5 hours ago, Seelfed said:

Im listening. I haven't found a doc so far to do subcision and I'm not sure if I'm goinf ro find a acne scar specialist (atm its very hard to go abroad).

Do you think there is no fat loss? How do I tell?

It's just not how the skin works, I'm not an expert but the reason for the look of your scars is because the scar bands are pulling them down... like hundreds of little tiny tight strands are pulling your skin down and you need to break them. Subcision method does that but you haven't done a procedure yet. When you did microneedling, did you hear cracking crunch, that's sort of the sound of subicison makes but you will it feel with subcision, microneedling doesn't cut the scar bands up like subcision does.

I will try to look for the post on here but one user treated his scars subcising his cheek at home, try to search for it. That's the idea but it's up to you if you are up for it. You'll need a 27g or higher(the higher the number the smaller the needle) dental needle, emla or some numbing cream as your tools..

6 hours ago, Insearch said:

It's just not how the skin works, I'm not an expert but the reason for the look of your scars is because the scar bands are pulling them down... like hundreds of little tiny tight strands are pulling your skin down and you need to break them. Subcision method does that but you haven't done a procedure yet. When you did microneedling, did you hear cracking crunch, that's sort of the sound of subicison makes but you will it feel with subcision, microneedling doesn't cut the scar bands up like subcision does.

I will try to look for the post on here but one user treated his scars subcising his cheek at home, try to search for it. That's the idea but it's up to you if you are up for it. You'll need a 27g or higher(the higher the number the smaller the needle) dental needle, emla or some numbing cream as your tools..

Cool, thanks. Yes, I heard that popping noise I think. I thought that was the scar tissue breaking.

If you find the post, please link it to me. I'm going to search for it too. Im going to do what harmlessboy said and so a spot. I think my left side is the easiest to do. My right cheek hummm.

If you fuck it up doing subcision whats the worst that can happen? How do you know you are hitting the scar bamds and not the derm and fat?

Update: ive found a doctor that's willing to do subcision Nokor (thats his specialty). I heard cannula was better and less risky. Thoughts?

Update: I'm almost 1,5 months post CO2RE and I feel my scars got more noticeable. I don't think they got filled in any way, perhaps even lost a bit density or it's because my skin looks less thick and thus scars may be looking more noticeable. Some scars look wider. Is this normal/permanent? Will it get better?

On 9/24/2022 at 9:50 AM, Seelfed said:

Update: I'm almost 1,5 months post CO2RE and I feel my scars got more noticeable. I don't think they got filled in any way, perhaps even lost a bit density or it's because my skin looks less thick and thus scars may be looking more noticeable. Some scars look wider. Is this normal/permanent? Will it get better?

There are a few lesser known ways to improve the skin texture and enlarged pores that most people are unaware of.

But the first thing I want to inform you is that after undergoing the CO2 laser, your scars, pits and pores will seem much more noticeable under certain types of lighting, especially when the light glares at it from certain angles. When your skin is so new and shiny, as well as after the moisture barrier has been compromised, skin texture irregularities become far more noticeable. Furthermore, it can take up to 6 months to even partially heal post CO2 laser. I underwent a CO2 laser 1 year ago and my skin is still suffering the consequences (post inflammatory erythema, hyperpigmentation, red textured skin past the line of demarcation). Below, I have outlined a photobiomodulation treatment protocol you can adhere to in order to improve your rate of healing as well as to reduce the porous, red, shiny, and waxy look of the skin.

TO IMPROVE SKIN TEXTURE AND SUPERFICIAL SCARRING:

#1. Accutane/Isotretinoin

Before you panic, please let me state that this medication is highly misunderstood and its effects and functions are often taken out of context. Accutane is commonly prescribed in extremely high dosages, some ranging up to 80mg, and this is why people experience such severe side effects. The key to safely taking Accutane is to take 'micro-doses' based on your own individualized genetic response to the medication.This is a safe medication when taken conservatively. Doctors in South Korea have for a long time been prescribing Accutane in micro-doses of 5mg per day. Normally American doctors prescribe 20-50mg per day for the average acne sufferer. If you take only 5mg per day, or even better, take it every second or 3rd day, I almost guarantee you will experience zero side effects, except for the positive effects of Accutane which are shrinking of the sebaceous glands + pores, decreasing of the shiny, oily skin and as a result, improvement of overall skin texture. For myself personally, my body has no negative side effects on 20mg of accutane per day. This is the maximum dose for me and I am happy. As I said before, you can also take it intermittently (every second day) which appears just as effective. I experience no headaches, no dry lips, no psychological irregularities, no muscle aches and pains, no loss of night vision¦ nothing of that sort whatsoever. There are many celebrities as well as regular folks who also use micro-doses of accutane because it is truly one of the secrets to flawless skin. The root of most (not all) skin texture problems is overactivity or lack thereof when it comes to the sebaceous glands. Most children have beautiful, flawless skin for this reason, as their body has not developed these troublesome, unpredictable oil glands.

Accutane/isotretinoin is a derivative of Vitamin A that can be metabolized/processed in larger quantities by the liver without the same risk of overdose that comes from taking normal Vitamin A tablets. The point that I want to get across to you is that this medication and its underlying mechanisms of action need to be understood first before jumping to conclusions. The exact biological mechanisms of the accutane medication are not completely understood by doctors, chemists, scientists; but what is known is that accutane is one of the most powerful ways to impair the sebaceous glands. Furthermore, it has been observed that megadoses of regular store-bought vitamin A tablets (megadoses close to the overdose threshold) give people similar symptoms as those who take extremely high doses of accutane. This is because very high doses of vitamin A also impair sebaceous glands and dry out the skin, causing the same result caused by accutane. The reason why I am telling you this is because pore size and 'skin texture problems' are highly correlated with hyperactive sebaceous glands.

The more oil and sebum your skin produces, the shinier it tends to be and the larger your pores tend to be. Your icepick scars are basically pores that became dilated and expanded due to the keratin/sebum/dead skin cell clog that formed many years ago and now you are left with this permanent scar. Nevertheless, the pore still functions normally and continues to produce oil.  By taking the accutane at a low dosage of 5mg-10mg, your pores will shrink overtime as the sebaceous glands shrink. This is why people with dry skin have the smallest pores out of all the skin types; because their sebaceous glands are the smallest. This medication does not work instantly, (depending on your dosage) it can take weeks to months for the sebaceous glands to shrink but it is virtually guaranteed to occur. Taking accutane will not miraculously cure you of your icepick scars, and it will probably not do anything as for the scar depth, but it should shrink/dilate them a little bit as the enlarged pore contracts overtime due to the accutane.

#2. Aquagold/Mesobotox/microbotox/skin botox

This procedure has various different names, but it is commonly performed by celebrity dermatologists in order to create that 'filtered, glass-skin' look. NOTE: This is not the same as normal botox because it is not injected into the facial muscles, it is only injected into the outer layers of the skin (the epidermis/dermis) and therefore you will not experience any weird changes to your facial expressions. This procedure basically involves a microneedling device capable of injecting substances into your skin. The botox has a sebo-suppressive effect, meaning that it shrinks your oil glands and will create that seamless look with tiny pores. The botox also has an effect on the sweat glands, so your face will become less sweaty. This is an extremely effective procedure, and I guarantee you will not be disappointed. Aquagold can have extreme results when it comes to shrinking pores. The results are temporary and last to at most 6 months, but it is still a solution. Results will build upon each other if performed within a 6-month timeframe.

#3. Photobiomodulation

This treatment is quite new and many people are not aware as to how it affects the skin. It also seems somewhat incredulous, because of how simplistic the treatment appears to be. Nevertheless, with the right devices and treatment protocols, it can yield exceptional results. NOTE: I am not referring to those at-home LED masks that people can buy off amazon. These are mostly a waste of money, because they yield nowhere near the professional, medical-grade results. There is also a caveat that comes with this treatment because it has some unusual characteristics and some unusual applications.

Red light and LED light therapy in general can be extremely beneficial to the skin. It has been well documented to speed up wound healing and collagen formation. Photobiomodulation is a staple procedure performed by Dr. Jason Emer, one of the most famous Beverly Hills dermatological plastic surgeons. He always uses photobiomodulation/LED therapy after his laser-resurfacing, microneedling, chemical peel and dermabrasion procedures. There are years and years of high quality research showing the extremely beneficial effects of photobiomodulation on the skin. You can search up the widely-available studies from the National Center for Biotechnology Information if you would like more information. If you want to get started, there is only one system in the world that is good/powerful enough to pass tests that grant it a medical license - Dermalux by Aesthetic Technology. I purchased my ˜Dermalux Flex™ for about $3000 CAD. Other good devices are the 'LightStim ProPanel', as well as the 'Lutronic Healite'. You should only be using the same brand of medical grade devices used in salons and dermatologist's offices. Do not buy some cheap LED thing off amazon or alibaba and expect it to work. The real deal can be expensive but they are absolutely worth it.

The highest quality professional devices cost about $6000 dollars. The most important factors for light therapy are: Wavelength, LED tolerance, power generation and heat dissipation. The correct wavelength for red light is 633 nm. This is backed up by a vast number of research papers. The other spectrum of light you should use is blue light because it can regulate oil production and destroy acne bacteria. Photobiomodulation post microneedling/chemical peel/laser treatment can double or triple the results you would have otherwise experienced without the use of this adjunctive therapy, and this is why it can be extremely useful. The other factor is that using professional devices (not at home LED-masks) can encourage nice, soft and bouncy collagen to form as opposed to the unsightly scar collagen which leads to the bad skin texture so many people now complain about having experienced post-procedure.

#4. Chemabrasion Treatments performed by a reputable Board Certified Dermatologist

I would advise you to be extremely careful about Chemabrasion because this is a risky and extremely powerful treatment. The reason why many acne scar resurfacing treatments do not work is not only due to the scars being tethered, but also because the scar is not level with the surface. When the needles or lasers hit the skin, they cause the collagen to grow everywhere except the scar, or if they do manage to hit the scar, the effect is negligible because the collagen growth effects are not focused solely on the scarred area. If collagen remodels over the entire perimeter of the skin (rather than just the isolated scar) then the scar will stay at relatively the same depth as before. In order for the skin to be properly resurfaced, the ˜scar™ must be level with the rest of the skin surface. The skin™s surface must be flat and uniform. But as this is atrophic scarring,  it is a bit of a Catch-22.

Despite this, a potentially revolutionary technique that most people are not aware of is called ˜chemabrasion™. This is a combination treatment of dermabrasion + a chemical peel. (Dermabrasion is a deeper form of microdermabrasion that goes so deep that it causes pinpoint bleeding). The doctor must scrape away or sand away at the skin around the scar so that the unscarred outer surface comes closer to the base of the scar by scraping away at the unscarred, surface level skin. If you look at acne scars as if they were being measured on a depth graph, you would be able to see the layers of your skin and how deep the scar goes. Is the scar superficial? Where does the base of the scar reach? Does it reach the Epidermis? Does the scar depth reach the Dermis? The Hypodermis? If you can remove the epidermis layer of skin until you reach the very bottom (base of the scar), then by applying a chemical peel overtop of this it should cause the skin to grow back more uniformly. Overtime, and with repeated treatments, the base of the scar will get closer to the surface. Once you are satisfied, you should be able to eradicate the scar once and for all by using treatments such as standalone superficial chemical peels and radiofrequency microneedling. 

#5. Radiofrequency microneedling with either Platelet-rich Fibrin (PRF) or Platelet-rich Plasma (PRP)

PRF is superior to PRP. Some microneedling devices are better than others. When it comes to microneedling, the needle size is very important, because if the needles are larger than the pores, (which often they are), then the treatment will be less effective and can even make pores appear larger. I would advise you to see if you can find a reputable Board Certified Dermatologist operated clinic that offers a treatment called ˜Venus Viva™ which is a type of radiofrequency microneedling except that it contains needles about the same size as a human hair follicle thus proving highly effective. The needles/pins are so tiny that this treatment is actually classified as ˜NanoFractional radio frequency microneedling™ because they are ˜nano-needles™. Radiofrequency microneedling is different from regular microneedling as you already probably know. Please remember that this treatment only offers minor results, although it is fairly safe and can be performed as many times as you want. I guarantee that if you perform this treatment about 10 times, you will certainly see improvement in your acne scarring.

#6. Photodynamic Therapy 

This is similar to photobiomodulation but this specific treatment must only be performed by a reputable board certified plastic surgeon/dermatologist and there are some risks involved. The doctor will apply a photo-sensitizing cream to the skin then expose your skin to either certain wavelengths of light or to a pulsed-dye laser. This treatment is often used on melanoma/skin cancer patients because it eliminates abnormal tissue. Another known side effect is the pore-shrinking effect, thus improving overall skin texture. Photodynamic therapy is capable of destroying the sebaceous glands, thus reverting the skin back to a 'childlike state' with less oil, less pores, and less sweat. This treatment has some risks and it is very new so I would advise you to tread lightly. There are also certain precautions which must be taken otherwise the treatment will not work.

#7. Sebacia

This treatment works for some people, but doesn't work for others. It is also purported to be able to destroy the sebaceous glands. The doctor massages gold micro-particles into the pores then heats them up with an Nd: YAG laser. This causes some of the sebaceous glands to be destroyed, but usually the glands grow back after a year's time and thus the oily skin and pores will eventually return.

CONCLUSION: If you complete and adhere to the Accutane + Aquagold/mesobotox + Photobiomodulation protocols I have outlined, your pores will become virtually invisible and thus you will no longer have that 'pinhole/orange-peel' texture look that is bothering you. Your scarring is extremely superficial and mild, and thus I believe, in your case, this will provide quite a drastic improvement. These treatments will not be able to heal your deeper and wider boxcar and rolling scars but it will smoothen them out a little bit as well as they will become less noticeable because the overall texture and pore size will become so smooth and flat. If even after all this you are still unhappy with your skin texture, you can potentially go down the road of Chemabrasion treatments and eventually go on to undergo some radiofrequency microneedling treatments until you feel satisfied. Initially, if you go very deep and heavy with the resurfacing, you should be able to 'smooth things out' over a series of months by gradually performing lighter treatments on top of the already healed skin. 

For example:

Step #1 Undergo Chemabrasion until your scars are no longer noticeable.

Step #2 Smooth things out using the Venus Viva NanoFractional radio frequency microneedling with PRF protocol.

Step #3 Use a medical-grade Photobiomodulation device everyday as you are healing from these procedures.

Step #4 Start performing superficial chemical peels with microdermabrasion as a ˜final touch™ to smooth out the outermost layers of the skin.

Step #5 After fully healing, begin the accutane/isotretinoin to disable the sebaceous glands, causing the pores to shrink.

Step #6 Shrink the pores even smaller using Aquagold/mesobotox. [If you have been on accutane for a while, then you should have no more noticeable pores if you undergo Aquagold/mesobotox treatments.]

If you do all of this, I believe there is a very high chance that your skin will no longer possess any noticeable scarring.