Have you tried TCA peels on the full scarred area of the cheek? I would alternate with TCA peels and microneedle (your skin must be healed before you do the next procedure). You might try this for a year.

What I can see that would give instant improvement, is your scars look red. V-Beam vascular laser would normalize the skin color. If it's not reds but browns, you need to do IPL.

After all that is finished you can do some laser treatments, for texture, this will give some percentage of improvement but might have side effects. This is why I advocate to use avid peels and microneedle first to see what your body can do naturally without energy devices.

See the below FAQ for more information on all this.

MANY subcisions plus filler, the only way to improve your scars. I got scars like yours.
Needling, peeling and other things are good only for texture.
Good luck! (;

Scars cant be healed with naturally products, sadly. I dont have any scars atm since im 17 but i can see myself having scars all over my face in the future. The most popular way to clear the scars is laser. I dont know if its worth it - the side effects. It depends how much this effects your daily life.

Please listen to your gut and DO NOT do laser! I have seen the horror stories... My recommendation would be to try Microneedling (not Demarolling), done in a doctors office. I have seen people that have had very good results. Just make sure that you are at least ayear out from using Accutane. Best of luck to you!

BA, i was wondering. Why are acid peels and microneedling an effective combo? I do microneedling atm, but i'm a bit afraid to have acid on my face.

4 hours ago, beautifulambition said:

I think I said above acid peels and microneedling alternating between them are your best bet. You have so many spots subcision would be insane! 

Please see the official FAQ below. It explains all these procedures. You never want to do energy devices aka laser first, they do have serious side effects and it's a gamble. 

V-beam vascular laser is great for reds and ipl for browns from the scars to make them blend in more, this is not a resurfacing laser.

Why insane?? One scar is situable for subcision and many scars not?!  Many subcisions plus filler are needed here to improve his scars (nope, they're gonna still there) , this is a long journey, years and years. I got similar scars and I ve been trying every needling procedure, suctioning, every peeling type, every topicals for years and co2 laser once with no results except healthy skin and texture (but we re talking about scars here). From my experience, my skin  

On 1/2/2017 at 10:57 PM, Rdnhey said:

Why insane?? One scar is situable for subcision and many scars not?!  Many subcisions plus filler are needed here to improve his scars (nope, they're gonna still there) , this is a long journey, years and years. I got similar scars and I ve been trying every needling procedure, suctioning, every peeling type, every topicals for years and co2 laser once with no results except healthy skin and texture (but we re talking about scars here). From my experience, my skin  

Thank you for your input, I am sure you read lots of my advice including the FAQ which advocates for subcision and filler. When I said insane, I was referring to the anatomy, cost, big area covered, and possible side effects. In this case both cheeks would be quite torn up by subcision unless the doctor was extremely talented, not to mention the margin of error for poor healing and complications. Secondly there are issues when you use filler that superficially and to that scale of the whole cheek(s), the anatomy pictures prove this. Might it work or might he get some improvement yes. He has not tried like you ... "I ve been trying every needling procedure, suctioning, every peeling type, every topicals for years and co2 laser once with no results except healthy skin and texture." Different people heal differently, he should at least try progressively before going the ore surgical route and or energy devices like laser which have side effects. He might want to do a test of subcision and filler in a small area and see how it goes, but I still think you could get some benefits from peels and needling, before doing subcision.  

On 1/2/2017 at 7:15 PM, Noa27 said:

BA, i was wondering. Why are acid peels and microneedling an effective combo? I do microneedling atm, but i'm a bit afraid to have acid on my face.

Acid is like a laser it resurfaces the surface texture. Microneedling stimulates new collagen production like a fractionated laser. One stimulates collagen around the scars, and the other re-levels the surface of the skin, promotes a new epidermis, just as a laser it widens the scar and softens it's borders. Doctors used to do acid peels before lasers, they use lasers now because they are not sexy and they cannot charge as much for their toys..

[Redacted]

I don't know that filler would be possible in his case, subcision alone might be worth trying and possibly suction. That would be thousands in filler. The filler would be very close to the surface. I have seen filler that did nothing in these type cases. 

Will it work on majorly fat deficient scars, no (This is what subcision and filler are for). But these are surface scars so I tend to try surface treatments before I move onto the risky (side effects) lasers. As you know acne scars take several procedures and we all heal differently, this offers the lowest incident before spinning the wheel of luck on lasers / Infini. 

His case reminds me of this guy, no filler were used. 

Hey,

It always annoys me when people give flat out wrong advice as if they are a derm or something. Base your decisions on the advice of the derms while keeping in mind the treatments that you have researched that will work for you.

Here aresome actual medical journals that you may be interested in as some of the people have similar scaring and saw a significant 2 scar grade improvement.....

One link gives a explanation of 99% of the available effective treatments, and the other shows a cost effective strategy to manage scars with before and after pictures of patients of multiple scar types and ethnicity's undergoing systemic scar treatment. Also for significant improvement all i can say is be prepared to spend a significant amount of money... Asses the scar treatment on how effective it is not how much it costs otherwise you may as well burn your money doing silly 10% acid peels. Hope you can sort them scars out. Peace.

https://www.hindawi.com/journals/drp/2010/893080/

http://www.jcasonline.com/article.asp?issn=0974-2077;year=2014;volume=7;issue=1;spage=18;epage=23;aulast=Garg

I feel hard for you man. My scars are extremely similar to yours, and in the EXACT same area. None on my facial hair, very mild on my temple, but all over my cheeks.

I did needling about 7 years ago, I think 3 times with the single needle and it helped a little bit. Also did TCA 25% and it did help with skin texture. I did two more needling sessions with the derminator over the past 6 months and I think they helped a little bit, maybe a 10-15% improvement.

Honestly, laser will not do anything for the indented scarring.
You seem like a genuine guy, and I fully understand the emotional toll it takes on our social lives. What has helped me is going to the gym and drinking lots of water, it just helps me mentally with my acne scars. Water is essential to good skin texture I believe.

Anyways, some people may disagree, but I think you should get Silicone microdroplet injections. Using the medical grade Silikon 1000. This is permanent and cases of complications are about .01% and I don't even think it was with medical grade silicone. This technique is much safer and FDA approved. I'm considering getting it done within the next couple months when I save up some money. I'd do some research on this, unless you don't mind being patient and needling for years to get minor improvement. Although, subcision is definitely something I've always wanted to try and never got around to doing.

9 hours ago, Mclarensupra said:

I feel hard for you man. My scars are extremely similar to yours, and in the EXACT same area. None on my facial hair, very mild on my temple, but all over my cheeks.

I did needling about 7 years ago, I think 3 times with the single needle and it helped a little bit. Also did TCA 25% and it did help with skin texture. I did two more needling sessions with the derminator over the past 6 months and I think they helped a little bit, maybe a 10-15% improvement.

Honestly, laser will not do anything for the indented scarring.
You seem like a genuine guy, and I fully understand the emotional toll it takes on our social lives. What has helped me is going to the gym and drinking lots of water, it just helps me mentally with my acne scars. Water is essential to good skin texture I believe.

Anyways, some people may disagree, but I think you should get Silicone microdroplet injections. Using the medical grade Silikon 1000. This is permanent and cases of complications are about .01% and I don't even think it was with medical grade silicone. This technique is much safer and FDA approved. I'm considering getting it done within the next couple months when I save up some money. I'd do some research on this, unless you don't mind being patient and needling for years to get minor improvement. Although, subcision is definitely something I've always wanted to try and never got around to doing.

I hope your Silicone goes great! Just trying to educate. Everything we do is a risk.

I am not here to cause controversy or argue. I am a volunteer here to help other acne scar suffers through years of personal experience, research, and working in the acne scar revision field. I cannot in good conscious see silicone endorsed without the other side.

Is permanent better?...

If you search realself.com and see the silicone injection reviews (many which are paid to be positive for the same doctors - for a discount) you can see it is not the best treatment. While it is permanent, many things in life are permanent and lead to issues. Side effects from micro injected silicone do not appear for 7-12 years after the treatment. Permanent procedures leave permanent issues. The only way to get rid of it is surgery, cutting it out (it is injected in micro injections) or some have had their collagen destroyed with Kenalog steroid injections to tame the grandulomas or biofilm (infection) packets of infection that are in the skin. Silicone is a perfect surface area for bacteria and seen as a foreign invader by the body. As we age our face sinks, looses fat, and changes. Where our acne scars used to be can change locations and shapes, the injection can also "migrate" to other areas or be in the wrong spot. Everything is permanent here. There is no injection to dissolve it like a HA naturally occurring in our body already type filler. Why does Silicone work, it creates balls of scar tissues (potentially bacteria) - silicone in the middle which plump the skin.Many times people with fat deficient acne scars need massive amounts of silicone which increase the side effect risks. Thus it's not a micro injection any more as it accumulates.If someone gets sick with a unrelated disease it can also be a weak link where the body fights the permanent filler.

Silicone is NOT FDA approved for any sort of filler other than the tear trough. Thus it is off label. Many doctors warn against using it as it has a history of poor results with Hollywood who used to use this as a filler before HA and other things were created.

Bellafill was approved by the FDA to fill acne scars. While I would never get this done myself. Those who wanted a permanent result from fillers have gotten this filler. It is lab controlled the size of the fiberglass beads (other than a hand controlling a micro injection of silicone), the shape, and the carrier around the spheres. They changed it and have had less occurrences of side effects after Artefill first came out. Note this is banned in Europe and Canada, but not in the USA. Silicone is also banned but used "off label" meaning it is not approved but on the doctor for liability. Will your doctor be around forever for that permanent filler, where will he be in 7-12 years?

IF you are having this done please goto someone who has filled thousands of acne scars and whom you feel you can go back to if there is any issues. IF you have a history of cysts or healing poorly which is related to auto immune, such as myself I would never recommend either as your body will fight against these fillers. HA is much more natural and disolvable, Ellanse E (lasts for 4 years - All over Europe and Asia) this is made from disolvable suture material or Fat Grafting is a permanent solution but the most costly and invasive and needs to be done in micro injections.

Here is the truth: Silicone injections are a last-step treatment with proven (permanent) results. Who has time to spend years on needling their severe acne scars while youth slips by them, for a 5% improvement? You might. I do not. Silicone has risks; but it does not matter, with severe scarring the term "risk" means absolutely nothing (because we are already at rock-bottom)

There should be a questionnaire for all new members on Acne.org Scar Forum -

You roll a two-sided dice:

Side one: Your scars vanish.

Side two: You die.

If you wouldn't roll the dice, you do not belong on this forum. Registration denied.

3 hours ago, ChildhoodDreams said:

Here is the truth: Silicone injections are a last-step treatment with proven (permanent) results. Who has time to spend years on needling their severe acne scars while youth slips by them, for a 5% improvement? You might. I do not. Silicone has risks; but it does not matter, with severe scarring the term "risk" means absolutely nothing (because we are already at rock-bottom)

There should be a questionnaire for all new members on Acne.org Scar Forum -

You roll a two-sided dice:

Side one: Your scars vanish.

Side two: You die.

If you wouldn't roll the dice, you do not belong on this forum. Registration denied.

Please... Have u ever tested HA temporary filler on that type of scars? Probably not. I have and permanent filler, even with a pre-subcision, is not a good idea. The main goal is collagen stimulation, your skin is not a balloon.

9 hours ago, Rdnhey said:

Please... Have u ever tested HA temporary filler on that type of scars? Probably not. I have and permanent filler, even with a pre-subcision, is not a good idea. The main goal is collagen stimulation, your skin is not a balloon.

You say "collagen stimulation" as if it is easy (or even possible to any large degree) to fill deep indentations out of thin air; but you've been unable to, this is why you and I are here today.

Even in your own words: You have done numerous treatments (needling, topicals, Co2) to only have minimal results.

The logical final step is to attempt masking the problem, not fixing it.

@ChildhoodDreams

Lets stay civil, we are all here for different reasons. I am here to help people and that is all. Some are here for support and other are here because they want to look better, have you seen Yotube recently people with small discoloration think they are ugly. We live in a very superficial world. Just because he has had treatment means he has done something to better himself, good on him. As you know weather it's silicone injections or even a full face lift, people still have imperfections, these things are never perfect. They give a "percentage" of acceptable correction, it's a journey (silicone injections does not correct someone with severe scarring, it does nothing to the epidermis or fat structure, it must be in "micro" amounts for small scars).

Look at the Skin regeneration and future treatments post, if silicone worked for all of them it would not be around for 10 + years looking for a skin "regeneration" cure. He got fat grafting I recall which is better than Silicone and it is permanent if done correctly and over time, it's natural. It does not work for some people as it is soft and does not do small acne scars just wider areas that can create blood supplies. Again I wish you well if Silicone fixes your issues and maybe as you say it will cause you to as you said "move on" and find some happiness which is much more important than perfect skin.

There is a therapy app fro your smartphone called talkspace which is convenient to deal with the pressures of acne/ scars, I have recommended it to many, it is a hard burden to bear.

This thread is now locked for further posting, we don't need to start a fight here. If you wish to talk directly to the posters please PM to discuss.