3 hours ago, dezzyhoc said:i have done quite a bit of research on acne scarring and improvements and a lot of you are mentioning subcisions and lasers etc but nothing about fillers. after doing my research and looking at a lot of before and afters id say fillers or fat transfers are what are going to have u seeing the most long lasting results. it acts like a buffer to stop retethering with the scar and will build collagen. ive heard dr davin lim is like the best of the best but hes in australia so idk how long it would take to get in to see him or what the cost would be fore hotel and air fare. does anyone have experience with him?
Filler can make a huge improvementthe big issue however is it is not permanent and touch ups will be needed every 3-9 months. It also doesn't really work well if you have scars with defined edges as it gives your skin a lumpy and unnatural appearance with the scars still being present. Subcisions, tca, needling and lasersare used to smoothen out the surface and edges as much as possible before fillers are eventually applied and maintained. Davin Lim is one of the best but the nature of treating acne scars is multiplesessions 3-6 months apart. Unless you decide to relocate to Australia for a yearthat isn't really feasible.
On 10/29/2020 at 10:53 PM, dezzyhoc said:ive heard of him before and search him up on real self but its pretty much all word of mouth. i havent seen too many real reviews from him or before an afters for someone who's so recommended. if that makes sense.
Dr. Rullan is mostly word of mouth. He gets many referrals from members here. He's well known because he has two procedures that are sought after from scar sufferers: subcision and Phenol Cross (similar to TCA Cross).His practice isn't spectacular like a plastic surgeon's but he's the type of doctor that prides himself on results before anything else. Browse through the threads here and you'll see a number of people who have gone to him including myself.
Avoid the LA doctor who posts like crazy on Real Self. Y'all know who I'm talking about.
On 10/29/2020 at 10:49 PM, Sirius Lee said:One of the most well-known doctors on the West Coast is Dr. Rullan in San Diego. He usually offers a package deal, which includes subcision. He has many satisfied patients, many of which you can find here in fact. But the treatmentcomes with a hefty price tag, so beware. I say this because you most likely will need multiple treatments. One treatment is rarely enough to notice big improvement.
His prices have gone up substantially over the last several years. My guess is that he's gotten much higher demand and that the office knows that they can still charge more and be competitive with the other rip-off doctors. I've mentioned before that greed could be another reason but it's hard to fault a practice for this when patients are still willing to pay for its services.
If he charged what he did before the price hikes, I'd do several more subcision treatmentswith him but it's too much for wanting to experiment with improvement given mytype of scars.
On 11/3/2020 at 3:11 AM, gyuillie said:What is the typical cost of a subcision session with Dr Rullan (moderate-severe scarring)
Last time it was $1,250 or around there for both cheeks.
On 11/3/2020 at 1:00 PM, Miro said:Jesus Thats expensive as hell , he got famous here and raised prices .
Yes. It turned me off but I wanted to see what the hype was about so I did it once.He's a capable doctor though but it's up to you to decide if it's worth it.
About three years ago, you could have done 3 or 4 subcision treatments for that amount..... unless I got the info wrong from some person.
On 11/3/2020 at 6:28 PM, anon09299 said:The phenol peel I have heard 6000-8000 however his trio was always considered subcision, phenol cross and microneedling or fractional erbium. It definitely increased over the last few years however I haven't really seen anything that much cheaper on the west coast. All subcision treatments seem to be at least 1000. I have seen some places charging 750 nowadays for microneedling without rf which I think is ridiculous.
Microneedling is such a rip-off. I paid several hundred for one and it was stupid. Any place that charges $750 should guarantee your scars will improve. Just get a Derminator and do it yourself. You'll pay for the device and you can use the rest for fillers or another treatment.
On 11/3/2020 at 9:41 PM, BlueMaloney said:You are right. Nobody should assess improvement the first 4-5 weeks after treatments as the skin hasn't "settled" yet. What I see though with the people who go to Rullan or Emil is that they keep going back for a 2nd, a 3rd treatment so they must see results, right? Why else do they go back?
Cross is a procedure that necessitates repeat treatments. Even if it does jack s***, people know that they need multiple treatments so they continue. It just plain sucks for scar sufferers.
On 11/5/2020 at 11:30 PM, BlueMaloney said:Exactly. You get 30-40% improvement, 50% if you're lucky. You get multiple treatments, use your time off work not for holidays but for downtime after treatments, risk complications and long term negative effects with lasers or fillers, in the end get to spend tens of thousands and you still have your scars, they are still there even though improved. It's so frustrating. Yet, I'd still choose to get treatment over doing nothing at all.
Great point. Downtime is a huge factor is deciding whether or not you should get treatment. People take doctors words at face value...... "healing takes 2-3 days"...... what BS. They're selling you expensive treatments so of course they will give you the shortest recovery time frame. In my opinion, it's usually double or triple that amount of time.
Sure, you can go to work or school with big red/brown marks from TCA cross or your face scabbed and peeling from lasers and peels, but most people would be to self-conscious. Everyone needs to factor in downtime for procedures. Subcision (for me at leaset) is the easiest to recover from - I could have gone out the next day or two.
Despite recovery, I'd still try to improve my scars than do nothing so I agree with you. Money permitting that is....
On 11/5/2020 at 11:46 PM, BlueMaloney said:Following this forum has become totally eye opening for me as I am no longer disillusioned that treatments give only mediocre results. It's also very depressing reading how people are exstatic about initial improvement as first, probably due to swelling, and then don't come back to report on further improvement. Following this forum daily only makes you fixate on a problem that cannot reall be solved . Besides people who comment here are not experts and offer only their personal opinion which may or may not be right. So I think it's a good idea to take a break from this site from time to time. Otherwise you will get psychology issues fixating only on your scars.
None of us are experts and everyone should be aware of this. We can advise, recommend, suggest, etc. but please don't be stupid. You need to do your own research as well and be comfortable with any treatment or doctor. We are here to help fellow members because nobody wants to see another person get ripped off by greedy doctors or incompetent ones who could make your scars worse.
The thing we're doing is providing as much information as possible. We all learn more by reading about people's experiences and journeys so this forum has been helpful to people like me.
21 hours ago, Miro said:Yes , exactly, John Goldenmouth spoken, many people say they love swelling, i hate it, swelling sucks, it hides real results and gives you false hope for weeks, sometimes even moths.
With all the respect, this is not my opinion, i saw some posts by drs and few videos, they all say 30-40% up to 50% .
Also I never saw pics online same lighting same angle that i d say this is over 50% of course i m not talking about some superficial scars but medium to deep dents - holes . Of course if anyone has something like that bring it on. 6 months after last treatment same light same angle i will gladly change my opinion if theres proof.
40% to some doctors could be 10% to me. Forget the percentages. If someone sees improvement, it's best that they describe it instead of assign a percentage to it.
@amanda I've been following this forum for quite a while now and I'm very grateful to all sharing their good or bad experience. At the beginning I thought I would do a couple of laser treatments that will sort my scars out or at least improve them to the point of being almost invisible with make up. Now I realize thanks to the forum that scars are extremely frustrating to treat and chances are that you will do numerous treatments spend thousands of pounds and you'd still not be satisfied because regardless the small to moderate improvement your scars are pretty much still there. If there is one thing I've learned here it is managing expectations. However, I notice that following the forum closely like daily isn't affecting my mental health in a good way at all. I'm focusing too much on the problem and shifting attention to more possitive things would most certainly do me well.
The forum is a great place of information and first hand experiece though. I particularly like the threads wih photos documenting different treatments *thumbs up*.
On 11/6/2020 at 1:45 PM, Miro said:Yes , exactly, John Goldenmouth spoken, many people say they love swelling, i hate it, swelling sucks, it hides real results and gives you false hope for weeks, sometimes even moths.
With all the respect, this is not my opinion, i saw some posts by drs and few videos, they all say 30-40% up to 50% .
Also I never saw pics online same lighting same angle that i d say this is over 50% of course i m not talking about some superficial scars but medium to deep dents - holes . Of course if anyone has something like that bring it on. 6 months after last treatment same light same angle i will gladly change my opinion if theres proof.
I love the days after treatment while I still have swelling because for a few days / weeks my face looks normal. I hate when the swelling subsides...
I haven't seen more than 50% improvement either and I've done A LOT of research. I think smart docs know this and are overly friendly and caring compassionate to compensate for the lack of huge improvement
On 11/7/2020 at 8:12 AM, BlueMaloney said:I love the days after treatment while I still have swelling because for a few days / weeks my face looks normal. I hate when the swelling subsides...
I haven't seen more than 50% improvement either and I've done A LOT of research. I think smart docs know this and are overly friendly and caring compassionate to compensate for the lack of huge improvement
Everyone should also know that there's a chance that doctors purposely take "after" pictures at the most optimal time when there is good swelling. This is my suspicion.
After a laser treatment, I swear I got more than 60-70% improvement during the swelling phase. That went down to 10-15% in months.
7 hours ago, Amanda Hall said:Everyone should also know that there's a chance that doctors purposely take "after" pictures at the most optimal time when there is good swelling. This is my suspicion.
After a laser treatment, I swear I got more than 60-70% improvement during the swelling phase. That went down to 10-15% in months.
Doctors trick a lot with afters, unfortunately.
I follow a girl who got subcision and co2 laser (fully ablative) around 7 weeks ago. For now results are good but it's interesting if she ll still have them 6 months after. I'll be following.
37 minutes ago, BlueMaloney said:Doctors trick a lot with afters, unfortunately.
I follow a girl who got subcision and co2 laser (fully ablative) around 7 weeks ago. For now results are good but it's interesting if she ll still have them 6 months after. I'll be following.
Fully ablative CO2 is best for fair-skinned individuals for anyone even considering this. I would almost always recommend fractional CO2 due to fewer risks. Glad she got good results.
Thanks for helping contribute to this forum. I've gone through my share of ups and downs which has been rough. Hopefully my experience (as well as yours)with treatments can help others.
As mentioned by my derm, he considers that if you achieve 50% improvement, then your scar treatments are successful. I think that's where your numbers are from. Most of the people might get 10% - 50% based on the treatments they receive. Also the more severe condition that you have, the more improvement you might see.
For some people in this forum who only has severalicepicks. you definitely won't see a dramatic improvement.
45 minutes ago, BlueMaloney said:Doctors trick a lot with afters, unfortunately.
I follow a girl who got subcision and co2 laser (fully ablative) around 7 weeks ago. For now results are good but it's interesting if she ll still have them 6 months after. I'll be following.
Is that girl named acnescarskin on IG?
1 hour ago, Amanda Hall said:Fully ablative CO2 is best for fair-skinned individuals for anyone even considering this. I would almost always recommend fractional CO2 due to fewer risks. Glad she got good results.
Thanks for helping contribute to this forum. I've gone through my share of ups and downs which has been rough. Hopefully my experience (as well as yours)with treatments can help others.
Yeah definitely. Thanks for your posts as well. They've always been very helpful. You see what works and what not, even though we are alk different.It's also good to be able to share your concerns about the scars with people who understand cause not all friends feel comfortable discussing your struggles. And they are real!
As for the laser, I'm Fitzpatrick I or II so it should be ok to do it, but it's Veeery expensive and I'm not sure if it will bring improvement and if it won't burn my skin or cause more damage. And if I spend 3k and get 10% improvement for a few months only I'd be pissed as hell!
1 hour ago, Jack817 said:As mentioned by my derm, he considers that if you achieve 50% improvement, then your scar treatments are successful. I think that's where your numbers are from. Most of the people might get 10% - 50% based on the treatments they receive. Also the more severe condition that you have, the more improvement you might see.
For some people in this forum who only has severalicepicks. you definitely won't see a dramatic improvement.
Is that girl named acnescarskin on IG?
Yes, it's her. She posts not only pics but videos as well and I think videos are way better toshow the scar. Pics are no good.
Her skin looks great at the moment but I don't know if it's not still swelling. After all Taylor liberator is a brutal, brutal procedure and she herself said that she thinks there arestill rests of the anaesthetic injected in her skin. How is this possible after 3 monthsI don't know.
12 minutes ago, BlueMaloney said:Yeah definitely. Thanks for your posts as well. They've always been very helpful. You see what works and what not, even though we are alk different.It's also good to be able to share your concerns about the scars with people who understand cause not all friends feel comfortable discussing your struggles. And they are real!
As for the laser, I'm Fitzpatrick I or II so it should be ok to do it, but it's Veeery expensive and I'm not sure if it will bring improvement and if it won't burn my skin or cause more damage. And if I spend 3k and get 10% improvement for a few months only I'd be pissed as hell!
Yes, it's her. She posts not only pics but videos as well and I think videos are way better toshow the scar. Pics are no good.
Her skin looks great at the moment but I don't know if it's not still swelling. After all Taylor liberator is a brutal, brutal procedure and she herself said that she thinks there arestill rests of the anaesthetic injected in her skin. How is this possible after 3 monthsI don't know.
Its too soon , after 6 months you can if theres improvement and how much
3 minutes ago, Miro said:Its too soon , after 6 months you can tell if theres improvement and how much
11 hours ago, BlueMaloney said:Yeah definitely. Thanks for your posts as well. They've always been very helpful. You see what works and what not, even though we are alk different.It's also good to be able to share your concerns about the scars with people who understand cause not all friends feel comfortable discussing your struggles. And they are real!
As for the laser, I'm Fitzpatrick I or II so it should be ok to do it, but it's Veeery expensive and I'm not sure if it will bring improvement and if it won't burn my skin or cause more damage. And if I spend 3k and get 10% improvement for a few months only I'd be pissed as hell!
Yes, it's her. She posts not only pics but videos as well and I think videos are way better toshow the scar. Pics are no good.
Her skin looks great at the moment but I don't know if it's not still swelling. After all Taylor liberator is a brutal, brutal procedure and she herself said that she thinks there arestill rests of the anaesthetic injected in her skin. How is this possible after 3 monthsI don't know.
I think fully ablative CO2 will get you noticeablybetter results than fractional CO2. But you know what I'm gonna say...... higher risks and longer recovery times. Because you're fair skinned, the risks of PIH/PIE should be much less to the point where I don't think you have to worry. If you have a good doctor and follow up with all of your post CO2 care, the risks will be smaller. You'll also need to take a long time off of work - I'm talking at least several weeks according to what I've read and heard.
10 hours ago, Amanda Hall said:I think fully ablative CO2 will get you noticeablybetter results than fractional CO2. But you know what I'm gonna say...... higher risks and longer recovery times. Because you're fair skinned, the risks of PIH/PIE should be much less to the point where I don't think you have to worry. If you have a good doctor and follow up with all of your post CO2 care, the risks will be smaller. You'll also need to take a long time off of work - I'm talking at least several weeks according to what I've read and heard.
yeah i know. the problem is i don't have a good doc. the one near me has bad reviews and can't show a single pair of good before/ afters spaced out 6 months so that u can see if their is results or not. anything less than 6 months is not realistic
2 hours ago, BlueMaloney said:yeah i know. the problem is i don't have a good doc. the one near me has bad reviews and can't show a single pair of good before/ afters spaced out 6 months so that u can see if their is results or not. anything less than 6 months is not realistic
DM me and I'll help you search if you are interested. I don't want to divert this thread further.
So from 2 pages of this, it seems that Rullan and Lim are the best for subcision. Anyone other doctors?
People mentioned $1250 per treatment from Rullan. Is that per scar or per treatment of multiple scars?
And is that Peter Rullan or his daughter? Is his daughter good at subcision?
On 11/3/2020 at 7:23 PM, Sirius Lee said:
If I knew I would get at least 51% improvement, I would bite the bullet and spend that much. Unfortunately, none of these doctors, including Rullan, can promise anything. On the contrary, most overpromise and underdeliver. My biggest gripe is that posters who come here praising Rullan just one week out from their treatment with swellingstill present, they don't bother to come back after 6 months to update their progress. And yet people believe their BS.
Realistically speaking, most people with medium to severe scars require at least 3 treatments. I'm pretty certain a lot of these people do not have the means to pay $1000 per subcision.I really think the whole system is effed up. My advice: boycott the effers.
I have posted updates on my progress with dr rullan.
On 1/21/2021 at 10:04 PM, Rickyduds said:So from 2 pages of this, it seems that Rullan and Lim are the best for subcision. Anyone other doctors?
People mentioned $1250 per treatment from Rullan. Is that per scar or per treatment of multiple scars?
And is that Peter Rullan or his daughter? Is his daughter good at subcision?
peter rullan does the subcision and i believe its for both cheeks not just an exact scar
Hey older thread but wanted to chime in. I read the research paper https://pubmed.ncbi.nlm.nih.gov/20553364/ similar to Robertitoo:
In this research paper it talks about the effectiveness of suction cupping after subcision. BUT also clearly states that the most effective subcision is when the tethers are broken up, in a plane, higher up in the dermis called the "superficial dermis":
Quote...
Subcision was also performed in superficial dermis (SUPERFICIAL DERMAL UNDERMINING).Superficial dermal undermining under the whole scar surfaces including base, walls, borders or shoulders and 1 mm of the margins was the key point of successful undermining for various types of atrophic and depressed scars (Fig. 3b). Using this technique, most of acne scars of a patient in any type, number, shape and size could be treated in one session. Therefore, it was not necessary to use various methods to treat different scar types on a patient. Moreover, considerable change was achieved in overall appearance of scars and skin after one treatment course. These important points, as well as other advantages of subcision, differentiate superficial dermal undermining from other acne scar treatments. It must be noted that deeper undermining was not so effective in management of various types of scars (Fig. 3c)
Figure 3(c): https://imgur.com/a/ZzSyS2Z
Figure 3(c) is described:
Quote(c) Deeper undermining is not effective in release of all scar surfaces especially walls, shoulders and margins
To me, this might explain why some users have experienced theirsubcision-suction method not working as well besides them "healing poorly." Based on the research you have to find a doctor that cuts the tethers in the superficial dermis.
In Robertitoo's postabove he mentioned that Dr Rullan in fact cuts the tethers in the superficial dermis (as well as deeper dermis layer I guess):
QuoteHe has a special technique on how he approaches subcision; he not only undermines the superficial layer of the dermis but the deeper layers as well, continuously switching from the smaller to large gauge needlesand so forth on each area.
So this makes sense why people like going to Dr. Rullan. AFAIK other doctors may be cutting the "deep dermal subcutaneous plane," which the research paper suggets isn't as effective for subcision. If anyone goes to Dr. Rullan I'd confirm he's cutting the tethers in the superficial layer of the dermis just as Robertitoo did.For users going to other doctors, I'd confirm that also, again, you want them to cut the tethers higher up inthe "superficial dermis."
I can only guess why doctors don't cut higher up in the dermis. Guessingbecause if the doctor accidentally cuts a plane too far up closer to subepidermis (see below) than there's risk for some hypertrophic scarring (raised scarring). So I think they hedge this risk by cutting lower down. If this is true then that's more of a reason to find an experienced doctor who does subcision in the higher plane.
Research paper mentioned "subepidermal like undermining" risks:
QuoteSubepidermal like undermining by formation of subepidermal blood pocket causes hypertrophic scar. Undermining near epidermis is high risk for hemorrhagic papule and hypertrophic scar formation in subcision
Fortunately,in the research this only happened to 1.7% of the total scars.
Hope that helps!
Don't you need to do untether the scars on all planes for it to be effective? Just working superficially doesn't make sense to me, especially since the most dramatic subcision results have been produced by the Taylor Liberator (by Dr. Taylor + Dr. Hussein), which is operated on the dermal-hypodermal junction (higher risk, higher reward).
If you have only superficial scars, then yes, deeper subcision won't be effective. But if you have deep scars, I'd think you need deeper subcision. Ideally, you need to subcise on all planes where there is tethering.
I've seen some people with deeper scars claim that Rullan's treatment did nothing for them, and I suspect it's because he does bi-level subcision (according to his own papers). Whereas some other doctors (e.g., Lim) claim to do tri-level subcision.
13 minutes ago, k95 said:Don't you need to do untether the scars on all planes for it to be effective? Just working superficially doesn't make sense to me, especially since the most dramatic subcision results have been produced by the Taylor Liberator (by Dr. Taylor + Dr. Hussein), which is operated on the dermal-hypodermal junction (higher risk, higher reward).
If you have only superficial scars, then yes, deeper subcision won't be effective. But if you have deep scars, I'd think you need deeper subcision. Ideally, you need to subcise on all planes where there is tethering.
I've seen some people with deeper scars claim that Rullan's treatment did nothing for them, and I suspect it's because he does bi-level subcision (according to his own papers). Whereas some other doctors (e.g., Lim) claim to do tri-level subcision.
afaik and read, tethered scars are fibrotic strands from the epidermis that anchor to the hypodermis, but I guess not all tethers are tethered down that deep. To me it makes sense, if youcut all tethers in one plane, thefibrotic strands are all attached to the epidermis. i.e. Once you cut the tether the scar surfaces aren't anchored, doesn't matter if they're superficial or deeper scars.
also don't get confused with "superficial scars" and "superficial dermis," different ideas."superficial dermis" is just where the tether needs to be cut doesn't matter if the actual tether makes a deeper atrophic scar or not.