Recovery
Results
Treatment Time
Aftercare
The science of CALM birthmark treatments
- This is the most common ‘brown’ birthmark
- This birthmark can be effectively treated with pigment lasers
- Treatments are partially covered under Medicare
- Laser treatment is scarless with success rate of over 80%
- Remission time is variable
Pigment lasers have revolutionized CALM birthmark treatments giving predictable results in over 80% of patients.
What are cafe au lait birthmarks?
A cafe au lait macule is a common brown birthmark that presents at or shortly after birth. In most cases it measures 1 to 10 cm in diameter.
It is extremely important to first ascertain the diagnosis as other birthmarks resemble CALM birthmarks.
What other birthmarks resemble CALM, & what do they imply?
Getting the diagnosis is the most important bit, sometimes it’s not that easy. A diagnosis will give you an idea if the birthmarks will respond to lasers, or if they are resistant.
Naevus spilus looks like a CALM, but it has moles together with a CALM birthmark element. This birthmark is usually resistant to lasers.
Becker’s naevi are thicker than CALM, often present later & may have excess hair within the area. This birthmark gets darker in adolescence. It does not respond well to lasers, so save your money.
Congenital melanocytic naevi are deeper than CALM & usually darker. They can respond variably to CO2 lasers, but require 8-16 sessions.
What is the best way to treat CALM birthmarks?
Laser treatment is the best way to treat cafe au lait birthmarks. We use the very best pico & short pulse nano lasers, ensuring the most efficient, effective & safest treatments possible.
Surgery is not performed for CALM birthmarks but may be considered for congenital melanocytic naevi.
Treatmemt |
Recovery |
Scarring |
Clearance rate |
---|---|---|---|
Pico laser | 3-6 days | Nil | 80% |
Surgery | 7-14 days | In all cases | 100% |
What is the treatment like?
Treatments are comfortable & fast, taking less than 2 minutes to perform. For comfort, we use numbing cream, cold air as well as mild sedation (for larger Cafe Au Lait Macules).
*We only encourage treatments in the mid teens. For children, sedation is required (which is not performed in rooms in Sydney).
What is the recovery following laser for CALM?
2-5 days depending on the size of the birthmark. Here is what to expect-
- First 1 hour: frosting or skin whitening.
- 1-2 days: redness with slight oozing.
- 2-5 days: scabs & redness.
- 1-3 weeks: redness fading.
*Side effects such as pigment darkening are not uncommon in darker skin types, even using the very latest lasers.
How many sessions will it take to clear?
Typically 2-4 sessions, spaced 8 to 12 weeks apart. Less sessions for smaller CALM birthmarks in lighter skin types, more sessions for larger CALM spots in darker skin types. There is a partial Medicare rebate for CALM birthmarks.
Our Gallery of Results






Can creams treat birthmarks?
Creams have a marginal effect on birthmarks as they occur in the deeper layers of skin. If you are going to invest in a cream, the best one is sunscreen. Creams are occasionally prescribed after laser to reduce the effects of post inflammatory hyperpigmentation.
Will CALMs return after treatment?
Once cleared the chances of recurrence depends on your genetics. 20% get lifelong cure, 80% have some form of recurrence. Remission periods range from 2 to 10 years. Surgery provides 100% removal, but at the expense of significant scarring.
Are there any side effects of lasers?
Side effects are rare, with an increased incidence in darker skin types. They include –
- Darkening of birthmarks
- Hypopigmentation (lighter skin)
- Crusting, persistent redness
At what age can you get a birthmark treated?
Most cafe au lait macules do not require treatment, however if they occur in conspicuous areas such as the face or neck, laser treatments are a possibility.
A good age to treat is 13 or above. There is no evidence that early treatment of CALM birthmarks gives a better prognosis (unlike port wine stains).
*We do not treat birthmarks in children less than 13 as they most often require full sedation. This is done in a hospital setting.
Can cafe au lait birthmarks change to cancer?
No. Skin cancers such as melanoma do not occur in CALM birthmarks, hence no treatment nor follow up is required. Some birthmarks such as nevus spilus or congenital naevi have an increased risk of melanoma.
Retinoids such as #tretinoin & retinol can be useful in addressing melasma pigmentation. Best applied at night due to photosensitivity
.
👉Vitamin C: can be used as an antioxidant or as a pigment corrector. Personally I prefer patients to apply in the am, under sunscreen
.
👉Azelaic acid: can be applied twice daily
.
👉Glycolic acid: can be potentially photosensitising (in theory, however practically not too much of an issue)
.
👉Pigment correctors: generally applied in the PM, with exceptions such as #thiamidol, azelaic acid, HQ that can be applied twice daily depending on other skincare actives
.
👉Sunscreen: at least twice daily, AM & midday application
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #skincaretips #melasmaclinic #davinlim #melasmatreatment #themelasmaclinic #sydneydermatologist

Retinoids such as #tretinoin & retinol can be useful in addressing melasma pigmentation. Best applied at night due to photosensitivity
.
👉Vitamin C: can be used as an antioxidant or as a pigment corrector. Personally I prefer patients to apply in the am, under sunscreen
.
👉Azelaic acid: can be applied twice daily
.
👉Glycolic acid: can be potentially photosensitising (in theory, however practically not too much of an issue)
.
👉Pigment correctors: generally applied in the PM, with exceptions such as #thiamidol, azelaic acid, HQ that can be applied twice daily depending on other skincare actives
.
👉Sunscreen: at least twice daily, AM & midday application
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #skincaretips #melasmaclinic #davinlim #melasmatreatment #themelasmaclinic #sydneydermatologist
The Melanopro Peel is an awesome product from Dermalogica💯
.
👉What is it? Novel low downtime superficial peel for melasma, post-inflammatory hyperpigmentation, mixed sun & age related pitment
.
👉Where does it sit in the context of pigment treatments?: Sweet spot when it comes to pigment removal & prevention with minimal downtime as compared to other peeling agents
.
👉What else does it do? This is an awesome product to help improve skin texture & roughness
.
👉Ingredient list: backed with science, t.acid, azelaic acid, #retinol, #niacinamide as well as glycolic & lactic acids, salicylic acid & acetyl hexapeptide-1
.
👍🏻I’ve used it & IMO it outperforms even prescriptive high concentration retinoids, especially when it comes to improvement of textural issues. The phase 2 continuous resurfacing cream is my product of choice as part of my skincare routine👌🏻
.
😎Dr Davin Lim
Dermatologist
Sydney | Brisbane 🇦🇺
.
#melasmaclinic #tmc #melasmatreatment #melasmatreatmentsydney #pigmentationclinic #drdavinlim #dermatologistsydney #melanopro #dermalogica #melanopropeel #melasmapeel @dermalogicaaus

The Melanopro Peel is an awesome product from Dermalogica💯
.
👉What is it? Novel low downtime superficial peel for melasma, post-inflammatory hyperpigmentation, mixed sun & age related pitment
.
👉Where does it sit in the context of pigment treatments?: Sweet spot when it comes to pigment removal & prevention with minimal downtime as compared to other peeling agents
.
👉What else does it do? This is an awesome product to help improve skin texture & roughness
.
👉Ingredient list: backed with science, t.acid, azelaic acid, #retinol, #niacinamide as well as glycolic & lactic acids, salicylic acid & acetyl hexapeptide-1
.
👍🏻I’ve used it & IMO it outperforms even prescriptive high concentration retinoids, especially when it comes to improvement of textural issues. The phase 2 continuous resurfacing cream is my product of choice as part of my skincare routine👌🏻
.
😎Dr Davin Lim
Dermatologist
Sydney | Brisbane 🇦🇺
.
#melasmaclinic #tmc #melasmatreatment #melasmatreatmentsydney #pigmentationclinic #drdavinlim #dermatologistsydney #melanopro #dermalogica #melanopropeel #melasmapeel @dermalogicaaus
Bottom line; if you have normal skin, there are many ingredients better than niacinamide for pigmentation
.
👉When do we recommend it?
.
1️⃣Pigmentation-melasma with rosacea. For patients with compromised skin barrier function & or skin sensitivities, your rate limiting factor is skin irritation
.
2️⃣Post inflammatory hyperpigmentation & post inflammatory erythema in acne patients. Niacinamide can potentially reduce inflammation & re-establish skin barrier function, hence making it a useful ingredient in PIE (post inflammatory erythema) patients. Best combined with lasers for faster & more predictable outcomes
.
💪🏼What strength? 10% niacinamide is the sweet spot
.
📆How long before it works: 2-4 weeks in redness/PIE, 4-10 weeks for pigmentation
.
🤰Pregnancy rating: Supersafe
.
👍🏻Better ingredients for pigment: arbutin, azelaic acid, ascorbic acid
.
😎Dr Davin Lim
Dermatologist
Sydney | Brisbane 🇦🇺
.
#niacinamide #vitaminb3skincare #niacinamideskincare #pigmenttips #melasmatips #melasmatreatment #davinlim #dermatologistsydney

Bottom line; if you have normal skin, there are many ingredients better than niacinamide for pigmentation
.
👉When do we recommend it?
.
1️⃣Pigmentation-melasma with rosacea. For patients with compromised skin barrier function & or skin sensitivities, your rate limiting factor is skin irritation
.
2️⃣Post inflammatory hyperpigmentation & post inflammatory erythema in acne patients. Niacinamide can potentially reduce inflammation & re-establish skin barrier function, hence making it a useful ingredient in PIE (post inflammatory erythema) patients. Best combined with lasers for faster & more predictable outcomes
.
💪🏼What strength? 10% niacinamide is the sweet spot
.
📆How long before it works: 2-4 weeks in redness/PIE, 4-10 weeks for pigmentation
.
🤰Pregnancy rating: Supersafe
.
👍🏻Better ingredients for pigment: arbutin, azelaic acid, ascorbic acid
.
😎Dr Davin Lim
Dermatologist
Sydney | Brisbane 🇦🇺
.
#niacinamide #vitaminb3skincare #niacinamideskincare #pigmenttips #melasmatips #melasmatreatment #davinlim #dermatologistsydney
Here’s a tip, you don’t need to spend $$$ for a good formulation of azelaic acid
.
👉Azelaic acid: can reduce inflammation, acne, treat rosacea & is a great pigment corrector. It is our formulation of choice for some, but not all cases of #melasma pigmentation. It is also useful for PIH due to acne as it reduces acne, inflammation & pigmentation👍🏻
.
👉Concept: add ingredients specific to their tasks, maximal concentration without skin irritation, titrated according to skin’s sensitivity
.
👉Azclear: has 20% azelaic acid. Other brands? Go for it, you’re paying more for marketing & BS. Take note, this is an unsponsored post
.
🎬Action: For skin care tips, please consult our dermal clinicians & nurses.The Clinic’s aim is to solve a problem, not sell you products
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney🇦🇺
.
#melasma #melasmaclinic #azelaicacid #azclear #drdavinlim #dermatologistsydney @azclear

Here’s a tip, you don’t need to spend $$$ for a good formulation of azelaic acid
.
👉Azelaic acid: can reduce inflammation, acne, treat rosacea & is a great pigment corrector. It is our formulation of choice for some, but not all cases of #melasma pigmentation. It is also useful for PIH due to acne as it reduces acne, inflammation & pigmentation👍🏻
.
👉Concept: add ingredients specific to their tasks, maximal concentration without skin irritation, titrated according to skin’s sensitivity
.
👉Azclear: has 20% azelaic acid. Other brands? Go for it, you’re paying more for marketing & BS. Take note, this is an unsponsored post
.
🎬Action: For skin care tips, please consult our dermal clinicians & nurses.The Clinic’s aim is to solve a problem, not sell you products
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney🇦🇺
.
#melasma #melasmaclinic #azelaicacid #azclear #drdavinlim #dermatologistsydney @azclear
Tip: if you are skin of color & surfer from acne, see a dermatologist for effective & early management to place acne into remission. This will markedly reduce the chances of long term scarring & post inflammatory hyperpigmentation💯
.
👉Fact: 25% of PIH can last up to & beyond 5 years
.
👉How to treat it? You can ‘try’ at home remedies, retinol, salicylic acid washes, acne diet & azelaic acid. Tinted SPF is mandatory; minimum of SPF30+ with long wave UVA protection & blue light coverage (iron oxides)
.
👉How do dermatologists treat? Topical or oral retinoids, clinical peels, anti-hormonal medications & lasers such as #AviClear. For SOC, avoid #LLLT (LED therapy) as blue light often worses pigment. Photobiomodulation with red & IR light is tricky, there is a tipping point of which pigment worsens. We don’t prescribe fluff…
.
📸B+A by my colleague, dermatologist Dr Heba Jibreal @dr.hebajibreal No scar treatment required in this patient, just EFFECTIVE acne management
.
😎Dr Davin Lim
Brisbane 🇦🇺
.
Disclaimer: My work is procedural, not acne management. For acne treatments, please book a consultation with my colleagues @cutis_dermatology Brisbane. Sydney acne patients will be managed by our physician
.
#drdavinlim #acne #aviclear #acnetips #acnetreatment #acnecure #dermatologistsydney #acnetreatmentsydney

Tip: if you are skin of color & surfer from acne, see a dermatologist for effective & early management to place acne into remission. This will markedly reduce the chances of long term scarring & post inflammatory hyperpigmentation💯
.
👉Fact: 25% of PIH can last up to & beyond 5 years
.
👉How to treat it? You can ‘try’ at home remedies, retinol, salicylic acid washes, acne diet & azelaic acid. Tinted SPF is mandatory; minimum of SPF30+ with long wave UVA protection & blue light coverage (iron oxides)
.
👉How do dermatologists treat? Topical or oral retinoids, clinical peels, anti-hormonal medications & lasers such as #AviClear. For SOC, avoid #LLLT (LED therapy) as blue light often worses pigment. Photobiomodulation with red & IR light is tricky, there is a tipping point of which pigment worsens. We don’t prescribe fluff…
.
📸B+A by my colleague, dermatologist Dr Heba Jibreal @dr.hebajibreal No scar treatment required in this patient, just EFFECTIVE acne management
.
😎Dr Davin Lim
Brisbane 🇦🇺
.
Disclaimer: My work is procedural, not acne management. For acne treatments, please book a consultation with my colleagues @cutis_dermatology Brisbane. Sydney acne patients will be managed by our physician
.
#drdavinlim #acne #aviclear #acnetips #acnetreatment #acnecure #dermatologistsydney #acnetreatmentsydney
Not the definitive list as there are many variables depending on the concentration of ‘actives’ & the formulation
.
👉Clinic: HQ & cysteamine
.
👉Home: Azelaic acid is one of our favs, vitamin C equally so
.
😎Davin Lim
Dermatologist
Brisbane | Sydney🇦🇺
.
#davinlim #skinlightening #skinbrightening #pigmentationsolutions #dermatologistsydney #pigmentationclinic #azeliacacid

Not the definitive list as there are many variables depending on the concentration of ‘actives’ & the formulation
.
👉Clinic: HQ & cysteamine
.
👉Home: Azelaic acid is one of our favs, vitamin C equally so
.
😎Davin Lim
Dermatologist
Brisbane | Sydney🇦🇺
.
#davinlim #skinlightening #skinbrightening #pigmentationsolutions #dermatologistsydney #pigmentationclinic #azeliacacid
Azelaic acid guide
.
👉Concepts: we primarily employ azelaic acid for mitigation or rotational therapy. There are more effective ingredients out there (refer to previous post, or melasmaclinic.com.au website for more information). The ideal combination depends on your skin sensitivity, pigment diagnosis & phase of treatment
.
👉👍🏻Which brands? Azclear. It is cost effective, you don’t need to spend heaps to get a good formulation at 20% concentration
.
😡Sensitive skin: this is an ideal formulation
.
🌗When to use: PM
.
📆How long to use: Depends on the context of prescription, you can use this indefinitely
.
🍎Compatible with pregnancy - lactation: Yes, it is the ingredient of choice if you have melasma in pregnancy
.
🧐When do I see results: mitigation is something you don’t see, effects on other forms of pigmentation are marginal at best
.
🎬Pigment solutions: book an appointment with our clinicians in Sydney or Brisbane for more effective treatments
.
Dr Davin Lim
Brisbane | Sydney🇦🇺
.
#azclear #azelaicacid #drdavinlim #davinlim #dermatologistsydney #melasmaclinic

Azelaic acid guide
.
👉Concepts: we primarily employ azelaic acid for mitigation or rotational therapy. There are more effective ingredients out there (refer to previous post, or melasmaclinic.com.au website for more information). The ideal combination depends on your skin sensitivity, pigment diagnosis & phase of treatment
.
👉👍🏻Which brands? Azclear. It is cost effective, you don’t need to spend heaps to get a good formulation at 20% concentration
.
😡Sensitive skin: this is an ideal formulation
.
🌗When to use: PM
.
📆How long to use: Depends on the context of prescription, you can use this indefinitely
.
🍎Compatible with pregnancy - lactation: Yes, it is the ingredient of choice if you have melasma in pregnancy
.
🧐When do I see results: mitigation is something you don’t see, effects on other forms of pigmentation are marginal at best
.
🎬Pigment solutions: book an appointment with our clinicians in Sydney or Brisbane for more effective treatments
.
Dr Davin Lim
Brisbane | Sydney🇦🇺
.
#azclear #azelaicacid #drdavinlim #davinlim #dermatologistsydney #melasmaclinic
🙏🏼Please do not prescribe irritating topicals for dark circles if you are unsure of the cause
.
👉please don’t upsell skincare that is potentially irritating. It often worsens pigment causing post-inflammatory hyperpigmentation, making treatments much harder, as in this case. It clouds the underlying pathology & accentuates the condition.
.
👁️Dark circles: POH or periocular hyperpigmentation is mostly multifactorial, genetics (constitutional), irritation (PIH), congestion - vascular, shadowing (true tear trough), rubbing (lichenification), maturational, AN associated etc.
.
👉Treatments: treat the cause, genetic or constitutional causes are difficult. If unsure, prescribe some Azelaic acid 10%. This patient was prescribed a mix of ascorbic acid, as well as retinol, which resulted in skin irritation, rubbing & lichenification. I know many clinicians in corporate clients have KPIs to meet, but consider your skincare prescriptions carefully please 🙏🏼
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney 🇦🇺
.
#darkcircles #darkcircletreatment #darkcircleremedy #darkcircleDIY #darkcirclehomeremedies

🙏🏼Please do not prescribe irritating topicals for dark circles if you are unsure of the cause
.
👉please don’t upsell skincare that is potentially irritating. It often worsens pigment causing post-inflammatory hyperpigmentation, making treatments much harder, as in this case. It clouds the underlying pathology & accentuates the condition.
.
👁️Dark circles: POH or periocular hyperpigmentation is mostly multifactorial, genetics (constitutional), irritation (PIH), congestion - vascular, shadowing (true tear trough), rubbing (lichenification), maturational, AN associated etc.
.
👉Treatments: treat the cause, genetic or constitutional causes are difficult. If unsure, prescribe some Azelaic acid 10%. This patient was prescribed a mix of ascorbic acid, as well as retinol, which resulted in skin irritation, rubbing & lichenification. I know many clinicians in corporate clients have KPIs to meet, but consider your skincare prescriptions carefully please 🙏🏼
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney 🇦🇺
.
#darkcircles #darkcircletreatment #darkcircleremedy #darkcircleDIY #darkcirclehomeremedies


Dr Davin Lim
645K subscribersHow to treat PIGMENTATION
If I can identify the cause of pigmentation, chances are I can treat it. This can only be achieved with careful real time examination…
More of our mostFrequently asked questions
Can surgery be performed?
What is the cost of treatment?
Can chemical peels treat birthmarks?
Are pico lasers the best option for CALM birthmarks?
What are other conditions that may look like CALM birthmarks?
How does Picosure differ from Picoway for CALM?
How are café au lait macules diagnosed?
What are the symptoms of café au lait macules?
What causes café au lait macules?
Who performs the procedure?
What are natural ways to treat café au lait macule birthmarks?
A SummaryTreating cafe au lait birthmarks
Dr Davin Lim | Dermatologist
The Melasma Clinic, Brisbane | Sydney
Cafe au lait macules are common birthmarks present at, or around birth. Most are small & do not require treatment. They are more commonly seen in Africans followed by Hispanics than other races.
Though the older literature suggests that only 50% respond to lasers, we see up to 80-85% response rates. Most require a series of 2-4 sessions, spaced 6 to 12 weeks apart. I prefer the older nano short PD lasers over pico lasers for CALMs, especially if they are of low contrast or if they occur in lighter skin types. Pico lasers are preferred in darker skin types, not because of better clearance rates, but because they are inherently safer.