I'm sorry to hear about your treatment woes. You're right, scars will re-tether in a high percentage of cases and numerous subcisions would be required in order to really see any big changes. I doubt that the scars that were not treated have suddenly become tethered but it is possible that the scars that were treated have tethered in different places to before, making their appearance much different to how they were pre treatment.

Has your doctor looked into combining subcision with a Hyaluronic Acid based filler? I think that would give you much more significant results and would help keep the skin lifted for much longer to help prevent re-tethering.

Also, I personally think that the Dermapen is useless for scarring. The needles are straight and are not as effective in breaking up scar tissue. The Dermaroller needles enter your skin at a different angle to what they exit from. So, under your skin there is micro "sweeping" going on, helping to break up scar tissue. Straight needles might be good for those without scarring but I think it's a waste of money otherwise.

I haven't had subcision but it's on my list of things to look at for one rolling scar on my cheek. I would imagine that it wouldn't be that wise to needle that area straight after subcision as the collagen is still remodelling under the scar. The last thing I would want to do would be to risk halting or changing the process by adding secondary trauma to the area. But this is my take on things. If I do have subcision I will be insisting on the use of an HA based filler to increase my results.

I have a combination of mild/moderate rolling and box-car scars, with one severe rolling scar on my left cheek. My current treatment plan is the Dermaroller and I have been researching something called Airgent which looks exciting. On the surface it just looks like another way to deliver a filler, but that's not actually its purpose. Since Dermarolling and Hyaluronic Acid work so well together I might consider doing some Airgent treatments with my Dermaroller sessions.

Maybe you should give your skin a rest for 3 months or so and then start fresh. After my Fraxel sessions I waited a year before starting my Dermarolling to let my skin settle. The year off was tough as I really wanted to continue with my treatments but I held out. Glad I did. Please don't give up!

xx

I doubt that the scars that were not treated have suddenly become tethered but it is possible that the scars that were treated have tethered in different places to before, making their appearance much different to how they were pre treatment.

This is what I would think as well, although I don't have experience in subcision or rolling scars. Have your rolling scars become noticeably worse in the past months, or is this re-tethering issue just something that you can see when you stretch the skin?

I would recommend that you'd look into the suction-method if you are having more subcisions, and if it seems like something you'd want to try, give it a go. There was a research article about it and it seemed to be effective, also Mr. Matt on this forum has tried it with great success. I think you can still find the article and also buy a fairly cheap 'suction pump' on Sarah Vaughter's website (owndoc.com) if you decide to try. I would imagine it could help prevent the retethering of scars.

Don't lose heart, subcisions are a very effective treatment for rolling scars and I'm sure you'll get success even if it's going to take a few more rounds.

Thank you both for your replies, i am quietly freaking out about this!

What i still don't understand is that i was under the impression re-tethering happened in the first month or so following subcision. Four months after the inital subcision my doctor looked at them and said that they had improved a lot and didn't need another subcision and then they re-tethered again, which means that they must have re-tethered during months 4 - 7. I thought any re-tethering would have occurred way before this. If i had done the subcision-suction method surely it wouldn't have been of any benefit as re-tethering didn't start occurring until month 4 (at least) when i would be no longer suctioning.

Sorry to hear about your results. I was thinking if you had PRP after the subcision ( a little confused on the order of your treatments) that acts like a filler and would wear off after four months. I have looked into selphyl which is like PRP and some people say if does look good for awhile and then not so good, hopefully there will be permanent improvements with it, but it is a gamble. Maybe you should stop with the dermapen treatments for awhile. I remember another poster on here a while back that complained about the dermapen with Dr. Chu as well. He got worse and Dr. Chu said it was a rare occurrence but it did happen. He actually thought he was losing fat. I thought that was odd as I'd only heard of that side effect from lasers. I would voice all your concerns with Dr. Chu.

Was the PRP really injected into the skin? If so, I completely misunderstood how you were treated. I thought it was put on the skin for improving the healing and collagen synthesis after dermarolling and TCA cross, thus giving better results. I agree with Tricia that you should talk about your situation with Dr. Chu and hear his opinion, he seems like a trusted and experienced doctor and he can most likely give you better answers than any of us.

I haven't heard of people losing fat after dermapen treatments before, I hope it's not a typical side effect. :/ They do say that dermarolling is supposed act like lasers (I think it's a bit of an overstatement though), so who knows. Then again, you wouldn't get 'thermal damage' with dermarolling.

The order of treatments went like this - first off about 20 injections of prp followed by prp applied topically, then dermapen. Then due to the swelling he can see which scars are tethered and if any subcision is needed. I had about four scars tethered so he subcised those and then he finished with tca cross on my pitted scars.

I wouldn't say that i had lost fat or that my skin looked visually worse. I would say that the rolling scars look marginally better than they did seven months ago when i first started treatment, so i believe the dermapen and subcision have helped a bit, just not as much as i would like.

I did ask Dr Chu about it and he said that sometimes scars just seem to have a mind of their own and it happens sometimes.

Also most of my scars have occurred after coming off accutane. When i first came off accutane i had a few mild rolling scars. Over the space of a year they gradually got worse and more appeared out of no-where and i would say that they are now moderate to severe. I mentioned this to Dr Chu and he told me about AMVC which is where spontaneous linear scars appear out of no-where. I wonder if i have this and this is why my scars have started tethering again?

Also i agree with the fact that prp acts a bit like a filler. For about 6-8 weeks after treatment my skin looks radiant. Then it seems to gradually get worse again until my next appointment.

I'm sorry to hear about the spontaneous scarring! AMVC sounds very harrowing. Are you still getting scars spontaneously? If you haven't read about this yet on the forum, you should read the posts by lamarr1986 on this issue. I've never looked into it myself since I was never on accutane, but he seems to have given people some good advice on how to stop the scarring.

Yeah i've read the posts by lamarr and i've just recently started to take an anti-histamine in the hope that it will prevent any further scars. I've stopped it now as i didn't no if it would interfere with my dermapen treatments by reducing inflammation too much but i plan to start taking it again in a couple of weeks.

I'm not sure if it is AMVC that's caused my scars or if it's just as a result of being on accutane. Dr Chu said that accutane impairs healing and it may have been that that caused it. I went on accutane as my skin started scarring after having acne for over 10 years. So when i came off it i expected to have a few scars and everything i read said to give it 6 months and that the scars would start to look better, but for me it was the opposite and they just got worse and more widespread over the course of a year. I now have multiple rolling scars on my cheeks and chin that i didn't have when i came off accutane a year and a half ago.

That is interesting about the scars appearing more, maybe you should look into a nutritionist since the accutane may have caused deficiencies in certain vitamins. Things like borage oil and evening primrose oil may help you too. If you truly have weak skin that scars that easily I would think Dr. Chu wouldn't want to do dermapen on you for fear it could get worse. It sounds like you are not worse overall though, so it is good there has been some improvement. Try not to stress too much, that causes havoc in itself. Maybe your collagen is still building and you just need more time to see the most results, good luck!

I've just compared a photograph i took today with one back in May when i had my original subcisions done and i can see that two scars i have just had subcised were also done back in May, however the other two subcisions i've had were not done previously. I'm not saying that i didn't have rolling scars there before, i did, but they weren't bound down back then. So that means that previously untethered scars have become tethered and i haven't done anything to them other than the dermapen treatments i've had.

This means that all the treatments i've had that are supposed to induce collagen and help me have actually made some of my scars worse. I just really don't understand how this has happened.

I'll look into the borage oil and evening primrose tricia. I'll do anything i can to help this.

accutane is a definite factor. i heard one derm recommend no scar treatments post accutane for at least 1 year (despite the norm being ~6 months). it's a serious drug. try supplementing with vitamin C and eating a diet that hits all of the necessary nutrients that your skin needs.

and do you think you could post some pictures for us? that would be helpful

This was January this year (prior to having any treatments done at all) (photo removed)

3 days after first subcision in may (photo removed)

Taken last week just before this subcision (photo removed)

3 days after my latest subcision (photo removed)

Sorry the quality isn't great on the last one but you can clearly see that he has subcised a new area this time.

I'm taking 2000 mg vitamin c a day and zinc. Also i'm using terproline and a homemade 10% vitamin c serum.

If I'm reading your posts correctly, I think you said you didn't have rolling scars in the newly affected areas but did have TCA Cross done in different areas from subcision. Is that correct? If yes, did you by chance have TCA Cross done in the areas that are now tethered? I had a few areas kind of cave around scars that had been crossed too close together. By too close together, I am talking about the distance between your closer pits. The caving wasn't apparent for a few weeks, and sadly hasn't gone away. I had one doctor recommend subcision, but he was the only one who recommended it after consulting with over a dozen different doctors. You can't actually see the caved areas in my photos. They're very hard to pick up with my camera, and do look like rolling scars. I'm also not talking about my scars that deepened or widened from TCA, but am referring to surrounding skin that was never touched by the TCA. If co2 laser doesn't correct my newly acquired, non-acne related indents, then I will likely try a filler next.

Inspired, i did already have rolling scars there but they weren't tethered. I may well have had TCA in that area, i'm not sure. I stupidly didn't take any photos during my last procedure in September so i can't check back. Sorry that you're suffering with this too, I didn't know that was something that could happen with TCA, is it a common side effect?

Inspired, i did already have rolling scars there but they weren't tethered. I may well have had TCA in that area, i'm not sure. I stupidly didn't take any photos during my last procedure in September so i can't check back. Sorry that you're suffering with this too, I didn't know that was something that could happen with TCA, is it a common side effect?

 

I don't think it's a common side effect at all, but I do think there are risks with Cross. Even with the right, experienced doctor, there's no way to know how every patient's skin is going to react. I think I was just one of the unlucky ones with Cross, and my skin reacted poorly. At the time, I was only being treated with TCA Cross and gave my skin 4 months to heal afterwards, so I know the indents were related to my Cross treatment. In your case, it's hard to say why you're having this reaction. It could be a number of factors combined. I don't think you should be doing so many different treatments to your skin so close together though. I'm not familiar with Terproline but if it contains an acid for collagen building, you might want to stop using it a few days before and a few weeks after each treatment. At least, that's what I've been told by doctors with the use of Retin-A, glycolic cleansers, etc. after scar treatment. Your skin might be too fragile for topical use after treatment. I'd give it at least one month, if you're not already doing that. I also have never tried Dermapen, rolling, subcision, etc., so I don't know if retinol use makes sense with these procedures but I wouldn't be using them after TCA Cross. I do know Vitamin C can't hurt and should help with healing. Also, if you're using any kind of blood thinner (Vitamin E, Garlic, Fish Oil, etc.), you should definitely stop those for a period of time before and after each treatment.

Sorry if this doesn't help much. I'm sorry you're going through this. It's so frustrating when scar treatment goes wrong, but don't lose hope! Keep searching, and you will find the right treatment for you. I was anti-laser for a long time. In the end, it's the only thing that's helped me. It's a shame I've ended up with additional scarring in the process, but despite some setbacks, my skin has drastically improved over the last year of treatments. It's been a difficult journey though, so I can definitely relate to how you're feeling.

Could it be that the retethering was there all the time, but it just wasn't noticed before? Or I don't know if that could be an option. I know very little about rolling scars. I haven't heard of cross causing something like this, although that doesn't mean it couldn't happen. I hope you can revert this and get more improvement with further treatments, justmeuk. I know it's hard when you go through risky treatments and the results don't seem to be getting you anywhere.

And Inspired, I had no idea you got new rolling scars due to Cross. That's horrible.

I'm using Terproline Professional to improve the healing of new scars (and with needling aftercare in the future). It's not acidic at all but feels more like a moisturizer for sensitive skin, so I don't see why you couldn't start using it right after the scabs have fallen off. It does, however, contain "the building blocks for hyaluronic acid" or something along those lines. What has confused me the most is that it's also supposed to prevent hypertrophic scarring, which sounds fairly counterproductive.

EDITED

(I actually can't believe I posted that here, so I deleted it.)

Inspired - i didn't see what you deleted so i'm not sure what you're referring to. Is the photo showing your damage from tca cross?

Terproline is actually pretty mild and doesn't contain any acids or retinoids. Dr Chu actually recommends it and it is marketed as being suitable for use post lasers/burn treatments etc so i'm sure it's ok. I've stopped with the vitamin c serum whilst i still have the tca scabs.

Lasers really scare me due to all the horror stories around. Also i have redness from the tca which still hasn't gone away six months later and i've been told i'll probably need vbeam laser to get rid of it, so i'd be really worried about lasting redness from the lasers, plus the risk of possibly making my scars worse.

Austra, i'd have thought Dr Chu would have noticed if it was tethered before. He does dermapen first as he can then clearly see which areas are tethered due to the swelling from the dermapen.

The only thing i'm doing differently this time is trying the suction method. I've been suctioning since day 3 as per the study so i'll see how things go. Though i can't help thinking that even if suctioning gives me a better result there's still the possibility that they could re-tether some months down the line.... Gonna try not to dwell on that fact though.

Inspired - I agree that those aren't rolling scars. I can see what you mean. I'm quite shocked you got such bad and completely new scarring because of TCA cross. I hope you can get them sorted with a filler, if the laser treatments aren't enough. You seem to have had tremendous improvement after the DeepFX, though, and be well on your way to resolving your scarring to the point where you can move on and just live your life.

Best of luck with the recovery, justmeuk! The suction method seems very promising, hope it improves your results this time. And I agree, it's not worth dwelling on the worst-case scenario, even if it's hard not to. You should try to keep yourself relaxed and in good spirits - that's best for the healing as well.

Inspired - i didn't see what you deleted so i'm not sure what you're referring to. Is the photo showing your damage from tca cross?

 

I am sorry for the confusion. I meant to delete the photo too, but yes, I suffered some bizarre damage from Cross. I've actually seen a similar case documented in a clinical article and her skin caved much deeper than mine did, so I know I am not alone (that's relieving to a degree).