Nadine Dilong DR KENTARO OKU is a renowned dermatologist based in Japan and has been involved in the Cynosure APAC Medical Advisory Board since 2019. Here, he shares his expertise in acne treatments.
Dr Oku, what is your experience with acne patients?
As a dermatologist, I have been regularly seeing acne patients since I started practicing. Especially during the past few years when wearing masks was necessary, I have noticed an increase in acne patients and have developed various treatment options. Acne is a disease where dysfunction and overactivity of the skin occur simultaneously, so in addition to oral and topical treatments, treatments using energy-based technologies tailored to each patient’s symptoms are an effective choice. Currently, we have introduced four special treatment methods developed in our clinic, tailored to the symptoms, and the treatment effectiveness has significantly improved compared to a few years ago.
The advancements in oral and topical treatments in dermatological practice in Japan might have led to a slight decrease in the number of patients overall, but there is an increasing trend in the number of visits for severe acne. In particular, there was a noticeable increase in moderate to severe acne patients coinciding with the period when mask-wearing was necessary.
What are some treatment options you recommend for active acne?
The necessary treatment varies depending on each individual case, but as a general treatment for active acne, we promote epidermal turnover with retinol and suppress sebum production using ingredients like vitamin C, while using EBD (Energy-Based Devices) for the extraction of Acne core as well as simultaneous inflammation sedation and skin remodelling. By implementing a multi-aspected approach as early as possible, we can protect the skin tissue around the acne and prevent acne scars.
What are treatment options for acne scars?
Although treatment combining subcision with HA filler, collagen filler, and skin boosters, as well as full-face CO2 fractionated laser treatment, are some of the representative methods, we also offer CynoGlow, which combines Potenza with PicoSure Pro, and Skin ReGeneration, which combines PicoSure Pro with Sofwave. Of course, these treatments alone cannot address all types of acne scars. However, CynoGlow and Skin ReGeneration are highly requested by many patients as they can treat various types of acne scars with minimised downtime. Additionally, home care is an important part of acne treatment, so we often create our own original skincare products at our clinic and combine them with device treatments.
Nutrition/gut health seems to be a factor for many acne patients – how do you include this in your treatment plans?
At our clinic, we use prebiotics (not probiotics) and fermented products to correct disturbances in the gut microbiome. Particularly for fermented enzymes, we prescribe ‘Sakiwai Koso,’ a product developed by our clinic, which has shown effectiveness against acne. Sakiwai Koso is recognised for enhancing NK cell activity and improving microcirculation, and it is highly regarded not only as part of acne treatment but also as a component of overall well-being.
What is your go-to device when treating acne?
If there are pustules with deep inflammation, we use Potenza with the single needle mode. Potenza is an ideal treatment for sedating strong inflammation while remodelling the surrounding tissue. When there are many superficial pustules with pigment deposition, we often use PicoSure Pro, especially with fractional hand piece. This is because treatments using LIOB (Laser Induced Optical Breakdown) are suitable for the superficial dermal remodelling and epidermal reconstruction.
What are your favourite features of the PicoSure Pro and Potenza devices?
My favourite features of the PicoSure Pro are the adjustable fluence / diameter and irradiation parameters, as well as the fractional irradiation mode. The former allows for finely tuned settings according to the operator’s preference based on the target depth and density, achieving high efficacy in colour removal while minimising the occurrence of Post-Inflammatory Hyperpigmentation (PIH). The latter is because, with LIOB in the epidermis, not only the epidermis but also the dermis can be remodelled. This combination of features is not available in other picosecond lasers.
My favourite feature of Potenza is its ability to divide RF irradiation into pulses. The operator can choose whether to deliver the entire energy in one pulse or to deliver the same energy in a series of shorter two to five pulses. These two devices stand out from others in their ability to tailor settings according to the specific skin conditions. Both are indispensable in my practice.
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