You mainly have icepicks and small rolling scars.

Firstly your time schedule is way to rushed! We wait 3 months between treatments, not 3 weeks. The body takes time to heal.

I can see subcision helping you, RF needling filling some of those in, and tca cross lifting more of the icepicks. You have to do several. You will end with Peels. Do not do them now. The skin is not ready. You must do the other work first or you can do erbium laser resurfacing at the end instead.

1) 3 treatments of subcision, you will be doing suction. 3 months of healing is needed.
2) RF microneedling, for your skin use whatever brand the doctor has that is insulated (needles). You again will need 3 of these spaced between your subcisions and propper time to heal.
3) TCA Cross, you will need several of these, continue doing them, they will work also on some of your smaller box cars.
4) TCA peels, you will do several of these, because of your skin tone you must use hydroquinone and tretinorin before treatment for 3 weeks to prep the skin, and again when the skin has healed. Another option is erbium laser resurfacing if your skin does not respond well to peels.

Your doing too much at once, I caution you to spread things out even if the doctor wants to do things quick ($$$). You can try fractional co2 is you wish, I do not recommend it to you. Dr. Lim for your type of scars would do high energy and low density 5-7% for co2 laser. That is a option. But RF needling will get you there as well and is more safe. I reserve lasers for last if all else fails. There are side effects.

Checkout the FAQ

Subcision section, TCA / Acid peels Section, Microneedling Section.
Ba

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Hi. Thanks for taking the time to reply. I appreciate it. I read your posts and they are really helpful!

Well, yeah I am impatient and I try to wait 3-4 weeks before having a new treatment. BUT 3 months is such a long time to wait.

What is the difference of waiting 3 months for each treatment compared to having different treatments every month aside from the fact that it will make me poorer? lol Is there really no chance at all of improving every month? Will it make things worse? I think I heal fast since my skin recovered 4-5 days after subcision and left no scars or hyperpigmentation. What if I follow the FAQs tips for healing faster? Will that make any difference?

For subcision, it is kind of expensive so yeah I might wait every 3 months for it. Before, I thought subision is good for most scar types but my derma said that it's not good for icepick scars. Based on my pictures, how many scars should be subcised then (if it's not too much to ask and also, since you said I can TCA cross some of my small box scars and I am not sure where are they. Basically, I know all the ice pick scars and I'd rather not mess with the rest of them on my own and have my derma subcised them instead.) Is subcision ok for rolling scars?

For microneedling, I had a couple of them in random order last year. I have read they are good for oiliness too and I have oily skin so I am willing to have this every month if only for that alone. I noticed that after having this, it makes my skin look tighter and thus help improve the appearance of scars. Will it cause any damage or interfere with collagen production if I do this monthly? I mean, I see people doing dermaroller nightly/weekly and this one is not really different and it is safer, right?   

For RF microneedling, I am not sure if my derma has this (my derma is already one of the cheapest yet experienced in the field, she's one of those rare ones who do subcision). What if she doesn't have the one with insulated needles? Will that be riskier? If my derma doesnt have this then I'm stuck with ordinary microneedling. Will it still help me if I stick to microneedling? 

For TCA cross, I let my derma do this for a couple of times last year and when I felt confident doing it myself, I did it in November and December. So for November, it was ok. I saw improvements. When I did it the second time, I think that's when I screwed things over including the improvements I had from prior treatments. I think I crossed some scars that were not supposed to be crossed (and manually peeled some of them argh!) so when you said I can cross some of my smaller box scars, I feel like I'd rather not mess with my scars unless they are ice pick scars. I did another TCA cross right after subcision and is definitely working on my icepick scars so I will continue doing this one. Is it ok to do this monthly? I get transient white marks after but hydroquinone makes them go away in a few days.

For TCA peels, like I said, I've never had strong ones. But if you're saying that I need to wait every 3 months for each treatment, what about this one? Can I like have this every 1-2 months if it's just mild peeling like 20 to 30%? I am not expecting it will help with the scars but I am only doing it mainly to improve my skin's texture and color somehow. Does this affect collagen production in any way?

For lasers, my derma is definitely pushing for fractional CO2 but why don't you recommend it? Will erbium laser resurfacing be a better option instead of this one? Is it safer? Lasers of any sort is definitely my last resort and I am ok sticking to having microneedling, tca cross, subcision and peel alternately.

Thanks for reading and I'll appreciate the response.

@scarredletletters

We can't change the amount of time it takes to heal. I am sorry your impatient. Can't do anything about this. That is not how your body works. This sounds more like a debate between at home treatments and clinical treatments. At home sure you can microneedling once a month, this is not the same thing as RF microneedling and is not as effective. If your doctor is doing this treatment that can be done cheaply at home once a month I understand. This will do little for your scars. Peels again take months time to heal, because a doctor can use higher strength peels and lasers than you can do at home. The doctor would love to take your money weekly and ruin your face. That's not what is best for your body. It sounds like your Dr is not a professional at Acne Scar's. Just a general derm doing procedures that you could do at home once a month. I am talking about treatments that will actually be more effective and make a change.

For instance TCA cross done in a doctors office they can use very high percentage acid that no one can buy and use at home. The healing time is longer. Same thing with subcision, there is remodeling that occurs without any surface healing which occurs for months (either one uses filler or suction), collagen is fragile. Just because your face is normal in 3 or 4 days means nothing to me as collagen continues to forum and they body heals itself for up to 6 months "under the skin." You do more and you risk damaging the skin and stopping improvement. Again read above this sounds like more a discussion between a Dr doing at home procedures and not more powerful modalities.

There is NOTHING in the FAQ that tells you to do things faster or speed things up. I give you ways to heal in a better way, not faster.

No I am not going to count the scars for subcision. I am not there inspecting your skin, feeling it, using a directional light, ... your DR should be doing this. Sounds like they are not a good acne scar doctor. Pictures never give the full story of what's going on. You tca cross all your smaller scars and subcise the bigger pits. Subcision can be done for bigger rolling scars and box cars.

"My derma is already one of the cheapest yet experienced in the field, she's one of those rare ones who do subcision." That does not mean she is good at Acne Scar Revision. Go elsewhere to where they have the RF needling. You don't have to stay with one doctor. Don't do ordinary needling machine, buy one at home if you wish. This is not the same thing as the RF version. The RF insulated version is better than laser now days as a fractional treatment.

" I think that's when I screwed things over including the improvements I had from prior treatments. " Go see a professional, you sound like you could have made things worse between technique and doing treatments to often. TCA Cross can take a long time to heal from,especially a the high % that is most effective.

You have darker skin I would go get your TCA peels done by a professional. You can cause issues. 30% for a lighter person is going to be different for you. If your intent of doing this at home be aware of these safety issues all covered in the FAQ and linked in the guide to TCA peels (did you read the whole first page). We don't start at 30%. We do a spot test. For your darker skin it will take longer so yes 2 months for lower percentage peels between treatments. You may find a doctor doing fully ablative erbium resurfacing more effective. For any of these treatments you will have to pre-treat for hyperpigmentation aka tretinorin / hydroquinone. Peels can make your color worse if mistakes are made. Just like laser done by a un-experienced provider.

I would not be doing laser until you have tried all other options. Fractional rf microneedling is better than CO2 because it's insulated. Erbium would be better if it was FULLY ablative to resurface.

You have lots to do to get there. Many people take 2-3 years to treat between treatments and healing time.

BA

8 hours ago, scarredletletters said:

I think I heal fast since my skin recovered 4-5 days after subcision and left no scars or hyperpigmentation.

By healing, I assume BA and others are talking more about your body's ability to make more collagen rather than wound healing (eg. post-subcision PIE, swelling, etc). It can can take up to 6 months for your body to make enough collagen to fill in the pits, with the peak production at about 3 months. Hence, it's best that you wait at least 3 months, otherwise you're only disrupting the flow.

Why risk rushing? As said, the body can only heal so fast. I know it seems like a long time now, but it is a fraction of time really, and rushing and getting a bad result will end up taking longer.

Hey guys, I know that it takes months for collagen to build up and the longer you wait, the better, but I guess, it's just that I have read a couple of studies doing a combination of treatments in a space of 2-3 weeks and some are far apart than that, yes. I also know that of course, doctors will say you can do it in 3-4 weeks time but it's preferred that you wait longer. It's just the 3 months for me is a really long time just based alone on some studies I have read.

I know guys you mean well though and I definitely appreciate the input, especially BA's.

@scarredletlettersI am not going to debate white papers. Dr's can come up with small sample sizes, device sponsored results, or paid pharmaceutical fix outcomes.

I offered advice as a suggestion not telling you what you can or cannot do. It's a brainstorming session as I am not your doctor. As such please seek your doctor of treatment or you patient rights to be educated and make informed decisions.

If you want to do treatments every day cool. I just stated this is not how the body heals. We all here have seen countless cases of excess treatments, mega sessions for high $$$$, poor ability to heal, not knowing what is wrong because so many things are going on, or stunting the slow collagen formation from treatment. Sure one can do lots of things, but is it smart to do so, you have to be your own judge of this. Studies can say I can eat the whole bottle of supplements / vitamins, but is that healthy to do so, at that point you are in a risk taking area and playing the lotto with your health. 2-3 weeks for what microneedling ... sure. A light peel, cool. Any Dr's treatment with energy - I think not.

You must do what you feel is best!