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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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#61 acnescar123

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Posted 06 April 2013 - 07:26 PM

Thanks slee3.



#62 12xu

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Posted 07 April 2013 - 04:08 PM

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



#63 runnyeggsham

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Posted 11 April 2013 - 06:08 PM

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?



#64 slee3

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Posted 04 May 2013 - 10:09 AM

May 4th Update / Week 8 Post Mixto #2



#65 dragonn

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Posted 04 May 2013 - 09:06 PM

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



#66 Ozay

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Posted 05 May 2013 - 12:46 PM

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?



#67 acnescar123

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Posted 05 May 2013 - 06:36 PM

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).



#68 Ozay

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Posted 05 May 2013 - 09:12 PM

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!!



#69 DudleyDoRight

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Posted 25 May 2013 - 09:50 PM

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.


#70 collegeboy84

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Posted 27 May 2013 - 09:09 PM

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.



#71 acnescar123

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Posted 28 May 2013 - 02:46 AM

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, 28 May 2013 - 02:47 AM.


#72 collegeboy84

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Posted 28 May 2013 - 01:52 PM

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, 28 May 2013 - 01:53 PM.


#73 slee3

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Posted 01 June 2013 - 04:56 PM

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, 01 June 2013 - 04:56 PM.


#74 collegeboy84

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Posted 02 June 2013 - 07:06 PM

 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, 02 June 2013 - 07:08 PM.


#75 acnescar123

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Posted 02 June 2013 - 11:09 PM

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, 03 June 2013 - 08:38 AM.


#76 Celaya

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Posted 03 June 2013 - 06:23 AM

Slee3,  I sent you a private message.   Check it out.



#77 collegeboy84

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Posted 04 June 2013 - 08:26 PM

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).

 

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. http://www.youtube.c...h?v=iCqgMPZgzc8

 

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.

 

Looking forward to future updates!



#78 acnescar123

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Posted 05 June 2013 - 02:07 AM

If your main concern is depth of treatment, you can look into Fractora. Same principle as lasers, except it uses microneedles so it can go deeper without creating huge ablation channels. It goes 1MM in depth if I remember correctly. It's a more aggressive ematrix as it actually ablates the skin. No idea how the results are though.

 

"Clinical:

Histological studies show that skin ablation can reach a depth of 1mm with a coagulation zone of up to 100 microns around the crater.

 

Maximum Output Energy 62 mJ/pin"

 

130215101015-841-747.jpg

hqdefault.jpg

 

 

http://www.invasix.c...actora_SMMK.pdf

http://www.invasix.c...acasian_da_.pdf


Edited by acnescar123, 05 June 2013 - 02:16 AM.


#79 12xu

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Posted 08 June 2013 - 03:38 PM

greatly appreciate all the updates, hope all is well with you and best wishes to you for today's procedure!



#80 slee3

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Posted 08 June 2013 - 09:51 PM

Day 1 Post Mixto #3: Quick update.






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