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

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Hey guys, I went in for the mixto procedure two weeks ago at Dr. Rihimis office. I havent had any side effects at all and im pretty damn happy i got this procedure done. If you can afford the $3000 i would do it IMO.

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I got to say, your perseverance is a wonderful thing and I do see the scars softening quite an amount mate! I can see rounded and smoother lighting gradients on them.

How have you been doing lately? Are you planning to go in for another treatment or will you be going another route like fillers or are you quite satisfied? Keep it up mate, you're quite the inspiration on this forum and I appreciate it.

Edited by NUman

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Hey Slee... Thank you for keeping us up to date on your progress. The scars look much softer and more blended in with the surrounding skin.

What's been the reaction from friends and family? Are they noting a difference in your skin? I know your mom initially said that she was unimpressed after your first treatment. Has she come around and finally started to notice the improvement?

A year makes a big difference. I think though, like a lot of us who've done very serious things to improve our skin, there comes a point where you realize that perfection is really impossible with the current technology.

Edited by blahblah82

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Nov 28th, Around 5 months - 6 months post mixto # 3. HAPPY THANKSGIVING EVERYONE



Hey Slee... Thank you for keeping us up to date on your progress. The scars look much softer and more blended in with the surrounding skin.

What's been the reaction from friends and family? Are they noting a difference in your skin? I know your mom initially said that she was unimpressed after your first treatment. Has she come around and finally started to notice the improvement?

A year makes a big difference. I think though, like a lot of us who've done very serious things to improve our skin, there comes a point where you realize that perfection is really impossible with the current technology.

My family has said they notice significant improvement, but they say they still notice the acne scars, but they said it looks less prominent and not as noticeable as before. :)

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I think punch excision or TCA cross might have been better for the kind of scarring you have. subcision is usually ideal for rolling scars, not ice pick. I'm happy you've had improvement. Maybe try TCA cross for continued improvement.

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I think punch excision or TCA cross might have been better for the kind of scarring you have. subcision is usually ideal for rolling scars, not ice pick. I'm happy you've had improvement. Maybe try TCA cross for continued improvement.

I don't know how effective TCA cross is, but I can't say I disagree with the above.

I have scarring similar to OP & I recently underwent 2 rounds of TCA Cross (spaced 1 month apart). I've been in this "game" long enough to know not to expect miracles from TCA Cross, & my main purpose for undergoing the treatment was to hopefully raise the boxscar & ice pick scars a bit so that expected future laser treatments would be more fruitful.

I bring this up not to talk about TCA Cross, but more to assess the practicality of a person's treating such scars with lasers. I replied much earlier in this post encouraging OP Slee to continue treatments as I have personally experienced that 1 session alone will not "cure" the scarring more than 20-30% at best.

So, first, I want to really thank Slee for continuing this diary of his treatment. Board member's diaries of their treatment experience is the best gift they could give any other member. It helps us not only understand effectiveness, life during recovery, & as the case here, hope when a treatment has positive results.

Second, speaking of recovery, which spurred tho reply, I do not know how practical it is to treat these types of scars with lasers. While Slee has proven that significant improvement is possible (a glimmer of hope for which this board always is in desperate need), it ha come at significant downtime. Each laser has at least a week or two of complete can't-go-out-in-public downtime & probably another month of red face healing. I personally cannot imagine undergoing 4 treatments like Slee or losing a month and a half every year like Dudley and his 7 or so fraxel treatments (sincerely no offense by these mentions, just my own opinion). Not only will my professional life not allow such repeated extended off-time, but more

Importantly, to me, I do not want to bear that cost personally & socially. I will continue to do TCA Cross, which I'm still unsure of its effectiveness (but still feels good to say you're doing something about it while only having half a week or so of downtime, if that) & stay hopeful for treatments like Airgent (currently giving more hope than any other feasible treatment in recent memory) or other future advances.

[Posted via mobile phone, so please excuse any spelling or grammatical errors.]

Edited by LearnedHand

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I think punch excision or TCA cross might have been better for the kind of scarring you have. subcision is usually ideal for rolling scars, not ice pick. I'm happy you've had improvement. Maybe try TCA cross for continued improvement.

Isn't TCA Cross a very risky procedure for Asian,Hispanic, Afro-American skin and should not be done for our skin type? From what I understand TCA Cross should only be done for light skin patients mostly on Caucasians. Correct me someone if I'm wrong? I know this Dr. actually does them from looking at his website, but don't think he recommended that for Slee.

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I think punch excision or TCA cross might have been better for the kind of scarring you have. subcision is usually ideal for rolling scars, not ice pick. I'm happy you've had improvement. Maybe try TCA cross for continued improvement.

Isn't TCA Cross a very risky procedure for Asian,Hispanic, Afro-American skin and should not be done for our skin type? From what I understand TCA Cross should only be done for light skin patients mostly on Caucasians. Correct me someone if I'm wrong? I know this Dr. actually does them from looking at his website, but don't think he recommended that for Slee.

TCA cross was INVENTED by a Korean doctor, and was widely practiced by Asian doctors before it made its way over to the United States. The original studies and before/after pics were performed on Asian skin types.

I'm Hispanic and have never had complications or hyperpigmentation from TCA cross. African American skin types may be different though.

It takes about six rounds of TCA cross before you're supposed to see results. Depending on the person, results can be mild or dramatic.

I've tried TCA cross. Saw the best improvement around the bridge of my nose and the least on my nose and cheeks. That makes me think it works better on people with thick skin.

Edited by Starlite

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Starlite, Are you a light skin HIspanic? I am Hispanic as well, but have a medium tan skin. You think this will work for me? Doesn't this cause discolartion problems for people with darker skin?

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Starlite, Are you a light skin HIspanic? I am Hispanic as well, but have a medium tan skin. You think this will work for me? Doesn't this cause discolartion problems for people with darker skin?

I know that I'm Fitzpatrick skin type 4. I think my skin tends to be a little lighter.

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Hey guys,

Thought I'd update since I am in a giving mood today :)

I had my third Mixto on 1 Oct and my fourth (possibly last) Mixto on 26 November, exactly 8 weeks apart. Between the third and fourth I've also had Iridex Diolite done for redness which helped.

Anyway, today I'm just over 3 weeks out from the last Mixto, and everything looks good. I expect in another month that I will see the final verdict on my healing, since that's how long it usually takes for me to see the final result from Mixto. Good news is that yes, after four rounds of Mixto I am FINALLY in a much more comfortable position with my face. It's almost been a year since I first came to Dr. Rahimi for my consult on having Mixto done, so I'm relieved to say the least. The first two ultimately seemed to have had very little effect, but the third one (done approximately 5 months after my second Mixto) totally changed my mind on Mixto. It left a much smoother appearance, and my face responded really well to it.

So I'd say give it time and patience in seeing results you want, because I really was ready to give up hope....glad I didn't.

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I think punch excision or TCA cross might have been better for the kind of scarring you have. subcision is usually ideal for rolling scars, not ice pick. I'm happy you've had improvement. Maybe try TCA cross for continued improvement.

Hi Starlite, so your saying from your experience with TCA cross, i may see better improvement? One thing that I have noticed from this laser is that it has not effectively improved the depth of my acne scarring (i.e. the hole from the ice pick scar is still there and noticeable). I read up on TCA cross and it seems like that may be the most viable option in terms of "filling" up the holes on my face or "craters" on my face. However, I spoke with Dr. Rahimi about possible TCA Cross, excision, and even fillers, and he told me with TCA cross, it can lead to unpredictable results, that is bad results. I wouldn't mind doing TCA cross or even trying it out, i may push Dr. Rahimi to at least try one of my deep cratered scars with TCA cross to see how I react to it. Ive just been extremely hesitant because Ive read the unpredictable results here on this forum and how some people have had disastrous results, further backed up by Dr. Rahimi's opinion of it as well.

I think punch excision or TCA cross might have been better for the kind of scarring you have. subcision is usually ideal for rolling scars, not ice pick. I'm happy you've had improvement. Maybe try TCA cross for continued improvement.

I don't know how effective TCA cross is, but I can't say I disagree with the above.

I have scarring similar to OP & I recently underwent 2 rounds of TCA Cross (spaced 1 month apart). I've been in this "game" long enough to know not to expect miracles from TCA Cross, & my main purpose for undergoing the treatment was to hopefully raise the boxscar & ice pick scars a bit so that expected future laser treatments would be more fruitful.

I bring this up not to talk about TCA Cross, but more to assess the practicality of a person's treating such scars with lasers. I replied much earlier in this post encouraging OP Slee to continue treatments as I have personally experienced that 1 session alone will not "cure" the scarring more than 20-30% at best.

So, first, I want to really thank Slee for continuing this diary of his treatment. Board member's diaries of their treatment experience is the best gift they could give any other member. It helps us not only understand effectiveness, life during recovery, & as the case here, hope when a treatment has positive results.

Second, speaking of recovery, which spurred tho reply, I do not know how practical it is to treat these types of scars with lasers. While Slee has proven that significant improvement is possible (a glimmer of hope for which this board always is in desperate need), it ha come at significant downtime. Each laser has at least a week or two of complete can't-go-out-in-public downtime & probably another month of red face healing. I personally cannot imagine undergoing 4 treatments like Slee or losing a month and a half every year like Dudley and his 7 or so fraxel treatments (sincerely no offense by these mentions, just my own opinion). Not only will my professional life not allow such repeated extended off-time, but more

Importantly, to me, I do not want to bear that cost personally & socially. I will continue to do TCA Cross, which I'm still unsure of its effectiveness (but still feels good to say you're doing something about it while only having half a week or so of downtime, if that) & stay hopeful for treatments like Airgent (currently giving more hope than any other feasible treatment in recent memory) or other future advances.

[Posted via mobile phone, so please excuse any spelling or grammatical errors.]

Glad to see your doing well with TCA Cross, please keep us (or me) updated with your results with TCA cross. You state you have similar scars as me, are you similar skin type as well? Could you PM me before and after pictures once your done with your treatment so that I may decide whether or not I want to pursue that route in the future?

I think punch excision or TCA cross might have been better for the kind of scarring you have. subcision is usually ideal for rolling scars, not ice pick. I'm happy you've had improvement. Maybe try TCA cross for continued improvement.

Isn't TCA Cross a very risky procedure for Asian,Hispanic, Afro-American skin and should not be done for our skin type? From what I understand TCA Cross should only be done for light skin patients mostly on Caucasians. Correct me someone if I'm wrong? I know this Dr. actually does them from looking at his website, but don't think he recommended that for Slee.

TCA cross was INVENTED by a Korean doctor, and was widely practiced by Asian doctors before it made its way over to the United States. The original studies and before/after pics were performed on Asian skin types.

I'm Hispanic and have never had complications or hyperpigmentation from TCA cross. African American skin types may be different though.

It takes about six rounds of TCA cross before you're supposed to see results. Depending on the person, results can be mild or dramatic.

I've tried TCA cross. Saw the best improvement around the bridge of my nose and the least on my nose and cheeks. That makes me think it works better on people with thick skin.

Glad to see you got improvement with TCA cross, i may need to look more into it in the future. Its just that Dr. Rahimi insists that mixto is the better option, and like i stated previously, TCA cross can lead to unpredictable results.

Hey guys,

Thought I'd update since I am in a giving mood today smile.png

I had my third Mixto on 1 Oct and my fourth (possibly last) Mixto on 26 November, exactly 8 weeks apart. Between the third and fourth I've also had Iridex Diolite done for redness which helped.

Anyway, today I'm just over 3 weeks out from the last Mixto, and everything looks good. I expect in another month that I will see the final verdict on my healing, since that's how long it usually takes for me to see the final result from Mixto. Good news is that yes, after four rounds of Mixto I am FINALLY in a much more comfortable position with my face. It's almost been a year since I first came to Dr. Rahimi for my consult on having Mixto done, so I'm relieved to say the least. The first two ultimately seemed to have had very little effect, but the third one (done approximately 5 months after my second Mixto) totally changed my mind on Mixto. It left a much smoother appearance, and my face responded really well to it.

So I'd say give it time and patience in seeing results you want, because I really was ready to give up hope....glad I didn't.

Glad to see your doing well and getting the results Ozay! Glad that my post has been beneficial to you!

Hey guys,

I got my 4th mixto procedure done on December 21st , 2013. Im about 3 days in so far, very similar type of experience as my last one, he went pretty deep again, maybe not as deep as the third, but around or little less in intensity than the third mixto. Ill post up pics sometime next week after the peeling is done. I just hope that with each and every treatment, Ill get more and more improvement until the point where my scars become non-prevalent and less noticeable. Unfortunately, the ice pick scars are still on my face, I do not think the doctor can go full blast with the laser to reach those deepest scars.....since it may lead to hypopigmentation spots. But steady as it goes.

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Well, every doctor has their own idea on how to treat acne scarring. I went to one doctor who pushed dermabrasion which seemed like it would be a disaster for my skin, since I'm thin and sensitive skinned and Fitzpatrick 4. I think it's good that your doctor is suggesting treatments that he genuinely believe will help, but from my perspective TCA cross is worth a try because it is a less expensive/invasive treatment. Did he tell you why he prefers not to do punch excision or punch elevation?

I'm also happy for OP! I've been debating whether or not to try Mixto and have been hearing nothing but positive reviews on this laser.

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7 Days Post Mixto #4 Update w/ pics

Where are your pics ? For some reason I can't see them

Edited by eagle1

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7 Days Post Mixto #4 Update w/ pics

I don't see them. Are they in your gallery ?

They are attached on this post, right underneath my written text. the latest ones are usually at the end .

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Dude, Slee, your results and your dedication to improving your skin is nothing short of amazing.

I do have one question for you, though: how much do you think the improvement of your results is due to higher settings versus incremental progress of the multiple treatments?

I know that it is practically impossible for you to differentiate between how the improvement came about, but I still ask because it seems that your improvement following your 2nd and 3rd treatments were far more apparent than following the first treatment. I also do remember you saying that you requested Dr. Rahimi to be much more aggressive in the subsequent treatments than the first.

Having boxcar & icepick scars similar to yours (primarily centered on the cheeks), I know the depth of the scars requires a more aggressive laser setting, yet, understandably and regrettably, most doctors will be weary to treat a new patient with such a setting until they see how it responds.

In the end, if you do thnk the higher, more aggressive settings of your latter Mixto sessions was a big factor in the increased improvement, then I feel like people like you and me essentially have a wasted first session because the doctor does not use settings that are aggressive enough to yield results for our type of scarring. Agree or disagree?

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Dude, Slee, your results and your dedication to improving your skin is nothing short of amazing.

I do have one question for you, though: how much do you think the improvement of your results is due to higher settings versus incremental progress of the multiple treatments?

I know that it is practically impossible for you to differentiate between how the improvement came about, but I still ask because it seems that your improvement following your 2nd and 3rd treatments were far more apparent than following the first treatment. I also do remember you saying that you requested Dr. Rahimi to be much more aggressive in the subsequent treatments than the first.

Having boxcar & icepick scars similar to yours (primarily centered on the cheeks), I know the depth of the scars requires a more aggressive laser setting, yet, understandably and regrettably, most doctors will be weary to treat a new patient with such a setting until they see how it responds.

In the end, if you do thnk the higher, more aggressive settings of your latter Mixto sessions was a big factor in the increased improvement, then I feel like people like you and me essentially have a wasted first session because the doctor does not use settings that are aggressive enough to yield results for our type of scarring. Agree or disagree?

how much do you think the improvement of your results is due to higher settings versus incremental progress of the multiple treatments?

Great question, a question that I have also asked myself throughout this laser process. And like you mention later on, it is not really *impossible*, but hard to gauge whether or not the improvement in results are due to higher settings or incremental progress (i.e. time lag, collagen build up). But to give you a straight up answer, I will have to say its a combination of both. Let me elaborate. But before i do, please do not quote me on any of my recommendations or words that I type out here, I am not a trained professional, I have not done thorough scientific research on lasers and their effects of different types of ethnic skin, I do not thoroughly understand the science behind how lasers may help with acne scarring. That being said, I will state what I have noticed throughout this process and just the small background knowledge I do have of lasers just reading articles and other peoples forums, and hopefully that will answer your question.

Firstly, due to my ethnic skin, Dr. Rahimi is a bit more hesitant to go as deep due to risk of permanent damage to my skin. Therefore, he cannot and will not go @ full laser settings. I believe that for the first session, that he went soft with the laser, just to see how my skin would react to the laser. For example, if he sets the settings around 7/20/10 (index or pulse duration / treatment density in terms of % / watts or "power"), I think he may have only done 2 passes in the more severed areas and just one pass in the areas where there are no scars. This led to very little downtime, less then a week, and only minor hyperpigmentation. Second mixto he may have done the same settings as the first, but he may have went over the more severed areas 3 times instead of 2. This led to another week of downtime but medium HP. After the third mixto, he may have went the same settings again and went over the severe areas 2 times, but then changed the settings to 7/20/13 where he increased the watts or "power" from 10-13 and maybe went over my scarred areas 1-2 additional times. Here, i had one week of downtime, but really really HARSH HP, i was literally tomato red from weeks 2-6, and it started to finally fade considerably after 6 weeks. So what is a common theme we have here? Common theme is not the downtime from the laser, cause it usually always last about one week, or if i were to give a range, 7-10 days. What differentiates every single time is the level of HP after all the skin sheds. PLEASE NOTE: this is just my hypothesis and theory, if you want to know exactly how Dr. R approaches it, you may have to ask him personally.

So there are I think two competing factors that help with the reduction of acne scarring after a laser treatment:

1. Immediate shedding of the outer skin or the technical term is the "epidermis". It is quite logical, your scars are imbedded deep within your skin, so when your "shave" a layer or the outer layer of your skin off, then your scars will not looks as deep anymore since your surround skin region is at a closer level to your scars, which will make the scars look less noticeable.

2. The collagen production after a laser treatment, or, the lasting effects of the HP after a laser. I read somewhere on this board that the longer the HP, the ability of collagen production increases. Please do not quote me on that. But logically, sort of makes sense, because if your face is red, your body notices that something is quite not right with your skin, so it will send aid to help heal it, or level or or dissipate the redness, in which where I think your body may be sending extra collagen proteins due aid in the assistance of healing of the skin.

So to really answer your question, it is actually quite complicated lol. I believe the higher laser settings leads to more HP which then leads to more collagen production throughout a 1-6 month time frame. However, the incremental treatments of multiple laser session allows the shedding of my epidermis each session, which then helps level my skin level to my scars, which is essentially saying, im shaving off layers of my skin so that it can reach the same depth of my scars. Which leads me to my next point, I DO NOT THINK that this is a good thing, which is why Im seriiously considering maybe to stop continuing on with these treatments. My skin riight now looks smooth and feels very very smooth. But I DO think I am shaving off layers of my skin everytime i do this laser, essenitally weakenning it considerably. I do not see any bad side effects right now, but I may pay the price in the future as i get older, and as my skin starts to deterioriate and get weaker. Obviously less elastic, thinner, and thus weaker skin will definitely be more prone to aging issues. But the question then is, after each laser session, doesnt my skin or epidermis layer regenerate ? That I am unsure of, and cannot answer, if it does, then I have less to worry about, if it doesnt, then that is not good for my skin. If it is in between then its something to consider. But I do know my skin is getting weaker due to 2 things, my face is getting more proned to dark sun spots, and my skin is more sensitive, meaning it gets red VERY easily. What I mean by that is, if i touch my face or i scratch my face, it turns red very easily, meaning its very sensitive. This is not just after a laser session, but even 6 months after a laser session, it is like this. That being said, I do believe the benefits have been worth it so far, my face does look extremely better IMO, I can actually look myself at the mirror now and not squint at my acne scars, they are considerable less prominent on my face. But in the long term future, I do not know If i will see any side effects due to the weakening of my skin from this laser. That is why I have been VERY VERY active in taking care of my skin here are some things that I do:

1. Drink Green/Black Tea every day

2. Take Vitamins every day (vitamin C, fish oil, multivitamins)

3. See an esthetician once a week who does a variety of things like facials and other types of facial treatments)

4. Workout 3-4 times a week

5. Try to eat healthy , lots of fruits and veggies

6. During this 4th treatment, I bought those green machine naked juice, I think that may have helped my healing process and explained why I healed SO FAST.

7. Religiously using aquaphor after each and every mixto session, as well as hydrocortisone after the peeling process.

8. EVERYDAY use SPF 50+ sun block.

9. USe other ointments on my face such as EGF (epidermal growth factor) serums that my esthetician provides for me.

So basically in conclusion, I think after-care is just as important if not even more important then the laser itself. Like i stated previously, I do not have any ill side effects from this laser other than the sensitivity of my skin, but in the future we shall see whether or not my skin starts to weaken considerably faster due to my thinner skin.

further, I do think its MOST Optimal to spread out the laser sessions 6 months apart, not 3 like I did............ I believe I did 3 straight in three month time spans, I do not think that was good for my skin......I think its best if you spread out the treatments 6 months - 12 months apart to allow your skin to FULLY heal before going at it again. I do not mean to scare anyone from lasers from this post, but Ive been doing a lot of thinking and I talked to my family members, and they are telling me to stop with these treatments, simply due to the fact that I am weakening my skin considerably with each and every treatment. Further, my % improvement from each treatment is reducing, meaning the law of proportions, you get 50% improvement after 2-3 treatments, 4th treatment, maybe 20-25% improvement, etc... So you have to really gauge whether or not that extra % of improvement is worth it when considering the fact you are weakening your skin. In a perfect world, I would do this laser 1-2 times every year, but now I am starting to feel hesitant because I need to really understand if there are any long term impacts and damages I am doing to my skin from these laser treatments.

Sorry for the extremely long rant, this has just been something I have been talking about with my family members and something you guys should also consider, the "long term ramifications" from laser treatments. Dont get me wrong, I am EXTREMELY happy with DR. Rahimi and these laser treatments, I see much better improvement, and no ill side effects currently, but Im starting to look into the future and hopefully will not see ill-side effects when i get older, which is why I have been very active in taking care of my skin currently so that will not happen in the future.

Anyways, best of luck, hope this post helped out.

PS I do not proofread, sorry for any grammatical errors.

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Great post Slee. I really commend you for keeping this really insightful thread alive. This is far one of the most impressive accounts on this board for it's exhaustive thoroughness. You've really come a long way over the past year. I do agree that any kind of resurfacing treatment essentially thins the skin over time. How much exactly is still an unknown. For example, if 1 mm is 1000 microns, and each time you do a laser you are vaporizing 250 microns or more of your skin, how much of that regenerates? If you do 4 sessions of laser at an average of 250 microns, does that mean you have lasered the skin down 1 mm in depth? That would be a significant reduction in skin thickness. I think the key difference is that you are doing fractionated lasers, which leave large portions of the skin untouched. Essentially each time you laser your skin, the scars are vaporized little by little, and the collagen that grows in to fill those vaporized holes are organized more normally instead of as rigid scar tissue.

I also agree, that there is a diminishing marginal return to any kind of scar treatment. Eventually the improvement gets smaller and smaller with each successive treatment and you may reach a tipping point where you can do more damage than good. Example, with resurfacing you probably have to go deep to cause a real change, but if you go too deep than you will cause additional scarring.

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