All sebaceous follicles in the face originate in the subcutaneous layer of skin. If you plan to remove all scarring, you will have to go down that far.

It's the sebaceous gland that the infection and inflammation originates from. The bulk of the infection/infection is in the dermis. The very edge/base of the hair follicle is attached to the subcutaneous layer of the skin, it does not enter it but is supplied by blood vessels into it. You still have some dermis under an acne scar. It goes subcutaneous layer, dermis, scar tissue, epidermis like covering, saucer like void.

Bulgarian Derm-

 

You got a little too technical with your description of the LED laser and kind of got hung up on the technological aspects of the equipment rather than the effectiveness and treatment. I don't think most of us know much about this treatment. When I hear laser, I automatically tune it out because I think it's just another Fraxel. How is this different? How can it be used in conjunction with ACell for better results?

I'm not bulgarian derm, but i am going to tune in here....

If you search under my name you will find i have been using light therapy for over 18 months, and specifically for scarring for about a year.

Now LLLT is much different to fraxel and such, as they aim to cause micro wounds or in the case of co2 laser ablative destruction of the upper layers of the skin.

With LLLT essentially you are just stimulating the bodies own functions to improve the structure and capabilities of the skins healing process.

The reason why many of us scarred in the first place is due to a prolonged inflammatory stage of healing, LLLT is known to reduce this along with many other beneficial things such as increased collagen production from fibroblasts, increased elastin and many others.

What bulgarian derm is saying is that when used in conjunction with other scar removal techniques you can greatly enhance your results. If you imagine that you have a 5 times increase in collagen production from these LED units then you can see how when used in conjunction with a scar revision technique that aims to remove some of the scar tissue and stimulate collagen production. You have a very effective combo.

I have been using needling/dermarolling, coupled with Light therapy and a product recommend by Tony Chu from the hammersmith hospital in london and honestly my scars bother me very little anymore.... I will continue with my Light therapy and terproline in order to maintain and possibly continue to enhance my results in the long run. I am pretty certain i won't see any wrinkles till a very late date in life.

Answers to some questions...

(1):

holdontohope,

You are correct that scarring does occur if the skin is wounded at the level of the hypodermis. There are no doubts about this in the medical community. Such wounds, either due to an infection, deep inflammation, cut, abrasion or burn are considered very serious. Nonetheless, others who voiced their countering opinions in your recent debate are also correct to an extent. After all, scars can also form in the dermis itself when an abnormal histological response occurs that simply does not rebuild collagen in an organized fashion. That said, when the skin that lies in the vicinity of acne scars is evaluated under a microscope one can usually (not always) see histological changes in the all three layers of the skin from the epidermis unto the dermis and down in the hypodermis. When the hypodermis is seriously affected one gets very deep pitted scars due to a partial loss of adipose (fat) cells. Some scars are so bad that even the underlying muscle tissue can be atrophied directly below the skin depression. Either way, all scars are unique and therefore impact different levels of cutaneous, subcutaneous and even deeper tissue.

With regard to Acell I really don't know what to tell you. I have never used Acell and I am not certain how effective it will be. However, if it is as effective as some scientists believe it may be, then I don't necesserily think we'll have to perform dermabrasion all the way through the hypodermis. My best bet is that multiple light dermabrasions done every two months followed by Acell applications each time would work better than doing one very deep dermabrasion... The former option would likely take 6-8 months of repeated treatments with a relatively safe risk profile and likely excellent results, while the latter could result in very disfiguring scars.

Going into the dermis would be enough as this area is supplied with nutrients via blood vessels and thereby the Acell ECM will be able to interact with the underlying tissue and thus attract the proper cells and indeed regulate the complex histological response.

(2):

hoursafter,

LED light comes in many different wavelengths. For the stimulation of peak cellular activity, the red wavelengths at 660nm are exceptionally beneficial. For the stimulation of subcutaneous blood flow and beneficial gene upregulation, it has been shown that infrared light between 850-880nm is superb. According to recent studies, it would seem that human cells (mammalian cells as well as those of reptilians) have evolved to utilize these wavelengths of light in order to aid in ATP production, fibroblast regulation, inflammatory process surpression and as I said even gene upregulation. Tests have shown that the MMP2 gene is definitely upregulated by light at the said wavelength, while some researchers are seeing evidence that MMP9 may also be upregulated. This gene in particular is very good for scarless healing.

Anyway, I've posted information about LED treatments in the Autologous Blood Transfer thread, where I mention that the LED light at the wavelengths stated above can also be captured by the haematoma from the blood injection. In essence, the haematoma (bruise/clot) acts not only as a temporary matrix for invading ECM building cells, but also as a chromophore for the penetrating LED light. The combination of the histological processes stimulated by the haematoma, coupled to the LED thermal effect on the haematoma and its stimulation of complex ATP, gene and fibroblast activation leads to a flattening of the scars over time. I've also posted about this in a thread started by wiki regarding LED devices in general.

I recommend everyone with acne scars to do daily LED treatments at 4-8 joules of light energy per day. Even without any other dermal remodelling treatments, the light therapy itself leads to a flattening of the scars over a few months time. Yesterday I decided to experiment and upped the light energy dose to 24 joules. Note that most academic studies conclude that 4 joules is optimal for fibroblast stimulation. However, since only ~10% of the light energy reaches 1cm below the skin surface, I decided to up the optimal dose 6X so that I could deliver 4 joules of light energy at approximately 0.6mm below the skin surface. In this way the cells in the upper layers of the skin essentially got overdosed which leads to less efficient functionality in the short-term. However the cells at 0.6mm presumably got the optimal dose and therefore would start a more efficient repair process at the deeper levels.

Either way, I don't recommend anyone try such a high light dose on their own. I'm simply experimenting at the moment in order to see if my theories will be confirmed. If everything works out as I hypothesize it will, then in a few weeks I may recommend the following LED regimen:

1) Daily 8 joule doses of red and infrared light combined for a month.

2) Daily 4 joule dose of red and infrared light combined for the second month.

3) In addition to (1) and (2), a bi-monthly or maybe just a single monthly super-dose of 24 joules.

4) Repeat cycle (1) and (2) indefinitely...

Note: Even though this is LLLT, I am adamant that special protective goggles have to be worn in order to protect the eyes. Some doctors say this isn't necessery for LED treatment, but I strongly disagree. Only do this treatment if you are willing to protect your eyes with red and IR resistant eyewear.

(3):

lamarr1986,

I'm glad you've gotten good results with your light therapy treatments. However from your posts I gather that you've only been using red light. If that's the case, I strongly recommend that you combine your current treatment regimen with infrared light therapy.

I am also not sure if you've calculated what doses you've been giving yourself over the last year. If these doses aren't at the minimum 4 joule level than you will not be getting maximal results. If your treatments are daily, then going over 8 joules will also result in sub-optimal dermal remodelling. Nonetheless, as I stated above, I am currently testing to see what a super dose of LED light does for subcutaneous stimulation.

When all is said and done the most important factor is that you are happy with your current results. Good for you.

----- ----- -----

Best of luck to you all and I'll keep you posted on my results.

Hey Bulgarian Derm,

I actually have a 700 LED array with both 350 660nms leds and 350 880nm leds. I asked you through email how you recommend i tackled my rosacea using the lights as i have had some trouble with increased facial flushing (i have rosacea) from the 880nm when i use both combined.

It seems like i may have to use a much lower dose of the 880nm wavelength.

I did try and calculate the time required for 4 joules using both wavelengths switched on and i reached the conclusion that is around 5 minutes when both are switched on...

Each LED (both the 660 and the 880nm are 6.4mw in my array) the array is also about 7x7 inches so using your calculations i came to the conclusion of about 5 minutes required for 4 joules per cm2.

I can switch one or the other wavelength on with my array as i knew before i bought it that my skin may agree with one wavlength better than the other!!

My deepest scar has been needled/dermarolled for over a year and it is now almost completely gone. It wasn't deep deep but atleast 1mm or the boxcar vvariety.

I have been using the light therapy consistently throughout this process, but yes mostly the 660nm wavelength. I think i will add a few minutes of the 880nm only.

I take it from the sheer quantity of treatments you are recommending that this is an at home , diy procedure. What kind of gadgets do we need to buy to perform this? LED and IR? How do we do this? Where do we buy the equipment? Any estimated costs?

That said, when the skin that lies in the vicinity of acne scars is evaluated under a microscope one can usually (not always) see histological changes in the all three layers of the skin from the epidermis unto the dermis and down in the hypodermis. When the hypodermis is seriously affected one gets very deep pitted scars due to a partial loss of adipose (fat) cells. Some scars are so bad that even the underlying muscle tissue can be atrophied directly below the skin depression. Either way, all scars are unique and therefore impact different levels of cutaneous, subcutaneous and even deeper tissue.

I was unaware that the inflammation due to acne traveled past the hair follicle into the hypodermis (the histology of skin is also not my expertise). I thought the bulk of the inflammation starts at the sebaceous gland and travels upwards to the surface....with some of it traveling to the base of the hair follicle...but not into the hypodermis. After all aren't the mast cells located in the dermis and aren't they they culprits of the inflammation and scarring associated with inflammation? This would lead me to believe that the pit of an acne scar is missing dermis, not missing dermis and fatty tissue. If the pit is more extreme and deeper than the dermis than it is due to scar tethers to the hypodermis, exaggerating the pit keeping it from springing up (why subcision is an option for some.)

Hopeseed you said, "I was unaware that the inflammation due to acne traveled past the hair follicle into the hypodermis." When in fact, as BulgDerm said, the hair follicle is actually rooted in the hypodermis. How far into the hypodermis the follicle goes varies, but the base of the follicle is found in the hypodermis.

Hopeseed you said, "I was unaware that the inflammation due to acne traveled past the hair follicle into the hypodermis." When in fact, as BulgDerm said, the hair follicle is actually rooted in the hypodermis. How far into the hypodermis the follicle goes varies, but the base of the follicle is found in the hypodermis.

The base is follicle ..the very bottom side is found on the BORDER. I was told that one of the criteria of defining a tissue as dermis was from the hair follicle to the epidermis. I'm still convinced that the the majority of the scarring occurs in the dermis and that the pit or missing tissue is missing dermal tissue.

Sigh. Don't you guys wish we could all start over? Ever since Acell came up in this discussion, I've had these morbid daydreams of having all the skin on my cheeks ground off, down to the subcutaneous layer and just putting Acell over it, treating it with an Infrared laser, and two months later, viola, the nightmare's over. Everything is new. Hey, a girl can dream, can't she?

Sigh. Don't you guys wish we could all start over? Ever since Acell came up in this discussion, I've had these morbid daydreams of having all the skin on my cheeks ground off, down to the subcutaneous layer and just putting Acell over it, treating it with an Infrared laser, and two months later, viola, the nightmare's over. Everything is new. Hey, a girl can dream, can't she?

I wished I had forced my parents a long time ago to bring me to the derm, before all this shit had happened. sigh.

So are there ANY news on how acell works for scars YET? I hate procastination.

Also, why we have genetically modified mouses who heal without scarring and the scientists dont use the similar genes in us or find some ways to emulate it in humans? Also, shouldnt the results of whichever doctors who used acell be out already?

Im sorry, im really really depressed, ive waited so long for this day i really wish it will all end...

Sigh. Don't you guys wish we could all start over? Ever since Acell came up in this discussion, I've had these morbid daydreams of having all the skin on my cheeks ground off, down to the subcutaneous layer and just putting Acell over it, treating it with an Infrared laser, and two months later, viola, the nightmare's over. Everything is new. Hey, a girl can dream, can't she?

ditto ditto ditto! Sometimes when I'm in a car I just want to stick my head out the door and onto the pavement and sand my cheeks down... and sometimes I just want to take a hot iron to my face.

Let's hope that a regimen for SIGNIFICANT improvement is near.

I was just on the acell website and on the banner along the bottom of the page it reads

Significantly reduces scar formation - Restores tissue to normal state and function

along with many other uses. My question being can a tissue be restored to its normal state and function if any scar tissue remains? Being that acell claim it Significantly reduces not stops scar tissue formation.

Hi Guys,

Just thought I'd post this, you might be interested.

I was just on the acell website and on the banner along the bottom of the page it reads

 

Significantly reduces scar formation - Restores tissue to normal state and function

 

along with many other uses. My question being can a tissue be restored to its normal state and function if any scar tissue remains? Being that acell claim it Significantly reduces not stops scar tissue formation.

They have to say things like "significantly reduce" scar formation b/c in the event that there is an injury so severe that acell can not prevent the scar ...then they need to account for that.

For example I don't think Acell can completely inhibit scar formation for lets say a shotgun wound point blank...but for a controlled CO2 or some TCA applied in a controlled fashion ......hmmmmm

I was just on the acell website and on the banner along the bottom of the page it reads

 

Significantly reduces scar formation - Restores tissue to normal state and function

 

along with many other uses. My question being can a tissue be restored to its normal state and function if any scar tissue remains? Being that acell claim it Significantly reduces not stops scar tissue formation.

 

 

They have to say things like "significantly reduce" scar formation b/c in the event that there is an injury so severe that acell can not prevent the scar ...then they need to account for that.

 

For example I don't think Acell can completely inhibit scar formation for lets say a shotgun wound point blank...but for a controlled CO2 or some TCA applied in a controlled fashion ......hmmmmm

 

OK ok, all talk. But should you guys living in the US be more pro-active? Put in more action? Arent there doctors ALREADY using TCA applied in a controlled fashion for acell( Forgive me, Ive forgotten who or where is that doctor located but it was mentioned like a month earlier in this forum ).

I wouldn't trust much this adviser (doctor?) has to say. First off, they've never even heard of the product and admitted that they simply looked it up on the internet. If you look it up on the internet, it takes serious digging to understand that ACell isn't just in matrix form (the dressing) but that it also is manufactured in a powder form. This substantially changes things.

Most scarring is not depressed, yet he only addresses depressed scars.

It seems like the aid in wound healing and no help in scar healing are contradictory statements based on hypothesized methods in these forums. Perhaps this adviser did not even consider injury to the scar site follow by ACell application and thought you met immediate application. Doctors (internet advisers) are not geniuses and when fielding many questions via the internet at a time can easily rush to answers.

That being said, information regarding ACell is becoming more and more sparse with the impracticality of treatment even if effective looming, it's beginning to feel like I'm just chasing my own white whale.

Well I finally got my derm to call up Acell to find out what is going on with their ECM product. Mike Manning told my doc. that Acell has been available to purchase via a prescription (only) in the US for the past six weeks. And when pushed on why Acell have not yet conducted any double blind placebo controlled clinical trials to prove ECM's effectiveness at preventing scar formation, Mike Manning seemed to imply that the company doesn't currently have funds to organise such trials. Instead, he states Acell is relying on opinions from outside doctors who are 'testing' the product on their own patients eg the hair transplant study mentioned on hairsite.com.

What I find amazing is that Acell is available to all you guys in the US, all you have to do is get a prescription/script from your GP to try this product out! But it seems no one thus has, why??! If I was in your position I would jump at the chance to purchase some of Acell's ECM. You obviously would only need to test it on a single scar minimising a chance side-effects.

I asked my doc if he could prescribe me some but Acell say they can only supply US addresses as they have yet to submit the ECM for European approval.

Surely, instead of logging on to acne.org daily and checking for Acell updates it would be better to just go out there, speak to your doc and pick some up?

As each day passes I am beginning to face the depressing fact that the nearest hope we have to finding something to treat these scars will only be available to us in 2009 when Juvista is released. Not only is that ages away but also the drug has a limited 30% success rate with success being defined as the scar improved well > not exactly encouraging.

Unfortunately, something is telling me that Acell is just another over-hyped internet phenomenon.

Most people with acne scarring that causes them enough grief to frequent these boards have scarring down to the hypodermis (subcutaneous) - the texture is fuked. The problem will be solved on the day that full thickness skin wounds between 10 and 3 cm in diameter can be healed over completely and totally without much different between the new tissues and the surrounding tissues. This may be 10 years ahead. This may never be. I don't know. If there ever is one, the true "savior" to facial scars will be high risk and scary as hell to undertake.

I really am totally curious as to how effective Acell + LLLT (low level laser therapy) would be in full thickness skin wounds. I want to know.... This is also exciting and holds promise: http://www.mirm.pitt.edu/news/article.asp?qEmpID=328 ------- That entire site is pretty damn cool....

To hopeseed that sounds about right, to cover themselves in the event there is some massive trauma. Neca I didn't know that they could just get a perscription for it. If there is someone in US reading this.

1) Have you seen a doctor regarding acell?

2) What did they say to you about obtaining the product and potential results?

Most people with acne scarring that causes them enough grief to frequent these boards have scarring down to the hypodermis (subcutaneous) - the texture is fuked. The problem will be solved on the day that full thickness skin wounds between 10 and 3 cm in diameter can be healed over completely and totally without much different between the new tissues and the surrounding tissues. This may be 10 years ahead. This may never be. I don't know. If there ever is one, the true "savior" to facial scars will be high risk and scary as hell to undertake.

 

I really am totally curious as to how effective Acell + LLLT (low level laser therapy) would be in full thickness skin wounds. I want to know.... This is also exciting and holds promise: http://www.mirm.pitt.edu/news/article.asp?qEmpID=328 ------- That entire site is pretty damn cool....

Holdon, you mention 10year...

I think you just dont know how close we are to complete regeneration in our softer tissues.

This is what a lesser ECM has done

Hey kirk do you have a before photo for that pic. Would be great to know how much difference is the before and after.

Hey kirk do you have a before photo for that pic. Would be great to know how much difference is the before and after.

No but there is an in between photo. I'm sure I read somewhere he was a skin cancer patient.

hmmm well i have a friend who is a GP, are u saying he can get Acell or does it have to be a PS or derm. And if did get it, what are ur thoughts about applying it after a laser procedure like repair. Sorry if this has already been discussed.

I'm guessing this is the product Tony Is talking about...

http://www.apligraf.com/patient/what_is_ap...d_apligraf.html

hmmm well i have a friend who is a GP, are u saying he can get Acell or does it have to be a PS or derm. And if did get it, what are ur thoughts about applying it after a laser procedure like repair. Sorry if this has already been discussed.

Hey damn!, yes this is exactly what I am saying. According to Mike Manning (Marketing Director at Acell) anyone in the US can get Acell all they have to do is get a prescription written by their doctor to authorise this.

I guess it can be a GP, derm or any doc, they just have to have the authority to write prescriptions. Phone (800) 826-2926 and ask to speak with Mike Manning, he will gladly help out and explain what is required to get hold of Acell's ECM.

And if did get it, what are ur thoughts about applying it after a laser procedure like repair.

That would definitely be an appropriate time to 'test' Acell's potential as your skin will be in its healing stage. However, since this is just a trial I would first use Acell by patching testing it on a section of my skin or face. I wouldn't think there is much risk at all doing a full face test with Acell but it is always best to be on the safe side.

Since I have visible scar tissue, if I ever got hold of some Acell, my aim would be to remove about 0.5cm in length of the scar tissue with a scalpel and apply Acell to that area. Leaving the remaining scar tissue in tact would ensure the wound can heal with the need of stitches as the scar tissue acts almost as support.

Damn! you will be a hero if you acquire Acell's ECM and trial it for us, I just don't understand why there aren't more people in America trying to do this...it's a shame!