Your assessment is correct. I would say if you want to start seeing improvement firstfull ablative laser on the edges of boxcars and subcision together. Alsocross for icepick. Consider excision for 1 or 2 as well. Just to see how you heal from them. If after two session of cross and u dont see much improvement from them then you can technically excise them. Smaller the excision area the better the outcome. That is why it is always done for icepick scars. I would suggest mark taylor in Salt Lake City if you can. He can combine all these in a single session. He will most likely suggest you to get a lot of excision since you have some deeper indent scars but say that u are not comfortable and want to try with safer modalities. So u can say under 5 excision, subcision, laser or boxcar edges, he will also add a tca peel. Dont get fractional laser it could likely give you otter appearance look. Go for full abaltive Erbium laser at the end when u have fixed most of you boxcar and icepick scars.

4 minutes ago, getsmart121 said:

Your assessment is correct. I would say if you want to start seeing improvement fast full ablative laser on the edges of boxcars and subcision together.

Thank you! Is TCA/Phenol cross necessary then? The thing is that Dr. Rullan doesn't provide full ablative laser. If cross isn't necessary, then I will start with a local doctor on subcision and laser first. Or I can start with subcision and cross with Rullan, and full ablative with a local provider.

21 minutes ago, ThickHumor said:

Thank you! Is TCA/Phenol cross necessary then? The thing is that Dr. Rullan doesn't provide full ablative laser. If cross isn't necessary, then I will start with a local doctor on subcision and laser first. Or I can start with subcision and cross with Rullan, and full ablative with a local provider.

Cross is done for smaller area but deeper dents in skin, excision can also be done. But a little risky as it could indented. In my opinion smaller scars are less likely to open up after excision. The fastest is excision more safer is cross phenol or tca. Phenol is better as it stops scar widening. I had similiar scarring, and dr rullan 2 sessions didnt work for me. Maybe u can try if you have money. Dr mark taylor is very good with working with lasers as he knows how to flatten the sharp edges of boxcars. I remember he kept ablating an area with a hard edge and it became more rolling.

smaller deep scars aka icepick:excision(faster)or cross(could take 3 to 4 session not guaranteed results)

rolling: subcision and full ablative erbium laser on the edges.

boxcars: full ablative on scar edges. Excision for the deep one again not large in area.

filler and full ablative erbium laser at the end or you can also consider deep peel from rullan.

On 12/9/2021 at 10:57 PM, getsmart121 said:

Cross is done for smaller area but deeper dents in skin, excision can also be done. But a little risky as it could indented. In my opinion smaller scars are less likely to open up after excision. The fastest is excision more safer is cross phenol or tca. Phenol is better as it stops scar widening. I had similiar scarring, and dr rullan 2 sessions didnt work for me. Maybe u can try if you have money. Dr mark taylor is very good with working with lasers as he knows how to flatten the sharp edges of boxcars. I remember he kept ablating an area with a hard edge and it became more rolling.

smaller deep scars aka icepick:excision(faster)or cross(could take 3 to 4 session not guaranteed results)

rolling: subcision and full ablative erbium laser on the edges.

boxcars: full ablative on scar edges. Excision for the deep one again not large in area.

filler and full ablative erbium laser at the end or you can also consider deep peel from rullan.

Thank you for the detailed explanation. I guess your suggestion is to focus on subscision and full ablative laser? Cross won't be as effective on boxscars?

On 12/9/2021 at 10:57 PM, getsmart121 said:

Cross is done for smaller area but deeper dents in skin, excision can also be done. But a little risky as it could indented. In my opinion smaller scars are less likely to open up after excision. The fastest is excision more safer is cross phenol or tca. Phenol is better as it stops scar widening. I had similiar scarring, and dr rullan 2 sessions didnt work for me. Maybe u can try if you have money. Dr mark taylor is very good with working with lasers as he knows how to flatten the sharp edges of boxcars. I remember he kept ablating an area with a hard edge and it became more rolling.

smaller deep scars aka icepick:excision(faster)or cross(could take 3 to 4 session not guaranteed results)

rolling: subcision and full ablative erbium laser on the edges.

boxcars: full ablative on scar edges. Excision for the deep one again not large in area.

filler and full ablative erbium laser at the end or you can also consider deep peel from rullan.

I did look into dr. Mark Taylor. My concern is that his subcision procedure seems a little too aggressive. I read some people's cheeks feel numb for months. Not super comfortable with the risks.

11 hours ago, ThickHumor said:

 

Thank you for the detailed explanation. I guess your suggestion is to focus on subscision and full ablative laser? Cross won't be as effective on boxscars?

I did look into dr. Mark Taylor. My concern is that his subcision procedure seems a little too aggressive. I read some people's cheeks feel numb for months. Not super comfortable with the risks.

Hmm then just go for full ablative erbium laser for boxcars but he doesn't do cross for your icepick scars. I see that you have mostly icepick and some deeper boxcar scars. Cross should work on boxcar scars but it just that it might taketime.

seems like maybe you can start with dr rullan for 2-3(each session two to three month apart) sessions and analyze your situation as your scars moderate in depth. And then go forfullablative laser for boxcar edges. Send your pictures to dr rullan and see what he says.

4 hours ago, getsmart121 said:

Hmm then just go for full ablative erbium laser for boxcars but he doesn't do cross for your icepick scars. I see that you have mostly icepick and some deeper boxcar scars. Cross should work on boxcar scars but it just that it might taketime.

seems like maybe you can start with dr rullan for 2-3(each session two to three month apart) sessions and analyze your situation as your scars moderate in depth. And then go forfullablative laser for boxcar edges. Send your pictures to dr rullan and see what he says.

Thanks again. Just curious have you received treatment from Dr. Mark Taylor?

I'm not sure if subcision would help with your boxcar scars that much. I think that money could be better spent on more Cross sessions, or maybe a fractional CO2 laser treatment down the road.

Cross can take a series of treatments for you to see a noticeable difference. It seems to have demonstrated results on some patients who have stuck with it for months to years.

If the cost of Erbium from Rullan is fine with you, it might be a good option. It will save time as you can do both treatments at once. Recovery will also overlap with Cross.I think he still uses an Alma Pixel laser (2940 or something similar). There might be better Erbium machines or doctors out there but it could be a crapshoot. My 2nd Erbium session was better than my first one with him.

13 hours ago, Amanda Hall said:

I'm not sure if subcision would help with your boxcar scars that much. I think that money could be better spent on more Cross sessions, or maybe a fractional CO2 laser treatment down the road.

Cross can take a series of treatments for you to see a noticeable difference. It seems to have demonstrated results on some patients who have stuck with it for months to years.

If the cost of Erbium from Rullan is fine with you, it might be a good option. It will save time as you can do both treatments at once. Recovery will also overlap with Cross.I think he still uses an Alma Pixel laser (2940 or something similar). There might be better Erbium machines or doctors out there but it could be a crapshoot. My 2nd Erbium session was better than my first one with him.

Thank you for your response! Do you know if the Erbium at Rullen is ablative? I believe for my boxscars, ablative laser will give better results.

46 minutes ago, ThickHumor said:

Thank you for your response! Do you know if the Erbium at Rullen is ablative? I believe for my boxscars, ablative laser will give better results.

Yes, it's ablative. While I've said Erbium isn't as powerful as CO2, if you do enough treatments, I believe it could improve your scars somewhat unless you have deep scars. It's also much easier to recover from than CO2.

You will have scabbing for about five days with either Cross or Erbium.

1 hour ago, ThickHumor said:

Thank you for your response! Do you know if the Erbium at Rullen is ablative? I believe for my boxscars, ablative laser will give better results.

Yes dr rullan does fractional ablative laser but he does less passes. Yes, I did receive treatment with dr taylor. Dr taylor treatment worked for boxcars in the sense that he did full ablative on the edges of boxcarsand for deep icepicks excision combined with fractional erbium laser. But i did notice worsening of texture like dotted appearance from erbium fractional laser. All in all dr taylor approach worked for boxcar and icepick scars but didn't work for overall smoothness. I believe fractional co2 would be better than erbium,as erbium fractional only vaporizes columns of tissue where co2 fractional besides removing also coagulates the surrounding issues.

22 hours ago, Amanda Hall said:

Yes, it's ablative. While I've said Erbium isn't as powerful as CO2, if you do enough treatments, I believe it could improve your scars somewhat unless you have deep scars. It's also much easier to recover from than CO2.

You will have scabbing for about five days with either Cross or Erbium.

Thank you. How do you like your results from Dr. Rullan? Do you also have some boxscars?

10 hours ago, ThickHumor said:

Thank you. How do you like your results from Dr. Rullan? Do you also have some boxscars?

I like Dr. Rullan and his office which is why I've gone back multiple times. As far as results go, I haven't gotten the results I thought I'd get. I think some people get better results because of their scar types. Maybe some boxcar scars are different.

However, I believe he's geniune and knowledgeable and his approach makes sense. It's kinda like stains on clothes. Sometimes you can buy stain remover and get those things out. But if they are oil or dye stains, you can only do so much. That's how I feel with some of my scars.

11 hours ago, Amanda Hall said:

I like Dr. Rullan and his office which is why I've gone back multiple times. As far as results go, I haven't gotten the results I thought I'd get. I think some people get better results because of their scar types. Maybe some boxcar scars are different.

However, I believe he's geniune and knowledgeable and his approach makes sense. It's kinda like stains on clothes. Sometimes you can buy stain remover and get those things out. But if they are oil or dye stains, you can only do so much. That's how I feel with some of my scars.

Thank you. Really appreciate your insights. I think I will consult with a local provider who has experience with subcision and ablative Eurbium first and decide. I might get a treatment and see how my skin responds before spending a lot of money to travel to see Rullan.

On 12/16/2021 at 8:28 PM, ThickHumor said:

Thank you. Really appreciate your insights. I think I will consult with a local provider who has experience with subcision and ablative Eurbium first and decide. I might get a treatment and see how my skin responds before spending a lot of money to travel to see Rullan.

Sounds good. Let us know how that goes and hopefully other members can help. Always do your own research. Doctors can tell you anything but results are not guaranteed.