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IMO this is what I'd do. I know nothing about the facial fat, etc... but i'd work out a plan similar to this. If you've spent this much money i'd cut the bullshit out right now and see a REAL dermatologist.
Figure out how long it will take to start seeing LIM. Even if it's a year it doesn't matter, Lim gets results and you can wait it out.
In the meantime figure outwhat can be done cheaply and within reason. Lim would be my end goal here. See if you can book subcision + filler somewhere for a reasonable price. You could also look into RF Microneedling treatments. If not at least start saving whatever is within your means.
Once you do get in with Lim I suspect you are in good hands. If he knows you update on acne.org he will most likely make sure you get results. Worst thing that could happen to his business is to give you 5 treatments and you post before and afters here with 0 results. My guess is he will assure you see significant improvements.
Just my two cents
Last time I checked it was for a certain list of things. My future subcisions might be covered but I know laser isn't covered under Medicare because I didn' get a rebate for it and I'll doubt I'll get any back when it comes to the filling stage but I shall ask on Monday when I see the derm.
2 minutes ago, victor71 said:Last time I checked it was for a certain list of things. My future subcisions might be covered but I know laser isn't covered under Medicare because I didn' get a rebate for it and I'll doubt I'll get any back when it comes to the filling stage but I shall ask on Monday when I see the derm.
In Australia there is a medicare rebate for fully ablative lasers, but not for Fractional lasers or infini rf. Subcision has a medicare rebate, but not fillers. TCA cross may be covered, I'm not sure. It also applies for grade four scars. Now I could be wrong with all of this, but that is my current understanding. Please correct me if you find any additional or conflicting information.
On 2/7/2018 at 8:52 PM, ScarRight said:In Australia there is a medicare rebate for fully ablative lasers, but not for Fractional lasers or infini rf. Subcision has a medicare rebate, but not fillers. TCA cross may be covered, I'm not sure. It also applies for grade four scars. Now I could be wrong with all of this, but that is my current understanding. Please correct me if you find any additional or conflicting information.
Thank you for speaking from an informed place. That's good info. OP, at this point I think trying to consult with Dr. Lim is probably your best bet. He's the most informed and competent doctor you'll find in your area.
I will investigate further with the derm. Hopefully he understands that 3 laser and little result a different method needs to be taken otherwise I'm outta there.
Can anyone share some information on sculptra or prp and if it will benefit me at all or will I need to fork out the hard cash and just constantly get fillers for the rest of my life
@victor71Have you read the FAQ linked below here, filler section? He mainly uses HA Filler and has done "some fat" transfer. He does PRP masks with most of his Infini sessions with injections as well. PRP offers quicker healing and stimulation of fibroblasts with "potential" collagen synthesis. Remember he is a laser doctor, one of the top ones of the world (this is my opinion) based on the settings and techniques he uses. I have seen many cases where he does subcision and a filler, infini with prp mask (I don't recall if this is covered under medicare) and then fully ablative resurfacing with the erbium laser which is covered under medicare. Unlike the other doctors he does not do this in fractional mode but instead using full ablation to resurface the top of the skin to smooth the surface. Unlike other doctors he will feel your skin and use directional lighting to provide the appropriate procedure. None of us can do this here in person. Give it a go.
If you don't want lasers tell him you just want subcision and filler and I don't know if phenol peel resurfacing is covered under medicare.
Your in control of the process tell him your concerns and he will help you. Subcision and filler will get you most of the way there.
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Prp is not a filler. Like BA said, it's meant to accelerate healing and won't give you any long lasting volume. I'm going to make it simple, you need some very robust filler like Voluma (at the very least). Unfortunately, I think the volumes you need with be significant, and that will be very expensive. That is why a few of us have recommended fat grafting because fat is plentiful, and what survives is permanent.
I would reach out to his office, show him your pics, and ask if he could do fat grafting in your case. Ultimately, it's his opinion that matters. We're just all regular people offering our non-medical advice.
@thepwhispI am going to be in contact with Lim after the follow up Monday and will see what my current derm will offer. I will give him a chance, at least he has done subcision and has mentioned doing tca and infini on me so imo he has done much better than my previous derms where they have just taken guesses on what "might" work. But yes now that Lim has been mentioned it will be my main aim to get seen and treated by him but I will need some serious $$$ saved before stepping into his office.
@beautifulambitionI have done a fair bit of research on fillers, I feel like fat grafting is the way to go long term but it's about $4k a session. Not cheap!
Surely if I've had 3 co2 laser sessions surely Lim won't put me through another one..
@victor71
If prp is expensive for you than skip it. If you have the money then great get it done. IT's not going to change scarring for you like filler will. It's priorities really and what works for you. I have seen some ugly fat results, and I have seen people who's bodies absorb the fat and they get no benefit. This is why you have to try it before knowing, everyone is different. Few Doctors do fat. Ask Lim what he think's in your case. Filler you know what your getting. Yes and with fat you need about 3 treatments 4K or whatever times 3. Another option is bellafill also called aretefill and it is approved in AUS, Lim won't do it. I would start with HA and see if you like how filler looks, ... it's natural and reversible.
BA
Update
I was in the derms office for over an hour! Crazy.
I asked a LOT of questions.
So basically the derm told me that yes, subcision/tca is cheaper but it is not as effective as adding a laser to get underneath the skin to "re-stimulate" collagen reproduction. Also with my skin tone there are cases of the tca causing major hyperpigmentation which could take months to clear up.
The main reason he didn't push towards fillers yet is because he wants to clear up as many scars before going down the filler path. Also once I have fillers he says that It would be pointless doing co2 lasers as it will "melt" the filler away.
So he has basically given me 2 paths to go down. Do another 2 more co2 sessions followed by fillers afterwards which will give me a more permanent scar treatment. Or I can get subcisions and try tca treatments with filler which will give me a "fuller" result, but non permanent and the scars will be left untreated, just filled with filler so they don'
Look so depressed.
Fat grafting is also risky as it's apparently new technology in aus and very few doctors will do it because of how sensitive the" fat spinning" method works? Apparently if its not spun right your body will consume it and he said with me being so fit and little in body fat I could end up being unlucky.
Medicare topic - the safety net threshold is when you pass $2093 in Medicare rebates they will cover 80% ( or even more) of future treatments. Correct me if I'm wrong but that is what the derm told me yesterday.
4 minutes ago, victor71 said:So basically the derm told me that yes, subcision/tca is cheaper but it is not as effective as adding a laser to get underneath the skin to "re-stimulate" collagen reproduction.
In theory, anything can "re-stimulate" collagen when the skin is traumatized (i.e. fibroblast). The problem with laser in general, and CO2 in particular, has a very limited use. I personally would never advocate laser unless one has a relatively deep pit with a very defined border. Even though you're eager to jump on the treatment bandwagon to fix your scars, please take the time to do your homework. You won't regret it.
You've already done 3 co2 laser sessions. If they haven't done one single thing to improve your scars, then it's logical to assume that the 4th session won't magically make a difference. Again, I see no rational argument why someone would refuse to do fillers.
I find his answers a little disingenuous. First, if you don't want to do more lasers, than his argument that lasers will "melt" the filler is no longer a factor. Also, co2 lasers also have a pretty significant risk of hypopigmentation / hyperpigmentation. In fact, lasers pose a greater risk of unwanted color changes more so than TCA. It kind of sounds like he is not an expert. I'm also really sick of the "collagen stimulation" claim made by derms about lasers. They simply don't work like that, or at least won't create enough volume to help your case. One syringe of filler will give you more volume immediately, versus an unknown amount of lasers.
On 2/13/2018 at 8:34 AM, victor71 said:Medicare topic - the safety net threshold is when you pass $2093 in Medicare rebates they will cover 80% ( or even more) of future treatments. Correct me if I'm wrong but that is what the derm told me yesterday.
I know this threshold and you are correct, but I thought this included only treatments that are covered by medicare. For example, in Australia, Infini rf and prp are not covered under medicare, you get zero rebate. So I thought they would not count towards that 2093 yearly threshold, because it is a treatment not partially covered under medicare.
I could be very wrong here, but that is what I thought. I know Infini rf is not covered at all for medicare, because Lim has that written on his website for Laser and Lifts.
Did you dermatologist say all treatments go towards that yearly threshold? Fillers don't count for that, surely?
Dazzed some it up perfectly below here.
17 hours ago, dazzed said:You've already done 3 co2 laser sessions. If they haven't done one single thing to improve your scars, then it's logical to assume that the 4th session won't magically make a difference. Again, I see no rational argument why someone would refuse to do fillers.
@dazzedI'm not going ahead with any more lasers I have told him. He said because of my skin tone the tca is at a higher risk of pigmentation which confuses me because i thought the co2 laser is much more harsh on the skin than tca?
I have read up on a few stories on here with tca/subcision/fillers giving much better results than lasers. The next step from here is a subcision with filler. Also waiting for a consultation from Dr Lim but it seems the answer is subcision and fillers. I am going to shop around because some places charge $1500/ml and others charge $500/ml of radiesse
@ScarRightOnly treatments covered under Medicare count towards the threshold. It sucks because having grade 4 scars the treatments towards it are still classified as "cosmetic". Gold Coast is a very superficial city. We have people concerned about how small their lips are meanwhile I'm here trying to look like an everyday person. It's a cruel world
@victor71 I totally understand how you feel. I've been on this journey for a long time, been through tons of trial and error, and spent a king's ransom on all sorts of procedures. My scarring at the outset was described as "severe" by a lot of clinics I went to. My goal wasn't even to have good skin, just "below average" to "bad skin". I wanted skin that would not draw unwanted attention and comments from assholes, frankly.
Through all my ups and downs, the only thing that truly made a difference in my face and the appearance of my scars has been fillers and maybe TCA cross on a few scars. I think fillers will help a lot. I don't know how financially feasible it is for you, but is traveling out of the country an option? Fat grafting is sometime commonly done in South Korea.
Just to clarify a few things-
1. Subcsion is covered by Medicare if performed by plastics or dermatologist if Grade 4 scars ( which you have)
2. Medicare Threshold applies in your case. Australia is a lucky Country if you have acne scars, once you reach the threshold- no other country subsides 80% of billing.
3. I think Lim uses Sculptra - seen a few presentations by him.
4. Your scars are definitely treatable, providing you have realistic expectations.
5. Specialist acne scar Dermatologist in Australia include Shawn Richards (Sydney), Greg Goodman (Melbourne- grumpy old man, but good when he wants to be), Phillip Bekhor (conservative but good in Melbourne), Adrian Lim ( conservative), none in South Australia, none in WA. Do not see Lim as he does not hand hold, he just gets the job done with no BS.
6. In your case, I think manual revision with TCA - subcsion- spacer or buffer filler will be in your best interest over CO2.
Your scars are not hard to treat, unless you have subdermal fibrosis, - you just need to think positive and listen to advice. BA is probably the best guy to listen to in this forum.
16 minutes ago, Obi wan said:Just to clarify a few things-
1. Subcsion is covered by Medicare if performed by plastics or dermatologist if Grade 4 scars ( which you have)
2. Medicare Threshold applies in your case. Australia is a lucky Country if you have acne scars, once you reach the threshold- no other country subsides 80% of billing.
The first point is correct.
The second point not, because fractional lasers, fillers and infini rf do NOT count towards the Medicare threshold. They have no Medicare eligibility. TCA cross may possibly for grade 4 scars.
16 minutes ago, Obi wan said:Do see Lim as he does not hand hold, he just gets the job done with no BS.
Had a call from the derm today wanting to try a New treatment on me called "Venus viva" rather than getting the fillers on monday. Can anyone give some more information about this procedure and if it's worth giving it a go? It will be a free session because it's new to their clinic.
@victor71If it's FREEthen just do it. IT's a inferrior RF device. Non insulated unlike Infini, etc.
https://www.realself.com/question/lombard-il-infini-venusviva-moderate-acne-scarring
@victor71No one can tell you that from a single treatment. Ok fine don't do a free treatment, which was very kind of them and shows they want to work with you. Insulated rf needling is better but again it's not free. Some would be all about the free, but I respect your caution to not do it based on it's newness and no guaranteed outcome. Which we really don'y get with anything based off our bodies ability to heal, and aftercare.
@victor71 I can tell you this, I feel Dr. Lim who was recommended to you in this subis probably not the guy for you if you want to talk about choices, or a debate on scarrevision options, however if you see him, he will give be transparentrevising your scars. Dr Lim just gets the job done in a professional manner, but does not do hand holding orA-la-carte treatments of choice. All the below Drs are my colleagues and we share how we deal with scarring.
Venus VivaI saw his presentation in Singapore 3 years ago. As a guide Venus Viva is non insulated and aimed at the cometic market, not as a medical device like Infini or Intensif. The device cost 1/4 the price of Infini, but this debate is mute. With a $1 NOKOR needle and $2 worth of saline can beoutperform the average dermatologist with Venus Viva, and 1/4 million dollars worth of pico. or whatever the latest trending lasers are. BA is spot on regarding the use of insulated vs non insulated devices.
If you mentioned the word Venus Viva, you probably saw Dr Bekhor at Box Hill, Laser Dermatology. If you did see him, you are in very good hands, he is well respected. Venus Viva is just a device- like BA says it does not rate, however Dr Bekhor is a brilliant procedural dermatologist. If Venus Viva does not work as well as it should, he may perform dermal fillers and subcision. His skill levels in context of scar revision are up there, even though 80% of his practice are birthmarks related, with the odd scar revision. So in this context of who performs Venus Viva, stick to Bekhor as even if it does not work to the degree that one expects, he will subcise, fill and use his other fractional devices.The before and afters will give you a good guide as the primary practice of a specialist and their skill sets. If you are in the Gold Coast..., you probably saw Dr Michael Freeman, again a very good general dermatologist. He is a patient gentleman who can guide you and talk about your scars. I know you did not see Dr Portia Miller if you at the Gold Coast as you would be out the door within 10 minutes with the only option of laser resurfacing. Miller doesn't hand hold and her subcsion skills are limited. She is however very good with cosmetic Co2 fully ablative lasers. (Not recommended for your scar type)
Prof Greg Goodman is also an excellent scar revision dermatologist who has contributed may papers in the field of acne scar revision. Scar grading is named after him (Goodman - Baron scale), and this is the most frequently used method of grading for OBJECTIVE measurement under the Medicare system. This man will have hundreds of before and afters. If you are after no BS advice from an academic, Goodman is another resource. Not a good hand holder. If you need someone to discuss, talk, and spend time with you discussing the pros and cons of scar revision, Dr Robert Sinclair in Brisbane is one of the most compassionate and patient dermatologists, - his solution however will be to dermal graft your atrophic scars after subcision. He will perform 4-6 session over the year, at a very slow pace, then use ablative lasers to resurface the crescent shaped nicks. 10-20% of these grafts will have inclusion cysts as the dermis he harvests from behind your ear will still have the epidermis attached, as CO2 laser that the uses may not fully ablate the donor site. He will then excise or injected the dermal grafts that do not 'take'. He will be very apologetic, and nice about things. You can talk to him, he will listen and give you advice on your research, he is a nice gentleman, and brilliant at old school scar revision.
Some of your atrophic scars will develop sub dermal fibrosis (lumps) due to the dermal grafts. These can then be revised by another scar specialist down the line. Dr Sinclair does not charge a lot, as each dermal graft carries a Medicare Rebate, and within a few sessions, you are over the threshold. For good, cost effective, old fashioned scar revision by a dermatologist who likes to listen to your thoughts on how your scars should be revised, Robert is the man.
@ScarRight
regarding point 2 - you are indeed correct,fractional laser, INFINI RF are not covered under Medicare, but in this context of @victor71 scars, most good dermatologist will combine subcsion procedure with other treatments, and only bill for the claimable procedures. These include subcision and nerve blocks. The legal justification is that the most amount of time is taken to subcise, and this is the primary modality for scar revision. Fractional laser will take 3-4 minutes to perform, whilst blocks to the secondary branch of the trigeminal nerve and subcision may take 25 minutes. Medicare unfortunately sees fully ablative lasers as the only 'energy device' to treat acne scars, however gives the surgical subcsion item number to plastics and dermatologist to use wisely (Grade 4 objective measurement scars on the face - either from surgery, burns, trauma, 'inflammation' - hence acne and chicken pox scars, as well as lupus profundus fall under this category).