The Skin Clinic Fremantle | Dr Sarah Boxley


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Photo of a mother about to breastfeed her baby

Cosmetic Procedures when Breastfeeding – are they safe?

So, you’ve made it through 9 months of pregnancy and now that the dust has settled and you are getting down to the joys of motherhood, you are perhaps realising that you might have lost that pregnancy-glow and perhaps haven’t had your anti-wrinkle injections for over a year? Frown lines are creeping back and your skin is looking dull and tired? This is a familiar story we hear from our patients on a fairly regular basis, and the question for many at this point is whether cosmetic procedures are safe to have when you are breastfeeding?

What are the facts about cosmetic procedures when breastfeeding?

Very few actual scientific studies have been conducted looking particularly at the safety of cosmetic procedures during lactation (breastfeeding). Clearly, the main concern in this situation is the possibility of chemicals or medications being absorbed into the mother’s system and from there excreted into her breast milk, which could potentially affect neonatal growth and development. Review articles in Dermatological Surgery in 20131 and in the International Journal of Women’s Dermatology 20172 both summarised that most cosmetic procedures are safe to use during lactation since there is low concern for significant systemic absorption of any of the agents used in these procedures. In more detail….

Chemical Peels when breastfeeding

Superficial and medium depth chemical peels do not lead to absorption into the body, as long as care is taken around mucosal surfaces such as the mouth and eyelids. Therefore, we can be confident that routine cosmetic peels are safe during breastfeeding. Peels containing high concentrations of salicylic acid (including Jessner’s peels) and TCA are not recommended for use in pregnancy but can be used safely when breastfeeding.

Anti-Wrinkle Injections & Dermal Fillers when breastfeeding

Scientifically speaking, the doses of neuromodulators/anti-wrinkle injections (sorry – I am writing this in Australia where the law prevents me from mentioning the names or ingredients of these) that are used cosmetically are very small compared to the doses used for medical reasons and carry only a very low risk of systemic absorption into the mother. On top of this, the molecular size of neuromodulators, and incidentally of dermal filler materials, make them incredibly unlikely to be excreted into breast milk, with their use in lactation being deemed by experts to be safe1,2. However, despite this consensus opinion, the use of these products in lactating mothers remains off-label. No large scale studies have been (or will be) performed, and so as prescription medications they are not technically licensed for use during breastfeeding. For patients who remain concerned, we recommend the “pump & dump” technique – continued breastfeeding with pumping and discarding the breast milk in the first 24 hours after treatment.

Hydrafacial® when breastfeeding

This popular medical-grade facial treatment uses a low concentration of salicylic acid, but at a level that would be considered safe to use both during pregnancy and breastfeeding.

Fat transfer when breastfeeding

Procedures which necessitate the redistribution or removal of fat such as fat transfer or tumescent liposuction are not recommended in the immediate postpartum period, although not specifically because of breastfeeding. These procedures have an invasive nature and there is a lack of safety studies particularly in the postpartum period. Increased fat stores are expected because of pregnancy, and women should allow for stabilization of their postpregnancy weight before pursuing cosmetic procedures. Non-invasive fat removal methods such as cryolipolysis (fat-freezing) and injectable fat-dissolving medications have also not been studied during breastfeeding and therefore safety data is not available, although it would seem reasonable that these could be used during breastfeeding once post pregnancy weight has stabilised.

Sclerotherapy when breastfeeding

Sclerotherapy should also be avoided during lactation1. Generally, hypertonic saline solutions that were traditionally used in sclerotherapy are safe but there are no data on whether other sclerosing solutions are excreted in breast milk, which has led to the recommendation to avoid this therapy while breastfeeding. However, anecdotally, some women have pursued this therapy and continued breastfeeding with pumping and discarding the breast milk in the first 48 hours after treatment. Nevertheless, there are no reports on the outcomes and/or complications of doing this and therefore experts can not make a recommendation on its safety.

Laser & Lights

With regard to laser procedures, the wavelength of light is theoretically not deep enough to affect function of the milk ducts. Low-level laser therapy can be used to treat postpartum mastitis as well as sore nipples and to enhance wound healing after episiotomy, and has been shown to have no serious effects on lactation3,4,5. Laser therapy should not produce adverse effects on lactation, breast milk production, or quality of breast milk1, and so can safely be used for cosmetic facial indications during breastfeeding. This applies to LED light therapy and biophotonic treatments (Kleresca®) such as are used for acne, as well as pigment, vascular and fractional ablative lasers. We should point out that treatment of pigmentary changes (such as melasma) and increased facial hair growth caused by pregnancy-related hormonal changes should not necessarily be treated until the hormones have stabilised as results may be suboptimal in these situations.


1. Lee K.C., Korgavkar K., Dufresne R.G., Higgins H.W. Safety of cosmetic dermatologic procedures during pregnancy. Dermatologic Surg. 2013;39:1573–1586.
2. Trivedi M.K., Kroumpouzos G., MuraseJ.E. A review of the safety of cosmetic procedures during pregnancy and lactation. Int J Women’s Dermatol. 2017; 3(1):6-10.
3. Kymplova J, Navratil L, Knizek J. Contribution of phototherapy to the treatment of episiotomies. J Clin Laser Med Surg, 2003; 21:35–9.
4. Pietschnig B, Pani M, Kafer A, Bauer Wais E, et al. Use of soft laser in the therapy of sore nipples in breastfeeding women. Adv Exp Med Biol, 2000; 478:437–8.
5. Kovalev MI. Prevention of lactation mastitis by the use of low-intensity laser irradiation. Akush Ginekol (Mosk), 1990; 2:57–61.

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Photo of man and womens feet in bed,

Sex in Menopause: The Painful Truth

Findings of a recent health survey in the US suggest that women are not well-informed about one of the most common and troubling symptoms of menopause: painful sex.

Key Survey Findings:

  • 73% of women were still sexually active after menopause.
  • 62% were experiencing pain during intercourse.
  • Of those who reported experiencing pain during intercourse 83% reported experiencing pain in half or more instances of sexual activity with 73% rating the pain moderate to severe.
  • 60% had never discussed their painful sex with a health care provider.
  • 69% did not know that the painful sex they were experiencing is treatable.

The survey, conducted by HealthyWomen, an independent, nonprofit health information source in the US, was conducted among 832 women aged 45 years and older and 305 women’s health care providers (HCPs). It really highlights the importance of women sharing their symptoms with their health care providers for proper treatment and to prevent symptoms from worsening.

About Dyspareunia (painful sex)

Before menopause, oestrogen, the primary female sex hormone, helps maintain the thickness and elasticity (stretchiness) of vaginal tissues. However, as women age, oestrogen levels drop, causing changes in these tissues. These changes can lead to a medical condition called vaginal atrophy (VA), also known as GUSM (Genitourinary Syndrome of Menopause), which can lead to painful sex. Left untreated, painful sex due to menopause can worsen. Dyspareunia is a common postmenopausal condition, with as many as one in three postmenopausal women experiencing pain during intercourse.

The survey also gave some insight into how women were electing to cope with painful sex – 33% of respondents were avoiding sex altogether, and 45% were resorting to lubricants to manage pain.

Lubricants can provide temporary relief, these do not treat the underlying condition. A number of prescription therapies, including hormone replacement tablets or patches, as well as vaginal oestrogen are available. For women who can’t (or prefer not to) take hormonal therapy, laser regeneration treatment can be delivered directly to the vulval and vaginal tissues to specifically treat the dyspareunia related to menopausal lack of oestrogen.

“Women’s health is a topic that is often in the headlines, yet menopause is still an under-discussed stage of life, especially when it comes to lesser-known symptoms and impact on a woman’s sexual health,” said Barb Dehn, NP, and member of the HealthyWomen Women’s Health Advisory Council. “These findings show the need for improved communication between women and their HCPs, as well as general condition and treatment options awareness so women can lead fulfilling sex lives, pain-free.”

If painful sex is an issue for you, please bring it up with your GP.

If you would like to talk to us about quick, painless, non-hormonal laser treatment please send us a confidential message through our contact form or book online for a MonaLisa® Consultation with our experienced female doctor.

Read more about Vaginal Rejuvenation

or Contact Us to Arrange Your Appointment.

 

sex in menopause info-poster


For more information on the survey: healthywomen.org/painfulsex

* This survey titled “What Do You Know about Your Sexual Health After Menopause?” was conducted within the United States by HealthyWomen in partnership with Duchesnay. It was conducted online from December 4, 2017, to March 18, 2018, among 832 women ages 45 and older and 305 women’s health care providers.

References:

  • Davis SR, Lambrinoudaki I, Lumsden M, et al. Menopause. Nat Rev Dis Primer. 2015; 15004. doi:10.1038/nrdp.2015.4.
  • Freedman MA, Kingsberg SA, and Portman DJ. Dyspareunia Associated with Vulvovaginal Atrophy: Innovations in Counseling, Diagnosis, and Management. Supplement to OBG Management. 2018: S1-24.
  • Krychman M, Graham S, Bernick B, et al. The Women’s EMPOWER Survey: Women’s Knowledge and Awareness of Treatment Options for Vulvar and Vaginal Atrophy Remains Inadequate. J Sex Med 2017; 14: 425‐433.
  • Simon JA. Vulvovaginal atrophy: What is it, what causes it? OBG Management. 2015;(suppl):1-2.
  • What Do You Know About Your Sexual Health After Menopause? Healthy Women website. healthywomen.org/painfulsex Updated May 2018.
  • Wysocki S, Kingsberg S, Krychman M. Management of Vaginal Atrophy: Implications from the REVIVE Survey. Clin Med Insights Reprod Health 2014; 8:23-30.
  • HealthyWomen. Data on File.
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Photo of lady with clear skin - DOT Therapy Special Offer

20% off DOT Therapy

AUTUMN OFFER: 20% off DOT therapy

Summer is over, the weather is cooling down, and now is the perfect time to repair and rejuvenate your skin.

Fractional CO2 laser +RF = the ultimate in skin rejuvenation. Fast recovery times and tailored laser settings so that we can address skin resurfacing and wrinkle reduction for almost all skin types.

The addition of RF therapy assists tightening and reduces the recovery time after treatment.

Full face laser peel only $880 for a limited time.

Read more about DOT Therapy

or Contact Us to Arrange Your Appointment.

T&Cs: Valid for treatments booked until 31st May. Non-transferrable. Requires medical consultation prior to treatment.

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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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vitamin-C-photo

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-free-radical-diagram

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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Real-Men-take-care-of-their-skin

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%.



1. https://www.thefactsabout.co.uk/plastic-microbeads—in-depth/content/251
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
6. https://www.businessinsider.com.au/how-smoking-ages-the-face-of-identical-twins-2013-11?r=US&IR=T

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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
Liquorice

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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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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