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Hi fellow community members. On Tuesday December 29th 2020, I saw Dr. Sajic for TCA Cross on my rolling scars, V-Cannula Subcision with tumescent anesthesia, Lutronic eCO2 (I will update with the settings used once I get that info) & subdermal filler + meso-style application of Radiesse immediately after the Lutronic eCO2. Total sum with taxes was $3.7K CAD. Skin type 3.5/4. I was told they discounted $1K.
In office treatments I have done in the past are listed below:
- 3 Blunt Cannula Subcision with overly diluted saline and sculptra with Dr.Lemckert (Dissatisfied with the practitioner, Dr.Lemckert from Hamilton Ont, so can only speak so much on effectiveness)
- 2 Blunt Cannula Subcision with radiesse with Dr.Sajic
- 3 Infini RF Sessions at Medispa in TO
- 1 Profractional session at Medispa in TO
At home treatments I have done in the past are listed below:
- Innumerous derminator sessions with hyaluronic acid
Regular Skincare Routine Includes:
PM: Cycling of Hydroquinone 2%, prescription-based micro-retinal, squalene oil if i'm feeling very dry, triple lipid restore cream from Skinceuticals, aquaphor, cerave, etc
AM: CE Ferulic from Skinceuticals, Vivier Grenzine (Adding this after i'm back to my skincare routine), mineral sunscreen, Cetaphil moisturizer
Feedback of treatment:
Dr.Sajic did a punch biopsy on a pitted scar on each side of my cheek to insert the v-shape cannula for subcision. I do currently have sutures that will probably be taken out next Tuesday during follow-up but not 100% on that. What struck me most was the difficulty Dr.Sajic had to break up some of my big adhesions with the v-shape cannula - very forceful tugging to break up. When I asked him about this and why it was so difficult compared to cannula, he informed me that the v-shape cannula can break up bigger adhesions versus the bluntcannula which breaks up smaller adhesions. - this point has definitely made me consider choosing v-shape cannula for future subcisions. While Dr. Sajic offers the liberator full field subcision, he believes the difference in final result between the v-shape cannula and the liberator is insignificant, especially given the higher risks associated with the liberator. The liberator is also much larger in size than the v-shape cannula and would require a larger incision. So lots of things to consider. I was happy with my choice of radiesse until I read a post on here that radiesse is not great for immediate post-subcision application since it's a subdermal filler and not the best spacer... but here's to hoping the tumescent anesthesia and the other treatments are also acting like a spacer...
Feedback on multiple treatments in one day: I'm now thinking this is probably ideal for acne scar revision, especially after witnessing how difficult it was for Dr.Sajic to break up some of my scar adhesions, even with the v-shape cannula. Bigger recovery required but so far I think it's worth it.
Rando pre-treatment photo in Aug 2020. This is prior to Infini #2 (08-29-2020), Infini #3 (09-24-2020), 1 Radiesse & Subcision (10-29-2020), 1 Profractional (12-02-2020) and obviously the session on 12/29
Pre-Treatment Photos with Dr.Sajic on 12/29
Post-Treatment (Today - Dec 31st): I still have a ton of tumescent anesthesia in my face and won't be vinegar soaking til tomorrow. Staying away from the sun (what little of it we have in Ontario). I definitely think i'll be doing another CO2 in the future - if only for the resurfacing potential... but obviously also too early to say since i'm only 2 days out. Will continue to update.
4 hours ago, Catharsis2018 said:What struck me most was the difficulty Dr.Sajic had to break up some of my big adhesions with the v-shape cannula - very forceful tugging to break up. When I asked him about this and why it was so difficult compared to cannula, he informed me that the v-shape cannula can break up bigger adhesions versus the bluntcannula which breaks up smaller adhesions.
Has it ever crossed your mind that Nokor would have been a better instrument? Whereas Nokor has the blade on the side, both V-shape cannula and Taylor liberator have the blade at the tip. There are, of course, downsides to all of them. For instance, unless you're handling the instrument with a pinpoint accuracy, you will likely miss the scar band using the VC or TL since the width of the cannula is small. Nokor, on the hand, will indiscriminately cut anything in its path. But, in your case, Nokor would have given a nice clean cut. As you might know, how a cut is made can make a big difference in the formation of the scar. The cleaner the cut, the cleaner the scar. Otherwise you end up with a mess.
Anyway, good luck going forward. Do keep us updated.
On 12/31/2020 at 5:01 PM, Sirius Lee said:Has it ever crossed your mind that Nokor would have been a better instrument? Whereas Nokor has the blade on the side, both V-shape cannula and Taylor liberator have the blade at the tip. There are, of course, downsides to all of them. For instance, unless you're handling the instrument with a pinpoint accuracy, you will likely miss the scar band using the VC or TL since the width of the cannula is small. Nokor, on the hand, will indiscriminately cut anything in its path. But, in your case, Nokor would have given a nice clean cut. As you might know, how a cut is made can make a big difference in the formation of the scar. The cleaner the cut, the cleaner the scar. Otherwise you end up with a mess.
Anyway, good luck going forward. Do keep us updated.
Admittedly, it didn't cross my mind because of the risks associated with the Nokor. But I am considering it now....I will post some photos after I see Dr.Sajic tomorrow to remove the sutures. I think I may be sticking to subcision versus heat energy going forward. The co2 wasn't worth the bang in buck.
On 1/4/2021 at 1:38 PM, Catharsis2018 said:Admittedly, it didn't cross my mind because of the risks associated with the Nokor. But I am considering it now....I will post some photos after I see Dr.Sajic tomorrow to remove the sutures. I think I may be sticking to subcision versus heat energy going forward. The co2 wasn't worth the bang in buck.
Before you dismiss CO2 lasers, you should know that there are a wide variety of lasers and settings. And the most important component..... the doctor. I've had laser treatments and I saw improvement in some scars. Based on your pictures, your treatment was mild. That scabbing is nothing. I got a CO2 procedure done weeks ago and I peeled in 3-4 days easily. With another doctor and a different CO2 laser, I was bloody after the treatment and recovery took at least a week. There is a huge difference in recovery, redness, scabbing, and hopefully improvement.
Manual methods such as subcision and CROSS may be your best bet during this time if you have the patience. When your scars are raised, then you may consider laser treatments at a more aggressive setting (some more risk though).
On 2/11/2021 at 3:23 AM, Amanda Hall said:Before you dismiss CO2 lasers, you should know that there are a wide variety of lasers and settings. And the most important component..... the doctor. I've had laser treatments and I saw improvement in some scars. Based on your pictures, your treatment was mild. That scabbing is nothing. I got a CO2 procedure done weeks ago and I peeled in 3-4 days easily. With another doctor and a different CO2 laser, I was bloody after the treatment and recovery took at least a week. There is a huge difference in recovery, redness, scabbing, and hopefully improvement.
Manual methods such as subcision and CROSS may be your best bet during this time if you have the patience. When your scars are raised, then you may consider laser treatments at a more aggressive setting (some more risk though).
Yeah. I™d say overall, it was a mild treatment since I recovered pretty well. I would say improvement was minimal. 
he did use more mild settings on the CO2, since I™m skin type 4. But based on how well I recovered he did say he was open to going more aggressive next time. I™m still torn as to what my next treatment will be. CO2 was nice for the fine lines and anti aging...
12 minutes ago, Catharsis2018 said:Yeah. I™d say overall, it was a mild treatment since I recovered pretty well. I would say improvement was minimal.
he did use more mild settings on the CO2, since I™m skin type 4. But based on how well I recovered he did say he was open to going more aggressive next time. I™m still torn as to what my next treatment will be. CO2 was nice for the fine lines and anti aging...
What type of CO2 laser was it? Fine lines and anti aging are nice to improve but that's not what you paid for.
Before you spend any more money, do some more research and hold off on any treatments if you are not comfortable. I would rather save the money and spend it on a deeper treatment, but that's me.
Look at this woman's recovery. She exhibits healing of a deeper treatment. For my CO2 procedure, I actually bled more than this woman. Unfortunately, most doctors aren't proficient at lasers so you just get a mild peel.
17 hours ago, Tonitrus09 said:Why is Nokor riskier than Cannula?
Nokorsubcision is associated with more complications and cannula subcision has been deemed to be more effective anyway. Check out these two scientific studies
26 minutes ago, Catharsis2018 said:Nokorsubcision is associated with more complications and cannula subcision has been deemed to be more effective anyway. Check out these two scientific studies
Thank you so much for sharing this! Is there any merit to the claims that sometimes nokor is necessary over cannula because "the fibrous bands are too thick" and a cannula can't adequately sever them...? I'm inclined to think cannula can sever fibrous bands just as well as nokor but I could be wrong. Next question...why do any providers still use nokor if it's riskier?
7 minutes ago, Tonitrus09 said:Thank you so much for sharing this! Is there any merit to the claims that sometimes nokor is necessary over cannula because "the fibrous bands are too thick" and a cannula can't adequately sever them...? I'm inclined to think cannula can sever fibrous bands just as well as nokor but I could be wrong. Next question...why do any providers still use nokor if it's riskier?
No problem!
I think there may be some merit to it, yeah. This study ( http://c60antiaging.com/pdf/therapy-in-treatment-of-atrophic-acne-scars.pdf ) used primarily cannula (23 Gauge), but they did note that they used Nokor for very fibrotic scars.
This study ( https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=248182 ) used23G cannula needle, 27G insulin needle in few small + superficial scars and Nokor was again used for very fibrotic scarring.
Though, I am not sure how the practitioner will discern what is "very fibrotic scarring" to just "fibrotic"... maybe the difficulty in subcising with the cannula? Not sure
Providers do use Nokor, but from the physicians i've talked to, most shy away from it because of the risk of complications since a nokor needle is very sharp, could cause more bruising/hematoma/vessel rupture etc
6 minutes ago, Catharsis2018 said:No problem!
I think there may be some merit to it, yeah. This study ( http://c60antiaging.com/pdf/therapy-in-treatment-of-atrophic-acne-scars.pdf ) used primarily cannula (23 Gauge), but they did note that they used Nokor for very fibrotic scars.
This study ( https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=248182 ) used 23G cannula needle, 27G insulin needle in few small + superficial scars and Nokor was again used for very fibrotic scarring.
Though, I am not sure how the practitioner will discern what is "very fibrotic scarring" to just "fibrotic"... maybe the difficulty in subcising with the cannula? Not sure
Providers do use Nokor, but from the physicians i've talked to, most shy away from it because of the risk of complications since a nokor needle is very sharp, could cause more bruising/hematoma/vessel rupture etc
thank you so much! this is very helpful! 
I love that you're sending me the relevant studies, too!
I am about to do similar treatments ie. TCA Cross/Peel + Collagen Stimulator + subcision if needed and Fractional Erbium. I am looking around for the info if these treatments could all be done altogether and apparantly they could from this thread. What would be the sequence then? My derm said TCA Cross then Collagen Stimulator and subcision if needed, finished by Frac Erbium. I wonder when the TCA Cross frosted, could you poke the frost with needle or Nokor/Cannula??
Also if I prefer to wait between these procedures since they seem so excessive to be done within a day. What would be the most effective interval for them? Might do the TCA Cross + Fract Erbium first than after some intervals with inflammation from initial treatments still there, come back for the collagen stimulator + subcision when needed or anyone would like to recommend better sequence of these treatments?
Four months away until my phenol peel¦ feels like the time is flying to be honest lol I am very excited yet nervous on ensuring I follow all the pre - care instructions & post - care recovery guidelines to the letter.
since march 2022, I™ve done 5 laser sessions which included
- 4 RFM & CO2 sessions - with modalities being used each treatment.
- 1 RFM session
I plan to continue monthly laser sessions as long as I am able to, prior to getting the peel. My scarring has looked more shallow to me lately
under my harshest lighting, today: 
12 hours ago, froyosh said:I feel like you are good enough for phenol peel. More CO2 is excessive, it won't give you further improvement.
Yeah. The reason I stopped the co2 is because I was noticing hypopigmentation in my scarred pitted areas, I was told this may have been caused in combination with the sun
So likely sticking to just RFM until the phenol
On 8/22/2022 at 3:25 PM, getsmart121 said:Dr rullan mentioned he used to do a lot of co2 and he found that it is good for scars that stretch out but causes fibrosis whiteness. He has seen superior results fro, phenol peel 2 day with the least possibility of side effects. Ipersonally can attest tot that
Think Im ready for phenol?
11 hours ago, getsmart121 said:Filling collagens the last priority for our body as it does not Involve life and death. From an evolutionary perspective the body first aim is to just make it in working condition and put filling collagen on the back burner on a low priority
Is that your rationale for why acne scars are so hard to treat?