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Had Fractional Co2 Done


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#1 acnescar123

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Posted 14 July 2013 - 11:26 AM

Since this forum has turned more into putting urine and other crap onto your face rather than actual medical devices, thought I would detail my experience.

 

Some other good threads on lasers:

 

http://www.acne.org/...cars-on-cheeks/

http://www.acne.org/...-cheekstemples/

http://www.acne.org/...o2-with-photos/

http://www.acne.org/...ates-to-follow/

 

History:

 

Had pretty bad acne in teens that left scarring as I didn't really do anything to treat the active acne. Mainly boxcar and icepick scarring. Scarring was localized on only the cheeks and that was a major factor in finding a doctor - one who would agree to only treat the cheeks. Also wanted a doctor that would go as aggressive as possible.

 

<space reserved for before pics>

 

Pre-procedure:

 

Was given pain pills, valium type injection, valtrex and an anti biotic. Was also given a blood thinner as the plastic surgeon believes more blood = better results and it prevents blood clots. Was pretty loopy for the procedure.

 

Procedure:

 

Was given ~10 local injections on the cheeks. No numbing cream was used. He did light settings on the outside of the cheeks and a strong setting with multiple passes on the inside where the scarring was.

     

      Pain - 3/10

      Swelling - 9/10 (eyes were almost swollen closed). I assume this is mainly because of the injections rather than the laser. I was frozen up pretty good

       General Discomfort - 3/10

 

Immediately post procedure had a tiny bit of pain, intense swelling and cold compresses were applied. Was sent home around an hour later with some polysporin applied to the face.

 

Post procedure/day 1:

 

c6q.png

 

 

Have just been applying aquaphor. There is just some mild residual pain and bad swelling but otherwise nothing else to note.

 

Day 2:

 

es7i.png

v2y.png


Edited by acnescar123, 27 June 2014 - 10:52 AM.


#2 *Inspired*

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Posted 14 July 2013 - 12:15 PM

Good luck with your recovery and thanks for sharing. So happy to see a real scar treatment thread again and someone actually taking action that can improve scars. I really hope this works for you.

Interesting that your doctor gave you a blood thinner. I have never heard of that as most say co2 laser is attracted to water in the skin so the less blood, the better. I have also read that coagualtion and blood cotting at the base of the scar is good. No idea if either really make a difference.

Which laser did you choose? Based on the bleeding and swelling, it looks like Repair. With Total FX, they do Active FX last as it helps seal the skin and blood vessels. It just leaves you with a little pinpoint bleeding after the procedure. Deep FX alone is a different story.

What is your skin type? Curious to know if you are predisposed to any potential side effects, like people with Asian or olive skin.

You might start questioning your sanity over the next few days. Just remember, this phase is temporary and chances are, it will be worth it. Stay strong and best wishes for an awesome outcome!

Best of luck!

#3 acnescar123

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Posted 14 July 2013 - 12:55 PM

Good luck with your recovery and thanks for sharing. So happy to see a real scar treatment thread again and someone actually taking action that can improve scars. I really hope this works for you.

Interesting that your doctor gave you a blood thinner. I have never heard of that as most say co2 laser is attracted to water in the skin so the less blood, the better. I have also read that coagualtion and blood cotting at the base of the scar is good. No idea if either really make a difference.

Which laser did you choose? Based on the bleeding and swelling, it looks like Repair. With Total FX, they do Active FX last as it helps seal the skin and blood vessels. It just leaves you with a little pinpoint bleeding after the procedure. Deep FX alone is a different story.

What is your skin type? Curious to know if you are predisposed to any potential side effects, like people with Asian or olive skin.

You might start questioning your sanity over the next few days. Just remember, this phase is temporary and chances are, it will be worth it. Stay strong and best wishes for an awesome outcome!

Best of luck!

Thanks.

 

Not sure why it was given - but I trust the doctor. Personally I see some basis for it - for example when doctors inject PRP after laser treatments, same idea to some extent. More blood at the trauma site = more opportunity for healing. For example noone says to take any blood thinners before subcision but Dr.Rapaport says to take asprin before the procedure in order to pool more blood at the site. Who knows.

 

Didn't really have too much choice in lasers - as there are only a few doctors who have fractional co2 lasers around here (only one has re:pair and he's not very good). I went with doctor rather than type of laser (personally I think they're all the same.) To be honest - I'm not sure what brand he uses, but we agreed to go as aggressive as possible. I'll find out during the next checkup.  If there was a good doctor around here who had the re:pair, I would do it - but there wasn't.

 

Probably skin type III if I had to guess?



#4 maclas

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Posted 23 July 2013 - 03:49 PM

How is everything working out?  Any estimation upon the percentage improvement?



#5 austra

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Posted 23 July 2013 - 05:27 PM

Can't believe I only just saw this thread now (hard to follow what proper there is amongst all the urine/avocado stuff). Definitely following! I hope you heal well and get great results! Can't wait to hear future updates. I'm also considering fractional CO2 for my scarring which is the same type as yours.

 

Good luck and keep us posted!



#6 blahblah82

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Posted 24 July 2013 - 03:43 AM

Thank you for elevating the discussion on this board.  Hopefully the conversation can get back to science-backed treatments instead of the aforementioned urine / avocados / god knows.  LOL...   Anywhoo, it does look intense and I'm not aware of other C02 lasers that can cause this much bleeding.  Would be great to know more details.  Like Inspired said, can you give us some details about your skin type, level of scarring prior to treatment, etc?



#7 tracy521

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Posted 24 July 2013 - 07:44 AM

hey thanks for this thread and please keep updating us on your progress as time goes on. i think you are going to have great results! i am getting co2 done (not the fractional co2 though) on some raised scarring on my chin and i just keep praying that i will get good results. the plastic surgeon who will do the laser claims this is the only way to try and make the raised scarring look better is to try and level it with the rest of the skin. anyway good luck and thank you for sharing your story!



#8 acnescar123

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Posted 24 July 2013 - 03:11 PM

I was pretty much healed after about 6-7 days, only just some left over redness still present (3 weeks later). You can pull off a sunburn look after a week however. There wasn't any pain or anything during the recover, moreso annoying due to the peeling skin, itchyness and swelling. After about a week everything peeled and 80% of the swelling went away. 2nd week the bad redness got better and 90% of the swelling went away. Now there's just a tiny bit of swelling and some redness. I'll upload pics when I have some time.

 

hey thanks for this thread and please keep updating us on your progress as time goes on. i think you are going to have great results! i am getting co2 done (not the fractional co2 though) on some raised scarring on my chin and i just keep praying that i will get good results. the plastic surgeon who will do the laser claims this is the only way to try and make the raised scarring look better is to try and level it with the rest of the skin. anyway good luck and thank you for sharing your story!

 

I don't have any raised scarring so don't know, but good luck to you - hope it goes well.

 

How is everything working out?  Any estimation upon the percentage improvement?

 

If I had to give an estimate right now, with 90% of the swelling gone - I would say 30% on one side and 40% on the other. The biggest improvement is from a distance - which tells me the scars are getting shallower. Hopefully they fill up a bit as the last of the swelling goes down for around 30-40% total improvement after one session. I went into this expecting 2-3 treatments and ~20% improvement each time, so far it's in line with that I expected - maybe a bit better.

 

Most of the improvement at the moment is coming from the fact that the edges of the scars were "sanded" down, the scars weren't really filled in yet. From what I understand collagen takes 30-180+ days to produce - so hoping they fill in a bit as well. I still see trackmarks + redness.

 

Thank you for elevating the discussion on this board.  Hopefully the conversation can get back to science-backed treatments instead of the aforementioned urine / avocados / god knows.  LOL...   Anywhoo, it does look intense and I'm not aware of other C02 lasers that can cause this much bleeding.  Would be great to know more details.  Like Inspired said, can you give us some details about your skin type, level of scarring prior to treatment, etc?

 

Any fractional co2 will produce bleeding like this if you use an aggressive setting (see collegeboy's thread for example). Skin type = white/fair, brown hair. Scarring = on a scale of 1-10 I would say a 6. Mainly boxcar and icepick scars a few mild rolling scars here and there. If you have a specific question, feel free to ask.


Edited by acnescar123, 24 July 2013 - 03:11 PM.


#9 AntLee

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Posted 24 July 2013 - 10:08 PM

I'm glad that you're getting good results.  I did Mixto laser recently too but at a lower setting.  How many passes did you do exactly?  For my next session I don't know if I'm going to do 2 or 3.



#10 DudleyDoRight

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Posted 25 July 2013 - 09:53 PM

Eye of newt, and toe of frog,
Wool of bat, and tongue of dog,
Adder's fork, and blind-worm's sting,
Lizard's leg, and howlet's wing

 

Ok I guess you guys are tired of the voodoo cures.  NOT ALL FRACTIONSL LASERS ARE CREATED EQUAL!!  Know your laser and your treatment levels, or you will come away dissatisfied.  I haven't updated this in quite a while, but surely some of it must still be relevant.

 

http://www.acne.org/...er-link-o-rama/


Edited by DudleyDoRight, 25 July 2013 - 09:57 PM.

Dermabrasion - Full Face

CO2 Full Face 1996

Fraxel Re:pair 70 mj - 60% May 22, 2008

Fraxel Re:pair 70 mj - 60% Jan 08, 2009

Fraxel Re:pair 70 mj - 60% Oct 30,2009

Fraxel Re:pair 70 mj - 60% Oct 08,2010

Fraxel Re:pair 70 mj - 60% Nov 04,2011

"The Road To Wellville" 1994
Goodloe Bender: Health! The 'open sesame' to the sucker's purse!

#11 acnescar123

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Posted 26 July 2013 - 02:53 AM

Ok I guess you guys are tired of the voodoo cures.  NOT ALL FRACTIONSL LASERS ARE CREATED EQUAL!!  Know your laser and your treatment levels, or you will come away dissatisfied.  I haven't updated this in quite a while, but surely some of it must still be relevant.

 

http://www.acne.org/...er-link-o-rama/

 

I don't see your point Dudley unless you're just posting for general info? The re:pair, smartxide, deepfx, affirm and to an extent mixto can provide similar settings. Yes, the re:pair goes a bit deeper and the ultrapulse & affirm can provide up to 100% ablation but generally speaking, the fractional co2 lasers are similar (especially for someone who doesn't have access to the re:pair). It depends more on the settings imo and if you read my previous posts, you would know that I wouldn't go into a laser without aggressive settings.....

 

ps. I also don't know why you're such a prophet of the re:pair. There have been no studies comparing the different lasers. They each have some advantages and disadvantages & there are other more important questions ie why is one pass at 60% better than 3 passes at 20%?

 

Most of the lasers comparing to the re:pair:

Use 30W, spot size is 350 microns and pulse width / dwell time is up to 2 ms - so ~60mJ. (pretty similar). You can actually hit 60mj with a 0.8ms dwell time. Technically speaking - the "30w" measurement is taken as an average between on and off times of the laser, I think the actual "on" wattage is higher.

The mixto is power 8 and index of 6 is 3.5ms pulsewidth and ~40mJ. (less risk of PIH)

They use spot treatment rather than rolling (advantage imo)

They go from 150-1000+ microns in depth (disadvantage imo), but deep enough to reach most scars. The deepfx goes even deeper than the re:pair at a similiar mj setting.

The affirm and dot can be adjusted each time from 0-100% ablation (advantage imo). This can also make them go deeper.

 

So you can either have smaller holes with less energy per hole but deeper (re:pair and deepfx) or you can have bigger holes with more energy but less deep (dot and affirm).

 

It is also yet unclear whether it is the depth of the "hole" drilled into the skin that is important, or whether it is the lateral thermal energy delivered to a particular depth that is the key point to get clinical results. I haven't seen any studies addressing this issue. Personally, I think heat/power to the site is more important than depth. I think 600 microns is more than enough to reach the base of most scars.

 

If you were posting just for general info, then you can disregard everything I said tongue.png. Sorry for the rant, hope this might help someone in the future though.


Edited by acnescar123, 26 July 2013 - 03:02 AM.


#12 DudleyDoRight

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Posted 26 July 2013 - 05:12 AM

acnescar123, frankly I am too far removed from the debate to have any desire to research the differences.  I did that at one time, but now I am content with knowing what worked for me.  I compiled the laser link thread some time ago when I was still actively having treatments, and I have not updated it in some time.  At the time of the compilation Re:pair and DeepFX were considered far superior to the other lasers in results.  If that has changed I wouldn't know.  4 years ago when I was looking at lasers anything other than Re:pair and DeepFX was considered inferior.  All I know is what worked for me.

 

Quite frankly since I am older my interest has turned to Plastic Surgery.  I come on here more out of habit than anything else, and I only comment on laser threads.  I will continue with Re:pair as a tune up after plastic surgery.  I went through dermabrasion and regular CO2 with no results.  When I did Re:pair it worked so why go anywhere else.


Edited by DudleyDoRight, 26 July 2013 - 05:28 AM.

Dermabrasion - Full Face

CO2 Full Face 1996

Fraxel Re:pair 70 mj - 60% May 22, 2008

Fraxel Re:pair 70 mj - 60% Jan 08, 2009

Fraxel Re:pair 70 mj - 60% Oct 30,2009

Fraxel Re:pair 70 mj - 60% Oct 08,2010

Fraxel Re:pair 70 mj - 60% Nov 04,2011

"The Road To Wellville" 1994
Goodloe Bender: Health! The 'open sesame' to the sucker's purse!

#13 *Inspired*

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Posted 27 July 2013 - 12:50 PM

I agree with Dudley. Not all fractional co2 lasers are equal. MixTo isn't even a pulsed laser. It is not a deep laser either. It is no different than traditional co2 in fractional mode. They claim this carries less risk of side-effects and that this makes their technology (which is only different from traditional because it is micro fractional) superior. I have done a lot of research on this too over many years.

#14 DudleyDoRight

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Posted 27 July 2013 - 01:49 PM

Inspired we have fought these debates some time ago, and neither of us have the need to go back.  I assume Re:pair and DeepFX are still considered the superior lasers.  As you can tell I am a little removed from the debate, and not up to date.  I am either through with my laser work or I might get Re:pair as a tune up after plastic surgery.  It is great for tightening the skin also, which was its intended application.


Dermabrasion - Full Face

CO2 Full Face 1996

Fraxel Re:pair 70 mj - 60% May 22, 2008

Fraxel Re:pair 70 mj - 60% Jan 08, 2009

Fraxel Re:pair 70 mj - 60% Oct 30,2009

Fraxel Re:pair 70 mj - 60% Oct 08,2010

Fraxel Re:pair 70 mj - 60% Nov 04,2011

"The Road To Wellville" 1994
Goodloe Bender: Health! The 'open sesame' to the sucker's purse!

#15 no_hope

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Posted 27 July 2013 - 02:31 PM

holy crap that looks intense! where in ontario did you have this done? i wish you the best of luck man



#16 acnescar123

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Posted 27 July 2013 - 03:35 PM

 MixTo isn't even a pulsed laser. It is not a deep laser either. It is no different than traditional co2 in fractional mode. They claim this carries less risk of side-effects and that this makes their technology (which is only different from traditional because it is micro fractional) superior. I have done a lot of research on this too over many years.

 

That's not true at all. The reason the mixto carries less risk is due to the dwell time - it has nothing to do with depth. Longer dwell times = less heat = less thermal damage = less risk of PIH

 

"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" - which is ~500 microns.

 

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 old school co2 lasers did ~100 microns per pass.

 

Every fractional co2 laser can hit the reticular dermis. BUT - the question is, would you prefer more heat/power (smartxide, affirm), depth (re:pair, deepfx) or less of both but less risk of PIH (mixto). If I was in a big city in the US, I would find a doctor who does multiple lasers at the same time to get all the benefits.

 

ps. Just a small update : all the swelling is gone, just still redness, noticing about a 30% overall improvement. All the actual scars are "there" but they're less noticeable. Hopefully they get plumped up from the bottom over the next few months.


Edited by acnescar123, 27 July 2013 - 03:49 PM.


#17 *Inspired*

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Posted 27 July 2013 - 07:15 PM

Mixto is a continuous light, not pulsed light, laser. It is carefully worded on their site. 500 microns is superficial and is comparable to Active FX in terms of depth. If I had the energy and wasn't restricted to a phone right now, I would do this debate.

Glad you are healing well and still wish you the best of luck.

#18 *Inspired*

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Posted 27 July 2013 - 07:41 PM

Keep in mind, in my research, I needed a laser that could improve deep damage. Softening of scars is great but after time, the surface returns to normal. At least, that's been my experience. I had one deep scar treated with MixTo and found the scar looked smoother for several months. The depth looked improved during the swelling stage. The scar eventually returned to normal and I saw no improvement in depth. Your skin does have memory. If you are not destroying the deeper damage, i believe the scars return to normal. Shaving down is no different than a deep peel in my opinion. As your skin recovers and ages, I believe the scars do return to normal when you have only had a superficial depth treated because the real damage exists deeper than 500 microns. If you search the forum, you will find posts where we have been really technical on this in the part on this board.

Also, I want to add that while I have done Total FX, I do believe the surface improvement and softening are temporary. I am willing to pay for that temporary improvement.

#19 DudleyDoRight

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Posted 27 July 2013 - 08:50 PM

Ain't no big thing.  That is just blood that washes off.  It may look scary but it is nothing.  Once he washes it off everything is brought into perspective.

holy crap that looks intense! where in ontario did you have this done? i wish you the best of luck man


Dermabrasion - Full Face

CO2 Full Face 1996

Fraxel Re:pair 70 mj - 60% May 22, 2008

Fraxel Re:pair 70 mj - 60% Jan 08, 2009

Fraxel Re:pair 70 mj - 60% Oct 30,2009

Fraxel Re:pair 70 mj - 60% Oct 08,2010

Fraxel Re:pair 70 mj - 60% Nov 04,2011

"The Road To Wellville" 1994
Goodloe Bender: Health! The 'open sesame' to the sucker's purse!

#20 acnescar123

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Posted 27 July 2013 - 11:10 PM

Mixto is a continuous light, not pulsed light, laser. It is carefully worded on their site. 500 microns is superficial and is comparable to Active FX in terms of depth. If I had the energy and wasn't restricted to a phone right now, I would do this debate.

Glad you are healing well and still wish you the best of luck.

 

I'm not arguing that the mixto is less powerful because it is (with the reduced risk of side effects due to the decreased dwell times.) The active fx only goes to 120 microns at the highest setting.

 

However, you have to keep in mind "ablation depth" and thermal damage depth are two different things. Yes - the deep fx has up to 1.6mm of thermal damage *but* it has only a 700 micron ablation depth (same as all the other lasers.) However some of the other lasers deliver more thermal damage horizontally to the columns themselves (rather than depth.) Once multiple passes gets into the mix, it becomes even more complicated (since you can do a 700 micron ablation and then do 1-2 more passes.) So the question becomes if you want heat deeper OR heat into the thermal columns - I have no idea which works better. Considering that the erbium lasers do work (in most studies similar to co2 ones) I think there is more to the equation that just depth alone. Something like dermabrasion also gives decent results and only goes 200-300 microns in depth.

 

Sanjoseskin summed it up well in another post:

 

"You can see the total lesion depth at 70 mj is 1.5mm. You can also clearly see the ablation vs thermal zone 2 thermal damage, which penetrates down achieving the 1.5mm lesion depth, or more commonly the averaged lesion depth of 1.6mm that is advertised.
This wonderfully shows that the ablation depth is actually around .600-.700mm if we are visually estimating, the remainder is about .900mm or approx 1mm of thermal damage. The ablation depth plus thermal damage depths add up to give you lesion depth of 1.5mm or 1.6mm.

To compare with ultrapulse, approx .700mm of ablation depth, results in only an additional .200mm of thermal damage. For a total lesion deapth approx of .900mm. So you attain the same ablation depth, but you spare healthy tissue, and avoid possible complications that comes along with too deep and wide of thermal damage. What does this mean? It means you can go deeper, without worrying that you are causing excess thermal damage, which is the leading cause of hypopigmentation with CO2. You can also treat deeper, and treat patients who alreadly have thermal damage, such as burn patients. However, both have pretty good records. There is no reason why acne scar patients, shouldn't see good results with both. That is if lasers work for scarring."

 

I think the re:pair is probably the best choice, although I'm not a fan of the rolling handpiece and the fact it's usually 1.5-2x more expensive (disposable costs). Barring that - I would choose the best doctor rather than best laser and people shouldn't be put off just because it's not the deepfx or re:pair.


Edited by acnescar123, 27 July 2013 - 11:14 PM.





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