The Skin Clinic Fremantle | Dr Sarah Boxley

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Lady doing Facial Exfoliation

Facial Exfoliation

Facial Exfoliation – where to begin?

Our skin cells have a natural life cycle that sees them rise from the lower skin levels and flatten as they develop, until they mature and are shed as dead particles from the top layer (the stratum corneum).

As we age, the cells in the stratum corneum become stickier and are harder to shed, leading to a build up of the dead top layer of skin. This can give the skin a lacklustre dullness and make it more challenging for active ingredients in our skincare products to penetrate.

The answer to this issue is regular exfoliation.

Regular exfoliation will remove that dead top layer and reveal the more radiant healthy skin layers beneath. This is a simple step that we generally recommend you add to your skincare routine from your early 20s (but it is never too late!) or earlier if you are a acne sufferer.

There are a number of ways that exfoliation can be achieved, which can be mixed and matched to suit lifestyle and budget.

Physical exfoliation

You can clean and exfoliate at the same time using your normal gentle cleanser if you apply and remove this with a light abrasive cloth. This is a cost effective, easy solution and may be enough for young, non-acne prone skin. Muslin is a great option and can be cleaned and reused. You can buy ready-made muslin cloths specifically for this, or if you are feeling crafty you can pop into Spotlight for some muslin and make your own. Other examples would be facial buffers, exfoliating mitts and the fancier version made of 100% floss silk (eg Microdermamitt®) which are available online as well as from the bathroom section of department stores, pharmacies and skincare stores.

Facial scrubs

Another way to cleanse and exfoliate in one step is with a facial scrub, which is a cleanser with something gritty added to it. Avoid scrubs with plastic microbeads (banned in many countries as they are harmful to aquatic life) and choose biodegradeable products instead, which tend to use substances such as natural earth minerals (eg Synergie® Mediscrub) or nut shells as their exfoliant (eg Aesop Tea Tree Leaf Facial Exfoliant). If you are a coffee fan, you can use your left-over grounds to make your own facial and body scrubs.

Chemical Exfoliation

This sounds scary but it merely involves using substances such as light fruit acids to dissolve the sticky bonds between the matured skin cells in the stratum corneum, allowing them to fall off naturally without any sort of physical rubbing. The most commonly used chemical exfoliants are alpha hydroxy acids (AHAs- see below) and beta hydroxy acids (BHAs) such as salicylic acid. These are often combined and applied as a serum (eg Synergie® Reveal) between the cleansing and moisturising steps of a skin care regime. There are different preparations and strengths available for different skin needs and so it is good idea to seek appropriate advice for your individual skin before using a chemical exfoliant.

AHA Source
Glycolic Acid Sugar Cane
Lactic Acid Milk Products
Malic Acid Apples
Tartaric Acid Grapes
Citric Acid Citrus Fruits

Professional exfoliation

If daily home exfoliation is not enough for your skin, or doesn’t fit into your lifestyle, then regular clinic treatments may be for you. The simplest of these is microdermabrasion, which is literally a light mechanical sandpapering to remove the dead top layer of skin. Slightly more advanced are the hydrabrasion treatments, that use water to assist with the removal of the dead skin. Medical grade treatments such as the Hydrafacial® will have the same effect as a good microdermabrasion but with the additional benefit of a light chemical exfoliation and an infusion of nourishing ingredients into the skin.

Chemical peels

You can step it up even further and go with this alternative in-clinic option for removing that dead top layer of skin. Lactic or glycolic acids can be applied at stronger concentrations than are available in at-home products, and cause a gentle peeling of the entire uppermost skin layer over the following few days. Downtime is minimal due to the light superficial nature of these peels and side effects are rare. This sort of peel can be combined with a microdermabrasion for people with thicker or oily skins. This is definitely a treatment for the winter months as you should avoid exposing the skin to bright sunlight for a few days afterwards.

There you have it, there is something for everyone when it comes to exfoliation. So get scrubbing!

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Kate & Abel Hat Giveaway

Giveaway for National Skin Cancer Action Week

Image by @makersportraitperth

Awesome hat giveaway for National Skin Cancer Action Week | November 19-25 2017

WIN A HAND-FINISHED BESPOKE HAT FROM @kateandabelperth Valued at $165!!

Some scary statistics:

With two in three Australians diagnosed with skin cancer by age 70, and more than 2,000 people in Australia die from skin cancer each year. The Cancer Council estimates that Australia spends more than $1 billion per year treating skin cancer, with costs increasing substantially over the past few years.

Yet most skin cancers can be prevented by the use of good sun protection.

Each year Cancer Council Australia and the Australasian College of Dermatologists come together for National Skin Cancer Action Week, which in 2017 runs from 19th to 25th November. This year, to encourage Australians to remember to use the five forms of sun protection, the Cancer Council are inviting everyone to join the #SunSmartGeneration.

Today’s children have grown up with the SunSmart message and are our most sun savvy generation ever. Parents understand the importance of protecting their little one’s skin with rashies, hats, sunglasses, shade and sunscreen, and yet they frequently neglect their own skin and sun protection. It’s never too late to prevent further damage and parents play a hugely important role in setting a good example for their kids.

That’s why this National Skin Cancer Action Week, Australians of all ages are urged to use the five forms of sun protection. These are to:

  • slip on sun-protective clothing
  • slop on SPF30 (or higher) broad-spectrum, water-resistant sunscreen
  • slap on a broad-brimmed hat
  • seek shade
  • slide on sunglasses.

A combination of these measures, along with getting to know your skin and regularly checking for any changes, are the keys to reducing your skin cancer risk.

Many folk tell us that they struggle to find a hat that suits them, fits them, or compliments their style. Which is why, to help our lovely patients out with their own slipslopslap mission, this November The Skin Clinic Fremantle shall be GIVING AWAY a fabulous hand-finished, bespoke hat worth $165. Kate and Abel are a local company, based right here in the Many 2.0 Project in Fremantle, who have achieved international success with their one-of-a-kind hats. Whether you are male or female, young or old, big headed or small, they should be able to find the perfect fit for you.

How to enter

Entering is simple: any patient that comes to us for a skin cancer check during the month of November will be automatically entered into the draw. The winner will be picked at random on 1st December and notified via email and/or phone. Be a role model for your kids, join the #SunSmartGeneration 🙂

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Understanding Skincare Ingredients: Antioxidants

We all know we need more antioxidants, right? Antioxidants are good for us. We are told we should be having more of them – in our diets and on our skin. Sounds great and we are all totally on board with that.

But do any of us actually know what the hell an antioxidant is? What is the point of them and what is all the drama about?

Antioxidants are substances that protect our body’s cells from the stress on them caused by the environment around us. They do this in a number of ways and in order to understand how it all works, cast your mind back to high school science…

The human body is made up of many different types of cells. Each cell is composed of many different types of molecules, and each molecules consists of one or more atoms of one or more elements joined by chemical bonds.

Still with me?

Each atom consists of a nucleus made up of neutrons and protons, with some electrons orbiting around the outside. The electrons are negatively-charged, and the number of them in orbit is determined by the number of positively-charged protons hanging out in the nucleus.

The electrons are involved in chemical reactions, which bond atoms together to form molecules. The electrons are orbiting the atom in layers called “shells” and it is the number of electrons in the outermost shell that determines the chemical behaviour of the atom. Atoms behave a bit like they are on the dating scene.

An atom that has a full outer shell is stable and tends not to enter into chemical reactions. The other atoms out there are looking to stabilise themselves by completing their outer shells. They can do this by:

  • Gaining or losing electrons to either fill or empty the outer shell, swap-meet style.
  • Hooking up – sharing electrons by bonding together with other atoms in order to complete their outer shell, making themselves stable.

Now sometimes, these bonds between atoms can split, particularly if the bonds are weak or have been damaged in some way, which can create a “free radical” – an atom with an odd, unpaired electron. Free radicals are very unstable and are quick to react with other compounds, trying to capture an extra electron to gain stability.

Imagine a slightly drunk ex on the rebound at a party. Generally, a free radical will attack the nearest stable molecule, “stealing” an electron to stabilise itself and leaving its victim short of an electron. This “attacked” molecule has now becomes a free radical itself and will in turn try and stay an electron as well, beginning a chain reaction like dominoes.

The chief danger of free radicals comes from the damage they can do when they react with important cellular components such as DNA, or the cell membrane. Cells may function poorly or die if this occurs.

Some molecules within the body are particularly susceptible to free radical attacks, including fats, DNA, RNA, cell membranes, proteins, vitamins and carbohydrates. Of particular importance is that free radical damage accumulates with age.

How do free radicals form?

Some free radicals arise normally during metabolism. The cells of our immune system can purposefully create them to neutralise viruses and bacteria. However, they can also form from the result of exposure to heat, light or environmental factors such as pollution, radiation, cigarette smoke and herbicides. Oxygen within our bodies is very susceptible to free radical formation. Oxygen free radicals have been implicated in the overall ageing process of the skin, playing a part in photo-ageing as well as skin cancer and skin inflammation.

This is where “antioxidants” come in…

Normally, the body can handle a certain level of free radicals, using substances known as “antioxidants”. Antioxidants neutralise free radicals by donating one of their own electrons, ending the electron-stealing reaction. Despite donating an electron, the antioxidant doesn’t become a free radical itself as it has a unique ability to be stable in either form.


Antioxidants act as scavengers, helping to prevent cell and tissue damage, but if antioxidants are unavailable, or if the free-radical production becomes excessive, damage can occur. As a species, our environment is changing quicker than our bodies can adapt, creating an imbalance between the formation and the neutralisation of free radicals.

The aim of using antioxidants in cosmeceutical products is to deliver them directly to the skin, soaking up free radicals to prevent cell damage. A good antioxidant is able to:

  • inhibit environmental stress by scavenging free radicals
  • reduce DNA damage
  • have an anti-inflammatory effect and reduce skin redness
  • promote new collagen growth

The bees-knees, gold standard of antioxidants for skin is vitamin C, at concentrations of >5%.

This can be irritant to the skin when first using it, particularly if the barrier function is impaired and the skin is “sensitive”, and application can cause stinging and redness. When first using vitamin C, it is helpful to start with a lower concentration and build up to a higher strength preparation once the skin gets used to it. Vitamin C is included in many anti-oxidant serums and is also available as powder that can be mixed just prior to application.

Other compounds that are useful cosmeceutical antioxidants are:

  • Vitamin E (tocopherol) – naturally found in vegetable oils, nuts, fish and leafy green vegetables.
  • Vitamin B3 (niacinamide) – foods with the highest levels include fish, poultry, pork, liver, peanuts, beef, mushrooms, green peas, sunflower seeds, and avocados.
  • Ferulic acid – an antioxidant found in the cell walls of plants such as rice and oats and the seeds of apples and oranges.
  • Flavonoids and Carotenoids – a diverse group of phytonutrients (plant chemicals) responsible for the vivid colours in fruits and vegetables.
  • Phloretin – a type of natural phenol that can be found in apple tree leaves and the Manchurian apricot.
  • So now you know, by ensuring your skincare includes antioxidants you are helping to protect it from ongoing environmental damage, slowing down the ageing process.

    Most of us begin to stick to a regular skincare regime in our 20s, and this is the perfect time to introduce these little hardworking scavengers.

    – Dr Sarah Boxley

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Male Grooming Tips

International Male Grooming Day

This Friday, August 18th marks International Male Grooming Day, and we are talking people, not dogs.

Its not so long ago that a man who spent too long in the bathroom was met with scorn and suspicion. Thankfully, times have changed and male grooming is now acceptably mainstream. Even so, it is easy to feel confused by the overwhelming amount of advice, opinion and small pots full of expensive gloop aimed towards the male market.

Sneakily using your female partner’s skin care products may seem like a great idea, but there are a few important differences between male and female skin that mean you may get better results using a range specifically developed for men. Men’s skin is around 30% thicker and more robust than female skin, with a thicker outer layer (stratum corneum) that effectively reduces the absorption of active ingredients in skin care products. Male facial skin produces 75% more oil than female skin, making acne and skin conditions such as seborrhoeic dermatitis more common. Shaving makes the skin more sensitive and it is a good idea to avoid harsh chemical products if you are a regular shaving.

To clarify the male skincare process, we have broken it down into some essentials, but don’t panic – it is easier than you think.

The trick is to keep things simple – you don’t need to spend a fortune on a hundred different products, or spend hours locked in the bathroom.

All you need is a quick daily routine aimed at maintenance and protection, using a minimal number of products.

1. Cleanse

Give your face a thorough clean morning and night with a gentle, chemical free cleanser to wash away environmental dirt and dead skin cells. For a deeper clean that will also stimulate the growth of new skin cells, you can alternate this once or twice a week with an exfoliating scrub. (Ensure your scrub is environmentally-friendly and doesn’t contain polyethylene “microbeads”1)

2. Regenerate

After cleansing, apply a rejuvenating anti-ageing serum to boost skin immunity and strengthen the skin. With serums, less is more and only a small amount is needed. A good serum will perform a number of multi-tasking benefits such as increasing collagen production, repairing the skin’s barrier function, boosting natural hydration, controlling oil and soothing the skin.

3. Moisturise

Moisturiser is an absolute must, and using one that doubles as a sunscreen saves both time and money. Moisturisers formulated specifically for men are less likely to upset the oil balance of the skin and tend to have more masculine scents. Look out for the super ingredient niacinamide (vitamin B3), which is often added to moisturisers. Niacinamide boosts skin immunity, improves hydration, assists in collagen production, reverses UV damage, reduces hyperpigmentation and minimises inflammation2.

4. Stay Hydrated

Your skin needs moisture from the inside as well as the outside. Make sure you are downing enough water and keep tabs on how much caffeine and alcohol is going in, as both of these have a diuretic effect and can make you dehydrated. A lot of us think we only need water when it is hot or we are exercising but air conditioning and/or heating can draw extra moisture from the skin, so if you are spending a lot of time indoors don’t forget to keep your fluids up.

5. Get enough sleep

Whilst you are sleeping, your body has time to heal, renew and eliminate toxins from the skin. During the hours you spend asleep, your body’s hydration rebalances and there’s a rise in growth hormone as it repairs itself, allowing the skin to recover moisture and damaged cells to be repaired3. Getting the recommended 7-8 hours sleep on a regular basis will stave off the signs of ageing, give skin a greater ability to retain essential moisture and protect you from environmental stressors such as the sun’s rays and everyday pollution4.

6. Load up on fruit & veggies

Carotenoids (compounds that give fruit & vegetables a yellow/red colour) are powerful antioxidants that fight off free radicals, reducing the effects of inflammation, sun damage and ageing. Upping your dietary intake of fruits and vegetables by just 2 servings a day has been shown to improve the appearance of the skin within only 6 weeks5.

7. Ditch the cigarettes

Smoking decreases circulation and collagen production, so skin loses its natural colouring and a ends up looking sallow and pale. Studies of identical twins have revealed the visible difference that smoking makes to the ageing process6.

8. Avoid Aftershave

Aftershave lotions high in alcohol content will dry the skin, reducing the natural barrier function and leading to skin sensitivity. Look for an alcohol-free moisturising lotion instead or use aftershave behind the ears if you want the fragrance without the irritation.

9. Protect your lips

Normal sunscreen just won’t last on the lips as eating and speaking removes the product within minutes. Our harsh climate means that dry cracked lips are often the first signs of sun damage. Look for a lip balm with an SPF of 30+ for day time use, and then repair and protect with a healing (non-shiny) lip balm at night.

10. Step up to specialised products

Adding in a vitamin A serum at night will give you additional protection against the ageing process, reducing fine lines, wrinkles & pigmentation, as well boosting cell growth and improving skin tone. For the keen amongst you, using a home dermal roller for 5 minutes a night will increase the absorption of active ingredients through that thick outer skin layer by up to 80%.

2. Forbat E, Al-Niaimi F, Ali FR. “Use of Nicotinamide in Dermatology”, Clin Exp Dermatol. (2017) Mar;42(2):137-144
3. HR Colten and BM Altevogt, ‘Sleep Disorders and Sleep Deprivation’, National Academies Press, (2006)
4. ‘Esteé Lauder Clinical Trial Finds Link between Sleep Deprivation and Skin Aging’, University Hospitals, (2013),
5. Pezdirc K et al. “Can dietary intake influence perception of and measured appearance? A systematic review. Nutr Res. 2015 Mar;35(3):175-97

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Melasma on forhead - treat hyperpigmentation

How to Treat: Hyperpigmentation

No matter the natural base colour of our skin, an even and consistent skin tone is universally associated with youthfulness and health.

Unfortunately, excessive patchy pigmentation of the facial skin is incredibly common, particularly in women with darker skin types who are naturally capable of making greater levels of melanin, the substance in skin that gives it a brown colour. Here we discuss a common type of pigmentation issue, what causes it and the most effective ways of controlling it.

“Melasma” is the medical term given to a common, benign skin condition characterised by symmetrical overly-pigmented patches with irregular borders, most often on the face.

The forehead, cheeks, upper lip and chin are the areas most likely to be involved.

The condition is caused by an overstimulation of melanocytes, which are the cells within the skin that produce melanin. These cells can be kicked into overdrive by sunlight and by hormones, specifically the female hormone oestrogen. Melasma is therefore most commonly seen in women who live in geographical areas that have a high degree of UV light, who are pregnant or on the oral contraceptive pill.

Although not medically harmful, the discolouration of the skin that occurs in melasma can be psychologically distressing. Many patients with melasma report feeling they look “dirty” or “old” because of the pigmentation patches. Whilst some are happy to cover the patches with makeup, others would like to remove the excess pigmentation and return their skin colour to a more even tone.

N.B. Not all brown patches on the skin are simple pigmentation, and some forms of skin cancer can present in a similar way. It is important to get your skin assessed by a doctor with experience in skin cancer diagnoses prior to starting any treatments or therapies targeted at pigmented patches.

There is usually no simple solution to melasma, but getting to grips with the complex mechanisms underlying the condition is fundamental to successfully controlling it.

The layers of human skin (diagram)

The diagram above represents human skin. Melanin pigment is manufactured by the melanocytes, which are situated along the basal layer, in the mid portion of the skin where the dermis meets the epidermis. The melanin is then transported down the spider-like arms of the melanocytes and moved over into a different skin cell, the keratinocyte. Keratinocytes migrate upwards through the layers of the epidermis as they mature, until they are shed from the stratum corneum, a process that generally takes around 6 weeks in facial skin.

It is helpful to think of the process underlying excessive pigmentation as having 3 stages:

  1. Production of melanin
  2. Transportation of melanin
  3. Retention of keratinocytes

Rather than addressing only one aspect of this pigmentation process, the most successful treatments for melasma are those that tackle all these stages:

Stage 1: Production of melanin

  • Pregnancy
  • Hormonal contraception
  • Sunlight

The most common ways in which melanocytes are overstimulated are through exposure to sunlight and to oestrogen. If melasma has been brought on by the higher oestrogen levels associated with pregnancy, the melanocytes will tend to continue their overproduction until delivery, after which the hormones settle back to their usual levels and the melanocytes will calm down, however the pigment may remain trapped in the keratinocytes of the upper skin layers.

Oral contraceptive pills that contain derivatives of oestrogen can also be a cause of melasma. Changing to a lower dose pill or to an alternative form of contraception can be helpful in some cases, and this should be discussed with your medical practitioner if it applies to you.

Ultraviolet (UV) light is a powerful stimulator of melanocytes and therefore exposure to UV should be avoided whenever possible. Daily sun protection in the form of sunscreen should be the first step in controlling the pigment production. The visible spectrum of sunlight is also involved in the stimulation and so sunscreen should be broad spectrum, preferably a physical barrier such as zinc or titanium, which will block out the visible as well as the UV light. The most recent generations of zinc-based sunscreens are easy to use, non-comedogenic and can deliver an SPF of >50. There is little point moving on to steps 2 and 3 if you are not cutting off the pigment stimulation at its source, and so when treating melasma in our clinic we insist upon a daily SPF of at least 30+ or higher.

Stage 2: Transport of melanin

As discussed above, the melanin that is made in the melanocyte factories is then moved away and into keratinocytes, which are a different type of skin cell. Keratinocytes migrate upwards and spread through the epidermis as they mature, until they arrive at the uppermost layer, the stratum corneum, where they sit until they are shed as part of the natural skin cycle. Preventing the melanin from entering the keratinocytes reduces the distribution of the pigment into the higher levels of the skin, making it less visible.

There are a number of compounds available in cosmetics, cosmeceutical or prescription creams that disrupt this transportation process. Some of these are listed below:

  • Hydroquinone
  • Retinoids (Vitamin A)
  • Ascorbic Acid (Vitamin C)
  • Niacinamide (Vitamin B3)
  • Kojic Acid
  • Tranexamic Acid

In addition, a variety of botanical products have been found to have alter to some extent both the production and transport of melanin, although many these have not been extensively studied, and therefore we do not know how effective they actually are. The more common of these agents seen in cosmeceutical products are:

Aloesin (isolated from Aloe vera) Marine algae
Arbutin (bearberry) Orchid extract
Boswellia (herb) Pycnogenol (pine bark, witch hazel bark)
Coffeeberry extract Resveratrol (red grapes)
Grape seed extract Silymarin (milk thistle)
Green tea extract Soy extract

Stage 3: Retention of keratinocytes

Once the melanin pigment has been transported into the keratinocyte cells, it will remain there until either natural shedding occurs (which may take many months), or the dead cells of the stratum corneum are targeted for removal by methods such as:

  • Topical vitamin A
  • Gentle dermabrasion
  • Chemical Peels – superficial/medium depth
  • Microneedling
  • Spot cryotherapy (light freezing of the skin surface)
  • Intense Pulsed Light (IPL)
  • Laser (Q-switched or picosecond)
  • Fractional Radiofrequency

Skin types that are prone to melasma are also prone to post-inflammatory hyperpigmentation, whereby inflammation in the skin kick starts the overproduction of melanin. All of the above treatments have a significant limitation in the management of melasma, in that they have the ability to cause inflammation of the basal skin layer, leading to the potential for rebound pigmentation or worsening of existing pigmentation. These treatments should be performed conversatively by practitioners that are well-trained and experienced in dealing with hyperpigmentation.

Although it may seem to have an initial benefit, any treatment that removes the pigment-loaded keratinocytes will be ineffective in the long-term unless the other steps in the pigmentation process are also addressed. Once the pigmented keratinocytes have been removed, unless the underlying stimulation of the melanocytes has also been eliminated, more pigment will inevitably form. Maintenance therapies are therefore as important as initial treatment, and non more so than daily application of a broad-spectrum, high SPF sunscreen 🙂

Contact Us for more information or to see how our team at The Skin Clinic Fremantle can help you with your skin concerns.

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Photo of smiling girl with glowing skin wearing a hat.

Winter Special Offer – 30% OFF!

A series of 3 x Enerpeel® chemical peels for just $630!
plus a FREE cosmeceutical pre-treatment home care kit from Synergie® (rrp $104)
SAVE $374

The cooler months are the perfect time to repair and strengthen the skin with a monthly chemical peel.

The 25% TCA peel by Enerpeel® uses a breakthrough technological formulation to minimise surface trauma and effectively rejuvenate the skin, with significantly less downtime than traditional peels. Ideal for fine lines, pigmentation and dullness, this peel promotes skin that not only looks fantastic but is stronger and healthier. The best results are achieved with the correct skin preparation, which is where the home-care kit comes in. Preparing the skin for a fortnight prior to each peel results in more even penetration of the peel and also a quicker recovery period.

Find out more about peels here >

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Photo of a ladies lower half with a flower.

Lets talk about vaginas..

Genital rejuvenation technology can revolutionise lives, yet most women who would benefit from it are not even aware that it exists……

Even in our current society of assessable digital information and public “oversharing”, talking about the vagina is still a social taboo. Unfortunately for those of use who possess a vagina, and for those who like to recreationally enjoy a vagina, the plump, well lubricated playground of our youthful 20s inevitably dries and shrivels as we get older, affecting intimate relationships, self-esteem and general well-being. Many of us put these problems down to simply “getting older” and do not realise that there is an effective treatment available.

When many of us hear the words ”genital rejuvenation” we think of surgical tightening of the vaginal or of surgical trimming of the labia. Whilst these procedures do exist (and have their place), the rejuvenation techniques that have the biggest lifestyle impact are actually aimed at turning back time, restoring the vaginal walls to their former plump, springy, well-lubricated existence.

When the vaginal walls reduce their secretion output, the vagina itself becomes dry and in some cases sex becomes uncomfortable, painful or even impossible. Vaginal secretions are packed full of a family of molecules known as glycosaminoglycans (GAGs), that serve as a food source for the healthy bacteria that live there. Without this food source the ecosystem down there is disrupted, opening the door for recurrent vaginal or urinary infections as well as chronic inflammation, burning and itching sensations. Another feature of the maturing female genital area is the development of urinary stress incontinence, a distressing and embarrassing condition that can have a major impact on social life, physical activities and even clothing choices.

A simple, quick and non-surgical procedure using a small laser probe can bring life back into the vaginal walls in the exact same way as laser facial rejuvenation.

The laser makes little “dots” in the lining of the vagina and the body’s natural healing response then stimulates the production of new collagen and elastin, rebuilding the skin of the vaginal wall and allowing secretions to flow once again. The whole procedure takes 5-15 minutes, is done in the same position as a PAP smear but is far less uncomfortable. Generally, an initial course of 3 treatments spaced a month apart is followed with an annual maintenance treatment. Patients report significant improvements as early as one month after the first treatment, most commonly a sensation of a tighter, better lubricated vagina with less urinary issues.

Women that can be helped by laser vaginal rejuvenation include those going through menopause (either natural or medication-induced such as after a hysterectomy or as a result of chemotherapy), those with postpartum vaginal laxity, minor urinary incontinence, or with symptoms of atrophic vaginitis and decreased sensation. Patients range in age from their early 20s up to their 80s, some of whom have been putting up with symptoms for many years.

Since we have been performing laser vaginal rejuvenation, we have found the biggest challenge for patients is getting the information that they need and becoming aware that a treatment does actually exist for troublesome vaginal issues, that it is safe, successful and pain-free. So please speak up, don’t be embarrassed – we would love to talk vaginas with you 🙂

More about MonaLisa Touch™ Vaginal Rejuvenation >

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Fresh fruits and vegetables

Adult Female Acne – what you need to know about lifestyle factors

A recent study published in the Journal of the American Academy of Dermatology has shed some light on risk factors for developing female acne in adulthood, and how these differ from the risk factors for adolescents. The researchers looked at environmental and personal factors in 270 women with adult acne (mean age 32.2yrs) and compared them to similar women without acne. These are the things they discovered are associated with acne in adult women, listed in order of highest to lowest risk:

  • A personal history of acne in adolescence
  • A family history of acne in parents
  • Hirsuitism (abnormal patterns of excessive hair growth)
  • Having a high degree of psychological stress
  • A low fresh fish consumption
  • A family history of acne in siblings
  • A low weekly fruit/vegetable intake
  • Working in an office rather than being unemployed or a stay-at-home mum
  • No previous pregnancies

Interestingly, unlike in adolescent acne, there was no association with a high intake of milk or with body mass index (BMI). They also found that acne in adult women was more likely to involve inflammatory lesions such as cysts and pustules, as opposed to comedomes (whiteheads), with 75% of the adult women in the study having inflammatory acne, with 30% of them having acne involving the trunk (chest or back).

Clearly, some of these risk factors are not adjustable, but correction of the lifestyle factors identified – particularly increasing the amount of fresh fish, fruit and vegetables consumed, may well be worth trying.

Reference: J Am Acad Dermatol 2016;75(6):1134–41

If you are an adult women suffering from acne and would like to talk to us about treatment options, including non-prescription options such as light therapy or biophotonics Contact Us to arrange an appointment.

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What is Fat-freezing??

An insiders guide to Cryolipolysis.

One of the hottest treatments around at the moment, fat-freezing or “cryolipolysis” is an effective, non-invasive method of destroying fat cells. It works best on hard-to-shift pockets of fat that do not respond to diet and exercise but should not be used as a weight-loss technique.

How does fat freezing work?

We have known for a long time that by reducing the temperature of the fat layer in a controlled manner, it is possible to cause selective death of the adipose (fat) cells without harming the skin1, as fat cells are more susceptible than skin to temperature changes. Research has shown that cooling the fat tissue to between -8 and 10°c results in local controlled fat cell death and the release of cytokines and inflammatory mediators2.

The lipids from the fat cells are slowly released over the next few months and are transported by the lymphatic system to be processed and eliminated from the body, reducing the thickness of the fat layer. The loss of fat cells treated in this way is permanent3. Commercial cryolipolysis machines have been around since 2009 and have been shown to be safe & effective. With these devices, it is possible to target specific fat areas by using a vacuum action that sucks the skin into an applicator head. The powerful suction causes a temporary reduction to blood flow through the targeted area, making the fat cells easier to freeze.

Is fat freezing just hype or does it actually work?

Research into cryolipolysis technology has shown that the average fat reduction in a particular area is around 25% after one session4,5, although in real life, results can vary from person to person. Post-procedural massage has been shown to improve results6. For large amounts of fat it is possible to repeat the treatment more than once in the same area. Treatment outcomes can be seen by 2-3 months2, at which time a repeat treatment can be performed if required. There is published evidence to show that the results last for at least 5 yrs3 and it is probable that the effect is sustained beyond that period.

Whilst a reduction in localised fat has been well-documented following cryolipolysis, these non-invasive fat removal procedures do not achieve a significant amount of weight loss, or any improvement in visceral fat (internal fat around organs). They also do not improve the appearance of cellulite. If you are generally overweight, cryolipolysis is not going to make you drop kilos and you will probably be disappointed with the outcome. However, if you have a BMI of <30 with specific areas of fat that you would like to smooth out, and are willing to wait a few months to see results, then you could be an ideal candidate for treatment. A number of cryolipolysis devices are currently available which vary slightly in terms of their treatment parameters of suction strength and temperature. All are indicated for treatment of the abdomen, arms, flanks (muffin tops), thighs and knees.

Are there any contraindications?

Contraindications to cryolipolysis.

Like most medical and aesthetic procedures, there are some situations where it is not possible to use this technology. These include:

  • Pacemakers or heart valve replacements
  • Heart, liver or kidney disease
  • Arterial disease
  • Autoimmune conditions such as cryoglobulinaemia, paroxysmal cold haemoglobinuria or cold urticaria
  • Metal implants in the treatment area
  • Past history of keloid scarring in the treatment area
  • Epilepsy
  • Cancer
  • Pregnancy or lactation
  • Anti-coagulant drugs
  • Recent surgery in the treatment area

What are the down-sides to fat freezing

After cryolipolysis is it usual to have redness and possibly bruising in the treatment area, both of which can take 2 weeks to subside. It is also possible for the skin of the treated area to feel slightly numb for up to a month, although research has shown that the effect on the peripheral nerves is not permanent7. An uncommon (1 in 1500) side effect associated with treatment is severe shooting pain, although this is reported to resolve without any lasting effects after 1-4 weeks8.

There is no effect on blood fat levels or liver function9 and no reported systemic side effects to date. With the increase in popularity of cryolipolysis, the rare (1 in 20,000) side effect of “paradoxical adipose hyperplasia” has emerged10. This results in a delayed enlargement beyond baseline of the fat cells in the treated site. The reason for this remains unclear and there is no effective way to predict who will be at particular risk for this side effect, although it is more common in men.

What is a treatment like?

In general, the cryolipolysis procedure takes about 60 minutes per treatment area. Treatment times vary depending upon body site, type of machine and number of applications. Some of the newer machines in the market have double applicator heads, enabling 2 areas to be treated at once (i.e. both thighs, both muffin-tops, or both upper and lower abdomen), which has seen a significant reduction in the time taken to complete the treatment and therefore is more cost-effective for both the client and the clinic. Some machines have specific applicators for thighs and chins that are a different shape or size to the ones used for abdominal fat.

A glycerine pad is applied to the skin underneath the applicator head after which you simply lie back and relax for an hour. Some clients have a facial at the same time, others prefer to relax and listen to music or watch videos. In our experience, the suction should not be painful, although some clients experience a tickling or a sucking sensation. Surprisingly, the treatment does not actually feel cold, although the area will feel cold to touch for a short time afterwards.

How much does cryolipolysis (fat freezing) cost?

The cost varies according to machine type, number of applications and cost of consumables. At time of writing, average costs in Perth are around $850 per application area. We are able to offer cryolipolysis at $450 per application area as our machine has significantly less consumable and running costs than some of its competitors, with comparable results.
Read more about cryolipolysis here >

or Contact Us to Arrange Your Appointment


Author: Dr. Sarah Boxley MBBS BSc(Hons) MRCGP FRACGP FSCCA

1. Epstein EH Jr, Oren ME. Popsicle panniculitis. N Engl J Med 1970;282(17): 966–7
2. Manstein D, Laubach H, Watanabe K, Farinelli W, Zurakowski D, Anderson RR. Selective cryolysis: a novel method of non-invasive fat removal. Lasers Surg Med 2008;40(9): 595–604.
3. Bernstein EF. Longitudinal evaluation of cryolipolysis efficacy: two case studies. J Cosmet Dermatol 2013;12(2): 149–52.
4. Dierickx CC, Mazer JM, Sand M, Koenig S, Arigon V. Safety, tolerance, and patient satisfaction with noninvasive cryolipolysis. Dermatol Surg 2013;39(8): 1209–16.
5. Krueger N, Mai SV, Luebberding S, Sadick NS. Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction. Clin Cosmet Investig Dermatol 2014;7: 201–5.
6. Boey GE, Wasilenchuk JL. Enhanced clinical outcome with manual massage following cryolipolysis treatment. A 4-month study of safety and efficacy. Lasers Surg Med. 2014;46(1): 20-26
7. Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J. Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves. Aesthetic Plast Surg 2009;33(4): 482–8.
8. Dover J, Saedi N, Kaminer M, et al. Side effects and risks associated with cryolipolysis. Annual Meeting of the American Society for Laser Medicine and Surgery, 2011; Grapevine, TX
9. Klein KB, Zelickson B, Riopelle JG, Okamoto E, Bachelor EP, Harry RS, Preciado JA. Non-invasive cryolipolysis for subcutaneous fat reduction does not affect serum lipid levels or liver function tests. Lasers Surg Med. 2009;41(10): 785–90
10. Jalian HR, Avram MM, Garibyan L, Mihn MC, ANderson RR. Paradoxical adipose hyperplasia after cryolipolysis. JAMA Dermatol. 2014;150(3): 317-9

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Important Notice – Until 23 Sept ’16

If you have an appointment at our clinic between Monday 29th August and Friday 23rd September 2016, please be advised that there will be extensive works being carried out on the front of our building and entrance via the front of the building will likely be blocked during this period.

The map below shows how to access the clinic via the car park on Leake Street. Please look for The Skin Clinic sign board at the rear of the carpark, showing the way to the back door. When entering, please proceed down the corridor and turn left, walk down this corridor and you will arrive at The Skin Clinic.

At times there will be access but we will not have advance notice of this. Please contact us on the morning of your appointment if you wish to know about access on that day.

We apologise for the inconvenience. If you have any concerns regarding this please contact us on 9336 3066.

See you soon!

Map of access during roadworks

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