What strength of tca did you use?

your gonna have to more likely continue tca peels to smoothen out your texture anyways.i am getting good results at 25-30%,just increased the percentage on my last peel.

i wouldnt class your texture as severe i would say its more spread over a bigger area especialy so down your temple,in your dimples and edge of mouth.

if you get the dimples snoother your skin would look soo much cleaner,this is one of the worse areas to work,dimples are stubborn.

what do you think you could cross?i dont see loads but maybe a few ice picks that can be crossed,every little helps as you should know.

i dont see lots of deep stuff,you got a lot of surface scar pore type,realy shallow boxcar on temples,do you realy think filler can go under and pop that out?

what tca oercentage did you use?

i would have suggested to carry on tca work but me i am at home treatment type of guy.just go stronger on the tca but more info.

I recognize the username, I have already helped you and given a treatment plan...

Go get 3+ treatments of Infini RF or Vivance rf Microneedle

Baseline your face withsubcision.

Get Sculptra injected in your cheeks. You have major fat loss.

Fine tune with HA injections there after when you do other subcisions.

Follow Quadbodys advice and do stronger TCA peels when your skin is baselined and TCA cross for your ice picks, (it will take many of them).

This will be a 3+ year process with down time in between treatments. Acne scars are never one and done. CO2 will do nothing for you.

We just had success with someone doing this treatment plan who had severe scars, it has helped countless with this condition. You get a percentage of improvement with each

I don't see severe scars. Yes, you have scars. Severe, no. I notice some fatloss in your face compared to a pic of your face last year. Did you lose some weight?

I have a similar severity to you.

I have consultations set up and am doing the BeautifulAmbition protocol listed above.

How is it that you have had only slight improvements, while this before and after is only after a single subcision and looks to be a 70% improvement:

Does this all just fall down to luck / genetics / scar-type?

7 hours ago, ChildhoodDreams said:

Does this all just fall down to luck / genetics /scar-type?

Technique and scar type.

Edit: OP I think the biggest aesthetic gain you can make is from a volume replacement. Look in to fat grafting, voluma, sculptors, or, considering the severity, bellafill. You'll still have pocking but your face will look better and more contoured.

11 hours ago, beautifulambition said:

I recognize the username, I have already helped you and given a treatment plan...

Go get 3+ treatments of Infini RF or Vivance rf Microneedle

Baseline your face with Nokor subcision, must be NOKOR.

Get Sculptra injected in your cheeks. You have major fat loss. 

Fine tune with HA injections there after when you do other subcisions.

Follow Quadbodys advice and do stronger TCA peels when your skin is baselined and TCA cross for your ice picks, (it will take many of them). 

This will be a 3+ year process with down time in between treatments. Acne scars are never one and done. CO2 will do nothing for you.  

We just had success with someone doing this treatment plan who had severe scars, it has helped countless with this condition. You get a percentage of improvement with each 

I've been having TCA peels since 2013. They don't do much if anything for acne scars. I've microneedled since 2013. I have the derminator. Plenty of bloody microneedling sessions that required me to hide for 3 days. 3 subcision treatments that didn't live up to what i thought they would. I've been positive about the treatments but there is a difference between positivism and straight lying to myself. 
Why do you say CO2 will do nothing? I'm aiming for fully ablative CO2. Not fractional.
 

14 hours ago, Quadboy said:

What strength of tca did you use?

your gonna have to more likely continue tca peels to smoothen out your texture anyways.i am getting good results at 25-30%,just increased the percentage on my last peel.

i wouldnt class your texture as severe i would say its more spread over a bigger area especialy so down your temple,in your dimples and edge of mouth.

if you get the dimples snoother your skin would look soo much cleaner,this is one of the worse areas to work,dimples are stubborn.

what do you think you could cross?i dont see loads but maybe a few ice picks that can be crossed,every little helps as you should know.

i dont see lots of deep stuff,you got a lot of surface scar pore type,realy shallow boxcar on temples,do you realy think filler can go under and pop that out?

what tca oercentage did you use?

i would have suggested to carry on tca work but me i am at home treatment type of guy.just go stronger on the tca but more info.

I've had many ranging from 8%-30% since 2013. It helped with the acne on the surface but not deep scars. I agree, dont know if filler would help. 

10 hours ago, Noa27 said:

I don't see severe scars. Yes, you have scars. Severe, no. I notice some fatloss in your face compared to a pic of your face last year. Did you lose some weight?

What type of scars would you say i have?

I definitely see the loss of volume on my skin.

10 hours ago, ChildhoodDreams said:

I have a similar severity to you.

I have consultations set up and am doing the BeautifulAmbition protocol listed above.

How is it that you have had only slight improvements, while this before and after is only after a single subcision and looks to be a 70% improvement:

Does this all just fall down to luck / genetics / scar-type?

Wow. That is amazing before and after. Is this you? Was it subcision alone or filler as well? It would be nice if i had that kind of improvement. Especially after having 3 subcisions. 
 

8 hours ago, QuanHenry said:

Technique and scar type.

Edit: OP I think the biggest aesthetic gain you can make is from a volume replacement. Look in to fat grafting, voluma, sculptors, or, considering the severity, bellafill. You'll still have pocking but your face will look better and more contoured.

I've definitely considered fillers. Especially now that it has been a year since my first subcision and i'm not sure how far i've progressed. I thought about bellafill last year but opted for subcision because bellafill is known to have potential for developing granulomas and given its permanence i dont know if that would be wise for me. 

I agree about bellafill and don't usually recommend it. I just think you should pursue volume correction first.

Why volume correction? According to his pictures that he posted last year, my guess is that he lost weight. His face was more rounder.

Start with stop losing weight and eat some more?

12 hours ago, mr.wantsgreatskin said:

Wow. That is amazing before and after. Is this you? Was it subcision alone or filler as well? It would be nice if i had that kind of improvement. Especially after having 3 subcisions.

That is not me, but from a known study involving subcision + tca peels + dermaroller.

I look at your face and I see a scar type that would react positively to subcision, so perhaps you have underrated your results? Perhaps the doctor did an insufficient job?

@mr.wantsgreatskinThis forum has a grudge against c02, if you want you can look at my results so far with c02 and see maybe one positive experience. Seeing as you have done tca and subcision, and micro needling multiple times I think it is worth trying laser out. C02 causes skin tightening and contraction of scars that can help improve the texture of the skin.

Also saying c02 will do nothing for your scars, and that tca/ subcision is better even after you have had multiple treatments of this kind shows the level of delusion/arrogance of some people in this forum. And that they would tell someone to forgo a treatment that could really help them based of their acne.org degree.

.

On 9/9/2017 at 1:41 AM, Noa27 said:

Why volume correction? According to his pictures that he posted last year, my guess is that he lost weight. His face was more rounder.

Start with stop losing weight and eat some more?

Idk about all that. Maybe it is the problem. Either way I think he should start by bringing volume back to his cheeks, then follow ba's advice. The pockmarks already look very shallow, even in this harash light.

I also doubt laser laser will make a significant improvement

You need rf microneedling with stem cells followed by fat grafting.

@beautifulambition which type of HA filler (there seems to be several) shall the threadmaker get, and how many cc's are to be used on him?

Scars are tethered, anchored and atrophic. You have contour changes that can not be corrected with fully ablative CO2 laser to a safe depth. First step is to break the tethered scars- NOKOR best, or someone skilled with 21- G windscreen wiper. Can add adjunctive PRP if NOKOR. Then address the scars from a vertical plane (subcsion address horizontal), so go vertical with insulated RF microneedling with or without PRP, option for low density but high power CO2 Fractional. Fractional e.g., with the Lumenis Ultrapulse actually goes 0.5 mm deeper than the Infini at 3.5 mm. This is irrelevant in your case as your scars are not visually deep. The flip side is that touch may reveal fibrosis. I agree with beautifulambition . Once your contours have been addressed, sure fully ablative erbium over CO2 can be performed to treat the textural changes (smaller component compared to your predominant scar type) .

Thanks Obi wan for your comment ;-), some interesting contribution coming from you, thanks for helping the community.

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Want to use this as a generalized info moment to all...

Stronger is not always better (thermal damage), higher is not always good (double stacking), more expensive does not mean miracles (your buying their lasers). When you are talking about depth differences of 3.5mm and 4mm your starting to talk about dissolving fat and permanent damage if you look at the anatomy. Acne scar suffers are already quite fat deficient so easier to go deeper. When these doctors / device manufactures boast higher levels and deeper lengths, this isn't good. A recent study found most lasers do not meet their targeted marketing / histogram levels, why ... they are selling specs and a machine, ... what happens when resistance occurs with energy, ... Infini is a physical needle. One of the biggest initial problems with Infini is doctors were maxing out the power and going to deep with the needles. You want to go deep enough to hit the dermis (not epidermis) and shallow enough to not hit the fat. Now if your using the Ultrapulse or ScaarFX on someone with burn scars / their body you need these deep settings and higher powder for the fibrosis. Infini thus goes plenty of deep enough. The guy already has fat loss. Perhaps he could do full ablative erbium or simply a high strength TCA where he is sedated. They discontinued fully ablative CO2 as it was burning people badly (lots of side effects), we already heal poorly since we have scars, laser is a risk and should be the last step so it it with information and full knowledge to make a contentious decision. I just want everyone to get to a better place in their acne scar personalized journeys .

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@ChildhoodDreams
That's not how filler works, we don't say how many mls. It's not a exact science. It depends what you can afford. It depends on your scar type, and what they are trying to do, and the area of the body. Also different fillers are sold in various countries. If it's a surface issue less than a pencil eraser length (pitting) get a non water attracting filler or it will bump up. Your talking about a very complex subject here nurses and doctors goto school for years on.

@beautifulambition

Sorry if it's a bit off topic but have you managed to get positive results yourself? Genuinely curious if anything has worked well for you.

@thepwhispI give people plans that will help their scars daily with positive results.

Itis up to them to have the mental heal improvement needed for scar work (often therapy is needed for BDD and support - Talkspace is a great app or Therapy is offered at colleges even if you do not goto one).

I wrote a whole FAQ - top of the acne scar sub with things that actually work, check it out. It's worked well for hundreds if not thousands of people. There is no secret magic to scar treatment here.

I have my follow up tomorrow.

I have to go to work soon and dont have time to reply. It would be nice if this website was easier to work with.
I'm uploading a few pics i took after MANY pictures. Either my phone is not very good at taking pictures or perhaps its me. I selected the pictures that depicted the worst in my skin. I'm sure i could do better under better lighting but i tried. I will try to update within the next few days.
As you will see in the pictures. Lighting makes a significant difference so its difficult to take the most accurate pictures sometimes.

Can we please stop with this idea of "BDD", I detest hearing it.

It is absolutely insulting and anger-inducing when you have a severe deformity that negatively effects your life and then people claim "BDD" as if it's a problem with your head and not the fact you are disfigured. Just stop it.

I had bellifill done and it is more for spot treatment than doing some sort of massive facial volumization (made the word up but it works I guess). I do have spots where it was used that I can feel are thicker than the rest of my skin. There are also spots on my face that were injected on 4 different occasions and it seems like my skin just "ate" it and there was no change. I was told by my doctor that what you see with bellifill after the procedure is what you get but I dont believe that to be true at all. I think everyone's body reacts differently to how it forms its own collagen around the micro droplets. I think doctors need to wait 6 months before retreating the same area with it to see what your skin does. I wouldnt go the route of a permanent filler until you are at the end of the road on your scar revision. You might see more improvement by gaining a healthy 5-15 pounds. I dont know what your height and weight are but my face looks better at 5ft8 150 pounds 8% body fat than I did at the same height but 120 pounds.

"BDD" as if it's a problem with your head and not the fact you are disfigured

permanently disfigured. 10-20% improvement at max, this is what you can expect with serious scarring issues from current methods. threads like this or baby91's (honest users with honest photo documentation) are so frustrating to read.

5 hours ago, CoconutRough said:

permanently disfigured. 10-20% improvement at max, this is what you can expect with serious scarring issues from current methods. threads like this or baby91's (honest users with honest photo documentation) are so frustrating to read.

I am a pessimist, but not this pessimistic as I have seen 50%+ improvements all around the board and in medical journals.

Baby91 has had 20%+ improvement thus far but there is room for much more; you need at least 75% for it to be life-changing. QuanHenry has had a spectacular improvement, but those must be fillers doing the heavy lifting.

I have hope in the back of my mind that I can reach 75% over the next few years utilizing subcision, suction, fillers (routinley injected), and resurfacing techniques. But sometimes, hope may lead to devastation.

Just wanted to chime in.   

Your scars look more exaggerated because of the volume loss in your cheeks.  When the cheek lies in shadow like that, the surface scars and texture issues is magnified and makes it look even worse than it really is because of the shadowing.   Look at the girl below.  See how her scars look much worse in the before and how much better it looks after?  She has a similar type of scarring to you because there is textural issues.  When the face is hollow and lies in shadow, the scars are accentuated.  When the face is filled out, the cheek is convex and so it reflects light.  Scars are really an issue of shadows.  This is why re-volumizing a sunken face helps to improve the look of scars - because light is now reflected off the cheeks.  

From the google translation (it's all in Chinese by a Chinese doctor), I don't think she had anything done directly to the individual scars.    This is also similar to what Dr. Novick did with Quanhenry, he basically re-volumized the face to create more convexity instead of have a concave face. 

http://ccskinblog.pixnet.net/blog/category/1695336