I think what most likely happens is that the top of the columns gets healed quickly (within the 1-2 weeks) and then the columns underneath the top layer take a few weeks to properly build up collagen and thus why you notice a plumping effect a few weeks later. I don't think they need to go deeper than the scar itself, but they need to go deep enough to hit the bottom of the scars. Technically speaking - I don't think blood matters a lot with lasers as in principle lasers are supposed to coagulate the blood vessels at the same time as they burn it off.
Also from what I understand, almost all fractional co2 lasers can reach similiar power settings - it's just based on the doctor to properly set them up (except the ultrapulse which can reach 100% ablation).
I have seen all the studies, fancy diagrams and photos over the course of a few years but I am still not sure I 100% agree with that status quo acne scar treatment.
I believe that there is 3 things that happen from fractionated lasers that improve appearance of scars:
1) The heat from the laser causes the skin to "shrink" or tighten. That can be seen here.
2) Vaporizing the scar tissue. Yes, technically the laser depth only has to hit the bottom of the scar, BUT I believe this only yields a limited improvement.
An example of this would be when I had the ultra pulsed laser done, not the Lumenis Ultrapulse. Same idea but two different technologies. The Lumenis Ultrapulse can reach a 100% coverage but the ultra pulsed laser I had done is an old school CO2 "flat beam" laser that is only 100% coverage (and not made by Lumenis). The depth was set at 90 microns, but there was 3 passes done for a total of 270 microns, which is pretty darn deep and aggressive for a 100% ablative laser. This would also explain why it literally took my skin 6-7 months to fully recover. Anyways, the laser definitely went below the threshold of even some of my tiniest scars at 100% coverage. Logically you would think this would basically erase the scar, but it didn't. This is a big reason why I believe you can only get a limited amount of improvement from hitting the bottom of the scar, even at 100% coverage.
3) Collagen production weeks~months later or "plumping" of the skin as you described it. I believe this is where the biggest and most important factor comes in to play for treating scars. And although I agree that technically you only have to hit the bottom of the scar, I believe you are limiting your results by doing so. I think you can get more plumping or collagen production by going deeper. How much deeper ? I don't know. But it just seems from random studies, people on this board and my own experiences that deeper settings = better results. My scars are pretty darn shallow and yet it seems the "overkill-method" works best. Notice that most of those published studies on fraxel repair for wrinkles on the face, the power was 70 joules (1600 microns).
I understand that some may claim that the depth of of the reticular dermis begins at 700 microns. However, a few doctors on realself have stated that the eyelids dermis+epidermis is 400 microns thick with the chin/nose being 1400 microns. This would lead me to believe that 700 microns to ablate the entire dermis at the cheeks would be a very conservative estimate. For the sake of argument lets say the reticular dermis does start at 700 micros. My theory is that you would want to ablate beyond that point anyways to stimulate collagen for maximum results. Yes it is true, the deeper you go the greater chance of scarring. I hate my scars so I am willing to gamble a little more than others.
I also think that doctors overstate the whole " lasers are dangerous for asians" scenario. Has there been one documented situation where an Asian patient has had permanent hyper-pigmentation from fractionated lasers? That is a serious question as I honestly don't know. Though I have searched for evidence with little success. Hypo-pigmentation from non-fractionated lasers are a different story, and even then, very rare. The only difference with Asian skin that I know of is that the hyper-pigmentation can last longer. I am aware of this as I had significant hyper-pigmentation from a very aggressive oldschool co2 laser treatment for 6 months (which did eventually go away). Being half Italian, I would argue that my skin tan's even easier than it would if I was 100% Japanese. The Italian side of my family is much darker and tanned than the Japanese side due to genetics (actually the Japanese side is very pale).
All of this goes back to my original post when I stated that doctor's care very little about how much your skin improves as long as there isn't adverse effects that could potentially cause litigation. Sure, they say they care. But they don't go home feeling sad about OUR scars. As I said before, I believe that the majority of patients who request fractionated lasers are for wrinkles and sun damage, not scars. Doctor's pockets won't take a hit if an acne scar patient decides not to repeat business. This is why I believe so many people see underwhelming results.
I could be 100% wrong. I just want to reiterate what my theory is on treating scars and doctor's reasoning for making us believe otherwise. It is a very odd and easily disagreeable point of view but something to think about! Also, none of this is a reflection of my thoughts on slee's treatment. He just reminded me of something when he talked about his lagging improvement weeks later.
Looking forward to future updates!
If your main concern is depth of treatment, you can look into Fractora. Same principle as lasers, except it uses microneedles so it can go deeper without creating huge ablation channels. It goes 1MM in depth if I remember correctly. It's a more aggressive ematrix as it actually ablates the skin. No idea how the results are though.
Maximum Output Energy 62 mJ/pin"
http://www.invasix.com/upload/ARTICLES/WP_Fractora_SMMK.pdf
http://www.invasix.com/upload/peerrev_jcdsa_fracasian_da_.pdf
Thank you slee for continuing to update one of the few compelling threads on this forum. I'm gonna come out and say it. This board has devolved and the intelligent and informed conversations seemed have gone by the wayside. Seriously, just look at the top discussed threads.
I clearly see the hyperpigmentation in your pictures. Now that you are three weeks out, probably most of the micro swelling has gone down. Can you give us an idea of any changes to the scars or texture of your skin? Do you see noticeable improvements from this more aggressive session?
Thank you slee for continuing to update one of the few compelling threads on this forum. I'm gonna come out and say it. This board has devolved and the intelligent and informed conversations seemed have gone by the wayside. Seriously, just look at the top discussed threads.
I clearly see the hyperpigmentation in your pictures. Now that you are three weeks out, probably most of the micro swelling has gone down. Can you give us an idea of any changes to the scars or texture of your skin? Do you see noticeable improvements from this more aggressive session?
If you feel that way (I do as well), then please do complain about the new forum structure and merging of the hyperpigmentation + scar forums, since I think that's the most important reason for why good knowledgeable people have stopped posting and the scar forum is a mess. If enough people complain, mods will hopefully react.
And sorry this is off-topic, but oh how I wish someone could lock/delete the urine thread. Such nonsense should be banned.
Thank you slee for continuing to update one of the few compelling threads on this forum. I'm gonna come out and say it. This board has devolved and the intelligent and informed conversations seemed have gone by the wayside. Seriously, just look at the top discussed threads.
I clearly see the hyperpigmentation in your pictures. Now that you are three weeks out, probably most of the micro swelling has gone down. Can you give us an idea of any changes to the scars or texture of your skin? Do you see noticeable improvements from this more aggressive session?
I'd just like to second Austra's suggestion. Please do say something here:
I added a comment yesterday. Perhaps if more of us spoke up, they'd actually give us back our old board. We never had to deal with this kind of nonsense in the past.
SLee - Good luck with healing. I hope this works out for you. Be gentle with your skin. He was very aggressive. Your bleeding was very different from what I experienced with "pinpoint" bleeding. If you're using some kind of bleaching regimen, be sure to only apply it to the dark areas. Don't apply it to your whole face. Combine it with some kind of topical to increase cell turnover, like Retin-a, but apply that to your entire face first. Your hyperpigmentation will likely take a couple months or possibly longer to fade. As a suggestion, slow down with your laser treatments. Give your skin time to heal and allow collagen to fully rebuild before going for another aggressive treatment. You could end up doing more damage than good. I'd wait a minimum of 6 months to see the full results of your latest session.
Thank you slee for continuing to update one of the few compelling threads on this forum. I'm gonna come out and say it. This board has devolved and the intelligent and informed conversations seemed have gone by the wayside. Seriously, just look at the top discussed threads.
I clearly see the hyperpigmentation in your pictures. Now that you are three weeks out, probably most of the micro swelling has gone down. Can you give us an idea of any changes to the scars or texture of your skin? Do you see noticeable improvements from this more aggressive session?
Hello Blahblah82,
Ive definitely noticed better improvement of my scars this time around. However, the hyperpigmentation that i currently have is tending to hide my scars right now. But when i do examine my scars, they seem to be shrinking ever so slightly. They are still there, but are starting to look less prominent on my face. Texture is the same, skin feels smooth. As of now, I would rate it about 50% "overall" improvement of my right side and about 65% improvement on my left side. Simply put , they are starting to look a bit better, still not drastic however since all the scars are still there, but are starting to shrink a bit.
Thank you slee for continuing to update one of the few compelling threads on this forum. I'm gonna come out and say it. This board has devolved and the intelligent and informed conversations seemed have gone by the wayside. Seriously, just look at the top discussed threads.
I clearly see the hyperpigmentation in your pictures. Now that you are three weeks out, probably most of the micro swelling has gone down. Can you give us an idea of any changes to the scars or texture of your skin? Do you see noticeable improvements from this more aggressive session?
I'd just like to second Austra's suggestion. Please do say something here:
I added a comment yesterday. Perhaps if more of us spoke up, they'd actually give us back our old board. We never had to deal with this kind of nonsense in the past.
SLee - Good luck with healing. I hope this works out for you. Be gentle with your skin. He was very aggressive. Your bleeding was very different from what I experienced with "pinpoint" bleeding. If you're using some kind of bleaching regimen, be sure to only apply it to the dark areas. Don't apply it to your whole face. Combine it with some kind of topical to increase cell turnover, like Retin-a, but apply that to your entire face first. Your hyperpigmentation will likely take a couple months or possibly longer to fade. As a suggestion, slow down with your laser treatments. Give your skin time to heal and allow collagen to fully rebuild before going for another aggressive treatment. You could end up doing more damage than good. I'd wait a minimum of 6 months to see the full results of your latest session.
Thanks for the advice, after i read your comment, i started to apply your regime. Thanks.
Hope your treatment is going well as well!
Also yes ill wait a bit before i go in for my 4th treatment, i do feel like i am rushing it a bit.
Thanks for posting your experience slee3. 50% improvement after 3 treatments sounds really great, from your pictures your skin looks much smoother and I'm sure it will look even better when the redness fades.
I'm planning to go for my first session of Mixto in a few weeks, probably on low settings because it'll be the first treatment I have after Accutane. Do you think it does anything for shallow boxcar and rolling scars? Because that's what I mostly have.
Month 2 Post Mixto #3 Update
Hey Slee,
How are you healing? I am in the same boat as you with hyperpigmentation right now. Hopefully you are seeing some fading by now.
Healing has been going well, ive updated my HP issue in my most recent update.
Hi Slee!
May i ask what "tinted sunscreen" you are using?
I have a lot of hyperpigmentation i want to hide
Hello,
Im using dermaesthetics SPF 50+ sunblock , dermaesthetics EGF blemish balm concealer, with some BB cream, and neutrogena skin liquid makeup concealer. Yes I know its a bit overboard, and very girly, but ehh gotta do what i gotta do to hide the redness. even with all the crap on my face, it would conceal okay...but would wear off after like 3-4 hours. But now, my HP has faded almost completely, so dont really worry about it anymore, just only for the first like 6 weeks.
How did you go out in public with such crazy pigmentation (makeup)? What would you tell people if they asked you why your skin was so red? Nice improvement bro!! Could you look at my picture in my gallery and tell me if you think I'm too dark for mixto lol...
Makeup can do miracles when it comes to hiding or should i say masking your face.
Month 2 Post Mixto #3 Update
Hey Slee,
How are you healing? I am in the same boat as you with hyperpigmentation right now. Hopefully you are seeing some fading by now.
Healing has been going well, ive updated my HP issue in my most recent update.
Hi Slee!
May i ask what "tinted sunscreen" you are using?
I have a lot of hyperpigmentation i want to hide
Hello,
Im using dermaesthetics SPF 50+ sunblock , dermaesthetics EGF blemish balm concealer, with some BB cream, and neutrogena skin liquid makeup concealer. Yes I know its a bit overboard, and very girly, but ehh gotta do what i gotta do to hide the redness. even with all the crap on my face, it would conceal okay...but would wear off after like 3-4 hours. But now, my HP has faded almost completely, so dont really worry about it anymore, just only for the first like 6 weeks.
Im thinking of using bb cream only. I dont know if that is enough. Though, bb creams already have spf and some do have medium coverage.
I dont think it's girly. We have to do what we have to do. I mean if we had good skin, we woudnt even think of makeup.
