How much improvement have you had from these treatments? I can't really see enough active acne for you to take accutane, have you had acne for years that you have not been able to treat effectively with topicals and such? For treatments I think subcsion + suction, microneedling, and chemical peels would be ideal for you. Fillers would also likely be very effective for your scars, they are just expensive if you go the temporary route and permanent fillers have some uncertainty associated with them.

If you have not already seen Mr.matt's blog take a look: http://www.acne.org/messageboard/topic/232731-man-in-the-mirror-pre-and-post-subcision-photos/

Thank you for your advice.
I do get pimples and lumps because of my acne/rosacea but less than before. I struggled the last 45 years with skin problems. I never got accutane but metro (cream). In my youth, a cosmetician picked all my pimples so I got all my scars.

I was so stupid. I haven't taken pictures in the same light. Now the scars are a bit shallower but wider. In certain light they are less
noticeable than before. But my skin remains looking very bad because I have a lot of scars which are deep and wide.

Do you think I have completely destroyed my skin?
What type of scars do I have?
What about my texture?
Other advices?

I agree with PCT14's good advice. Multiple subcision + suction treatments with or without fillers (maybe at final treatment depending on improvement achieved from subcision alone), microneedling (Derminator, dermastamp), possibly chemical peels once scars are level. Also, a dermatologist can inject any hypertrophic scars to flatten them. A prescription for topical retinoids (retin-a, tazorac) might be a good idea for active acne and between treatments to help promote collagen and faster healing. Once scars are raised up I think the hypopigmentation would be best covered with a light layer of mineral makeup powder (less irritating to rosacea than stuff with lots of chemicals). I think these treatments can give you more improvement and more immediate results than multiple laser treatments and are also less invasive/risky than punch elevation + dermabrasion, which would create new scars from the punch elevations. I don't think I see any scars that would need TCA cross so if it were me I would stick to lower strength peels like 10-35%(max) TCA, lactic, glycolic. Best wishes and keep us posted.  

Thank you very much. Which filler would you recommend me?

I don't have much experience with fillers other than I would personally never get permanent filler. I would post a question with your pics on RealSelf for that or find a reputableprofessional and get their opinion on which filler.

Fillers. Check out Restylane Vital. First try filler to raise them (juvaderm voluma), along with subcision at the same time (ask doctor if he can remove the threads that pulls scars down it is not always called subcision - you are a great candidate for this treatment), then a course of 3 treatments of Restylane Vital. Start usingRetin-A.

Good diet, with meat (my mistake was going vegan). Exercise (actually good for scarring and mind).

You can always grow your hair to hide it a bit. This close it will obviously look bad but from normal distance I bet it doesn't look as bad as you think.

Please seek psychological help as well. Everyone can benefit from this.Scarring can be treated but mostly it is our perception of not being accepted that drives the need for such expensive treatments. But, I have done a lot, but the more I do the more I am starting to accept my battle ground of a face.

Good luck!

Thank you.

Do you know what can be injected to remove the hypertrophic scar?

I thougth that if my daughter's acne would be hormonal, spironolactone and birth controll would help. Spironolactone is for hormonal acne, isn't it? Should she go to a gynecologist to have a blood test of her hormones? She has already done a blood test to find out if she has a deficiency of zinc, magnesium etc. And a test of the thyroid. Everything is ok. She is very, very thin. I think the reason why she suffers from acne is a histadelic metabolism. Her body produces more toxins than normal and ingests less vitamins and minerals than normal. Therefore, she takes various supplements: zinc, several minerals, opc, vitamin c, msm, alpha lipon acid, sam-e, map...But her acne doesn't disappear completely, I think accutane is the only way.

If you have bad experience with accutane (e. g. accutane causes acne scars), please let me know.

8 hours ago, malia02 said:

Thank you.

Do you know what can be injected to remove the hypertrophic scar?

I thougth that if my daughter's acne would be hormonal, spironolactone and birth controll would help. Spironolactone is for hormonal acne, isn't it? Should she go to a gynecologist to have a blood test of her hormones? She has already done a blood test to find out if she has a deficiency of zinc, magnesium etc. And a test of the thyroid. Everything is ok. She is very, very thin. I think the reason why she suffers from acne is a histadelic metabolism. Her body produces more toxins than normal and ingests less vitamins and minerals than normal. Therefore, she takes various supplements: zinc, several minerals, opc, vitamin c, msm, alpha lipon acid, sam-e, map...But her acne doesn't disappear completely, I think accutane is the only way.

If you have bad experience with accutane (e. g. accutane causes acne scars), please let me know.

Hey Malia,

I have some pretty bad experience with accutane being an indirect cause of pretty much all of my scarring. But the thing is, everyone reacts different to medication, I just had really bad luck. I would never tell anyone not to take it, but you do have to keep in mind that it is a possibility you might end up worse off. Is it a risk worth taking? It very well may be. You have to decide for yourself.

On 7/5/2016 at 7:47 PM, malia02 said:

Thank you for your advice.
I do get pimples and lumps because of my acne/rosacea but less than before. I struggled the last 45 years with skin problems. I never got accutane but metro (cream). In my youth,  a cosmetician picked all my pimples so I got  all my scars.

I was so stupid. I haven't taken pictures in the same light. Now the scars are a bit shallower but wider. In certain light they are less
noticeable than before. But my skin remains looking very bad because I have a lot of scars which are deep and wide.

Do you think I have completely destroyed my skin?
What type of scars do I have?
What about my texture?
Other advices?

Have you considered collagen or other fillers? Seeing your skin I can tell that you are not young, maybe hasnt worked ideally because of that? Decrease in collagen,etc etc and since you have tried lasers, excision, subcision, maybe fillers that are not permanent can aid

OOops didnt see the rest of the helpful messages, sorry! Btw spirolactone shouldnt be taken lightly... it was the reason for the worsening of my scars since it broke me out like crazy... the moment I stopped with it the acne went away. Take into account that I had all the tests done and it was prescribed by a doctor... 

Hey guys, I need really your help once again. Last week, I had an appointement with a dermatologist. He suggested me to do the following treatments in this order:

1) Skinoren for my skin texture/orange peel texture/hypopigmentation
2) Nd-Yag Laser to remove my redness and telangiectasias on my face and to make the hypopigmentation less visible
3) Lipolysis to remove fat which hangs down on my face (cheeks/chin)
4) Microneedling + PRP
5) Subcision + Filler (Voluma)
6) Iso (low dose for my rosacea/lumps)

He said that I should first concentrate on removing my telangiectsias and my fat hanging down because these treatments would give me an improvement in my face. Removing acne scars, especially when they are already treated 3 times by ablative laser, is more difficult. I have a lot of scar tissue. I don't trust laser and invasive methods anymore. I am worried about getting Nd-Yag Laser and lipolysis. What do you think about it?
I don't know where to start with my skin.
Does it make sense to do microneedling + prp before doing subcision + filler?
Can I do anything for my hypopigmentation? Are my pigments permanently lost?

Too many things on that list for me to offer much help. I would think you should first address the issues that bother you the most. You've tried laser a number of times, if you are worried about it then don't do it.

As for the microneedling and subcision steps, I think they would have the same effect in either order. Microneedling is not known for having a big effect after one treatment, you will probably need multiple. It is something out can perform at home, less the prp, if you are interested.

Lipolysis does seem to be the main one you need to make a decision on, not sure if you will find any help regarding that treatment here.

Thank you BA. I think that he uses various fillers that can be reversed (different fillers of juvederm, belotero etc.). Although I am 61 years old, I still get pimples. My skin is very greasy. Should I go for accutane? Then I will have to wait another year to do fillers. Or can I go for subcision and filler and start accutane shortly afterwards? The doctor doesn't offer v-beam for my "broken" blood vessels. I think that if I do v-beam, I will do it only on my nose where I have many big "broken" blood vessels. I am terrified of getting more hypopigmentation due to another laser (although it's v-beam). Do you know if there is a risk of hypopigmentation?

Ok guys, I really need again your advice again. I'll have an appointement at my doctor's next Wednesday. He suggested to do subcision + filler (he prefers Belotero Basic or Juvederm Ultra 3). He also has Juvederm Voluma, but he says that he doesn't use it for acne scars. If I want, I could do microneedling + subcision + filler in one session (microneedling of course first). He advised me against accutane first. What do you think about his suggestions? What would you do? Thank you in advance

ok, microneedling, subcision and then filler juvederm ultra 3 in one session, right?
what depth of microneedling?
i haven't tried professional microneedling yet. Is it like a dermaroller or like a dermastamp?

On Wednesday I wil get another scar treatment: subcision + microneedling + filler.
I usually take several supplements to increase my wound healing/collagen production: opc (red wine/grape seed extract), vitamin c, vitamin d, several minerals, map (master amino profile), zinc and vitamin k2. I stopped taking them a few days ago. I feared the side effect of opc and vitamine k2 because they make the blood thinner like aspirine. Was it a good idea? I want to start taking them again after my scar treatment on Wednesday or Thursday. Is it a good idea?
For my hypopigmentation I started to put Melagenina Plus from Cuba. I stopped putting it, too. I haven't experienced any improvement yet, but I used it only a few days. I don't know if I can start putting it on the hypopigmented areas after my treatment.
I also bought the Melgain Lotion from India, but it has to be used with an uvb lamp. I wanted to use Melagenina first before trying the Melgain Lotion to improve my hypopigmentation
Several years ago, Lamarr recommended the use of Led light therapy (red, infrared and yellow) in combination with needling or subcision. I have a red lamp and red/violet lamp at home to increase the collagen production and reduce acne. Should I use it?
I have too many supplements, creams and devices at home and I really need your help what to use pre and post treatment (subcision + needling +filler).
And I still do get pimples. Can I take mynocycline?

First of all sorry for my english:)
If you still get pimples take
accutane and 6 months post accutane start to treat scars.because mynocyline not cure acne only accutane cure acne , I take mynocycline but acne return after stop therapy but when I take accutane acne not return, i suggest you accutane.