Hello. I've been advised by my dermatologist to get a combination of TCA Cross/Subcision/Dermapen for my mild/moderate acne scarring, and i am completely confused about whether or not I should do it. In fact, it's been consuming my thoughts to the point of my becoming antisocial.
I never had severe acne -- it was moderate at worst, but over a period of 10 years, each cyst i had left a scar of some sort (even though i never picked -- my skin is extremely sensitive). That left me with about 8-10 noticeable acne scars scattered on both cheeks -- I would say only 2-4 are v deep, remaining are shallow but still noticeable. they are a mixture of boxcar and rolling, i don't have any icepick scars and I would say in most lighting my scarring isn't that obvious -- besides about 2 of the deep scars.
About two years ago, I got fraxel done, even though my dermatologist at the time said people with serious acne scarring would be happy with skin that had scarring as shallow as mine (at the time). A part of me wishes I had listened to him -- the treatment, which cost me a fortune, did not do much for my skin -- in fact, i feel it worsened its texture, though it's hard to tell. A couple of severe breakouts since then left me with additional scarring which led me to reconsidering further treatment on my skin.
I am at a point where i'm not sure if this will do more harm than good. I know for a fact that my scarring is not noticeable in most lighting (i frequently check, out of pure paranoia). i also am convinced not many people notice the scarring. I have no hyper-pigmentation and my skin is very clear now.
I'm frequently told that i'm pretty -- and if it were not for this scarring that i have -- i would believe myself to be, as well. I have no problem dating, etc, and am approached frequently. not to sound vain, i am most certainly not. just saying that i don't think the scarring is a major, determining factor in my appearance, evening though i know it to be there, and it disturbs me psychologically.
I suppose my question is -- should i take the risk of going for more treatment? On some days and in most lighting i feel completely content and the scarring doesn't bother me. then i'll catch a glimpse of it in bad lighting and i will become a recluse for days. that's not to mention the harsh lighting at the dermatologist's office, which merely highlighted every indentation i had, and furthered her case for having some work done.
beyond this, i am worried about the risks associated with the procedure, which my dermatologist will complete for me in one sitting. she also said i need to have it done 3 times -- and i'm reluctant to even get it done once. she failed to elaborate on what the potential side effects are, and that worried me a little.
I'm new to the forum so would appreciate any advice from people who have had the procedure done, or who have similarly wondered whether or not leaving the scars alone is the best thing to do.
thank you
Oh i know what you mean about reflections and lightings. I try my very best to avoid looking at reflections but sometimes it is just unavoidable. The worst is when i see my skin and the sun is shining so brightly and then i see shadows on my skin. After that i feel like i haveto get away from the world and hide.
From your post, it seems like you are looking for treatments with the lowest risk possible? Correct me if im wrong.
Treatments with low risks are dermastamping, not dermarolling.
Single needling.
Chemical peels.
All of the above partnered with topicals that help the skin heal from a cellular level.
You should look into beta glucan. Research it, it's very interesting and i must say amazing.
Though it would be nice if you could post a picture of the area of your skin which is scarred. Not the whole face because of privacy issues.
But of course, you dont have to if you dont want. I just think that it will help us more to evaluate which kind of treatment would be appropriate.
Cheers and goodluck 
Oh i know what you mean about reflections and lightings. I try my very best to avoid looking at reflections but sometimes it is just unavoidable. The worst is when i see my skin and the sun is shining so brightly and then i see shadows on my skin. After that i feel like i haveto get away from the world and hide.
From your post, it seems like you are looking for treatments with the lowest risk possible? Correct me if im wrong.
Treatments with low risks are dermastamping, not dermarolling.
Single needling.
Chemical peels.
All of the above partnered with topicals that help the skin heal from a cellular level.
You should look into beta glucan. Research it, it's very interesting and i must say amazing.
Though it would be nice if you could post a picture of the area of your skin which is scarred. Not the whole face because of privacy issues.
But of course, you dont have to if you dont want. I just think that it will help us more to evaluate which kind of treatment would be appropriate.
Cheers and goodluck
^^ That's useful advice, I was wondering about this too. How are you using beta glucan - as a supplement or topical?
Right now, I don't want to risk possible side effects from procedures/lasers as my skin is very sensitive, so I'm sticking to gentle peels, high frequency, red/blue light treatments, and I recently tried something that was similar to IPL but since it was free (and normally $20 at my spa) I think it was just a lower setting pulsed light treatment. Depending on how deep your scarring is, you might want to start with peels and red light, but those will obviously take several treatments to see dramatic improvement.
Pictures would be ideal, yes. Subcision should be a fairly low-risk and effective treatment, so I don't see why you couldn't try it. Although if your rolling scars are shallow, it may not be that effective. And TCA cross doesn't really work for boxcars, at least I wouldn't recommend it. I've had 3 TCA cross treatments for small boxcars (which at the time I thought were closer to ice-picks, but there's a difference) and most of them seemed unaffected, a couple of them improved for a couple of years and then reversed to what they were like before, and one got worse. The TCA peel I got at the same time on the other hand made my skin in general (and thus scarring) look much much better, although the effect wears off after a while. I've tried to find out more valid information about the effectiveness of dermapen or dermarolling, but I haven't found much unfortunately. Some say it can help though.
If your scarring is truly not affecting your looks and most people don't seem to notice, it may not be worth the risks though. The more you look into treatments, the more obsessed you tend to get with your scarring and if they're getting better or worse and it easily ends up taking up more of your life than it deserves.
Oh i know what you mean about reflections and lightings. I try my very best to avoid looking at reflections but sometimes it is just unavoidable. The worst is when i see my skin and the sun is shining so brightly and then i see shadows on my skin. After that i feel like i haveto get away from the world and hide.
From your post, it seems like you are looking for treatments with the lowest risk possible? Correct me if im wrong.
Treatments with low risks are dermastamping, not dermarolling.
Single needling.
Chemical peels.
All of the above partnered with topicals that help the skin heal from a cellular level.
You should look into beta glucan. Research it, it's very interesting and i must say amazing.
Though it would be nice if you could post a picture of the area of your skin which is scarred. Not the whole face because of privacy issues.
But of course, you dont have to if you dont want. I just think that it will help us more to evaluate which kind of treatment would be appropriate.
Cheers and goodluck
^^ That's useful advice, I was wondering about this too. How are you using beta glucan - as a supplement or topical?
Right now, I don't want to risk possible side effects from procedures/lasers as my skin is very sensitive, so I'm sticking to gentle peels, high frequency, red/blue light treatments, and I recently tried something that was similar to IPL but since it was free (and normally $20 at my spa) I think it was just a lower setting pulsed light treatment. Depending on how deep your scarring is, you might want to start with peels and red light, but those will obviously take several treatments to see dramatic improvement.
HI! 
well, i've been using beta glucan ( Topically ) for only 2 months.
I dont observe my scars so i dont know if it has gotten better or not.
BUt there are improvements. Improvements im very very happy of.
My skin got smoother and more even toned. It seems like some of my scars are getting smaller or shallower but not much. I'm not sure though cause as i said i avoid looking at mirrors especially up close lol 
I also notice that, my pimples arent inflamed as they used to be. Also when i touch my cheeks, it's sooo much smoother.
If you ask me, i am 100% sure there is improvements and that i will continue to get improvements as time passes by. It's only been 2 months since im using it so ima wait till my 6 month or even 1 year before evaluating my face again.
Also, i think it's much more effective if it is paired with treatments. It doesnt have to be invasive though. Like a 1.5mm dermastamp or even a 0.5mm dermastamp will help it be more effective.
But yeah! One thing is for sure, I am never gonna give up beta glucan because it also prevents and reduces wrinkles and has studies to prove it
Although i dont have wrinkles yet, hahah im still a teenager but "prevention is better than cure" right?|
Oh i forgot to say, beta glucan can penetrate the skin layers effectively so it also increases product absorption. Amazing huh?
It also increases immunity of your body and skin.
HI!
well, i've been using beta glucan ( Topically ) for only 2 months.
I dont observe my scars so i dont know if it has gotten better or not.
BUt there are improvements. Improvements im very very happy of.
My skin got smoother and more even toned. It seems like some of my scars are getting smaller or shallower but not much. I'm not sure though cause as i said i avoid looking at mirrors especially up close lol
I also notice that, my pimples arent inflamed as they used to be. Also when i touch my cheeks, it's sooo much smoother.
If you ask me, i am 100% sure there is improvements and that i will continue to get improvements as time passes by. It's only been 2 months since im using it so ima wait till my 6 month or even 1 year before evaluating my face again.
Also, i think it's much more effective if it is paired with treatments. It doesnt have to be invasive though. Like a 1.5mm dermastamp or even a 0.5mm dermastamp will help it be more effective.
But yeah! One thing is for sure, I am never gonna give up beta glucan because it also prevents and reduces wrinkles and has studies to prove it
Although i dont have wrinkles yet, hahah im still a teenager but "prevention is better than cure" right?|
Oh i forgot to say, beta glucan can penetrate the skin layers effectively so it also increases product absorption. Amazing huh?
It also increases immunity of your body and skin.
thanks for the info, that's very interesting! 
Do you just use the supplement topically, or is there a certain product that you use with beta glucan?
About the fraxel, I was told by a doctor that it does have chances of producing more breakouts if the skin is sensitive to it, but you won't know unless you try it....ideally, it would be useful to get a test spot but they don't typically do that.
HI!
well, i've been using beta glucan ( Topically ) for only 2 months.
I dont observe my scars so i dont know if it has gotten better or not.
BUt there are improvements. Improvements im very very happy of.
My skin got smoother and more even toned. It seems like some of my scars are getting smaller or shallower but not much. I'm not sure though cause as i said i avoid looking at mirrors especially up close lol
I also notice that, my pimples arent inflamed as they used to be. Also when i touch my cheeks, it's sooo much smoother.
If you ask me, i am 100% sure there is improvements and that i will continue to get improvements as time passes by. It's only been 2 months since im using it so ima wait till my 6 month or even 1 year before evaluating my face again.
Also, i think it's much more effective if it is paired with treatments. It doesnt have to be invasive though. Like a 1.5mm dermastamp or even a 0.5mm dermastamp will help it be more effective.
But yeah! One thing is for sure, I am never gonna give up beta glucan because it also prevents and reduces wrinkles and has studies to prove it
Although i dont have wrinkles yet, hahah im still a teenager but "prevention is better than cure" right?|
Oh i forgot to say, beta glucan can penetrate the skin layers effectively so it also increases product absorption. Amazing huh?
It also increases immunity of your body and skin.
thanks for the info, that's very interesting!
About the fraxel, I was told by a doctor that it does have chances of producing more breakouts if the skin is sensitive to it, but you won't know unless you try it....ideally, it would be useful to get a test spot but they don't typically do that.
I use it topically.
If you want to know the product im using. It's called Oats Beta Glucan from GardenOfWisdom. It's an online shop.
Thanks everyone. I appreciate the support. I suppose yes - i'm looking for low-risk treatments. I guess i've read so much about subcision and tca cross etc that i've become somewhat terrified that i risk making my skin worse, as there are lots of terrifying accounts out there. To some extent I feel like i should just leave my skin alone, but then on some days (like today), when i catch my skin in bad lighting, i feel like i will regret not doing anything about it. when i apply make up well i only have about 3-4 visible scars, as the rest are quite shallow. to some extent i occasionally feel like i'm motivated by vanity, particularly as my family insist this is the case. at other times i feel like all i want is to "look like everyone else" -- to have smooth skin, and that this is not at all related to my looks, but how i feel about myself.
i'm also a bit nervous about dermapen. i feel like there's not enough research out there on it, though my doctor (at skin clinics in london) insisted it's great. i might not be psychologically ready to actually do this! in a moment of panic i canceled my session, which was initially scheduled for Nov. 4. i'm now thinking i should reschedule 
i will check out beta glucan -- thank you so much for the recommendation and for taking the time to reply. i'm new to the forums (though i've been a faithful reader for years).
i've attached pics here in the most unforgivable lighting without a stitch of makeup on. one side of the face is noticeably worse than the other. notice there is a little hyperpigmentation (i didn't realize this before because ive literally never taken a pic of myself in such lighting). i'd appreciate some feedback.. many thanks
If these are accurate pictures, I don't think I would notice your scarring if I met you in person. And I usually notice people's skin and look out for scars because of my own situation. So my opinion would be not to do anything. If you really want to try something, then maybe dermarolling by a professional at the most or light TCA peels - definitely not cross.
Thanks austra, that's very reassuring. it's very difficult for me to judge my own skin and i usually exaggerate. to be honest, with makeup and primer, i know that only 2-3 scars actually show (and those are the deeper ones, the shallow ones are completely covered up). when i told my dermatologist i'd like work done on the scars, she herself didn't even realise i had any until she got quite close to me and angled my face in the light. i think i will look into peels, as you suggested -- that would help with discoloration and texture. i haven't yet had TCA done and it's something i'ld like to explore.
any other feedback is welcome. thanks again.
If these are accurate pictures, I don't think I would notice your scarring if I met you in person. And I usually notice people's skin and look out for scars because of my own situation. So my opinion would be not to do anything. If you really want to try something, then maybe dermarolling by a professional at the most or light TCA peels - definitely not cross.
I don't think your scarring is noticeable at all, but I know pics can be deceiving. If you do feel the need to do something, I would suggest doing one thing to one or two spots. You don't need to do everything all at once. I would try subcision to one spot and see how you like it. That is, only if you really feel the need to do something.
I don't think your scarring is noticeable at all, but I know pics can be deceiving. If you do feel the need to do something, I would suggest doing one thing to one or two spots. You don't need to do everything all at once. I would try subcision to one spot and see how you like it. That is, only if you really feel the need to do something.
Hi Michi - thanks a lot. I actually took several pictures in different lighting, and these were by far the worst ones. the cluster of three on the lower cheek are mainly hyperpigmentation from my most recent breakout and are easily covered with concealer; it's difficult to tell if they will leave indentations as well, though seemingly they will.
i agree that i don't necessarily need to undergo several procedures at once. i think that's why my dermatologist frightened me a little - she suggested TCA Cross/Subcision/Dermapen in one go. i feel relieved that i canceled this but am still considering doing something regardless.
I am more inclined to try dermaroller or a light TCA peel before going for subcision on even one of the scars, to see how i feel afterwards. i've attached more pictures for the cheek i consider most problematic in different lighting. do you still think they are not so bad? i really do appreciate the help and as i'm incredibly tough on myself i appreciate objective opinions. please share experiences too, if you've been through something similar. i have been reading the forum religiously for the past few days and it's been incredibly helpful.
In these pics, it's hard to tell that there is indented scarring. So no, I don't think it is noticeable. It just looks like some pores and red marks, which are no big deal. I think you are really wise to proceed with caution, I really do. You would feel 100X worse if things were to go wrong. I had a subcision to my worst scar on my chin and then had to battle for a few months to undo some negative side effects. If you ever feel bad or want to talk you can message me! But I think you are fine and should enjoy life.
Hi Dana1983,
I think you don't need any invasive treatment. Your skin is basically fine! Your scarring is VERY superficial. You should try a low strength retin a (or retinaldehyde - safer form of retin a) with beta glucan (over 6 to 12 months [maximum time - then stop] twice a week - just make sure you are not planning on becoming pregnant - as retinols are not okay for pregnant women, and keep a hat on if you're in the sun to avoid sunburn). I'm sure with a very healthy organic, non-GMO, mostly raw vegan wholefoods, unprocessed, natural diet and mild organic natural non -toxic cleanser/ shampoos/ vegetable soaps etc, non- fluoride mineral-herbal toothpaste, your skin will heal 100% naturally.
Also, as AghhNe suggested, if you need more help after 6 - 12 months, try a short length safe dermaroller from clearskincare.com.au to use on your scarring once a month for 6 months (along with your beta glucan) for deeper product penetration & to stimulate collagen. Just keep your skin and utensils sterile during your rolling sessions (and don't over roll, you need space between rolling sessions, please research for a safe & effective needling protocol. And keep products & clean roller in fridge to prevent pathogens).
I wouldn't recommend any subscision, chemical peels (apart from pure lemon juice), lasers etc for you at all!
Cheers,
AS
PS Look into The Body Deli, Pure Skin Junkie, Jess Organics or Sukin range etc for a simple gentle natural organic skin care program. Keep it simple and mild.
PPS Look into natural organic plant oil treatments too.
PPPS Don't wash you face daily or shower daily/ avoid dairy/ don't fuss or over process your skin/ stay away from toxic chemicals, harsh salon treatments and toxic acne products/ use 100% organic lavender oil or tea tree oil on blemishes. Keep it natural and simple!
http://www.realself.com/question/convenient-laser-treatment-after-45-days-tca-cross#965110
Don't mean to scare you (actually maybe a little), but this is potentially what can happen after a botched TCA Cross job. If your physician does not have impeccable technique things can go south really fast. With your very minor scarring, at most I would do needling or peels but you certainly don't need to have anything done.
hi blahblah -- thank you. this was actually very helpful. it's the type of thing i'm very scared of -- taking a risk when not entirely necessary, and then suffering consequences of things potentially going wrong, which is quite possible. i am very grateful for all of the advice. i have decided i definitely will not do tca cross or subcision. i think my doctor was too quick to suggest these procedures without discussing things further with me. she barely even looked at me properly. it really makes me wonder how many people have serious procedures when they are not entirely necessary.
http://www.realself.com/question/convenient-laser-treatment-after-45-days-tca-cross#965110
Don't mean to scare you (actually maybe a little), but this is potentially what can happen after a botched TCA Cross job. If your physician does not have impeccable technique things can go south really fast. With your very minor scarring, at most I would do needling or peels but you certainly don't need to have anything done.
That is precisely the problem I have run into with some dermatologists. Some of them seem to be on auto pilot, and repeat the same course of action for everyone that comes into their office. Everyone's scars are different, and yet from the many discussions I've had in private with folks on here, the same physicians will prescribe a one size fits all approach for everyone.
That is precisely the problem I have run into with some dermatologists. Some of them seem to be on auto pilot, and repeat the same course of action for everyone that comes into their office. Everyone's scars are different, and yet from the many discussions I've had in private with folks on here, the same physicians will prescribe a one size fits all approach for everyone.
Hello blahblah -- i completely agree with you. what's worse is that i consulted my clinic again, a few days ago, and told them that i was having second thoughts about the harsh combination of treatments, given the fact that my scarring is not severe. they never got back to me, which is part of the reason i felt very comfortable cancelling.
i guess we occasionally delude ourselves into believing that these clinics/dermatologists ALWAYS have our best interests at heart. in this case i genuinely felt like my dermatologist was far too quick to suggest the procedure (which is quite expensive - $650 USD excluding consultation fees) and just wanted to get me out of there so she could move on to the next patient. i understand that i do not have severe scars, and at the same time, that i should not expect a dermatologist to say "oh but your skin's fine!"
that said, what i appreciated about my dermatologist who performed fraxel on me 2 years ago is that he clearly told me that my scarring was minor and that i really didn't need to do anything to my skin. it was almost a friendly warning (which i wish i listened to). i think that's the correct approach. not like this one -- who said oh yeah you should do A, B and C - these are pretty bad etc
there is something to be said about not being gullible, even with experienced dermatologists. i've told someone on this forum that my mother had acne that was much worse than mine (and it was certainly cystic), and at 54 now has wonderful skin, without a scar or mark in sight, only slightly enlarged pores. she has been trying to convince me to not do anything with my skin and says that i need to be patient and heal without being harsh.
i think i will listen to her for now -- although i admit the tipping point was getting feedback and support from all of you (i needed the objectivity). i know my skin is far from perfect but at the same time i do know that it's not bad enough to take any major risks. thank you for reassuring me! this forum is really great and i can honestly say i had a much better week because i've been interacting with you. i'm going to wait about 6 months to see how i feel after the redness from my most recent breakout subsides. and i also just started tretinoin 0.05% about two weeks ago -- i have seen noticeable improvement so far. i admit skin needling seems very tempting to me, but for now i'll stick to primer