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I finally found a local surgeon who is experienced in cannula subcision +filler and has agreed to do it (thanks to the FAQ in this forum). The only thing is that he wants to use Radiesse instead of Sculptra. He does inject Sculptra, butbelieves that Radiesse is superior because it not only hascollagen stimulating benefitsbut also hasadded benefit of immediate results. I explained that waiting for results is no problem, but that didn't seem to resonate.
I'm pretty much sold on Sculptra being the best filler for volume loss, but I may not be able to convince this surgeon to use it.
@Brent21Sounds like he has experince with Radiesse and not Sculptra and that's ok. Sculptra takes more skill. Radiesse also provides long lasting filler and collagen stimulation.
Seriously find anyone who does Sculptra and have it done do a search for your city and Sculptra. They don't have to be on the list or even a acne scar specialist, make sure it's injected deeply and over dilute, any acne like treatment do with a specialist who treats such things.
Thank you. If Iunderstandcorrectly, are you recommending to have the subcision/radiesse with the surgeon nowand then do Sculptra later? I didn't clarify this in my post, but when I initially asked him for subcision, he said he is not sure whether the scars are tethered and he will determine that while injecting the radiesse and subcise as needed.
I have foundgood Sculptra injectors, but theydo not do subcision.
@Brent21Get subcision done by someone who specifically does that, ... go elsewhere to your Sculptra practitioners a week latter and have that injected all under the scar areas.
@beautifulambitionAfter another month of searching for a local doctor to perform subcision, I found only 2 who will do it, and Iam hoping to get a few more of your thoughts about the techniques they say they'll use(I still plan on seeing Dr. Rullan in a few months, but would like to get at least one subcision treatment done locally before I go) .
In my case, both of thesedoctorswill only do subcisionin conjunction with Sculptra orfiller, and they both seem to view subcision as mostlya tool to enable them to inject the filler (although not specializing in subcision, these two doctors seem to have as much experience as any in my area).Based on the way they describe the technique they would use on me, I'm concerned whether either of them will do an adequate job of subcising.
- The first doctor, a general plastic surgeon, said he uses a microcannula to inject Radiesse and will "subcise as needed". Am I correct that if any injector is using a cannula to injectin a scarred area, he would necessarily have to subcisethe area in order to inject?
- The second doctor, a dermatologist, said he only uses Nokor needles or standard hypodermic needles. In my case, he said he would use a standard hypodermic needle and use a fanning technique to inject Sculptra, thus subcising along the way. Am I right in my understandingthat a standard needle doesnot adequately break up much scar tissue?
Once again, thank you for all of your help.
1) Yes and no, ... if there is scarring of course. If the skin does not have scarring then no. Itmay be semantics.
2) No standard needle is not as effective. IT will not provide the aggressiveness needed with subcision, and is not like a cannula.
3) Perhaps try the first Dr as you wait for Rullan, worth a try depending on cost, ...you don't have to get filler with him if you don't want to.
14 hours ago, beautifulambition said:1) Yes and no, ... if there is scarring of course. If the skin does not have scarring then no. Itmay be semantics.
Attempting not to flog a dead horse, I'm trying to make sure I understand fully. From my understanding now, any doctor who injects sculptra/radiesse through a cannula has to subcise in order to inject (provided that subdermal scars exist there).If I've got that right, then the criteria I should be using is whether the injector has a lot of experience usinga cannula--not so much whether they do a lot of separate subcision. Did I get it right this time? Unfortunately, I can't find a single doctor in my area who will do subcision on me without Sculptra or filler.
@Brent21Flogging a dead horse ;-P Evaluate their expert injection techniques off experience and products they use / review.
Evaluate their subcision for scars separately. They do not have to be one and the same. One can be good at both, ... or one cannot know how to subcise and be a great injector. You can See Dr - A for Sub, and Dr - B as a expert injector a week latter when the swelling is down.
It's easy to know if they are a"expert" and part of the consult process. Ask lots of questions, how long have you ___. what are your favorite products, have they won any awards, is their named mentioned anywhere, their writing on the topic, reviews, patient before and afters, word of mouth, fame, do they speak on the topic, ... of if it's a nurse ... they have been doing it for 20 years and do it all day long in some spa or med office.
Sculptra and filler are fine, ... if your anti filler, get prp which does not act as filler but at least it's natural right.
Field subcision with Sculptra is not the same as acne scar subcision by a expert, ... they don't have to be.
I finally tracked down two practitioners who will subcise without fillers. Neither seem to be as much of experts in subcision as Id like, but this may be the closest Im going to find locally.
The first is a cosmetic surgeon. He uses cannula for filler and said that he could use a cannula for subcision with or without filler at my option. He was thorough in answering all questions and open to my suggested treatment plan, but he did not do a close-up exam and that was somewhat concerning.
The second is a general practitioner doctor who specializes in aesthetic medicine. He runs a spa and has lots of experience using cannula to inject scupltra and fillers. He performed a close-up exam with tangential lighting and said he would be glad to subcise without filler. His approach is to first hydrate the skin with a hydrofacial, see which scars are still visible while hydrated, and only subcise those. He estimated that he would only need to subcise 5-6 scars and would use a 30 g needle instead of cannula. He thinks the cannula subcision would be overkill for me. This doctor says he takes a very conservative approach to his treatments to minimize risk of collateral damage.
I also found a third doctor--a dermatologist, whom I did not consult with yet. This doctor seems to be an expert in Nokor needle subcision. He charges a $200 consult fee which he does not apply to procedure costs. Given the number of physicians who have refused to do subcision without a filler after consultation, Im reluctant to pay another fee for this.
@Brent21See Dr 1 for ... one or two treatments, see how that goes. If that does not work see someone else who also does filler.
The second guy sounds ... :-/ . What does a hydro facial have to do with directional lighting and finding scars, silly. Also a normal 30G needle - NO.
1 hour ago, beautifulambition said:The second guy sounds ... :-/ .
@beautifulambition LOL. It did sounds somewhat wacky, but I took his comments to mean that the hydro facial would cause untethered artrophic scars to temporarily rise to surface level, and that effect would allow him to differentiate between tethered and untethered scars. He reasons that smallscars that elevate to surface levelduring a hydro facial will not benefit from subcision.
I didn't previously mention this, but while we're talking about wackiness, I will tell you that the 1st doctor's technique is to use the inside of the mouth as the entry point for the cannula.
@Brent21Well I get that a hydrofacial will clean away surface dead skin. But are we talking about tiny scars(I was going by older pictures, perhaps I don't see in a up-close example what you need done, can you send a close up picture of these tiny scars or are we just dealing with textural scarring. Bigger atrophic pits are pretty evident. You see how silly that sounds unless they are tiny or the person is clueless. You don't goto Lim and say, can I have a hydrofacial so my scars can be treated.
Do a hydrofacial to brighten your skin, clean up and exfoliate. That is a maintenance, and cheap I suppose. But red flag here.
Wow though the mouth, ... why? I get it he is a plastic surgeon and does face surgery through the mouth, but for normal filler administration.
Send me another picture "macro "up close", perhaps we are speaking in circles instead of addressing the issue.
On 5/23/2019 at 11:41 AM, Brent21 said:I have many hypertrophic scars along with a small number of rolling and depressed scars.
Many years ago, I had treatment with co2 ablative laser, which seemed to help the depressed scars, but did little for hypertrophic scars. There are hundreds of these small hypertrophic scars throughout my face.
Recently, I consulted with 4 doctors asking them for treatment with Kenalog and/or 5-FU for the hypertrophic scars, but the doctors say the scars are not raised high enough for Kenalog and none use 5-FU in their practice.
I have the same on my chin and have done everything. I have had some improvement with skin pen treatments. I used to go to a doctor that would tap the syringe filled with kenelog on the skin all over. He would never inject it just make tap it on my skin. I remember that he did it on my back and it cleared up pretty good. I live in another state now and no other doctor I've seen does it.
Did you ever go with Rullan @Brent21or do something else?
As a former patient of Dr. Rullan I would advise against using him for subcision. He is very aggressive with his subcision treatment. It caused additional scarring on my face. I am friends with another person that has had the same result. I have seen reviews with the same complaint too. He also created textural issues on my skin after a series of microneedling treatments.
I had good results with his TCA cross and my friend had good results with a Phenol Peel. If you are going to have a chemical treatment done then he is the Dr. Otherwise I would find someone else.