so he's not a derm or a ps, is he a nurse practioner? or a physician's assistant? I'd want to understand his background and experience sure.

I've had the erbium resurfacing, it did help, but the downtime was very rough, much worse than I thought...so you really need a minimum of 2 weeks off, minimum- but there was improvement, no doubt....I now do dermastamping on the remaining rolling scars, but the erbium smoothed things out, no doubt....but wowzer, what a long recovery

I had fraxels too, and I honestly think the 5 of those I had gave me as much % wise as the big erbium resurfacing, but each of those had a few days downtime...but honestly all up all in, I'd take the series of fraxels. personally

What kind of practice is this? Dr's name? And do you have pictures of your scarring?

so he's not a derm or a ps, is he a nurse practioner? or a physician's assistant? I'd want to understand his background and experience sure.

I've had the erbium resurfacing, it did help, but the downtime was very rough, much worse than I thought...so you really need a minimum of 2 weeks off, minimum- but there was improvement, no doubt....I now do dermastamping on the remaining rolling scars, but the erbium smoothed things out, no doubt....but wowzer, what a long recovery

I had fraxels too, and I honestly think the 5 of those I had gave me as much % wise as the big erbium resurfacing, but each of those had a few days downtime...but honestly all up all in, I'd take the series of fraxels. personally

Well he is a doctor but not dermatologist, just a family practice but realized his passion was lasers and skin after he graduated. This is what his website said anyway.

I really wish there were pictures of what you look like after these procedures! I have small children and I would like to know if they would be scared of me? QHe said he would not be doing my whole face- just the temples to the chin.

What kind is scars did you have and which did you do first- the fraxel a or erbium?

I would rather go to someone with experience and 100% guaranteed your getting the correct treatment

It's a laser clinic so I knew they would be recommending laser

That's your first red flag. Beware of anybody with a financial incentive to push you towards a certain type of treatment.

Said cross doesn't work well

And there's your second red flag, he's either ignorant of the research or is flat-out lying to you. TCA CROSS is one of the most effective treatments available for icepick and boxcar scarring. To date there have been dozens of clinical studies done and not a SINGLE one has suggested it "doesn't work well." On the contrary, when performed correctly it works remarkably well and improvements of 70% and up are routinely seen, the more rounds you have the more the scars will fill in.

 

He is not a derm or ps but has experience with subcision.

WTF? Don't let somebody without the proper qualifications mess with your face. Run away as fast as you can and consult an actual PS.

Ok here's the thing- I can't find anyone else who does this around me! Minneapolis is a long drive for me and I called all the derms there and only 1 said they do the procedure and they have their esthetician do it. The nurse said they can do it on the same day of your consultation. Seems kind of weird to me that the dr wouldn't be doing the subcision!

The lady who does my microneedling used to work at the laser clinic and she said he has done plenty of subcisions and said she would absolutely trust him to do it. When I talked to the receptionist she knew exactly what I was talking about whereas when I called all the dermatologist offices they had no idea...( what was it called? submission?) lol. I asked her if he had experience doing it she said yes and I asked if he had done more than 50 subcisions and she said "oh yeah." Maybe she was just trying to sell me on it but it's not really a big money maker. When I called after my consultation to see how much it would cost me to just do subcision, the nurse called me back and said he would for $200. And at the consultation I showed him my scars I wanted subcision done on and he was like yeah that's not a big deal but we will probably have to do it a few times. Said I would have bruising and swelling for about a week.

Is subcision so rare that I can only find 1 derm in Minneapolis that has their estheticians do the procedure? Or do you think the receptionists just are not aware they do this at their office?

 

WTF? Don't let somebody without the proper qualifications mess with your face. Run away as fast as you can and consult an actual PS.

Ok thanks all for your advice. I'm unsure how to proceed with subcision but will keep all this in mind. I did find a ps 4 hours away who said he could do subcision. The nurse had to ask him about it so I am assuming he doesn't have much experience with it. The closest ps or derm that lists it on their website is Dr. Despain in missouri. I saw someone on this site had him do subcison. Unfortunately that is a 9 hour drive for me!

Subcision isn't some super-complex procedure, its actually a fairly simple one, any plastic surgeon who has ever done a scalpel excision (i.e. every legit PS) will be able to perform subcision after getting a grasp of the concept. So what you could do is find a PS closer to home and show up with printouts from PubMed describing the procedure, there are a bunch of them available.

More likely than not he'll be all "oh, yeah, that's easy" and quote you a price.

Subcision isn't some super-complex procedure, its actually a fairly simple one, any plastic surgeon who has ever done a scalpel excision (i.e. every legit PS) will be able to perform subcision after getting a grasp of the concept. So what you could do is find a PS closer to home and show up with printouts from PubMed describing the procedure, there are a bunch of them available.

 

More likely than not he'll be all "oh, yeah, that's easy" and quote you a price.

I wouldn't say it's 'fairly simple'. A fairly simple procedure in my book would be performing microneedling or chemical peels. Subcision is a bit more complex, because of the needed local and topical anesthesia as well as the knowing where to insert the needle and all that good stuff. I am aware though that it's something every dermatologist and most surgeons gets to experience during their residency and I'm sure it's extremely easy to learn with HANDS ON training. My Dr, Dr. Peter Rullan told me how it disappoints him how many surgeons and derms have ruled off subcision, he says it's a very important modality/step in acne scar revision and I think we can all agree.

Your right though: One could possibly successfully pull of doing their own ?targeted? subcision on individual scars as shown here:

Now wide sweep undermining with nokor needles is a bit more trickier:

The latter would possibly only require a good 22-26 gauge needle no higher or it can break and you don't want that lol

Now ang, I really hope you find a sincere doctor that can help you out and give you your money's worth. I hope you find a doctor that wont charge you over one grand or waste your time by offering you something you really don't need.

I paid $300 for subcision in California

Matt paid $250~ in Texas

Some doctors charge 500+.

I love Philip Young's work. He's in Washington, he's my go to in case something goes wrong: http://www.drphilipyoung.com/procedures/acne-scar-treatment/acne-scar-treatment-before-after-photos/

What kind of practice is this? Dr's name? And do you have pictures of your scarring?

It is a laser clinic. They do Laser, chemical peels, injectables. When I initially called and asked about what they can do for acne scars they said lasers, excisions, subcision, peels. The Dr's name is Dr. Hansen.

I wouldn't say it's 'fairly simple'. A fairly simple procedure in my book would be performing microneedling or chemical peels. Subcision is a bit more complex, because of the needed local and topical anesthesia as well as the knowing where to insert the needle and all that good stuff.

Microneedling and chemical peels aren't surgery and can be easily and (relatively) safely performed by complete amateurs at home. When it comes to plastic surgery there is a spectrum of complexity, with excision/botox/filler injections being simple outpatient procedures, rhinoplasty/facelift/boobjobs being moderately complex (but still routine), and then you have stuff like maxillofacial reconstructive surgery, which is highly taxing and demands serious expertise, often with many hours of surgery involved.

So on that spectrum subcision clearly falls into the first range, like botox/filler injections, it essentially involves introducing needles into superficial facial tissue, nothing terribly complicated about it, takes a few minutes to perform and you're on your way home. Considering that scalpel excision is one of the first things a plastic surgeon learns (including how deep to go, location of facial nerves, etc), applying the basic tenets of that procedure to something similar like subcision is child's play, every legit PS is capable of it, even if they don't know it yet.

My Dr, Dr. Peter Rullan told me how it disappoints him how many surgeons and derms have ruled off subcision, he says it's a very important modality/step in acne scar revision and I think we can all agree.

Any PS not willing to learn something so basic is not somebody genuinely interested in knowing how best to fix cosmetic defects.

And yes, subcision is practically crucial, its easy to perform yet gives such impressive gains, especially when used in combination with other effective treatments.

Your right though: One could possibly successfully pull of doing their own ?targeted? subcision on individual scars

Self-subcision is likely not going to be as efficient as the professional approach but you'll still probably be able to achieve a decent amount of un-thethering if you can ignore the pain and patiently work the entire scope of the scar

Now wide sweep undermining with nokor needles is a bit more trickier:

 

The latter would possibly only require a good 22-26 gauge needle no higher or it can break and you don't want that lol

I don't think the wide sweeping should even be attempted at home, needles of that thickness would hurt too much, require too much pressure and basically be too difficult to work with. Thinner needles might not be ideal but you can still make straight, neat punctures with them. Make enough of those and you should be able to sufficiently weaken the tethers enough to then easily snap them with minor sweeping. Also, thinner needles tend to be shorter in length, which reduces the risk of pushing in too deep.

2 hours ago, goals113 said:

Hey thanks for your reply and the info. Have you tried laser/ dermaroller then? I am having dermaroller next week.

Caroline

tried dermaroller it wont work neither will laser it simply doesn't go deep enough to reach these pits. I have done both tca cross and punch excision and have got relatively good results from these. Honestly if you go ahead with the dermaroller or laser you will be left disappointed and out of pocket. i see you are from the uk perhaps look into tca cross with Dr Tony chu in Hammersmith hospital. watch this video to understand what it entails .

I can attest, nothing will remove ice pick unless u excised or crossed. And reviews on the exchange for one scar to another are a mixed bag.. the jury still seems to be out. But, lasers, peels, needling..nope wont help unfortunately

My boxcar scar responded well to laser, though my icepicks remained the same.

Im interested to see more comparisons from people who have had a series of fraxels to a single ablative treatment.