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Im with JaysonC its a tough call for me to goto see Dr Rullan for a phenol peel so im up in the year to go thru all that redness and pain and yet it is only good for texture and real smaill superficial scars and wont do much for my big scars!
But all credit to shei514 she has done well and stayed strong!
3 hours ago, pleasehelp321 said:Im with JaysonC its a tough call for me to goto see Dr Rullan for a phenol peel so im up in the year to go thru all that redness and pain and yet it is only good for texture and real smaill superficial scars and wont do much for my big scars!
But all credit to shei514 she has done well and stayed strong!
I was surprised to hear that after the phenol you are also expected to be on a low dose of accutane? Not sure how credible this is maybe @shei514can comment
This is a really interesting thread I've been casually following but just rereading it now, I'm surprised you thought 10-15 minutes of subcision is rushed. I'm curious now, have you heard others accounts of it being longer?
The reason I ask is I'm interesting on what the standard usually is? I've had varying lengths of subcision based on the specialist but I wouldn't think any would have been that long, though maybe I don't have the best gauge of time when sedated etc.
How long did Dr Rullan spend subcising?
4 minutes ago, Flooressence said:This is a really interesting thread I've been casually following but just rereading it now, I'm surprised you thought 10-15 minutes of subcision is rushed. I'm curious now, have you heard others accounts of it being longer?
The reason I ask is I'm interesting on what the standard usually is? I've had varying lengths of subcision based on the specialist but I wouldn't think any would have been that long, though maybe I don't have the best gauge of time when sedated etc.
How long did Dr Rullan spend subcising?
I think the reason it felt so rushed to me with the previous dermatologistsis that no special lighting was ever used, and rarely were my scars marked (marked only with Dr.Sajic).Having subcision done with Rullan was truly a different experience for me. He really blew my cheeks up with the tumescent anesthesia (more than it's ever been done before), and it felt like he was quite thorough (special lighting was used). I think my subcision was about 20 minutes yesterday. But mind you, at this point in the game i've had 8+ subcisions, and I don't have any rolling scars, so the subcision was primarily focused on breaking up the fibrosis from the previous TCA cross procedures i've had done
I believe subcision can be done longer, especially when I spoke to Dr.Lemckert & Dr.Sajic during previous subcisions and they mentioned how it would be "impossible" to break up all of the scar bands at once.... so it makes me think it is up to the practitioner with the length of time they spend subcising + how much needs to be subcised
2 minutes ago, Catharsis2018 said:I think the reason it felt so rushed to me with the previous dermatologistsis that no special lighting was ever used, and rarely were my scars marked (marked only with Dr.Sajic).Having subcision done with Rullan was truly a different experience for me. He really blew my cheeks up with the tumescent anesthesia (more than it's ever been done before), and it felt like he was quite thorough (special lighting was used). I think my subcision was about 20 minutes yesterday. But mind you, at this point in the game i've had 8+ subcisions, and I don't have any rolling scars, so the subcision was primarily focused on breaking up the fibrosis from the previous TCA cross procedures i've had done
I believe subcision can be done longer, especially when I spoke to Dr.Lemckert & Dr.Sajic during previous subcisions and they mentioned how it would be "impossible" to break up all of the scar bands at once.... so it makes me think it is up to the practitioner with the length of time they spend subcising + how much needs to be subcised
Thanks, its good to get your perspective on the matter. I always felt my subcisions were too rushed, so I went to a more renowned Dr more recently and while the experience was way better (more thorough), I was still questioning whether it was enough. Similarly though he combined it with quite a powerful laser so perhaps he didn't want to go overboard, though from your most recent update it sounds like you've had much more all in the same session.
Anyway thank you, this is something I'll raise next time I see my specialist.
6 hours ago, pleasehelp321 said:Im with JaysonC its a tough call for me to goto see Dr Rullan for a phenol peel so im up in the year to go thru all that redness and pain and yet it is only good for texture and real smaill superficial scars and wont do much for my big scars!
But all credit to shei514 she has done well and stayed strong!
Exactly my thoughts. People with superficial scarring are perfect candidates fo the phenol peel and can realistically expect nice improvement but for deep scars? I am yet to see it. Why do it then in the first place? It makes no sense. If it wasn't such an invasive procedure with half a year of recovery time, ok get it done just for the texture. By imprving the texture and eliminating the small scars your skin will generally look better so it's a win scenario. But I honestly wasn't impressed with the before and afters for the deeper scars. Life is short I am not willing to spend a year of my life time recovering from a brutal treatment which wont do any change to my deeper scars.
6 hours ago, JaysonC said:Exactly my thoughts. People with superficial scarring are perfect candidates fo the phenol peel and can realistically expect nice improvement but for deep scars? I am yet to see it. Why do it then in the first place? It makes no sense. If it wasn't such an invasive procedure with half a year of recovery time, ok get it done just for the texture. By imprving the texture and eliminating the small scars your skin will generally look better so it's a win scenario. But I honestly wasn't impressed with the before and afters for the deeper scars. Life is short I am not willing to spend a year of my life time recovering from a brutal treatment which wont do any change to my deeper scars.
Wrote this to @getsmart121but reposting it here and adding some more infoafter talking to my previous derm about it (who believed phenol was the gold standard), and readingRullan's 2004 study...please keep in mind CO2 and Erbium lasers have NOT changed since 2004. The laser technology is THE SAME. They both still target water in the treatment area (this is called the target chromophore) BUT I do believe deep atrophic scars will need excision or a punch graft etc prior to the phenol in order to have the most benefit.
"Carbon dioxide laser energy has water as its target, and after several passes, the tissue is desiccated and cannot be ablated more deeply no matter how many passes are done. This limits its effectiveness on deep scars and wrinkles. This limitation is compensated by combining carbon dioxide with erbium-YAG laser energy and is currently considered the gold standard. Dermabrasion is typically performed on tumesced skin in a bloody field, and separating normal versus scarred skin during dermabrasion requires a skilled operator.9 The lead authors dissatisfaction with carbon dioxide laser resurfacing even with dermabrasion, as Fulton10 has described, and the complication profile of the BG peel, prompted him to search further into the world of modified phenol peels. "
https://www.drrullan.com/wp-content/uploads/2020/01/3431158a99250d951e124f497a9197c2.pdf
1 hour ago, Catharsis2018 said:BUT I do believe deep atrophic scars will need excision or a punch graft etc prior to the phenol in order to have the most benefit.
Do you know a reputable place where excisions or punch grafts are offered?
Thank you for Dr Rullan's paper but I have already read it. This is part of the reason why I am skeptical about the results of any laser for deep scars. Lasers just dry the skin.
The combination co2 + erbium as suggested by Dr Rullan is interesting but I haven't found a derm who offers it. It is just as difficult as finding one who performs tangential lasering of the scar's edges. The only one I know of is Dr Mark Taylor but he is in the US.
12 minutes ago, JaysonC said:Do you know a reputable place where excisions or punch grafts are offered?
Thank you for Dr Rullan's paper but I have already read it. This is part of the reason why I am skeptical about the results of any laser for deep scars. Lasers just dry the skin.
The combination co2 + erbium as suggested by Dr Rullan is interesting but I haven't found a derm who offers it. It is just as difficult as finding one who performs tangential lasering of the scar's edges. The only one I know of is Dr Mark Taylor but he is in the US.
Maybe my previous derm in Guelph, Ontario (Dr Sajic). But I am sure finding a derm that is experienced in mole removal would be a good bet for punch excision, and requesting for micro botox to ensure the scar remains closed.
i dont know , erbium and CO2 combo seems quite intense to me just because of the possibility of fat depletion
38 minutes ago, Catharsis2018 said:Maybe my previous derm in Guelph, Ontario (Dr Sajic). But I am sure finding a derm that is experienced in mole removal would be a good bet for punch excision, and requesting for micro botox to ensure the scar remains closed.
i dont know , erbium and CO2 combo seems quite intense to me just because of the possibility of fat depletion
Thanks for the tip. I see already i will have to travel to the US to get my scars treated properly. Excision and tangential lasering of the edges are treatments from which I hope to see improvement.
6 hours ago, JaysonC said:Thanks for the tip. I see already i will have to travel to the US to get my scars treated properly. Excision and tangential lasering of the edges are treatments from which I hope to see improvement.
Where are you from? i believe there are decent dermatologists around but you just have to find them
16 hours ago, pleasehelp321 said:what bothers me alot is there anything one can do for scarred pores and the ice pick type scars that look like real tiny holes pierced by a toothpick? I have tried everything to minimise these but they just stand out so much?
What you are defining is texture. From the pictures I was not able to tell if you have these if yes phenol,Chemobrasion is the method to go with. He could perform physical abrasion procedures as well lol the procedure you dream, Inhis article he said use uses curette,sandpaper etc. As long as they are not deep this procedure should be able to Work. Laser cant for some reason remove this. Not sure if someone does fully cheek full ablative will the result be comparable. So far I have read is people who have done fully ablative full cheek they havent seen their texture issues taken care of completely . I mean they saw results but I guess the texture was still there.
15 hours ago, pleasehelp321 said:i know its real hard to say but from my picture/s could u draw a circle or outloine what scars you think a phenol peel could help? thanks getsmart121
No one knows it will work or not. Even the top derms. It wont correct volume loss or fat loss as that is not an indent due to collagen. Your body doesnt create fat. But if what you are saying you want to correct texture issues such as scarred pores etc, the rule of thumb is the closest scar to normal skin should see the most improvement and the farther the scar is always from normal skin lower the improvement . If dr rullan decides to use physical abrasion procedures then maybe all those scars will be softened. If you are counting if these procedure will work for texture aka scarred pores. Tiny icepick, shallow boxcars,you are on the right track. If you are thinking to correct volume its preferred to keep your expectation low.
17 hours ago, pleasehelp321 said:i know its real hard to say but from my picture/s could u draw a circle or outloine what scars you think a phenol peel could help? thanks getsmart121
A phenol peel isnt a slam dunk for acne scars unfortunately nothing is. I would pay an arm and a leg for something that was like most of us would. Hopefully the future is promising.
update 2 (06/20/2022): Yesterday, I was visiting my mom and her new kittens and one of them inevitably scratched my nose, above my lip and below my right eye - leaving a long laceration on my nose and a puncture below my left eye. I began to bawl. My mom questioned why I was bawling, and I spoke aloud the thoughts racing in my head: I can™t deal with potentially having another two scars to treat when I have such difficult treatable acne scars in the first place. To my annoyance, she went on some rant about how œno one notices my scars and I am delusioned. Extremely irritating to hear, especially when your mother has porcelain skin (seriously - porcelain. My whole life, she has had perfect porcelain skin. Sometimes people do a double fake when I introduce her as my mom and my worst self-critic says it™s because of the difference in our skin). Anyways.. long story short, I took a few facial photos last night in my teary state in her living room¦ and despite the overhead lighting at my moms, myscars are looking more shallow (no where near where I™d like them to be. But I have been doing monthly Secret PRO RFM + light co2 peel in the same session and will continue this regimen until my phenol in December. So far I have done two sessions - third session is booked for this afternoon. The other part of me says my scars look better because of the lighting.. though in the past I™ve taken photos in this lighting before at her place and thought my scars looked worse). As for the mental, I am trying to find a therapist¦ not sure why I didn™t do this sooner, maybe denial.. but at this point, I think it™s needed. Photosfrom June 19 2022 after that ¦.. scratched my face):
