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EvidentNancy

Still can't get rid of scars after two full fraxel treatments and accutane (pics included)

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I'm 24 and have dealt with acne scarring ever since I had really bad acne in high school and went through accutane (late 2007). I got fraxel laser treatments twice - I think the first treatment was around 2011 and they did about 3 treatments, and then I just finished the second round (went 4 times) in 2016. I am still having scars which I can easily see in indirect light. I think the second round in 2016 helped out a little bit to make my face smoother and round out the edges on my scars, but these scars are still very visible in my mind. I'm not going through any psychological issues where I dont want to be in public, its just I kind of want these all to go away and move on with my life. I'm still doing fine socially as well as with girls, but I feel like they can still definitely notice them. As you can see I can make the indirect light to show these scars, but in other lighting it doesnt look like I have any scars at all! I really just want to know what types of scars I have and what you guys think I should do about it. I'm open to anything, and id be willing to spend up to 5K if need be for any procedures. Do people think I shouldn't use lasers again?

As to the scars - I think left cheek is worse because of the two scars at the top of my check which are the deepest scars that I have. I feel like the right cheek doesnt have as deep of scars. Also, on the bottom left side of my chin I have this very deep crater which is unlike any other scar on my face. It sorta just gapes deep into my skin. I  think you can see it best in my very last picture.

**let me know if you need me to post any more pics with better lighting to make a better read on what I have/should do, this was my first time taking pictures like this

Pictures (I took two of each cheek):

Right cheek:Screen Shot 2017-08-02 at 10.54.38 PM.pngScreen Shot 2017-08-02 at 10.54.57 PM.png

Left cheek:
Screen Shot 2017-08-02 at 10.57.02 PM.pngScreen Shot 2017-08-02 at 10.56.42 PM.png

Edited by EvidentNancy
fixed auto-correct from accurate to accurane in title, added tags

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Yes these are pretty deep, but you have a few things working in your favor in my opinion.  First, the overall texture of your skin is decent - you don't have extensive texture abnormalities like tons of ice pick scars.   Your scars are deep rolling scars with volume loss.   Your best bet is to do subcision and fill those suckers in with dermal fillers.  I really think you will get significant improvement.   When it comes to dermal fillers, I would suggest a thicker and long lasting filler like Voluma.   There are also permanent fillers like Bellafill, which does have side effects (granulomas), but I think if they are used judiciously it may be a reasonable trade-off between risks and results.  Most of the issues with permanent fillers involve injecting huge pools of filler that can shift and migrate.  If they are used in isolated spots like individual acne scars, I think its mostly safe.   Before you go the permanent filler route, it would be smart to do a temporary filler first to make sure you like the effect before committing to something that irreversible.  

There is no way that lasers will fill in a deep indentation.   It is just impossible, and any doctor who tells you otherwise does not know what they are talking about or is trying to recoup the cost of his $100K laser.  

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Been there done that. Fortunately these scars look tailor made for subcision with filler. I think even your first treatment can yield a nice improvement for you.

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ı have same scars and subsission with filler is the best solution in my opinion.Search best doctor near to you.

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Thanks for the replies everyone. I have been researching for good doctors to see for subcision, and I am really considering going to see Dr. Novick in NYC. I am from Boston so the commute is only about 3 hours which I am willing to do. Does anyone know of any good doctors in New England? I checked the list of recommended doctors on beautiful ambitions list and there wasn't any, so I'm resorting to NYC. Also I saw that Dr. Novick may charge per scar for subcision - does anyone have a rough guess of how many scars I have? I would say 20? Thankfully some are very deep on my left chin, but i also feel like i have a lot of small ones on both cheeks and also along both jawlines.

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@EvidentNancy

Have you figured out your plan for your scars yet?  I'm from the boston area and am trying to figure out what i'm going to do as well.  I spoke to someone on reddit and they recommended a place just north of Boston somewhere over the New Hampshire line.  I guess they offer subcision, fillers, and this very cheap laser option for like 50$ a touchup  (forget the name but can find it again).  I forget the name of the place but if you're interested i'll go back through my messages.  For months i've been basically planning the same thing as you.  If nothing else fails I've told myself novick is my next option.  Have you figured out your plans yet?

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@thepwhisp so as of now I'm coming down to either going to see dr. novick or dr. rullan (all the way out in san diego). I really want to make sure I get the best treatment and they seem like the best (I've never seen any reviews for what you mentioned on this site). I've been doing my research and have seen that a lot of people who get subcision + filler are saying that subcision is definitely the one thing that helps them out the most because its permanent. For me, I feel like I have about 15-20 scars on my face, so if i went to see Novick (who charges 250-375) per scar, then there's no way I would able to afford subcision on every scar. That's why I'm leaning a little more towards Rullan, who can do subcision on the whole face for about 350, and add filler if you want for a total of subcision and filler for $800ish (flights to San Diego are ~400 so still cheaper than novick). Also, it just seems that subcision is the most important thing and I can get that done on my whole face cheaper with rullan than what Novick can do for like 5 scars.

So now I'm really in a dilemma. I want to go out to CA to see Rullan to get subcision on the whole face, but I'm worried about also getting a filler with him. It's best to get a filler after the swelling has gone down, but I can't make two trips out to CA (one for filler and one for subcision). So I'm debating going to Rullan to get whole face subcision, and then trying to find someone reputable and trustworthy enough to do the filler in New England (maybe go to Novick for just filler or some nurse near-by MA?). If you look at recent posts from Rullan experiences, @Guardian10 mentions that he wishes he didn't get the filler same time as subcision. @keving100 mentioned that he had the same problem as me which is he went to see novick but only could get subcision on 5 scars even though he has like 30, but he went to go see rullan after to get subcision on the whole face and he likes his treatment better. @QuanHenry seems like he's had good experience with novick for subcision and filler but mentioned that the cost is 2K per visit which adds up quickly (novick responded to my email saying i'll need at least 2-4 visits for my deep scars). 

So not 100% sure what to do. Either go to novick and get subcision on some of my scars and get the filler for 2K per visit, or fly out go Rullan and get subcision for ~300 or subcision + filler for ~800 (still cheaper than novick after flights too).

@beautifulambition any suggestions? i feel like i can't really go wrong with either, but im just having trouble deciding which one. i really just need someone to help make a decision with/for me without considering $ costs. Edited by EvidentNancy
grammar

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@EvidentNancy

My suggestion would be to first try and find someone locally or closeby. I told you about Dr Dover and his associates in boston. thepwhisp also has some suggestions for docs in boston. You always need multiple treatments for acne scarring. Make every effort to try and find a good local doctor and build up a relationship with them, so your subsequent treatments will be cheaper. Also its easier to go back to them if there are any issues after your procedure. Eg i got lumps after subcision which can only be fixed by repeated kenalog injections.
Who knows maybe you will find a better doc then Novick and Rullan. Flight, hotel, food bills quickly add up. 

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@EvidentNancy Those prices do not seem accurate. Remember Novick includes filler, Rullan does not. This is a huge price difference if you add that into subcision. Listen to Quan It's a couple thousand dollars with filler. It isn't per scar, I believe it is per area. Yes Rullan is per face. It does not include filler. It does not matter where you get the filler as long as they are a expert injector (nurse most of the time) and have experience filling pits or acne scarring. You wait till your swelling goes away from the sub and then do filler, It does not have to be his nurse or him. Sure if you get some quick injector they will not care, but if they have experience and take the time on the pits it can be done after anywhere. You get what you pay for. To me it's crazy to travel across country for sub, for PS or a face lift / fat graft maybe but not sub or fillers. It will take some homework to find someone who does this procedure with a nokor needle. You will need several of them not just one. It's not 2k per visit. If your doing 2k, you wait till the filler is gone and then go back that could be a year. You can always say no to filler. Goto Novick and jet get subcision if it's a issue, tell him you will consider filler the next time, or find someone cheaper and local like Keving says ;-) If you did novick you could fly home the same day or do it your last day in NYC, so no hotel. 

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@beautifulambition yeah i agree with you that it is kinda ridiculous to fly across the country for sub + filler. now you've got me leaning just driving 3 hours to NYC to see novick. I don't want to see Dover because I looked around his site and it seems he does lasers, I'm really just trying to see the best of the best in my area and get this over with (70-80% better scars). As for prices - I kinda disagree with you on that unless you were saying those prices aren't accurate for just subcision (which I think you may be). I was considering sub with filler, which is why I was gunna mention Quan wrote earlier in this thread be prepared to pay 2K per visit and @keving100 said for Novick he paid 1250 for only 5 scars which is ridiculous (just 5....?) and add that + filler I'd bet you'd reach 2K. Anyways, I'm prepared to pay that much I just wanted to point that out. Also, FYI just for anyone's reference, I got an email back from Rullan's assistant saying subcision for the whole face is $300 and filler averages between 250-1000.

@QuanHenry If im going to be getting just subcision + filler, how long do you recommend to take off work? Is getting it done on friday and then going in on monday fine? I really only work with one or two people who would see me so I don't mind it. I may just be honest with them and tell them I got my scars fixed and my face may seem swollen for a week. Is your face in bad shape for a few days after?

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@EvidentNancy   The price i mentioned about Novick includes fillers. Mine was a combintation of restylane Lyft and Radiesse...i had swelling and some bruising for about 1.5 weeks after my procedure, can be covered by tinted suncscreen or makeup. Novick sells his own brand of tinted suncreen for $35 i think.
 

Also, Dr Dover is an expert in subcision, he has coauthored papers on subcision with Dr Alam, another expert subcision Dr in Chicago. Dover has 10 other experienced Drs working with him.. He may push for combination treatment, that I am not sure of. You can find that out via consultation or email. Please do your research. I just told u he is worth a consultation, maynot be worth the treatment. Here is the link:

http://www.skincarephysicians.net/services/cosmetic-dermatology/acne-scarring/

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Hey so it’s the OP here. I just wanted to post an update. I had Sub+filler done in the fall and spring with Novick. I’m planning on seeing Him again in the summer for the same procedure. 

As to my results, I haven’t seen as much as I had hoped. I’d say some of the smaller scars have gotten about 20% better, but some of my deep ones (2 on each cheek I’d say) I’ve seen less improvement. I ave I remember Novick did say it could take 3-4 procedures I see improvement. I’m considering doing one more procedure with Novick, then flying out to Rullan for the same procedure. I am not sure if I can afford Novicks prices, as Rullan is cheaper and can subcise my whole face. Also I may want to just try another person.

As to the pictures, they were taken today -about 6.5 months after two procedures. See my original pics in my post up top. I still clearly got a long way to go. I think I may need up to 5-6 procedures to get 50% considering how deep my scars are. 

Right cheek (first picture is original):
85BBF55F-0E5E-439C-B3EA-A3E9C4F77CB7.png.375a90605a918f996caf27d5461fcfcf.png
CF99E793-44DC-4569-9128-E6E2D49CC201.thumb.jpeg.b40158c028f347f42ce15a0934f9aae5.jpeg
95BFA6BF-7AE0-4211-BD22-8CA82367878C.thumb.jpeg.aea88272449df05b8ba2f3c0900a62ec.jpeg

left cheek (first picture is original):
9AD1641F-2827-4DA6-80BD-9A0645CCA180.png.132f7ab951540cb96b0f4f7d5df54291.png

4A8EA63B-2785-4B34-8B71-84F0278874A6.thumb.jpeg.4b4b93401d6e1fadc3aaab19270a9c4b.jpeg7E430162-7F5A-405B-B35C-086A2019DB8F.thumb.jpeg.4850495ac8176046416f70a1fa1ae7a0.jpeg

Edit - after comparison, the really only difference I can see is the two big scars on my right cheek look like they have raised a little

Edited by EvidentNancy

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@EvidentNancy  I'm from boston too and have planned on seeing Novick forever.  I still might see him at some point but after calling place after place I found a pretty cheap local option that I think I'm going to try once my acne clears up.  It's https://shanthalamd.com/.  I can't 100% recall their prices but from what I recall she would probably be about half of Novick maybe less.  I think subcision alone (you could do suction) is literally only a few hundred dollars.  I felt pretty comfortable talking to them as opposed to most of the other places I called.  Lady at the front desk said Shanthala is 100% customer oriented meaning she will only do what she feels comfortable with.  Honestly If I were you I'd give them a call and see what they say.  I'll be trying them within the month so if you want to wait for that I will gladly give you an honest review. 

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@ChildhoodDreams Yeah I’m not really sure what’s going on. I think I can see the scars in my right side of face have raised, but I haven’t seen much improvement on the left side. After seeing @Cleopatra88 improvement after 1 sub with rullan it’s making me want to go to him 

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@EvidentNancy now that ive got to see your pics, I had very similar scarring in many areas and they seem to have responded best. I really think its worth going to see DR. RULLAN for your next subcision.  If you dont see the improvements youd like, it wont be too much out of your pocket because  I definitely  agree with @ChildhoodDreams that 2000 is brutal!!! 

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@EvidentNancy at least your improvement on one side is quite OK. I went to see him as well and feel like I spent money for nothing, I see no improvement after 2 weeks from his field and individual subcision.. He didn't even fill up my scars enough so they would level up at least for few months or so..  I cant believe how highly recommended he is in here.. Edited by Nina22

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I'd consider switching strategy and go with Rullan.   That is way too much to pay for poor results.

Your scars are discrete with soft edges, and suited for subcision and filling.  This should be a straightforward case.   I would not be happy with this either. 

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I am considering two things now:
1. Going to Novick one more time just for the scars that have actually improved on the right side of my face
2. Cancelling Novick's appt and just going to Rullan

I know I'm going to go to Rullan eventually, its just when. Novick did say it should take 3-4 appointments to see improvement (and I'm only at 2, but my results so far haven't been great except the two bigger scars on right cheek)

When I do go to Rullan I'm still debating if I should get suction or filler. I want to do filler but it seems like a lot of people on here say Rullan isn't that great at placing the filler. I may just get filler like 3-4 days after sub when swelling goes down.

@Cleopatra88 why are you wanting to do filler next time? How many procedures do you plan on doing? Also what was the downtime for subcision with him aka when you felt you could go to work/be in public? 3 days?

Edited by EvidentNancy

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@EvidentNancy mainly because I have a wedding to go to and suctioning delays healing, and induces bruising and swelling. The suctioning produced fantastic results though. I'd say I suctioned daily for 2 weeks and the third week about every other day. But I'm still debating  on the fillers . It's hard to tell when i would have been good from the subcision swelling/healing wise because i had microneedling as well. I think i looked pretty good about a week after despite suctioning though. It was really only a week due to micronnedling, because for me, the microneedling looked like road rash. Sorry it sounds confusing, my case was just a tad different due to adding that extra procedure. If I were to guess ...about 4 to 5 days from sub

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@Cleopatra88 what do you mean delays healing? If suctioning induces bruising/swelling, doesnt that appear on your face and thus not make you look good for the wedding? Wouldn't you want filler than since it doesn't do those things

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I don't think you should do any more lasers because they won't do much for this type of scarring.  You don't have much sharp edged scars that need planing down.  You really just need volumizing and subcision mostly.

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@EvidentNancy lol. Yes!!! That's why I was looking into filler this next time, I cant look that bad and that swollen for the wedding I'm going to. It sucks though,I'd rather suction because i feel that was key to my results. I'm wondering if I'll even be able to do filler with my scars being more surface oriented?any thoughts on that?

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