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Scar Revision Questionnaire

Scar Revision Questionnaire

Algorithms by Dr Davin Lim

Thank you for your inquiry. This form is designed for me to understand more about your acne scars & how to best treat them. It allows my team & I to triage your appointments & provide you with a report.

Though high-resolution photos will be useful in determining the algorithm, it does not re- place a real time clinical examination. Clinical features such as atrophy (thin areas) & hyper- trophy (thick areas), 3D depth perception, & fibrosis (hard to feel areas) cannot be captured with photos. I do need to touch, stretch & poke to understand the true nature of your scars.

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HOW THIS WORKS

Step 1. Questionnaire.

Step 2. Good quality photos.

Step 3. Send email to Cutis Dermatology.

Step 4. Processing fee.

Step 5. Report generated.

Cost - AUD $490.00 – includes report and zoom call.

This cost covers administrative costs in preparing this document.

A report will be generated within 7 working days. Following the report, you will be given the option to book a real time consultation with myself. In cases where simple treatments are sufficient, you will be given an option to be treated by my senior nurses.

PERSONAL & CONFIDENTIAL INFORMATION ABOUT YOU

Name(Required)
Born Gender(Required)
Has your weight been stable for the past 12 months?(Required)
This gives me a gauge of skin laxity which plays a part in revision.
What is your ethnicity?(Required)
Have you regularly smoked in the past 12 months?(Required)

ACNE TREATMENTS. PAST & PRESENT.

1. What acne treatments have you had?(Required)
2. Are you currently on acne treatments?(Required)
3. Do you still get acne?(Required)
It is very important to answer this correctly as it has a significant impact on how you remodel scars following a procedure. Active acne refers to any spots, cysts, zits & breakouts you may have in the last 30 days.

SCAR TREATMENTS

1. What scar treatments have you had?(Required)
2. Has any treatment been successful?(Required)
3. What is the emotional impact with your scarring?(Required)
4. How do you rate your scars physically?(Required)
5. What is your aim of scar revision?(Required)
6. What are your expectations & aims?(Required)
This dictates the algorithm of revision.
7. Is there a family history of acne & or acne scarring?(Required)
This dictates the algorithm of revision.

HOW TO TAKE PHOTOS

The better the photos the more accurate the assessment. Please follow the guide outlined below. No make-up.

For NORMAL lighting I require- • Full face: 1 • Side (right & left): 2 • Oblique (right & left): 2

Minimum total: 5 photos. Additional close ups will be great. High resolution photos will allow me to zoom in.

Angled lighting. Please take at least 4 photos of angled or tangential lighting. This allows me to understand depth perception. I cannot assess this with 2D imaging using normal lighting.

In summary 10 plus high-quality focused photographs are required.

Take 5 photos in total. 1 front on, 2 on the right side. 2 on the left side. You can take additional photos of areas such as the temples, nose etc. should there be any scars visible.

Drop files here or
Accepted file types: jpg, jpeg, png, pdf, heic, Max. file size: 50 MB, Max. files: 20.

    REPORT

    A detailed report will be sent to you based on your photos & questionnaire. The accuracy of this report ranges between 50% to 95% accuracy, depending on your scar signature.

    The body of this report gives one algorithmic approach, based upon your answers & photo- graphs. In some cases, there are several algorithms that can be undertaken.

    *Remember, this report is not a substitute for real time examination. I employ touch, stretch, animation & 3D visualization to understand scar signatures.

    BODY DYSMORPHIC DISORDER & SCARS.

    BDD presents as follows; if you have scars but only you notice them. This means your scars are subjectively severe, but objectively mild. A good test is to ask your family members & close friends for an objective option.

    I do not treat BDD acne scar patients with epic & invasive treatments such as surgery, ex- tensive subcision or deep fully ablative lasers. The risks are too great. If you have BDD scar- ring, smaller, more cost effective & less invasive treatments are advocated. These include small dot CO2, erbium lasers, TCA Paint & collagen stimulating fillers such as Profhilo. Given the banal nature of these treatments, your revision program will be with my experienced team of nurses.

    EXPLAINATION OF COSTS INVOLVED IN ACNE SCAR REVISION

    Cost for each treatment (conducted by myself) is inclusive of all treatment methods that I may use to rectify your scars, this includes-

    • Surgery- excision, punch, punch elevation, dermal grafting, fat transfer

    • Collagen stimulating fillers- example Profhilo, Radiesse

    • HA fillers

    • Surgical subcision

    • All types of lasers- fractional, fully ablative, non-ablative, pico, vascular

    • Peels- TCA, phenol

    • RF microneedling

    • Microneedling

    NURSE RUN ACNE SCAR REVISION PROGRAM

    Wherever possible I will refer you to my senior nurses for scar revision. As a guide this cost saving is in the region of 50-75% compared to my procedural fee. They have extensive experience in lasers, deep peels, RF devices, & dermal fillers. The four main situations that I may refer you to my nurse include-

    • Easier to remodel scar signatures. Examples include boxcar & ice pick scars. This pat- tern is amenable to lasers & deep focal peels. My nurses will give you a similar result as to what I can deliver.

    • Darker skin types. For deep scars in darker skin, the aim is to raise the scars to a more superficial level. This allows me to perform one (or two) sessions to treat the remainder of scars.

    • Objectively mild scars. This pattern does not require complex surgery or epic lasers with prolonged recovery. Small, low downtime, low risk lasers & EBD (energy-based de- vices) are all that is needed.

    • Budget conscious. I am aware of the costs involved in scar revision. My nurses can de- liver good outcomes using non-surgical techniques as per above.

    PAYMENT DETAILS

    Option 1) Direct Deposit

    1) Direct Deposit - Please send screen shot if option 1.

    Account Name: Cutis Clinic

    Bank: NAB

    BSB: 084-801

    Account number: 984-160-823

    Reference: PATIENT FULL NAME

    Max. file size: 50 MB.
    Deposit Screenshot

    Option 2) Credit Card (Please note we do not accept AMEX)

    Visa / Mastercard

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