So I've been trying to find a doctor that would perform subcision here in Ireland for a while and have had very little success. The one doctor i found that would do it still touted fraxel as being better than subcision for all scars. I'm starting to look to going to the UK to get the procedure done there, but again nearly every doctor wants to do fraxel.
So i'm wondering why are doctors so reluctant to perform subcision? From reading many stories on here, it seems to be the most successful treatment for rolling scars with nearly every person satisfied to some degree. On the other hand i only see about 1 in 10 good stories for fraxel.
Is it that subcision is a more difficult procedure to do? Or does it have to with money or something else?
All insights into the topic are welcome.
most doctors want money because when fraxel fails you , they think you probably gonna come in again for several treatments stuff like that
its hard to find a genuine doctor who wants to really help you
also its good to have a understanding of what treatments are gonna help you instead of relaying on the doctor most of the time
Honestly, from all the discussions I've seen on here and other forums, cosmetic surgery and especially treatments for scarring are way behind in the UK and Europe. People seem to come to the US for cosmetic stuff, so the industry is far behind the US.
Subcision is a much older technique than fraxel though which is everywhere here?
I would keep searching for a doctor if I were you. Look for someone who doesn't advertise laser treatments for acne scarring, and has been in practice for a long time. I would think every dermatologist is familiar with subcision but many simply don't practice it. You do need to find a doctor experienced with the procedure, as it is possible to cause additional scarring and raised lumps with subcision. I'm sure an experienced doctor exists but he/she is just difficult to find.
Research any procedure and then find a doctor. Saying Fraxel means nothing to me because when people say Fraxel they are usually talking about Fraxel Re:store which is inneffective. You have to dig in and find what treatments people really had and at what level. You are writing off the most effective acne scar treatment. Fraxel Re:pair is effective, and it is the best thing I ever did.
Research any procedure and then find a doctor. Saying Fraxel means nothing to me because when people say Fraxel they are usually talking about Fraxel Re:store which is inneffective. You have to dig in and find what treatments people really had and at what level. You are writing off the most effective acne scar treatment. Fraxel Re:pair is effective, and it is the best thing I ever did.
i know fraxel repair has worked for you but it might not work for everyone
Research any procedure and then find a doctor. Saying Fraxel means nothing to me because when people say Fraxel they are usually talking about Fraxel Re:store which is inneffective. You have to dig in and find what treatments people really had and at what level. You are writing off the most effective acne scar treatment. Fraxel Re:pair is effective, and it is the best thing I ever did.
i know fraxel repair has worked for you but it might not work for everyone
My sole purpose in posting on these forums is to present an answer to critics who most of the time do not know the difference between Re:store and Re:pair or any other laser. Maybe it is time for me to stop wasting my time. 6 years of trying to educate people and they still call it Fraxel.
I would keep searching for a doctor if I were you. Look for someone who doesn't advertise laser treatments for acne scarring, and has been in practice for a long time. I would think every dermatologist is familiar with subcision but many simply don't practice it. You do need to find a doctor experienced with the procedure, as it is possible to cause additional scarring and raised lumps with subcision. I'm sure an experienced doctor exists but he/she is just difficult to find.
The added problem though is that even if i find a doctor who will do it, how do i know if this person is experienced at it. Especially since there's very little demand for it
I would keep searching for a doctor if I were you. Look for someone who doesn't advertise laser treatments for acne scarring, and has been in practice for a long time. I would think every dermatologist is familiar with subcision but many simply don't practice it. You do need to find a doctor experienced with the procedure, as it is possible to cause additional scarring and raised lumps with subcision. I'm sure an experienced doctor exists but he/she is just difficult to find.
The added problem though is that even if i find a doctor who will do it, how do i know if this person is experienced at it. Especially since there's very little demand for it
What Skullkid said is correct to a point. Doctors perform a type of light subcision (moving the injection needle to break up fibers) as they inject filler to create room for it. When doing subcision on an acne scar, most doctors use a Nokor needle to break tightly tethered fibers and to create a permanent layer of scar tissue under your scar. That's where experience with performing subcision to a scar is key because the doctor can create a raised lump outside the boundaries of a scar. With light subcision, they're just creating space for the filler. While this can also result in collagen production/remodeling, doing subcision while filing a wrinkle or sagging skin is not done in a manner that will create scar tissue to permanently fill lost tissue. It doesn't hurt to ask some "filler" doctors if they perform subcision on acne scars though.
It would be unethical for a doctor to claim experience when he/she doesn't have any. You can usually tell if a doctor is confident with the procedure by how he/she reacts when you ask about it. I always ask a few technical questions too, just to see if the answer sounds plausible.
If I were you, I would start emailing or calling every derm and plastic surgeon to see if he/she performs the procedure on acne scars. What kind of subcision are you looking for? Be sure you understand the type of subcision you're looking for and that it does make sense for your scars. What kind of scars do you have? If you find a specialist who is experienced with multiple procedures and he/she still recommends laser over subcision, there could be a valid reason for this. Subcision isn't the best answer for all types of scarring. I thought I was a perfect candidate for subcision but discovered my scars were too small and shallow for subcision. I didn't really understand why until I had my scars filled. The doctor performed light subcision with the filler and I was unhappy with the results. Filler made the borders of my boxcar scars more apparent, causing the texture to look awful. Fortunately, it was temporary and the area did not end up permanently raised. I guess I'm just trying to say that you should keep an open-mind. If your scars are shallow, laser may be your best bet and the safest approach to providing you some improvement without risking further damage.
Inspired,
Thanks for your post on "light" subcision. I thought I had read quite a bit on this and did not know about this. I have been unable to find a dermatologist in my area of Ohio that will perform subcision so I started to look into plastic surgeons for this rather simple procedure. A plastic surgeon recently recommended subcision and scluptra filler for my rolling scars in one setting. He was pretty open that laser treatment would not really help. But I was trying to figure out how he would know where and how much filler to use after subcision since that procedure causes considerable swelling. Your description of "light" subcision answers my question. I am not opposed to collagen-producing fillers like scluptra, but I would prefer things done separately to I can evaluate the effect from each procedure.
You seem to know quite a bit about this. Do you see any advantages or disadvantages to the combination subcision/filler in one setting? Thanks.
Inspired,
Thanks for your post on "light" subcision. I thought I had read quite a bit on this and did not know about this. I have been unable to find a dermatologist in my area of Ohio that will perform subcision so I started to look into plastic surgeons for this rather simple procedure. A plastic surgeon recently recommended subcision and scluptra filler for my rolling scars in one setting. He was pretty open that laser treatment would not really help. But I was trying to figure out how he would know where and how much filler to use after subcision since that procedure causes considerable swelling. Your description of "light" subcision answers my question. I am not opposed to collagen-producing fillers like scluptra, but I would prefer things done separately to I can evaluate the effect from each procedure.
You seem to know quite a bit about this. Do you see any advantages or disadvantages to the combination subcision/filler in one setting? Thanks.
I think every derm or plastic surgeon is familiar with subcision, especially if the doctor offers fillers. However, filler doctors that don't do it for acne scars are probably not confident with their ability to improve an acne scar with filler.
Hard to say what your doctor intends to do. In some cases, a doctor will cut tethered fibers and then swipe under the scar to create a layer of scar tissue. This leaves a pocket of empty space under the scar. The doctor may then choose to fill the pocket with filler to prevent skin from reattaching during the healing phase. Some doctors will just create a pocket under the scar without creating a layer of scar tissue, and just use filler to raise any void and also to prevent the skin from becoming tethered again. Some doctors, just perform "light" subcision as the filler is being injected to raise an indent. I don't believe this can cause much permanent improvement to deep acne scars. It normally takes more than one round to properly inject filler. When my doctor injected my scars, he only used half the syringe and asked me to return in two weeks. He said once the skin settles, he'd be able to see any areas that he missed. If scar tissue is thick, they can't tell on the first attempt if enough room was created for the filler to stay in the right places. I think your doctor's approach is going to depend on his/her experience and the type/depth of scar being treated.
Perigon,
When i went to dr here few years ago to get filler she flat out refused and said she MUST FIRST DO SUBCISION
and does it quite a bit. Shes also a platinum level injector
which means shes injected some craaazy number of units of filler (this is south florida so no surprise I guess :-/)
Going to UK if you live in us is extreme. Id be happy to give u her information if you'd
like?
Perigon, forgive me. I crossed your post with another poster. Thought u lived in Ohio. :-/
Zen9821,
This thread does have some great info. So, I'll add a little more.
At my consult in Columbus the Dr recommended 2 rounds of subcision and sculptra filler. Subcision $150 + 9mm of Sculptra $650 = $800 for each round.
I have another consult scheduled for May in Toledo. Plan to compare and see what they think.
Inspired has some good thoughts on subcision. I'm a veteran of some very intense subcision procedures. I agree that for many deep scars, they are almost required, because I've definitely experienced the dreaded "doughnut" effect. Imagine a scar being like a button on a couch cushion. You have to cut the tether pulling the scar down or the filler will have no place to go and just spread to the edges of the scar, making it more pronounced.
As for Sculptra, I highly recommend AGAINST it. I've read too many disaster stories with Sculptra and I do not believe it is a predictable filler. If you read the package insert for Sculptra, it states that it works through a "granulomatous tissue reaction" meaning that it is designed to cause granulomas. That is how it creates volume. Unfortunately, depending on how your body reacts, the sculptra can continue to grow and cause bumps.
If you are going to do a filler go with Juvederm Voluma, a hyaluronic acid filler, because it lasts for up to 2 years and is completely reversible with an enzyme called hyaluronidase. Make sure that your scars can be filled before committing to a permanent filler. With hyaluronic acid fillers, essentially what you see is what you get. You do not have to wait and see how much volume your body creates like with Artefill, Sculptra, or Silikon 100.
Inspired,
Thanks for your post on "light" subcision. I thought I had read quite a bit on this and did not know about this. I have been unable to find a dermatologist in my area of Ohio that will perform subcision so I started to look into plastic surgeons for this rather simple procedure. A plastic surgeon recently recommended subcision and scluptra filler for my rolling scars in one setting. He was pretty open that laser treatment would not really help. But I was trying to figure out how he would know where and how much filler to use after subcision since that procedure causes considerable swelling. Your description of "light" subcision answers my question. I am not opposed to collagen-producing fillers like scluptra, but I would prefer things done separately to I can evaluate the effect from each procedure.
You seem to know quite a bit about this. Do you see any advantages or disadvantages to the combination subcision/filler in one setting? Thanks.
blahblah82,
Thanks. That is also very good advice on sculptra. At the "no-cost" consult the Dr did also offer the possibility of using my own body fat as a filler after the subcision, but said that it would also require a liposuction procedure to acquire the fat. I guess he was saying that it would be more costly. But maybe not! Fat is free! and unfortunately I have more than enough. Sculptra is $650 per vial. (And I understand that is a pretty good price for sculptra.) Although his thinking was "if your skin is short collagen, then it is best to use a filler that generates collagen". But I do see a problem of using a filler that make take up to 3 months to build the collagen and you won't know the final result for such a long time.
Not sure if this particular doctor is looking out for your interests or trying to line his pocket. A lot of doctors suggest high priced procedures obviously because of the bottom line.
As for that "collagen" that they always promote with Sculptra, it's really scarring. Sculptra is essentially the stuff they make dissolvable sutures with, Vicryl, that has been powderized. It is diluted into a suspension with saline a few days before injection. Before it was called Sculptra, it was called Newfill in Europe, and they did not dilute the material with as much saline. That caused huge nodules and lumps that basically disfigured people. After that, they changed the protocol and called for Sculptra to be super diluted to prevent nodules.
Artefill, Silikon 1000 (silicone), and Sculptra all work by this same mechanism, which is through a foreign body reaction by design.
The best analogy is an oyster that forms a pearl around a grain of sand.
It's true. After all this time many people still don't know the difference. I think it's one part blind trust in doctors, and frankly laziness in doing one's own research. The other part is that doctors also contribute to this confusion because they count on patients being uneducated so they can push whatever laser or device is in their office. I've read about people who went in thinking they were getting Fraxel, and then being "surprised" that they had a red, oozing, weeping face. They didn't even know that they were going in for Fraxel Repair and not Restore. They don't know the difference between ablative and nonablative.
Research any procedure and then find a doctor. Saying Fraxel means nothing to me because when people say Fraxel they are usually talking about Fraxel Re:store which is inneffective. You have to dig in and find what treatments people really had and at what level. You are writing off the most effective acne scar treatment. Fraxel Re:pair is effective, and it is the best thing I ever did.
i know fraxel repair has worked for you but it might not work for everyone
Good insight in this post indeed!!!
Curious about a few things
and questions for "inspired".
Does subcision often need to
be done more than once?
Also, can subcision be done in same area again if a permanent filler like artfill is used?
TY
Hi,
Yes, from what I've read, subcision normally requires multiple sessions to improve a scar. However, some people claim improvement after one session but they probably didn't have deep scars.
Unfortunately, I can't answer your question about whether it's safe to do subcision in an area where you've had a permanent filler. I wouldn't think it's a problem. Isn't Artefill just basically plastic beads that your collagen ends up growing around? If you did it a couple years ago and only once, I don't think there's any reason to be concerned. It's probably part of normal tissue in that area, at this point.
If your scar can be improved with subcision, I think it's best to improve it as much as possible using subcision with/without a temp filler before trying a permanent filler. Like blahblah82 said, you want to be sure the scar can be improved before trying a permanent filler. In some cases, if subcision is successful, you might not even need a filler, at all.
I could be wrong, but I don't think Mr. Matt has used any fillers. He benefited from suctioning after each subcision session.
Wow about Sculptra. I didn't know that about its history or that any filler produces scar tissue. Even if the doctor follows proper protocol with diluting, I certainly wouldn't risk it until it's been proven to be safe like an HA filler. Thanks for sharing blahblah82.
most likely subcision can be done in area where any kind of filler has been. i still have restylane left over from my last treatment, and i had subcision, i was able to move the restylane around underneath the skin and help it fill into the scar more since the bands were broken. it felt weird, but i noticed improvement after my 1st subcision treatment since restylane. im about 4weeks post treatment and seeing results better each week !