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Treating Very Severe Scarring


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#1 sld235

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Posted 14 June 2014 - 08:25 PM

8/6/14

 

Acne surfacing procedure done with Dr. Taylor. Pictures on the 3rd page. 

 

http://i103.photobuc...zpsfeef1637.jpg

http://i103.photobuc...zpsf2b9eb69.jpg

http://i103.photobuc...zps21c988a3.jpg

 

Treatments so far - Fractora. 


Edited by sld235, 08 August 2014 - 03:15 PM.


#2 waitingforacure

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Posted 14 June 2014 - 09:48 PM

if u had no improvement from the first i would certainly take a different route..lasers are mostly effective w the combination of recell but if that option is unavailable u should consider fat grafting or some type of dermal filler


Edited by waitingforacure, 14 June 2014 - 10:03 PM.


#3 sld235

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Posted 14 June 2014 - 09:56 PM

if u had no improvement from the first i would certainly go a different route..lasers are mostly effective w the combination of recell but if that option is unavailable u should consider fat grafting or some type of dermal filler

 

The doctor I went with originally told me that I would not see improvement until I get at least 3 very aggressive fractora treatments...he gave me a 40-50% improvement in scars. I understand collagen is still building, but I don't think I should choose this route anymore based on the types of scars I have so I completely agree on taking a different route. Thank you for taking the time to reply :)



#4 waitingforacure

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Posted 14 June 2014 - 10:10 PM

np..u have very similar scars as ernestoria but less deep...therefore fraxel/recell/subcsion combo would be the best treatment option for u imo


Edited by waitingforacure, 14 June 2014 - 10:14 PM.


#5 sld235

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Posted 14 June 2014 - 10:17 PM

np..u have very similar scars as ernestoria therefore fraxel/recell/subcsion combo would be the best treatment option for u imo

 

Yup, I actually commented before that they were very similar to ernestos scars except I'm a girl (which makes it worse in a way I think). I won't be flying to the UK anytime soon, but at least I have a doctor who is a couple of hours away from me :P



#6 waitingforacure

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Posted 14 June 2014 - 10:28 PM

same here.. if i had the time and money i would fly to UK in a heartbeat lol..u live in the U.S? 



#7 sld235

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Posted 14 June 2014 - 10:38 PM

same here.. if i had the time and money i would fly to UK in a heartbeat lol..u live in the U.S? 

 

i would too - yup, I live in the US! 



#8 waitingforacure

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Posted 14 June 2014 - 10:40 PM

nice...i have a feeling recell and celution will be available here in the next yr or 2..and let us know how ur appt goes w the dr smile.png


Edited by waitingforacure, 14 June 2014 - 10:43 PM.


#9 DudleyDoRight

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Posted 15 June 2014 - 02:57 PM

Go directly to Re:pair at 70mj.  I forget Ernesto's protocol, but Re:pair will be a very large part of your treatment.  Don't buy into the lasers of a Lesser God, you will just waste time.  


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!

#10 sld235

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Posted 15 June 2014 - 05:04 PM

Go directly to Re:pair at 70mj.  I forget Ernesto's protocol, but Re:pair will be a very large part of your treatment.  Don't buy into the lasers of a Lesser God, you will just waste time.  

 

Do you think subcision and fat grafting will be a waste of time for my skin (or do you mean this should be included)? I'm just scared about using such a strong laser on my dark skin. 


Edited by sld235, 15 June 2014 - 05:05 PM.


#11 DudleyDoRight

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Posted 15 June 2014 - 05:16 PM


Go directly to Re:pair at 70mj.  I forget Ernesto's protocol, but Re:pair will be a very large part of your treatment.  Don't buy into the lasers of a Lesser God, you will just waste time.

 
Do you think subcision and fat grafting will be a waste of time for my skin (or do you mean this should be included)? I'm just scared about using such a strong laser on my dark skin.


I never comment on subcision because frankly I don't have a working knowledge of it. I won't kid you Re:pair may not be the thing for darker skin. I don't pull a lot of punches, but I won't BS you either.
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!

#12 blahblah82

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Posted 16 June 2014 - 01:06 AM

http://www.realself....ubcision-fotoma

 

This is one of the most stunning improvements I've seen yet online, and I would argue even better than ernestoria's because the documentation is thorough. There are little to no lighting inconsistencies.  The photos are taken in the same bathroom under the same lights.  Given the severity of his acne scars, this is a life changing improvement.  I say invest your money in time tested and proven techniques.  I am not discounting ReCell, but there is not much independent research showing that it significantly improves the result.  If you have unlimited funds, then ReCell might give you that extra boost but I would not count on it to be the critical factor in your scar revision journey.

 

I think your scars are very similar to this guy and I believe that a combination of extensive subcision, long lasting fillers like Voluma or fat grafting, and Fraxel Repair / Total FX will help.  

 

As for lasers on dark skin, it is a nuisance, but hyperpigmentation almost always resolves.  Plus, you are female so makeup will help you during your recovery.  

 

Lasers are good for improving texture and color and fill scars to a degree, but they do not have the ability to create lots of volume where there are deep indentations.  They help to soften the relief / texture of the skin and to blunt sharp edges on scars. Other adjunctive techniques like subcision / fat grafting / excisions must be done first.  You need to elevate the scars as much as possible to the level of normal skin before you start resurfacing.  If you don't, you will not be maximizing your potential results. Remember, the best results are ones that employ many techniques, and each type of scar must be approached differently.  Icepicks can be excised and sutured, rolling scars respond to subcision, and the sharp edges of boxcars can be softened by resurfacing.   Laser alone will not give you the maximum results.


Edited by blahblah82, 16 June 2014 - 01:17 AM.


#13 AcnePwns

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Posted 16 June 2014 - 02:55 PM

GET SUBCISION! Your skin and scars look like it will be a very good candidate for subcision. Subcision suction, generally, is the best treatment for rolling scars.

 

From what I've seen, it is safer, cheaper, and more effective than fraxel laser with less downtime. As a veteran of subcision, I highly recommend it. Feel free to consult me for more information. I have/had scars that are very similar to yours, albeit not as much.


Edited by AcnePwns, 16 June 2014 - 03:07 PM.


#14 sld235

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Posted 17 June 2014 - 02:05 AM

Thank you blahblah82 & AcnePwns for the replies, I really appreciate! I def. understand that I need to elevate the scars at this point, laser won't really do much with the indentations. The inflammation just completely destroyed the tissue so I'm going to have to work hard just to make my skin decent. I already made up my mind; I will mostly concentrate on subcision and fat grafting/fillers at this point. I've been feeling absolutely horrible about my skin the past few months, but asking you guys for advice has made me feel a lot better :). I guess it's nice to know that I'm not completely alone and there are people out there that are willing to help you out on something that is so depressing. Thanks guys :)



#15 sld235

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Posted 21 June 2014 - 12:43 AM

Hey guys, I had my appointment with Dr. Rahimi and I really need some advice :/. I'm going to make this quick because I'm exhausted (I apologize if anything sounds odd). He said he would do mixto laser and ultherapy on my skin two separate times for a whopping $5000. That's a lot of money so I'm still kind-of recovering from that; $3000 the first time then $2000 the second time. I do have a lot more scarring (and it is way worse), so I figured it was because of that. I told him I felt that subcision and fillers/fat grafting would be a better option for me and he said that the subcision was already included, but that he didn't recommend the fat grafting because that is mostly used for deeper scaring (I def. thought mine were deep enough) and that it would only make my round face rounder. He said he would have done punch excision as well, but that he didn't see any scars deep enough for it. I would need to prep 2 weeks before the procedure by using bleaching cream (anyone know why - is it because I have dark skin?) and retin-a (which I already use). That was mostly my experience. Otherwise, he was a really nice guy and I do believe he wants to help you. He said he could definitely make my skin look a lot better and gave me a 50% improvement (not sure what to think of that). I didn't feel rushed at all during the appointment, and he showed me pictures of patients like I figured he would (none from acne.org members). He did ask me how I found out about him and I told him realself (which is the truth, but I also found out about him from this site too). If you guys have any specific questions, feel free to ask, but I'm just really not sure if I should jump in. That is soooo much money and I"m terrified that I won't see much improvement *Just wanted to add that he said he was going to be really aggressive with the treatments and that I would need at least a week off from work (he showed me the peeling skin, etc). Furthermore, he showed me images of the patients a week after treatment but I disregard those due to the swelling I'm sure they are still experiencing.


Edited by sld235, 21 June 2014 - 12:57 AM.


#16 blahblah82

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Posted 21 June 2014 - 02:52 AM

Okay..... 
 
1.  I agree that fat grafting is more for volume loss as opposed to injecting focally into indentations.  From what I've read, the fat is too globular and lumpy to be injected smoothly under a scar.  
 
Personally I have not seen many good examples of fat grafting on acne scars.  In theory it sounds like it should work well, but in practice I actually am not convinced.  People like to oversell the "stem cells" in transferred fat but I think it is overhyped.  A lot of the fat does not survive the harvesting and injections, so a good percentage will dissipate.  A portion does become permanent, but that is unpredictable.  This is why doctors overinject, because they need to compensate for some fat dissolving.   Unfortunately a lot of the fat may survive, so you could end up looking too full and over injected, which is a not a good look, trust me.  I would agree with Dr. Rahimi on this.  If you had very deep fat loss and sunken cheeks due to acne scarring this would make more sense.  What you have are deep indentations but not large areas of hollowness.  
 
There are a few fat grafting disasters on Realself that should give you pause.  Read these carefully because they are very insightful.
- http://www.realself....at-transer-face
-http://www.realself....om-lacks-skills
 
A lot of doctors don't think fat grafting is effective for acne scarring
-http://www.realself....post-acne-scars
 
2.  Sticker Shock - I think everyone who enters this journey is always shocked by how expensive it is to do serious treatments for severe acne scarring.  As for his pricing, I think this is the exact standard price he has quoted other people, so that does not seem unusual.  I noticed that you said he is throwing in ultherapy and subcision in the mix as well.  He didn't offer ultherapy as part of that package in the past, so that part is new.   Given that Ultherapy by itself is around $2K in LA, that seems reasonable.  
 
3.  What ethnicity are you?  If you have darker skin tone the bleaching cream is to minimize hyperpigmentation after the laser.  That is the standard of care.
 
4.  Pictures after a week are meaningless, glad you are savvy enough to realize this.  Everyone looks amazing at one week with all the microswelling.  Did he show you pictures of patients months out from the procedure?  That is more meaningful.   
 
5.  A week is the bare minimum, and that seems a little optimistic if you are going to do a very aggressive procedure.  You may be done peeling after a week, but there is significant redness, but you can hide that with makeup.  
 
All in all, I think this is a reasonable approach he sketched out for you, but it is indeed a lot of money.  

Edited by blahblah82, 21 June 2014 - 04:20 AM.


#17 sld235

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Posted 21 June 2014 - 02:24 PM

 

Okay..... 


 
 
1. Thank you for such a detailed answer, it really means a lot to me! Now that you showed me the links, I could see why fat transfer can be a bad idea, I def. don't want to come out looking swollen. I have always had a round face, but my recent weight loss thinned out my face. I personally think my scarring looks worse now, but there's not much I can do now. Are fillers considered the same as fat grafting (make my face look worse)?
 
2. Yup, the price did indeed shock me, but I also wasn't familiar with prices. I am willing to invest in my face, but I am also terrified about seeing absolutely no improvement after spending thousands of dollars. I can't help, but feel really nervous. 
 
3. I'm hispanic, so I have brown skin. I figure the bleaching was for hyperpigmentation, but I just wanted to make sure since I forgot to ask. 
 
4. There was one picture of a woman he showed me that looked like it was taken months after. These seem to be the main pictures he shows people because they were made much larger for display purposes. They look old and you can def. see improvement, but I don't know much about them to be honest. All other images he showed were on his ipad and he would show me the before and after (one week).
 
5. He said I should be done peeling by day 7, but I would be red for a while. He made a point that I can not work at all during the week so he seemed to be really serious about how aggressive he will be. 
 
I think I'm going to do it. I was planning to ask a week in July so it works out (except I'll have no fun haha). I'll keep you guys updated throughout the whole time. I'm hoping to see decent improvement after the first treatment. I'll be out $3000 by that time...not sure when I'll be having the second treatment (which would also require a week off). 


*One last thing I wanted to mention is that he said that my scars were "box car" . To be honest, I never knew what my scars were...all I knew was that they looked bad haha. From what I researched online, it's supposedly the easiest scar to fix (to an extent of course, scars are permanent), but I'm also reading they don't respond as well to lasers. Can anyone give me some input on this?

Edited by sld235, 21 June 2014 - 02:36 PM.


#18 blahblah82

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Posted 22 June 2014 - 04:41 AM

Fillers do the same kinds of things as fat grafting except that there are many different kinds with different characteristics.  There are some that are very soft like Belotero, which is suited for very fine lines and superficial defects.  Juvederm Voluma, by contrast, is very thick and injected deeper.  It is very viscous, so it can be used to lift deeper defects and lasts approx 18 months they claim.  I'm positive that Rahimi uses Voluma on acne scarring because he's posted about it on Realself.  Fillers are nice in that you can take them right off the shelf and they're ready to use, as opposed to fat which requires liposuction to harvest the fat.  It's a little more invasive for that obvious reason.   You can look overinjected from any filler, so it always comes down to the skill of the surgeon.

 

I think you are on the right track with the subcision and fractional co2 laser, but of course go in with realistic expectations.  You can't expect miracles, even though at $3000 one would hope for significant improvement.   Good luck with your procedures.



#19 *Inspired*

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Posted 22 June 2014 - 09:10 PM

Is Rahimi planning to do Ultherapy, Mixto and subcision in one session? Did he explain the benefits of Ultherapy to you? I am curious to know how that can improve atrophic scars.

#20 sld235

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Posted 24 June 2014 - 12:52 AM

Is Rahimi planning to do Ultherapy, Mixto and subcision in one session? Did he explain the benefits of Ultherapy to you? I am curious to know how that can improve atrophic scars.

 

 

Yup, all three in one session for 3 grand and then he's going to do it again for another 2 grand. He said that ulterapy will stretch my face and make my scars look better (he asked me to stretch my cheek to see what he meant). I've been reading that supposedly it has helped with scars (because of collagen being built)...apparently they are having clinical trials on its use for atrophic/acne scars for those who live near those areas and want to try it out! 

 

http://clinicaltrial...how/NCT02145364


Edited by sld235, 24 June 2014 - 01:12 AM.





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