if u had no improvement from the first i would certainly go a different route..lasers are mostly effective w the combination of recell but if that option is unavailable u should consider fat grafting or some type of dermal filler
The doctor I went with originally told me that I would not see improvement until I get at least 3 very aggressive fractora treatments...he gave me a 40-50% improvement in scars. I understand collagen is still building, but I don't think I should choose this route anymore based on the types of scars I have so I completely agree on taking a different route. Thank you for taking the time to reply 
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np..u have very similar scars as ernestoria therefore fraxel/recell/subcsion combo would be the best treatment option for u imo
Yup, I actually commented before that they were very similar to ernestos scars except I'm a girl (which makes it worse in a way I think). I won't be flying to the UK anytime soon, but at least I have a doctor who is a couple of hours away from me 
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Go directly to Re:pair at 70mj. I forget Ernesto's protocol, but Re:pair will be a very large part of your treatment. Don't buy into the lasers of a Lesser God, you will just waste time.
Do you think subcision and fat grafting will be a waste of time for my skin (or do you mean this should be included)? I'm just scared about using such a strong laser on my dark skin.
Go directly to Re:pair at 70mj. I forget Ernesto's protocol, but Re:pair will be a very large part of your treatment. Don't buy into the lasers of a Lesser God, you will just waste time.
Do you think subcision and fat grafting will be a waste of time for my skin (or do you mean this should be included)? I'm just scared about using such a strong laser on my dark skin.
I never comment on subcision because frankly I don't have a working knowledge of it. I won't kid you Re:pair may not be the thing for darker skin. I don't pull a lot of punches, but I won't BS you either.
This is one of the most stunning improvements I've seen yet online, and I would argue even better than ernestoria's because the documentation is thorough. There are little to no lighting inconsistencies. The photos are taken in the same bathroom under the same lights. Given the severity of his acne scars, this is a life changing improvement. I say invest your money in time tested and proven techniques. I am not discounting ReCell, but there is not much independent research showing that it significantly improves the result. If you have unlimited funds, then ReCell might give you that extra boost but I would not count on it to be the critical factor in your scar revision journey.
I think your scars are very similar to this guy and I believe that a combination of extensive subcision, long lasting fillers like Voluma or fat grafting, and Fraxel Repair / Total FX will help.
As for lasers on dark skin, it is a nuisance, but hyperpigmentation almost always resolves. Plus, you are female so makeup will help you during your recovery.
Lasers are good for improving texture and color and fill scars to a degree, but they do not have the ability to create lots of volume where there are deep indentations. They help to soften the relief / texture of the skin and to blunt sharp edges on scars. Other adjunctive techniques like subcision / fat grafting / excisions must be done first. You need to elevate the scars as much as possible to the level of normal skin before you start resurfacing. If you don't, you will not be maximizing your potential results. Remember, the best results are ones that employ many techniques, and each type of scar must be approached differently. Icepicks can be excised and sutured, rolling scars respond to subcision, and the sharp edges of boxcars can be softened by resurfacing. Laser alone will not give you the maximum results.
GET SUBCISION! Your skin and scars look like it will be a very good candidate for subcision. Subcision suction, generally, is the best treatment for rolling scars.
From what I've seen, it is safer, cheaper, and more effective than fraxel laser with less downtime. As a veteran of subcision, I highly recommend it. Feel free to consult me for more information. I have/had scars that are very similar to yours, albeit not as much.
Thank you blahblah82 & AcnePwns for the replies, I really appreciate! I def. understand that I need to elevate the scars at this point, laser won't really do much with the indentations. The inflammation just completely destroyed the tissue so I'm going to have to work hard just to make my skin decent. I already made up my mind; I will mostly concentrate on subcision and fat grafting/fillers at this point. I've been feeling absolutely horrible about my skin the past few months, but asking you guys for advice has made me feel a lot better . I guess it's nice to know that I'm not completely alone and there are people out there that are willing to help you out on something that is so depressing. Thanks guys .
Hey guys, I had my appointment with Dr. Rahimi and I really need some advice :/. I'm going to make this quick because I'm exhausted (I apologize if anything sounds odd). He said he would do mixto laser and ultherapy on my skin two separate times for a whopping $5000. That's a lot of money so I'm still kind-of recovering from that; $3000 the first time then $2000 the second time. I do have a lot more scarring (and it is way worse), so I figured it was because of that. I told him I felt that subcision and fillers/fat grafting would be a better option for me and he said that the subcision was already included, but that he didn't recommend the fat grafting because that is mostly used for deeper scaring (I def. thought mine were deep enough) and that it would only make my round face rounder. He said he would have done punch excision as well, but that he didn't see any scars deep enough for it. I would need to prep 2 weeks before the procedure by using bleaching cream (anyone know why - is it because I have dark skin?) and retin-a (which I already use). That was mostly my experience. Otherwise, he was a really nice guy and I do believe he wants to help you. He said he could definitely make my skin look a lot better and gave me a 50% improvement (not sure what to think of that). I didn't feel rushed at all during the appointment, and he showed me pictures of patients like I figured he would (none from acne.org members). He did ask me how I found out about him and I told him realself (which is the truth, but I also found out about him from this site too). If you guys have any specific questions, feel free to ask, but I'm just really not sure if I should jump in. That is soooo much money and I"m terrified that I won't see much improvement *Just wanted to add that he said he was going to be really aggressive with the treatments and that I would need at least a week off from work (he showed me the peeling skin, etc). Furthermore, he showed me images of the patients a week after treatment but I disregard those due to the swelling I'm sure they are still experiencing.
Okay.....
1. I agree that fat grafting is more for volume loss as opposed to injecting focally into indentations. From what I've read, the fat is too globular and lumpy to be injected smoothly under a scar.
Personally I have not seen many good examples of fat grafting on acne scars. In theory it sounds like it should work well, but in practice I actually am not convinced. People like to oversell the "stem cells" in transferred fat but I think it is overhyped. A lot of the fat does not survive the harvesting and injections, so a good percentage will dissipate. A portion does become permanent, but that is unpredictable. This is why doctors overinject, because they need to compensate for some fat dissolving. Unfortunately a lot of the fat may survive, so you could end up looking too full and over injected, which is a not a good look, trust me. I would agree with Dr. Rahimi on this. If you had very deep fat loss and sunken cheeks due to acne scarring this would make more sense. What you have are deep indentations but not large areas of hollowness.
There are a few fat grafting disasters on Realself that should give you pause. Read these carefully because they are very insightful.
- http://www.realself.com/review/california-fat-transfer-fat-transer-face
- http://www.realself.com/review/bellevue-wa-fat-transfer-stay-away-from-lacks-skills
A lot of doctors don't think fat grafting is effective for acne scarring
- http://www.realself.com/question/fat-injection-solution-post-acne-scars
2. Sticker Shock - I think everyone who enters this journey is always shocked by how expensive it is to do serious treatments for severe acne scarring. As for his pricing, I think this is the exact standard price he has quoted other people, so that does not seem unusual. I noticed that you said he is throwing in ultherapy and subcision in the mix as well. He didn't offer ultherapy as part of that package in the past, so that part is new. Given that Ultherapy by itself is around $2K in LA, that seems reasonable.
3. What ethnicity are you? If you have darker skin tone the bleaching cream is to minimize hyperpigmentation after the laser. That is the standard of care.
4. Pictures after a week are meaningless, glad you are savvy enough to realize this. Everyone looks amazing at one week with all the microswelling. Did he show you pictures of patients months out from the procedure? That is more meaningful.
5. A week is the bare minimum, and that seems a little optimistic if you are going to do a very aggressive procedure. You may be done peeling after a week, but there is significant redness, but you can hide that with makeup.
All in all, I think this is a reasonable approach he sketched out for you, but it is indeed a lot of money.
Okay.....
1. Thank you for such a detailed answer, it really means a lot to me! Now that you showed me the links, I could see why fat transfer can be a bad idea, I def. don't want to come out looking swollen. I have always had a round face, but my recent weight loss thinned out my face. I personally think my scarring looks worse now, but there's not much I can do now. Are fillers considered the same as fat grafting (make my face look worse)?
2. Yup, the price did indeed shock me, but I also wasn't familiar with prices. I am willing to invest in my face, but I am also terrified about seeing absolutely no improvement after spending thousands of dollars. I can't help, but feel really nervous.
3. I'm hispanic, so I have brown skin. I figure the bleaching was for hyperpigmentation, but I just wanted to make sure since I forgot to ask.
4. There was one picture of a woman he showed me that looked like it was taken months after. These seem to be the main pictures he shows people because they were made much larger for display purposes. They look old and you can def. see improvement, but I don't know much about them to be honest. All other images he showed were on his ipad and he would show me the before and after (one week).
5. He said I should be done peeling by day 7, but I would be red for a while. He made a point that I can not work at all during the week so he seemed to be really serious about how aggressive he will be.
I think I'm going to do it. I was planning to ask a week in July so it works out (except I'll have no fun haha). I'll keep you guys updated throughout the whole time. I'm hoping to see decent improvement after the first treatment. I'll be out $3000 by that time...not sure when I'll be having the second treatment (which would also require a week off).
*One last thing I wanted to mention is that he said that my scars were "box car" . To be honest, I never knew what my scars were...all I knew was that they looked bad haha. From what I researched online, it's supposedly the easiest scar to fix (to an extent of course, scars are permanent), but I'm also reading they don't respond as well to lasers. Can anyone give me some input on this?
Fillers do the same kinds of things as fat grafting except that there are many different kinds with different characteristics. There are some that are very soft like Belotero, which is suited for very fine lines and superficial defects. Juvederm Voluma, by contrast, is very thick and injected deeper. It is very viscous, so it can be used to lift deeper defects and lasts approx 18 months they claim. I'm positive that Rahimi uses Voluma on acne scarring because he's posted about it on Realself. Fillers are nice in that you can take them right off the shelf and they're ready to use, as opposed to fat which requires liposuction to harvest the fat. It's a little more invasive for that obvious reason. You can look overinjected from any filler, so it always comes down to the skill of the surgeon.
I think you are on the right track with the subcision and fractional co2 laser, but of course go in with realistic expectations. You can't expect miracles, even though at $3000 one would hope for significant improvement. Good luck with your procedures.
Is Rahimi planning to do Ultherapy, Mixto and subcision in one session? Did he explain the benefits of Ultherapy to you? I am curious to know how that can improve atrophic scars.
Yup, all three in one session for 3 grand and then he's going to do it again for another 2 grand. He said that ulterapy will stretch my face and make my scars look better (he asked me to stretch my cheek to see what he meant). I've been reading that supposedly it has helped with scars (because of collagen being built)...apparently they are having clinical trials on its use for atrophic/acne scars for those who live near those areas and want to try it out!
Ultherapy is quite popular right now in SoCal, and tends to be expensive. I have read a bit about it being used differently on acne scars to make them appear less deep. Example:
http://m.palmbeachpost.com/news/lifestyles/health/facelift-vs-ultherapy-sagging-facial-scars/nXRsx/
I think the combination of all three is quite a lot to put your skin through in one procedure but I am not a doctor. Have you consulted with other doctors?
This is actually the first time I have heard of Rahimi using Ultherapy on scars. I have consulted with him in the past, and have followed him on this board and RealSelf for the last two years. It seems his pricing has jumped quite a bit in the last year which has likely been caused by his Internet popularity and the resulting demand.
Did he give you an estimate on improvement after two sessions? Did he feel you would be satisfied after two sessions? I will be honest and say, severe scarring will require more than two aggressive sessions for decent improvement. I just hope you're being realistic in your expectations because $5000 for MixTo is very expensive.
It is too bad there are so many exclusions for that study. I don't qualify.
I wish you the best of luck with your treatment journey.
Ultherapy is quite popular right now in SoCal, and tends to be expensive. I have read a bit about it being used differently on acne scars to make them appear less deep. Example:
http://m.palmbeachpost.com/news/lifestyles/health/facelift-vs-ultherapy-sagging-facial-scars/nXRsx/
I think the combination of all three is quite a lot to put your skin through in one procedure but I am not a doctor. Have you consulted with other doctors?
This is actually the first time I have heard of Rahimi using Ultherapy on scars. I have consulted with him in the past, and have followed him on this board and RealSelf for the last two years. It seems his pricing has jumped quite a bit in the last year which has likely been caused by his Internet popularity and the resulting demand.
Did he give you an estimate on improvement after two sessions? Did he feel you would be satisfied after two sessions? I will be honest and say, severe scarring will require more than two aggressive sessions for decent improvement. I just hope you're being realistic in your expectations because $5000 for MixTo is very expensive.
It is too bad there are so many exclusions for that study. I don't qualify.
I wish you the best of luck with your treatment journey.
I think he started experimenting with ultherapy in 2012 based on his blog. Apparently, he claims that the patients that have been getting it done also saw improvement with their scars. Regarding the pricing...it isn't good after-all? I was told by his staff that he normally charges $3000 for mixto and $3500 for ultherapy and he's doing it twice for a total of $5000. I'm only getting one treatment done, and it looks like I can get it split evenly ($2500 just for both lasers as opposed to $3000 upfront). I mean, they could have just been saying that because they are employed there, but they said he was giving me a "break" and that it was a really good deal. Now I'm hesitant to continue, I was actually planning to have it done the beginning of July. I know with others in the past, he has done mixto twice for $3000. Like I mentioned before, my scarring is a lot worse. *Sigh*, I'm not sure what to do now. I am not a candidate for other lasers because of my darker complexion and I liked the fact that he was also doing subcision. He gave me at least a 50% improvement which I'm assuming is after two treatments & he told me straight out he can make my skin look a lot better. All those treatments might be too much, but I have this dumb mentality that a harsher treatment is better (thanks to ernestos story).
I haven't consulted with any other doctors because I'm not having much luck looking elsewhere (if anyone knows any San Diego docs, please let me know), but like I mentioned before, I really wanted to include subcision as well. I know I shouldn't get my hopes up regarding the treatment, but I can't help, but be hopeful. I'm still pretty young so I won't give up fixing my skin.
sld235, Have you seen the reviews on realself on regards to ultherapy? About 438 reviews and only 70% satisfied rating with most using this procedure for aging sagging skin & wrinkles which what it is intended for. Supposedly the results only last for like 2 years and the procedure is very painful when done on the face as many have complained about the pain even with numbing their skin before the treatment. A lot also said to see & know full results it takes about 2-3 Months after 1st treatment, but many have reported minimal to no results after a year they've gotten the treatment. Check out the link here to read about ultherapy if it's worth it or not at: http://www.realself.com/ultherapy/reviews
I would advised against it as you might be back to square one after 2 years and really didn't need ultherapy after all. And also there are risks with it, Like permanent Fat tissue loss(if things go wrong) that you can't get it back ever making you look a lot older with premature wrinkles or even sunken cheeks. One lady got two burn holes in & she was using it tighten her skin(not for acne scars), So be careful if you go this route. I think Mixto though is still good to try out, Maybe you can get 4 of those treatments done several months apart for that $5,000 price as posters Slee & DragZ have gotten really good results without the need for ultherapy. With DragZ i think he got more than 50% after doing 4 Mixto's mixed in with Subcision.
ultherapy may give you better results in the beginning, but with the aging process all are skins eventually sag little by little as we get older as you do see Old people getting face lifts, but after a few years they need to get another one to build tightness again. yes this does build collagen inside the skin, But why get this painful procedure done also with the risks of permanent fat tissue loss when you can get fillers like Juvederm Voluma which last just as long or maybe longer than this? that builds collagen the same way too without having to go through that pain or any risks.
One lady from realself has also recently documented her story with Dr.Rahimi and said she got really good results using MixTo, But mixed it with Pelleve which is not as strong as ultherapy treatment. You can see her pictures and read her story here www.realself.com/review/unknown-acne-scars-treatment-29yo-caucasian-female-moderate-acne-scaring She has several pictures including some at 6 weeks post treatment and results look good and skin looks a lot smoother & she paid $3,000 for 1st procedure. yes he is giving you a great deal in price as the average price based on 1-ultherapy treatment is $2,700 based on what realself customers who have gotten this procedure done all over the U.S.
MixTo is not the only laser out there for dark skin. Did you read BlahBlahBlah's earlier link to you on that Asian Man's procedure done in Salt Lake City, Utah he got? The Doctor also did Subcision & the laser he used is Fotona SP Dynamis Laser in Erbium Mode to do an aggressive Fractional resurfacing. His results were phenomenal & he has dark skin too. He also had other things done in one day and his results are still holding strong 6 Months later, Although he had to comeback one month later after 1st treatment to get the fillers put in. it wouldn't hurt to do a consultation & booked a flight out there to see what he can do for you. Utah is not too far a flight from Cali. Doctor claims he's done treated 400 patients in the past 6 years and the average improvement after one treatment is 72% on the first 114. I would normally call bullsh*t on that high 72% but with the results this Young Asian Man got maybe he is getting very high results like he is claiming. Hope this helps.
I'm confused on some things. You said you are "only getting one treatment done, and it looks like I can get it split evenly ($2500 just for both lasers as opposed to $3000 upfront)." So am I understanding correctly, that even if you only do the Mixto it's $5000 total for two sessions? The only difference is that if you do the Ultherapy as well is that you pay $3000 upfront vs $2500 for two Mixtos? If that's the case, then it would seem like it is kinda a deal if he's throwing in two Ultherapy sessions and also charging a flat rate of $5000. It doesn't seem like you get a price break at all if you omit Ultherapy and just do Mixto. Maybe I'm misunderstanding something. Whether this pricing seems too high depends on how you look at it I guess. If you compare it to the old pricing scheme with two Mixtos for $3000 and $500 for additional touch ups, then yes he really jacked up the prices.
Pricing aside, I agree with Celaya that Ultherapy is really just an experimental procedure with anecdotal stories of improvement in scars. Any long term improvement has not been proven because none of the patients have been followed that long. It could help, but then who really knows? A lot about Ultherapy reminds me of the hype a few years ago about Thermage, which turned out to be a total dud. It was marketed for skin tightening as well. Although Ultherapy seems to have gotten much better reviews.
Also Juvederm Voluma, which I think is the best filler out there on the market in terms of safety and longevity, is not cheap either. The going rate is $1000 per syringe. All these expenses really can make your head spin.
That Dr. Mark Taylor seems to be getting solid results as well. Interestingly, the way he performs subcision is a little different than how many other physicians perform it. Apparently he created and had manufactured a tool specifically to do extensive subcision. He makes an incision near the ear like in a facelift and from that single entry point, he extensively undermines the entire scarred area. Typically most physicians enter the skin directly in the cheek area and in multiple points. He has some good videos on his website.
http://gatewaylasercenter.com/AcneScars.html
Dr. Rahimi is essentially doing the same things but it wouldn't hurt to get a second opinion. Normally, I'd think that claims of over 70-80% improvement in one procedure is a little over the top, but that Asian guy certainly got tremendous results. The only thing I would add though is that Asian guy's latest update was 3 months post op back in January '14. We haven't seen how he looks now many more months out from his procedure.
Blahblah, where do you get your info on Juvederm Voluma? Have you seen it used for acne scars anywhere or had personal experience. I want to get filler in a few spots and am confused about which filler is best. I had one doctor tell me to use Juvederm but I didn't follow up as to why since I wasn't considering it at that time.