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

ice pick co2 fraxel cortisone needling aha alpha hydroxy acid concealer hyperpigmentation

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#21 jbird12

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Posted 21 December 2012 - 08:18 PM

Looking good so far!

#22 Black*Falcon

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Posted 22 December 2012 - 06:01 PM

Yeah looks awesome, scott.

#23 slee3

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Posted 23 December 2012 - 07:42 PM

I should also note, im experiencing a negative side affect, which I am hoping is temporary. He performed the laser right underneath my eyes to help with my eye bags and darkened spots near my eyes due to just tiredness as well as excess use of acne treatments which dried out my face a lot. Anyways, right now, I have these large dark spots which look like bruises right underneath my eyes. It looks like I got punched in the face. Anyways, I hope this fades away.

#24 DRaGZ

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Posted 23 December 2012 - 09:22 PM

Those peel off. The weaker the laser was, the longer it takes to peel off.

#25 *Inspired*

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Posted 23 December 2012 - 11:08 PM

I just wanted to wish the best of luck with healing. I did notice the dark bruises under your eyes in your pictures. Hopefully, that will resolve for you soon. I don't think they will peel off though but should fade like any bruise. Good luck!

#26 slee3

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Posted 29 December 2012 - 11:24 AM

2 Weeks Post Mixto Updated.

#27 DRaGZ

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Posted 29 December 2012 - 03:55 PM

In response to your newest update, I suspect it may be because they are ice picks. Ice picks are hard to treat with ANY treatment, particularly because they're hard to get at. That's why isolated ice picks are often singled out for excision or similar treatments, because it's just easier to remove it altogether than improve it.

In the case of Dr. Rahimi's sculpting technique, it probably won't work as well on ice picks simply because there's no much to sculpt around the picks. With my scars, which were mostly rolling and boxcar with a few icepicks, he could sculpt down the edges and make them much softer, causing an immediate effect while waiting for the collagen remodeling process (which takes at least a month just to see anything at all). With ice picks, you can't really do that, so you just need to wait for the remodeling process.

Honestly, Dudley and I went through a similar thing where the improvement just crept up on us a month or so after the procedure. I remember looking in the mirror one day and going "whoa...it wasn't like that before."

And then there is also the distinct possibility that the treatment just didn't take. I'd always suspected that my own strangely effective improvement with the Mixto was because it was bolstering a previous session I had with the Lux 1540, which technically hadn't completely finished its own collagen remodeling process (it had only been three months, I think).

Unfortunately, you won't know for sure until a few months down the line. And waiting's a very difficult game.

#28 austra

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Posted 29 December 2012 - 04:34 PM

Thank you for the update! I'm sorry to hear you haven't seen improvement, but it really is too early to say anything about the final result yet. Hopefully things will look better in a month or two.

And the hypopigmentation is a rather scary side effect! At least you do have it in such an unnoticeable place though. I hope it's going to fade away with time. It will probably at least look better and more unnoticeable down the line. But thanks for reporting about that too, and please keep us updated. Good luck with the healing!

#29 austra

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Posted 29 December 2012 - 04:57 PM

Another thing i should note is that i have been taken 4x the dosage of doxycycline ( ~400 MG). I actually didnt ask the Doctor if this was okay, but Ive been taking 4 times the dosage (2 after breakfast and 2 after dinner) because I really really do not want to break out from this aquaphor treatment. and so far, havent broken out yet! so pretty happy with that.

This is a bit late, but in any case - please do check with your doctor from now on before quadrupling your dosages! I know very little about antibiotics or pharmaceuticals in general as I'm so early in my medical studies, but some antibiotics are liver toxic and it really may not be safe to take any more than what your doctor tells you to take. Please do not take any liberties as you may not know the full risk you're taking. It's important to consult your doctor first.

#30 DRaGZ

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Posted 29 December 2012 - 10:17 PM

Doxycycline is known to cause stomach and liver issues if taken in too large quantities at once, so be careful. It also probably doesn't help with your body building up an immunity to it, either.

#31 whoartthou1

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Posted 30 December 2012 - 02:33 AM

A standard dosage of doxy is 100 mg 2x a day.

#32 blahblah82

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Posted 30 December 2012 - 06:06 AM

Hey slee..... Am I reading correctly that it is white? Are we talking like no pigment at all? If it truly is hypo pigmentation it may be more cause for concern because that can be permanent as opposed to an excess of pigment. This should be closely monitored.

Dragz, do you think the palomar would really contribute much to collagen remodeling? I thought it is standard knowledge that non ablative treatments are negligible if not useless for atrophic scars.

I would agree with you slee that this was not that aggressive. Did he do multiple passes? A day after mine my face looked like a skinned knee. I didn't see that part in your sequence of pics.

#33 DRaGZ

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Posted 30 December 2012 - 10:18 PM

Dragz, do you think the palomar would really contribute much to collagen remodeling? I thought it is standard knowledge that non ablative treatments are negligible if not useless for atrophic scars.


They are not useless, they are just incredibly slow.

#34 slee3

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Posted 31 December 2012 - 12:40 AM

Hello guys,

To Dragz: Yes, your right, I completely understand that patience is a virtue with these kinds of things. And I do really understand that I have pretty deep ice pick scars that are really hard to treat. Due to this, I understand it will probably take multiple laser sessions to get to where I want my face to be at. What else complicates things is due to my ethnicity (asian), which is much harder to treat. Where Dr. Rahimi has to go more conservative than he wants simply due to the negative side affects that may occur with ethnic skin. Ill be more patient and I do believe I over-reacted in my last update. It was just very disheartening to see every single one of my scars back, but looking at my skin from a macroscopic (overall) point of view, I do see some improvement, slight improvement, but definitely not where I want it to be. Anyways, It is extremely hard to judge these kinds of things and actually put a percentage on how much improvement there is.

To Austra/Dragz: Yes, you guys are probably right. And one of the posters mentioned that its 2 tablets per day, so essentially i was taking 2 X the dosage, not 4, my mistake. But anyways, I have heard about the side affects and only did this for the first week after my laser, and I stopped taking them all together now, since I am actually not breaking out anymore (thank you Winter!). But yes, Ill make sure I monitor how much doxycycline i take in the future, and to be honest with you, im probably just going to stop taking them all together, I just hope I stop breaking out, especially during summer time in the dreaded heat Posted Image.

To Blah Blah, yes the hypopigmentation is something I am pretty worried about. But luckily, its very small, and near the side of my face, and its very unnoticeable. On the other hand, it is a slight disappointment. Not exactly sure what happened there, I spotted it immediately after the surgery when they handed me a mirror. I didnt ask the doctor about it, but I was thinking in my head why does that small region look so different from the rest of my skin? It seems that it got completely ablated and all the upper layer skin got lasered off. It was weird, I do not want to challenge Dr. Rahimi's ability, but if he made a mistake, he made a mistake. And to me, it really seems like a mistake to me, since all my skin other than that small region looks all the same. But before I start making any accusations, Ill talk with Dr. Rahimi and ask him what he thinks and what course of action we should take.

Also, didnt ask him how he did the procedure, but Im pretty sure he did multiple passes on my cheeks/temple region where the scars are the most prominent, simply because right now, that is only where the hyperpigmentation is. Also yes, he went conservative, my face after the surgery didnt look anything like I expected. Basically, I wasnt bleeding anywhere, my face was just swollen and extremely red. I really think he went conservative this first time around. The thing is, I truly understand where he is coming from as well, its better to be conservative than be un-conservative and have some permanent damage to the skin. So I actually prefer his method, other than that one region that I mentioned previously. But next time, Ill ask him to maybe go a little harder at it if he thinks thats whats best.

Edited by slee3, 31 December 2012 - 12:46 AM.


#35 *Inspired*

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Posted 12 January 2013 - 07:54 PM


It's been about 2 weeks since your last update. How are you doing at this point? Hopefully, your skin has fully healed and the hypo-pigmented spot has resolved.


#36 slee3

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Posted 13 January 2013 - 11:35 AM

Hey guys,

Day 30 Post Mixto Update.

#37 LearnedHand

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Posted 13 January 2013 - 11:55 PM

Hey, I just wanted to thank you for sharing your experience, and importantly also for documenting it with photographs and progress updates. While it may seem like a pain to do, each post you make is a critical aid in helping us also decide on which treatments might or might not work for our own skin.

I am commenting because I actually have riddled skin with icepick scarring that looks very similar to your scarring, and I too have also made an intial appointment with Dr. Rahimi and am considering doing the same treatment as you are currently.

Prior to deciding I wanted to get treated by Dr. Rahimi, I actually have already underwent another laser treatment (Active FX+Deep FX combo), maybe 4-5 years ago. I noticed similar things you are noticing right now, and, on the positive, you will actually continue to see improvement after the micro-swelling has gone done. It is important to realize that the micro-swelling will remain longer than you believe and it's reduction is commonly what gives many patients to believe that their laser treatment has not helped at all (b/c initially the swelling hides many scars). On the negative, regarding icepick scars, I have undergone many treatments, and their depth meakes them really difficult to treat. BUT each treatment you perform does in fact improve their appearance, as the grass will always be greener (or prettier) on the other side, judging our acne scars from present day feelings. In retrospect, I found that even just undergoing the treatment was beneficial for my psyche, opposed to remaining idle and passive regarding my scars. The improvement was probably around 20-25%, and while that might sound minor, it is still 20-25% better than it was before (in addition to providing other overall benefits to the complexion of my skin).

I say this to provide hopefully another baseline from which you can judge the efficacy of your treatment, but also to make the important point that multiple treatments will continue to provide improvements that will benefit your skin and your psyche/confidence slowly, but greatly. Specifically, I am interested in working with Rahimi because I was drawn to the fact that, at the outset, he has you scheduled for two sessions of laser treatments. While I know the downtime will be tiresome and unpleasant, I believe these multiple sessions will provide the aggressive approach to getting the skin that you, or I, want, and so I encourage you to continue posting and following up if you can.

I will be following your journey closely and I hopefully anticipate your results because, like I said, our scars are similar.

Thanks for all you have written and that which you may continue to write.

#38 slee3

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Posted 14 January 2013 - 12:32 AM

Hey, I just wanted to thank you for sharing your experience, and importantly also for documenting it with photographs and progress updates. While it may seem like a pain to do, each post you make is a critical aid in helping us also decide on which treatments might or might not work for our own skin.

I am commenting because I actually have riddled skin with icepick scarring that looks very similar to your scarring, and I too have also made an intial appointment with Dr. Rahimi and am considering doing the same treatment as you are currently.

Prior to deciding I wanted to get treated by Dr. Rahimi, I actually have already underwent another laser treatment (Active FX+Deep FX combo), maybe 4-5 years ago. I noticed similar things you are noticing right now, and, on the positive, you will actually continue to see improvement after the micro-swelling has gone done. It is important to realize that the micro-swelling will remain longer than you believe and it's reduction is commonly what gives many patients to believe that their laser treatment has not helped at all (b/c initially the swelling hides many scars). On the negative, regarding icepick scars, I have undergone many treatments, and their depth meakes them really difficult to treat. BUT each treatment you perform does in fact improve their appearance, as the grass will always be greener (or prettier) on the other side, judging our acne scars from present day feelings. In retrospect, I found that even just undergoing the treatment was beneficial for my psyche, opposed to remaining idle and passive regarding my scars. The improvement was probably around 20-25%, and while that might sound minor, it is still 20-25% better than it was before (in addition to providing other overall benefits to the complexion of my skin).

I say this to provide hopefully another baseline from which you can judge the efficacy of your treatment, but also to make the important point that multiple treatments will continue to provide improvements that will benefit your skin and your psyche/confidence slowly, but greatly. Specifically, I am interested in working with Rahimi because I was drawn to the fact that, at the outset, he has you scheduled for two sessions of laser treatments. While I know the downtime will be tiresome and unpleasant, I believe these multiple sessions will provide the aggressive approach to getting the skin that you, or I, want, and so I encourage you to continue posting and following up if you can.

I will be following your journey closely and I hopefully anticipate your results because, like I said, our scars are similar.

Thanks for all you have written and that which you may continue to write.


Hello LearnedHand,

I totally agree with everything you have said in your post. First of all, I am writing such a comprehensive blog on this so that I can help people like myself (and you), because to be honest with you, only people with acne scarring knows the pain that we all go through everyday with such horrible skin. Its kind of funny because I told my manager at work I was going to do some laser treatment to help with my acne scarring and he was like "what!?, I dont even notice them"...and I just rolled my eyes at him haha. Because first of all, they are definitely noticeable and not very normal to have......but i guess normal people with good skin, or just normal people in general dont really notice that kind of stuff. And all my friends are just used to me having these scars, so they dont really notice them either. But ya ive been living with horrible acne and then horrible acne scars for 10 years already, and I am trying to do whatever it takes to make it look better, cause yes, it sucks to have them.

And yes I am proud to say that I feel so much more confident right now, just after one laser, even if it was only 15-20% improvement. I feel confident now because like you mentioned, the grass is always greener on the other side, and I know that after 2-3 more of these laser treatments, I think I will be satisfied with where my skin can potentially be. And yes, I will definitely continue to write a comprehensive blog about my overall journey, so that I can help as many people as I can. You should also thank "dragz", the original poster of his mixto journey, he is the main person that led me to Dr. Rahimi. But yes, I think people definitely need to understand that ice pick scars are probably the hardest scars to treat, so one must definitely needs to show patience, but yet also persistent in their future journey in helping improve their acne scars.

Im really happy Ive helped you LearnedHand, best of luck on your journey as well.

#39 dragonn

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Posted 14 January 2013 - 01:20 AM

Hey LearnedHand, did you only have one TotalFX done? And if it worked well, why not do that multiple times, why the switch to Mixto?
And yes, thank you Slee and LearnedHand for the time you spend writing your experiences. It is invaluable!

#40 LearnedHand

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Posted 14 January 2013 - 10:50 PM

Hey LearnedHand, did you only have one TotalFX done? And if it worked well, why not do that multiple times, why the switch to Mixto?
And yes, thank you Slee and LearnedHand for the time you spend writing your experiences. It is invaluable!


Yes, I only had one done. I did not do it multiple times because the doctor I chose to go with did not advocate such an aggressive treatment plan as that would be.

I am actually only heavily leaning towards Mixto just because of (1) the positive reviews he has gotten on the board, (2) his aggressive treatment plan, (3) good pricing + local.

I will say though, because my scarring is so similar to Slee's, with icepick/boxcar scars heavily concentrated on my cheeks, that my choice of the Mixto treatment with Dr. Rahimi will be heavily impacted by Slee's outcome. However, I do expect that he will see positive results because, despite all the various comparisons between one laser versus the others, acne scars, especially those involving deep scarring like mine and Slee's (as opposed to rolling scars), are not generally amenable to results that will be given rave reviews after only one treatment. That is not to say they won't produce results after the first treatment, but rather it is just to emphasize that my belief is that it is multiple treatments, regardless of minor differences b/w the lasers, which produce the results for our types of scars that we can be satisfied it.

(I liken it to TCA CROSS, which I also used to do with varying results, due to difficulty in precise placement into the scar of the high concentration of TCA acid. Ultimately, I moved on from continuing TCA CROSS b/c although I believe some scars might have become less deep, I also observed a widening of other scars, making them more boxcar-like, from an imprecise placement of the TCA Acid.)

And yes, everybody should thank Slee & Dragz (whom I also heavily read, but did not feel so compelled to comment due to what I believed to be inherent differences b/w the type of my and his scarring) because, when I chose TotalFX, I spent months and months scroungingall over the web to find reputable reviews of the laser that included more than just mere journaling, but pictures as well. The pictures are incredibly important, not only to our own evaluation of the scars, but to those evaluating whether we think the treatment will be effective for our own skin.

Edited by LearnedHand, 14 January 2013 - 10:50 PM.





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