*Inspired*

Hey guys! I really apologize for not updating this thread sooner. My computer died and I decided not to fix it because I have a brand new one at home in Japan. I am headed to Hawaii and then Japan tomorrow. I will update this thread once I am settled back at home in another week. In the meantime, I will say I am still scarred but my skin is greatly improved. Hyperpigmentation is 90% faded at this point. Posting from my phone is difficult, so I will add more detail later. As of now,I have no regrets over my second laser treatment but I am definitely not done with treating my scars. There's still work to be done. My confidence is up 80% though and it feels awesome. Hope you all are well. I look forward to providing a more detailed update soon. Btw, I am approximately 3.5 months post-op.

I'd also ask:
How many patients have you treated with my skin type?
Have you ever experienced complications with my skin type? If so, how did you remedy it?

Readytosmileagain,

I think your healing is very normal for Deep FX. I still have blotches all over my face, and I'm one month out. I only have blotches from where Deep FX hit. You really can't compare Deep FX to MixTo or Active FX. It's a totally different kind of Co2 laser. It does not resurface the epidermis. It targets deep damage in the dermis. That causes bleeding & swelling under the skin, and the recovery is slow. For me, it's caused deep hyperpigmentation. It will take months to fade.

Unfortunately, scars will look worse before they look better after Deep FX. After my first Deep FX treatment, it took about 3 months for me to realize just how much my skin had improved. Just look at my picture from before my first Deep FX:
http://www.acne.org/...e/46216-before/

The shallowing of my pits is undeniable and truly amazing. I hope you get similar results.

Honestly, if you didn't have redness at this point, I would be concerned about your potential results. To me, that would mean your treatment was not aggressive or deep enough.

Frankly, if you have pits, Deep FX is the way to go. I was disappointed a month after my first treatment, but I don't regret it at all! It was absolutely worth having blotchy skin for a couple months. It's the best thing I could have ever done for my scars.

I do think your doctor could have prepared you better.  

Hang in there!

happy new year! Well its three weeks after my procedure, all of my scars have returned and look exactly as they had before. its kind of really such a let down because the past two weeks i basically had clear skin and then everything reemerged within the past three days but my dermatologist did tell me this would happen and that results will not surface for awhile as the procedure works from the inside out and the collagen will build up to fill the holes. But still it was so nice to have nice skin for the holidays, im really hoping the results are similar to what it looked like swollen that would be amazing. As for redness, most of my redness is gone, funny that it went away for the most part before the swelling did

Keep your head up! It will improve with time. You should have noticeable shallowing of pits within a couple months. At least, that was my experience after my first treatment in Feb. My redness finally faded at about 3 weeks, but I am now dealing tan hyperpigmentation. Are you experiencing any hyperpigmentation? What is your skin type?

In my last update, I was kind of negative. My scars have actually improved since this treatment. My skin does look smoother. I just wish the indents would completely vanish. Some of my scars are only visible in very harsh lighting now. I should be grateful for that. Looking at my before pictures from last year in my gallery, I can hardly believe how far I've come since Feb 2012. Fractional Co2 laser really does work. At least, it has worked for me. It has not erased my scars though.

Based on your photos, it looks like you're healing well and the redness is fading. It will definitely continue to improve over time.

Let us know how things go with your doctor.

Inspired
When you were healing - were your red marks, also raised? Some of mine are so it looks like i just have horrible inflamed acned again all over my face - thank god it doesnt feel the way. I just want to make sure this is also "normal".

I just cancelled all my appointments for this week due to my skin looking like this....

today is not any different from yesterday as far as the way my skin is looking and I have decided i cant look in the mirror at all today... So I looked this morning, took a shower, lathered with lotion and thank god I work from home.... If I would of gone under the impression that this was a 7 to 10 recovery time til i was back to normal and worked in an office, oh my, would I be stressing. I already cancelled a meeting I had to go to this friday. I have a very important thing to be at on monday afternoon of next week - lets hope im feeling okay to make it to that... If im not, i dont know what im going to do

wow, what an experience this is.

I go back to the doc in 48 hours

After Deep FX, I did have raised, red blocks on my face where Deep FX hit deeper. It was just erythema and swelling deep in the dermis. It took a few days for my skin to settle back down. I could not really see those areas after Total FX because Active FX was used over Deep FX and caused my skin to crust & scab. After both procedures, I looked hideous for a good week. After Deep FX, it looked like someone took a square meat tenderizer to my face.

I'm glad you're going to see your doctor. Hang in there! The first 7-10 days are the most difficult.

Looking forward to more updates from you. So, what do you do about the hyperpigmented areas? Wait it out until they fade?

Thanks for the support, CherrySoda! I appreciate it.

I am currently using the Cicalfate Restorative Skin Cream and will continue with that until the redness subsides.

I restart the pre-op creams with hydroquinone (Glytone SunVanish & Glytone Clarifying creams) tomorrow morning. I can't wait to start! The tan blocks that are now surfacing look ridiculous. Unfortunately, I can't use an exfoliant until it's been 30 days, so there's no speeding the cell turnover rate for another couple weeks. I definitely don't mind temporary hyperpigmentation though. I am hoping for permanent scar improvement!

It's best to avoid non-ablative laser treatment of acne scars as most people don't see much, if any, improvement. It's also best to avoid medspa type places that put your care in the hands of a nurse or assistant. Based on your picture, your skin type looks like Fitzpatrick IV. Is that correct? If so, your options for laser treatment may honestly be limited. Consult with a few doctors (dermatologist/facial plastic surgeon/plastic surgeon) who specialize in scar treatment, as well as darker skin, to find out your best options for scar treatment.

I've not had any treatment yet or seen a doctor, when i had my free consultation with the head nurse of skn clinic i was told i may need 5 treatments of laser resurfacing to see 40% results. I was also told the doctor may suggest c02 & fraxel laser but with that i remember the nurse saying because my skin is dark i may have problems with this laser, something to do with colour pigmentation ( think i need more info on this)

I have what i think are ice pick scars & i really hope my appearance-of scars are less visible. From the pics how bad do you think my acne scars are & do you think the laser treatment is worth it? I am little worried about side-affects if there are any

The nurse hasn't even consulted with a doctor on the best laser treatment for you, but she's willing to sell you a package with a possibility of 40% improvement. I would stay clear and save your money. For your type of scars, I don't think you'll see 40% improvement from a fractionally non-ablative laser. Whatever you do, don't pre-pay for a package of laser treatments. Packages are about making money. They make their money whether you complete all 5 sessions or not. I've bought packages in the past as well (not for laser but for skin treatment) and never completed them. I wish I could turn back time and get that money back for a treatment that actually works on scars.

Ice pick and boxcar scars can be difficult to treat. You really should consult with a few doctors who have experience with your type of scarring and skin type. You probably won't find that doctor at a medspa. Looking at your scars & skin type, I think you might want to consider a surgical approach and top that off with a low density laser for smoothing, but I am not a doctor.

Great! Stay positive, worries aren't good for your recovery. Good luck girl

Thank you, FruitBiscuits!

many thanks for documenting your experience. it seriously means a lot to get some real stories here...

can you describe why you decided not to use the aquaphor? do you think that will have an effect on your results? also, are the antibiotics required for your treatment or can you safely forego them?

good luck. we are all rooting for your success

It's not that I decided not to use Aquaphor. I am following my Facial Plastic Surgeon's post-op regimen. I am actually using most of the items in this kit, plus a free mask that was included with my kit:
http://www.dermstore...y Kit_36053.htm
I am not using the facial cleanser. Instead, I am using Cetaphil.

I posted about this in my original thread. If I run out of the Thermal Spring Water Gel & Thermal Spring Water Spray, then I was actually told to use Vaseline (not Aquaphor). I only mentioned Aquaphor because I know most people use it and I've used it in the past.

In terms of recovery, my skin actually looks amazing where it's peeled and the scabs have flaked off. Looking closer at the "scabs", they're probably not scabs, but more like dead skin that's getting darker with time. I was told not to speed the exfoliation process and let my skin heal/peel naturally, so the dead skin is probably lingering much longer than most people experience.

When I had Deep FX done in February, my skin turned a very dark red with pinpoint bleeding for 24 hours. The dark color eventually faded to lighter red and then developed into hyperpigmentation. For a few days, I also had small reddish, brown dots from where the laser hit. As of right now, I don't see any signs of hyperpigmentation. There are no dots, at all, and I actually didn't experience pinpoint bleeding this time. My skin is a little pink, but I think I'm going to get lucky with the pre/post regimens this time because my skin really does look fresh where it has completely peeled so far.  

My treatment was much more aggressive this time. The darker "scabs" have formed where he hit it hard with Deep FX and then went over it with Active FX. So far, aside from the downtime, I'm very pleased with my results. Of course, it's too early to say if my results will stay. I didn't feel this positive after Deep FX.

I did take Doxycycline for 7 days. I started 2 days prior to my treatment. I'm already done with that. I took Doxycycline prior to Deep FX and TCA Cross, as well. The Aquaphor really aggravated my skin despite the antibiotics.

I also took Acyclovir for 7 days to prevent cold sores. Previously, I was given Valtrex, which made me really sick. I thought it was the Doxycycline that made me sick but have since discovered it was the Valtrex. I puked several times while taking Valtrex, so he prescribed Acyclovir.

Thanks for the luck. As of today, I'm once again feeling positive!

I'll be following this very keenly. All the best with the treatment! I bet your skin is going to look great afterwards.

Thank you, Austra!

37 more hours to go... I am anxious and a bit scared. I'm questioning my sanity right now. I am actually paying someone $1000s to vaporize my face. LOL! The things we do to "improve" our scars.

I have to admit, I'm not too excited about posting detailed pics of my recovery on the Internet. We'll see how I feel about that later.

Hoping for the best and some rest! I can't seem to sleep right now and imagine tomorrow will be worse. Will keep you guys updated.

After searching all over Los Angeles and Orange County for a year, I finally picked a doctor. I am confident, I found the best doctor using the most effective laser for my kind of scars. I have decided to document my journey so that others know what to expect.

My laser treatment is scheduled for Dec. 4th. I had my pre-op today. The doctor was nice enough to make a special trip to his LA clinic on Thanksgiving weekend just to deliver my pre-op kit and meet with me. His laser clinic is actually located a couple hours outside of LA. Starting my pre-op regimen today will allow me to prep my skin for nearly 2-weeks while also giving me 3-weeks of healing time by Christmas. I made this request at the last minute before Thanksgiving, and am happy he was flexible and able to accommodate my needs.

My pre-op kit includes six items:
* Morning routine *
Glytone Cream Wash - Gentle Cleanser
Glytone Tone - Essential Prep Toner w/Salicylic Acid
Glytone SunVanish - Skin Bleaching 4% Hydroquinone with Sunscreen
Glytone Sunblock SPF 40 - Mineral based w/Micronized Zinc Oxide
* Evening routine *
Glytone Cream Wash - Gentle Cleanser
Glytone Tone - Essential Prep Toner w/Salicylic Acid
Glytone Clarifying Cream - Skin Bleaching 4% Hydroquinone
Glytone Enhance Night Renewal Cream- 0.05% Retinaldehyde + 5.5% Free Glycolic Acid
A picture of the kit:



For my procedure, he will use the Total FX "multi-layer" approach for acne scars. First, he will hit each scar hard/deep at 20mj/15% density with Deep FX. He will then pass over each scar again at nearly full ablation with Active FX. Finally, he will do a pass over my entire face with Active FX at a lower density.

Starting one or two days (need to confirm the exact timing) before my procedure, I will start taking an antibiotic and an antiviral medication.

On the day of the procedure, I will be given a Xanax, a topical numbing cream, dermerol shots, and a painkiller (either vicodin or percocet) to ensure my comfort during the procedure.  

I am excited and can't wait until Dec. 4th! I will update this thread as I learn more and following my procedure. I can't promise too many detailed pictures though.

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Dec 3 Update:

Met with my doctor a couple days ago to pick up my prescriptions. I've been given the following:
Doxycycline - Antibiotic to prevent infection - Started yesterday
Acyclovir - Antiviral to prevent cold sores - Started yesterday
Xanax - For anxiety - Will start 1 hour before procedure and then every 6 hours afterwards, as needed
Percocet - For pain & swelling  - Will start 1 hour before procedure and then every 6 hours afterwards, as needed

I am not sure I'll need the Xanax or Percocet after treatment, but I have them just in case. I've never taken either. I Googled them and they appear to be pretty strong drugs. I had Deep FX in February, and wasn't given anything for pain or anxiety. I walked into the laser room shaking with fear, and experienced incredible pain from just treatment of my scars. I'm glad this doctor cares about my comfort. I will also be given demerol shots & numbing cream one hour before my procedure. Compared to last time, I'm hoping this will be a breeze to tolerate.

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Dec 6 Update:

I had the procedure on Dec 4. I took a Percocet and Xanax about one hour before the procedure when they applied the first layer of numbing cream. I was then given a Demerol shot (painkiller) in the arm and 6-8 Lidocaine shots in my face & mouth. After the shots, a second layer of numbing cream was applied. About 30 minutes later, the doctor came in and started with Deep FX. Deep FX was tolerable. I barely felt any pain. He went over my scars only with Deep FX at a setting of 20mj/15% density (I think - am pretty sure). He then followed that up with Active FX on setting 3. I believe the maximum setting is 4 (I don't know why I think this, so it could be wrong. I also have no idea what setting 3 or 4 mean in terms of density, mj, etc.). Active FX has to be the most painful thing I've ever experienced in my life. If you have a low tolerance for pain, you may not be able to tolerate Active FX very well. I actually thought I had a high tolerance for pain, but this was EXTREMELY painful. I couldn't hold my body still during the procedure, and fear I may have forced him to be less aggressive. I am going to ask him about that during my post-op appointment next week. If I had a patient react like me during a procedure, I probably would have finished up as quickly as possible.

For post-op care, I was given a kit by Avene called SOS Post Procedure Recovery kit. A photo is below:


I apply the following a few times a day:
1. Thermal Spring Water Gel
2. Avene Thermal Spring Water Spray
3. Cicalfate Restorative Skin Cream
4. Antirougeurs CALM Smoothing Repair Mask (I'm actually using this one, once a day)

I am not using Aquaphor/Vaseline at this point. I will use those if I run out of the Thermal Spring Water Gel before I heal.

I am looking very scary at this point. I have attached one photo below and plan to delete it in the near future. I just can't leave an image of myself looking like this on the Internet! I actually look ten times worse in real life than the photo reflects. My skin is also cracking at this point with some flaking, and is extremely itchy. The dark areas in the picture are more like the color of a dark red scab right now. The reflection of the light also makes some areas appear normal color when they are actually red & brown too.
Photo of left cheek (this is my worst side in terms of scarring):


As of now, I can still see my scars but they are shallower. My scars on my right cheek are the hardest to see, so there's no point in posting a picture.

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Dec 7 Update:

My skin is extremely itchy and covered in small purplish scabs. Sleeping with itchy skin has been difficult. I ended up scratching my face in my sleep, and have since cut off my nails, which were very long. I wish I had thought of this sooner, and bought soft mittens. A little too late now.

Add-on
I am also now using Avene Tolerance Extreme cream for hydration as part of my regimen.
http://www.dermstore...CFcN_Qgodi1QA_w

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Dec 9 Update:

Over half my scabs have fallen off at this point. Below is a picture of what I mean by scabs:


I've written a bit more on this in a post further down this thread.

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Dec 11 Update:

I've added current photos below, and have tried to keep them as realistic as possible. My left cheek is my worst cheek in terms of wide, indented scars. They're closer to the outside of my cheek, and bother me the most. I have Asian cheekbones. They look awful when I smile. I used to have much deeper scars on both cheeks. If you look at my gallery, you can see I've come a long way after two laser treatments. Hopefully, collagen rebuilding over the next few months will plump my remaining scars some more. I did experience that  with most of my scars after my first Deep FX treatment.

Right side:
Looks a little smoother so far but I still have scars.


Left side:
The scabs and lighting are exaggerating the depth of the indents on my outer cheek in the second picture. I am doing that intentionally because I was having trouble picking up the indents. The indents are hard to see at most angles. They don't look nearly as bad in person as they do in the picture, and the scab in the base of my largest indent is making it look deeper. These wider indents were caused by TCA Cross, not acne. I used to only have boxcar and ice pick scarring. Some of my TCA Cross indents seem to have vanished, and others have shrunk in diameter. I'm extremely happy to see that. I will likely have to just settle for a filler on these in the future. I'm not convinced laser will improve them much more.



Looking closely at the second pic of my left cheek, you can actually see where my deeper ice picks used to be in the deeper indent. The ice picks are still there but they're shallower. Sadly, the skin just caved around them a few weeks after TCA Cross. It's like I'm going through a process of reversing damage with the hope of getting some of my original acne scars back.

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Dec 17 Update:

Just a quick update. I am now dealing with hyperpigmentation. It's very difficult to capture the lovely, multi-colored pattern on my cheeks in a photo. The varying colors make my scars & skin texture look significantly worse. I look absolutely ridiculous in person.



As of this morning, I am using the following to treat my pigment issues:
Cicalfate Restorative Skin Cream for the redness
Glytone SunVanish Skin Bleaching 4% Hydroquinone with Sunscreen
Glytone Clarifying Cream Skin Bleaching 4% Hydroquinone

Unfortunately, I can't use any exfoliants to speed cell turnover until I hit the 30-day point. This is going to take time to fade. I am flying out this weekend to meet with family for the holidays and am dreading that at this point. I can only imagine the comments I'm going to get.

Other than the hyperpigmentation where Deep FX was used, my skin looks great at this point!

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Jan 6 2013 Update:

Just a quick update. I am not noticing much improvement to my scars at this point. I started using Retin-a a few days ago, and it has opened up my pores again.   I was enjoying the smaller pores. I am still dealing with hyperpigmentation, and am not noticing much improvement to that either. The photos do not give the discoloration and funny blocked pattern on my face justice.

Right side:


Left side:


I was pretty disappointed one month after my first Deep FX treatment. I am trying to remain positive about this treatment, and hope to see much more improvement over the next few weeks. Once I get the hyperpigmentation under control, I will be able to take clearer photos of my scars.

More to follow later...

I came across an excellent publication on grading types and severity of acne scarring, as well as the best treatment approach for each type of scarring, a few months ago. I wanted to post it to the forum, but the file is too large at nearly 3MB. After a few Google searches, I found the publication on Scribd. You can find it here:
http://www.scribd.co.../Acne-and-Scars

The document is long at over 120 pages. If you join Scribd, you can download the pdf. It's a great read and resource for anyone hoping to treat their scars. I hope you find it as useful as I have.

For your reference, here's a glimpse of what's touched on:
==================
Table of Contents.

1 Classification of acne scars: A review with clinical and ultrasound correlation
2 Pathophysiology of acne scars 8
3 Hypertrophic and keloidal scars 11
4 Topical therapy for acne scarring 20
5 Superficial peeling 27
6 Medium depth and deep peeling 34
7 Dermabrasion for acne scars 42
8 Fillers and fat transfer for treatment of acne scarring 49
9 Needling 57
10 Fractional photothermolysis for acne scars 67
11 Nonablative and ablative devices for the treatment of acne scars 72
12 Surgical techniques: Excision, grafting, punch techniques and subcision 76
13 Camouflage: Clinical importance of corrective cover cosmetic (Camouflage)and quality-of-life outcome in the management of patients with acne scarringand/or post-inflammatory hyperpigmentation 87
14 Acne scars in Asian patients 90
15 Acne scarring and patients of African descent 98
16 Treatment algorithm for acne scars 110
==================

Best of luck to all fellow sufferers!

 Acne-and-Scars-scrfmt.pdf   3.99MB   352 downloads

How long were you off of Accutane before you had laser treatment?  I met with a plastic surgeon yesterday. We talked a bit about Accutane because he had to put his son on it. I've never been on it. He told me he would be reluctant to treat anyone who used Accutane with such a powerful laser. He said that if he were to consider it, the patient would have to be off of Accutane for a minimum of 2 years because Accutane stops the production of oils in your skin and you need those oils to be able to heal from laser treatment.

You appear to have a few rolling scars that are shallow to moderate in depth. Unfortunately, your scars will not fade on their own. I would certainly understand if you wanted to do something about them. If so, I think subcision is your best bet. I've never done subcision and don't have rolling scars, but know most people with your type of scarring do see good improvement with subcision.