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139 Remuera Road, Auckland

Varicose Veins Treated by Laser and UGS

Varicose Veins treated with Laser

This man with large varicose veins sought treatment because he had symptoms of sore aching legs and restless legs syndrome as well as severe cramps.

He had varicose veins in both great saphenous veins and both small saphenous veins which were assessed by a comprehensive Duplex ultrsound examination and then treated with a combination of endovenous laser ablation and ultrasound guided sclerotherapy.  These are walk in/walk out treatments and he has been absolutely delighted with complete resolution of his symptoms and the major cosmetic improvement.


Rosacea before and after treatment

Rosacea is a skin condition of unknown cause. The symptoms can range from repeated intense flushing, dry flaky skin, often with small lumps and may resemble acne. The cheeks are generally cherry red due to actinic or photo-damage to the underlying blood vessels.

These dilated “broken” blood vessels are most likely caused by UV-A light that leads to the destruction of the collagen support around the blood vessels the result of chronic photo-degradation of both vitamin A and C.

To begin, we must address the chronic deficiency of vitamin A in the skin that has been a major contributor to the problem. Generally, the use of a skin-care range containing vitamin A and C with antioxidants will be sufficient treatment for mild cases of rosacea, but it may take several months before the skin is comfortable. In more severe or resistant cases a Benefit or Timeless (vitamin A) peel is recommended.

If these treatments are unable to fully control the rosacea we can reduce the facial redness with IPL treatments.

Lightwave Therapy

Elite Lightwave

As we age, the cells that manufacture the skins supportive structures begin to slow down. Environmental damage from the suns rays speed up this process and produce free radicals that damage the skin and the cells that synthesize collagen and elastin. 
Using a combination of different lights delivered at different times we are able to stimulate these cells that help counteract the effects of ageing.

Lightwave Therapy uses a combination of pure, visible red light and invisible infra red light to stimulate natural processes in deeper skin tissue. After a course of Lightwave combination Therapy clients notice a softening of fine lines and wrinkles, improved skin tone and super smooth skin.

Lightwave Therapy treatment immediately after Fraxel, laser or chemical peel is found to reduce pain, reduces the side effects and speeds up the time your tissue takes to regenerate. This means that you recover much quicker and the overall response is improved.

Liposuction or Tummy Tuck

Abdominoplasty or liposculpture

Abdomen overhang before and after Liposuction

Dr John Barrett of Palm Clinic discusses the process on deciding whether it is better to have a tummy tuck or liposuction.

The main indication for liposuction is to remove unwanted fat to produce a more youthful contour whereas the main indication for a tummy tuck (abdominoplasty) is to remove excess skin and this is often combined with liposuction to remove unwanted fat at the same time.

The risk profile for the two procedures is significantly different. A tummy tuck is a relatively major procedure with significant downtime and produces a very large scar running across the lower abdomen from hip to hip, plus around the belly button (umbilicus) which is generally repositioned.  Liposuction or liposculpture by comparison is a relatively minor procedure and most clients can return to work within three days and there is seldom any visible scarring from liposuction after a few months.  There are risks for both procedures which would be discussed in depth at an initial consultation.

For those patients with a large overhang (pannus) or very poor skin tone a tummy tuck would clearly give a better result.  For those with a small overhang and/or moderate to good skin tone liposuction will generally give a good enough result to warrant avoiding the tummy tuck procedure.

It is important to assess patient expectations before deciding on which procedure would be appropriate and I typically use the Palm Clinic before and after gallery to explain likely outcomes for the individual being consulted.

You can see in the accompanying abdomen before and after photos that this lady has a very large overhang and the best result for her would have been obtained by a tummy tuck but she did not want the added risk, cost or downtime so elected to have liposuction alone and was extremely pleased with the outcome.

If you press Continue Reading you will see the other before and after abdomen liposculpture shows a women with very good skin tone and an excellent result was achieved by liposuction alone.  For further results please view Palm Clinics liposuction photo gallery.

Mole checks

Skin Cancer Checks

Skin Cancer photos.

Winter time means our skin is well covered with clothing and we have generally forgotten about the deleterious effects of the sun.  The UV damage that stimulates skin cancer change has been shown to be worse in our younger years and the resultant cancerous change typically takes many years to appear.

Melanoma typically arises as a result of a genetic tendency although a sub type called melanoma in situ arises as a direct result of sun exposure. Normal benign moles (naevi) can undergo malignant change to form melanomas and the usual ABCD (Assymetry, irregular Border, Colour change and Diameter >6mm) signs should be watched for.

Most other skin cancers reflect the degree of UV damage particularly when we are vulnerable as children and young adults.  The first sign of UV damage on the skin is generally small scaley patches on the face and other sun exposed areas of the body.  These are actinic keratoses (AK's) or solar keratoses and they tend to go through cycles of heaping up keratin causing the scaley patch which often comes off or is picked off leaving the skin smooth for a while until the keratin builds up again.  AK's are a precancerous lesion which may change to skin cancer if left unattended.  It is a good idea to have your skin checked if you are getting this type of problem particularly if they are multiple areas on the face or scalp.

For those who have a BCC or SCC or melanoma previously they are at significantly increased risk of a new skin cancer and should have regular skin checks.

Dermatoscopy Course

The Doctors at Palm Clinic recently attended a dermatoscopy course to hone our skills at detecting skin cancers. With New Zealand having amongst the highest rates of skin cancers in the world, it's important that we, as clinicians are excellent at detecting skin cancer early. The course, run through the University of Queensland, is internationally recognised, and covers dermatoscopy and advanced surgical management of Skin Cancer. Dermatoscopy allows early skin cancer changes to be detected long before these changes are visible to the naked eye.

We were lucky to gain Dr. Martin Denby last year, who works exclusively in detecting and treating Skin Cancer at Palm Clinic. He is working towards his Masters in Skin Cancer

We highly recommend having a full body skin check once per year if you have had high sun exposure, sun burn or a family history of skin cancer. Much like a warrant of fitness on your car, it's a way to check for potential problems that may not be visible to you before they become major ones.

Palm Clinic is an Affiliated Provider to Southern Cross Health Society for skin cancer treatment, skin biopsies, and skin cancer surgery. Medical necessity criteria apply.

Facial Veins and Aurora IPL

Facial Veins and Aurora IPL

Facial veins are a common problem for men and women.  At Palm Clinic we treat facial veins and rosacea with either Aurora (combined IPL and radiofrequency) or Coolglide 1064 NdYag laser or a combination of both.

The initial reaction is some facial flushing and the veins can turn a little dark if they are large but within 2-3 weeks the veins fade.

You may need between 1-5 treatments depending on the severity of the problem with an average of 2-3 treatmments being the norm.

In this case the veins are more of a birthmark quality but show excellent clearance with Aurora.

Fraxel Laser for Melasma and Skin Texture

Melasma and skin textural issues were resolved for this patient with Fraxel Dual Laser

Fraxel works by punching tiny microscopic holes in the skin which are then repaired with new skin.  The hyperactive melanocytes that cause melasma are replaced with melanocytes that do not produce so much melanin.

Melasma is a complex condition and results will vary considerably from patient to patient.  At Palm Clinic we have seen some excellent results for melasma with the Fraxel Dual Laser but in some cases the results have not been as good.  It is critical that the skin is protected from UV light before and after treatment and any hormonal issues need to be stabilised before treatment.

Love My Thighs

Liposuction of thighs

Testimonial:  Here are some of my thoughts about the procedure;

I had liposculpture of my thighs at Palm Clinic with Dr John Barrett because I had been self-conscious about the disfiguring "saddlebags" that were there. The discomfort of recovery was minimal and I have been so pleased with the results. I now can wear tights, jeans, jodhpurs and shorts without a second thought. I feel my body looks in proportion now, whereas before I was a definite pear shape. I am grateful to have had this procedure because its very pleasant to now be so content with my appearance.

By the way, yesterday evening out of nowhere the guy I am dating told me he loves my legs... they are perfect.... This is great to hear, I could not stand my upper legs all my adult life but now I am fine with them and I can believe compliments like this.

Thanks again for your excellent work!

Tips for Preventing DVT

Sitting and DVT

Prevention of DVT (deep vein thrombosis) mainly involves using the foot pump and calf muscle pump to stimulate blood flow through the deep veins.

Blood is taken down to the feet through arteries and taken back to the lungs and heart via veins.  About 90% of the venous blood is returned via the deep veins which are situated inside the calf and thigh muscles. 

The foot pump involves squeezing of blood through a complicated venous plexus in the foot and the blood is then further squeezed towards the heart via calf and thigh muscle action on the deep veins.

When we sit for long periods the foot pump and calf muscle pump are inactive and this can lead to pooling of the blood (venous stasis) which in turn can cause a DVT.  In a worst case scenario a piece of the blood clot (thrombus) can break off and block the main arteries to the lungs causing a pulmonary embolus (PE).  A small PE may not even be noticed but a large PE can cause dramatic symptoms of severe chest pain, shortness of breath or coughing blood.  In these circumstances a PE could be fatal so you need to get urgent attention by dialling 111.

Although small DVT's are quite common and usually don't cause symptoms, larger DVT's can cause calf or thigh pain and swelling of the leg.  These symptoms should always be checked by ultrasound.

DVT's are more likely if you have long periods of sitting eg long car travel or long flights over 4 hours duration or if you have had recent surgery or a prolonged illness requiring bed rest.  If you have had a DVT before or a superficial thrombophlebitis you may be at greater risk of a further DVT. It is worth having a thrombophilia screen if your doctor is concerned about a strong family history of DVT.

Prevention of DVT's can include:

1. wearing class 1 or 2 compression hosiery.

2. working the foot and calf to stimulate venous return.

3. getting up and walking around regularly if you are sitting for long periods.

4. keeping well hydrated on flights and avoid alcohol on flights.

5. the foot pump works better in people who do not have flat feet or high arches.  If you suffer from these problems a good orthotic device will improve venous return.

6. varicose veins may increase the liklihood of DVT so having your varicose veins treated may be a good long term solution.

7.  there is no evidence that aspirin reduces the risk of DVT

Liposuction and Pregnancy

I am often asked if liposuction should be performed before or after a planned pregnancy.  There is no golden rule but if you have concerns about a particular area of your body prior to a planned pregnancy it is very reasonable to treat it with liposculpture beforehand.

With liposculpture we are removing fat cells which cannot be replaced so any gains made from the procedure will be permanent. 

Of course you will put on weight in the next pregnancy but you should be able to return to your pre- pregnant contour more easily after the liposculpture as there are less fat cells in the problem areas.

If you are planning pregnancy and want to have liposuction beforehand you will need to ensure that adequate contraception is in place as you must not have the procedure performed if you are pregnant and for about 2-3 months after the procedure to allow a full recovery.