Jump to content
Acne.org
Search In
Find results that contain...
Find results in...
Freakshow

Severe Scarring And Pigmentation - What Are My Options? (W/ Pic)

Recommended Posts

Hi, I'm a 19 yo Asian male. I had a breakout of severe acne a couple of months back. I'm 100% clear of active acne now, but it left me with really bad scarring and pigmentation, especially on my cheeks. You can see some pics of my scars below. I think they're a bit blurry unless you zoom out, sorry about that.

Can someone recommend me what type of treatment to go for? I read the forums and it seems like lasers are really popular, but I'm concerned about the damage/pigmentation it can cause to my sensitive Asian skin. I'll be glad if anyone can share their experiences or knowledge about that. Also, I think subcision would be good because I think I have rolling scars (?).

Money is not an issue, and I can afford more than a month of downtime after whatever procedure I go for, so please help me out with suggestions smile.png

Edit: Uploaded another pic of my 'worse' side

Edited by Freakshow

Share this post


Link to post
Share on other sites

You have mixed scarring and it'll probably take several different methods, including laser, to adequately treat them all. The risk of hyperpigmentation definitely exists with lasers, but that risk also exists with deep phenol peels and dermabrasion which are other options. It's difficult to tell from a photo but in this lighting you do not appear especially dark and there are not many brown marks, this might mean your risk of hyperpigmentation is less than you think it is. You'll be best off making an initial visit to a good cosmetic dermatologist to discuss those options rather than going in with one method preselected.

All of those methods treat hyperpigmentation as well, though gentler peels like glycolics and regular use of retinoids or acids can also help with hyperpigmentation. You can do some of that hyperpigmentation treatment at home (there are relatively gentle home peels available on the web) if you are very careful and use a good sunscreen.

Share this post


Link to post
Share on other sites

Dermarolling, it's safe for asian type skin.

In a study Percutaneous Collagen Induction with Dermaroller TM for Management of Atrophic Acne Scars in 31 Thai Patients they show

In conclusion, percutaneous collagen induction by skin needling with high quality

single-use device (Dermaroller TM, Horst Liebel Co, Germany) had been shown to be

highly effective and safe method for treatment of atrophic scar in Fitzpatrick skin

type III to V Thai patients.

Edited by Remicade

Share this post


Link to post
Share on other sites

Thanks for the replies! I've scheduled my first derm appointment in about a month's time.

@staple - Do you have any recommendations for mild peels that can be done at home? I'm kind of worried that a peel would make my skin extremely sensitive and unsuitable for other treatments (e.g. laser) in the short term so I'll probably start with an extremely mild one. Appreciate your help!

@Remicade - Correct me if I'm wrong, but dermarolling seems to be more of a long term process while laser/subcision/etc gives significant improvements in the short term. I think I would pick up dermarolling after going for a more aggressive short term treatment.

Share this post


Link to post
Share on other sites

If money is not an issue, I would skip the home peel (it won't do anything for your scars) and start consulting with some cosmetic dermatologists & facial plastic surgeons on how to approach treatment. Looking at your photos (they're very blurry), they appear pretty deep on one side of your face. I wouldn't even risk or waste time with home treatment. At the same time, use caution when talking with doctors. You can find tons of great advice on how to select a doctor by simple reading through threads on this board.

Edited by TokyoGirl

Share this post


Link to post
Share on other sites

If money is not an issue, I would skip the home peel (it won't do anything for your scars) and start consulting with some cosmetic dermatologists & facial plastic surgeons on how to approach treatment. Looking at your photos (they're very blurry), they appear pretty deep on one side of your face. I wouldn't even risk or waste time with home treatment. At the same time, use caution when talking with doctors. You can find tons of great advice on how to select a doctor by simple reading through threads on this board.

Thanks for the advice! Would really love to visit a derm as soon as possible, but I went for a minor knee op (too much sports ><) so I can't walk for a month. I've scheduled an appointment with a reputable derm in a month's time, so hopefully it goes well :) I'll be asking her if I'm suitable for fraxel repair, as it seems to have worked for a lot of people in this forum.

Share this post


Link to post
Share on other sites
@staple - Do you have any recommendations for mild peels that can be done at home? I'm kind of worried that a peel would make my skin extremely sensitive and unsuitable for other treatments (e.g. laser) in the short term so I'll probably start with an extremely mild one. Appreciate your help!

As I mentioned, the home treatments will only help with hyperpigmentation, only a doctor can help with scarring. Basically, any gentle exfoliation process will help speed things up slightly, including very simple store bought products (like Neutrogena's "glycolic peel" which is not really a glycolic peel product, just a bi-weekly exfoliator) or starter level mandelic/glycolic/lactic peels available over the internet. (Spot test the peel for allergy first and follow the directions carefully. Discontinue any peel at least a week before your consultation.) Do not consider or attempt a high concentration peel or any kind or a TCA peel. Those are dangerous to do at home, especially if you have hyperpigmentation issues.

Since you'll be going to the dermatologist fairly soon though, if you already have a good exfoliation process, stick with it and find a good quality daily sunscreen that does not cause breakouts or irritate your skin that you can wear whenever you go out, including to go driving. Keeping your marks from darkening will help them fade faster.

Whatever you do, do not tan the marks or put lemons on them. I've read this elsewhere on the board and it's poor advice.

Edited by staple

Share this post


Link to post
Share on other sites

@Nope.avi - Oh I'm not expecting instant results if thats what you were concerned about. I know it takes many months for collagen to grow after laser but compared to other scar treatments its considered short term right? Probably have to roll for more than a year to get the same kind of results as what laser gives in a few months.

Well I was completely clueless about how to treat my scarring a few days ago, and now I have a basic idea thanks to these forums and you guys. Needless to say I'll be doing more research and considering the derm's opinion. Whatever treatment I go for in the end, I'll remember to post back the results.

Edited by Freakshow

Share this post


Link to post
Share on other sites

Seeing your new picture, I would say your actual scars are not bad. The blurry picture made them appear deeper. I suffer from the same kind of hyperpigmentation as you. Mine normally starts off red, turns brown and then slowly fades to tan over time. I haven't had much luck with using peels for hyperpigmentation. Peels tend to irritate my skin and that always leads to hyperpigmentation for me. I have had success using a cleanser with 2% salicylic acid, AHA cream and Hydroquinone, as well as Retin-A 0.01% & Hydroquinone. Unfortunately, as soon as I stop using Hydroquinone, my hyperpigmentation starts to return in some areas. It's an ongoing battle. From what I've read on Realself, this is a common issue for some Asian skin types, so simply doing a peel is not going to be enough because it doesn't inhibit the production of melanin in your skin, like Hydroquinone & similar bleaching topicals.

For your scars, you'd probably benefit from co2 fractional laser. For faster results, subcision prior to laser would be helpful.

Share this post


Link to post
Share on other sites
Peels tend to irritate my skin and that always leads to hyperpigmentation for me. I have had success using a cleanser with 2% salicylic acid, AHA cream and Hydroquinone, as well as Retin-A 0.01% & Hydroquinone. Unfortunately, as soon as I stop using Hydroquinone, my hyperpigmentation starts to return in some areas. It's an ongoing battle.

TokyoGirl,

Are you using a sunscreen with good UVA protection? Most sunscreens do not protect well against UVA rays, even high SPF ones which can pass through windows and also destroy collagen and pigment skin. Many very fair skinned people use Canadian and European imports to protect their skin better.

Share this post


Link to post
Share on other sites
Peels tend to irritate my skin and that always leads to hyperpigmentation for me. I have had success using a cleanser with 2% salicylic acid, AHA cream and Hydroquinone, as well as Retin-A 0.01% & Hydroquinone. Unfortunately, as soon as I stop using Hydroquinone, my hyperpigmentation starts to return in some areas. It's an ongoing battle.

TokyoGirl,

Are you using a sunscreen with good UVA protection? Most sunscreens do not protect well against UVA rays, even high SPF ones which can pass through windows and also destroy collagen and pigment skin. Many very fair skinned people use Canadian and European imports to protect their skin better.

Of course! I use Shiseido SPF 55 that's 16.3% Zinc Oxide & 2.2% Titanium Dioxide. Beats any sunblock offered by my dermatologist. I have Asian skin, like the OP. I avoid the sun, and have lived like a vampire over the last 6 months. I still hyperpigment. It's definitely not related to the sun because I don't allow the sun to touch my skin.

Share this post


Link to post
Share on other sites
I have Asian skin, like the OP. I avoid the sun, and have lived like a vampire over the last 6 months. I still hyperpigment. It's definitely not related to the sun because I don't allow the sun to touch my skin.

Hyperpigmenting after injury to the skin is not unusual at all, even without much sun exposure, but it's unusual to re-hyperpigment after consistent successful hydroquinone use with good protection. I wonder what is going on there. Maybe your skin has become very sensitized to even miniscule amounts of uv rays?

Share this post


Link to post
Share on other sites

Taken from: http://www.acne.org/...-with-pictures/

You're wise to be skeptical of the before and afters. I am too. So much trickery in this industry. AFAIK the link isn't a medspa's site though, the girls blog is here http://pookyzchuthab...blogspot.co.uk/ , here http://pookyzchuthabhon.wordpress.com/ and Youtube here www.youtube.com/user/ThePookyz/videos

Look at that internet stalking. eusa_shifty.gif

I have to be honest, and say I didn't translate the page. I hit "home" and saw a doctor plus other treatments advertised. For that reason, I looked at it as promotional. I have no idea what the site is about.

Share this post


Link to post
Share on other sites
I have Asian skin, like the OP. I avoid the sun, and have lived like a vampire over the last 6 months. I still hyperpigment. It's definitely not related to the sun because I don't allow the sun to touch my skin.

Hyperpigmenting after injury to the skin is not unusual at all, even without much sun exposure, but it's unusual to re-hyperpigment after consistent successful hydroquinone use with good protection. I wonder what is going on there. Maybe your skin has become very sensitized to even miniscule amounts of uv rays?

I'm not sure it's unusual. I think it depends on the depth of damage & skin type. I had Deep FX in February and my hyperpigmentation was clear after a few months. I stopped using hydroquinone almost one month ago, and some of my brown spots returned pretty quickly. I've just started using hydroquinone again and am hoping another couple months will clear it. Although, I am planning to have fractional co2 again soon, so I will likely be using hydroquinone for another 4-6 months. I just know that a superficial peel alone does not improve hyperpigmentation with my skin type, and can actually aggravate it.

Here's a link that mentions it can return:

http://www.realself....perpigmentation

Depending on the cause of hyperpigmentation, sometimes the dark areas return once patients discontinue hydroquinone. These unfortunate patients need hydroquinone for longer periods of time.

from what I can tell it's just a skincare board for thai speakers. not unlike this place It was originally posted here http://pookyzchuthab.../04/part-1.html

Blog or not, the photos still look promotional and fake to me. It definitely doesn't look like the pictures you'd find on this board.

Edited by TokyoGirl

Share this post


Link to post
Share on other sites

Always a possibility. Short of contacting her there's no way to verify, and I can't be bothered with that.

Lol! That's my thought exactly. I just don't trust it. It looks staged to me. Plus, even if you contacted her and she replied, you would still never know if she's telling the truth.

Edited by TokyoGirl

Share this post


Link to post
Share on other sites

To the OP, if you're thinking about doing a home peel for hyperpigmentation, you might want to consider the responses from doctors here:
/>http://www.realself.com/question/chemical-peel-acne-asian-skin

Share this post


Link to post
Share on other sites
I just know that a superficial peel alone does not improve hyperpigmentation with my skin type, and can actually aggravate it.

Yes, definitely, nothing that can burn substantial portions of the epidermis should ever be used outside a medical office. Most of the low level stuff available on Amazon (20% glycolic and lower, 25% mandelic) are actually pretty weak in strength and just exfoliate well. They definitely shouldn't be able to burn through the epidermis unless there is a skin sensitivity (like one caused by retinoids in which case a peel is unnecessary), an allergy, skin injury or they are left on too long.

Frankly, I'm surprised they are able to sell stronger concentrations or TCA peels online and that people are buying them because they are very dangerous.

Before laser treatment, were you ever prescribed finacea? If the pigmentation is down deep it probably wouldn't have helped but it's shown to reduce hyperpigmentation, even in darker asian skin and even if you don't have rosacea.

Edited by staple

Share this post


Link to post
Share on other sites

@TokyoGirl - Yeah, I have red marks which turn brown then fade after an incredibly long time too. I'll not be doing any peels for now and just try to stay out of the sun. You mentioned that you went for Deep FX and it gave you hyperpigmentation? Do you mean that the areas treated by the laser all became hyperpigmented?

@remicade - That girl achieved some amazing results, but I think on average dermarolling would take over a year to achieve significant results, which isn't what I'm looking for right now. However I'll definitely consider dermarolling after going for laser/subcision/etc.

Share this post


Link to post
Share on other sites

@TokyoGirl - Yeah, I have red marks which turn brown then fade after an incredibly long time too. I'll not be doing any peels for now and just try to stay out of the sun. You mentioned that you went for Deep FX and it gave you hyperpigmentation? Do you mean that the areas treated by the laser all became hyperpigmented?

@remicade - That girl achieved some amazing results, but I think on average dermarolling would take over a year to achieve significant results, which isn't what I'm looking for right now. However I'll definitely consider dermarolling after going for laser/subcision/etc.

Yes, the areas treated with laser became hyperpigmented. The redness faded pretty quickly but I am still trying to correct some of the brown spots where the laser penetrated deeper. Originally, the hyperpigmentation was pretty uniform across my cheeks. I only had my cheeks and temple lasered. It's not as severe as hyperpigmentation from acne or what I experienced with TCA Cross. I can easily cover it with makeup.

I just know that a superficial peel alone does not improve hyperpigmentation with my skin type, and can actually aggravate it.

Yes, definitely, nothing that can burn substantial portions of the epidermis should ever be used outside a medical office. Most of the low level stuff available on Amazon (20% glycolic and lower, 25% mandelic) are actually pretty weak in strength and just exfoliate well. They definitely shouldn't be able to burn through the epidermis unless there is a skin sensitivity (like one caused by retinoids in which case a peel is unnecessary), an allergy, skin injury or they are left on too long.

Frankly, I'm surprised they are able to sell stronger concentrations or TCA peels online and that people are buying them because they are very dangerous.

Before laser treatment, were you ever prescribed finacea? If the pigmentation is down deep it probably wouldn't have helped but it's shown to reduce hyperpigmentation, even in darker asian skin and even if you don't have rosacea.

I used 4% hydroquinone before and after laser which is pretty standard for my skin type.

While I have purchased peels off the Internet in the past, I would never do it today. There is no way to know the quality of the product you are buying. I have made too many mistakes with my skin.

Share this post


Link to post
Share on other sites

I have Asian skin just like you guys! Do you guys think microdermabrasions would help or is the pigmentation just way too deep? Also, what are some good brands for make up concealer? I'm considering doing this because I have post-inflammatory hyperpigmentation around my mouth that looks fairly dark and doesn't look like it will fade anytime soon. It looks like a 'goatee.'

Share this post


Link to post
Share on other sites
@remicade - That girl achieved some amazing results, but I think on average dermarolling would take over a year to achieve significant results, which isn't what I'm looking for right now. However I'll definitely consider dermarolling after going for laser/subcision/etc.

Seems like you don't fully understand collagen formation in the body.

I'm in full agreement with Remicade on giving dermrolling a go first before you try anything else.

Why? Simple, because:

1) Collagen formation takes time period; no matter what scar treatment you decide to try; anywhere from 8 weeks to several months before collagen changes from type 3 to type 1.

2) Lasers (unless profractional) destroy the epidermis in order to get to the dermis where all scarring is located. Dermrolling creates micro-injuries without destroying the epidermis and going straight to the dermis.

3) Lasers are expensive as phuccck! Total rip off and the potential side effects and loss of $$$ aren't worth it IMO. I tried a Erbium Profractional laser last summer; it did give me some noticeable results, but the downtime and cost weren't worth it.

4) Peels do NOTHING to correct the actual scar, they destroy the epidermis as well, thinning the skin. Some peels can help induce collagen but its very minimal compared to lasers and dermrolling.

--------------------

Dermrolling, combined with LED therapy will do incredible things to your skin, not only for scarring but visible signs of aging etc.

Educate yourself, research, read and read some more.

I do agree that you should go to several different cosmetic derms and ask them questions; find out if they are truly trying to help you or just make a quick buck.

I'd ask them what kinda of scarring you have, how deep it is and how many treatments and what kind they recommend along with cost.

Then come back and give us the feedback and we can guide you with more accuracy.

I know scars suck, but don't RUSH and make a brash decision based on what some random stranger who is simply looking at blurry pics and advising you to try super expensive treatments.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


  • Personalized Advice Quiz - All of Acne.org in just a few minutes

×