Your scars are mild compared to everyone here.

Subcision is mostly for rolling scars and I don't see any really noticeable onesin the pictures. There are a few areas on your left cheek that I think may be rolling from your point of view, but it's so hard to tell. You can try subcision, but the results may be minimal.

You have some boxcar and icepick scars that Cross can help with. The risk is the scar widening but the benefit is it becoming shallower. After treatment, your scabs will last 5-7 days and you'll be left with residual red marks for at least a week or two. I use tinted moisturizer and you can use makeup after your skin heals and the scabs are off. The redness isn't the same as from laser. It will go away in weeks, not months.

RFM is a crapshoot just like every other method. I had it done and didn't see results but all of our scars are different. If you have the money, go for it. The downtime for me was about a week.

Lasers will give you erythema and/or hyperpigmentation so it's not the method you want to go with if you have reservations or if you're just starting out. I saw benefit from it but I also got some new scars due to it. It's a risky one.

Have you considered traveling for your procedures? There aren't many scar experts so some people go out-of-state and pay more. If you let us know where you are located, I'm sure someone could help with recommendations.

My concern is that it looks like you are currently breaking out. Most important is to prevent acne so you prevent future scarring. I don't believe dermatologist or plastic surgeons will treat scarring if you are still breaking out. Do you have a plan to get your acne under complete control first?

12 hours ago, Amanda Hall said:

Your scars are mild compared to everyone here.

Subcision is mostly for rolling scars and I don't see any really noticeable onesin the pictures. There are a few areas on your left cheek that I think may be rolling from your point of view, but it's so hard to tell. You can try subcision, but the results may be minimal.

You have some boxcar and icepick scars that Cross can help with. The risk is the scar widening but the benefit is it becoming shallower. After treatment, your scabs will last 5-7 days and you'll be left with residual red marks for at least a week or two. I use tinted moisturizer and you can use makeup after your skin heals and the scabs are off. The redness isn't the same as from laser. It will go away in weeks, not months.

RFM is a crapshoot just like every other method. I had it done and didn't see results but all of our scars are different. If you have the money, go for it. The downtime for me was about a week.

Lasers will give you erythema and/or hyperpigmentation so it's not the method you want to go with if you have reservations or if you're just starting out. I saw benefit from it but I also got some new scars due to it. It's a risky one.

Have you considered traveling for your procedures? There aren't many scar experts so some people go out-of-state and pay more. If you let us know where you are located, I'm sure someone could help with recommendations.

Hi Amanda. Thanks so much for taking the time to respond.I have consulted a few dermatologists in my area who arent acne scar specialists but they have experience with identifying scarring/treated many patients with scarring. Most have recommended me a combination of subcision/70% TCA cross or subcision/microneedling.

The RFMtreatments in my area are quite reasonably priced (300-500 USD for one session) with the newinfini device soI wanted to give it a shot but I know that TCA and microneedlingcannot be combined in one treatment so Im trying to do some research on which one would be more effective.

I am actually located in bangkok, Thailand at the moment and may consider traveling in the future but its rather difficult with the pandemic situation. However, I will keep that in mind when I return to the US. I wanted to proceed with a starter round of treatments because they are more reasonably priced here than in the US!

What is your experience with chemical peels, have they helped with your own boxcar scarring?

thank you again!

4 hours ago, Dan said:

My concern is that it looks like you are currently breaking out. Most important is to prevent acne so you prevent future scarring. I don't believe dermatologist or plastic surgeons will treat scarring if you are still breaking out. Do you have a plan to get your acne under complete control first?

Hi Dan,

Thank you for your response. I am still uncertain whats classified as active acnea lot of the redness is PIH from acne I got approx. 2monthsago. Would that be still considered active acne? How long would you recommend waiting until I am clear of active acne before proceeding with treatments? The few dermatologists I saw didnt mention anything of this so Im a bit clueless at the moment about what active acne is.

1 hour ago, Tee60 said:

Hi Amanda. Thanks so much for taking the time to respond.I have consulted a few dermatologists in my area who arent acne scar specialists but they have experience with identifying scarring/treated many patients with scarring. Most have recommended me a combination of subcision/70% TCA cross or subcision/microneedling.

The RFMtreatments in my area are quite reasonably priced (300-500 USD for one session) with the newinfini device soI wanted to give it a shot but I know that TCA and microneedlingcannot be combined in one treatment so Im trying to do some research on which one would be more effective.

I am actually located in bangkok, Thailand at the moment and may consider traveling in the future but its rather difficult with the pandemic situation. However, I will keep that in mind when I return to the US. I wanted to proceed with a starter round of treatments because they are more reasonably priced here than in the US!

What is your experience with chemical peels, have they helped with your own boxcar scarring?

thank you again!

Hi Dan,

 

Thank you for your response. I am still uncertain whats classified as active acnea lot of the redness is PIH from acne I got approx. 2monthsago. Would that be still considered active acne? How long would you recommend waiting until I am clear of active acne before proceeding with treatments? The few dermatologists I saw didnt mention anything of this so Im a bit clueless at the moment about what active acne is.

$300-500 is pretty not expensive compared to US prices. Mine was $1,000 per session. Another doctor wanted to charge $1,750 for one session including PRP. Rip off!

If your doctor has experience with TCA Cross and you are comfortable with the risks, I think you should stick with him/her. TCA Cross in the hands of a professional should be fine - as long as your doctor doesn't have shaky hands. It's a combination of knowing the proper acid %, pinpointing where the scar is, and then putting the right amount in the scar without going over the border. Some people do it themselves.

Unless your boxcar scarring is reallllllllllllllllllllllllllly shallow, chemical peels won't do anything for scars. If you combine with microneedling, maybe you will get light improvement. But I'm not an optimist when it comes to enough improvement for satisfaction.

5 hours ago, Tee60 said:

soI wanted to give it a shot but I know that TCA and microneedlingcannot be combined in one treatment

Is this accurate? Because I've had TCA cross and microneedling in the same session before and was never told that it would be a problem. What are the cons of doing it?

5 hours ago, Tee60 said:

I am still uncertain whats classified as active acnea lot of the redness is PIH from acne I got approx. 2monthsago

Active acne means new pimples every now and then, which you seem to have in the pictures you posted.

What I'm about to say is a massive generalisation so don't take it as gospel, but the fact you have access to doctors doing cannula (and even nokor) subcision is a good sign for starters. Cannula is, AFAIK, still quite a recent technique (picked up in the last few years, as is the literature on it). Also, the fact they didn't try and sell you lasers first, but rather sub/TCA. Many countries don't even have doctors that do sub, let alone the modern versions. Follow your doctor, assuming they have good reviews or seemknowledgeable from your consultation (e.g. things they told you in consultation matched what you have read in literature or at least good secondary sources). Good on you for having consultation with multiple doctors, definitely the way to go.

I agree with previous comments your scars are super mild, hard to say if they would be worth subcising, but a couple of pictures don't tell much. IMO follow their (your doctors) advice if, as I said, they are trustworthy/reputable. Subcision however, is a genuinely good treatment though with countless studies supporting its efficacy -its just better for rolling scars though.

As per your question about which needle, I haven't had either, but I have had the old school hypodermic needle sub many times, and the bruising/swelling/downtime really isn't that bad at all. Since you noted this as a concern, I wouldn't stress too much, but IIRC yes Nokor is a bit harsher and may have a little more downtime. Cannula is ideally better but I'd choose doctor skill above all.

8 hours ago, Amanda Hall said:

$300-500 is pretty not expensive compared to US prices. Mine was $1,000 per session. Another doctor wanted to charge $1,750 for one session including PRP. Rip off!

If your doctor has experience with TCA Cross and you are comfortable with the risks, I think you should stick with him/her. TCA Cross in the hands of a professional should be fine - as long as your doctor doesn't have shaky hands. It's a combination of knowing the proper acid %, pinpointing where the scar is, and then putting the right amount in the scar without going over the border. Some people do it themselves.

Unless your boxcar scarring is reallllllllllllllllllllllllllly shallow, chemical peels won't do anything for scars. If you combine with microneedling, maybe you will get light improvement. But I'm not an optimist when it comes to enough improvement for satisfaction.

Thanks a lot for all the advice. I have a much better idea of the treatments I want to do now which is probably going to be subcision and TCA. I guess now its all about finding the right dermatologist who has experience in my area. Thank you again.

3 hours ago, Wish we could go back in time said:

Is this accurate? Because I've had TCA cross and microneedling in the same session before and was never told that it would be a problem. What are the cons of doing it?

 

Active acne means new pimples every now and then, which you seem to have in the pictures you posted.

I was quite certain of proceeding with a combination treatment of subcision, TCA cross and RF microneedling but two dermatologists I consulted with expressed that it would be too much on the skin for one session so it would be better to choose between TCA or the RFM. Ive also tried to find definitive info on this and havent been able to. What are you thoughts and experiences withthis? It would be really helpful to know for sure. Thank you!

23 minutes ago, Flooressence said:

What I'm about to say is a massive generalisation so don't take it as gospel, but the fact you have access to doctors doing cannula (and even nokor) subcision is a good sign for starters. Cannula is, AFAIK, still quite a recent technique (picked up in the last few years, as is the literature on it). Also, the fact they didn't try and sell you lasers first, but rather sub/TCA. Many countries don't even have doctors that do sub, let alone the modern versions. Follow your doctor, assuming they have good reviews or seemknowledgeable from your consultation (e.g. things they told you in consultation matched what you have read in literature or at least good secondary sources). Good on you for having consultation with multiple doctors, definitely the way to go.

I agree with previous comments your scars are super mild, hard to say if they would be worth subcising, but a couple of pictures don't tell much. IMO follow their (your doctors) advice if, as I said, they are trustworthy/reputable. Subcision however, is a genuinely good treatment though with countless studies supporting its efficacy -its just better for rolling scars though.

As per your question about which needle, I haven't had either, but I have had the old school hypodermic needle sub many times, and the bruising/swelling/downtime really isn't that bad at all. Since you noted this as a concern, I wouldn't stress too much, but IIRC yes Nokor is a bit harsher and may have a little more downtime. Cannula is ideally better but I'd choose doctor skill above all.

Hi! Thank you so much for taking the time to respond to my subcision questionthat was really helpful and has really calmed my nerves a bit about the bruising and swelling associated with the procedure.

Ive consulted probably 5dermatologists so far and going to a few more and unfortunately,they have tried to sell me on their laser treatmentsbut based on my own research on Asian skin and Dr. Davin Limavideos on YouTube, Ivebeen quite adamant about no lasers for my firstgo and expressed that during my consultations.

So Ive just sat through consultations and veeredconversations away from lasers and instead asked more info about TCA and subcisions. And because Im in anAsian country, dermatologists are more understandingabout patients concerns with PIH afterlasers.

Thanks again!

I have another question regarding subcisionhave you experienced re-tethering after the procedure? And do most doctors use fillers to prevent that fromhappening or is that only used in cases of more serious atrophic scars?

1 hour ago, Tee60 said:

I have another question regarding subcisionhave you experienced re-tethering after the procedure? And do most doctors use fillers to prevent that fromhappening or is that only used in cases of more serious atrophic scars?

Yes I believe so. It took about 4 subcisions for there to be no more 'popping' (the sound of a tether breaking), with less and less on each subsequent one. But I also think this may also be in part due to my derm missing some or some not fully breaking due to the old needle method. They can't see under our skin so can only guess and feel where they are and I'm sure its a mix of both retethering and gaps they missed. I believe I heard in a vid by Dr Lim that no derm is perfect and spots will always be missed.

I also had a lot of rolling scars over my cheeks, so everyone will be different.

Well its good you are getting lots of opinions but if none of them are initially suggesting subcision - it may be for a reason. Subcision is really best for rolling/tethered scars. As I said, I can't gauge your skin over 3 photos, but its hard to spot any rolling, so perhaps that's why they have suggested laser.That said, if you do have tethered scars you will definitely be wanting it, so keep at it. There is still some benefit with it inducing collagen formation even if your scars are not tethered, but I'm not sure how exactly it would compare to the collagen formed from lasers or needling.

Also, not that many people globally seem to know how to perform subcision, so they may simply be offering laser because that's what they specialise in. Like I said in my previous comment, if they're offering cannula subcision, that's a good sign and shows they're right up to date with modern literature.

23 hours ago, Tee60 said:

What are you thoughts and experiences withthis? It would be really helpful to know for sure. Thank you!

I've only had one session so far so can't really give you an accurate advice, but I would say TCA cross does seem to improve from first session, whereas RFM didn't seem to do anything at all, but I don't know anything about this and I just follow what other knowledgable people recommend tbh.

1 hour ago, Wish we could go back in time said:

I've only had one session so far so can't really give you an accurate advice, but I would say TCA cross does seem to improve from first session, whereas RFM didn't seem to do anything at all, but I don't know anything about this and I just follow what other knowledgable people recommend tbh.

Thank you for sharing your experience, Ill keep that in mind!

On 6/22/2021 at 10:11 PM, Flooressence said:

Yes I believe so. It took about 4 subcisions for there to be no more 'popping' (the sound of a tether breaking), with less and less on each subsequent one. But I also think this may also be in part due to my derm missing some or some not fully breaking due to the old needle method. They can't see under our skin so can only guess and feel where they are and I'm sure its a mix of both retethering and gaps they missed. I believe I heard in a vid by Dr Lim that no derm is perfect and spots will always be missed.

I also had a lot of rolling scars over my cheeks, so everyone will be different.

Well its good you are getting lots of opinions but if none of them are initially suggesting subcision - it may be for a reason. Subcision is really best for rolling/tethered scars. As I said, I can't gauge your skin over 3 photos, but its hard to spot any rolling, so perhaps that's why they have suggested laser.That said, if you do have tethered scars you will definitely be wanting it, so keep at it. There is still some benefit with it inducing collagen formation even if your scars are not tethered, but I'm not sure how exactly it would compare to the collagen formed from lasers or needling.

Also, not that many people globally seem to know how to perform subcision, so they may simply be offering laser because that's what they specialise in. Like I said in my previous comment, if they're offering cannula subcision, that's a good sign and shows they're right up to date with modern literature.

Thanks again for all the helpful info. Imunsure if I have that much rolling going on either but mostdermatologistsIvegone to have mentioned rolling but I think the vast percentage of my scars are boxcar.

And yes! Ive read about collagen inducing effects so I will proceed with itand see how it goes!

I actually went to a dermatologist today and he mentioned subcision and TCA right away and didnt even talk lasers so Im pretty confident that Ill do a treatmentwith him. He also seemed super up to date with methods and mentioned that he no longer used nokor as there is more damage.

I have one another question regarding TCA. I am a bit anxious about the acid burning quite big holes in my face as Ive seen a post on here, what is your own experience with the treatmentif youve had any? Thank you again!

On 6/22/2021 at 12:04 PM, Amanda Hall said:

$300-500 is pretty not expensive compared to US prices. Mine was $1,000 per session. Another doctor wanted to charge $1,750 for one session including PRP. Rip off!

If your doctor has experience with TCA Cross and you are comfortable with the risks, I think you should stick with him/her. TCA Cross in the hands of a professional should be fine - as long as your doctor doesn't have shaky hands. It's a combination of knowing the proper acid %, pinpointing where the scar is, and then putting the right amount in the scar without going over the border. Some people do it themselves.

Unless your boxcar scarring is reallllllllllllllllllllllllllly shallow, chemical peels won't do anything for scars. If you combine with microneedling, maybe you will get light improvement. But I'm not an optimist when it comes to enough improvement for satisfaction.

Hi again!

can you please tell me more about your experience with the TCA treatment? Just any other helpful info about the procedure and aftercare?I just consulted with a dermtoday and with my type of scarring and skin type, he said its best to start with 70%.

I am especially worried about the treatment burning (somewhat) large holes in my faceas it does seem quite invasive? I know its supposed to restructure the scar and is collagen producing but have you or anyone else experienced the scar getting worst/larger?

He also mentioned that in his experience with the treatment, its best to use a syringe needle? What are your thoughts about this? I also found it interesting that he said he no longer uses a brush as he found the TCA solution to depigment the brush and that affecting the treatment? Does this sound legit?

thank you again!

6 hours ago, Wish we could go back in time said:

I've only had one session so far so can't really give you an accurate advice, but I would say TCA cross does seem to improve from first session, whereas RFM didn't seem to do anything at all, but I don't know anything about this and I just follow what other knowledgable people recommend tbh.

Thank you for this! Definitely confirmed my decision to go with TCA!

On 6/22/2021 at 4:32 PM, Wish we could go back in time said:

Is this accurate? Because I've had TCA cross and microneedling in the same session before and was never told that it would be a problem. What are the cons of doing it?

 

Active acne means new pimples every now and then, which you seem to have in the pictures you posted.

I consultedwithanother dermtoday and he said subcision, TCA cross (70%), and microneedling with a dermapen would be too much in one treatment. He just said it would be either subcision/MN or Subcision/TCA as it is too damaging for the skin to have all three? I guess perhaps the TCAwill burn a hole in the scar and then MN would further impact that? Im still unsure.Or perhaps its because of myAsian skin type?

10 hours ago, Tee60 said:

Thanks again for all the helpful info. Imunsure if I have that much rolling going on either but mostdermatologistsIvegone to have mentioned rolling but I think the vast percentage of my scars are boxcar.

And yes! Ive read about collagen inducing effects so I will proceed with itand see how it goes!

I actually went to a dermatologist today and he mentioned subcision and TCA right away and didnt even talk lasers so Im pretty confident that Ill do a treatmentwith him. He also seemed super up to date with methods and mentioned that he no longer used nokor as there is more damage.

I have one another question regarding TCA. I am a bit anxious about the acid burning quite big holes in my face as Ive seen a post on here, what is your own experience with the treatmentif youve had any? Thank you again!

Hi again!

can you please tell me more about your experience with the TCA treatment? Just any other helpful info about the procedure and aftercare?I just consulted with a dermtoday and with my type of scarring and skin type, he said its best to start with 70%.

I am especially worried about the treatment burning (somewhat) large holes in my faceas it does seem quite invasive? I know its supposed to restructure the scar and is collagen producing but have you or anyone else experienced the scar getting worst/larger?

He also mentioned that in his experience with the treatment, its best to use a syringe needle? What are your thoughts about this? I also found it interesting that he said he no longer uses a brush as he found the TCA solution to depigment the brush and that affecting the treatment? Does this sound legit?

thank you again!

Thank you for this! Definitely confirmed my decision to go with TCA!

I only had TCA Cross done once on one scar. The dermatologist put it in the corner of a boxcar and missed about 75% of the scar. Many times patients can see their scars better than doctors. That was the only time I saw her. One treatment was certainly not enough to see any improvement.

Then I decided to see Dr. Rullan who is in the same state where I live. He does Phenol Cross which is supposedly safer than TCA Cross. I only did a few scars but I didn't see changes in the scars I hated the most. Almost all of my scars are boxcar scars so maybe Cross is better for ice pick ones.

I mention Cross to people because of other's successful experiences, not mine.

18 hours ago, Tee60 said:

I consultedwithanother dermtoday and he said subcision, TCA cross (70%), and microneedling with a dermapen would be too much in one treatment. He just said it would be either subcision/MN or Subcision/TCA as it is too damaging for the skin to have all three? I guess perhaps the TCAwill burn a hole in the scar and then MN would further impact that? Im still unsure.Or perhaps its because of myAsian skin type?

I'm not sure if it's because of your skin type, but I've had those 3 treatments in the same session, the microneedling was the new genius device however not sure if it matters. No one ever told me it was too damaging for the skin to have all three, many drs say they do a combination of treatments for better improvement so I thought it would be fine, I don't know if my skin got damaged because of doing all of those but I don't think so? Hopefully not

And although people recommend tca cross for boxscars as well, the truth is you will see a lot more visible improvement on icepick scars than boxscars with this method

1 hour ago, Wish we could go back in time said:

I'm not sure if it's because of your skin type, but I've had those 3 treatments in the same session, the microneedling was the new genius device however not sure if it matters. No one ever told me it was too damaging for the skin to have all three, many drs say they do a combination of treatments for better improvement so I thought it would be fine, I don't know if my skin got damaged because of doing all of those but I don't think so? Hopefully not

And although people recommend tca cross for boxscars as well, the truth is you will see a lot more visible improvement on icepick scars than boxscars with this method

Thats really good to knowthanks for the info. I dont know either if its because of my skin type,perhaps it is!

sighitdoes seem likeTCA is better for ice pick but Im super against lasers atm (because of PIH associated with Asian skin and most people here seem to agree that lasers have caused more damage it seems?)so I feel like subcision and TCA is the best course of first round treatment?

what are your thoughts? Do you have majority boxcar scarsand what have you found to be more helpful than other treatments?

1 hour ago, Tee60 said:

Thats really good to knowthanks for the info. I dont know either if its because of my skin type,perhaps it is!

sighitdoes seem likeTCA is better for ice pick but Im super against lasers atm (because of PIH associated with Asian skin and most people here seem to agree that lasers have caused more damage it seems?)so I feel like subcision and TCA is the best course of first round treatment?

what are your thoughts? Do you have majority boxcar scarsand what have you found to be more helpful than other treatments?

I'd say PIE (erythema) is worse than PIH - this is just for me. I got PIH and I had brown spots after fractional CO2. It resolved after several months. But PIE is worse because it sticks out more. The redness to me looks worse than the brownness.

Some doctors won't be aggressive with lasers to avoid this. But you kinda have to take that risk if you want better results. I've gotten erbium treatments done before and saw no results. Healing time was fast and I got no PIH/PIE but there was no improvement.

Lasers can cause new scars. I got new ones. But it also smoothed out a number of scars. For me, it's been a good trade-off but I'm at the point where I've gotten enough improvement and it's not worth the time and recovery to do more treatments, unless I am really picky and have months of downtime. I'm still recovering from my last fractional CO2 treatment from two months ago. The PIE really needs to be taken seriously. But if you wear makeup, it's easier to deal with.

My scars are mostly boxcar scars. Lasers aren't a miracle and some scars don't get better with lasers. I tried Phenol Cross on them but haven't seen results. I'm still going to get more Cross treatments because the downtime is much better than lasers.

2 hours ago, Amanda Hall said:

I'd say PIE (erythema) is worse than PIH - this is just for me. I got PIH and I had brown spots after fractional CO2. It resolved after several months. But PIE is worse because it sticks out more. The redness to me looks worse than the brownness.

Some doctors won't be aggressive with lasers to avoid this. But you kinda have to take that risk if you want better results. I've gotten erbium treatments done before and saw no results. Healing time was fast and I got no PIH/PIE but there was no improvement.

Lasers can cause new scars. I got new ones. But it also smoothed out a number of scars. For me, it's been a good trade-off but I'm at the point where I've gotten enough improvement and it's not worth the time and recovery to do more treatments, unless I am really picky and have months of downtime. I'm still recovering from my last fractional CO2 treatment from two months ago. The PIE really needs to be taken seriously. But if you wear makeup, it's easier to deal with.

My scars are mostly boxcar scars. Lasers aren't a miracle and some scars don't get better with lasers. I tried Phenol Cross on them but haven't seen results. I'm still going to get more Cross treatments because the downtime is much better than lasers.

What doc did your co2 if you don't mind me asking

18 hours ago, Tee60 said:

what are your thoughts? Do you have majority boxcar scarsand what have you found to be more helpful than other treatments?

Yea I have boxscars mostly and quite frankly can't tell you if I got any improvement on those, but I heard the best treatment for these is ablative laser on the edges, which I haven't tried yet but want to. TCA Cross is what most Drs recommend tho, to avoid pigmentation issues and other concerns, so that's the way to go for sure if you don't wanna take any risks.