Just now, dazzed said:I read that you plan to go to Southcoast Med Spa.... They're one of those chain med spas that try to push package deals. They're pretty aggressive with the marketing. I would go in and listen critically to everything they're saying.
really? Thats good to know i chose them bc everytime i google image acne scars all their patients are stamped w their logo. They seemed pretty professional over phone, they set me up w the nurse practitioner over skype. They said i could buy one at a time but its cheaper if i buy 3. She did say one is around $1300, which is the same as where i live. San diego is not that far from me, so if their price is same as where im at, might as well go to san diego where they have done loads of scar cases.
OK.. Update you guys, help me out...
I made an appointment for a consultation w 2 different derm surgeons to talk about subcision w filler on April 13th, (but won't do anything till mid may i promise). I know i have to ask them if they use nokor 18G, and will ask them what filler is best, I know VOLUMA is the best option, but i know about 4 syringes is like $3000, whats the next best, cheaper option? I want to go to this consultation prepared. thanks guys.
Obi wan, BA , HELP!!
@Amp2695I can't do anything about the cost of fillers. You do not need 4 syringes. Rullan does subcision with/without filler, use Chinese cupping (amazon) at home if you need to save money.
Voluma might not be the bet filler for you, you have surface scars, hence you need a softer filler so it does not bump. Doctors know this. Voluma is for pits. You don't need to worry about the filler type, ... just that you can afford it. There are so many types of HA.
I can give you a plan PM me.
Just now, beautifulambition said:@Amp2695I can't do anything about the cost of fillers. You do not need 4 syringes. Rullan does subcision with/without filler, use Chinese cupping (amazon) at home if you need to save money.Voluma might not be the bet filler for you, you have surface scars, hence you need a softer filler so it does not bump. Doctors know this. Voluma is for pits. You don't need to worry about the filler type, ... just that you can afford it. There are so many types of HA.
Also stop using 18G, that means nothing. There are different sizes of Nokor 😉
i see, so subcision and probably something like belotero? (Im not sure if thats HA) anyway ill ask him when i go.
after i get the subcision w filler, you said it was a-ok to go ahead and do infini tx a few months after the subcision correct, then space the infinis out about 3 months apart from that point.
thanks BA, are you a derm?
That works,
Not answering the second part, part of a confidentiality agreement with me helping here. My advice has been endorsed by other top acne scar specialists 😉 . I do work in the field.
Always research anything you want done, I offer general advice and am not your treating Dr. There are many paths to get to the same place.
Quickly skimming this topic-
1. You plan to undertake Scition Profractional Erbium. As you know the deepest setting is 1.5 mm- that is the maximum depth. Even at that depth you are 0.5 mm short of Intracel, and a full 2 mm short of Infini RF at the deepest setting. Personally I think you are going backwards in your planning. Infini RF at 3-3.5 mm respecting anatomy, with a level of 12 and a pulse duration of 500 ms will outperform Scition, even at 1.5 with coagulation modulation at 22% density. Its about the operator- if one has access to BOTH Scition and RF insulted microneeedling, its the later that will give you the better results, again operator dependent.
2. Can I suggest you see someone who does good Infini, and combine this with 21 g cannular subcsion with saline or PRP (not HA) due to safety factor. This can be combined with 18 G point NOKOR subcsion for the focal tethered scars. Multi - level cannular subcsion is not well described and practiced by only a handful of specialist. Again one good session will give you a marked improvement. Your temples are relatively straight forward with 29- 30 G subcision and filler.
3. Space treatments out in your case 8 weeks to 12 weeks. A typical scar revision job like yours should be completed over 12 months, considering your skin type and scar type. You can DIY 0.25 -0.5 Skin needling at home between treatment sessions to help with epidermal induced scar remodelling- this has 1-2 day downtime and cost $10-30 if you DIY. Logic is that hitting the epidermis can induce collagen remodelling (LIOB - cytokine theory).
The choice is obviously yours, but all of us try to help guide you as to the safest and best treatment, BA has a huge amount of knowledge as does @Sirius Lee, - sometimes there are many roads to the same destination, but Erbium Sciton ProFractional is a longer road with potentially more complications.
9 minutes ago, Obi wan said:Quickly skimming this topic-
1. You plan to undertake Scition Profractional Erbium. As you know the deepest setting is 1.5 mm- that is the maximum depth. Even at that depth you are 0.5 mm short of Intracel, and a full 2 mm short of Infini RF at the deepest setting. Personally I think you are going backwards in your planning. Infini RF at 3-3.5 mm respecting anatomy, with a level of 12 and a pulse duration of 500 ms will outperform Scition, even at 1.5 with coagulation modulation at 22% density. Its about the operator- if one has access to BOTH Scition and RF insulted microneeedling, its the later that will give you the better results, again operator dependent.
2. Can I suggest you see someone who does good Infini, and combine this with 21 g cannular subcsion with saline or PRP (not HA) due to safety factor. This can be combined with 18 G point NOKOR subcsion for the focal tethered scars. Multi - level cannular subcsion is not well described and practiced by only a handful of specialist. Again one good session will give you a marked improvement. Your temples are relatively straight forward with 29- 30 G subcision and filler.
3. Space treatments out in your case 8 weeks to 12 weeks. A typical scar revision job like yours should be completed over 12 months, considering your skin type and scar type. You can DIY 0.25 -0.5 Skin needling at home between treatment sessions to help with epidermal induced scar remodelling- this has 1-2 day downtime and cost $10-30 if you DIY. Logic is that hitting the epidermis can induce collagen remodelling (LIOB - cytokine theory).
The choice is obviously yours, but all of us try to help guide you as to the safest and best treatment, BA has a huge amount of knowledge as does @Sirius Lee, - sometimes there are many roads to the same destination, but Erbium Sciton ProFractional is a longer road with potentially more complications.
Thank you for your advise ob wan. So it would be smart for me to start out with a nokor subcision w filler (you advise against the filler..why?) Then do a series of infini tx spaced out between 8-12 weeks. After treatments with the infini when can i micro needle at home w the 0.25 after healing from infini tx? Also what type of ha filler do you recommend for temples? Thank you for your time
7 minutes ago, Obi wan said:2. Can I suggest you see someone who does good Infini, and combine this with 21 g cannular subcsion with saline or PRP (not HA) due to safety factor. This can be combined with 18 G point NOKOR subcsion for the focal tethered scars. Multi - level cannular subcsion is not well described and practiced by only a handful of specialist. Again one good session will give you a marked improvement. Your temples are relatively straight forward with 29- 30 G subcision and filler.
Man, that's exactly what I wanted to say all along! Obi Wan, make me your Jedi...LOL (BTW multi-level cannular sounds exotic, almost erotic. 
)
23 minutes ago, Sirius Lee said:Man, that's exactly what I wanted to say all along! Obi Wan, make me your Jedi...LOL (BTW multi-level cannular sounds exotic, almost erotic.
can someone educate me on 21 g annular subcision, how does this differ from using a nokor needle. My derm did saline submission, but when i looked it up everyone was saying saline subcisions are much weaker than nook subcisions.
wanted to ask a quick question
ok so after my last infini tx on march 30 i had to immediately drive across town to get a prp, (bc the first place didn't do them), i asked the doc for a prp and he said he likes to do combo tx for better results. He injected the pro, ran a fraxel over it (just one pass, I'm assuming not such a high level), then he injected and rubbed the rest of the prp, and just charged me for the prp. I have heard of this method before by davin lim i think he calls it the under over method, but what is the benefit of doing this? As he was doing it i remembered davit lies under and over method and thinking...wow my derm knows what he is doing.
Thank you
1 hour ago, Amp2695 said:can someone educate me on 21 g annular subcision, how does this differ from using a nokor needle. My derm did saline submission, but when i looked it up everyone was saying saline subcisions are much weaker than nook subcisions.
21-G is the size of the needle. Higher the number, smaller the needle.
Cannula, unlike the standard needle or "sharp", has a blunt tip at the end. This helps prevent possible bruising. As such, it's widely used for dermal fillers. But it's not in wide circulation for subcision, as you can see why from the pic. I suppose 16- or 18-G is more preferable, but how effectively it can sever scar fiber is debatable.
On the other hand, NOKOR is very different. It's more like a knife than a needle. It has a blade at the tip so you can both slice the scar and inject with whatever you want, be it filler or saline. "Saline subcision" is just that--injecting saline after chop chop.
53 minutes ago, Amp2695 said:i asked the doc for a prp and he said he likes to do combo tx for better results. He injected the pro, ran a fraxel over it (just one pass, I'm assuming not such a high level), then he injected and rubbed the rest of the prp, and just charged me for the prp. I have heard of this method before by davin lim i think he calls it the under over method, but what is the benefit of doing this? As he was doing it i remembered davit lies under and over method and thinking
The jury is still out on the whole PRP shebang. Some folks swear that it works while others are meh! It's just plasma, right? Well, we know that it helps with blood clots but also has been shown to promote faster wound healing. Laser is often used as a drug delivery method to help bypass the skin barrier.
Interestingly enough, I saw a paper noting how cannula subcision is better than nokor:
23 minutes ago, Raster said:Interestingly enough, I saw a paper noting how cannula subcision is better than nokor:
hmmm i wonder how the blunt cannula does more cutting through fibrous bands though then a mini scalpel.
1 hour ago, Raster said:Interestingly enough, I saw a paper noting how cannula subcision is better than nokor:
Interesting. Thx for sharing. Here's the full article if anyone's interested.
I agree with Obi Wan for the most part but there are some things you need to be aware of that are not obvious here.
1) Good luck finding blunt cannula subcision, ... hell it's hard enough to find subcision by very few Drs who do it. Perhaps everyone should fly to Dr Lim.
2) Were using semantics here and a silly study. Sirius every time you tell someone to do Sculptra, ... guess how they inject it. With a cannula. Hence "cannula subcision." Or even HA filler can be injected with a cannula. Field subcision is filling the face with a cannula.
3) If you have tethered scars no amount of cannula subcision will work.
4) I have seen some really shitty filler jobs for scars with a cannula. When the cannula avoids blood vesels do you think it magically finds fibers of scars. No I guess the doctors can just poke around for hours unless they have some clairvoyant skills. Half the people on here complain the doctor missed spots with sub, now have them put a blindfold on and wallah poking around for fun.
5) Hasn't the OP already been doing Infini RF with PRP and wants to do "more" of them followed by resurfacing at the end with Erbium. Confused by this part with order is backwards.
6) I don't think many doctors use the term cannular subcision. The more common phrase is prp with cannula, filed subcision (which means stretching out the skin to hide scars), or filling with a cannula. Most doctors use a cannula to do wide volumization throughout the cheek sub to pinpoint individual scars. Different substances can be done (prp, saline, filler, sculptra, stem calls, fat).
7) 3 months between treatments is 12 weeks. Sure he ca complete it in a year if he has the down time, money, and doctor readily available. Most take 2-3 years to treat and that's ok.
To recap: Few Doctors do "cannular subcision," lots of doctors do cannula filling, One has to do sub if they are doing cannular subcision as well (they work in different ways). Even harder to find extremely rare specialists. If they mess up their cannular subcision with no sub it can really be bad, luck of the draw. They will probably charge you as much for PRP + Cannula field subcision as getting a filler.
The pictures in the study of what was it only 30 something participants (extremely small selection) look swollen - yellow edema, and stretched out with over volumization (plumping of the cheeks).
BA
[Edited image out]
7 hours ago, beautifulambition said:5) Hasn't the OP already been doing Infini RF with PRP and wants to do "more" of them followed by resurfacing at the end with Erbium. Confused by this part with order is backwards.
Wait, BA why are you confused by this, i thought you said getting a subcision with filler and then "knocking out'' a few infini tx was a good idea then evaluating and perhaps getting a sciton pro fractional at the end of the year.
Also how long after my infinite rf tx should i wait to get a submission w filler? My infini tx was march 30, and plan to get the submission with filler mid may.
Obi wan is saying for your sub... do subwith Rullan but also have him to do "saline or PRP throughout the area with a cannula," They call this subcision, but I do not, just difference in terminology (filling throughout the cheek, fanning, filling with a cannula). Rullan can do this field sub for you. Everything else is the same. We discussed 3 months apart, ... doing more Infini sessions after, and finalizing with a peel for texture.
3 hours ago, beautifulambition said:@Amp2695Obi wan is saying for your sub... do both: Nokor with Rullan but also have him to do "saline or PRP throughout the area with a cannula," They call this subcision, but I do not, just difference in terminology (filling throughout the cheek, fanning, filling with a cannula). Rullan can do this field sub for you w/ your Nokor. Everything else is the same. We discussed 3 months apart, ... doing more Infini sessions after, and finalizing with a peel for texture.
ok thanks i know I'm annoying with this plan structure but I'm trying to schedule my derms out since they are busy ok BA how about this: (keep in mind my latest infini was march 30)
Final (hopefully) Plan:
May 30th: Subcision w filler
Aug 1st: Infini #3 w prp
Mid september: VI PEEL (I Have a groupon thats why i threw it in there)
October 15ish: Infini #4 w prp.
At thus point i will see where i am at and if not happy will consider Sciton erbium.
oh yea and i guess micro needling with 0.25 at home in between tx.
The reason i space things out 2.5 months out is bc when i ask weiner or lim this same qs they say its ok to wait a month, so I'm trying to find a middle ground.
BA: is this a much better plan?
@Amp2695The plan is your plan 😉 I am trying to empower you. If you want to do them every day that is cool - and your decision right, since your getting treated. Both Obi and I said 3 months. Some people don't have the time between for 3 months or get pushy Drs who want everything in mega sessions.
Continue with your plan. Have your prp filled with a cannula throughout the areas, I have seen the same results also with sculptra, fat, saline. Collagen stimulation and spacer.
For filling acne scars, I believe that you need precision and you can only get that with a fine needle. Cannulas really are for widespread filling, not microinjections directly into indentations. Cannulas are used mainly for filling in highly risky areas like the tear troughs to avoid piercing and injecting directly into an artery, which would be catastrophic
For filling acne scars, you are mainly working in areas that are not danger zones like the cheeks.
addit- agree that for some scars, fibrotic and tethered (subdermal fibrosis), cannular would bend- even 21 G or 18 G, hence Nokor 18G for these scar types. Impossible to assess sub dermal fibrosis unless one is the treating specialist. So, bottom line is that your dermatologist will come up with a plan that he or she is comfortable at doing, - many roads to the same destination. You do not want too much bleeding with any procedure, as this can lead to lumps - haematomas or seromas. Some resolve, some do not and will need intervention. Your specialist can usually tell during the procedure how much bleeding there is, and they should guide you accordingly. Agree for very fine work, needle is great- especially around the temples. Fine needle injections andprecision are good. Cannula for wide areas that are textural scars.
Mini update:
Its been 7 weeks since my first batch of tx which were the intracel + tca cross + prp
ill post pics in a few weeks, just had a question.
So the tca cross spots are still red, i know since i have ethnic skin the redness can last a long time 3-5 months (according to davinlim) but quansaid his lasted 8 months and he was light skinned ( i know i shouldn't compare my skin to his i know i know) I would say the redness has faded maybe 25% but the redness is making it really hard to evaluate the effectiveness of the actual cross on the ice picks. At what point do i consider getting Vbeam for the redness? After say 6 months and the redness is not fading???
thanks guys.
On 4/8/2018 at 4:02 PM, beautifulambition said:@Amp2695The plan is your plan 😉 I am trying to empower you. If you want to do them every day that is cool - and your decision right, since your getting treated. Both Obi and I said 3 months. Some people don't have the time between for 3 months or get pushy Drs who want everything in mega sessions.Continue with your plan. Have your prp filled with a cannula throughout the areas, I have seen the same results also with sculptra, fat, saline. Collagen stimulation and spacer.
Aside 😉 I wonder how many doctors just do normal injections for these textural cases instead of cannula filling, it's cheaper that's for sure, cannulas take more skill... I know Novick/Rullan/Emil/Lim do Cannula if asked, something for me to ponder. Subcision is the act of making a pocket for various substaces. I think the shift here is Obi sandardizing advice or treatment. Not having nokor for these supper shallow textural scar cases (which we normally don't recommend - some posters here get them done anyways) unless they have deeper pits and this is more appropriate (many have mixed scarring and need both treatments filling with a cannula and nokor sub to the pits). We have already covered this with filler using a cannula throughout the area (filling). But it is good we standardize this advice (if only Drs listened).
For textural cases they should be filling anyways with a cannula, can you imagine that many scars doingstandardized injections, it would be on the wrong plane vertical vs horizontal.
BA
Mini update:
Its been 7 weeks since my first batch of tx which were the intracel + tca cross + prp
ill post pics in a few weeks, just had a question.
So the tca cross spots are still red, i know since i have ethnic skin the redness can last a long time 3-5 months (according to davinlim) but quansaid his lasted 8 months and he was light skinned ( i know i shouldn't compare my skin to his i know i know) I would say the redness has faded maybe 25% but the redness is making it really hard to evaluate the effectiveness of the actual cross on the ice picks. At what point do i consider getting Vbeam for the redness? After say 6 months and the redness is not fading???
thanks guys.
Do you plan on more tca cross? If so, then it's pointless to get Vbeam if you're going to do another procedure that makes you red again. In the interest of spending money wisely, you should probably save the vbeam for the last stages of your treatment, or if you know you will be taking a long break from treatment. At $200-500 per session, Vbeam is not cheap.
@Amp2695This is common. Completely normal. As you state you have ethnic skin. Did you prep, with hydroquinone and retin a or tretinorin prior to treatment for 3 weeks with a one week break. You must continue this once the scabs fall off from cross. We are inducing a raised wound with cross which raises the deep icepicks. Most men in this position just buy some tinted moisturizer or some dermablend concealer and spot treat as they are red for several months. Of course you don't vascular laser or ipl till you finish treatment unless it bugs you and then some do it progressively
Emu oil is healing as well.
BA