Publications by topic
Acne scars & scar revision
Subcision, laser resurfacing, surgical excision and the prevention of pigment afterwards. Most of my published work sits here, and a good deal of it is about what goes wrong rather than what goes right.
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.
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.
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.
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.
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Last updated September 2026.
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