Subcision

Nokor -scapula

Windscreen - Individually treat scars, more limited range of treating adjacent scars, not as effective to break fiberous bands of scar tissue - "try to" use manual force to windscreen or windshield wiper the needle back and forth, common thing many doctors do when doing your basic filler job (they don't consider it subcision), lots of doctors / nurses do this. Not aggressive.

Blunt Cannula - On the horizontal plane from one point of entry for massive amounts of textural shallow scars, few Doctors I know call it this and instead call it using a cannula to fill with (filler, fat, saline, prp) which acts as as spacer. The needle is blunt thus avoiding veins and arteries. Not a good method for deep pits. The fewest number of doctors do this, though you can get many to do filler with a cannula throughout the cheek. Poking at the invisible to try to not miss tethers.

Thanks BA! So I must have had the blunt cannula as it had the filler. It has been 2 weeks since my first sub and things look good (i hope it is not just swelling though). The needle warped as my scars were very tethered Lim said. But the next time I go, he wants to do the same...then build up to the Nokor.

I honestly expect him to go into each scar with the nokor and then use filler. I did not expect a windscreen wiper thing with filler. But I'm not complaining. Skin so far looks good!

I've wondered about this too - in the blunt cannula method, how would the doctor know where to place filler, considering (1) they've created a pocket across a large area and (2) microswelling likely starts quickly?

I know they'd probably mark the scars before hand, but even so how will filler stay in the right place if there is a fanning motion being used to break tethers and there is new space over a large area?

@jaspa0411 - would love to hear more about your experience. Best of luck.

5 hours ago, NeoFight said:

I've wondered about this too - in the blunt cannula method, how would the doctor know where to place filler, considering (1) they've created a pocket across a large area and (2) microswelling likely starts quickly?

You usually fill as you subcise the scar. Of course, you mark the areas to be subcised beforehand.However, unlike NOKOR, swelling is very minimal with cannula.

But as @beautifulambitionmentioned, cannula defeats the whole purpose of subcision. Subcision is usually required for those with severe scars, which are likely tethered. But without the use of NOKOR, it would be quite a challenge to cut the scar fibers, especially the thick ones, by using only the cannula.

10 hours ago, Jaspa0411 said:

So I must have had the blunt cannula as it had the filler. It has been 2 weeks since my first sub and things look good (i hope it is not just swelling though). The needle warped as my scars were very tethered Lim said.

FYI: NOKOR fits Luer lock, which means you can inject dermal fillers while subcising with the NOKOR. There's no need for cannula filling after NOKOR. Lim, as far as I can tell from all his videos, does use the NOKOR attached to a filler syringe.

6 hours ago, NeoFight said:

I know they'd probably mark the scars before hand, but even so how will filler stay in the right place if there is a fanning motion being used to break tethers and there is new space over a large area?

First, there are two subcision techniques: fanning and lancing. The first one involves the windshield-wiper technique where the blade is moved horizontally from left to right, and vice versa. The second is a vertical method where you poke in and out.

Can facial fillers migrate? Yes, but very unlikely. Remember, the space carved out from subcision will be filled with blood (yeah, pretty sticky stuff). Also the viscosity of the filler is quite thick. Unless you add pressure, like sleeping on one side of the face, migration is not very common.

Keep us posted with results. Im curious as to how your journey went with Lim. At two weeks all the swelling would have gone down, so if you are seeing results thats great. What is the treatment plan? When he did the procedure did you feel the scars snap when the needle thingy bent? Super curious to know.

@obiwan, @NeoFight 
Thanks all for the feedback, but it has made me even more confused about what I had (at a guess I would say it was a straight filler via blunt needle).  Lim was very fast.  I didn't have any numbing cream and before I knew it he was using the needle and fanning it about. 

Unfortunately he was talking too much and I didn't hear any scars snap,  I don't think I felt any scars snap either!  I was very much hoping to in any case!

The only aftercare was a tube of QV cream and the 50+ sunscreen.  

When I wrote my ditty above I was pretty happy with the results, but I'm in my third week.  Swelling has gone down somewhat and I noticed I am back to a smattering of scars.  I hope I'm not being too naive but will my skin improve?

...does it
a. swell
b.  Look slightly 'worn' (like tired leather)
c. improve a great deal or just improve a little?

We are all different at healing I understand but is there a universal process?  

Check out my photos.  I am back there in 2 weeks for round number 2 (this time he said he would be more aggressive).

THE TOP PHOTO IS BEFORE ANY SUBCISION - THE 2ND AND 3RD ARE AFTER (in the 3rd photo you can see slight line formations).

@Jaspa0411This is all normal. Some never hear any snapping, I never do.

Yes your skin has texture, subcision will not make your skin glass smooth, nor will it fix texture issues. It's a tool right and we have other treatments for texture which Lim I am sure will use after.

Your skin will heal after any procedure is done, it's in process. Remember 6 months after sub is when collagen should have grown and things should be finalized. It's progressive. The skin always swells and looks nice after any procedure is done. This is why you wait a few months after to see progress.

What I am seeing is you need volume and filler though cannula throughout the area (cheeks), Lim also uses PRP. IT's a roller coaster ride, be prepared for the ups and downs.

Do you use Differin, Retin A, Tretinorin for after care at night normally. This helps many also get a boost of skin renewal / collagen production.

BA

@beautifulambition
To be honest am scared to use anything. Would Finacea be helpful? Retin A is too strong.

I only use Soolantra for the rosacea as well as moisturiser.

I will try some Differin though if you recommend it.

And why is it always about 4 subs are recommended? Why can't it just be one or two? I am impatient as you can tell.

@Jaspa0411I don't blame you, you have sensitive skin. I would follow what Dr. Lim says regarding this. Ask him next time about this.

4 Subs are recommended, this of course you are right can change, for some they need many more and for other's less. It's how your body responds. But realize these scars happened (damaged your skin) over a long time, doctors can miss things, the body can respond slowly and need more correction. As I stated above the body heals very slowly over 6 months, so doing one won't give you the percentage you could get out of the treatment with repeated application. I know many people want quick treatments, ... and their body to heal quickly. Sometimes it's anxiety or a event coming up. I find it's best to do other things to distract yourself from worrying and looking in the mirror. Your doing the best you can do and doing something about it and that is what matter most, let you body heal and don't stress about the rest. It often looks worse before better, just how it is.

Impartial to this, from the first photo to the afters, definite improvement. Considering its your first session - its noticeable. Agree with BA - you do have textural changes, and you will benefit from other treatments. You do have multiple scar types, and you will need to be patient - treating your scars from all avenues namely addressing tethered scars, atrophic volume loss, and textural changes will give the best outcomes. Ask Lim if someone could video your procedure- I understand he's transparent and doesn't mind sharing his methods with others (that is if you don't mind). Really curious as to how he does things and will help others understand the complexities of subcsion methods.

@beautifulambition, @obiwanThanks for the encouragement I am genuinely grateful for all the insight that you both have.

I will most definately ask him if I can film it. It felt like all of less than 5 minutes and he was done.

I failed to mention he concentrated on the 'beard' part of my facial anatomy. Next time I want around the eyes/sideburns area. It is going to be interesting if he does a total different part of the face or works section by section.

He did say for me he would do it gentler then build up. I am a wuss so that was welcome news.

And BA was right the entry spots of the needle go in no time.

On 4/14/2018 at 7:38 AM, Jaspa0411 said:

@beautifulambition, @obiwanThanks for the encouragement I am genuinely grateful for all the insight that you both have.  

I will most definately ask him if I can film it.  It felt like all of less than 5 minutes and he was done.  

I failed to mention he concentrated on the 'beard' part of my facial anatomy.  Next time I want around the eyes/sideburns area.  It is going to be interesting if he does a total different part of the face or works section by section.  

He did say for me he would do it gentler then build up.  I am a wuss so that was welcome news.

And BA was right the entry spots of the needle go in no time.

 

Curious to hear how you™re doing