Monday, 24 September 2018

How well does your sunscreen work? In fact, does it actually work at all?

I love a good device. Especially ones that aid communication in the cosmetic dermatology area! Being a busy working single parent with a job that involves educating people on cosmetic skincare, I'm often time poor, and I know that many of my patients are in a similar position. Understanding cosmetic skincare is so fundamentally important to your skin's health though.  After all, what's the point of all those facial laser and injectable procedures if your skin still can't cope with your lifestyle?

So some of my favourite technologies are the photographic imaging devices that are helping doctors to demonstrate the effectiveness of sunscreen.

I recently attended the Australasian Society of Cosmetic Dermatologists conference, where I spotted a Skinscope device at the Skinceuticals stand.
We also have a Skinscope device at Skin Temple, however I'm usually too busy consulting to get to play with it.  So I thought I'd go and have my photo taken using the UV filter on the Skinscope device.  UV filters are such a great way to investigate sunscreens, and what better way to see how well you applied your sunscreen that day?  In fact, I often use my Visia device in the consulting room for this purpose too!  Unfortunately, many patients find that their trusted "sunscreen" isn't actually doing anything at all. Sometimes this is because it hasn't been applied evenly, or has been overly rubbed in (male patients are especially guilty of this), and sometimes it's due to an inherent formulation problem in the product. 
Trivia fact: The Visia machine was originally developed as a tool for sunscreen product research by Proctor &Gamble in the USA.

Here's my pic on the Skinscope device:
So it's easy to see where I've applied the sunscreen that day..and the areas of white skin without sunscreen.  Luckily, I seem to have covered most parts of my face pretty well (must be all that practice, since I don't even leave the house without it on!) and have taken it fairly close to the junctions with my eyes, eyebrows and hairline. Some sunscreens look quite purple under a UV light, whereas others will look almost black. It's always easy to see if they're working (don't waste your time relying on a SPF15+ product though..they can be very hit and miss in terms of their efficacy) but remember that just because it works at 8am, it rarely means that it's still working at 3pm, and if you haven't applied it properly in the first place then don't be surprised if you still end up getting precancerous and eventually cancerous sun damage.

In the example above, I'm wearing La Roche Posay Uvidea SPF50+, which is a chemical sunscreen that also doubles as a light foundation, and on top of that is Skinceuticals UV Defence SPF30+ which is a zinc based mineral sunscreen. I don't generally wear any other makeup products, other than eye makeup, just because I really prefer to have natural looking skin.
I often double up the sunscreen on weekends or if I'm going to be outside in the garden or doing something active like skiing or playing tennis.   As for the grey hairs that are highlighted in the UV light..well that's just a little depressing although I'm trying to age slowly...perhaps it's time for a few lowlights to hide my natural "highlights"?

Want to find out more?  Check out our website at and our facebook page or call us on 03 9867 2992 for an appointment.

Thursday, 27 March 2014

Restoring Skin Health with Microdermabrasion- Mother's Day Promotions 2014



     "A common complaint at this time of year is that patients report an increase in textural changes, acne breakouts, milia and blackheads towards the end of summer, or after returning from holidays at the beach.

     The most common reason for the skin deteriorating at this time of year is that frequent applications of sunscreen can increase pore congestion.  If you are over 25yo and not using medicated night cream to assist with dead cell turnover, your skin will rapidly worsen during summertime. Many people who routinely use medicated skincare don't take all of their usual active products on long-haul trips..which prevents adequate skin turnover and aggravates the sunscreen clogging problem.

Deluxe Microdermabrasion is a great way to quickly restore skin health, with minimal downtime!"

                                                       Dr Alicia Teska, Cosmetic Physician


Are you wondering if microdermabrasion would benefit your skin?

Microdermabrasion can be used on most skintypes, but is best suited for the following skintypes:
* Oily, open pored skin
* Acne prone skin
* Dull, congested skin prone to pigmentation, milia (whiteheads) and open pores 
Microdermabrasion may not be suitable if you have very sensitive skin, or any vascular conditions, such as rosacea or severe broken capillaries.  These clients may be more suited to our hydrafacial procedure, or one of our specially formulated soothing facials for sensitive and reactive skin.


So how does microdermabrasion help and why is it so popular?

Microdermabrasion is a cosmetic procedure that enhances the effects of 'active' or medicated skincare, by mechanically exfoliating the skin.  The chemical exfoliative effects of the medicated skincare are thereby accentuated, allowing a more rapid improvement in the skin.  Microdermabrasion is able to 'polish' the topmost layer of skin, at the same time vacuuming away the dead cells in a controlled manner.  It allows for easier penetration of topically applied creams and serums, and stimulates the upper skin layers to promote new collagen production which improves resistance to the effects of aging.
The procedure is relatively quick, easy and involves a minimal amount of discomfort when performed by an experienced operator.
It can be done as a one off procedure, but for best results a course of 6 x monthly treatments are generally recommended.

What can be expected post procedure?

Apart from noting an immediate increase in smoothness, hydration and brightness, most clients can generally expect some mild redness immediately post microdermabrasion, but this should subside within 24 hours.  The most important thing to remember is that you have removed part of the outermost thickened layer of the skin, which was partially protecting the skin, so this is not the time to go to the beach or to spend extended periods outdoors without maximal protection.  Additionally, you may experience up to 3 days of mild peeling following our Deluxe Microdermabrasion.  This is a normal and temporary response, and will rapidly resolve once active skincare is resumed.

At Skin Temple we recommend regular daily use of an SPF30+ or 50+ sunscreen, which will need to be reapplied at least once a day.  There are several different types of sunscreen available here.  The most important factor in choosing your sunscreen is to know that you will be happy to wear it every day.  There is no point buying sun protection products that are too white for you if you don't ever wear makeup.  This point is frequently an issue with sundamaged men, who really need to have tinted sunscreens in order to avoid the ghostly effect of many untinted sunscreens.  La Roche Posay make an excellent lightly tinted cream SPF50+ sunscreen, and Becca make fabulous tinted and untinted zinc SPF30+ sunscreens very popular with oily skintypes. 

Most clients will need to withhold their usual active medicated skincare products for 24-72hours after microdermabrasion, but must remember to resume all usual products thereafter.  Failure to resume active skincare in a timely manner can contribute to new breakouts!

Combination therapies

Although microdermabrasion is a very effective stand alone treatment for some skin complaints, there may be other conditions which will require a combination of different modalities for the best cosmetic outcome.  
There is no doubt that the effect of microdermabrasion will be enhanced by follow up home use of active skincare in the long term. eg use of prescription skincare and/or over the counter ranges such as Skinceuticals, selected Avene or ASAP products.
Whilst we advocate selective use of active skincare, it is very important that these products are specifically selected for your individual skin complaint, so please avoid the temptation of purchasing other active products from online sites that aren't able to offer personalised advice.  Active products, if overused, can lead to new skin complaints, such as irritation and sensitivity..which clearly are best avoided!
The procedures commonly combined with microdermabrasion include:
    *laser procedures eg for removal of dilated capillaries or unwanted hair

How is the Deluxe Microdermabrasion treatment different from other microdermabrasion procedures?

The Deluxe Microdermabrasion incorporates an AHA/BHA mask (which loosens the dead cells ensuring a better result), steam application prior to the microdermabrasion commencement, and sonophoresis of soothing hyaluronic acid serum post treatment.
In addition, all microdermabrasion treatments at Skin Temple are customised to suit your individual skin problems and are performed in our uniquely designed medispa with a number of complimentary additional components.  For example, use of handmade custom designed ikat robes, a scented cleansing footbath, perfumed shea butter hand massage and choice of relaxing music on our Bose system are all standard with any facial (relaxation and therapeutic) at Skin Temple.
Please note that if you have more than 6 milia requiring removal per session, additional time and cost is required.

Special Mother's Day Offer for April/May:

Spoil someone special (including yourself!) with these offers:

* purchase a Deluxe Microdermabrasion treatment midweek, and receive 10% OFF OR a complimentary cleanser from ANY of the ranges carried here at Skin Temple...even Skinceuticals and Phytomer!

* purchase a series of 3 Deluxe Microdermabrasion OR Hydrafacial OR Laser Genesis midweek treatments and you'll receive 20% OFF 

* purchase a series of 6 Deluxe Microdermabrasion OR Hydrafacial OR Laser Genesis midweek treatments and you'll receive 15% OFF

Terms and conditions apply:
*Not available on Saturdays or after normal business hours.
*No rainchecks or further discounts applicable.
*Cancellations of bookings with less than 24hours notice will result in forfeiture of session.
*Series of treatments must be used within 12 months

To make a purchase or gift voucher for this promotion or make further enquiries, please contact reception on 03 9867 2992.

To view the full range of cosmetic and spa procedures available at Skin Temple, please see our website.

Thursday, 2 May 2013


Sometimes it can seem that no matter what you try to improve your skin, nothing will work.
It's so important not to lose hope though, as the solution may be a lot easier than you might think.

Recently I met the beautiful and very personable Tanya Ali-Jani, who initially came to Skin Temple with a completely unrelated skin concern.
I couldn't help wondering how she managed to hide her obviously pigmented acne lesions and scars during her photographic modelling assignments, and why she wasn't asking me to help her with it.

Tanya replied that she has had acne problems for many years, "like so many models!" and that after consulting numerous people over the years, and trying every over the counter acne product, she had now accepted the acne as being incurable, and something that she hoped she would one day "grow out of".  Instead, she was relying on the use of heavy MAC makeup and carefully placed hairstyles and camera angles to hide the side of her face most affected by acne.  Going to a "no hair, no makeup" casting call was a living nightmare for her, and so she joined the group of up and coming models who refused to be seen without makeup.

Well I'm almost always up for a challenge,  so I confidently tell her that I'm SURE I can improve her acne!
And I'm so glad that she decided to give it a go, because the after photos (above right & below) tell a story that words alone will never match.

I can't wait to see the new portfolio shots, including those she recently did without makeup (wow! that's an incredibly brave thing for anyone to do, let alone someone with a history of chronic acne!).

And I'm super thrilled that in the 2months since we cleared her acne up, she has acted in a short drama style movie, landed a hosting job on a community tv show, and has a lot more work steadily coming her way!

Watch out Melbourne (&beyond), this is a face & personality you're going to be seeing a lot more of in the next few years!

A big thank you to Tanya for her permission to be identified in this post, and to her photographer, Peter Coulson, for permission to use the professional shot above.

Sunday, 31 March 2013



To get the full effect from this, one first needs to perfect a cute lisp, so remember to use your inner Ita Buttrose during the delivery:

Knock knock!

Who's there?


Ether who?

Ether bunny!

Knock knock!

Who's there?


Another who?

Another Ether bunny!

Knock knock!

Who's there?


Cargo who?

Car go down the road and kill all the little Ether bunnies!

Knock knock!

Who's there?


Boo (hoo) who?

Now now, don't cry!  Ether bunnies come back next year!

So, we hope you've all had a fabulous Easter, and that you eat all of that chocolate in moderation over the next few weeks...maybe even months if you're good at pacing yourself!  We wouldn't want to encourage increased internal glycation (which is thought to contribute to premature ageing) would we?

Thursday, 28 March 2013




Sometimes a well marketed laser procedure creates a reputation for itself in the public domain that goes beyond what experienced clinicians think of it.
Fraxel can be a very useful laser procedure, but there is no doubt that some people who don't need it are being treated aggressively with it and aren't always happy with the outcomes.

For the lucky ones, it may have just been a waste of money without any permanent physical or psychological harm.
For some less fortunate, unnecessary (albeit well intentioned) laser procedures create issues that horrify those of us asked to correct them.
One such patient I met recently who appeared to attend for advice about a facial related issue, only to open up at the end of the consult with the real reason.

This isn't an unusual thing in the field of cosmetic medicine.  After all, it takes a while to establish rapport and trust when you've had a horrendous experience previously.

In this case, the patient had travelled interstate for Fraxel resurfacing to her face, neck and chest area about 9months previously.  It had appeared to go according to plan initially, in that she had woken from the general anaesthetic with some moderate discomfort on all areas, and then healed quickly on the face, but the chest was a different story.
Having returned to her home in Melbourne within 24 hrs, the patient reports very slow healing of the chest, with horrendous scarring initially appearing after 2 weeks, especially in the central/sternum area, which has steadily worsened over the next 6months.

I'm rarely lost for words, or ideas on how to fix a problem, but in this case I really did feel her pain and distress.
Her entire chest is covered in thick, contracted keloid scarring from one side to the other, from top to bottom.

I wish I could show you her photo, if only to warn you that some areas of the body are particularly prone to keloid scarring and the chest is probably the greatest example of that.

Here is an example, it is NOT of the patient described above.  This was apparently one that formed from a mole having been excised, and is not one of my patients, but is a good example of the keloid scarring that can result from even a minor surgical procedure on the chest.

I have a keloid scar on my own upper chest.  Fortunately it is only about 0.5cm diameter.  It developed 2 years ago after I was bitten by a mosquito there.
I'm highly allergic to mosquito saliva, as is my son, so I took antihistamines to suppress the inflammation and made sure not to touch the bite or scratch at it.  Despite these measures, the inflammatory response was so strong in this area that I have developed a hypertrophic scar that really does extend beyond the location of the original bite, hence is a genuine keloid scar.  I suppose if it really worried me I would have some cortisone injected it, but so far I've just left it alone, hoping that with time it will settle. 

If a mosquito bite can give me a keloid scar, it just goes to show how sensitive and keloid prone that part of our body really is.  Whenever someone asks me to perform an unnecessary (in my opinion) procedure on their chest area, I always show them my keloid scar, and explain how I got it.  Sometimes people just need to weigh up the risk/benefit ratio a little more carefully before diving in to a procedure that may have inherent risks no matter who is doing the procedure.  I guess that affects my income at times.  Big deal.  I would rather sleep well than lie awake stressing that some gorgeous previously confident woman has now had to undergo psychiatric assistance and adapt her entire wardrobe because I had given her a keloid scar that would be the envy of any Masai warrior in Africa.

Some laser procedures should never be done on areas off the face.  Others can be done, but very very carefully...especially in the central chest area.  

I NEVER encourage patients to have any laser or any injectable procedure done under a general anaesthetic or even "twilight sedation".  It is much safer to have a mentally alert (albeit somewhat anxious) patient able to give verbal feedback on what she is experiencing (ie feeling) as far as pain is concerned, than to have someone rendered incapable of providing this valuable feedback.  Very anxious patients can safely use an inhalation anaesthetic like Penthrox if necessary, without it impacting on their ability to liase during their treatment.  

Early recognition of a laser burn is essential if gross complications such as keloid scarring are to be prevented.  The best way to recognise a laser burn early is to have the patients awake at the time of the procedure, and to have them attend for follow up within 2 weeks of the procedure.  It's hard to do that if you're going interstate or overseas for your treatment, so think again before deciding that the only factor worth considering in the choice of your treatment is the price.

After all, any burnt patient will tell you that it hurts like hell being truly burnt by a laser..and it's a very different sensation compared to the normal fleeting mild-mod pain experienced during most routine laser treatments. 

Our pain fibres provide very valuable information to the doctors treating us.  But only to those who actually want to know about it.

Tuesday, 26 March 2013



Treatment of Flat Inverted Nipples

I viewed a presentation by a visiting dermatologist at IMCAS, Paris earlier this year, who was discussing the use of dermal fillers for the treatment of flat inverted nipples.
He suggested the careful placement of filler around the edge of the nipple itself, and felt that it worked very well in those clients treated, as the surgical correction of this problem is fraught with difficulty and often doesn't have satisfactory outcomes.

It all sounded quite interesting so I thought I'd ask him some questions about the procedure afterwards, thinking that there are no doubt a number of female patients in Australia who may be interested in this.
My first question was whether the filler procedure had caused any breastfeeding or mammography problems.  You know, my number one concern with any new treatment is ALWAYS: IS IT SAFE?
He responded that he had only done the procedure in younger women, under the age of needing screening mammography, so couldn't comment on whether it caused any radio-opacity.
As for the breast-feeding/mastitis concern, his response surprised me:
"the milk only comes out of the duct in the centre of the nipple, so it shouldn't effect breast-feeding, though I'm not sure how many of the women I've treated like this have needed to breast feed.."

I'm afraid that's when he lost all credibility in my eyes.
As a woman who has breast fed my child, I can assure anyone reading this post who perhaps hasn't yet found themselves in that situation, or witnessed their wife expressing breast milk, that breast milk doesn't come out of a central duct in the nipple.  It comes out of multiple ducts throughout the nipple.

Given that the dermatologist has only treated "about 20" women with this procedure, and has no followup safety data to present to the captivated audience (judging by the number of eager male doctors asking for detailed 'how to' instructions at the end of his presentation) I had some real concerns about whether this procedure should be promoted in any way at this time.

Don't get me wrong..I'm all for treatments that help women to overcome problems that affect their self-confidence.  But experimenting on women's breasts without any regard for functional side effects or mammogram safety is really not on.  Ductal carcinoma in-situ is a relatively common cause of (sometimes bilateral) mastectomy, and it would be an absolute tragedy to have either unnecessary surgery or missed diagnosis because of a cosmetic procedure that hadn't been investigated enough before being marketed to the world.  Having said that, I think this procedure would have a place helping those who have already undergone major breast reconstruction, and need their new nipples to look a bit more 3 dimensional.  Might have to suggest it to a couple of clients who fit this category.  Will let you know how they go!

Minimising Earlobe Creases

This is something that I already perform on patients who make the request, and it really is very easy, straightforward and effective.
Interestingly, the results appear to be quite long lasting without any particular side effects of note, other than the usual possibility of bruising and temporary excessive swelling.

Earlobe creases appear in older patients, and when I was a medical student were thought to be related to heart disease, so it is interesting that some patients notice them and complain of their cosmetic appearance.  However, if you want to have your earlobe creases injected, it might also be a good idea to make sure that your GP is monitoring you for other much more reliable signs of coronary artery disease.  We wouldn't want to overlook the onset of angina would we?   

Saturday, 23 March 2013



Are men finally catching up with women when it comes to looking after their skin? Apparently yes!
Data from multiple sources show a clear upwards trend in the numbers of men seeking medical advice for a variety of cosmetic skin problems, and given the extremely high rates of severe sun damage amongst Australian men, it's little wonder.
In my opinion this isn't because Australian men have fallen prey to the dreams of Dorian Grey immortality.  Rather, Australian men are increasingly sophisticated enough to realise just how far behind the game they have fallen.

Sophisticated!  I hear you scoff!  It isn't a word one usually hears uttered in the same sentence as "Australian male".  And perhaps by some markers of sophistication there's still room for much progress!  However I like to consider basic sophistication as an awareness of others' cultural norms brought about by repeated global travel..and that's something that Australians are very very fond of.  Thanks to a relatively high Australian dollar, falling air travel costs over the last 40 years and a penchant for extended overseas work postings, Australians are increasingly globally aware citizens.

My oldest patient is almost ninety years old and happens to be a delightful farmer from a warmer part of the state.  He first came to see me 9 years ago following the removal of several small skin cancers on his face, and looking to do something about the remaining severe sun damage visible from the opposite side of the street.  His children (all in their 60s themselves) initially thought it was hysterically funny that their salt of the earth father would care so much about his weathered face to see a cosmetic medical skincare specialist.  However, they've now come to love the way he looks vibrant and spritely, with very few other skin cancers requiring excision over the last decade.  If they realised how many operations and chunks of skin excisions/grafting their father would have faced if he hadn't taken action 9 years ago, they'd probably be coming in themselves!  The reality is that for many Australian men, recurrent facial skin cancer ultimately causes extreme disfigurement.  Even the most stoic and ocker of us would rather not have to watch ourselves slowly morph into an image that is unrecognisable from our former selves.     

Farmers and other outdoor workers aside, there is another much more urban source of male skincare customer.  Visit any golf, tennis, cricket, surf life saving or sailing club in Australia and you'll see them there by the dozens amongst the senior members.  They're the men whose lifelong sporting obsessions have brought much enjoyment (&sometimes elite success) but along the way the stubborn refusal of many men to wear sunscreen on a regular (read daily) basis, has left their delicate pale complexion blotchy, reddened, scaly and persistently "dry".  Here are a few typical examples of the sort of sundamage that many of you may recognise amongst your own friends and relatives:

The top of the head is a classic area of sundamage for those who are bald!

I love looking after unhealthy skin.  There are few things that appeal to my medical/motherly need to fix someone's evidence of chronic self-neglect than a mature man in need of some very practical and very inexpensive skincare quickfix solutions!   

These men are often remarkably well educated in their field of expertise, have travelled widely and have seen with their two eyes how much more youthful looking their fellow fair-skinned Caucasians are in their native countries.

In Paris recently I found myself sitting next to a well known New York dermatologist who gasped in wonder when I confessed to being Australian.  "But you don't have enough sun damage to be an Australian!" he replied.
"Especially for a 44year old"  I thought to myself.  "I've been looking after my skin for a very long time" I replied.
Another patient, an Australian born male who recently returned after working in London for the last decade, reported how he'd noticed on moving there that his colleagues all looked very youthful for their age, but on returning to Melbourne he is horrified to see how much his school friends have aged.

Rejuvenating men's skin isn't necessarily about using injectable treatments such as anti-wrinkle injections or dermal fillers.

Most men can be remarkably rejuvenated with medicated prescription skincare alone. 
Pre treatment-actual Skin Temple client

Post treatment-actual Skin Temple client, medicated prescription skincare only!

Some may require laser treatment if significant pigmentation or broken capillaries exist.
Significant facial redness due to extensive broken capillaries is a Medicare rebatable laser treatment, when performed by a medical practitioner.
The downtime post laser treatment is really quite minimal, though significant healing is required with some of the medicated prescribed skincare.

So, if you're reading this and identifying strongly with some of these descriptions, perhaps its time you did yourself a favour and consulted a cosmetic medical specialist today.  There's no time like the present to make up for yesterday's sun damage!