Mixto Sx Co2 Fractional Laser Surgery Diary: Asian With Ice Pick Acne Scars On Cheeks/temples.

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Hey BlahBlah82,

Yes I can tell he went more aggressive this time around...He stated to me he went medium the first time, and that he will go aggressive for this 2nd procedure. Further, he focused mostly on my cheeks/temples since those are where my scars are localized. Also, to be honest with you...my mom's opinion has no credibility lol. My mom (and my entire family in fact) were under the presumption that these laser treatments would miraculously make my skin look as smooth and clean as a 2 year old baby's skin. I explained to them that The fact of the matter is that the damage has already been done, and that I will never achieve perfection, but am trying my best to lessen the severity and make them look less noticeable. So ill repeat again, people who dont know much about lasers think its some kind of miracle procedure, but an educated person about lasers and about acne scars knows that is not the case.

And your welcome. I am doing such a comprehensive blog simply due to the fact that as i was scrounging around the internet to read upon other people's journey with CO2 fractional lasers....I simply didnt find that many...and if I did find some...they really werent that detailed and very descriptive....therefore i took it upon myself to do so...so that i can help others like me achieve the better skin, which in turn will give me better confidence in life in whatever challenges come forth my way (I am actually studying and prepping to get into medical school, so nicer/cleaner skin would be nice if i do ever become a doctor in the future haha).

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Just wanted to say thanks for keeping us updated with this.

Is Dr. R combining the laser with anything like subcision or just doing a straight laser? Is there any particular reason you chose to treat the whole face vs just the cheeks?

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Hi AcneScar123,

For the first session he performed a laser + subcision. 2nd time he only performed the laser. I didnt really ask him why he didnt do it the second time...i guess because I have mostly ice pick scars, where as subcision is good for rolling scars which i do not really have.

Secondly, Dr. Rahimi prefers to treat the whole face for evenness...but areas where I dont have scars he only passes once, in essence does it very lightly. The more prominent areas he does more passes, which leads to more aggressiveness. And secondly, I didnt have a preference whether or not he does my entire face, he is the doctor and the expert, so I just allow him to do whatever he thinks is best for my situation. So I dont really ask why he does this or that since he is the expert...i just ask what he is exactly doing so I can let you guys know whats going on.

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Thanks for the update! :) I'm glad the healing has been going well, and looking forward to hearing what improvement you get later on. All the best!

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Thanks for keeping us in the loop. From the pics it looks like your scars are getting softer?

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Slee3,

Would you be able to upload some of the pictures on imgur.com or something (as a gallery) as some of them appear out of order in the attachments I think. Your scarring looks like it's slowly smoothing out. The edges are looking softer.

Have you looked into TCA Cross? I know Dr. Rahimi doesn't do it but I think something like that may help? "70%+ improvement on 50-70% of patients with ice pick scarring." Might be worth looking into.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956965/

http://www.ncbi.nlm.nih.gov/pubmed/21332915

http://www.ncbi.nlm.nih.gov/pubmed/16918559

http://www.ncbi.nlm.nih.gov/pubmed/12460296

http://www.ncbi.nlm.nih.gov/pubmed/21031068

http://www.ncbi.nlm.nih.gov/pubmed/19076629

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hey acnescar123,

Ive uploaded a link to the album of my pictures per your request, let me know if it works.

And yes, I have looked into TCA Cross method, one of the first doctors that I saw for my acne scarring (not Dr. Rahimi) was planning on doing the TCA cross on me. But after doing some research on this site about that method, I decided not too due to some of the negative experiences some people had with it.

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thank you slee3 for the updates, i'am waiting and hoping for the same treatment, this has been a tremendous help thank you

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What's the diff bet Mixto and Fraxel? I only read this india asian girls treatment with Fraxel and it seems cheaper and work better?

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May 4th Update / Week 8 Post Mixto #2

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May 4th Update / Week 8 Post Mixto #2

I'm so happy for you Slee! The scars do look a lot softer and I agree with your assessment of your improvement.

I hope your next one is even better! Thank you so much for your diligence in keeping up this log. You have definitely given me hope.

I, too, plan to do multiple sessions; as many as it takes to be satisfied. rolleyes.gif

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I'm over six weeks post-op from my 2nd Mixto, and plan on going in for Ultherapy with Jessner Peel at the eight-week mark. After being depressed from my scars for so long my face etched itself a permanent sad look. So my goal is to perk it up with Ulthera and get rid of old discolorations with Jessner.

Mixto (via Dr. R) did a superb job in lessening the acne scars, so I plan on getting a couple more in the next 6-8 months to fully get the results I want. But so much for saving and spending money on luxuries many other people take for granted; i.e. sporting events, vacations, new car, etc...sigh

It's been my personal experience that you get convincing results from Mixto (or any other invasive laser) after 2 treatments, and not the first.

PS: Does anyone know the best way to heal the red scar marks that just wont' go away for me?

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Any % improvement guesstimate Ozay? What type of scarring did you have? Did he combine it with subcision ?

I think IPL laser is the best way to get rid of redness, but you can try other exfoliation stuff (ie retin a).

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Honestly, if I had to guess I'd say it's about 60% improvement...way better than what it was from my first Mixto. In the past I've done dermarolls, YAG laser, various peels, creams, etc. etc...but NOTHING compares to getting treated via ablative lasers a few times. I'm so glad I did this but I need to deal with my other issues regarding discolorations/uneven skin tone...so that's where I'm at now.

I only had Mixto done, no subcisions or anything else...but like I said I am going to wait a few more months for my third Mixto and get Ulthera with Jessner Peel done in two weeks.

My scars were almost as bad as Ernestoria's (if not the same)...I think I had every type of scarring you can think of coming from acne; rolling, ice pick, boxcar. LOTS of depressions all over, but nowadays most are smoothed out and I feel more confident than I've ever been...but those darn discolorations/uneven skin tone!!

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Very good post. I was wondering who was writing such an informative post, and then I saw the formerly TokyoGirl.

Thank you for sharing your experience.

You said Vicodin ES for cold sore prevention. Do you really mean Valtrex? Vicodin a painkiller. It won't do anything for cold sores.

180 micrometers (0.18 mm) is actually very superficial for scar treatment. 300 micrometers (0.3 mm) is deeper. 0.3 mm is how deep Active FX penetrates. This is the reason I chose not to proceed with MixTo.

70 MJ is the maximum energy setting for Re:pair. You can't really compare it to other lasers because every laser uses energy differently. In other words, 70 MJ is only relevant to depth when you're talking about Re:pair. You get about the same depth with Deep FX around 18-20 MJ. I'm not sure of Deep FX's setting exactly but it's much lower than Re:pair at the same depth.

I hope this treatment works for you, and am hoping for the best! Best of luck!



thanks for sharing and i hope the best for you,, also i would to ask u about doxycycline?? are you know the role of it?,cuz my docter gave it for me to treat my face redness that caused from using 10%hydroxy acid exfoliator 7 months ago..


I am using Doxycycline right now for active acne, and used it before and after laser treatment to prevent acne. Does your doctor think you have an infection? It is an antibiotic.

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Looking great bro. I notice significant improvements before and after. I am curious as to what the coverage rate and depth was. Also, did you experience any pin-point bleeding or in my case (massive bleeding)? I am intrigued as to why some of the deeper ablative fractional lasers cause bleeding and some don't, and how it relates to their results and improvements.

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Looking great bro. I notice significant improvements before and after. I am curious as to what the coverage rate and depth was. Also, did you experience any pin-point bleeding or in my case (massive bleeding)? I am intrigued as to why some of the deeper ablative fractional lasers cause bleeding and some don't, and how it relates to their results and improvements.

He posted the settings in the first post:

"Settings he plans on using on mixto: 7/20/9 or 7/20/10. With the 180 micrometer, not the 300 microumeter (300 micrometer I believe is for superficial scars/wrinkles/fine lines, while 180 micrometer is for deeper acne scars)."

From what I gather these are fairly low settings? Probably because of his skin tone.

Edited by acnescar123

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Looking great bro. I notice significant improvements before and after. I am curious as to what the coverage rate and depth was. Also, did you experience any pin-point bleeding or in my case (massive bleeding)? I am intrigued as to why some of the deeper ablative fractional lasers cause bleeding and some don't, and how it relates to their results and improvements.

He posted the settings in the first post:

"Settings he plans on using on mixto: 7/20/9 or 7/20/10. With the 180 micrometer, not the 300 microumeter (300 micrometer I believe is for superficial scars/wrinkles/fine lines, while 180 micrometer is for deeper acne scars)."

From what I gather these are fairly low settings? Probably because of his skin tone.

That is the width of the MTZ (micro thermal zones). 180 micrometer is used for deeper treatments such as DeepFX and fraxel repair. 180 MM goes without saying assuming he had the Mixto for indented scars. I'd like to know at what coverage % he was treated, how many passes and the actual depth of the treatment. mJ is a bad way to compare depths of lasers as they all require different energy for the depth required. I'd also like to know how much bleeding and swelling was experienced from the Mixto.

Edited by collegeboy84

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Looking great bro. I notice significant improvements before and after. I am curious as to what the coverage rate and depth was. Also, did you experience any pin-point bleeding or in my case (massive bleeding)? I am intrigued as to why some of the deeper ablative fractional lasers cause bleeding and some don't, and how it relates to their results and improvements.

Hi Collegeboy84, full coverage, depth I am uncertain, Dr. R did say that the mixto can reach all the way down to my deepest scars.

Yes I did experience some pin point bleeding in some locations (only a few), other than that my face was just raw red. my face did not look like your face whatsoever after your fraxel, goes to show I think Fraxel Repair is more ablative and more aggressive. I was turned off my Repair because of that, I wanted to be more conservative due to my ethnic background (korean), and did not want to risk permanent damage from Repair. But, that being said, Repair Probably does give better improvement than mixto since it is more aggressive.

June 1, 2013 Month 3 Post Mixto #2 Update (disappointing post)

Edited by slee3

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So, apparently, laser results do have a time lag in terms of results, I am happy to say that I have noticed some improvement from Week 2 to Week 4 after the mixto laser. Although results have been very subtle, slight improvement, nothing drastic in any way.

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.

Keep us posted!

Edited by collegeboy84

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Collegeboy - that's most likely because traditional co2 doesn't go deep at all

AblativeFractional-diagram.png

I think what most likely happens is that the top of the columns gets healed quickly (within the 1-2 weeks) and then the columns underneath the top layer take a few weeks to properly build up collagen and thus why you notice a plumping effect a few weeks later. I don't think they need to go deeper than the scar itself, but they need to go deep enough to hit the bottom of the scars. Technically speaking - I don't think blood matters a lot with lasers as in principle lasers are supposed to coagulate the blood vessels at the same time as they burn it off.

Also from what I understand, almost all fractional co2 lasers can reach similiar power settings - it's just based on the doctor to properly set them up (except the ultrapulse which can reach 100% ablation).

According to slee's post - his doctor used, "7/20/9 or 7/20/10" which is an index setting of 7, density of 20% and a power setting of 10 watts which on the mixto website are the base settings for acne scars:

"21. What is the best setting for acne scars? Use the 300µm spot - start with a setting of 12 Watts and Index of 7 with a density of 20%. For sever acne scars a double pass or an increased density of 40% could be chosen if clinically indicated."

However, if the doctor wants -

"The MiXto does have the ability to go as deep as our competition when using the 180µm handpiece with the proper Wattage and Pulse Duration, however clinical evidence is showing that while using the 300µm handpiece, at 10-12 watts, 20- 40% density, and an index of 6-5 (3.5-4ms) in enough to produce significant skin tone, color, and skin tightening results while maintaining patient comfort and satisfying their expectations."

Now in terms of depth - the mixto can go up to 500 microns, whereas the deepfx can go up to 1600 microns BUT the epidermis of the skin is only 100 microns (1600 microns is something you use for scars on the back for example). Since he's using a power setting of 10 and the mixto can go up to 20 (for 500 microns) - he's probably at around 250 microns of depth.

Personally speaking with a lot of the stuff you read online about lasers, you have to take into account skin tone, treatment parameters, type of laser etc. I haven't read too many reviews of people who actually knew they were treated at the maximum settings with a fractional co2 laser and with 2-3 treatments (and there are a lot of people who can't use the maximum settings ie asians).

I think the key to treating acne scars with fractional co2 is power + depth. If you do too much power - you won't reach deep enough to treat the scars and if you do too much depth but not enough power - you get activefx/fraxel restore. Ideally you should be at 500+ microns with a 40%+ coverage

The energy setting doesn't matter too much as that is just the power it needs to reach a certain depth i.e.

NsxozOx.png

Most doctors only go until they hit the reticular dermis - which is ~300-700 microns in depth (as there is no more tissue to ablate). The issue with icepicks though is that they're usually around 2000 microns in depth (boxcars are ~500) - this is why the top of the scar will improve and look softer, but the scar itself is too deep to actually improve. Dermabrasion is usually around 300 microns and Phenol peels are 500-1000 microns. The new scarfx is 4000 microns.

The reticular dermis beings around where the pink ends in the pictures:

acne-scars-types.jpg

Edited by acnescar123
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