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Scars - What Would You Do To Fix These? Advice Please.

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#1 jane1987

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Posted 09 June 2012 - 05:30 PM

I have some scars on my cheeks that I really want to get rid of. In most indoor light they look fine but as you can see in some harsh outdoor light, they really stand out. I have included soft light and harsh light of each side so you can see the difference. I would say they are mostly pretty shallow. Any advice on what treatments would be best would be appreciated.

My doctor recommended smoothbeam to me but I have read a lot of not so great things about it and am a little worried that it might do more harm than good.

I just want to get rid of these marks and feel confident about my skin again.

I have a light olive asian skin tone.

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Edited by jane1987, 14 June 2012 - 02:47 AM.


#2 khill1968

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Posted 09 June 2012 - 05:45 PM

TCA Cross could do wonders for you. Ice picks on the cheek can be really ironed out with it. Check out this for example: http://www.acne.org/...cross-pictures/

Don't let anyone shove lasers down you; they are simply a cash cow and noone who recommends them on this can ever back it up with photo evidence, rendering their claims useless, leading me to conclude they are either delusional or in the business.

#3 DRaGZ

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Posted 09 June 2012 - 05:54 PM

Lasers do work. They don't work for everyone, though.

#4 LZOMG

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Posted 09 June 2012 - 05:58 PM

Im not sure, I believe smoothbeam does nothing for scars and only helps red marks. I would try looking for a different doctor, one who has a Fractional CO2 laser like the DEEP FX, or Fraxel Repair

#5 DRaGZ

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Posted 09 June 2012 - 06:08 PM

Yeah, smoothbeam is not very effective for indented scars. There is no point in treating red marks since those go away on their own anyway.

#6 khill1968

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Posted 09 June 2012 - 06:20 PM

Please someone show me evidence that lasers work. Just one before and after (genuine, taken six months apart so no swelling present). I'd love to believe they work. Many of the top PS and dermatologists on Realself, the type who have made their millions and don't need to rip vulnerable people off with nonsense, the type that take pride in their work and reputation, believe lasers do nothing for acne scars. Good for pigmentation, wrinkles and texture in general, yes. But acne scarring, with the tissue loss that comes with it? NO. Cashcow. And a potentially dangerous one at that.

#7 DudleyDoRight

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Posted 09 June 2012 - 06:31 PM

First to dispense with the laser hater nonsense. There are many posters who have showed pictures of laser success. Here is a quote from Dr. Michael Persky, California Plastic Surgeon.
"Fraxel re:pair works, and it works better than any other technology that I have been exposed to during my 25 years of facial cosmetic surgery experience."

Now that I have dispensed with the laser hating nonsense, a few people have been posting about a combination fractionalized ablative CO2/subcision combo that looks interesting. Since it appears you have ice pick this may be especially interesting to you. Lumenis has also just released SCAAR FX which is the first laser specifically marketed for scars. Both Fraxel Re:Pair and Deep FX originally where directed towards the wrinkle and skin tightening applications, and were soon applied to the acne scar problem. There is really no information available for SCAAR FX that I know of, but of course I must be working for the company according to one poster.

Anything that only reaches a shallow depth can do nothing for ice pick scars. Even ablative fractionalized CO2 has not proven very effective with ice pick. That is why that combo looks interesting. Non-ablative lasers have no real track record with acne scars. Read some of the threads where people have done this. http://www.acne.org/...cars-on-cheeks/ Research, Research, research, and don't get sidetracked by naysayers. Many people swear by subcision, but I have never done it so I don't know anything about it. There a few negative people who will sway people to methods that will not work for them. See a few Derms and Plastic Surgeons and see what they say.

#8 AlexWong

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Posted 09 June 2012 - 06:47 PM

First to dispense with the laser hater nonsense. There are many posters who have showed pictures of laser success. Here is a quote from Dr. Michael Persky, California Plastic Surgeon.
"Fraxel re:pair works, and it works better than any other technology that I have been exposed to during my 25 years of facial cosmetic surgery experience."

Now that I have dispensed with the laser hating nonsense, a few people have been posting about a combination fractionalized ablative CO2/subcision combo that looks interesting. Since it appears you have ice pick this may be especially interesting to you. Lumenis has also just released SCAAR FX which is the first laser specifically marketed for scars. Both Fraxel Re:Pair and Deep FX originally where directed towards the wrinkle and skin tightening applications, and were soon applied to the acne scar problem. There is really no information available for SCAAR FX that I know of, but of course I must be working for the company according to one poster.

Anything that only reaches a shallow depth can do nothing for ice pick scars. Even ablative fractionalized CO2 has not proven very effective with ice pick. That is why that combo looks interesting. Non-ablative lasers have no real track record with acne scars. Read some of the threads where people have done this. http://www.acne.org/...cars-on-cheeks/ Research, Research, research, and don't get sidetracked by naysayers. Many people swear by subcision, but I have never done it so I don't know anything about it. There a few negative people who will sway people to methods that will not work for them. See a few Derms and Plastic Surgeons and see what they say.


Is this what you're referring to? http://www.aesthetic.../scaarfx<br />It looks very promising.

By the way Dudley, I understand that you don't have any pictures of your scars from the baseline, but did you keep some photographic record of your improvements since starting on your laser treatments?

Thanks for the feedback.

#9 khill1968

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Posted 09 June 2012 - 06:49 PM

Well, that does sound like a lovely comment from Michael. However I will naturally remain unconviced untill i see one genuinely good before and after.Here is a typical finding I have on lasers, in this case with RE:Pair: http://www.realself....g-forehead-only The immediate afters look great, but the last comment, months after the procedure, reads a final improvement of approx 30%,which is low and indicates poor results. BTW I have never done laser so have no reason to be bitter about it not working or any other agenda, im just going with the facts I have gathered, and only those WITH EVIDENCE. Theory doesnt interest me, only visual results, and I know thats what we are all here for. Believe me, I hope my inclination to believe lasers are largely inaffective is wrong, and that some laser is going to come along and do wonders. It just annoys me how the average derm or surgeon seem to suggest laser straight off for acne scarring, and of you requitring a number of tratments to see results, costing thousands and thousands, and seem disinterested in other methods.

Anyhow, back to the OP Jane, TCA cross would be my opinion. Here is another example of its success http://www.westderm....e=colorboxnode. In the afters,the ice picks are virtually undetectable, with only the larger boxcars remaining (which you have none of). So i feel this could work for you. Get an expert opinion, of course. This is just my two cents. Hope this helps and best of luck, and remember you are lucky they are on your cheek as these are easier to treat, so be optimistic!

Edited by khill1968, 09 June 2012 - 07:16 PM.


#10 LZOMG

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Posted 09 June 2012 - 07:06 PM

Fractional CO2 is not a one and done, depending on the severity it can be anywhere from 2-5 treatments.

#11 DRaGZ

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Posted 09 June 2012 - 07:36 PM

Well, that does sound like a lovely comment from Michael. However I will naturally remain unconviced untill i see one genuinely good before and after.Here is a typical finding I have on lasers, in this case with RE:Pair: http://www.realself....g-forehead-only The immediate afters look great, but the last comment, months after the procedure, reads a final improvement of approx 30%,which is low and indicates poor results. BTW I have never done laser so have no reason to be bitter about it not working or any other agenda, im just going with the facts I have gathered, and only those WITH EVIDENCE. Theory doesnt interest me, only visual results, and I know thats what we are all here for. Believe me, I hope my inclination to believe lasers are largely inaffective is wrong, and that some laser is going to come along and do wonders. It just annoys me how the average derm or surgeon seem to suggest laser straight off for acne scarring, and of you requitring a number of tratments to see results, costing thousands and thousands, and seem disinterested in other methods.

Anyhow, back to the OP Jane, TCA cross would be my opinion. Here is another example of its success http://www.westderm....e=colorboxnode. In the afters,the ice picks are virtually undetectable, with only the larger boxcars remaining (which you have none of). So i feel this could work for you. Get an expert opinion, of course. This is just my two cents. Hope this helps and best of luck, and remember you are lucky they are on your cheek as these are easier to treat, so be optimistic!


http://www.acne.org/messageboard/index.php/topic/315693-asian-doing-mixto-for-acne-scars-on-cheeks/

That's my results. It's been...1.5 months now? And my face look more or less like the last picture I posted.

Also, I remember at least three other cases on these boards of successful procedures with before/afters. There was this one Middle Eastern dude in particular whose face was pockmarked to the point where it looked like granite, and the Mixto laser gave him a LOT of improvement.

#12 khill1968

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Posted 09 June 2012 - 07:57 PM

Your results are good, fair play.. And i think i recall the MIddle Eastern case you talk about and if its the same guy im thinking of, he used recell and subcision aswell as laser. One cant forget, in severe cases improvements are easier. Im sure lasers do do some good. My main gripe is them being floated in just about every post on this and by derms as a solution when other methods would be more suitable. Like the girl on this post, i believe, would be wasting her time with laser, yet low and behold its what her derm recommended her. Thats my main gripe with them, along with the false and misleading advertising they get everywhere.

#13 DRaGZ

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Posted 09 June 2012 - 08:06 PM

Your results are good, fair play.. And i think i recall the MIddle Eastern case you talk about and if its the same guy im thinking of, he used recell and subcision aswell as laser. One cant forget, in severe cases improvements are easier. Im sure lasers do do some good. My main gripe is them being floated in just about every post on this and by derms as a solution when other methods would be more suitable. Like the girl on this post, i believe, would be wasting her time with laser, yet low and behold its what her derm recommended her. Thats my main gripe with them, along with the false and misleading advertising they get everywhere.


I think he only used Mixto. That other dude with the Recell and subcisions used Re:pair, I believe.

In any case, this is why you get multiple consultations from multiple doctors while trying to evaluate the sincerity of each doctor.

I knew my doctor was honest when he told me give my old dermatologist another chance before trying him.

#14 jane1987

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Posted 09 June 2012 - 08:07 PM

Thanks for the comments. I appreciate it. TCA cross definitely interests me and is something I have considered. I have to admit that lasers do scare me a little especially with the red bleeding after pictures. My face is really important in my line of work, so I would need to do something with the least downtime even if that means slower more gradual results.

I did notice though that my doctor has an erbium fractionated laser listed on his site that sounds pretty much essentially the same as the fraxel repair without extreme downtime. I might try and talk to him about this and see what he says http://www.johnguage...in-resurfacing/

#15 LZOMG

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Posted 09 June 2012 - 08:14 PM

Thanks for the comments. I appreciate it. TCA cross definitely interests me and is something I have considered. I have to admit that lasers do scare me a little especially with the red bleeding after pictures. My face is really important in my line of work, so I would need to do something with the least downtime even if that means slower more gradual results.

I did notice though that my doctor has an erbium fractionated laser listed on his site that sounds pretty much essentially the same as the fraxel repair without extreme downtime. I might try and talk to him about this and see what he says http://www.johnguage...in-resurfacing/

The Fraxel Restore (Erbium) takes about 5-8 treatments to see reults that you would see after 1 Repair.

#16 jane1987

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Posted 09 June 2012 - 08:15 PM

Also DRaGZ I checked out your post and I think your results are pretty amazing. May I ask what your doctor charges for a consultation (I am based in LA also)? Could there be an option to do something similar to what you did but at lower settings? I am hoping to do something that means I can wear makeup a couple of days later and it be not so noticeable. A week is a little too long to take off work :(

#17 DRaGZ

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Posted 09 June 2012 - 08:34 PM

Also DRaGZ I checked out your post and I think your results are pretty amazing. May I ask what your doctor charges for a consultation (I am based in LA also)? Could there be an option to do something similar to what you did but at lower settings? I am hoping to do something that means I can wear makeup a couple of days later and it be not so noticeable. A week is a little too long to take off work Posted Image


Consultations with Dr. Rahimi are free.

My downtime was a little over a week, during which I had to apply Aquaphor every four hours. I don't think make-up would be an option until after that recovery time.

And I don't know what that website means by "erbium fractional laser". There ARE some erbium fractional lasers that are ablative, but there are also lots of different types of erbium fractional lasers, so it's somewhat confusing.

#18 DudleyDoRight

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Posted 09 June 2012 - 08:53 PM

Fractional laser resurfacing for acne scars: a review.

Ong MW, Bashir SJ.

Source

Department of Dermatology, King's College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS, London, U.K.

Abstract

This review investigates the effectiveness of ablative and nonablative fractional photothermolysis (FP) lasers for treating facial acne scars. Twenty-six studies (13 ablative FP, 13 nonablative FP) published between 2003 and January 2011 were reviewed. Quantitative and qualitative data from each article were examined and analysed. Four studies were split-face randomized controlled studies. While the data analysed were all clinically relevant and significant, there were some methodological differences between the studies. Outcomes included subjective and objective assessment of scar appearance, pre- and postoperative treatment, side-effects and pain scores. A small number of studies used three-dimensional optical imaging profiling and histology for objective assessment. Even allowing for methodological variability, ablative FP had an improvement range of 26-83% whereas nonablative FP had an improvement range of 26-50%. Patients who underwent treatment with an ablative FP laser experienced erythema for 3-14 days which resolved by 12 weeks, whereas patients who opted for the nonablative FP laser experienced erythema for between 1 and 3 days and this resolved within a week. A higher proportion of patients (up to 92·3%) who underwent ablative FP experienced postinflammatory hyperpigmentation (PIH) than those who had nonablative FP (up to 13%). The maximum duration of PIH in ablative FP was up to 6 months whereas in nonablative FP it lasted for up to 1 week. The procedure with ablative FP was relatively uncomfortable compared with nonablative FP. The pain score with ablative FP ranged from 5·90 to 8·10 (scale 1-10) and with nonablative FP from 3·90 to 5·66 (scale 1-10).
© 2012 The Authors. BJD © 2012 British Association of Dermatologists 2012.

#19 DudleyDoRight

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Posted 09 June 2012 - 09:18 PM


Also DRaGZ I checked out your post and I think your results are pretty amazing. May I ask what your doctor charges for a consultation (I am based in LA also)? Could there be an option to do something similar to what you did but at lower settings? I am hoping to do something that means I can wear makeup a couple of days later and it be not so noticeable. A week is a little too long to take off work Posted Image


Consultations with Dr. Rahimi are free.

My downtime was a little over a week, during which I had to apply Aquaphor every four hours. I don't think make-up would be an option until after that recovery time.

And I don't know what that website means by "erbium fractional laser". There ARE some erbium fractional lasers that are ablative, but there are also lots of different types of erbium fractional lasers, so it's somewhat confusing.


I am telling you that doctor should give you a kickback for all the business you are throwing his way.

Also DRaGZ I checked out your post and I think your results are pretty amazing. May I ask what your doctor charges for a consultation (I am based in LA also)? Could there be an option to do something similar to what you did but at lower settings? I am hoping to do something that means I can wear makeup a couple of days later and it be not so noticeable. A week is a little too long to take off work Posted Image


You are going to have to look at something else if you cannot take off but a few days. I would imagine you could wear makeup shortly after subscision, but I may be wrong.

#20 DRaGZ

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Posted 09 June 2012 - 11:00 PM

I am telling you that doctor should give you a kickback for all the business you are throwing his way.


Haha, that would feel really gross and wrong.

I'm just glad that people are finding the doctor they want.