Lol... thanks. Honestly I do care to some extent though. But shoot, after the FIRST day of class they required us to give our FIRST speech, and I went up there looking like a completely burnt freak, it couldn't get any worse right? LOL. 60% coverage was definitely the worse redness I have dealt with in terms of fraxel repairs go. I just keep telling myself, " in 6 more weeks I'll never see these people again".
Yep, that can't be stressed enough. I feel the effects/benefits of repair are maximized by aggressive treatments. At very low, conservative energy/coverage levels you will almost certainly come out disappointed. Disappointment also stems from the belief that repair is one and done like many doctors claim; its not, it almost never is. In fact, its quite costly to go through multiple treatments. And as many readers on this site are young teens with limited funds, I can sympathize with their anguish.
I take back what I said earlier. Fake bake flawless for whatever reason does not maintain a tan for long. Actually, its gone within 12-16 hours. Maybe I am applying incorrectly or not applying enough but I can't get it to remain on my skin. So I am back to looking like a freak with reddish cheeks due to the laser and pale skin else where.
The funny/sad thing is... for summer school I am taking an 8 week crash course on Public Speaking. Six speeches in 8 weeks; I have been doing them in front of the class looking like a freak. Oddly enough nobody has yet to comment on it.
Post-op 16 days since my last fraxel repair. This treatment was probably the most aggressive repair I have had yet @ 60% coverage on the cheek/temple area.
I took a bunch of photos though after looking through them all carefully on my laptop they don't really show much scarring. My scars are quite difficult to catch on camera now as they are more like big pores at this point aside from a few tiny boxcar scars.
I never like to judge results a near 16 days out but I personally already see small results. People often ask, what kind of results? 50%? 75%? Nope, much less than that. I feel like when its all said and done, the results are like 15%. And that 15% is going with very aggressive coverage. I also feel that as the scars get smaller you get diminishing returns. Anyways, 15% with each treatment is more than satisfying for me.
Anybody who plans on having laser treatments done should realize even the most aggressive treatments are not a one-and-done procedure. Its all about expectations. I believe most doctors are much too conservative to go with aggressive treatments like the ones I have had done. Due to this, most people see results in the 5% range.
16 days out I am still very red. Not INSANE redness like the 100% ablative CO2 laser I had done, but a very sun-burnt red. It looked a bit weird as I only had the cheeks and temples done. My eyes/forehead/chin/nose area untouched which kind of makes the redness look more pronounced. That was until I discovered... FAKE BAKE FLAWLESS!
Fake Bake Flawless is a fake tan that comes in a spray bottle. You spray it onto a mitt and rub it on to your skin. I did this on the areas not touched by the laser and BAM, you can hardly even tell my face was lasered. I wish I discovered this stuff 4 laser treatments ago. For anybody who has uneven skin tone from only having part of the face treated I highly recommend it.
I may or may not get around to posting the photos. The 1-3 day post-op photos look much like the ones I already posted. Incredibly BLOODY and SWOLLEN!
Oh, one more thing. As a guy who is big on nutrition, I understand the role nutrition plays on wound healing as well (such as healing from having your face burned off with a laser). I found this interesting link from the Hospital of University of Pennsylvania. The link discusses the different stages of wound healing, collagen production and the quantity/types/duration of nutrition/calories required for optimum collagen/wound healing.
It also explains that going on calorie restrictive diets can impair or slow down collagen production during wound healing. 30-35 kcal per kg of body weight. I believe this to be true. Its like weight training to gain muscle. You can not increase muscle mass while cutting calories. Your body needs extra calories and amino acids to build new muscle. This is why body builders go on zig-zag or carb-cycling diets where they have a surplus of calories to gain muscle then switch to calorie restriction to burn off the added body fat.
Sorry to all those who have emailed me with specific questions in recent months. I have my preferences on this site setup to where I am emailed when personal messages are sent. For whatever reason I stopped receiving those emails. I have been insanely busy with work and school so I don't often log on to manually check.
Anyways, with Spring semester just ending and Summer school beginning in a little over two weeks, I will take this opportunity to have another laser treatment done. Beginning tomorrow, 5/21/14, I go in for fraxel repair. I had a few different options, namely DeepFX or Repair, and again opted for the Repair. Doc recommends the repair as it is apparently better at treating larger areas. The doc also points out that I have "textural" issues now as opposed to big scars. DeepFX is nice for treating specific areas while leaving the surrounding tissue untreated. Repair is nice for hitting an entire area.
Beyond all that, I am not really sure what else to say. I think everything that could be said has been said on this 16 page thread.
Been a long time since I last posted. Its been about 9 months since my last Fraxel:Repair. Oddly enough I feel like my skin has still improved every so slightly 5 to 9 months out. The first three lasers I had done were separated by about 6 months a piece. However, I felt like the extra few months of healing this last time around may have had a positive effect on my skin.
Random observation : It may be my mind playing tricks on me but I've noticed that slimming down a few pounds may have also helped decrease the appearance of acne scars. I have always been rather fit but I have made a conscious effort to get my body fat into 8% range this last year. In doing so, my face has become even more angular and less "round" which helps hide scars that do remain. Imagine scars on a full, round face vs one that has a thinner jaw line. Maybe this is why acne scars on say... Brad Pitt doesn't look so obvious as he has maintained incredibly lean body mass throughout his acting career.
With all that being said, I still am looking to further improve my skin. I had a consultation last week with my Doctor for another Fraxel:Repair at 50% coverage set for May. Keep you guys posted then!'
Oh one more thing. It's been 16 months since I had the 2nd (and 22 months since I had the first) "old-school" 100% ablative CO2 laser. I have no signs of
hypo-pigmentation (which is the permanent whitening of the skin) which has apparently been an issue about 12 months out with the older, 100% ablative lasers. That's good news.
I don't have any rolling scars though I do believe Dudley did. From what I gather, rolling scars seem to have the greatest improvement. I would agree with your doctor that 15~20% sounds like a reasonable number. However, I would say that it varies scar to scar. I had a shallow but wide boxcar scar on my cheek near my nose that improved by 80~90% on the first repair. At the same time, I have had scars that showed only 10~20% improvement (which in my opinion is still good).
As I mentioned in one of my earliest posts, as the face becomes bloody, it becomes difficult for the doctor to find her "starting point". Due to this, some areas tend to get overlapped much more than others. The scar that improved nearly 90% on the first repair was in the area that she started from and probably overlapped several times over. While most areas got treated at 4 passes on this particular treatment, I believe that specific boxcar scar got treated closer to 60%. Does that make sense or am I blabbering on?
Here is a crappy drawing of what I mean...
I believe she started in that location to get as close to the nose as possible. The second and third treatment I had I believe she went with a horizontal and vertical passes as opposed to the odd angles.
PS. Yes I shaved the day of laser. I started shaving again usually by day 7-10 with an electric razor.
EDIT: And one more thing, I had 5 or 6 Affirm Multiplex treatments before these Repairs, which is more or less the same technology as Restore. I would agree that restore's non-ablative technology is not nearly as good as an ablative treatment.
Been awhile since I last logged on but I figured I'd give a quick update for anyone who cares. I've been pretty busy with work and a maxed out summer school schedule so I have been totally procrastinating on the updates.
I haven't really been "studying" my scars much since the initial improvement post-laser. However, I got a glimpse of my skin today and was pleasantly surprised that my skin seemed to have improved even more. This added improvement would probably go unnoticed to anybody other than myself as it is very minor compared to the initial "shrinking" of scars 14-30 days out. I would say a 1~2% improvement maybe? Sounds dumb right?
Maybe I am going insane. After awhile you begin to forget what you started with. It is like saying the same word over repeatedly and eventually it loses its meaning.
Furnace. Furnace. Furnace. FURNACE. FURNACE! Never mind.
I am going... ... yep, you guessed it, bananas.
I am not sure if I already posted this thought but I may go in to see my doc next week. I plan on asking what the cost would be to do 5 passes on a small 1'' x 1'' section where the deepest boxcar scar remains. If it is affordable, I would rather hit this one spot so I am not awkwardly red during the winter again. Then, again in the summer I will do the whole "half-cheeks" in an aggressive manner. I know this sounds backwards to most but the sun has never been a problem for any prolonged hyper-pigmentation issues in my case. Sport a big hat and some decent sun-block and all is good.
Today marks day 80 and there is almost no sign of hyper-pigmentation. Considering I work outdoors and spend many hours a week swimming, that is pretty impressive.
Oh, and if I go through with this 1'' x 1'' section in October, I plan on taking zoomed up before/after photos of that one, dreaded scar as a way to study the fraxel:Repair's potential in detail.
99% of my swelling is gone about 10-14 days out. But in reality is probably subsides to a point that is unnoticeable by day 5-10 depending on the aggressiveness. People claim that there is "micro-swelling" that lasts months. Personally, I don't buy it. If there is such a thing as micro-swelling more than 2 weeks out, it is so unnoticeable that it shouldn't make your results appear to be better than they really are. I never notice my skin getting worse pass about day 10-14ish.
If I had to guess what my improvement % is as a whole, meaning averaging out all my scar/pores/texture since the last laser, I'd say about 15%? The biggest scar I have, that boxcar scar on the cheek seemed to have improved closer to 30%.
By the way its been about 47 days since the laser.
I also believe that once scars get so small, you begin to get diminishing returns. By that I mean, you get bigger improvements on big scars than you would with a tiny scar. Most of my scars are on the small side so my results may not be as significant as others.
Long time no see Fruits. Your skin looked fine to me. If you go for a repair I'd suggest they go with an above average coverage rate. I know higher coverage % means longer, more pronounced redness but low coverage produces rather weak results; then the redness you get will be all for naught!
35 days out and really happy with the results thus far. I was originally planning on waiting 12 months til the next laser treatment as it is a bit difficult to squeeze a Repair in the Fall/Winter (like I did last year) because of School/work. However, with the results being better than I anticipated I may just take a week off from school in the middle of the semester to get it done. I don't mind the redness so much in the summer because it looks like a sunburn but in the winter it is a bit more awkward. Either way, if it means significant improvements I am willing to bite the bullet.
Everybody knows their own scars very well; how they look, where they are, appearance in specific lighting etc. There is no doubt that several of my scars have shrunk considerably.
- I had this weird, small, dent-like scar near my left eye, which I received from getting a fingernail to the face a few years ago. This scar is nearly gone at this point.
- I also had this very, very shallow box-car scar on my right temple that has faded quite a bit.
- My biggest scar, that dreaded, deep, box-car scar on my left cheek also has shrunk. It was initially so big that it still looks deep to the untrained eye but I know it shrunk a bit. I look in the mirror and expect to see the scar the way it looked for the last 6 months and I am happy to see that it looks less noticeable.
- More or less my skin improved in every way. My mini-icepicks or scarred pores have even diminished in size.
Don't get me wrong, my skin still needs more treatments. It is just satisfying to see an improvement in every scar, even if its it only a 15% improvement. It really takes the wind out of your sails if you have your face blasted off and see NO improvements. This would suggest that your permanently stuck with your scars but fortunately this is not the case.
One thing that I think many people under estimate is diet's role after a laser treatment. I have spent many years lifting weights and cardio and realized rather quickly that your body CAN NOT build muscle with out two important things.
1. Calorie surplus. This means to eat more calories than your Basal Metabolic Rate. In other words, more calories than your body needs to maintain its current weight. You can find out your BMR by using calculators, or a more accurate way, wear a heart rate monitor for a few days. Your body can RARELY manufacture more muscle mass when your on a calorie deficit. I believe the same works for ideal skin healing conditions. I am not saying to feast every night after a laser treatment, though I did for the first few weeks, but don't go on a really aggressive diet while you are still healing.
2. Quality of diet. You also can't gain muscle when your body is lacking in proteins, glycogen and healthy fats. Typical weight trainers eat about 1.5 times their lean body mass in grams of protein. I feel that quality of diet is an important factor in ideal conditions for collagen production weeks after a Repair too. I have been digesting a consistent amount of berries, cauliflower each day for the Vitamin C. Extra-virgin Olive oil or a handful of nuts for the healthy fats. Cereals fortified with 100% DV of iron (which is one of the highest nutrition deficiencies in the US) as it increases blood-flow to the skin and hair. And last but not least. tons of protein. I found that using the myfitnesspal app works great for making sure you are hitting all the nutrient benchmarks- not just for your skin healing but for life in general.
Keep in mind that supplements are not as beneficial as eating food itself for many vitamins/mineral/amino-acids. Also, your body can only absorb so much at once. This means eating a few berries in the morning, mid-day and evening will give your body the best chances of staying Vitamin-C rich as opposed to taking 1 1000 mg vitamin-C pill before bed.
Took a few photos which I will upload from my phone this afternoon. Redness is still apparent, well, it is more of a tannish color than an abrupt red. Nothing too abnormal looking for the hot summer Californian weather.
Oh and 1 more thing. "Feathering out" or blending to hide the redness isn't worth it for the repair. She did 5 passes on the scarred areas (high cheeks) and just 1 pass on the jaw area where there is no scarring. The redness dissipated within a week on the area done with 1 pass. In my opinion, it is not worth keeping this area protected with the Aquaphor during the healing process for a blending area that will disappear so quickly. No need to laser good skin as the Aquaphor can cause breakouts that may result in more scarring, though unlikely.
Hey Spartan, I am still red today @ day 20. The redness doesn't look as bad when I just get out of the shower, but during a hot, exhausting day of work in the sun, the redness is more pronounced. But yes, I would say that I am presentable 10 days out. The funny thing is, I have been working out in the sun every day since my day 10 after the laser. I have been swimming and running every day as well. Though, I do tend to where a big sombrero at work or when jogging outdoors.
Honestly, I really don't care if I am a little red as long as I get some improvements as the redness always fades. The hyperpigmentation from fraxel repair looks more like a sunburn or tan compared to the Ultrapulse which looked more like a burn-victim.
20 days out and I do already notice some significant improvements. My biggest scar, the box-car scar on the cheek has shrunk in width/depth. I can actually see the bottom of the scar now without having light shine directly head-on. I still think it will take another 2 treatments to get it to where I want but a definite improvement so far. I have been making a conscious effort to not examine my skin daily so I can notice subtle changes 5-6 days apart, which I do.
I am not quite informed when it comes to dermabrasion but I hear the recovery and risk is just as bad as fractionated lasers if not worse. Honesty, I don't think I would ever try it. I do believe you get better results from the repair because it works in a variety of ways.
-It tightens the skin from the heat. Seen here ->
-It vaporizes the "bad" skin.
-Stimulates collagen production.
I have seen all the studies, fancy diagrams and photos over the course of a few years but I am still not sure I 100% agree with that status quo acne scar treatment.
I believe that there is 3 things that happen from fractionated lasers that improve appearance of scars:
1) The heat from the laser causes the skin to "shrink" or tighten. That can be seen here.
2) Vaporizing the scar tissue. Yes, technically the laser depth only has to hit the bottom of the scar, BUT I believe this only yields a limited improvement.
An example of this would be when I had the ultra pulsed laser done, not the Lumenis Ultrapulse. Same idea but two different technologies. The Lumenis Ultrapulse can reach a 100% coverage but the ultra pulsed laser I had done is an old school CO2 "flat beam" laser that is only 100% coverage (and not made by Lumenis). The depth was set at 90 microns, but there was 3 passes done for a total of 270 microns, which is pretty darn deep and aggressive for a 100% ablative laser. This would also explain why it literally took my skin 6-7 months to fully recover. Anyways, the laser definitely went below the threshold of even some of my tiniest scars at 100% coverage. Logically you would think this would basically erase the scar, but it didn't. This is a big reason why I believe you can only get a limited amount of improvement from hitting the bottom of the scar, even at 100% coverage.
3) Collagen production weeks~months later or "plumping" of the skin as you described it. I believe this is where the biggest and most important factor comes in to play for treating scars. And although I agree that technically you only have to hit the bottom of the scar, I believe you are limiting your results by doing so. I think you can get more plumping or collagen production by going deeper. How much deeper ? I don't know. But it just seems from random studies, people on this board and my own experiences that deeper settings = better results. My scars are pretty darn shallow and yet it seems the "overkill-method" works best. Notice that most of those published studies on fraxel repair for wrinkles on the face, the power was 70 joules (1600 microns).
I understand that some may claim that the depth of of the reticular dermis begins at 700 microns. However, a few doctors on realself have stated that the eyelids dermis+epidermis is 400 microns thick with the chin/nose being 1400 microns. This would lead me to believe that 700 microns to ablate the entire dermis at the cheeks would be a very conservative estimate. For the sake of argument lets say the reticular dermis does start at 700 micros. My theory is that you would want to ablate beyond that point anyways to stimulate collagen for maximum results. Yes it is true, the deeper you go the greater chance of scarring. I hate my scars so I am willing to gamble a little more than others.
I also think that doctors overstate the whole " lasers are dangerous for asians" scenario. Has there been one documented situation where an Asian patient has had permanent hyper-pigmentation from fractionated lasers? That is a serious question as I honestly don't know. Though I have searched for evidence with little success. Hypo-pigmentation from non-fractionated lasers are a different story, and even then, very rare. The only difference with Asian skin that I know of is that the hyper-pigmentation can last longer. I am aware of this as I had significant hyper-pigmentation from a very aggressive oldschool co2 laser treatment for 6 months (which did eventually go away). Being half Italian, I would argue that my skin tan's even easier than it would if I was 100% Japanese. The Italian side of my family is much darker and tanned than the Japanese side due to genetics (actually the Japanese side is very pale).
All of this goes back to my original post when I stated that doctor's care very little about how much your skin improves as long as there isn't adverse effects that could potentially cause litigation. Sure, they say they care. But they don't go home feeling sad about OUR scars. As I said before, I believe that the majority of patients who request fractionated lasers are for wrinkles and sun damage, not scars. Doctor's pockets won't take a hit if an acne scar patient decides not to repeat business. This is why I believe so many people see underwhelming results.
I could be 100% wrong. I just want to reiterate what my theory is on treating scars and doctor's reasoning for making us believe otherwise. It is a very odd and easily disagreeable point of view but something to think about! Also, none of this is a reflection of my thoughts on slee's treatment. He just reminded me of something when he talked about his lagging improvement weeks later.
-Swelling seems to be gone.
-Redness dissipating very quickly. Can easily pass it off as a sunburn, unlike my 100% ablative CO2 treatment.
-Notice no improvement in my deep/big scars, yet. I don't really expect to this early.
-Few of my "scarred pores" and/or tiny ice-picks seem to be gone or smaller.
Over all, too early to judge the results. Face is streaky, red and maybe even a bit raw. Keep you all posted!
EDIT: Bleh, a few of the photos are apparently too big to upload. I will resize and post the rest later
I have a few theories on treating scars so I'll just throw out some ideas.
I agree, there is a lag in term of results. In my opinion, this lag is the biggest improvement one will see in terms of treating scars. I notice an almost insignificant improvement the first 10 days or so. The greatest improvement comes about 20+ days later from what I have seen in my own skin. One would think the improvement comes from the vaporized skin that "regrew" , for a lack of a better term, but this just doesn't seem to be the case. If it was true, then I should see a huge improvement immediately from scars that were hit at 50% coverage. And this brings me to my next point.
Doctor's often say that the depth they are treating at is deeper than the scars. That statement may be accurate, but as I just pointed out, the results don't come from the vaporized portion of the scar, they come from the collagen production weeks later. So *WHAT IF* to properly treat scars you have to go further below that scarred layer (sorry for my lack of knowledge on skin terminology, I am by no means a doctor). I always read about rolling scars that get "attached" to the deeper layers, which explains why subscision can be effective in some cases. What if this deeper layer needs to be vaporized as well to be effective? Or the deeper the penetration, the more collagen production? Which would explain why the highest mJ setting tends to bring on the most significant results no matter the depth of the scar.
Most of these doctors who perform these treatments don't have a ton of knowledge on acne scars. They are taught how to safely use the laser, which hasn't even been out that long in retrospect. And from dealing with several "laser doctors" myself , I get the feeling that they almost always prefer to go with the lowest setting possible. Quite frankly, I think they could care less how much improvement we see. As long as it doesn't cause any further damage they are happy to see our business. And even more so, I think 90% of ablative laser treatments are done for aging adults who are trying to get rid of wrinkles and sun damage, not scars. I practically had to beg my doctor to go "aggressive". The third time I actually opted to go without the anxiety medications so I could keep an eye out on what she actually set the mJ at.
I guess what I am saying is, I am suspect of all these laser doctors including my own (definitely my own). And I am always curious as to what depth treatment was done at when there was little-to-no bleeding. I had the 100% ablative CO2 laser done (with 3 passes and wiping of the epidermis in between) and had no bleeding at all. With this laser I also noticed the least improvement in my deeper scars.
Anyways, I am not sure I agree with your family. Your scars look to have improved more than 10%. They look softer with less defined edges, if that makes any sense.