Hi There, ... this is very common with Canada. Because of the health care system, I have seen many travel to other countries for treatment after poor outcomes.

Regarding your acne, you can take low dose and treat (tane) or Mino does not have these issues. Please let whatever Dr who treats you know about your acne and the medications. You must stop 1 week before treatment and wait for healing. You can spot treat any zits with a topical.

You are right your scars are all surface textural issues, no major fat loss.

I think you need 3-4 sessions of cannular subcision. With PRP.

As you know lots of tca cross work needs to be done, some scars need paint on or spot peels with tca. Several sessions.

RF microneedling could help you, it's insulated so it works for your skin type. Or CO2 3-7% low density with the highest power. Especially on some of those boxcars. This is optional depending on the results from the cross and subcision.

A resurfacing textural procedure like erbium laser would benefit you once you improve the texture more.

Because of your skin type you need to be using retin-a/tretinorin/differin nightly and a konjac albutin cream. Your skin type is prone to hyperpigmentation with treatment. You can use a concealer like dermablend while you treat. Picosure is very effective for discoloration for your skintype.

If you wish you can start with your plan of tca cross first before sub as well.

Thank you very much for your reply. I really appreciate it  but I have more questions to ask ..

1) So is it okay to take very low dose Accutane and do the TCA Cross? (only if I stop taking Accutane 1 week prior to the treatment)

2) You said Mino "does not have these issues" what do you mean by this? what issues are you talking about?

3) What would be the best topicals to use for spot treating any zits?

4) You said I need to use retin-a/tretinorin/differin nightly and a konjac albutin cream. Is it okay to use these items while on taking low dose Accutane or Mino? I thought if you use Retin-A you become more sensitive so more chance to get sun burn or hyperpigmentation..

Since there are no good clinics in Canada, my plan is to aim for scar improvement (I sadly know I cannot be 100% fixed) with comparatively affordable price. I am planning on doing only TCA Cross (6 or more sessions) and deal with hyperpigmentation later on with Picosure or IPL Lasers. Do you think it is a good plan? How much improvement will I see approximately? 

Thank you very much for your help... I really really appreciate it..

Internet is the only source I can trust right now....

Sincerely 

-Danny.

7 hours ago, beautifulambition said:

Hi There, ... this is very common with Canada. Because of the health care system, I have seen many travel to other countries for treatment after poor outcomes.

Regarding your acne, you can take low dose and treat (tane) or Mino does not have these issues. Please let whatever Dr who treats you know about your acne and the medications. You must stop 1 week before treatment and wait for healing. You can spot treat any zits with a topical. 

You are right your scars are all surface textural issues, no major fat loss. 

I think you need 3-4 sessions of cannular subcision. With PRP.

As you know lots of tca cross work needs to be done, some scars need paint on or spot peels with tca. Several sessions.

RF microneedling could help you, it's insulated so it works for your skin type. Or CO2 3-7% low density with the highest power. Especially on some of those boxcars. This is optional depending on the results from the cross and subcision.

A resurfacing textural procedure like erbium laser would benefit you once you improve the texture more.

Because of your skin type you need to be using retin-a/tretinorin/differin nightly and a konjac albutin cream. Your skin type is prone to hyperpigmentation with treatment. You can use a concealer like dermablend while you treat. Picosure is very effective for discoloration for your skintype.

If you wish you can start with your plan of tca cross first before sub as well.
 

Thank you very much for your reply. I really appreciate it  but I have more questions to ask ..

1) So is it okay to take very low dose Accutane and do the TCA Cross? (only if I stop taking Accutane 1 week prior to the treatment)

2) You said Mino "does not have these issues" what do you mean by this? what issues are you talking about?

3) What would be the best topicals to use for spot treating any zits?

4) You said I need to use retin-a/tretinorin/differin nightly and a konjac albutin cream. Is it okay to use these items while on taking low dose Accutane or Mino? I thought if you use Retin-A you become more sensitive so more chance to get sun burn or hyperpigmentation..

Since there are no good clinics in Canada, my plan is to aim for scar improvement (I sadly know I cannot be 100% fixed) with comparatively affordable price. I am planning on doing only TCA Cross (6 or more sessions) and deal with hyperpigmentation later on with Picosure or IPL Lasers. Do you think it is a good plan? How much improvement will I see approximately? 


Thank you very much for your help... I really really appreciate it..

Internet is the only source I can trust right now....

Sincerely 

-Danny.

@Gimozzi
Thank you for your patience, I often help 20 severe acne scar cases a day, and try to get back to you the best I can.

Yes you can low dose Accutane and cross, again stop a week before treatment, let the Dr know about accutane before booking. Mino can be taken through treatment if you let the Dr know and they ar e comfortable. Mino has less side effects, look at drugs.com for side effects.

You can use any topical that works for you for sport treating zits, including Acne protocol sold here, or sulfur cream.

No retin-a/tretinorin is related to accutane, do not use both, one or the other. Konjac and Albutin can be used as it's for pigmentation, please check with your Dr concerning this prior to application. Hydroquinone is the medical equivalent.

Sun treatment is always necessary.

Sure do TCA Cross, RF microneedling and picosure / ipl if that works for your plan. Space out treatments - not to often, goto someone with experience in your skin type. I cannot give you a % if improvement, we all heal differently, see what works and does not. You will get improvement unless you heal poorly.

Treat as you have time and money, no rush.

Your very welcome.

On 7/27/2018 at 8:51 PM, beautifulambition said:

@Gimozzi
Thank you for your patience, I often help 20 severe acne scar cases a day, and try to get back to you the best I can.

Yes you can low dose Accutane and cross, again stop a week before treatment, let the Dr know about accutane before booking. Mino can be taken through treatment if you let the Dr know and they ar e comfortable. Mino has less side effects, look at drugs.com for side effects.

You can use any topical that works for you for sport treating zits, including Acne protocol sold here, or sulfur cream.

No retin-a/tretinorin is related to accutane, do not use both, one or the other. Konjac and Albutin can be used as it's for pigmentation, please check with your Dr concerning this prior to application. Hydroquinone is the medical equivalent.

Sun treatment is always necessary.

Sure do TCA Cross, RF microneedling and picosure / ipl if that works for your plan. Space out treatments - not to often, goto someone with experience in your skin type. I cannot give you a % if improvement, we all heal differently, see what works and does not. You will get improvement unless you heal poorly.

Treat as you have time and money, no rush.

Your very welcome.

Thank you very much for your reply again.

So 10-20mg/day or 10-20mg/2days would be good enough right?
I remember there was a general cumulative dosage for Accutane, which is about 120-150mg/kg.
If I take low dose Accutane, should I take it for more than a year? to reach the required cumulative dosage I must take it more than a year.. or.. is it okay to take extremely low dose Accutane forever?

Is taking low dose Accutane have less side effects than taking normal dosage?
Is it okay to apply topical for spot treatment while on Accutane?
Do I still have to take monthly blood test even If i take very low dose Accutane?
Which one do you think is more effective between low dose Accutane and Retin-A?

Thank you very much again I really really appreciate it.

I will be waiting for your response patiently :>

Hope you have a great day.

It's up to your practitioner to monitor you as there can be liver damage. They must do the blood tests. I don't know that I would consider Accutane as a long term treatment with it's side effects. Yes your low dose but I don't see major break outs on your face in the pic. It's typically for emergencies, and huge cystic acne.

Regardless discuss with your doctor.

Yes that's low dose. You can stop and start any time, it's not a every day thing.

This is not a forever solution. You need to get to the root of why this is happening. Is it fungal acne, folliculits, gut issues, hormone issues, other health concerns, food (sugars - grains-dairy) or environmental allergies,sensitivities, other medications, live or kidneys.

Retin A can be effective, not overly harsh, topical, a forum of vit a like tane. Give that a try first, see if it works.

Have you tried washes Salicylic or Acne's (store) Zit creams, etc...

10 hours ago, beautifulambition said:

It's up to your practitioner to monitor you as there can be liver damage. They must do the blood tests. I don't know that I would consider Accutane as a long term treatment with it's side effects. Yes your low dose but I don't see major break outs on your face in the pic. It's typically for emergencies, and huge cystic acne.

Regardless discuss with your doctor.

Yes that's low dose. You can stop and start any time, it's not a every day thing.

This is not a forever solution. You need to get to the root of why this is happening. Is it fungal acne, folliculits, gut issues, hormone issues, other health concerns, food (sugars - grains-dairy) or environmental allergies,  sensitivities, other medications, live or kidneys. 

Retin A can be effective, not overly harsh, topical, a forum of vit a like tane.  Give that a try first, see if it works.

Have you tried washes Salicylic or Acne's (store) Zit creams, etc... 

 

Yeah... my acnes are not severe anymore (maybe because I finished one normal Accutane course). However, I still have few cystic acnes on my face and they are staying on my face over a month now. Unfortunately, I picked them... and I know they will now be new scars... forever vicious cycle... 

I totally agree that I need to get to the root of my acnes.. but its really hard.. I think it is why I tend to lean on other products like Accutane, retin-A.. If I could resolve my acne problem naturally.. it would be the best option actually.

I am also thinking about trying Acne.org regimen.. other than trying Accutane/Retin-A since there are certainly less side effects.. What do you think about it? Is it possible to do Cross while on this regimen? 

If I stick to this regimen, will it be enough to deal with my moderate and persistent acne? would other products / topical be needed with Acne.org regimen? or will it be enough?
I read some of the reviews on acne.org regimen reviews, and some people were saying their ance got worse.. should I just stick with my regimen (I use cetapill cleanser/moisturizer) and apply spot treatment product?

One last question is, my cystic acnes they become like fester (they turn whitish? fester? really easy to pick), then is it okay to pick them? or should I not pick any acne in any circumstances?

Thank you very much, I will be waiting patiently again :3

Hope you have a great day

@Gimozzi
Worth a try tretinorin/retin-a and Acne protocol. Your spot treat the zits. Especially if being treated elsewhere.

I don't know what country you live in but it might be worth looking into a Chinese Herbalist, Naturapathic Dr, Functional Medicine, (these drs look at you as a whole - not a symptom to be treated) etc... To get at the root cause of the acne. Traditional medicine won't do this. It's most likely the gut, try some probiotics, try a elimination diet (dairy/cheese/sugar/overly processed) add back in things that don't cause you issue, or it could be a allergy to a product your using, .... use water and start slowly building back to products that are sensitive. Often it can be food, or environmental allergens. IF you had fungal acne, even "Cetapill" which is for sensitive skin could cause you to react, try to cut back on it and see how you do (adding things that cause you no issue slowly).

You do not pick, this spreads bacteria and causes deeper infection - scarring. This is why we spot treat with items that dry out the spot.

Perhaps"try" charcoal facial masks.

Hydropeels are very cheap and effective to clean out your pores, give it a try.

4 hours ago, beautifulambition said:

@Gimozzi 
Worth a try tretinorin/retin-a and Acne protocol. Your spot treat the zits. Especially if being treated elsewhere. 

I don't know what country you live in but it might be worth looking into a Chinese Herbalist, Naturapathic Dr, Functional Medicine, (these drs look at you as a whole - not a symptom to be treated) etc... To get at the root cause of the acne. Traditional medicine won't do this. It's most likely the gut, try some probiotics, try a elimination diet (dairy/cheese/sugar/overly processed) add back in things that don't cause you issue, or it could be a allergy to a product your using, .... use water and start slowly building back to products that are sensitive. Often it can be food, or environmental allergens. IF you had fungal acne, even "Cetapill" which is for sensitive skin could cause you to react, try to cut back on it and see how you do (adding things that cause you no issue slowly).

You do not pick, this spreads bacteria and causes deeper infection - scarring. This is why we spot treat with items that dry out the spot. 

Perhaps"try" charcoal facial masks.

Hydropeels are very cheap and effective to clean out your pores, give it a try.

I'm so lost.... this persistent cystic acne stayed on my face for about a month and I picked it... like few days ago.. and not it looks like this.. lol.. I put some duoderm bandage on it .. but.. I can already feel it that its going to be huge scar... hah
I am so indecisive these days.. I cant make my mind.. I think about my scars all day.. How I look... I was almost acne free but after I tried microneedling 2 months ago it started break out so badly...

Im so sorry for asking you so much questions.. but ... please understand me.....
and thank you for helping me... really..

What do you think about these combination treatments?
a ) Infini RF + Picosure Laser + TCA Cross 
b ) Duet RF + Scarlet RF +  Subcision

Im so lost.... I guess I should just start low dose Accutane.. again... probably with Benzagel Acne Gel I got from my friend for spot treatment.. and then TCA Cross...? maybe..? What do you think about Benzagel Acne Gel?

I live in Canada.. and there are no clinics I can trust.. these clinics who offered option a ) and b ).. I cant really trust them.. they dont seem like professional.. their methods are limited.. a ) doesnt  do subcision, b ) deosnt do TCA.. what would you pick between these two options for my scar types? 

I researched that most of the people think Infini RF is much better than other RF devices like duet, scarlet, intracel.. what do you think about these RF devices?

Is it okay to do either a ) or b ) while on Accutane?

what do you think about doing many Fractora sessions?

Thank you very much.... again..

God bless you.

Your Welcome!

Yes please get to the bottom of the acne (under control) before treatment. That could be a nightmare with spreading bacteria.

TCA Cross + Infini RF + + Picosure Laser (laser last)

Machine does not matter. IT's the insulated needles that do (rf needling), some take more treatments.

See what your derm says: " low dose Accutane.. again... probably with Benzagel Acne Gel I got from my friend for spot treatment.. and then TCA Cross...? maybe..? What do you think about Benzagel Acne Gel?"

Sure try to spot treat acne and get it under control before treatments. Works for some and not for others. Try a few things.

You need tca cross and paint on (called also spot treating) tca method (3x paint a lower % inside of scar pit only) to your scars, lots of icepicks and boxcars. This will take several sessions.

""Is it okay to do either a ) or b ) while on Accutane? "" -- Please check with your Dr - some won't treat at all. Just get the acne under control. Yes you can treat if they agree to Low Dose. You want to stop at least a week before.

""what do you think about doing many Fractora sessions?"" - Not a fan, seen incredibly bad results.

Many from Canada fly elsewhere for treatment, Ex. USA, Treat locally by dividing up treatments among various Drs and or searching for Drs, schools that teach dermatology, or Med Spa's, and doing some of the treatment at home using the faq acid peel guide mega post.

BA 😉

9 hours ago, beautifulambition said:

Your Welcome!

Yes please get to the bottom of the acne (under control) before treatment. That could be a nightmare with spreading bacteria.

TCA Cross + Infini RF + + Picosure Laser (laser last)

Machine does not matter. IT's the insulated needles that do (rf needling), some take more treatments.

See what your derm says: " low dose Accutane.. again... probably with Benzagel Acne Gel I got from my friend for spot treatment.. and then TCA Cross...? maybe..? What do you think about Benzagel Acne Gel?"

Sure try to spot treat acne and get it under control before treatments. Works for some and not for others. Try a few things.

You need tca cross and paint on (called also spot treating) tca method (3x paint a lower % inside of scar pit only) to your scars, lots of icepicks and boxcars. This will take several sessions.

""Is it okay to do either a ) or b ) while on Accutane? "" -- Please check with your Dr - some won't treat at all. Just get the acne under control. Yes you can treat if they agree to Low Dose. You want to stop at least a week before.

""what do you think about doing many Fractora sessions?"" - Not a fan, seen incredibly bad results.

Many from Canada fly elsewhere for treatment, Ex. USA, Treat locally by dividing up treatments among various Drs and or searching for Drs, schools that teach dermatology, or Med Spa's, and doing some of the treatment at home using the faq acid peel guide mega post.

BA 😉

Thanks again for replying : )

What do you mean by paint on TCA method? and what do you mean by 3x paint a lower %?
Did you mean for small Ice pick scars I should use 100% and for big boxcar scars I should use lower % to fill up pitted boxcar scars? what % should be ideal? 3x mean by I need to do 3 sessions?

I also heard for TCA Cross, ifthe scars are close by and treated with 100% TCA, there are high chances of these scars being joined? Could the scars be bigger and larger by any chance?

You said I am very prone to hyperpigmentation. Do you think it is better for me to wait out til summer is over to start treating my scars with TCA Cross?

What do you think about Laser Resurfacing? ablative? non-ablative? unfortunately there is no clinic doing the Full ablative laser I think. What do you think about Fractionated C02 Laser(such as Mixto or Fraxel Repair C02)? Doing maybe 3 sessions of fractoinated C02 would help?

What do you think about Lux 1540 device? (compared to Fractionated C02)

What about ProFractional Laser by Sciton? (compared to above 2 devices)

and yes..... that Dr who performed microneedling spread bacteria over my face I guess.. he said it was totally fine doing the microneedilng on active acne.. total nightmare..

I am so sorry for asking so much questions..

Thank you again.. Hope you a wonderful day!

Thank you very much for your advice. However, unfortunately, in my country, Canada, most of the clinics have very limited devices/methods/techniques.. I just can feel it right away by doing the consultation with doctors here. I just do not feel comfortable doing so much expensive treatments here... maybe if I was rich enough.. I guess I will most likely visit other great dermatologist like Dr. Lim if I was rich haha...

I just do not think scar treatment system is not developed very well in my country. I wish there is at least one dermatologist who has the skills you mentioned.. who I can really trust.. who knows what he/she is doing professionally. I just hate myself .. my life.. so much haha..

The methods you recommended, there is no TCA Cross. Does it mean you do not consider TCA Cross as not a proper scar revision treatment for my type of scar?

Thank you very much for your advice again

Have a great day!

I just got reply back from the Doctor who performs TCA (there are only 2 doctors who performs TCA in Canada) and she said I will respond to subcision better.. so she told me to go to different clinic.. I think doctors here kinda don't want to treat my scars as it is extremely severe.. maybe I should research more and find some more clinics.

Thank you very much for cheering me up.

Have a great day bro!

Responded by PM