanocytes) can sometimes by activated or triggered to produce excessive amounts of melanin pigment, giving rise to pigmentation problems. Some of the common triggers include skin injury, ultraviolet radiation from sunlight and hormones. Not all brown spots on the face are the same, and different conditions will need different forms of treatment.

Freckles are small, light brown marks that appear more frequently in people of fair skin. They are more common on sun-exposed areas such as the nose and cheeks, and become darker with sun exposure.

Lentigines are brown patches that arise due to exposure to sunlight and are more common in people above 40. They are sometimes called "age spots". Lentigines can be found on the face and the back of the hands, and are seen in people with both fair and dark complexions.

While freckles may lighten with sun protection, lentigines usually do not. If treatment is desired, laser treatment or cryotherapy (for lentigines) may be used.

Hori's nevus is a collection of pigment cells (melanocytes) deep in the skin. They present as small, round brown spots on the cheeks, and are more commonly seen in Asian women between the ages of 30 to 50. Treatment for Hori's nevus usually requires multiple sessions (at least 4) of laser. Laser treatment may initially cause increased pigmentation (post-inflammatory hyperpigmentation), but this will settle over time.

Melasma presents as light to dark brown patches on the cheeks, forehead, nose or chin. It is more common in women and tends to appear between the ages of 20 to 40. Multiple factors contribute to the formation of melasma, including sun exposure, hormonal changes (eg. pregnancy, menopause or use of oral contraceptive pills) and genetics.

Treatment for melasma includes:

1. Lightening creams. These may include combinations of hydroquinone, retinoids, mild steroids, vitamin C, etc.
2. Oral medications eg. tranexamic acid
3. Chemical peels
4. Lasers

It is important to avoid excessive sun exposure and use a broad spectrum sunscreen to prevent melasma from recurring after treatment.

Individuals may want tattoos removed for various reasons. Usually, it signifies a break from the past and a fresh beginning, or a change in what one identifies with. Tattoos can now be lightened or removed using laser. Laser energy is targeted at, and breaks up the tattoo ink particles underneath the skin, which are then removed by the body's natural cleansing mechanism. Our clinic employs the German-made, BiAxis Q-switched Nd:YAG laser for tattoo removal. This is effective against blue, black and red tattoos.

Numbing cream is first applied over the area to be treated. There may be a slight stinging sensation during the laser treatment. After the session, redness and swelling may be present for 1 - 2 days. Blistering and crusting will take 1 - 2 weeks to heal. Fading of the tattoo may be seen over the next few months. Multiple laser sessions at 2 to 3-month intervals are required.

TCA CROSS stands for trichloroacetic acid chemical reconstruction of skin scars. It is a relatively straightforward and quick office procedure to treat atrophic acne scars that are ice-pick, or boxcar in nature. During treatment, a tiny amount of highly concentrated trichloroacetic acid is applied to the scarred areas of the skin. This controlled injury to the skin stimulates the skin's natural healing mechanism, which fills up the scar. Patients will notice scabs forming at the treated areas a few days after. These scabs will generally fall off in 1 to 2 weeks. There will be some redness initially that will fade over time. TCA CROSS can be repeated every 1 to 2 months and scar improvement can be gradually seen after a few sessions.