Matt,
I just thought I'd let you know how my consult went. The doctor and the nurse didn't think subcision would be the best idea for me even for the couple of deeper ones on my right cheek. From everything I read in my research I thought those would be the best two options.
For now they said for me to continue use of tazorac until acne is completely clear and everything and they also said that tazorac can remodel skin with 12-24 months of use. I agree that I should stay on Tazorac until all redness and acne are completely gone and perhaps it can even improve scarring.
The doc and the nurse seemed to think that subcision would leave behind a worse scar than the ones I currently had. I know the subcision leaves something behind, but do you agree with this assessment? He described my scars on my right cheek as rolling scars. He performs a laser surgery at his place but he said my skin was too young for that type of laser...but he recommended a doctor with Fraxel and said it would probably take me 5 or 6 treatsments to get where I want to be.
I asked him about subcising the scars first but he didn't think it was necessary. I don't really know what to think or do. I agree that for now I'll stay on my current regiment but am not sure what my next step would be. The nurse seemed to think that a series of facial peels would probably help me significantly.
What do you think?
I'm surprised that he advised against subcision for your rolling scars. Honestly, I think it makes more sense to subcise rolling scars BEFORE they are treated with any type of laser as subcision deals with the root cause of the rolling scar: fibrous bands holding down the epidermis.
If you still have active acne, the chemical peels may actually help reduce your acne. I've used Glycolic and Lactic Acid as chemical peels. The Glycolic Acid is actually a harsher acid and will cause peeling. The Lactic Acid is not as harsh and the downtime is significantly less.
I would suggest that you look at buying 20-30% Lactic Acid off of
E-bay and try this every other week. It should help your overall skin tone and may help with any outbreaks.
Based upon what I've read on the internet so far, I'm not real impressed with Fraxel. My doctor recommends the Pearl Laser as if he feels that it is more effective in producing collagen remodeling than the Fraxel. I'll be getting a Pearl Laser treatment either in July or December of this year.
You may want to ask your doctor if he has performed subcision before. Most dermatologists I've gone to were not familiar with the procedure. That could be why he is recommending against the procedure.
Hopefully, you'll find the course of treatment that works best for both your acne and your scarring.
Matt
Hey Knicksrock- I've had the same problem finding a doctor willing to preform subcision even though most doctors know that the patient will see improvement! My best guess is why should they suggest subcision which is relatively cheap when they can suggest lasers for thousands? I'm going in to see a new doctor next week and I'm going to try a new approach I'm not going to ask about subcision I'm gonna TELL him I want it done and thats it....We will see how that plays out By the way my scars are exactly like Mr. Matts so I know for a fact it would help me!
Because I've been a long-time patient of my dermatologist, he gave me a substantial discount.
I only paid $200 for my subcision and TCA Cross (Chemical Reconstruction of Scarred Skin) Method treatments.
Of all of the things that I have done to help improve my scars, this has been the only thing that has actually worked.
I had three Laser Genesis laser treatments two years ago with absolutely no results, I've had more than 50 chemical peels and cryrotherapy and none of these treatments did anything to improve my scarring.
Ninety percent of my scarring was due to rolling scars. So, subcision was the right treatment option for me. I'm going back for round two in May.
I would encourage you to talk to your dermatologist/surgeon and see what the best option for your scarring might be.
Matt
it sucks because it says he performs subcision and he even said that he could do it...but they seemed to think that it could make the scar look worse rather than better??
I don't know if his opinion is good or not yet, am still debating...because he didn't try to sell me on his laser, but he referred me to a guy that does fraxel and said 4-6 treatments to get where I'd want to be, if he wouldn't be benefitting from the sale of the treatment is it possible he is telling the truth?
I agree I should continue to really look and find someone that is capable of doing this right.
As far as my active acne it is almost pretty much gone for a month now, tazorac has pretty much cleared me up.
He also recommended that I stay on the tazorac for at least 12 months- 24 months before doing anything for scarring because of "it's ability to remodel skin".
So I agree with him on staying on the tazorac for at least 6-9 months more and then slowly trying to find the right doc to do the procedure. I certainly don't want subcision to make it worse...but I feel that it is probably one of the better options.
matt,
question:
what did your doc say about risk to make the scarring worse: that seemed to be the main reason they didn't want to perform the procedure on me or warned me about it.
Any further info on this topic would be very helpful. I think subcision definitely needs to be done on my deeper ones and do not see how any laser treatment can bring it up to level. It simply doesn't make sense! I don't have the worst scars in the world but I mean it is there and I notice it and it upsets me so I need to do something about it.
My acne is pretty much almost clear now on a ligher note. Have you ever used any retinoids like retin A or tazorac btw? Just wondering.
YOu had over 50 peels? That is a lot of peels. Were they strong peels?
TCA cross is basically a peel just concentrated at a higher percentage right?
How bad were the scars the subcision left behind?
Honestly if I found a doctor that could do this in a different state and was skilled at it I would probably fly out.
KnicksRock said:matt,question:
what did your doc say about risk to make the scarring worse: that seemed to be the main reason they didn't want to perform the procedure on me or warned me about it.
Any further info on this topic would be very helpful. I think subcision definitely needs to be done on my deeper ones and do not see how any laser treatment can bring it up to level. It simply doesn't make sense! I don't have the worst scars in the world but I mean it is there and I notice it and it upsets me so I need to do something about it.
My acne is pretty much almost clear now on a ligher note. Have you ever used any retinoids like retin A or tazorac btw? Just wondering.
YOu had over 50 peels? That is a lot of peels. Were they strong peels?
TCA cross is basically a peel just concentrated at a higher percentage right?
How bad were the scars the subcision left behind?
Honestly if I found a doctor that could do this in a different state and was skilled at it I would probably fly out.
My doctor had me sign a release that the procedure(s) could result in scarring. I think that most doctors are going to require this to protect them from liability.
If you truly have rolling scars, I would seek out a second and/or third opinion. I do think that subcision is the best option for people followed by laser treatment to help the collagen remodeling.
I'm going for round two of subcision on May 8, 2009 and hoping that I'll see continued improvement.
I have been using Retin A .10% since March of this year. I think that it does help with collagen development and I say that based upon my baseline and post procedure photos.
I've been doing at home peels for the past two years and using 70% glycolic acid or 70% salycilic acid. However, these chemical peels did not appear to have impacted my scars much because they are deeper rolling scars.
However, I do think that chemical peels help with your overall skin tone and complexion and think they do help with some collagen remodeling.
TCA Cross (Chemical Reconstruction of Scarred Skin) Method is a treatment whereby the physician dips a sharpened wooden applicator in TCA and inserts it into a scar. This approach actually creates a wound and the skin responds by creating collagen and the scar fills in. TCA Cross Method should not be confused with a TCA peel. They are two very different and separate procedures.
You sound as if you are really motivated to see improvement in your scarring. I wish you a lot of success on your journey to healing.
mr. matt said:KnicksRock said:matt,question:
what did your doc say about risk to make the scarring worse: that seemed to be the main reason they didn't want to perform the procedure on me or warned me about it.
Any further info on this topic would be very helpful. I think subcision definitely needs to be done on my deeper ones and do not see how any laser treatment can bring it up to level. It simply doesn't make sense! I don't have the worst scars in the world but I mean it is there and I notice it and it upsets me so I need to do something about it.
My acne is pretty much almost clear now on a ligher note. Have you ever used any retinoids like retin A or tazorac btw? Just wondering.
YOu had over 50 peels? That is a lot of peels. Were they strong peels?
TCA cross is basically a peel just concentrated at a higher percentage right?
How bad were the scars the subcision left behind?
Honestly if I found a doctor that could do this in a different state and was skilled at it I would probably fly out.
My doctor had me sign a release that the procedure(s) could result in scarring. I think that most doctors are going to require this to protect them from liability.
If you truly have rolling scars, I would seek out a second and/or third opinion. I do think that subcision is the best option for people followed by laser treatment to help the collagen remodeling.
I'm going for round two of subcision on May 8, 2009 and hoping that I'll see continued improvement.
I have been using Retin A .10% since March of this year. I think that it does help with collagen development and I say that based upon my baseline and post procedure photos.
I've been doing at home peels for the past two years and using 70% glycolic acid or 70% salycilic acid. However, these chemical peels did not appear to have impacted my scars much because they are deeper rolling scars.
However, I do think that chemical peels help with your overall skin tone and complexion and think they do help with some collagen remodeling.
TCA Cross (Chemical Reconstruction of Scarred Skin) Method is a treatment whereby the physician dips a sharpened wooden applicator in TCA and inserts it into a scar. This approach actually creates a wound and the skin responds by creating collagen and the scar fills in. TCA Cross Method should not be confused with a TCA peel. They are two very different and separate procedures.
You sound as if you are really motivated to see improvement in your scarring. I wish you a lot of success on your journey to healing.
ROUND TWO SUBCISION AND TCA CR0SS METHOD MAY 8, 2009
This afternoon, I went to my dermatologist's office for my second round of subcision and TCA Cross (Chemical Reconstruction of Scarred Skin).
He and his assistant were very pleased with the results that I had with my first treatment. They both said they noticed a difference in my skin the moment they first saw me.
My dermatologist said he thought that I would need multiple treatments based upon his first evaluation of my scarring. Today, he told me that he thought that I would only need today's session plus one session of Pearl Fractional and I should be finished. 
Round two began with me washing my face with an antibacterial soap. Then, my doctor gave me a mirror and asked me to point out which areas I wanted to be treated.
Much to my surprise, he said that he was going to treat the three large boxscars on my left cheek that he had not touched during my first treatment. 
He then used a sterile pen and marked the "margins" of all of my scars and marked where my icepick scars were. He told me he was doing this now because once he began injecting my face with anesthesia, my skin would begin to swell and he would no longer be able to see the scars.
The assistant took several pictures and another assistant came in to the room to videotape the procedure (my request).
This time, I held a handheld mirror and actually watched both procedures. My dermatologist inserted a wooden applicator into 80% TCA and inserted the applicator into several icepick scars on my nose, chin, temples, and forehead. The areas he touched immediately frosted over.
For those of you who have had subcision and have not had good results, I think that the proper orientation of the needle is important. Throughout both subcision procedures, I heard the "popping"sound of the fibrous bands being broken.
During the procedure, the assistant placed ice packs on my face to reduce the bleeding, bruising, and swelling.
After one hour, the doctor and his assistant bandaged about 75% of my face with cotton balls and tape. I've been home four about four hours and I look like The Mummy. I'm going to upload a picture my wife took when I got home with all of my bandages into my album.
I talked to my doctor about having one session of Pearl Fractional done in July before I went on vacation and he advised that I not do it before going on a family vacation. After I saw photos of patients who had had the procedure, I saw why. They had very red and swollen faces and that's not how I want to be remembered on my family vacation. So, I will try to schedule it for another time.
I have an appointment scheduled in July and we'll see if I need a third round of subcision and TCA Cross.
I think that I had about 70-80% improvement with the rolling scars on my left cheek and about 40% improvement with the deeper rolling scars on my right cheek.
I cannot believe that I finally found a treatment that has actually helped my scars. As you may have read earlier in this thread, I have tried multiple sessions of Chryotherapy, three sessions of Laser Genesis, and over 40 chemical peels with no visible results.
If you have rolling scars, I strongly encourage you do to your research and find a good doctor who can help you. I've suffered for years with these rolling scars and to now see them going away is truly a blessing and a huge relief.
You need to keep in mind that it takes time for the collagen remodeling to occur. I noticed the biggest changes during weeks three and four after my scars had begun to resurface after the initial swelling had subsided. There were several times where I could feel my skin "tingling" and I knew that something was growing under the top layer of my skin; it was actually collagen developing. It is kind of like watching a swimming pool being filled with a garden hose. It takes a while for the pool to fill up, but eventually it does. It is the same way with subcision and rolling scars. It takes a while for the collagen to remodel itself, but eventually it does.
In fact, my doctor made a comment about how he was surprised at the amount of collagen remodeling that had occurred especially in my left cheek. (I'm in my forties and didn't think I could get these type of results because of my age).
I just bought an LED device and Vitamin C serum. I'm hoping that these two things will also help my scars to heal and will "jump start" the collagen remodeling.
I will post my "before and after" photos in 30 days.
In the meantime, hang in there and let's all continue to encourage one another on our individual journeys to healing.
Matt
your results are incredible matt. i've really enjoyed your updates.
for me i tried cross and subcision by rapaport and it backfired on me. after the procedure i got these huge black cysts that left deeper scars as well as pinkish/brown hyperpigmentation on my face that's still evident after 4 years.
this is counter to alot of peoples experience with both modalities. i'm still confused as to what the hell happened.
)
where is your doc again Matt? I wonder if it's worth flying out to a doctor in a different state if you cannot find one in your own state. Good luck with the healing.
My dermatologist's name is Dr. John DeSpain.
Here is his webpage:
Hope this helps.
Matt
how's everything going for ya now?
It will be two weeks tomorrow since my second round of subcision and TCA Cross Method.
I used ice packs on my face for the first four days after the procedures and that greatly reduced both the swelling and the bruising.
This time, I did not get the yellowish/orange hue in my skin that I had after the first procedure.
My dermatologist treated a large boxscar on my left cheek and it appears to have responded well to the subcision. I noticed that he missed two other boxscar scars and they haven't changed at all. 
The deep scars on my right cheek don't appear to have changed a whole lot since this second procedure. However, I am reminding myself that the progress I saw the last time came between weeks three and four.
I am also doing one thing differently this time: I'm using a topical Vitamin C serum on my skin each night to help increase the production of collagen.
I found a recipe online for the serum that costs a FRACTION of what a lot of companies are charging. If anyone is interested in the recipe, I can post the website. I'm also using a topical Vitamin E cream that I bought at Wal-Mart that was super cheap but supposedly very good for one's skin.
I'll post pictures in a couple of weeks. Watching your scars heal after subcision is like filling a swimming pool with a garden hose. It takes a long time (weeks or months), but eventually things begin to fill in. Some scars fill in more than others.
Slow and steady wins the race.
Take care.
Matt
couple questions Matt,
first off.
I just wanted to verify approximately how long the downtime was for subcision the first time around?
Can you do it on a Friday and return to work on a Monday?
How do you look after your first round of subcision and for how long?
Have you ever thought or asked about punch grafting?
The main few scars I want to treat with subcision and/or punch grafting are not boxscars
The main one I believe is a depressed scar and I think it is considered a rolling scar. It is probably almost a cm in alength and 1-2 mm depth.
Tazorac seems to smooth out my skin and make it better (after afew months but I don't think it has the power to completely heal my issues).
Thanks again.
couple questions Matt,
first off.
I just wanted to verify approximately how long the downtime was for subcision the first time around?
Can you do it on a Friday and return to work on a Monday?
How do you look after your first round of subcision and for how long?
Have you ever thought or asked about punch grafting?
The main few scars I want to treat with subcision and/or punch grafting are not boxscars
The main one I believe is a depressed scar and I think it is considered a rolling scar. It is probably almost a cm in alength and 1-2 mm depth.
Tazorac seems to smooth out my skin and make it better (after afew months but I don't think it has the power to completely heal my issues).
Thanks again.
After my first round of subcision, I made the mistake of not using ice packs on my face. As a result, I did have significant bruising on my face. The bruising manifested itself as large orange/yellow blotches on my face. At first, I was worried that it was hyperpigmentation as no one had warned me that this type of bruising could result from subcision. After doing some additional research, I found out that this was actually bruising.
So, after my second round of subcision, I used ice packs on my face off and on for one hour in the morning and one hour in the evening for about four days. The net result was that I had about 90% less bruising.
I had bruising for about a week after my first round of subcision. I only had a small bruise on my left cheek where my doctor aggressively treated a boxscar. That bruise only lasted four about three days.
Here is a word of caution about returning to work too soon: the orange/yellow bruising usually doesn't appear until day three or day four which means it could return right when you're either going back to work or to school.
I had my second round of subcision on a Friday and returned to work the next Wednesday. I had to attend a meeting with 30 of my colleagues and no one noticed anything. If you have the procedure done on a Friday, I think you could go back as early as Wednesday of the next week as long as you use ice packs on your face right after your procedure and throughout the following two-three days.
I have not considered punch grafts as I want to see how subcision, TCA CROSS Method, and Fractional Pearl Laser all work. I'm not aiming for a perfect complexion just improvement in the way that my scarring looks.
My scars are much less noticeable now since both procedures. In fact, I went to get my hair cut last Friday in the city where I live and my skin did not look as bad under the harsh lighting as it used it. In fact, it looked decent.
I would encourage you to use a topical Vitamin C before, during, and after any subcision treatment as this may help to stimulate collagen production. If you are a smoker, I would definitely cut out the cigarettes as this will adversely affect collagent production.
Also, I've been using Retin-A 0.10% for the last three months and it has definitely made my complexion look much better. I used to have fine lines that went from my eyes and "connected" the scars on my cheeks. Those fine lines have almost completely disappeared.
In addition, I have done two 70% Glycolic acid peels in the last eight weeks to also help the collagen production.
Slow and steady wins the race.
Hope this helps.
Matt
I use Tazorac currently which stimulates collagen and is similar (more potent) than Retin-A.
Matt,
I will have 2 or 3 subcisions with light sanding afterwards is what the nurse called it (I assume that is similar to dermabrasion? or sanding is just something they do after subcision?) I will get these questions answered soon.
Let me know what you think.
Thanks,
btw if there are any questions I should ask or need to ask before the surgery ina ddition to what I have told you please let me know.
The doctor does the surgeries quite often and is experienced in them. I will find out the exact frequency when I call Monday.
I put a deposit of 50$ down the surgery will between 250-500 is the estimate.
Thanks again as always for responding.
I am going to start taking C supplements today, and I use tazorac which will help collagen afterwards.
KnicksRock said:I use Tazorac currently which stimulates collagen and is similar (more potent) than Retin-A.
Thanks again as always for responding.
I am going to start taking C supplements today, and I use tazorac which will help collagen afterwards.
I am very happy to hear that you are taking proactive measures to help with your scarring.
Here are some suggestions:
1) use ice packs on your face for the first several days to minimize bruising and swelling
2) the needle used to anesthetize the areas on your face where he will do the surgery is the most painful. I told myself each time, "No pain, no gain."
3) keep the bandages on your face for as long as your doctor recommends. They are to prevent infection and to help reduce the bruising.
4) don't use aspirin or Vitamin E for a week before you're surgery to avoid excess bleeding
5) don't go out into the sun for extended periods of time afterwards to avoid hyperpigmentation
6) use topical Vitamin C to help with the collagen remodeling process
7) realize that your skin will look really good for the first week and then the swelling will subside and the scars will reappear. I had the most progress during weeks three and five after my first subcision treatment.
8) don't expect perfection or you will be sorely disappointed. Some of my scars completely disappeared after the first round of subcision (small rolling scars), the appearance of many of my scars was greatly reduced after subcision, however, some of them are still deep enough that I can see them.
9) ask your doctor if a laser treatment in between your subcision procedures would help with the collagen remodeling process or if dermal fillers injected into the subcised scars would also help with the collagen remodeling process.
10) take photos before and after the procedure. I was amazed at how quickly I had forgotten what some of my scars had looked like after my first procedure. When I looked at my "baseline" photos and my "after" photos, it was a stark reminder of how far I had come.
I hope that you'll post your photos along with your progress. I figure that we're all in this together and can definitely learn from one another.
Matt
Thanks so much for your responses.
Yeah I'll take some befores this week and afters a week after the surgery then 4 weeks after the surgery.
Will tazorac/retin A work with the collagen remodeling process after the surgery?
how soon afterwards do you think I can use benzaclin/tazorac?
I will look into a topical Vitamin C-- if you have any recommendations for one-- I was thinking mainly to take tazorac topically, then vitamin C orally for collagen boosting--
and benzaclin during daytime for usual acne maintenance (I'm 23).
I am planning ot have 5 days where I am just staying in and not doing anything after that and just staying in the house.
how long did you have to keep your bandages on?
What do you think of the derma sanding after the subcisions are done that day?
how many subcisions exactly did you have done? Afdter 5 weeks what would you say your improvement/satisfaction percentage is after the first round?
Thanks, P.s. I may do it again if I have to but I'd like to keep it a 1 round thing
also, do they put stictches in that you have to return after a couple days to get taken out?
Thanks