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

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#121 slee3

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Posted 28 December 2013 - 02:55 PM

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 .



#122 LearnedHand

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Posted 28 December 2013 - 08:29 PM

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?



#123 slee3

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Posted 29 December 2013 - 01:03 PM

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. 



#124 blahblah82

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Posted 30 December 2013 - 08:27 AM

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.



#125 acnescar123

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Posted 30 December 2013 - 02:05 PM

What kind of total improvement % would you estimate you got from starting laser -> now?



#126 slee3

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Posted 22 February 2014 - 09:43 PM

February 22nd 2014 Update - 2 months post mixto #4 update. enjoy!



#127 blahblah82

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Posted 22 February 2014 - 10:22 PM

Thanks for the update!  This thread will go down in the acne.org Hall of Fame :)



#128 zavvi

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Posted 23 February 2014 - 06:25 AM

February 22nd 2014 Update - 2 months post mixto #4 update. enjoy!

is it just me but where is this recent update i dont see it?



#129 blahblah82

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Posted 23 February 2014 - 07:44 AM

updates are always in the original post on 1st page...



#130 testytest

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Posted 23 February 2014 - 02:33 PM

Thanks for keeping things updated Slee, really appreciate it.  btw, did Doctor R. do any combo treatments are has it strictly been only the laser?  



#131 Srananman

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Posted 23 February 2014 - 03:11 PM

I remember you starting out months and months ago with your first results not being what we expected after seeing DraGz.. Now however, your face is looking great! Congratz for your determination and thanks so much for contributing, it says a lot about the person below the scars ;)



#132 4meracneguy

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Posted 25 February 2014 - 09:37 PM

Are those really considered to be ice pick scars though? They look more like boxcar/rolling imo. 



#133 blahblah82

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Posted 28 February 2014 - 03:29 AM

Slee, would you say that some of the milder scars are almost completely diminished?  Or would you say that all the scars are still there but are softened?

 

My thought is that after so many c02 laser sessions, I would think the really mild scars would almost be imperceptible to an observer.  


Edited by blahblah82, 28 February 2014 - 03:30 AM.


#134 slee3

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Posted 01 March 2014 - 06:39 PM

Sorry guys, ive been kind of bad answering your questions. been kind of busy and lazy too... but here we go...

 

What kind of total improvement % would you estimate you got from starting laser -> now?

 

Overall, 65% improvement after 4 mixto laser sesstion. about 75% improvement on the left side (the one with the shallower scars), about 55 % improvement on the right side. Also, i do believe % improvement is really hard to gauge.....its more of a subjective response. 

 

Thanks for keeping things updated Slee, really appreciate it.  btw, did Doctor R. do any combo treatments are has it strictly been only the laser?  

 

It has strictly only been laser, except the first session, where he performed some subscicion in some locations.

 

Slee, would you say that some of the milder scars are almost completely diminished?  Or would you say that all the scars are still there but are softened?

 

My thought is that after so many c02 laser sessions, I would think the really mild scars would almost be imperceptible to an observer.  

 

exactly, milder scars are mostly diminished, imperceptible to an observer, in essence, all the shallow scars are gone! unforutantely, the deeper scars are still there but less noticeable, not as sharp, but still noticeable. 



#135 blahblah82

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Posted 02 March 2014 - 04:41 AM

Thank you for your answers.  This is really helpful.

 

No need to apologize for anything.  You've already done an exhaustive job of updating this thread.  This is by far one of the most dedicated and complete documentations of any treatment on this board.  Look forward to your future updates.



#136 Celaya

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Posted 02 March 2014 - 07:49 AM

Slee, Thanks for all the information you have provided us on here.  Quick question,   How come only 1 Subcision was done on you?  Was that your choice & only wanted to stick with only the Mixto Laser?  Wouldn't it have benefited you even more to do some more Subcisions in combination  with the  Mixto  laser  for better results especially on the deeper scars on each visit?  Or do you think it would not have made any difference?  Did you question Dr.R on why he stop after one subcision on the deeper scars once you visited him for your next Mixto Treatments #2,3 & 4?  Thanks for your time.


Edited by Celaya, 02 March 2014 - 07:57 AM.


#137 BioNeedle

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Posted 21 April 2014 - 09:10 PM

Any updates?



#138 slee3

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Posted 17 May 2014 - 04:57 PM

Hi All, May 17th, 5 months post mixto #4 Updated post,

 

enjoy!



Slee, Thanks for all the information you have provided us on here.  Quick question,   How come only 1 Subcision was done on you?  Was that your choice & only wanted to stick with only the Mixto Laser?  Wouldn't it have benefited you even more to do some more Subcisions in combination  with the  Mixto  laser  for better results especially on the deeper scars on each visit?  Or do you think it would not have made any difference?  Did you question Dr.R on why he stop after one subcision on the deeper scars once you visited him for your next Mixto Treatments #2,3 & 4?  Thanks for your time.

 

Hi Celaya,

 

I'm not quite sure why Dr. R only did 1 subcision on me, only during the first session. I never asked, and it seems like my ice pick scars which are the most prominent do not work with subcision. He did mention i do have a couple of box scars, but I am not sure why he didnt continue doing the subcision, and I never asked him. I just trusted that he knew what was best for my skin. 

 

 

Any updates?

 

Just updated today May 17th, i apologize for the lagging! 



#139 blahblah82

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Posted 17 May 2014 - 11:28 PM

I understand what you mean when you say pictures never truly represent reality.  That said, your results are very apparent.   If you feel you have achieved 60-70% improvement, that would qualify as a resounding success.  Most doctors caution patients to expect at most 50% improvement, and that is on the higher end of realistic expectations.

 

The thing about scar treatments, is that it's a lot like money.   When you only make $10 bucks an hour, $20 bucks seems like it would make you completely satisfied, until you get there.   

 

Also, if you do decide to do TCA Cross, I would really recommend a test patch in an inconspicuous area, because I feel it is unpredictable.  Some people have gotten improvement, but I've seen a few examples of scars being made worse.  Also, do it in sections and not all at once, because you will look TERRIBLE for a month.  Every scar will look redder, deeper, and wider before it starts to rise (if it does at all).  It is easier to conceal when you do smaller sections as opposed to every single ice pick scar.  


Edited by blahblah82, 17 May 2014 - 11:52 PM.


#140 slee3

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Posted 18 May 2014 - 11:04 AM

I understand what you mean when you say pictures never truly represent reality.  That said, your results are very apparent.   If you feel you have achieved 60-70% improvement, that would qualify as a resounding success.  Most doctors caution patients to expect at most 50% improvement, and that is on the higher end of realistic expectations.

 

The thing about scar treatments, is that it's a lot like money.   When you only make $10 bucks an hour, $20 bucks seems like it would make you completely satisfied, until you get there.   

 

Also, if you do decide to do TCA Cross, I would really recommend a test patch in an inconspicuous area, because I feel it is unpredictable.  Some people have gotten improvement, but I've seen a few examples of scars being made worse.  Also, do it in sections and not all at once, because you will look TERRIBLE for a month.  Every scar will look redder, deeper, and wider before it starts to rise (if it does at all).  It is easier to conceal when you do smaller sections as opposed to every single ice pick scar.  

 

Blahblah, 

 

I agree, all the treatments (needling sessions, 4 mixto laser sessions, seeing my esthetician once a week for the past year and half), all of this has definitely led to over 50% improvement and should be considered a success. With my most recent update, i guess I should recant my statement that the newest photos are not truly indicative of my facial appearance. After reviewing the photos and my face in person in front of the mirror, it is pretty close. I just think that the photos cannot capture all the imperfections, unless i had some HD type camera. Your analogy about getting a raise is definitely true, we as human beings are naturally selfish and greedy, and will never be satisfied, the only way to control it is through perspective and self-discipline. There is definitely needs to come to a point in my life where I will need to accept my scars for what they are and completely move on with my life, but I dont think i am at that stage yet, i still yearn for more improvement. And thanks for the TCA advice, all in all, would you recommend me trying it out? I am just too scared of the possible negative side effects, which is why I have not done it yet. 






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