I think you have it. Sub and filler.

No one knows how long filler will last for you, some it's more than a year +. others it's short as they grunt alot and goto the gym. It's variable. You will know after first sub.

Do you subprior to rf needling. Then every 3 months do rf needling till you run out (filler), top up and sub again (a few times), and finish when things are more level with the skin - deep peel or erbium resurfacing.

The spacing of the first appointment & rf needling is not as important as subsequent as your just starting.

@beautifulambition Awesome thank you for the input. From what I hear cannula is safer on the temples? I have a few (maybe 2 scars) that look like they are maybe 1/3rd - 1/2 of an inch away from the artery. Does the cannula make it safer in this region? Also can you get good results with a cannula?

I'll plan on getting the subcision then starting the RF probably 3 months after. If all goes well it will look something like this.

month 1 - Subcision + filler with novick
month 4 - RF microneedling
month 7 - RF microneedling
month 10 - RF microneedling
month 12-14 meet with novick and continue subcision as we see fit

Appreciate it a lot

2 hours ago, thepwhisp said:

From what I hear cannula is safer on the temples? I have a few (maybe 2 scars) that look like they are maybe 1/3rd - 1/2 of an inch away from the artery. Does the cannula make it safer in this region? Also can you get good results with a cannula?

Here's a little twist, though. When it comes to injecting fillers, cannula is usually preferred over a needle in order to avoid bruising. That's understandable. But, is that so beneficial for subcision patients? In case of subcision, bruising is actually good because the fluid collection will stimulate fibroblast, which in turn will lead to the formation of collagen.

Anyway, cannula is indeed more safer than nokor when it comes to the temples. But will it give better results? Hard to say. Temple has always been a hard area to treat.

@thepwhispNovick. I think you will end up with 3-4sub sessions with Novick but I could be wrong, ... just form what I hear that's how he does it for the first time patient. He's a expert.

BA

@beautifulambition- Awesome thank you very much for the help. What do you think is a realistic percentage of improvement with something like 2 sub + filler and 3-4 Infini treatments? I know it's tough to judge but do you think something like 50-80% is possible? It's looking like this will probably cost me about 6-8 grand over the course of a year or two. Money isn't a huge issue as long as good results are feasible.

@Sirius Lee Thank you. I've been calling Novick's office but no answer yet. I'll keep trying until I get them on the phone. What percent do you think is obtainable from say 2 subcision + filler and 3-4 infini RF treatments? If I could get 50-70% I would be ecstatic.

1 hour ago, thepwhisp said:

@Sirius Lee  Thank you.  I've been calling Novick's office but no answer yet.  I'll keep trying until I get them on the phone.  What percent do you think is obtainable from say 2 subcision + filler and 3-4 infini RF treatments?  If I could get 50-70% I would be ecstatic. 

Sorry, but I don't recall your scars. It really depends how sever they are. I would like to emphasize, however, that you need to go slow. This is not only good for your pocketbook, but it will also spare you from all the psychological/emotional baggage.

Also keep in mind that subcision is more effective on severe pits, whereas RF devices are more suitable for mild to medium scars. For example,1 being very mild and 10 being very severe, subcision is for scars 5 and above; Infini is for 5 and below. I have yet to see anyone with severe scars getting much out of Infini. It's best to get the overall pits filled in as much as possible to about the same level (again, less than 5) before making the switch to Infini.

Regarding the overall improvement, two words: AIM LOW. It would be better for your sanity.  

@Sirius Lee  I posted on real self a while ago here's the link  https://www.realself.com/question/massachusetts-ma-acne-scar-advice-neededpictures-included# .  Most of the red is gone and i'm working on not getting any more acne atm.

I think the photos on realself have better lighting if you wanna check those out. 

Do you think RF will work or should I start with subcision and see how they are afterwards?

Here are more or less the scars I'm working with.  Would love to hear your thoughts.  

1 hour ago, Sirius Lee said:

For example,1 being very mild and 10 being very severe, subcision is for scars 5 and above; Infini is for 5 and below. I have yet to see anyone with severe scars getting much out of Infini.

This is really fascinating, but isn't this too simplistic? Subcision doesn't work well on all atrophic scars? I thought it was used when scars are tethered, which not all severe scarring will have this.

1 hour ago, ScarRight said:

This is really fascinating, but isn't this too simplistic? Subcision doesn't work well on all atrophic scars? I thought it was used when scars are tethered, which not all severe scarring will have this.

By "too simplistic", I'm not sure if you're referring to the number grading or my account of subcision not being effective for shallow scars. Nevertheless, allow me to start off by saying that using terms like "mild", "moderate" or "severe" to classify scars can be downright ambiguous. It would be easier to visualize using numbers to grade the scars, similar to the pain scale.

In regards to tethered atrophic scars, well, most deep scars are by nature tethered. The scar fiber is, for the most part, held down to the dermis, or even the muscle. That is why there is a deep indentation in the first place. Once you subcise the fiber in question, the scar will more often than not lift up. On the other hand, shallow scars are not tethered. Instead, what you see is a collagen depletion, eg. pit. Subcision will not be helpful here. Personally, I don't ever recall hearing anyone with mild pits getting a huge benefit from subcision.

2 hours ago, thepwhisp said:

@Sirius Lee I posted on real self a while ago here's the link https://www.realself.com/question/massachusetts-ma-acne-scar-advice-neededpictures-included# . Most of the red is gone and i'm working on not getting any more acne atm.

I think the photos on realself have better lighting if you wanna check those out.

Do you think RF will work or should I start with subcision and see how they are afterwards?

Here are more or less the scars I'm working with. Would love to hear your thoughts.

Maybe I'm not seeing it correctly, but your scars (in terms of depth) don't look too bad in these pics. But some of the wider scars on your cheek will need fillers. As such, go with subcision + filler, then evaluate for the next 3 months. Most of the heavy lifting will come from the filler, so take a lot of pictures and make comparison. If no significant improvement is seen, even with filler, after 3 months, I would switch over to Infini.