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blueflowers

Had A Consultation With A Plastic Surgeon For Acne Scars

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I went today for a consultation about my acne scars. The doctor recommended co2 laser but I'm not really interested in that. I told him I've read that it doesn't do anything for indeneted scars and that I'm more interested in subcision and fillers.. he said he could do subcision with juvederm filler but if he done that to all my scars (which are many) my face shape would change and look rounder. He also said tca cross would be good for my temple area scars. But he kept saying co2 laser is the main way to go and then the other 2 treatments can help, but I'm not really sure I want to spend all that money on laser and go through all that pain for something that will not likely do much for me and could make things worse. What do you think?

He also said subcision could be done with a knife or needle. I never heard of it being done with a knife? Does that sound right?

I asked him for before and after pictures of people with acne scars that he's treated but he didn't seem to have any saying something like before and after pictures wont really help me.

What do you think I should do? What treatments would be good for my scars?

Here are some pictures of the scars.

post-175909-0-80626200-1337116972.jpg

post-175909-0-36219000-1337117002.jpg

post-175909-0-62507000-1337117740.jpg

Edited by blueflowers

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I believe you should get a second opinion. Trust your judgement on these issues. It's hard to tell from your pictures but your scars appeat to be mostly rolling. Subcision SHOULD help those significantly.

There are doctors that perform subcision with a knife, but you want to stear clear from those. They involve cutting out the scar borders and attempting to elevate the tissue, its very dangerous, and could cause worse scarring.

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I think you are definitely a candidate for Re:pair. Allow me to quote Dr Persky's response on RealSelf again.

"Hello all, When in Doubt, Tell the Truth. Mark Twain I was asked by a colleague to say a few words about the dialogue that has been going on here regarding Fraxel re:pair. Fraxel re:pair laser originally manufactured by Reliant, now Solta, is a very powerful fractional CO2 skin rejuvenative laser. I am a board certified Facial Plastic Surgeon since 1986, and have used original fully ablative CO2 lasers since they were first approved cosmetically in the early 1990’s. I have been using Fraxel re:store for 4 years, and Fraxel re:pair for 9 months, having treated nearly 100 patients with repair. I have said from the start that unfortunately we will see severe complications from Fraxel re:pair laser because it is so powerful of a tool, and it is not a commodity that you just buy and use, and wah-lah!, every patient looks years younger. It is a great tool for achieving those results, but not without knowledge, care, experience, willingness to seek help when needed, devotion to meticulous details, and a cosmetic physician’s combined scientific and artistic skills. My heart goes out to those patients such as Christine here on this site who have suffered complications from the treatment. Again, there will be more untoward events as more physicians use this incredible, and powerful technology. Fraxel re:pair works, and it works better than any other technology that I have been exposed to during my 25 years of facial cosmetic surgery experience. It works in the hands of some of the world’s top dermatologists who have endorsed Fraxel, including the brilliant inventor Rox Anderson,MD; Richard Fitzpatrick, MD; Ron Geronimus, MD; Chris Zachary, MD; ophthalmologist Howard Conn, MD, and facial plastic surgeon Steven Weiner, MD. These physicians are treating many patients every day with excellent results and very high safety profiles. Fraxel re:pair is the most clinically studied of all of the other fractionated CO2 lasers with the most peer reviewed articles in our scientific journals. Before being released to the public, and being FDA approved, Fraxel re:pair was studied for 2 ½ years by multiple investigators. Fraxel re:pair not only costs as much as a Lamborghini, but is as much of a precision instrument as the Italian car. All one needs to drive a Lamborghini is a driver’s license. All you need to use a fractionated laser (from any of the laser companies) is a doctor’s license. Just because you have a driver’s license and buy the Lamborghini does not mean that you drive off the new car lot and floor the gas pedal. That would cause a bad accident. The same is true for Fraxel re:pair. Just because a physician purchases the laser and it arrives in his office in the crate, does not equate to safe results without complications for his patients. The physician must be well trained in laser physics, the cosmetic use of lasers, and most importantly the conservative use of Fraxel re:pair particularly until he or she is familiar with their specific laser. When I first treated patients I was very conservative, and chose patients who would benefit from minimal improvement allowing for low treatment settings. At an early point, I realized that my patients were taking longer to heal, and were having “allergic” reactions to something. Even though they all eventually healed with excellent results, I contacted Reliant and asked that my laser be checked, concerned that something was off. The company immediately took care of the laser, and there have been no further problems. Fortunately I had a surgical and cosmetic laser background and experience, and knew that my new powerful laser needed a fine tuning. Most fortunately none of my patients have experienced burns, or permanent scarring or discoloration. All of these complications, plus more are possible. As with any surgical procedure, an informed consent between physician and patient must include all risks, complications, and alternative treatments. Once the benefits of the treatment far outweigh the risks, and the patient is willing to accept the small risk of a complication, then it is reasonable to proceed with the treatment. Pre- and post-treatment instructions need to be followed most carefully to insure optimum recovery. People need to have their hand held in the first week, which is very critical to their ultimate outcome. Early recognition of problems can reverse any long term issues in most cases. For patients who desire to look years younger with a single non-surgical in office procedure under local anesthetic, I believe that there is no better fractionated CO2 laser treatment than Fraxel re:pair. I will emphasize again, that I can only speak for myself and site my own patient results with this technology. I have spoken to dermatologists who have either sent their re:pair back or want to because it was too much of a “surgical-like” procedure to perform. Certainly an ability to use local nerve blocks and tumescent local anesthesia along with proper dosing of analgesics makes the procedure much more tolerable for both patient and physician. I fully agree with my colleague’s opinion above that physicians using Fraxel re:pair should have more of a “surgeon” philosophy regardless of their specialty training. I only agreed to treat patients with Fraxel re:pair after I researched the technology thoroughly, and visited the headquarters in Mountain View, California, and was personally convinced that when performed properly it was both safe, and effective. Thanks to our new President, “hope and change” are very popular right now in America. In facial cosmetic surgery as well we “hope” to “change” patients to achieve their specific aesthetic goals, in the safest and most effective manner. Like our country’s future, there are no absolute guarantees that there will not be complications and problems along the way. I hope and pray daily that the complications that we have heard about here resolve rapidly for the patients involved. Good luck and be well. Dr. P"

View answers from Michael A. Persky, MD

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There are doctors that perform subcision with a knife, but you want to stear clear from those. They involve cutting out the scar borders and attempting to elevate the tissue, its very dangerous, and could cause worse scarring.

That's punch elevation, not subcision. Subcision always involves cutting UNDER the skin, hence 'sub'

Seconding subcision.

Different doctors use different terms. Since it was a plastic surgeon it is likely he was talking about this procedure since they often refer to this as subcision, even though I agree with you that it is not:

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I think I'm just going to go with subcision/filler and tca cross. The only thing is I felt like he might not have much experience because he didn't have 1 before and after picture of subcision or tca. But he's the only one I've found in my area that offeres these procedures. I'm going to think about it and if I do get the treatments I will update and post pictures on here hopefully.

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Is it a big deal if the doctor doesn't have any before and after pictures?

They almost never have before and afters, which concers me and also amazes me because this I would think is their bread and butter. Most plastic surgeons business is with 50 year old ladies, not acne scar pts.

Funny story: i took afters 2 months after my ablative laser and the before/afters they sent me were really good looking, some impovement i would rate at 50 to 60 percent (on certain areas). I couldn't even come close to duplicating that improvement with the before and afters I took with my personal camera. Weird huh (photo shop maybe!!!????)

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BlueFlowers, if I understand you correctly, if one doctor is inexperienced in a procedure you totally ignore the suggested course of treatment instead of seeking a 2nd opinion. This is a phenomenon common to humans, that they will accept recommendations of anonymous people over trained professionals. You see this also in investing where people listen to co-workers and ignore investment advisers. I am considering Plastic Surgery and I have some of my own ideas that I am finding to be wrong after talking to Plastic Surgeons. Should I ignore their advice and do it my way. I have already been convinced that I do not need two procedures that would have cost me 10k. Spend the money up front visiting multiple Plastic Surgeons and then make a decision. It was a Plastic Surgeon who advised me not to do Fraxel Re:store, and it saved me years and thousands of dollars. I have an appointment in July with another PS, and I have just contacted another. I am not visiting them about Re:Pair because I am already convinced of its effectiveness and have a PS who does that on a regular basis. Fractionalized Ablative CO2 is the greatest advancement in treating acne scars that I have seen in my lifetime.

Edited by DudleyDoRight

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I may be wrong, but that video doesn't look like subcision to me, at least not the type of subcision I've had. That looks similar to punch elevation without really the full punch. I'm not sure why he keeps referring to it as subcision. He has another video that looks more like traditional subcision, but even there he doesn't appear to be using a Nokor needle.

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I may be wrong, but that video doesn't look like subcision to me, at least not the type of subcision I've had. That looks similar to punch elevation without really the full punch. I'm not sure why he keeps referring to it as subcision. He has another video that looks more like traditional subcision, but even there he doesn't appear to be using a Nokor needle.

You're absolutely right, I just posted it to show that different specialties (plastics vs derm) often refer to different procedures by different names. Ive noticed that many plastic surgeons use subcision to refer to punch elevation, and it is possible that the subcision that the plastic surgeon talked about with the OP concerning using the scalpel rather than nokor needle was referring to this procedure.

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I think I'm just going to go with subcision/filler and tca cross. The only thing is I felt like he might not have much experience because he didn't have 1 before and after picture of subcision or tca. But he's the only one I've found in my area that offeres these procedures. I'm going to think about it and if I do get the treatments I will update and post pictures on here hopefully.

Just be warned, fillers are inherently temporary. The results that you get from procedures like subcision, TCA cross, and laser resurfacing, after the initial swelling has gone down, is permanent, as long as you don't get more scars, but fillers are, by and large, temporary, unless you get one of those permanent fillers, which are risky and untested.

Is it a big deal if the doctor doesn't have any before and after pictures?

It certainly helps if he has such pictures, but it doesn't really go against him if he doesn't. Some practices don't have patients sign release forms for those pictures, since they are technically priviledged information, because they don't want to go through the trouble.

Then again, some practices, like the one I go to, have pretty regimented picture procedures. My own dermatologist showed me an entire library of pictures, and even had me talk to a patient who had just finished a procedure about an hour beforehand before I made my decisions.

But, like I said, it can only help, lack of pictures isn't necessarily a negative.

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silicone microdroplet thus far has given me the most improvement in my rolling/depressed scars. I see Dr Resnik in Aventura, FL for it, and it has worked wonders for me. I also am on long term low dose accutane treatment (10 mg per day) and after many rounds of silicone and the accutant, my skin is 180 degrees for the better. That's what I love about silicone is that I can do it while on accutane, and I need to stay on accutane because I never stop breaking out. I have tried dermabrasion, deep fx, punch excisions, smootbeam, subcision, all w/ no results, but silicone has really been a lifesaver for me. I'm still not totally happy and will continue the silicone, but it is so much better, and IMHO it's the ONLY thing that works PERMANENTLY!

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I didn't get a good feeling from the plastic surgeon. He could be a great doctor, but I just didn't feel like he had much experience with acne scars.. so I'm going to have a consultation with a dermatologist named Dr. Adler. Wish me luck!

Here's his website if you're interested

http://dallascosmeticcenter.com/procedures_acnescarring.html

I think I'm just going to go with subcision/filler and tca cross. The only thing is I felt like he might not have much experience because he didn't have 1 before and after picture of subcision or tca. But he's the only one I've found in my area that offeres these procedures. I'm going to think about it and if I do get the treatments I will update and post pictures on here hopefully.

Just be warned, fillers are inherently temporary. The results that you get from procedures like subcision, TCA cross, and laser resurfacing, after the initial swelling has gone down, is permanent, as long as you don't get more scars, but fillers are, by and large, temporary, unless you get one of those permanent fillers, which are risky and untested.

Is it a big deal if the doctor doesn't have any before and after pictures?

It certainly helps if he has such pictures, but it doesn't really go against him if he doesn't. Some practices don't have patients sign release forms for those pictures, since they are technically priviledged information, because they don't want to go through the trouble.

Then again, some practices, like the one I go to, have pretty regimented picture procedures. My own dermatologist showed me an entire library of pictures, and even had me talk to a patient who had just finished a procedure about an hour beforehand before I made my decisions.

But, like I said, it can only help, lack of pictures isn't necessarily a negative.

Thanks for the info! I think I will leave the filler thing alone for now.

silicone microdroplet thus far has given me the most improvement in my rolling/depressed scars. I see Dr Resnik in Aventura, FL for it, and it has worked wonders for me. I also am on long term low dose accutane treatment (10 mg per day) and after many rounds of silicone and the accutant, my skin is 180 degrees for the better. That's what I love about silicone is that I can do it while on accutane, and I need to stay on accutane because I never stop breaking out. I have tried dermabrasion, deep fx, punch excisions, smootbeam, subcision, all w/ no results, but silicone has really been a lifesaver for me. I'm still not totally happy and will continue the silicone, but it is so much better, and IMHO it's the ONLY thing that works PERMANENTLY!

Glad it worked for you!

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silicone microdroplet thus far has given me the most improvement in my rolling/depressed scars. I see Dr Resnik in Aventura, FL for it, and it has worked wonders for me. I also am on long term low dose accutane treatment (10 mg per day) and after many rounds of silicone and the accutant, my skin is 180 degrees for the better. That's what I love about silicone is that I can do it while on accutane, and I need to stay on accutane because I never stop breaking out. I have tried dermabrasion, deep fx, punch excisions, smootbeam, subcision, all w/ no results, but silicone has really been a lifesaver for me. I'm still not totally happy and will continue the silicone, but it is so much better, and IMHO it's the ONLY thing that works PERMANENTLY!

Glad to hear something is working for you. I remember you were a little discouraged at first with the silicone microdoplet.

Edited by paquita

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I didn't get a good feeling from the plastic surgeon. He could be a great doctor, but I just didn't feel like he had much experience with acne scars.. so I'm going to have a consultation with a dermatologist named Dr. Adler. Wish me luck!

I would do research on this doctor before your consultation to be sure you're going in with your eyes open.

For example, this is just one link that compiles information & reviews pulled from around the web:

http://www.vitals.com/doctors/Dr_Max_Adler

He does not appear to be specialized in acne scar treatment. This would concern me. I would go in with a list of specific questions to be sure he's capable of producing the results that you're after.

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to all who may consider silicone microdroplet, I find Dr Resnik to have the best balance between skill, conservatism and results. I think you really need to find a good doctor for this and use it as a long term treatment for depressed scars. If you want the best results on deep scars, then you need to have many many rounds over the course of a few years. It takes persistence to get those depressed sites elevated, but it does eventually work, just because it has to. I think ive had 5 so far with my doctor (lost count), and seven rounds with a previous one that was too conservative, and i am still working on further reducing the depressions. i will prbably have at least 5 more. i love it! id rather have a face pumped up, chok full of silicone and a system that always has accutane in it, than have those unsighjtly depressed scars that catch light and huge carbuncles with pus that have continuously generated pitted scarring throughout my years, and have consequently ripped my heart out of my chest. For the first time in my life in over 15 years I feel as if I finally have CONTROL over my skin to get it to look the way I want it to look.

Edited by ylem

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to all who may consider silicone microdroplet, I find Dr Resnik to have the best balance between skill, conservatism and results. I think you really need to find a good doctor for this and use it as a long term treatment for depressed scars. If you want the best results on deep scars, then you need to have many many rounds over the course of a few years. It takes persistence to get those depressed sites elevated, but it does eventually work, just because it has to. I think ive had 5 so far with my doctor (lost count), and seven rounds with a previous one that was too conservative, and i am still working on further reducing the depressions. i will prbably have at least 5 more. i love it! id rather have a face pumped up, chok full of silicone and a system that always has accutane in it, than have those unsighjtly depressed scars that catch light and huge carbuncles with pus that have continuously generated pitted scarring throughout my years, and have consequently ripped my heart out of my chest. For the first time in my life in over 15 years I feel as if I finally have CONTROL over my skin to get it to look the way I want it to look.

Ylem: What were the risks that the doctor gave you with silicone. Im curious if nothing else works for my nose scar if this is an option. I'd problably try semi pernement first but still wondering.

Edited by Nightlilly89

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to all who may consider silicone microdroplet, I find Dr Resnik to have the best balance between skill, conservatism and results. I think you really need to find a good doctor for this and use it as a long term treatment for depressed scars. If you want the best results on deep scars, then you need to have many many rounds over the course of a few years. It takes persistence to get those depressed sites elevated, but it does eventually work, just because it has to. I think ive had 5 so far with my doctor (lost count), and seven rounds with a previous one that was too conservative, and i am still working on further reducing the depressions. i will prbably have at least 5 more. i love it! id rather have a face pumped up, chok full of silicone and a system that always has accutane in it, than have those unsighjtly depressed scars that catch light and huge carbuncles with pus that have continuously generated pitted scarring throughout my years, and have consequently ripped my heart out of my chest. For the first time in my life in over 15 years I feel as if I finally have CONTROL over my skin to get it to look the way I want it to look.

Ylem: What were the risks that the doctor gave you with silicone. Im curious if nothing else works for my nose scar if this is an option. I'd problably try semi pernement first but still wondering.

Not sure about the nose. If you're only worried about a nose scars then you'll always be better off than I'll ever be, and I haven't had it injected into my nose. My doc is ramping me down to ultra low dose accutane at 10 mg, twice a week, and that is what I will be on long term. I was afraid of an IB and additional scarring all of these years which is what made me afraid to take the accutane again. I never received an IB, and to be honest, I think accutane is the best for avoiding additional scars. I wish I had known about a low dose option years ago that would have prevented the additional scarring I got. It also lets the silicone do its job because im not fighting scarring pustules and cysts any more, and best of all, I can go back to consuming as much dairy and milk as my heart desires. Now I indulge in butter, ice cream, alfredo sauces that used to induce cystic acne and subsequent scarring. Gosh, it's so much better not to have to check the labels on all of the foods i eat for any milk ingredients any more!!! My life is changing, and I can finally go back to focusing on working out too and getting ripped.

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