The Skin Clinic Fremantle | Dr Sarah Boxley

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Understanding different moisturisers

There is a lot of confusion out there in what to look for in a moisturiser. Not all moisturisers work in the same way or are ideal for all different environmental conditions. This is a very basic summary to try and explain the two main types of moisturiser: Emollients and Humectants…


Many people use the terms “moisturiser” and “emollient” interchangeably, though typically an emollient describes a particular ingredient inside a finished moisturiser.

Emollients are used to soften and smooth the scales of the outer layer of skin (stratum corneum). They can be useful in helping reduce rough, flaky skin.  They are also occlusive agents: substances that provide a layer of protection to help prevent moisture evaporation from the skin, aka transepidermal water loss (TEWL).

A few examples of emollients are vegetable oils (grape seed, sesame seed, jojoba, etc.), butters (cocoa butter, shea butter), alcohols (stearyl alcohol, cetyl alcohol), silicones (dimethicone, cyclomethicone), and petrolatum derivatives (petroleum jelly, mineral oil).

Use an emollient directly onto damp skin after a shower to lock moisture in.


A humectant is a substance that actually bonds with water molecules to increase the water content in the skin itself. Humectants typically draw water into the skin from a humid environment, and they enhance water absorption from the outer layer of skin. However, a pure humectant moisturiser applied to the outside of the skin in a very dry environment will not be able to draw water from the atmosphere (as there is none) and so will suck water from the deeper layers of the skin instead. Whilst this may make the top layers of skin seem temporarily more hydrated, ultimately the deeper layers will be deprived of moisture and so the skin overall can become dryer.

Glycerin is one of the more typical and effective water binding agents found in skin care products.  Other humectants include sugars (glucose, fructose, sucrose, honey), hyaluronic acid, proteins, amino acids, elastin, and collagen. Lactic acid, which is one of the alpha-hydroxyacids (AHAs), is known for its moisturising properties as well as its ability to exfoliate. Whilst most AHAs can increase the skin’s ability to trap water due to an increased production of natural hyaluronic acid, good old lactic acid’s additional humectant properties make it ideal for treating dry skin. 

A bit more info on hyaluronic acid, which is being used more and more in skincare over the last few years for increasing hydration and reversing cell damage: Hyaluronic acid (HA) is a natural moisturising factor (NMF) found in the deeper skin layers. Referred to nature’s ‘super moisturiser’, this substance is able to hold 1000 times its weight in water and when applied topically it will attract moisture to the outermost layers of skin. This plumps those layers and temporarily reduces the appearance of wrinkles and fine lines. However, remember to be wary of using HA topically in very arid or air conditioned environments for the reasons stated above. In these situations you could consider injectable moisturiser directly to the dermis, with an emollient topically to prevent TEWL. 

Many humectant’s also have emollient properties, while not all emollients are humectants. The best moisturisers have a combination of emollients and humectants. 

Who needs moisturiser?

The requirements of our skin for moisture changes as we age. The skin naturally alters as we get older – the dermis, where collagen and elastin are predominant, gets thinner, whilst the stratum corneum, the thick horny outer layer of the epidermis, gets thicker. As a generalisation, by the time we are 70 years old, our skin only holds 20% of the moisture that it did when we were 20. Using regular and effective topical moisturisers from our early adulthood can reduce this moisture loss and slow down the natural ageing processes of the skin, as well as protecting the skin from additional environmental stresses. 

Moisturisers and acne:

Patients with acne are often hesitant to use a moisturiser as they believe this will clog their pores, increase their oil production and make their acne worse. However, even acneic skins need moisture and will in fact function better and be less inflamed if they are well hydrated. A light, non greasy, non-comedogenic moisturiser is suitable in this situation – we usually recommend either Hydrogel or BrightEnlite from Synergie, or NMF by The Ordinary.  Hydrogel is a lightweight noncomedogenic moisturising gel fortified with cosmeceutical botanicals and hyaluronic acid, great for those with oily skin and enlarged pores and for skin exposed to high levels of humidity.

Can my moisturiser do more?

Many modern moisturisers come mixed with other active ingredients to target different skin concerns. This is where it can get complicated. We would always recommend discussing your own skin’s requirements with a professional prior to spending money on skincare. If you are someone who has a bathroom cabinet crammed with costly products that promised miracles but don’t seem to deliver, then it may be worth a few minutes with a Dermal Therapist to design a tailored skincare regime.

My personal choices? As a middle-aged woman with naturally dry skin who spends most of my life either in air conditioning or outdoors in the harsh Perth climate, my personal choice for moisturiser is the lightweight but super hydrating and soothing MSM cream (MooGoo) twice a day. In the mornings, I follow this with UberZinc (Synergie Skin) – an antiageing moisturiser with 21% pure zinc oxide to give me effective UVA/B protection. As a body moisturiser I love Solarcare (Bernier pharmaceuticals) – a light but effective mixture of emollients and humectants with the addition of 5% niacinamide (vitamin B3) to fight environmental damage and reverse signs of ageing. 

*we do stock all the above products in the clinic but they are also easily available either online or at local pharmacies in Australia*

Would you like personalised skincare advice? Make an appointment with one of our Dermal Therapists here

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Ingredient focus: Lycopene

What is lycopene and why should we be using it on our skin?

Lycopene is the bright red carotene pigment and phytochemical found in red fruits and vegetables, such as tomatoes & red carrots, watermelons and papayas.

It is a powerful antioxidant and anti-inflammatory – helping protect skin from environmental agents that can contribute to clogged pores and breakouts. Most importantly for long-term skin health, it can help protect against sun damage. Studies have indicated that lycopene helps protect fibroblasts (skin cells that make collagen) & eliminate skin-ageing free radicals caused by ultraviolet rays, both UVA and UVB.

Lycopene accounts for a whopping 90% of the colour of tomatoes. As an antioxidant it is twice as effective as beta-carotene and 10 times more than alpha-tocopherol (vitamin E). Our favourite anti-ageing cosmeceutical skin product – Superserum+ by Synergie, contains lycopene sourced from hydrolysed tomato skins.

Lycopene is a relatively new product from a commercial point of view and recently it has been added to fortified foods such as yoghurt and drinks.

Can the lycopene in your diet actually help your skin?

Although the absorption via diet is still being researched, the current evidence indicates that lycopene is absorbed in the intestine and then distributed to the liver and kidneys. It appears to be excreted into the skin via sweat glands, therefore the lycopene from your diet tends to accumulate on specific regions such as forehead, nose, chin, palms etc. A small study on healthy volunteers showed that a 10-week lycopene-rich diet improved the minimal erythemal dose by 40% compared with the control group. (Minimal erythemal dose is essentially the amount of UV radiation needed to turn the skin pink) NB: Watermelons are NOT a substitute for sunscreen!

Could your skincare be delivering more than your diet?

Back to cosmeceutical skincare: Hydrolysation of tomato skins stabilises the lycopene. Once it is stabilised, it can be distributed evenly and homogeneously across the skin. It’s a clever little ingredient, naturally sourced, that boosts our skin’s ability to protect itself. “Clean science” in action. Find it in these Synergie products: SuperSerum+, Practitioner A+, BB-Flawless makeup.


Interesting fact: although lycopene is chemically a carotene, it has no vitamin A activity. 


Synergie Skin Hydrolysed tomato skin (lycopene) clinical data
Furr HC, Clark RM Intestinal absorption and tissue distribution of carotenoids Nut Biochem 1997 8:364-377
Fazekas Z et al. protective effect of lycopene against ultraviolet B-induced photo damage. Nut and Cancer 2003 47(2) 181-7
Stahl W et al. Dietary Tomato Paste Protects against Ultraviolet Light-induced Erythema in Humans J Nutrition 2001
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image of a young woman applying sunscreen to her face in the morning

Sunscreen: When should you use it?


Research from The Cancer Council’s recent National Sun Protection Survey show that nearly one in two Australians mistakenly believe that sunscreen can’t be used safely on a daily basis. 

For some years now, we have been advising our patients about the daily use of sunscreen here in Perth. We have been very pleased to see that in the last few weeks, the peak bodies responsible for sun safety advice in Australia and New Zealand have published an updated policy on sunscreen use, which makes our advice not only evidence-based but now also the accepted recommendation in this country.

The advice is now simple: make sunscreen part of your morning routine, just like brushing your teeth.

The national policy change has come about following a national Sunscreen Summit in Brisbane last year, that examined the current evidence on sunscreen use, and was published at the end of January in the Australian and New Zealand Journal of Public Health. The publication, led by Professor David Whitman and Associate Professor Rachel Neale from QIMR Berhofer Medical Research Institute, shows that there is now clear evidence on the benefits of daily sunscreen use.

As Associate Professor Neale explains “up until now, most public health organisations have recommended applying sunscreen ahead of planned outdoor activities but haven’t specifically recommended applying it every day as part of a morning routine,”

“In Australia, we get a lot of incidental sun exposure from everyday activities such as walking to the bus stop or train station, or hanging out washing.

“In recent years, it has become clear that the DNA damage that causes skin cancer and melanoma accumulates with repeated small doses of sunlight.

“At last year’s Sunscreen Summit, we examined all of the evidence around sunscreen use and we have come to a consensus that Australians should apply sunscreen every day when the maximum UV level is forecast to be three or higher.”

“For much of Australia, that means people should apply sunscreen all year round, but in areas like Tasmania and Victoria there are a few months over winter when sunscreen is not required.”

Facts you need to know:

  • Australia has one of the highest skin cancer rates in the world.
  • Research shows undoubtedly that sunscreen helps prevent skin cancer, including the deadliest form, melanoma.
  • There is consistent and compelling evidence that sunscreens are safe for human use
  • Adverse reactions such as allergies occur in a very low proportion of the population
  • Clinical trials have found that people who use sunscreen daily have the same levels of vitamin D as those who don’t.
  • The recommendation to apply sunscreen every day is to protect against the little bits of incidental UV exposure that most of us get each day, that cause damage over time.
  • Sunscreen is not a suit of armour – if you are planning outdoor activities you should also seek shade, wear a hat, protective clothing and sunglasses, and reapply your sunscreen every 2 hours.
  • Regular skin checks can save lives  – get your skin checked annually by your GP, a Skin Cancer Clinic (a list of accredited doctors can be found here) or a Dermatologist.


Sunscreen* should be applied and used regularly:

  • During everyday activities which add up over time (e.g. travelling to and from work; doing household chores; shopping etc)
  • During any planned or prolonged outdoor activities (e.g. doing outdoor work; gardening; playing or watching sport; going to the pool or beach; exercising outdoors etc)
Sunscreen for everyday activities

When the UV index is forecast to reach 3 or above, it is recommended that sunscreen is applied every day to the face, ears, scalp if uncovered, neck and all parts of the body not covered by clothing. Ideally, this would form part of the morning routine. This protects the skin from the harmful effects of everyday sun exposure.

Sunscreen for planned or prolonged outdoor activities

During planned or prolonged outdoor activities, for the best protection it is recommended that sunscreen is used along with other sun protection measures (i.e. clothing to cover as much of the skin as possible; hats; sunglasses; shade and scheduling outdoor activities to avoid the middle part of the day).

When the UV index is forecast to reach 3 or above, sunscreen should be applied to the face, ears, scalp if uncovered, neck and all parts of the body not covered by clothing.

Sunscreen should be re‐applied every 2 hours or more frequently if swimming, sweating or towel drying.

Sunscreens should not be used to promote tanning, but rather as one of five strategies (along with shade, hats, clothing, sunglasses) to reduce exposure to harmful UV radiation.

So, based on the average daily maximum UV index, residents in Australia’s capital cities should apply sunscreen daily in the following months:

Brisbane, Perth & Darwin

All year round


Every month except June

Canberra & Adelaide

Every month except June & July


Every month except May, June & July


Every month except May-August


*“sunscreen” means sunscreen with an SPF of 30 or more and compliant with Australian/New Zealand Sunscreen Standard AS/NZS 2604:2012.

To read the full recommendation “When to apply sunscreen: a consensus statement for Australia and New Zealand” click here

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make up brush on pink background at the skin clinic fremantle

Make-up and dermal filler procedures – what is the problem?

Make-up brush applicator on pink background. The Skin Clinic Fremantle

Do you ever wonder why we ask you to remove your make-up when you come in for a dermal filler procedure with us?

Quite simply, both your makeup and indeed your own skin are an infection risk. There is increasing evidence that the complications of dermal fillers that were once thought to be caused by our own immune system are in fact due to infection. The most likely time for introduction of infection is at the time of injection1,2.


Bacteria on Skin

It has been estimated that 30–50 million bacteria can be found on each square inch of human skin. The majority of these are normal, friendly microbes, and if they remain on the outside we have no problems. The skin and mucous membranes are the body’s protective barriers. Breaching these barriers (eg with a needle or a scalpel) can introduce those bacterial into the subcutaneous tissue, muscle, bone and body cavities.

We know that most surgical site infections originate from the patient’s own bacteria entering the wound at the time of surgery3. Dermal filler procedures involve multiple passes of a needle or cannula from skin to bone, so disinfection of the skin before the injection of a filler is absolutely crucial in reducing the risk of microbial contamination. If bacteria is introduced into the body with the dermal filler at the time of injection, it can use the filler substance as a food source and slowly multiply, potentially leading to the onset of lumps and hardening of the filler, and even to abscesses. Reducing the number of bacteria on the entire face, not just the site of injection, will reduce the risk of a patient developing an infection-related complication4,5,6,7.

We therefore need to thoroughly clean and disinfect your skin before and during your filler procedure. Logically, in order to do that we need to remove your makeup.

Bacteria in Makeup

Also, in addition to simply getting in the way, the makeup itself is potentially an infection hazard8. In a small study in 2015, items of out-of-date make-up were tested under strict laboratory conditions. All tested positive for enterococcus faecalis, a deadly strain of bacteria that can cause meningitis and septicaemia9. Other bacteria that were found growing in the make-up and their potential health risks include9:  

  • Ubacterium: causes bacterial vaginosis
  • Aeromonas: one of the causes of gastroenteritis and wound infections
  • Staphylococcus epidermidis: a bacterium which is resistant to antibiotics and can be deadly to people in hospital or who have catheters or surgical implants
  • Propionibacterium: one of the main causes of acne and other skin conditions
  • Enterobacter: causes urinary and respiratory tract infections


Make-up and photography

Makeup also interferes with our photography system – we can’t get reliable before and after photos when patients are wearing full contouring foundation, and the filters we use to highlight UV damage, vessels and wrinkles can’t see through the makeup.


At The Skin Clinic Fremantle

As dermal filler procedures become more and more popular, and access to them easier and easier, we find ourselves increasingly reminding patients that these are not beautician treatments. The injection of a foreign substance (that is going to last for months/years) into your face is a medical procedure and it should be treated as such.

Patient safety and outcomes are our paramount concern and so yes, despite our patients finding it inconvenient at times, we will insist on total make-up removal and thorough skin disinfection prior to dermal filler procedures.

Thank you for your understanding, Dr. Sarah 🙂



1. De Boulle K, Heydenrych I. Patient factors influencing dermal filler complications: prevention, assessment, and treatment. Clin Cosmet Investig Dermatol. 2015;8(8):205–214.

2. King M, Bassett S, Davies E, King S. Management of Delayed Onset Nodules. J Clin Aesthet Dermatol. 2016;9(11):1–5.

3. Ayliffe GA. Role of the environment of the operating suite in surgical wound infections. Rev Infect Dis. 1991;13(Suppl 10):S800–804 

4. Heydenrych I, Kapoor KM, De Boulle K. et al. A 10-point plan for avoiding hyaluronic acid dermal filler-related complications during facial aesthetic procedures and algorithms for management. Clin Cosmet Investig Dermatol.  2018 Nov 23;11:603-611

5. Signorini M, Liew S, Sundaram H. et al. Global Aesthetics Consensus: avoidance and management of complications from hyaluronic acid fillers—evidence and opinion-based review and consensus recommendations. Plast Reconstr Surg. 2016;137(6):961e–971e.

6. Wagner RD, Fakhro A, Cox JA, Izaddoost SA. Etiology, prevention, and management of infectious complications of dermal fillers. Semin Plast Surg. 2016;30(2):83–86.

7. Ferneini EM, Beauvais D, Aronin SI. An overview of infections associated with soft tissue facial fillers: identification, prevention, and treatment. J Oral Maxillofac Surg. 2017;75(1):160–166.

8. Collier H. Infection control in aesthetic medicine and the consequences of inaction. J Aesth Nursing 2018; 7(7): 352-361

9. Matewele P. Out of date make up can contain lethal bacteria, London Met scientist finds. 2015.

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Photo of a white shire on a white background

Sun Protection: How to get the most from your clothing

A patient recently asked whether it is really worth covering up; how much sun protection would he actually be getting from wearing a long sleeved shirt?

As a general rule, light-coloured, lightweight and loosely woven fabrics do not offer much protection from the sun. That white shirt you slip on at the beach when you feel your skin burning provides only moderate protection from sunburn, with an average ultraviolet protection factor (UPF) of 7. The sun protection lowers to an approximate UPF of only 3 when that shirt gets wet. (UPF stands for ultraviolet protection factor and is the rating system used for clothing and fabrics. It is different to the SPF system used for skin products. The UPF indicates how much of the sun’s UVA and UVB rays are absorbed. A fabric with the rating of 50 will only allow 1/50th of the sun’s UV rays to pass through)

So, what should you be looking for when choosing sun protective clothing? Not all clothing fabric is equal. You need to consider:

Fabric structure:

If you can easily see through the fabric, chances are UV can easily pass through it. The tighter the fabric structure, the better the sun protection. Tightly woven, lightweight natural fabrics such as linen, cotton or hemp will also help keep you cooler than synthetic fibre equivalents.


If a fabric is stretched, it will be less protective. This is common in knitted or elasticised fabrics.


Layering of fabrics and garments is an effective way of increasing protection from UV.


Darker colours absorb UV rays better than white or pastel colours of the same fabric.

Moisture content:

Fabrics offer less protection from UV radiation when wet. How much less protection will depend on the type of fabric and the amount of moisture it absorbs. To reduce the effect of the moisture, take dry clothes to change into or if dipping in and out of the water, choose a fabric that provides effective protection from UV and that will dry quickly.

Caring for your clothes:

Washing new clothes can improve their sun protectiveness by shrinking gaps in the structure. However, old, threadbare or faded clothes may offer decreased protection over time.

UV absorbers:

Some clothing is treated so it can absorb more UV radiation. Check the clothing label to see if your clothes have been treated and follow the care instructions.

Source: Cancer Council Australia, Coolibar

Related: What you need to know about Skin Cancer >

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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 what cosmetic treatments are possible when you are breastfeeding? This is a time when it is especially important to know who’s hands are treating you and which cosmetic procedures are safe to have so that you can perk up your skin with no risk of harm to your baby.

Dr. Sarah Boxley, our Medical Director, is on the faculty of the Allergan Medical Institute, sits on Medical Advisory Boards for dermal filler products and is a principal investigator in clinical trials. Here she gives us the low-down on the skin treatments that are safe to have when 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. Because we have such high UV levels in Australia, these are peels that are most appropriate in winter.

More about chemical peels >

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.

Dermal filler procedures are safe to have when you are breastfeeding, as long as you are physically well with no symptoms of mastitis or any other infection/illness. As at any other time, it is important that your filler procedure is performed in a clinic with rapid access to fully trained medical personnel with emergency protocols in place, as very rarely complications can occur.

More about Anti-wrinkle injections >

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. Your skin may be more sensitive post-pregnancy and so it is important that you let your therapist know you are breastfeeding so that he/she can adjust their technique and the level of suction if necessary.

More about Hydrafacial® >

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.

More about Fat Transfers >

Body-sculpting procedures when breastfeeding

Non-invasive fat removal methods such as cryolipolysis (fat-freezing), ONDA® (cool wave energy) and injectable fat-dissolving medications have also not been studied during breastfeeding and therefore safety data is not available. However, it would seem reasonable that these body-sculpting procedures could be used (on body parts other than the breasts) during breastfeeding. Again, we would recommend to wait until your post pregnancy weight has stabilised before investing in these treatments. Energy-based devices that result in skin tightening, such as ONDA® radiofrequency and HIFU can be really helpful post-pregnancy for women who feel they need to regain their body confidence.

More about ONDA® >

Sclerotherapy when breastfeeding

Sclerotherapy should 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.

More about Sclerotherapy >

Laser & Lights

With regard to laser procedures, the wavelength of light used for skin treatments is not deep enough to affect function of the milk ducts. Low-level light 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. Indeed, a recent systematic review of all the available scientific literature concluded that the use of lasers and light therapy, (including IPL, BBL, tattoo removal, vascular, pigment and ablative lasers) are safe to use on the skin even during pregnancy6. However, you need to be aware that treatment of hormonal pigmentary changes (such as melasma) and increased facial hair growth caused by pregnancy should not necessarily be treated until the hormones have stabilised as results may be suboptimal in these situations.

More about Kleresca® >

Come in for a Consultation

If you are currently pregnant or breastfeeding and would like to explore your options for cosmetic skin treatments please hit the link below to arrange an appointment with a member of our team. And we wish you many congratulations on the addition to your family 🙂

Dr. Sarah x

or Contact Us to Arrange Your Appointment.

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.
6. Wilkerson EC, Van Acker MM, Bloom BS, Goldberg DJ. Utilization of Laser Therapy During Pregnancy: A Systematic Review of the Maternal and Fetal Effects Reported From 1960 to 2017. Dermatol Surg. 2019 Jun;45(6):818-828.

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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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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 shaver.

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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