Acne.org Products
*Please note this comes from personal experience and my own opinion - I'm sure other people may have other experiences/opinions so keep that in mind*
Bit of background = Have moderate scars on the cheeks of all types. Spent around $8k on procedures so far which include: subcision, fractional co2, enerjet and fillers. Still in the process of working on the scars (about a year in.) I'm also writing this in a role a white skinned male, asian/darker skinned people will have to take some different precautions.
Experience with treatments (in order):
4 treatments of enerjet - was a first fairly simple low risk treatment I explored. Didn't really do anything for me, but I'm sure it can work on mild scars. They also changed the machine 6 months after I used it so now it can use different chemical agents - so not sure if it improved it. However I wouldn't really recommend someone wasting their money on this if they have moderate+ scars.
1st fractional co2 laser treatment + fractora - did a fairly strong 1000 microns treatment as a first step in order to see how I reacted. Was done only to the cheeks since that is where my scars are (I know a lot of people ask if this is possible.) You will be super swollen, you will have bleeding but it won't be painful. If you don't want to feel paid - ask for skin freezing and lidocaine injections. It will look like you got punched in the face multiple times. Had minor imporvements and was red about 2-3 months.
2nd fractional co2 laser treatment + fractora - did this one at 1500 microns. Had noticable improvements but was left with little "dots" after the treatment. Was pink around 6 months.
3rd fractional co2 laser + subcision + sculptra + fractora - did this one at ~1700 microns. It fixed the dots from before. Subcision was done a bit differently than most other posts on this forum. My PS did a small cut on the bottom of the cheek and used a special device to subcise the whole cheek and then followed it up with sculptra. It was fairly painless due to the freezing of laser but was a lot of tugging and pulling. I had the most improvement from this method, although it's 4 months out and it's still pink.
Overall improvement so far I would say around 40%. Biggest side effect = a bit of a "shiny" look to the cheeks.
Future treatments:
1-2 more co2 + sub. + fractora + sculptra. Followed up by IPL and voluma (my PS said in his experience voluma doesn't work well in combination with subcision and is more a "final" treatment after everything is done which is why he does sculptra)
Some Tips:
Combine treatments whenever possible
A lot of the cost of procedures comes from pre surgery prep + freezing. Combining treatments usually improves your results while at the same time saving costs/recovery.
Understand the differences between lasers.
There IMO are only 2 types of lasers that do anything for moderate/severe acne scars (as of writing this). The other types may help to some degree and may help redness, but if you want results you'd be better off choosing a co2 laser.
CO2 lasers = super strong and therefore super risky. They also don't penetrate as deep as some fractional co2 lasers, thus need multiple passes. Noone really does these anymore.
Fractional CO2 lasers (minus the non penetrating lasers). Please keep in mind you 100% will need 3-6 treatments to get results you're impressed with. 1-2 treatments won't do too much, but you will be able to see them start working. You need to discuss with your doctor to be as aggressive as possible as well (1.5mm @ a decent power setting.)
There's currently two lasers that are able to go to that depth with a one time "pulse." Meaning they shoot once and reach that depth. Those are specifically the deepfx and re:pair. Both lasers are good.
The ultrapulse, smartskin and smartxide are able to reach that depth using multiple "pulses." This means they can technically go even deeper. IMO I think they're also as good in the order listed.
Mixto works a bit differently but overall less powerful
Profractional isn't a real fractional co2 laser
There are a few other lasers, but they're more of the same. Also don't be fooled by the word "fraxel" without clarifying it's actually the re:pair and not the re:store.
Fillers
Most of the HA fillers only last a few months and are only good for a few scars here and there, not a cheek full of scars. They also generally don't help too much. Voluma is the only one that lasts up 2 years and I would recommend that one if doing fillers.
Saving money
Try to find doctors who actually do work/seminars for the companies you want treatments with. They get a lot of their equipment for free, are generally cheaper and know how their equipment works. Negative is they only have one company to choose from and no other options.
I'll add some more when I have some more time.
Thanks for your detailed reviews, they are helpful! I just got done with Fractora RF needling (went last Wednesday) and am about completely healed today. I do have some red dots on one side, but I think they will fade within a few weeks. It is similar to intracel. So far I would rate a few of my scars maybe 30% improved, but they say you really have to wait a month to get true results. I noticed the scars that responded were newer, older one's not so much. I liked the procedure because it is relatively safe, but it was painful and the recovery is not as easy as they make it out, if you do the highest settings, like I did. But still, I will be healed within a week which isn't bad. I may do it again. They recommend a series. Supposedly these results can be just as good as Fraxel laser but with less downtime.
Thanks for your detailed reviews, they are helpful! I just got done with Fractora RF needling (went last Wednesday) and am about completely healed today. I do have some red dots on one side, but I think they will fade within a few weeks. It is similar to intracel. So far I would rate a few of my scars maybe 30% improved, but they say you really have to wait a month to get true results. I noticed the scars that responded were newer, older one's not so much. I liked the procedure because it is relatively safe, but it was painful and the recovery is not as easy as they make it out, if you do the highest settings, like I did. But still, I will be healed within a week which isn't bad. I may do it again. They recommend a series. Supposedly these results can be just as good as Fraxel laser but with less downtime.
Sorry I forgot to add in my original post that I actually had Fractora with all my laser treatments (it was given to me for free basically.) It's impossible for me to say how much fractora (or other RF) contributed since I had it combined with other treatments, but one thing to keep it mind is that it is depth adjustable as well. Depending on the tip they use - it can be super mild or can go up to 2000 microns in depth. My doc did light laser over the top of the skin, strong laser into depth of skin, light fractora over top of skin and then deep fractora into depth of skin (combined with subcision and filler on the most recent treatment.)
Sounds like you've really had it all! Surpising you haven't seen over 40% improvement. The one thing I don't like about the fractora is the breakouts it has causes. Nothing severe, but just annoying. I was totally acne free beforehand.
*fingers crossed* but I haven't had any major breakouts from any of the treatments. I get some bumps from the polysporin that they have me use for 1-2 days and aquaphor, but those go away after I stop using them.
Small update = It's been 6 months since my last treatment and I noticed a tiny bit of improvement between the 3 months and 6 months. I've found that there's an improvement after 2-3 weeks and then it's the same/worse till month 3. Between month 3 and 6 is when the major changes happen.
Going to do another full treatment soon. Biggest negative I've found is that the cheek area seems a tiny bit raised compared to the surrounding skin and that the scarred skin has a "shiny" look to it.
Excellent write-up and very practical advice. This succinctly summarizes everything I've learned on my scar journey as well. Except for me you can add spot dermabrasion and excisions. I get exhausted thinking of all the things I've subjected myself to in trying to fix the scars.
Just wanted to bump this as I've had my 4th treatment about a month ago. Subcision + Fractora + Co2 Laser + Enerjet + Sculptra all at the same time.
Biggest things I've noticed/thoughts (postiives and negatives):
1. Adding full cheek subcision helps a lot vs just laser/fractora. I wish I did this from the very start.
2. Each procedure helps around 10-15%, so I can see why people might not get any improvement with just "average" settings laser.
3. All these procedures leave the skin with a raised+shiny look and sometimes grid marks. This is quite annoying.
4. If you do agressive settings, expect to be red for 3-6 months (not 1 week like they say).
I'll try to update this in a few months when it heals up completely.
I am assuming you have severe deep scarring? Because there really is no need for all those treatments. Never the less 5 treatments in one go because this causes all sorts of collagen interfering with one another. Correct me if I am wrong. I personally woukld have gone the traditional route of Subcision + Repair then Subcision + Filler touch up and maybe a few rounds of IPL or Vbeam after that, of course with a very skilled surgeon or doctor. Seems like your doctor is sucking your wallet dry. But if you're content with results and money is no big then carry on and good luck!
Where do you get your treatments? Clinic? Doctor?
I am assuming you have severe deep scarring? Because there really is no need for all those treatments. Never the less 5 treatments in one go because this causes all sorts of collagen interfering with one another. Correct me if I am wrong. I personally woukld have gone the traditional route of Subcision + Repair then Subcision + Filler touch up and maybe a few rounds of IPL or Vbeam after that, of course with a very skilled surgeon or doctor. Seems like your doctor is sucking your wallet dry. But if you're content with results and money is no big then carry on and good luck!
Where do you get your treatments? Clinic? Doctor?
I wouldn't say "severe" - I'd say like a 7/10 originally, probably like a 4/10 now. Based on the way he explained it to me - the treatments all happen at different levels and "stacking" (as he calls it) on each other ie lasers only go to X depth and then fractora goes to a different depth and subcision/fillers go even deeper so they all help each other rather than hurt. Also sculptra isn't really a traditional filler (and I know someone people don't like it.) All the scientific literature I've read says combining treatments helps, I've never read anything about it hurting results.
I don't really see why you say "all these treatments aren't needed" as its very well known just 1-2 random treatments of co2 laser won't give you results you want.
My doctor is considered one of the top PS's in North America and I'm paying ~$1200 for all these treatments per treatment, so I'm paying less than just a normal co2 laser treatment. I've done a lot of research on treatments + doctors prior. Reason is he sits on the board for a lot of these cosmetic companies and gets equipment/consumables for free. But either way, money wasn't a big factor in picking a doctor - moreso they did the treatments I wanted at the settings I wanted.
I am assuming you have severe deep scarring? Because there really is no need for all those treatments. Never the less 5 treatments in one go because this causes all sorts of collagen interfering with one another. Correct me if I am wrong. I personally woukld have gone the traditional route of Subcision + Repair then Subcision + Filler touch up and maybe a few rounds of IPL or Vbeam after that, of course with a very skilled surgeon or doctor. Seems like your doctor is sucking your wallet dry. But if you're content with results and money is no big then carry on and good luck!
Where do you get your treatments? Clinic? Doctor?
I wouldn't say "severe" - I'd say like a 7/10 originally, probably like a 4/10 now. Based on the way he explained it to me - the treatments all happen at different levels and "stacking" (as he calls it) on each other ie lasers only go to X depth and then fractora goes to a different depth and subcision/fillers go even deeper so they all help each other rather than hurt. Also sculptra isn't really a traditional filler (and I know someone people don't like it.) All the scientific literature I've read says combining treatments helps, I've never read anything about it hurting results.
I don't really see why you say "all these treatments aren't needed" as its very well known just 1-2 random treatments of co2 laser won't give you results you want.
My doctor is considered one of the top PS's in North America and I'm paying ~$1200 for all these treatments per treatment, so I'm paying less than just a normal co2 laser treatment. I've done a lot of research on treatments + doctors prior. Reason is he sits on the board for a lot of these cosmetic companies and gets equipment/consumables for free.
Yea by all means keep going man I'm glad you're content! $1200 for all those treatments sounds like a good deal, laser alone would cost $1500. Keep us updated and you forgot to mention who your doctor is 
that would help out the community. Unless you want to keep that discreet
Yea by all means keep going man I'm glad you're content! $1200 for all those treatments sounds like a good deal, laser alone would cost $1500. Keep us updated and you forgot to mention who your doctor is that would help out the community. Unless you want to keep that discreet
Am I content? Not 100% - but I know there's really nothing else extra that could've been done. But I'm fairly happy with the results. I also wanted to just do everything possible to get in my head that there's really nothing else I could've done (to get that thinking out of my head).
If someone wants to know the doctor, feel free to PM - don't want to post it publically.
Excellent write-up and very practical advice. This succinctly summarizes everything I've learned on my scar journey as well. Except for me you can add spot dermabrasion and excisions. I get exhausted thinking of all the things I've subjected myself to in trying to fix the scars.
Curious to hear your thoughts on excision. Thinking of having 2-3 done on my cheeks (cheekbone area). Thanks.
If this is addressed to me, I'd say excisions are high risk, high reward. There is the real possibility they can leave worse scarring if you don't heal well. Again, it comes down to your own personal physiology. I'd highly suggest doing only one as a test and go from there. You do not want to do a whole bunch at a time and then have them turn out disastrously.
Curious to hear your thoughts on excision. Thinking of having 2-3 done on my cheeks (cheekbone area). Thanks.
Just wanted to bump this thread as I finally had my "final" treatment done.
I had a final mild fractional co2 laser done to try to even out the skin texture and any grid marks. I also had full cheek subcision with volift to "lift/push out" the scars a bit and direct injection of voluma under the actual scars. It's still swollen and red though so can't say how it will look.
All these treatments were a lot to go through - but I'd say I got ~50-60% improvement pre this last treatment. I'll update in again in 3-6 months.
The three biggest negatives I've noticed pre this last treatment:
1. If you do a bunch of different treatments - you'll be bad looking for 10 days, super red for a month and then residual noticeable redness/pinkness for 3-6 months+. You should be able to leave the house after ~2 weeks though, but you'll be red for a looooonnnnnng time.
2. You'll be left with a somewhat shiny/odd looking skin texture in some places. (pending progress update from last treatment and a full 6 months of healing)
3. You'll be left with "grid marks" in some places and it will look like enlarged pores. (pending progress update from last treatment and a full 6 months of healing)