Thanks for the clear pictures. I'd classify them as mostly rolling scars with volume loss, especially on the left cheek area. For this, I think the most effective thing to start with would be possibly multiple subcisions and suctioning. Fillers would also work to restore some of the lost cheek volume. For that you have options that are temporary or permanent. Temporary fillers include Voluma, Restylane. Permanent fillers include Bellafill and a small minority of doctors use liquid silicone, although that is very controversial and always used off-label (meaning that it is not approved for dermal injections, but it can be used that way). Permanent fillers in general are considered controversial, and there are some doctors who think they should never be used, and others who think that they have a place if used only in specific indications like for scars. The risks include granulomas (lumps in the areas injected), rejection of the material, and poor technique which may be difficult to reverse because of it's permanent nature.

This video is of a patient getting injected with Bellafill and he has pretty deep scars with volume loss.

I recently had an appt/consultation with a derm in the Boston, MA area that provides various procedures for acne scarring. I let him know early on that did prior research on the types of scarring and various options (subcision, fillers, laser, etc). I mentioned that I had read that fillers should be used first if one has very bad atrophic scarring (volumes loss) and then perhaps Lasers. The Dr. suggested the opposite that fillers won't make much difference on sunken left cheek area and that Fraxel Restore Laser treatment will work better. Then the Dr. said some filler could be used after the laser treatments to even things out on the surface (especially around the cheeks)...

So I was quoted for to 6 Fraxel Restore laser treatments on only my cheeks since the Dr. did not think (and I agree) that my forehead or chin needed it. I did not schedule a appt yet since I have reservations about things possibly being made worse or that the Fraxel treatment is a sham and not a real cure: i.e. it produces temporary inflammation so that it appears that your skin has tightened (and thus removed some volume loss), but whose effects will go away after a few months....

Can anyone lend any insight? I think it is perfectly understandable to be worried about actual results (and especially not having skin made worse!) with such an expensive procedure.....

Make sure you are getting the highest energy (70 mj) otherwise the results will not be impressive, sometimes they like to start off at lower energy/treatment level so they can get you to pay for more treatments. Ask for treatment level 9 (at least)which covers 26%, that way you will only need 4 treatments to get to 100% coverage. They said 6 treatments which means they wanted to treat you at a lower level (probably 6). It will be more pain at higher energy/Txand increased rednessbut it is worth it. I think most of the people who are dissatisfiedwith it is because their settings were too low to have much effect.

http://whatsnew.soltadigital.com/content/media/fxl_clinedu_DUAL_TreatmentSettings_MK3100G.pdf

Why do laser at all? I heard that restore didn't do much else than treat wrinkles. And, repair is really intense with a lot of risks. You should do subcision for rolling scars. It will be a fraction of the price for laser and will give you more improvement. You could just do skin needling instead of restore since they both target wrinkles/ rough skin but also for the fraction of the price of laser.

Take a look at thisstudy: http://www.jcasonline.com/article.asp?issn=0974-2077;year=2014;volume=7;issue=1;spage=18;epage=23;aulast=Garg

Everything will be painful though. I just did it and I'm still in recovery. It was awful.

Good luck!

Btw, your scaring is not that bad. I would not have noticed unless I would be looking for it.

I'm going to keep it real....He advised getting 6 sessions of Fraxel Restore because he needs to pay off his machine. Seriously, this doctor is not being straight with you. Yes, I agree you have volume loss and atrophic scars, which calls for subcision+suction and possibly fillers. I'm not saying lasers don't have a place, but I personally think, and many doctors agree, lasers should be left to the end after you've done everything to elevate them as close as possible to the level of normal skin. As for Fraxel Restore, the only utility it may have is for minor scarring. I wouldn't waste my money on something that's basically a crap shoot. Personally, I think you should start with subcision and suction and see how much improvement you can get. That way, if you decide to refine the results with fillers, you will end up paying for less over time, since it will require indefinite maintenance if you get temporary fillers. Permanent fillers are an option IF you research the subject and know exactly what you are getting into. It is not risk free, but can provide good improvement on scars with volume loss.

It all depends on the lighting, dear....   I wish I could say the same about others..... If you are curious about some of the reactions I have received from strangers (especially women older than me (i.e. > 30 yrs old), then check out a thread I started in the Emotional & Psych Effects subforum on this site.....  Needless to say, even this level of scarring makes people very uneasy and possibly scared.....  Older women are probably scared that I might try to grope or rape them because they can probably infer than having bad acne probably means one has raging hormones.....

Why would only older women do so though? Why not younger? Get a younger girl then. How old are you? Maybe you project this anger to women you actually want because you just assume they won't like you because of your scars, because you yourself don't like you with your scars? I usually do this, and I just come off as a bitch. I'm trying to work on it. 

My theory on why older women seem to react more negatively upon seeing a young man (well maybe only me, I don't know) with bad facial acne and/or severe scarring is because they probably grew up in a time when it was less common to see people like that.  The number of people with moderate to severe acne and scarring has increased in the past decades in absolute terms simply due to population growth, but I do believe that the percentage of acne sufferers whose acne is severe is higher in recent years.  I think the main reason for that is the poor nutritional quality of the average Westerner's diet....  Now, I'm not saying that diet isn't the main cause of severe acne, but it surely can be a contributing cause. 

Putting it another way, I read this on another forum about the whole nature vs nurture debate:  The lady who posted said that current evidence suggests that it is not nature or nurture, but rather nature and nurture.  Put another way, genetics gives you a blueprint or range for your traits, and the environment determines whether or not certain genes are expressed.  Therefore, the % of people in the world of who have the gene for severe acne may not be higher now than any time in the past, BUT due to environmental factors, the actual % of people who have severe acne may be higher...

IchhasseAkne.... all good points and some good analysis. I've done my fair share of reading about lasers as well (more than I want to admit) and my conclusion on non-ablative lasers like Fraxel Restore is that it is a "compromise technology." What I mean by that is that if you research why and how they were developed, you'd know that non-ablative lasers came about because of the significant and sometimes devastating outcomes of traditional 100% C02 lasers. When people healed well, the results were actually really good. But when it it went wrong, people had scarring and hypopigmentation due to the very aggressive nature of those traditional c02 lasers. The laser companies developed these non-ablative devices to try and get around all the complications from the 100% c02 lasers. Unfortunately they make so many trade-offs for safety that in the end they actually don't do much of anything for real scars. Notice how the only people who say that these non-ablative lasers are good for scars NEVER actually have photos to prove it. They only use the stock photos provided by the laser companies. If you ask the real scarring experts, they'll tell you that simple, older, and less fancy minor surgical techniques like TCA Cross, subcision, and fillers are much more effective.

As for the reactions of other people to seeing severe scarring, I think it's really comes down to the fact that really bad acne scarring is quite rare. And "severe" to the general public can be what we here consider "not that bad," because we are just more sensitized to what bad scarring actually looks like. In everyday life, I honestly never see really really noticeable cases of acne scarring. That's why people have such visibly negative reactions when they do see it, because it's a shock to them.Just look at today's obesity levels - 40 years ago, the kind of obesity we have today would be shocking, and yet now the majority of American adults are overweight or obese.

And I can relate to those stares and awkward looks. It sucks, and it does hurt a lot to be subjected to that on a frequent basis.

To tie it back to you, I think the smart thing to do would be to do the minor surgical stuff first before considering lasers, which have a spotty track record in terms of results. You're right, it's really for "polishing" or finessing the results with the other procedures mentioned.

Also, I'm glad you didn't prepay for a series, because those never work out well. If it doesn't agree with your skin, you're screwed and won't get your money back.

Yeah perhaps. But I don't have acne in my family AT ALL. I guess you can argue that some distant relative I have never met might have. But no, I got acne because I of extreme psychological trauma. I know this with all my heart. I know another girl that got it from extreme internal stress too. I can eat whatever I want now when I'm better. I don't mean oh I failed my exams, but real psychological stress and anxiety from really traumatic events. I have no idea why though. But you are right, environmental factors (like pollution and indoor allergens - not food) make my eczema flare but if I am in a good place in my head the impact is not so bad.

Although, eating right is very important for your health I don't think because you eat chocolate or carbs or whatever you'll get acne. At least not severe or moderate acne. But if you have nutritional deficiencies yeah that might do it. So, I would say eating white flour is not necessarily what does it, but not eating anything else than white flour and processed shit that can give rise to numerous health problems, acne being one of them.

These candida diets and whatever is just too much though, and it is bullshit. Just eat right but the overdoing it is just not healthy either. The diets some people are advocating on this forum are just bad and too rigid. Just see to it that you get all you need. All these 'cleanses' are dangerous too.

And, I could also argue that some things (like acne) are inescapable in our industrialized society, you can't be totally natural unless you can afford going up in the Alps somewhere, so a lot of people need some help. Being apart of society is what makes us human and unfortunately our society does a lot of unhealthy shit, so you need to adapt if you get what I mean. But I still think internal stress from some traumatic events that builds up over time is a great factor for many people, like your body is telling you that you need to work out some shit.

I still doubt people stare at your scars though. I really don't think people think that much of mine, they really don't. This is so far from severe. I see a little bit on the side of your face, I've seen a lot worse on some really attractive guys. Acne is worse though, that I remember people starring at. I saw one today he had worse than you and some acne, still attractive.

You should go on reddit and see what people say to people with acne scarring, it is not as bad as one thinks it is. I think we think about it more because we're so obsessed by it. People who have had acne will be really sensitive to it, while people who haven't experienced it as bad won't even notice.

Maybe you can grow out your hair then no one will notice!

On 10/23/2015, 1214, IchhasseAkne said:

I recently had an appt/consultation with a derm in the Boston, MA area that provides various procedures for acne scarring. I let him know early on that did prior research on the types of scarring and various options (subcision, fillers, laser, etc). I mentioned that I had read that fillers should be used first if one has very bad atrophic scarring (volumes loss) and then perhaps Lasers. The Dr. suggested the opposite that fillers won't make much difference on sunken left cheek area and that Fraxel Restore Laser treatment will work better. Then the Dr. said some filler could be used after the laser treatments to even things out on the surface (especially around the cheeks)...

So I was quoted for to 6 Fraxel Restore laser treatments on only my cheeks since the Dr. did not think (and I agree) that my forehead or chin needed it. I did not schedule a appt yet since I have reservations about things possibly being made worse or that the Fraxel treatment is a sham and not a real cure: i.e. it produces temporary inflammation so that it appears that your skin has tightened (and thus removed some volume loss), but whose effects will go away after a few months....

Can anyone lend any insight? I think it is perfectly understandable to be worried about actual results (and especially not having skin made worse!) with such an expensive procedure.....

I did fraxel, cost me a load of money. The end result was major peeling after each session, basically the same as you would get from an at home tca. Then after 6 sessions the end result was fairly unchanged, apart from the peeling.

I now tca at home and dermaroll+vit-C at home, essentially a poor-man's fraxel. I'd save the money and use this protocol instead tbh