So I had Deep FX on my nose and some mild subcision on several pitted scars. My face still looks like hyperpigmented (I am fair skinned) I have dark spots where he used the laser - the scarring/pits look worse. I thought this was going to be a fairly easy process with some results. I am really regretting it now. I can't go out in public and I feel I made a mistake. I am using IS Clinical super seruon, Aquaphor and mederma? Any thoughts...where he did the Active FX healed quickly but my nose looks horrible....2 weeks out 
are you sure it is hyperpigmentation from the deepfx? sounds like normal residual bruising/hemotoma from subcision.
what settings were your deepfx and density? also what settings were your active fx and density?
you should find out if the issue you are having is from the laser or subcision.
cuz i did subcision before but im planning to do Deep FX only....Question: Did anyone do Deep FX only? (excluded the Active FX). is there any risk?
there is always risks. including keloid scarring, hypopigmentation, hyperpigmentation.
if you are fitzpatrick 1-3.... your risk of hyper is decresed. deepfx should not be used on the neck, unless the doctor is skilled and used at low setting.
hope that helps.... for acne scarring deep fx should be set between 15-22.5mj at 10-20 density.
how come ur not doing DeepFX? are you satisfied with the result of subcision?
Subcision works well. Yet every procedure has its limitations.
You wan't to know the real reason why I decided to lay off lasers for now. The reason is because these companies refuse to talk to the patient. Try calling reliant/solta medical, makers of fraxel repair. You go in circles, and they also never reply to your email. They treat you like shit. It is my face!
Why am I contacting them directly? Because there is a lack of transparancy. Sure most beverly hills 40something woman don't care about ablation depths and thermal damage depths and lesion depths of mj settings, and density.
However, for some patients like myself, this information is important. I want to know what this laser is exactly doing to my face.
I don't expect these laser companies to sit there and take calls from patients all day. However, I DO expect them to provide specifics on their website.
Some companies are better than others at this.
Any prescription med you take, as a patient you have a right to know the molecular formula and the mechanism of action. why should laser companies not be required to provide mechanism of action to us?
So that was a long answer. In short, till these companies talk to me, or provide this info on their sites, so I can make a true comparison, til then I won't do a laser, unless I get desperate. Why should they have the privledge to my face and money, without treating me with respect when I call them
Maybe you don't care, but I think it shows a lot about these companies.
Quick edit.... It is even more scary that most doctors don't even know what the mj settings correspond to what depth. Basically we are experimental rats.
HiClub, check out this thread for a lot of info.
http://www.acne.org/messageboard/Laser-Lin...ma-t252527.html
HiClub, check out this thread for a lot of info.
http://www.acne.org/messageboard/Laser-Lin...ma-t252527.html
the best thing you can do, since you've already had the procedure is to let yourself heal and to do the absolutely most possible whilst healing to ensure everything goes alright. i probably wouldnt get this done myself, though this obviously doesnt help you at all. i can agree with the logic of the doctor here. the subcision would remove the scars whilst the laser would smooth over the skin. doing them both together, reduces the downtime of multiple treatments.
id suspect most of the redness would be from the subcision, though an easy way to tell would be to look at your skin. look at the areas where you had the subcision and the laser and compare those those to where you just had the laser. the places where you had the subcision and the laser should be a lot darker. there was more damage done there so there should be more healing. its nothing to be really upset about.
As far as the settings, I dont really know - the dermatologist is pretty well respected, training in John Hopkins. He said it was set up to go 3-4 times deeper than the Active FX.
I am more upset at the downtime...I am a guy and can't really wear makeup to cover up this redness and it is very noticeable. I believe most of the redness that is left is from the laser. Also, my skin is like paper.I am normally a quick healer so this is surprising me.
Any suggestions on how much more time to plan for..ways to speed up the redness? Again, i am using the IS Super Serum (super Vitamin C) and the FNS Total Complex.
sanjoseskin- thx for the reply. I will double check with the doctor with the mj settings. how do you know the set has to be between 15-22.5mj at 10-20 density and why? Also, what if the doc does other mj? what are the consequence?
Lumenis the company that makes deepFx.. has set those values as the parameters for acne scarring. I've done tons and tons and tons of research on this laser and fraxel repair.
As far as Lumenis goes, these are the following parameters for acne scarring. They are 100 percent accurate.
Acne Scars DeepFx:
15 - 22.5 mJ
Scan Size 10mm
Density 10-20%
Hertz 300-600
Repeat Delay 0.3-1.5sec
No. of Pulses 1
No. of Passes 1
If your doctor went below 15mj, then It only put you at LESS risk for complications.
However, if he wen't above 22.5, I would find out how much higher he went.
I honestly don't think he would have gone higher than 22.5. One other thing, if your doctor is extremely skilled with this laser, and he can judge your skin type accurately, then maybe he has the experience and wisdom to safely go above 22.5 on your particular skin.
If they go too deep, well you obviously run the danger of scarring, hyperpigmentaion, hyporpigmentation, or hitting fat tissue. These risks are minimized with ultrapulse technology, which is what deepFX is. In contrast, these risks are higher with superpulse technology, because superpulse achieves the same lesion depth as ultrapulse, but only able to do so by extending thermal damage deeper into the dermis and possibly hitting fat. Excess thermal damage should be avoided, while some is necessary for healing and constriction. It appears only the Ultrapulse technology is the real Gold Standard in Co2. Other devices such as ProFractional and Pearl, are starting now to be able to ablate deep, with the option of minimal thermal damage turned on. I think the future is looking somewhat promising in terms of new lasers.
I should add, that all the above lasers, under a skilled doctor, should be safe.
DeepFx and Repair are good for skin type 1-3, sometimes 4.
Profractional can be used up to skin type 6, with thermal damage turned OFF. You get pure ablation with thermal damage turned off, no thermal zones.
Pearl I'm not too certain, I think it is 1-4 safely.
Thanks sanjose for all the info..I know he is extremely trained on the Lumenis lasers...his studies have been used in their marketing literature. I am more concerned with how long it will be until I look at least normal enough to go out in public..I was thinking the downtime was only 7-10 days. Any suggestions on how to speed this process up? Should I be worried?
thx for your response but how would I know if my doctor is skilled with the laser or not? He seems pretty confident but who knows? So I assume the more mj it is the best result would come out? so I guess 22.5mj will give better result than 15mj?
carolinaguy- which doctor did you see? how much was the price?
HiClub, I believe there exists a limit beyond which doctors won't go.
"The thickness of skin varies, depending on where it is found on the body. Skin averages 0.05 inches (1.3 millimeters) in thickness. The thinnest skin is found in the eyelids and is less than 0.002 inches (0.05 millimeters) thick, while the thickest skin is on the upper back (0.2 inches or 5 millimeters)."
I would have to believe that if 17.5mj ablates to 1.5mm it would make no sense to use a higher setting. I have no idea what is directly beneath the skin layer, but I don't think I want to be lasering it.
Hey Club- I got my done for $2300 + all the costs for the misc products. As far as the doc, Im not trying to rip him apart, but at two weeks out I am not completely satisfied. He is very well trained. I did not have any overexpectations for this. I only wanted some slight improvement. For the hassle, money, time and for possibly making my face look worse, I am just disappointed. Thats not to say thta others migfht have different results.
thx everyone who responded.
dudley- how come u did Fraxel:Repair over Deep FX?
carolingaguy- what type of scar do you have? how many amount? it sounds like you dont have too many scars? nose and several pitted scars? I mean i have scars on temple, cheek, forehead, and etc. You do not it's worth it? i have rollerscar, icepicked, boxcut, and keloid. my doc told me i can get 50-60improvement from DeepFX after 3rd treatment (every 6month) and after that im trying to do silicone injection at the end.
HiClub, I believe there was more research done by Reliant for the Re:pair. That and the application of the laser. Re:pair uses the rolling technique. Another very prime consideration was the fact I could get it done only 3 miles from my house and for DeepFX I would have had to travel to either Texas or Colorado. When I initially did Re:pair there were only 35 machines in the U.S. Re:pair and DeepFX are basically the same technology. The big difference that I have yet to understand is that DeepFX ablates to 1.6mm at 17.5mj and Re:pair ablates to 1.6 mm at 70mj.
HiClub, I believe there was more research done by Reliant for the Re:pair. That and the application of the laser. Re:pair uses the rolling technique. Another very prime consideration was the fact I could get it done only 3 miles from my house and for DeepFX I would have had to travel to either Texas or Colorado. When I initially did Re:pair there were only 35 machines in the U.S. Re:pair and DeepFX are basically the same technology. The big difference that I have yet to understand is that DeepFX ablates to 1.6mm at 17.5mj and Re:pair ablates to 1.6 mm at 70mj.
Hey Dudely, neither DeepFx or Repair ablate to those levels at those specified mj settings. DeepFx does not ablate to 1.6mm at 17.5mj, also Fraxel Repair does not ablate to 1.6mm at 70mj setting.
This is confusing, but there is a difference between lesion depth, ablation depth, vertical thermal damage or co-agulation depth, and also lateral thermal damage.
It is correct to say, Fraxel Re:pair has a "Lesion Depth" of 1.6mm. However, this is not the same as "ablation depth." Fraxel Re:store has a "Lesion Depth" of 1.4mm.... again this is not ablation depth since it doesn't ablate, and the formula for erbium Re:store is different.
For a Fraxel Treatment Matrix which shows maximum "Lesion Depths" here is a link:
http://www.fraxel.com/common/pdfs/fraxelTreatmentMatrix.pdf
The formula for Optimal Lesion Depth In CO2 lasers is :
Optimal Lesion Depth= Ablation Depth + Sufficient yet Safe Thermal Damage Depth
The goal is to achieve safe lesion depths by having a ratio of Ablation Depth being greater than Thermal Depth. You need a little thermal damage depth, but too much and you run into problems.
This is for going vertical, there is yet an ever more confusing formula for lateral damage. Lateral damage is used in calculating density settings.
Hopefully that helps to clear up some confusion from sources souch as realself, medspa sites.
For the same lesion depth, ultrapulse will always have a higher ablation depth than superpulse, it is just fact.
There are also continuous wave co2 lasers, or combination of contiuneous wave and superpulse together... more lasers to consider.
ProFractional is erbium based, but it is actually amazing in that it can ablate almost as deep as ultrapulse co2. However, it seems that some thermal damage depth is prefferred by some doctors to cause tightening of the skin. For this reason, ProFractional now has an option to turn on thermal damage depth. Some argue, if you turn on thermal damage with erbium, it essentially becomes a co2 in terms of complications, which means the safety of erbium goes out the door.
Pearl is also promising, it is a wavelength inbetween tradtional Erbium and Co2, which means it has ablation and thermal damage built in. Not sure how effective it is.
I think all the fractional technologies are good in a skilled doctors hands. I think some however offer more promise in terms of major scarring, such as burns. This is where ultrapulse will excell. Current studies of Military personal who where burnt in Iraq are being conducted with ultrapulse, because it ablates the deepest, with minimal thermal damage, since these people already had thermal damage to their skin via burns, SP or CW would just add to that damage.
For the rest of us scar patients, I think CW SP or UP are fine, if the doctor knows what they are doing. I have to add, after doing tons of research, not all doctors believe depth will necessarily equate to better results. I don't know though.
Hi Club- biggest area of concern is my noe..its scarred with several uneven areas, icepick and boxcar type scars. Because I am lightskinned, they tend to be noticeable and have gotten worse over time. This was the first time I had the Deep FX treatment and I am only 14 days out. I am just not very please right now, especially with the advertised downtime and over reduction of those scars. I am sure my derm will ptich me on another treatment in six months, he already set me up for that.
Hi Club- biggest area of concern is my noe..its scarred with several uneven areas, icepick and boxcar type scars. Because I am lightskinned, they tend to be noticeable and have gotten worse over time. This was the first time I had the Deep FX treatment and I am only 14 days out. I am just not very please right now, especially with the advertised downtime and over reduction of those scars. I am sure my derm will ptich me on another treatment in six months, he already set me up for that.
Hey, I think doctors underestimate the downtime. They all say you can be healed in 7 days, maybe, but they never tell you you will be red with erythema for a longer time.
I think you are fine, just give yourself a month for redness to settle. Dont use retinal products, no alpha hydroxy, nothing. I would say purchase cetaphil gentel soap free fash wash. Only use this, that is it! If you want get cetaphil 15 spf lotion, when you go out under the sun.
If you don't see results, then consider something else. If I was a doctor, I don't think I would pitch just fractional lasers alone as a solution. Usually you need a combo treatment, like subcision with resurfacing of some type.
Hang in there, I think your redness will resolve. I just beg you don't apply anything, topicals always just irritate more.
If the redness does not go down, your doctor can give you a topical steroid, use with caution, they can thin the skin and cause striae.
You can also try Vbeam treatments for redness.
Just give it time
sanjose- have u done vbeam before? if so, how was the result? how many treatments have u done?
I've done Vbeam before, I think twice. IT was a few years ago, now they have an updated Vbeam that is purpura free. I should rather say, I think they have an updated one.
I personally loved Vbeam. Really works well on red spots. At high settings it causes purple brusing called purpura that can last anywhere from a few days to several months. Mine lasted about a month on strong setting. Again I think an updated Vbeam laser doesn't cause this anymore. Or you can have several treatments at lower settings.
Vbeam is painless I thought, felt like rubber band snaps, with a puff of cold air.
I think complications can occur, such as hypopigmentation possibly, I'm not certain, I think I read that somewhere.
Also make sure you have safety gogles on and tell them to STAY AWAY FROM THE EYE ORBITAL. That intense light is so strong, it can really mess up your eye, even if they don't touch the eye area but get close. Say STAY AWAY FROM EYES.
I swear I think it got too close to my orbital, and inside my eyeball it lighted up like lightening. I was seeing blurry for a few mins, my eye could not focus, I was freaing out inside. I don't recall how close it got, maybe it was on my tempel or below my eye, but that thing was strong.
If your pigment issues are more severe, you might need 3-5 treatments.