26 minutes ago, Uglyasshoe said:

As the title suggests, I need help identifying my acne scars, as well as some suggestions about the best course of action in terms of treating them.

Firstly, I would like to have a few opinions and some advice to help determine the type of scars I have: Boxcar, ice pick, or other, as well as whether or not they are tethered.

Secondly, I need help determining their severity: are they mild, moderate, or severe. Furthermore, do they appear to be deep or shallow.

Thirdly, I need some advice regarding the best course of action to take in terms of treating them. Which of these treatments would be most suitable specifically for my scar type:

Punch Excision

Punch Grafting

TCA Cross (TCA or Phenol, which is more effective for my scars and my skin specifically. What are the differences between each, if any)

Subcision (Canulla, Nokor, or Taylor Liberator; which of these is the most effective for my scars specifically, and which one has the most research backing it up)

Fully Ablative Laser (Co2 or Erbium, which is more effective for my scar and skin type, what are the differences, if any.)

Fractional laser (Co2 or Erbium, which is more suitable for my scars specifically; would a fractional laser suffice for my scars or do I need a fully ablative laser to see any meaningful and substantial results)

Any other methods that might be more effective.

Lastly, what degree of improvement might be reasonably expected for my scars specifically. Could I expect total eradication, or only partial improvement. If so, what percentage of improvement might be reasonable to expect for my scars specifically.

Here are some pictures. They are on my temple, and are very easily detectable under harsh lighting:

Here are some pictures of them being stretched to help determine whether or not they are tethered:

 

Thanks!!!

Ice-pick. Traditionally simple to treat with TCA or punch excisions. 

2 hours ago, Dontgiveupitsonlyscars said:

Ice-pick. Traditionally simple to treat with TCA or punch excisions.

@Dontgiveupitsonlyscars are they deep or shallow? How much improvement can I expect? Can they completely go away?

Moderate icePick

53 minutes ago, Sky123123123 said:

Moderate icePick

Recommended treatments? How much improvement is it realistic to expect?

On 3/3/2022 at 4:07 PM, JesusChrist said:

If i were you i would leave it alone, since treatments might get them worse.

Tca cross or excision for your temples, these are the options.

Since they are on your temples i would suggest you to dont mess with them.

Any particular reason? Are temples more prone to averse side effects? I wish I could leave them alone but they are quite noticeable and very bothersome.

On 3/5/2022 at 3:00 PM, JesusChrist said:

You have two options tca cross or excision. Since your scars are on the temples and there are veins in there be careful with excision find a good dr.

I see. Which do you recommend? How much improvement can I expect? Can they completely go away? Is 80-90% improvement possible? I've heard punch excision can go very wrong and leave a worse scar than before. How many sessions of TCA cross might it take?

You never know how many it will take. However tca by a profession will be perfect for those scars and you could expect maybe 90 percent improvement and practically invisible to anyone who isnt 5 inches from your face

1 minute ago, Scarsmakemewanttodie said:

You never know how many it will take. However tca by a profession will be perfect for those scars and you could expect maybe 90 percent improvement  and practically invisible to anyone who isn™t 5 inches from your face 

 thats so relieving to hear!!!!!!! 90% improvement would make me more than happy!!! Plus i could then always proceed to get a laser treatment to further smooth them out and get near perfection.

9 minutes ago, Uglyasshoe said:

 thats so relieving to hear!!!!!!! 90% improvement would make me more than happy!!! Plus i could then always proceed to get a laser treatment to further smooth them out and get near perfection.

Do a test (1 spot) first with TCA to see if it works. Don't do all. Just my advice. Pay more if the doctor wants for that test/day. Moreover, I agree with most of what they said. They are pretty minor or moderate depth but minor as in appearance but I get they bother you. I would say just grow your hair over them lol.

2 minutes ago, harmlessboy1441 said:

Do a test (1 spot) first with TCA to see if it works. Don't do all. Just my advice. Pay more if the doctor wants for that test/day. Moreover, I agree with most of what they said. They are pretty minor or moderate depth but minor as in appearance but I get they bother you. I would say just grow your hair over them lol.

That's some greatadvice! I will definitely make sure to do that. And yeah I understand they are relatively minor, but they still stand in a glaring contrast to the surrounding skin. Theydo appear worse in some photos and thats because i keep picking on them making them red. As for the hair part, thats what i usually do, and for a while I forget about them, but come time for me to get a haircut, they become visible again and start bothering me. It'll just be relieving to know that theyre gone for good, once and for all no matter what my hairstyle.

Do you mind me asking where your from and I might be able to give you some recommendations

3 hours ago, Uglyasshoe said:

That's some greatadvice! I will definitely make sure to do that. And yeah I understand they are relatively minor, but they still stand in a glaring contrast to the surrounding skin. Theydo appear worse in some photos and thats because i keep picking on them making them red. As for the hair part, thats what i usually do, and for a while I forget about them, but come time for me to get a haircut, they become visible again and start bothering me. It'll just be relieving to know that theyre gone for good, once and for all no matter what my hairstyle.

I mean, again be careful with TCA cross. It seems to work for some but not for others, and has a risk of widening or deepening slightly. I don't know whether it's person or case that affects it. I saw in person 4 scars widen so I know it's not full proof. That's why I said, do 1 spot only, see if it helps if not you'll be thankful. Better to pay $700 extra than be stuck with 6 widened scars vs 1.

The only other thing that has been touted on the boards is something like punch excision for maybe the deeper/bigger one in particular. I honestly know almost nothing about punch excision just from reading it seems like your scars might fit at least some of them.

There are other things like needling with plasma rich platelets or whatever and I really don't know if it works. I'm negative on needling in general but one case I saw/read on here seems to show improvement along with some other stuff.

Keep your expectations realistic though. But honestly do more research and get opinions (at least 2).

These are moderate to shallow depth scar you probably dont need excision. Just few tcacross session. This is going to removethe edges and make scar rolling and hence least noticeable.

2 hours ago, getsmart121 said:

These are moderate to shallow depth scar you probably dont need excision. Just few tcacross session. This is going to removethe edges and make scar rolling and hence least noticeable.

Thank you for responding!! I really appreciate it! Other ppl here have alsomentioned tca so I might have to giveit a go. Theyre already pretty shallow and in some pictures seem to be worse solely because I have a bad habit of constantly touching them and hence irritating the skin.

5 hours ago, Scarsmakemewanttodie said:

Do you mind me asking where your from and I might be able to give you some recommendations

Sure!!!! That would be awesome. I live in the United States and am in the state ofMissouri. There unfortunately arent a lot of options in terms of scar treatments where I live, which is a rural town. I would definitely have to save up to eventually seek treatment else where.

3 hours ago, harmlessboy1441 said:

The only other thing that has been touted on the boards is something like punch excision for maybe the deeper/bigger one in particular. I honestly know almost nothing about punch excision just from reading it seems like your scars might fit at least some of them.

There are other things like needling with plasma rich platelets or whatever and I really don't know if it works. I'm negative on needling in general but one case I saw/read on here seems to show improvement along with some other stuff.

Yeah I was looking into that too. Im just scared that its a sophisticated surgical procedure and if done wrong cant be fixed. Its literally taking out a portion of your skin and stitching it together. If it goes wrong, that skin is lost forever and wont grow back.
I have looked into micro needlingand PRP too but honestly both seem to be simply pseudo science with no actual benefits, except perhaps RF micro-needling and that too isnt as potent as, say, lasers.

try subcision first. Its cheap and can break potential tethering, and it can stimulate collagen. Many ice-pickscars aretethered. It won't hurt you (if done by a professional), and if you will not hear popping sound then you can jump straight onTCA.

13 hours ago, Candy Says said:

try subcision first. Its cheap and can break potential tethering, and it can stimulate collagen. Many ice-pickscars aretethered. It won't hurt you (if done by a professional), and if you will not hear popping sound then you can jump straight onTCA.

Thank you for responding! If Im correct, isnt subscision more suitable for bigger scars like rolling or wider boxcar?Then again I may be wrong. But I will definitely look into subcision as well. Furthermore since the scars are on my temple the insertion point can be made at a spot that can be covered by hair.

4 hours ago, Uglyasshoe said:

Thank you for responding! If Im correct, isnt subscision more suitable for bigger scars like rolling or wider boxcar?Then again I may be wrong. But I will definitely look into subcision as well. Furthermore since the scars are on my temple the insertion point can be made at a spot that can be covered by hair.

Yes I think the thesis is that subcsision is more for larger or wider/rolling but I think it can be done for icepicks too that are generally deep enough. The hope is that a professional goes underneath to stir up an injury which subsequently attempts to heal "beyond" the original material. I mean if you think about it it tries to use the same principles as TCA cross, an injury that tries to heal beyond the original depth in the same general way/context.

I think subscision is safer because the "injury' is underneath and is poking rather than dissolving and it's "out of sight" if there are slight imperfections underneath that don't heal perfectly I guess. The "untethering" or noise is the removing the tether so the material can heal the injury above that old tether.

I'm not an expert on subscision I'm just using what I read/seen from others and a bit of logic. That's what I think Candy means.

15 hours ago, harmlessboy1441 said:

Yes I think the thesis is that subcsision is more for larger or wider/rolling but I think it can be done for icepicks too that are generally deep enough. The hope is that a professional goes underneath to stir up an injury which subsequently attempts to heal "beyond" the original material. I mean if you think about it it tries to use the same principles as TCA cross, an injury that tries to heal beyond the original depth in the same general way/context.

I think subscision is safer because the "injury' is underneath and is poking rather than dissolving and it's "out of sight" if there are slight imperfections underneath that don't heal perfectly I guess. The "untethering" or noise is the removing the tether so the material can heal the injury above that old tether.

I'm not an expert on subscision I'm just using what I read/seen from others and a bit of logic. That's what I think Candy means.

Thank you for the in depth explanation! I think that is the basic mechanism for all acne scar treatments, to cause a slight injury that then causes the skin to try to heal itself,hence stimulating collagen production.You made an excellent point about subcision working mostly underneath the skin surface hence if anything goes wrong, it wont be visible.

However, one crucial thing to remember that my tiny bit of research has led me to discover is that subcisionfor temples is unsafe due to the skin there being thinner, causing a greater chance for the needle to tamper with and damagethe underlying veins,leading to fatal consequences. Then again, this was mostly in the context of the Taylor liberator needle, which is substantially thicker. The more traditional types of needles such as canulla and nokor might be safer.

4 hours ago, Uglyasshoe said:

Thank you for the in depth explanation! I think that is the basic mechanism for all acne scar treatments, to cause a slight injury that then causes the skin to try to heal itself,hence stimulating collagen production.You made an excellent point about subcision working mostly underneath the skin surface hence if anything goes wrong, it wont be visible.

However, one crucial thing to remember that my tiny bit of research has led me to discover is that subcisionfor temples is unsafe due to the skin there being thinner, causing a greater chance for the needle to tamper with and damagethe underlying veins,leading to fatal consequences. Then again, this was mostly in the context of the Taylor liberator needle, which is substantially thicker. The more traditional types of needles such as canulla and nokor might be safer.

Well yes that is true also. That's why you'd have to obviously get like 2 opinions to make sure that area was safe for any procedure in that area. That area is very sensitive and thin.