Resources
My publications & presentations
Peer-reviewed papers and book chapters, each summarised in plain English so you can see what it found and what it means, with the full paper available to download.
Sunscreen, acne and dark marks in darker skin Most people with darker skin who get dark marks after acne are using sunscreen too rarely and in too small an amount — and almost none of them know that sunscreen is the thing that stops those marks getting worse.
What can go wrong with subcision Subcision is a safe procedure for acne scarring, but it is not a procedure without consequences — and the instrument chosen changes which consequences you get.
When subcision goes too far Two complications of aggressive, wide-field subcision are turning up in my clinic as referrals from elsewhere, and neither is well recognised: facial swelling that persists past six months, and increased sagging of the lower face.
Stopping dark marks after CO₂ laser for acne scars Dark marks after CO₂ laser are the reason many people with darker skin are never offered the treatment at all. A peel given before and after the laser reduced them — without slowing healing or costing any of the scar improvement.
A finer tool for ice pick scars Ice pick scars are narrow and deep, which is exactly what lasers and peels handle worst. Borrowing a punch from hair transplant surgery lets the tool be matched to each scar rather than the scar to the tool.
Does HRT cause melasma? The honest answer is that the risk looks low for every form of HRT, but the evidence is so thin that nobody can say so with confidence — and that is worth knowing before you either worry about it or dismiss it.
When pico lasers leave pale spots Picosecond lasers are routinely described as the safe option for pigment. In a series of 796 patients treated for melasma, a small number developed pale spots that had not repigmented six months later — and the reason is not what most people assume.
What sun protection actually costs in darker skin The sunscreen that actually protects darker skin from pigmentation is tinted, and following the official reapplication advice with it costs between $3,040 and $18,250 a year. That is the real barrier, and almost nobody names it.
Pale spots after pico laser for melasma Four patients treated with picosecond laser for melasma developed pale spots that had not recovered six months later. The biopsies showed the pigment cells were still alive — they had simply stopped making pigment.
Does pico laser beat the cream for melasma? Pooling every randomised trial that has been done, the standard prescription cream reduced melasma more than the picosecond alexandrite laser did — and the laser caused more pigment rebound than topical treatment.
Is it melasma, or something that looks like it? Several conditions produce brown patches on the face, they respond to completely different treatments, and treating the wrong one makes some of them worse. This is the table I use to tell them apart.
How melasma is actually treated, in order Melasma treatment is a pyramid, and almost everyone tries to start near the top. Sun protection is the ground floor, pigment correctors come first, tranexamic acid second, and lasers and peels are the fourth tier — not the first.
What can go wrong treating melasma Every treatment that works on melasma has a way of going wrong, and several of them go wrong by making the pigment worse. This is the complication profile of each one, set out so the risk can be weighed before treatment rather than after.
Why hair loss matters before laser resurfacing A woman had a routine ablative laser resurfacing, healed normally, and then scarred extensively across her whole face. The reason was a hair-loss condition nobody had diagnosed — because skin heals from stem cells that live in hair follicles, and hers were gone.
Sweating somewhere new after underarm treatment A man had microwave treatment for underarm sweating and, twelve days later, started sweating across his lower back instead. Thirty months on it has not settled. It is the first time this has been reported after this treatment — and I am publishing it about a procedure I am closely associated with.
Rebuilding a nose thickened by rosacea Long-standing rosacea can thicken the skin of the nose until its shape is lost. Tablets do not reverse it. It has to be physically reshaped, and there are at least six ways of doing that — this review sets out what each one is good at, what it risks, and why fully ablative CO₂ laser has become most clinicians' first choice.
Why the gentler laser clears sun damage better Sun spots live in the outermost layer of skin, so a laser that removes that whole layer ought to clear them best. In practice it does not. A non-ablative wavelength that penetrates twenty times less shallowly gets comparable or better clearance, with a fraction of the downtime — and the interesting question is why.
When a needle beats a laser for acne scars Laser and energy devices have transformed acne scar treatment, and they are not the answer to every scar. Some patterns — ice pick scars in particular — respond far better to precise manual techniques using instruments as simple as a needle, a tiny punch or a fine paint brush. This piece argues that the skill has been quietly displaced by the machine, and sets out which scars call for which.
Eleven things fifteen years of scar work taught me Eleven things fifteen years of acne scar revision taught me that are not in the textbooks: why the order of procedures matters more than the procedures, why you often do not need to treat the whole scar, what angled lighting reveals, and how to treat darker skin without trading a scar for a pigment problem.
A vitamin B3 tablet that lowers skin cancer rates Nicotinamide is a form of vitamin B3 available over the counter. In a large Australian trial it reduced new non-melanoma skin cancers by 23% over twelve months in people who had already had two or more. It is inexpensive, well tolerated, and it is not a substitute for sun protection — and in transplant recipients the evidence is conflicted.
Lasering sun spots before the light treatment Photodynamic therapy struggles with thick, crusted sun spots because the cream cannot get through them. Running a fractional laser over the area first opens channels for it — and across a series of trials that combination clears more, recurs less and improves the look of sun-damaged skin more than the light treatment alone.
Painting acid into the base of a boxcar scar A strong acid, painted into the base of a scar with an artist's brush and nowhere else. Every one of the 37 patients who completed three sessions improved, 57% of them by more than 70% — and darker skin, usually the cautious case in scar treatment, did better than fair skin.
By subject
Browse by topic
Each subject gathers the papers that belong to it, so you can read across a theme rather than one study at a time.
Acne scars & scar revision Subcision, laser resurfacing, surgical excision and the prevention of pigment afterwards. 8 publications Pigmentation & melasma Melasma, the dark marks acne leaves behind, and the pigment problems that follow treatment as well as precede it. 10 publications Lasers & energy devices What lasers do well, and where the honest limits sit — across pigment, scarring and sun damage. 10 publications Sun damage & skin cancer prevention Sun spots, solar keratoses and the prevention of skin cancer — what actually clears sun-damaged skin, what only appears to, and what a tablet can and cannot do. 3 publications
Follow the work
See the work before you book
Procedures, technique, before and afters, and the reasoning behind them — posted across three accounts, each with its own focus.
@101.skinThe main account — procedures, lasers, before and afters, and the reasoning behind treatment choices.Follow on Instagram → @the_melasma_clinicEverything pigment: melasma, sun damage, post-inflammatory pigmentation and the honest limits of each treatment.Follow on Instagram → @the.rosacea.clinicRosacea, flushing and facial redness — triggers, devices, and what actually settles it.Follow on Instagram →
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@101.skinSubcision, step by step Reel slot — supply 1080×1920
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@101.skinAcne scarring — 6 months Post slot — supply 1080×1350
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@the_melasma_clinicWhy melasma comes back Reel slot — supply 1080×1920
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@the.rosacea.clinicVascular laser, day 0 to day 7 Post slot — supply 1080×1350
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@101.skinFully ablative vs fractional Reel slot — supply 1080×1920
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@the_melasma_clinicTinted sunscreen, and why Post slot — supply 1080×1350
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@the.rosacea.clinicFlushing triggers Reel slot — supply 1080×1920
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@101.skinKeloid injection technique Post slot — supply 1080×1350
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