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macguyver

my take on scar revision from a nurse point of view

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I've tried all of the procedures everyone talked about minus the new total fx. I've come up with some interesting observation that I would like to share with everyone.

I would highly advise anyone to think very very carefully before they pour any sort of acid type of peel on themselves. I have not seen anything that would resemble satisfactory results compared to the risk involved. I've seen people have all sorts of problem from redness that never goes away, hyperpigmentation, hypopigmentation, or an unnatural plastic like shine to their skin. If you do intend to try this procedure I would highly recommend doing it in winter and stay out of the sun for a good 2 months to prevent chance of sun damage and give the skin proper time to heal properly.

Sub-incision, actually works if you know what you are doing but requires about 5 treatments before you see any real difference, don't expect your scar to disappear totally if its deep. Not all doctors do it properly or really understand the concept in proper way of doing sub incision . Most of the guides on the here are properly not the best. I would also highly recommend you using some sort of filler at the same time you do do your sub incision.

Needling for icepicks, works extremely well takes about 1 year to close the ice pick. You can needle yourself once a month, one of the most important aspect is to keep the scab on for at least 24 hours

Punch method works very well for icepick but pretty expensive if you ask me for what the doctor actually does. it will leave a very small scar which may be raise or not.

saline injection? Does not really work as well as sub incision if at all.

dermabrasion, only real sure way of scar treatment but requires long down time and should be done in the winter time to reduce the risk of sun damage. this procedure is pretty risky as far as pigmentation issue, also a good doctor is required.

fraxel, its pretty worthless for the money if you ask me, it does tighten skin make the skin tone even out or if you have large pores it can make them smaller but if you have acne scars that are moderately bad you probably need 15k before it looks really good.

total fx from what i've seen its way better than just doing the deep fx or active fx. Thats not saying it really works miracles, its just saying deep fx and active fx isn't as impressive when it comes to acne treatments. One of the problems with these laser treatments is that you look good for about a month after your treatment because your face is somewhat swollen or during the healing process with extra fluid under the skin to make your acne scar seem not as bad. Give it a year and you will notice that they didn't change that much.

Cost 4 k for one treatment? and you may need 3 or 4 treatments. Ouch to my pocket book with no guarantees.

retina A yeah it works probably because it thins out your skin and increases turnover rate so it helps scars fade.

Needling, haven't really tried this but if you look at guys with tatoos that go really deep their skin seems to be raised.

I wouldn't even dream about having a laser procedure during the summer months, those that are doing it right now are very brave if you ask me too many complication and how one heals

I've tried all of these procedures minus total fx, and acid peels. I suspect that in another year or 2 a better laser will come out and it will be the next best thing. I'm going to wait awhile before i decide if I'm going to try and do the total fx procedure. Any procedure that doesn't involve removing tissue with today current technology isn't going to do anything for your scars!

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I've tried all of the procedures everyone talked about minus the new total fx. I've come up with some interesting observation that I would like to share with everyone.

I would highly advise anyone to think very very carefully before they pour any sort of acid type of peel on themselves. I have not seen anything that would resemble satisfactory results compared to the risk involved. I've seen people have all sorts of problem from redness that never goes away, hyperpigmentation, hypopigmentation, or an unnatural plastic like shine to their skin. If you do intend to try this procedure I would highly recommend doing it in winter and stay out of the sun for a good 2 months to prevent chance of sun damage and give the skin proper time to heal properly.

Sub-incision, actually works if you know what you are doing but requires about 5 treatments before you see any real difference, don't expect your scar to disappear totally if its deep. Not all doctors do it properly or really understand the concept in proper way of doing sub incision . Most of the guides on the here are properly not the best. so do your research if you plan on getting this done or doing it yourself I would also highly recommend you using some sort of filler at the same time you do do your sub incision.

Needling for icepicks, works extremely well takes about 1 year to close the ice pick. You can needle yourself every 2 weeks or once a month, one of the most important aspect is to keep the scab on for at least 24 hours

Punch method works very well for icepick but pretty expensive if you ask me for what the doctor actually does. it will leave a very small scar which may be raise or not.

saline injection? Does not really work as well as sub incision if at all.

dermabrasion, only real sure way of scar treatment but requires long down time and should be done in the winter time to reduce the risk of sun damage. this procedure is pretty risky as far as pigmentation issue, also a good doctor is required.

fraxel, its pretty worthless for the money if you ask me, it does tighten skin make the skin tone even out or if you have large pores it can make them smaller but if you have acne scars that are moderately bad you probably need 15k before it looks really good.

total fx from what i've seen its way better than just doing the deep fx or active fx. Thats not saying it really works miracles, its just saying deep fx and active fx isn't as impressive when it comes to acne treatments. One of the problems with these laser treatments is that you look good for about a month after your treatment because your face is somewhat swollen or during the healing process with extra fluid under the skin to make your acne scar seem not as bad. Give it a year and you will notice that they didn't change that much.

Cost 4 k for one treatment? and you may need 3 or 4 treatments. Ouch to my pocket book with no guarantees.

retina A yeah it works probably because it thins out your skin and increases turnover rate so it helps scars fade.

Needling, haven't really tried this but if you look at guys with tatoos that go really deep their skin seems to be raised.

I wouldn't even dream about having a laser procedure during the summer months, those that are doing it right now are very brave if you ask me too many complication and how one heals

I've tried all of these procedures minus total fx, and acid peels. I suspect that in another year or 2 a better laser will come out and it will be the next best thing. I'm going to wait awhile before i decide if I'm going to try and do the total fx procedure. Any procedure that doesn't involve removing tissue with today current technology isn't going to do anything for your scars!

What about permanent fillers?

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What about permanent fillers?

The problem with fillers in general is that they don't always address every single different type of acne scar issues. Also keep in mind that fillers will reduce the appearance, whereas other procedures can actually eliminate the appearance or remove the scar to where its not noticeable to the human eye. With that being said permanent fillers, are just that permanent. If there a mistake during the procedure you will end up with a lumpy face. Even with the use of non permanent fillers you may experience some lumpiness or swelling after the procedure, which tend to go away. The same thing can't said with permanent fillers, this is the reason we don't do perm fillers at the derm office that I work in. Also keep in mind as you age so does your skin and these permanent fillers will not break down so they will make your skin look lumpy even if the procedure was an initial success.

Oh I forgot to add that if you get perm fillers, I wouldn't feel comfortable getting any laser treatment after getting perm fillers done. So you are pretty much toast in that department.

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Oh I forgot to mention that I'm not exactly sure what would happen if you had perm filler done than decided to get some sort of laser procedure like fraxel done. I don't think there been too many if any studies done on that, but I for one wouldn't feel comfortable having any sort of laser done treatment done after I had perm filler done

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macguyver,

thank you for these useful insights. you have really raised my hopes at a time when I was feeling totally desperate.

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macguyver said:
I've tried all of the procedures everyone talked about minus the new total fx. I've come up with some interesting observation that I would like to share with everyone.

I would highly advise anyone to think very very carefully before they pour any sort of acid type of peel on themselves. I have not seen anything that would resemble satisfactory results compared to the risk involved. I've seen people have all sorts of problem from redness that never goes away, hyperpigmentation, hypopigmentation, or an unnatural plastic like shine to their skin. If you do intend to try this procedure I would highly recommend doing it in winter and stay out of the sun for a good 2 months to prevent chance of sun damage and give the skin proper time to heal properly.

Sub-incision, actually works if you know what you are doing but requires about 5 treatments before you see any real difference, don't expect your scar to disappear totally if its deep. Not all doctors do it properly or really understand the concept in proper way of doing sub incision . Most of the guides on the here are properly not the best. so do your research if you plan on getting this done or doing it yourself I would also highly recommend you using some sort of filler at the same time you do do your sub incision.

Needling for icepicks, works extremely well takes about 1 year to close the ice pick. You can needle yourself every 2 weeks or once a month, one of the most important aspect is to keep the scab on for at least 24 hours

Punch method works very well for icepick but pretty expensive if you ask me for what the doctor actually does. it will leave a very small scar which may be raise or not.

saline injection? Does not really work as well as sub incision if at all.

dermabrasion, only real sure way of scar treatment but requires long down time and should be done in the winter time to reduce the risk of sun damage. this procedure is pretty risky as far as pigmentation issue, also a good doctor is required.

fraxel, its pretty worthless for the money if you ask me, it does tighten skin make the skin tone even out or if you have large pores it can make them smaller but if you have acne scars that are moderately bad you probably need 15k before it looks really good.

total fx from what i've seen its way better than just doing the deep fx or active fx. Thats not saying it really works miracles, its just saying deep fx and active fx isn't as impressive when it comes to acne treatments. One of the problems with these laser treatments is that you look good for about a month after your treatment because your face is somewhat swollen or during the healing process with extra fluid under the skin to make your acne scar seem not as bad. Give it a year and you will notice that they didn't change that much.

Cost 4 k for one treatment? and you may need 3 or 4 treatments. Ouch to my pocket book with no guarantees.

retina A yeah it works probably because it thins out your skin and increases turnover rate so it helps scars fade.

Needling, haven't really tried this but if you look at guys with tatoos that go really deep their skin seems to be raised.

I wouldn't even dream about having a laser procedure during the summer months, those that are doing it right now are very brave if you ask me too many complication and how one heals

I've tried all of these procedures minus total fx, and acid peels. I suspect that in another year or 2 a better laser will come out and it will be the next best thing. I'm going to wait awhile before i decide if I'm going to try and do the total fx procedure. Any procedure that doesn't involve removing tissue with today current technology isn't going to do anything for your scars!

Wait, you're a nurse and you support needling? There have been cases which people who needled too many times in the particular scar have made the scar worse, or caused hyperpigmentation. I'am one of those who needled an ice-pick scar only to have it hyperpigmented for 8 months. Needling is not safe due to the possibility of over-needling a scar.

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As a Nurse RN to be exact, one who works part time in a derm office. I would never suggest that anyone who hasn't been trained and understand the risk of any medical treatement or non medical treatment to resolve their acne scar , try it on their own. I was just sharing information of what actually works for the average acne scar patient without all the sales pitch. With that being said I've done needling on myself on icepicks and it works wonders. I don't think I would do needling on anything other than icepicks, because I don't think the results of icepicking a box car sort of scar would be as effective. If you needled your own icepick and made the scar worst than you just didn't do enough research to understand the PROPER PROCEDURE and how the skin is suppose to heal. If you did needled your icepick and got hyperpigmentation may I ask when you did the procedure? If it was during the summeer months thats your answer right there. I don't know why anyone would do any of these lasers or anything that going to remove tissue during the summer months or even late spring months! If you didn't do it during the sunny months, did you leave the scab on for at least 2 days? did you pack on the sunscreen onto the healed wound? Did you use somesort of hydroquinone at least a full month ahead of time on the area you were gong to do the procedure? Also being too aggressive, can cause that problem thats why it takes at least one year and multiple needling to close a small icepick

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I need help desperately. I needled about two weeks ago on many icepick scars but one of which was also I believe a boxcar.It was also clustered close to a couple other smaller ones.I thought that needling was supposed to help the boxcars also.I dont think I over needled but I did bleed alot.But then it didnt scab for some reason either. I then lightly put neosporin on and left alone. Well now where the boxcar is it seems to have connected with other smaller ones and looke like a deeper and wider indentaion. And they dont seem to look better. Overall it looks a bit worse!Did I screw up? I used a 30g needle on them.And what exactly is a hydroquinone? I have retinae however didnt use it 3 wks before or my oan oxyl bar. Have I possibly not waited long enough to see. I heard it can look worse at first but that doesnt seem to help me not freak out! please help, I am desperate!

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Newly raised mini scars seem to be helped from what I've seen in the hospital by applying silicone sheets which are taped down for most of the day for several months, I believe the way it works is actually rearranging how cells heal and regenerate. If its an old scar, you actually have to remove the scar tissue with a laser or dermabrasion. A punch can be used to remove the scar incase of a raised and enlarged pore. If it wasn't for the fact that there just a lack of doctors who are skilled enough to perform proper dermabrasion and how long the downtime is. I've seen dermabrasion do wonders that no laser could even come close to getting similar results.

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Hydroquinone is a cream inhibits the production of Melanin the substance that causes you to tan and give your skin its color etc.... Its important that you apply it for at least a month before you do any procedure thats going to injure your skin. Where many doctors go wrong in my opinion is that they recommend hydroquinone after the procedure which is of little use, since with most topical application it takes a much longer time than oral treatments. A week before the procedure is not long enough to prevent hyperpigmentation issue, if you ask me. The goal should be shutting off the production of melanin all together. I.E. michael jackson. The reason it didn't scab up could be your face was extremely oily or dirty, which is always a bad thing because you don't want to introduce any sort of germs to an open wound. Next time you need to wash your face, and you may want to use hydrogen peroxide on the area you plan to needle yourself. Let it air dry before you start needling yourself, when you start to see the blood come out tilt your head in such away that gravity doesn't allow all the blood to run down your face. If possible you should get someone to do it for you as you are lying down. Also try to use a hair dryer hold it far away from your face and blow warm air "not hot" at the blood which will dry the surface and form a scab. When performing needling on yourself, what I found that works well, is not to go deep or just stab at it. What you want is just not needle just the bottom of the icepick but on the sides as well. Your is not only to make holes in the icepick but to actually make little tears skin lifting it up like someone with spiky hair as the blood fills in between the gap new tissue will be built around these areas. It may take you 5 or 6 times before the hole is close to the point where its not big deal to you. i don't like using neelding for boxcar becasue the scar is too large to actually get good results, unless you plan to use a laser afterwards to smooth things out.

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You said saline does not work, so you have seen some examples of this? I do not get how needling does not work on larger scars, same principle as smaller scars.

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Thanks for the insight on this.So would retinae be considered a hydroquinone? And do you think that for boxcar scars the tca cross would be better? Using the retinae before and after needling or not at all is one thing Im confused on. Theres some on here that say that it speeds healing too much but since my scars looked so bad 2 weeks after I applied some and it seemed to help.But maybe im being way premature to be freaking out(that just tends to be my nature!)

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Oh yea, forgot to mention that I did use alcohol before I needled but I have been told I have very oily skin so maybe the peroxide would be better. And I bled like crazy but the warm rag I held up to it wiped it off. Also that makes sense about the retinae(if thats a hydroquinone) to use before and after to me.

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In regards to saline injection, I have not seen anything even close to dramatic from the patients that come into our office, that had this procedure done. Acne scar revision is filled with people selling snake oil. We have a general idea of how scars are formed, but I wouldn't say its an exact science yet. Saline injection in my opinion can work, the basic principle is that if you pump enough saline in a scar it detaches itself and new tissue is formed underneath. the problem with this is that its less likely for a scar to detach unless you inject tons of saline into that area, otherwise its just going to stretch out resulting in little or no new tissue formation "which is your goal" You would have to do this procedure over and over to the point where its so costly to see very little results. I've have moderate amount of acne and I've had 20 fraxel treatments at my office, using the non co2 fraxel. It certainly works, I've had excatly 25% improvement. I measured the most pronounce scars both width and length wise to see how the scars react. I was only able to afford the treatment because the doctor gave me a discount on them and I performed them on myself, by the way if you opt for a laser, a lot will depend on the person doing the procedure. As a acne sufferer I tend to be more thorough and take longer than shall we say a doctor whose only in it for the $. So the moral of the story is yeah saline injection work but do you really want to spend 5 grand to get semi decent results? Sub incision does the same thing that saline suppose to do, but works much better if you ask me. When i perform sub incision on a patient, I go into the scar tissue and actually try to lift the skin up in all directions where you can see the skin get raised. Even when doing this you still need to come back at least 4 or 5 times to actually see what i would call an acceptable reduction in the scar. " I have high standards I tend to measure before the procedure for my patients to see if its working if its not working, I advise them to see the doctor for other options he may suggest rather than continue.

Needling boxcars The problem is boxcars are much larger than icepicks so with a fine needle you can't control which areas you are actually hitting and which areas you are missing. As scar tissue form instead of having one shadow where the box car was you will have multiple small shadows also since boxcars tend to be shallow some of the scar tissue may end up being raised resulting in peaks and valleys in skin. You would have to use some sort of tatoo machine to be able to cover the entire scar properly, , however their is a risk of making the scar deeper since boxcars are on the shallow side to begin with. The other problem you face with using a machine is how to actually lift tissue fragments up to elevate the scar.

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TCA for scars? Seriously I'm just totally against acids unless its very very mild like 12 to 15 % aha maybe high as 20%, but at those percentages they are not really going to do much for scars, they give better tone to your skin and may reduce pore size. Any sort of acid that can actually reduce scars is a risky at best if you ask me. Reason being you have to be white as snow white, and have thick skin, plus a very experience MD performing the procedure to even make it sensible risk. When i say a very experience MD, that basically means one that messed up other people faces so he knows if it would help you or not. You really can't control the acid to the point where i would say the rewards outweigh the risk. Those people who say yeah it did wonders for them, etc... i would agree with them in this sense it can reduce the appearance of the scar, but at the same time if you look at their skin tone and texture, it looks off , skin tends to be waxy and shinny I.E. like a burn victim. I would rather have some scars than look like a wax figure. I would further argue that any acid you put on your boxcar can make the hole even deeper since more acid can pool in the scar. I'm open to most procedure but I would draw the line at any form of acid for the majority of people unless its use only to tighten up skin tone or a superficial peel.

with rolling scars sub incision isn't really going to get rid of the scar, what it will do is reduce its appearnce by a good 70% to 80 max. Its a very slow process you may have to do it 6 times to get a decent results

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macguyver this is great info, thank you very much for posting and sharing your knowledge.

I'm about to get my 6th fraxel out of 8 then have another 8 next year. I was hoping for a 30-60% improvement, but maybe that's too optimistic with only 16 treatments. Can I ask you your settings for treatments? I'm having 8-12 passes done at 70mj once a month and I have shallow ice-pick and boxcar scars.

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Thanks for info. You never know what you are getting on the net, or at a Doctor :shifty: , but what you say seems from experience and not $ driven.

What is used for subincision, what tool? Tiny scapel I guess. Not to be performed by self? :naughty: I have a bunch of those at work.

I am in SoCal area and will look around for Doctor that does them, nobody I found in Inland Empire where I live.

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I also went with 70 mj and 250/MTZ/cm2 with 15 passes which is the max, I swell up to the point where I look like a balloon for two days afterwards at those settings. You should consider the new co2 fraxel instead of spending money on another 8 fraxel restore. I m going to get a free consultation for the co2 fraxel this coming week will update the board.

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sub incision is performed by using a syringe with a special tip at the end, but you can do it with a diabetic syringe works just as well. The hole that is left by a syringe is extremely small and will heal without any real trauma to your skin and no I'm not motivated by money that's why I will not post where I work at because it would defeat the purpose of my posting. i just got tired of people doing things to themselves without knowing the proper technique and the rationale behind their actions and got tired of people being taken by snake oil salesman promising big miracles.

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thanks for the reply macguyver.

what is your opinion about either tretinoin cream 0.05% or tazorac gel 0.1%?

would either topical helps boxscars and rolling scars if i use it for at least 6 months or longer?

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what is your opinion about either tretinoin cream 0.05% or tazorac gel 0.1%

I haven't seen many people use tazorac, since it hasn't been on the market as long as other vitamin A derived products. I think that the average person would benefit from 0.025 of generic tretinoin. You should increase your percentage if you tend to have extremely oily thick skin, at 0.1 % can leave your skin feeling itchy and red. When using these products especially high percentages, you should not even think about going outdoors for any length of time. Even with sunscreen and a hat, you risk all sorts of problems including premature aging.

This will not really clear up your skin completely, since tretinoin base products only help to increase the turn over rate of skin tissue thus keep the pores open. You have to use a product like benzoyl peroxide to kill the bacteria otherwise you may have breakout and pimples. Instead of using 10% benzoyl peroxide, try 2.5% twice a day

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