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Had a follow up consultation yesterday. Prof did not see the textural issues I seeand said that he did not seeanything similar with otherpatients before....no tca worsening no after dermapen problems...he saw massive improvement...
elevation is there so I decided to repeat prp/sub/dermapen scars only/pdo forehead and cheeks. No dermapen for the places where I see texture change and no cross for now. Prof said the main thing with cross to wipe it quickly after the frosting appears. With 90% is takes seconds, with lower % 5 min to wait. That he does 90% only..was friendly and did not get annoyed when I repeatedquestions, no pushing. I read here review that he got angry, well it is not my experience and I hear how calm he talks to other people.
The procedure is today, will update.
Chu now practices at :Skinmedico, Chiswick, London, UK.
I h@ve been reading not good reviews on RealSelf about dermapen. About the damage of the texture, pores, new wrinkles and scars. There a lot of thesereviews. When I tried to tell Chu about it, he just said to stop reading crap in internet...that hehad invented and started using Dermaroller and then dermapen in the UK andin his experience it is only improvement from dermapen.. so all these people are imagining the damage?We all have different healing properties...
I felt like dermapen was done very hard pulling the skin under the eyes, so I asked about it, hesaid it was not hard and then some docs do it 3 mm deep to the bone...
also I asked what was the size of Nokor needle which he said was 18,5 gauge needle....I just wanted to know if the certain size is used for Sub or it is different size for diff scars.. but I did not continue the dialog feeling that he did not like thequestion... I always try to be careful and polite with the questions but it seems like patients asking a lot of questions are annoying..
So I see the textural issues, he does not, he sees the massive improvement while I see some elevation only of the scars on the cheeks. It is very sad to understand that we do not see the same outcome. I believe that Sub should help and that pdo will lift the sagging cheeks a bit. Dermapen, tca crosare under the question.
@SibelI am sorry you are getting misinformation from Chu. I don't think it's intentional. I think he is the type of Dr who is stuck in his ways. He is great for manual treatments but sometimes in cases like yours he offers limited treatments. Recent data says DO NO microneedle if your sensitive or a poor healer, the Dr will only make more scars. Dermapen has bad reviews as it's not designed that well compared to derminator and the Drs way over promise results . Chu does not want to hear the reviews, as that is his business and if 80% get results he will continue on doing the same thing. He has prestige so he does not want to hear from you or me anything else except the treatments he performs, Dr's are headstrong as you know. At least he gives people manual methods, and they can go elsewhere if they need more. The size of the needle does not matter, Nokor is a Nokor, ... the same for all scars. I would never use it on you as your just to sensitive, hence why I have said a few times to go see Emil in Denmark who now offers cannular sub and does fillers, like Sculptra which could be great for you if injected deeply and dilute,... unlike Chu's prp/prf and magically everything will be better. I tell most people to get filler elsewhere after swelling has gone down.That is pretty silly 3mm microneedling will cause extreme damage(Again he does not want to hear the new studies - but he does that...as he does not like to be challenged).
Textural issues, go try some skin boosters, or Meso HA in a med spa. They don't last long though. For a deeper filling Emil or another clinic for fillers, perhaps you will do both. IF you skin is supper sensitive perhaps none of this is appropriate.
Sure continue on with the sub and pdo threads if you wish, sounds good. At least the pdo will give you some lift and fill. A face lift could help with age related laxity and to hide the scars a bit, but PDO is fine if your happy or threads. Your probably >10% of the total cases he gets who are non res-ponders.
BA I read ur answer to floridagirl and u said that if Sub was done in the past with no fillers there wont be any result. So then it does not matter how many Sub u did, if no filler then no result? And again famous recommended here Chu said No to fillers. Also he says there is no rethetheting, when it is a cut it is a cut, u do not need a spacer. Prp is not a spacer only for healing. So absolutely diff points of view.
I tried filler and fat- all dissolved in 2-4 months. Lasers and dermapen damage the texture, no improvement for the scars. What are we left with?
@SibelI posted the below to Umar, hope you don't mind if I place it here as it applies to your case.
QuoteUmar99I choose not to battle Chu (Some say:tomayto, tomahto). He is prestigious in his 10 year as a professor and dermatologist. If he chooses to ignore a scar type, call it something different, or says you mainly have XYZ scar type so be it. I feel it's unproductive to challenge him. Let him do his package for scars. He has done this treatment for years. IF you need further treatment after several you can go elsewhere for energy devices and or filler. He is good at what he does, ... the basics of scar work -"manually" at a affordable price without much fuss. At least he does not blast you with a laser when you walk in the door. To him your icepicks are not a major concern which I agree. I have to be very through when I give a recommendation. 90% of people only do a treatment or a few and call it good if they see some good results compared to the before scars. One of course can spend a long time on a detailed plan. Easy baby steps, stay with Chu and then move onto someone else if you need more.
That is a bit strange on stop reading that crap, ... you know your skin better than anyone. If you heal poorly or are sensitive why do something that will cause harm to yourself. Your like 1% to him of patients with side effects, ... why re-invent the wheel. Just know what you want when you goto him and don't get what you don't. 3mm microneedling can cause fat loss and damage to skin, we have the photos and white paper, ... just because you can do something - should you... you know. New data says .75mm to 1.5mm is all that is needed with needling. He does not need the data though as he has a business based around his very long and successful esteem andtreatment buffet. I do agree with him, ... sometimes we read a lot of crap on the internet. There are people selling all sorts of things and saying things for alt reasons. He is selling his package, ... as long as you agree on the terms of doing this -that is great.
If cannula is so bad why does Lim get more scar cases than anyone else in the world, and that is what he uses now, Rullan, Weiner. They are all top Dr's. It takes effort. Nokor just cuts, but in cases like yours you need that extra protection of not making multiple wounds it seems. Cannula takes skill, Nokor just cuts anything in it's way. IF the person is very fibrotic and tied down I agree Nokor. If they are a poor healer, cannula. In your case you have age related complications of premature aging / fat loss from scars. Hence why a face lift was also mentioned. We are dealing with multiple things, not just a scar type.
Continue on with Chu, ... if you need to look elsewhere I Would look for a plastic surgeon. At least it does not hurt to do some consults right.
Regarding 2 drs. We recommend 2 drs because they are highly esteemed and treat 99% of our Europe patients. Sure there are other Dr's. I have been though so many of bad Dr's in Europe and USA. There is a laser Dr on every corner for $$$$$$$. At least they are ethical and want to help right. IF you need more you can try a plastic. I don't want to confuse people with a hoge podge of so so derms, they are already on the FAQ recommendation list if they cannot find anyone else. Often people travel to see these Drs.
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Your making me work today ;-P 50+ emails of the most sever scarring. But I am trying to help... Ok here is a update on post 2.
I truly believe one needs filler to have any sucess at Subcision. I tell each and every person if they goto Chu, to go elsewhere for filler. I know he does not believe it but Lim does, Emil Does, Rullan Does, Weiner Does, etc... Please don't go battle him on this. He gave you PDO threads - even though he does not believe in fillers ;-P. You know this is filler and a lift right? Threads make a collagen replacement. I have filler used in most younger patients but for you pdo threads are fine.
4 months filler says you have major fat loss, need many mls of filler because of age - premature aging of acne scars. Most people get 6 months out of filler at least. If you mean it's not as plump as initially, ... this means you did not get enough mls of filler, thus you don't notice it. Sculptra last's much much longer, but I am afraid in your case with healing poorly and complications to use it. Perhaps PDO threads would be best to keep stocking up on these.PDO threads are for someone before they decide to go all the way with a face lift.
I have said this a million times, prp is for quicker healing, I never tell people to get this unless they want to heal quicker. I say filler. You don't have to stay with 1 Dr for all treatments. But he is doing PDO on you so your lucky. Most he won't do anything else except PRP, they go elsewhere. That is complete bullshit, read the thousands of people who say they re-tethered or it was never cut. He is old school, but he does good subcision, what can I say. Believe the lines and great treated or go elsewhere. It's not conducive for me to fight with his ""views."" If once they are cut they are cut, then please tell all the people who have been helpedon here and complain about how subcision did nothing for them and it re-attached, they must be divisional! Again why does he want to believe something that is new data when he has done this for 30 years, ... goto someone else gfor filler or get your pdo threads.Don't mention my name, or fight with him. Accept it and work with it or move to someone better "for you" ( he is a great Dr) ;-).
You are not like most cases on here. Very very rare. Your sensitive, a poor healer, and dealing with age - and premature aging due to scars. Any of these treatments in your case can make the skin worse. Many for a case like yours I tell them to see a plastic surgeon, this is way beyond acne scars. Everything has a risk. Please tell them how you healed from all these procedures, it adds complication to anything else. This is why I think perhaps down the road permanent fillers - or ongoing pdo threads till you do a face lift is best in your case.
I don't want to fight about Chu, he is a great tool to the suffers here, but no he is not a one stop fix it all solution.
It is what I said why to do Dermapen again if I see damage.. the answer was it could not be damage, never had it in my practice with other patients... and what do u do if u know u need the treatment and there are only several docs who could do it.... so yes I decided not to argue because I would leave then...I said no to dermapen in places where I see damage and no to cross...at leathe agreed with this...so he does his package where Sub is the main thing and that is it, either it works or it does not...I just hoped for a dialog with the Doc which unfortunately did not happen...
more and more I understand there is Nothing there to fix the scars. The severe damage was done with inflammations once, the dermal structure inside is damaged. It can not be healthy again. It is no way to regrow the healthy skin on the place of dead scar tissue..
@Sibelyou need to find a good therapist that works for YOU. I have seen several therapists that weren't for me then I found an excellent therapist and I have made a lot of progress, your scars can be improved but they won't ever be gone, that is sad reality. Treatments do work for scarring, so I don't know why you think nothing works, it is a matter of finding the right physician and treatment as well as multiple other factors. These things take time, listen to what BA has to say, he has helped thousands of people and is more knowledgable than my dermatologist on scarring! Subcision can be effective without filler, though of course there is a chance the scars will reteher after if you don't use a spacer, Chu is excellent at subcision but his views on filler are odd, but you can always go to any expert injector to get filler as soon as your swelling goes down.. that is what I am doing. There are hundreds of places in the UK that will do this for you, or use chinese cupping. You need to be patient, you aren't going to improve overnight, this is why you need therapy, so that you can find happiness whilst you are being treated, and I believe you have some body dysmorphic disorder that is making you see your scars 10x worse than everyone else.
Treatments can and do work, just look at the countless cases that have had their scarring improved on this forum, many treat over 3 years as BA said, you need to be patient. I have acne scars, I know the temptation to get everything done at once but that isn't going to work. You are older than most people on this forum so recovery may take longer for you than most, something to consider, in addition the 'lines' created by the derminator point to some underlying health issue.
But priority for you should be a therapist first, then addressing your scars. I know you think that therapy is pointless, I did too, but once you find a good therapist believe it or not, it works.
Well, just read Nina22 post..not only Novick...the same happened to me with Chu after 2d Subcision(
From the first day I was worried about the big scabs forming on the insertion places after Nokor.After 3 weeks!when the scabs fell off I got 2more new scars((( on my right cheek which was better cheek...the cut with Nokor was much bigger this time. At the 1st time it was only one cut much lowerand after 3 weeks it healed fine.Why this time 2insertion points areright in the middle of my cheek and on my cheekbone? Devastated..g
The left cheek has 4 marks, muchsmaller but still visible also on my cheekbone which was not the case at the 1st time. The bruses are gone and the swelness is almost gone, I do not see any improvement for the old scars and there are new scars. The lines from dermapen are still there( and the new outbreak(small red spots)on the left cheek with developing pigment under the eye..at the dermapened zones the skin is more dry and the outbreak has occurred on this places only.
I asked Chu to be careful because the skin was extremely sensitive several times, during the dermapen process I asked him not to pull the skin on the cheekbones under the eyes so much but he just said that other guys do it more with 3mm dermapen...
I feel pdo threads in my cheeks, was pain got the first 3-5 days, I can see a little bump where it ends. I do not see any lifting. The threads inserted in the forehead gave some elevation of the middle but the scars are the same..
I have big doubts that the 3dSub with Chu isneeded.
If anybody who did Sub could suggest smth for healing they used? Chu said Nothing just usual routine. Well my usual routine is aloe gel and tretinoin which is not appropriate for now.
Yes, it is some healing to do, but I can not understand why to choose the most visible places for Nokor and shy they are much bigger this time..
That all sounds very distressing, my sympathies to you. 
Maybe Chu is not the right doctor for you. If he is not listening to your concerns about dermapen then stop. You are paying him to help fix your skin, if you don't like the dermapen you really don't have to do it - especially if you think it's making the condition of your skin worse?
Perhaps because your skin is so delicate you should take a short break from treating it? This must be very frustrating for you.
There's always things like skin boosters?
17 minutes ago, Sibel said:Who is near Atlanta, GA, check out the DR.Griffin.
I am trying to heal the cuts from Nokor... using hydrogel burnshield with tea tree oil... seems helping....
I have been thinking more about the visits to Chu...he is limited in the procedures, he does not dolasers,fillers and does not like roaccutane....he is quite hardwith Dermapen particularyunder the eyes areasand not quite concerned about the place for a Nokorcut...hedoes not answer the post treatment emails...he denies possaside effects from the treatment...
Again about Nokor size, seems like it does not matter - Nokor is a Nokor... but I find info that for smaller scars the smaller needle gauge is used. Then itleaves no or tiny mark,the larger Nokor size could leave a permanent mark! So different sizes are used! Not just 18,5 size. Probably ifsmaller needle wouldbeused in the middle ofmy cheek I would not have such a big cut..but when u are lying on the table it is very hard to tell the Dr !who knows better anyway ! that please do not stick the needle right in the middle of the cheek, choose another place....
At the begging I thought to start from Sub only and did not feel like doingDermapen and Tca Cross because I already had negative response from these procedures.....but I trust the Docand it is what I got... the worsening of the texture(Chu did not agree and said it could not happen), the new scars fromNokor cut(no answer from Chu), the old scars are the same maybe softer(Chu said massive improvement which as we knowis not poss after one treatment). I wish I would doSub only. It is really really frustrating to have such an experience with one of the best Drs of dermatology, I thought I would have a long treatment plan with him, now I doubt I should again..
You are so right.He never responds on emails and he does really aggressive dermapen.I got new scars near the eye area after i healed from dermapen.I havent had any zits or scars there.I think he streched my skin too much and with aggresive dermapen he created new scars.His tca cross,if done right,can give good results.On my 2 treatments with him,only on my 2nd treatment did good tca session but not on all my scars.Although he is great doctor,he doesnt give much attention on each scar individually or on the things you say.I think he can do better than this.
On my 1st treatment(subcision,tca cross) with him my improvement was fantastic.On my 2nd treatment(subcision,tca cross,prp,dermapen) i saw almost zero results and new linear + tiny boxcar scars creating on the places he didt dermapen and streched the skin.So,he did more bad than good.I asked him about it and no response since then.Its really bad cause we dont make these treatments for free.We pay them and also,some of us travel abroad for these doctors.
Reading this thread I have a few comments- please do not find the statements insulting, as I am a third party observer.
1. In context of Chu, as BA has suggested he may not be the correct specialist for you. Prof got his title NOT for scar revision but for general dermatology and his work on histocytosis - he is well respected by his peers in Europe and overseas. Many Well known derms referpatients to him, and places trust that he will look after the majority of patients. He is not financially driven and practices old fashioned 'manual methods.' Some patients need more than just objective improvements. The saying 'acne scars are MORE than skin deep' certainly applies to you and most people on this forum. Having someone who understand what YOU see is more important than what they see. The flip side is that if you are concerned with certain scars there maybe other options that are not on Chu's menu. This does not mean he's a bad doctor, it just means he has exhausted HIS treatments in YOUR context.
2. Medicine as BA has eluded, is a probability game. This means that even the best specialist can get things wrong. In your case its not acknowledging that AI or adverse incidence from Dermapen can and do occur- just look at the 'Dermapen' section of real self to see that you are not alone. Every third post is one of 'dots', poor healing, idiosyncratic scars, pin holes and redness following this treatment. Dermapen like it or not is a minimal invasive procedure, and like any other procedure, thing can go wrong. Question is how to fix things.
3. NOKOR debate. Firstly, if one heals up poorly, any puncture should be lateral not mid cheek. This is given. Secondly, there are many papers describing other techniques such as cannula subcision. NOKOR cuts- no debate about that. It produces more collateral damage than needles and certainly more than cannula. Specialist who are dynamic in their field will gravitate to new procedures, and most importantly teach other doctors this procedure. Sure subjective viewpoints on Nokor vs other will arise, however given the fact Weiner, Rullan, Lim ,Novick, and Rapaport and even Emer have adopted this peer reviewed modality says something about the efficacy of this procedure- provided it is done PROPERLY.
4. If one uses a cannula with one or at the most two lateral incision points, conducted in a two to three level 'tier'- first tier just below your dermis, the remaining 4-6 scars will be improved. You also have textural changes- this is where lasers or energy devices can be helpful. Focal delivery of energy can help whilst minimising collateral damage to the surrounding skin.
5. From the angled photograph you also demonstrate significant atrophy of your right cheek. I can not comment if thiswas due to age appropriate volume loss, inflammation secondary to uncontrolled acne,or secondary to excessive microneedling (BA is correct once again- literature does indeed suggest that 1.5 mm is max that microneedling delivered VERTICALLY is the safe and in the majority of cases the most effective depth). Your atrophy can be due to all 3 factors. Treatment of your atrophic areas will lead to COUNTER TRACTION of your skin- this improves not only volume loss but your scars. The debate as to how to correct atrophic scars can be a discussion you have with your specialist of choice. Fat vs HAs, vs Sculptra vs Belafill (If you are mis-informed enough).
Your situation is not difficult, as you have focal scars- the hard part is choosing appropriate treatments that improves the scars that YOU see, and have a low PROBABILITY of causing idiosyncratic scars based upon your history. What this means is to go slow with energy devices. Finding the correct specialist who understands scar revision is the challenging part.
Sibel, first I want to tell you this: your scars are not bad. I really think that most of the problem is in your head. I'm not telling you this to make you feel okay, no I'm telling you this because this is what I see. Search for a therapist who is specialised in BDD. 'Normal' psychologists are mostly not.
I've always had my doubts about Chu. I don't get it that in all these years (from the beginning of 2000 till today) Chu is seeing as some kind of God on acne.org. He don't want to try new things, only the package subcision, TCA cross and dermapen, which is the package he is doing with every patient that I've read throughout the years. I've read stories about him from his former patients that he's not that good in scar revision and making new scars. He might be a great derm, I don't know. But for scar revision, it was no brainer that I don't wanted to visit him.
I've visited Emil instead and I'm pleased. Maybe something to think about: he told me he was going this year or next year to London to a PS to learn how to inject Sculptra.
Obi: I do not see anything insulting in ur comment. Thank u for uropinion on thesubject)
Chuhas been doing scars revision for at least 15 years, this exact package, I found the review from 2003.Here he is reccomended for Scar revision.Not other things. Certainly all could be blamed on my poor healing but I ownestly do not understand why to stick Nokor rightin the middle of my cheek,it is a very visible place and for anybody even with good healing it would be a visible scab/markfor several weeks. At the first time he did not do so.It does not make him a baddoctor No!but just not attentive to the personal patient situation. One thing to see things differently with the patient, another thing to damage the skin more and to ignore the patient afterwards.
I understand that Dermapen is invasive. I got aside effects,I asked Chu about itBefore!the treatments and he denied it. I send him thepics.Instead he started to tell me about massive improvement. I wanted to repeat Sub so if I would continue to talk about aside effects it would be no procedure.
Athrophy of the cheeks: combination-high cheekbones, energy devices,derma-pen and aging. Unfortunately threads did not bring anyeffect. I asked a Chu if not fillers then what? No answer..
Noa: I have mild scars, with foundation on the cheeks from 2meters and no harsh light from the top it is fine. The forehead isthe worst,I can not open it or cover with make up. I had BDD, now it is very mild thank to the help of therapist.