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downinthedms

Subcision By Dr Rullan Results (Before/After Pics) - Help with Next Steps

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Hey guys,

Without further ado, pics below . I got subcision done with him on 9th October, so its been a week now.

Notes before you see the pics:
1. I am still a little swollen so this is not yet the final result.
2. I ended up bruising myself while suction so that is not a bruise caused by Dr. Rullan
3. This has to be mentioned. Dr Rullan is literally the best doctor ever (and I've been to a few). Honest, reasonably priced, really skilled. Please don't waste your $$$ going to money-hungry laser-selling doctors. You'd end up spending less even after flights with Dr. Rullan.
4. If you guys don't mind after seeing the pics, please help me with some of the queries I mention below regarding the next steps once you finish seeing the pictures. Thanks in advance :)

Next Steps (Advice Required):
As you will see in the pictures, there was improvement all over my face in terms of depressed scars. However, the maximum improvement was on the cheeks and temples. On the front of my face below my eyes, there are still visible ice picks and boxcar type scars. So my queries are:
1. Do I need another subcision? IMO, it feels like there are no more rolling/tethered scars left but I am not sure.
2. Ice Picks would be TCA Cross. I actually did 4 spots on my face just as a test to see how my skin reacts (can be seen in Day 7 pics - right front and left front). Those 4 spots ended up turning dark and they are still dark. Is this normal?
3. I have a lot of pigmentation issues and discolouration. I guess VBeam is the best option for that? Do I need hydroquinone? Can I do anything about it at home right now? I can't tell honestly if they are PIE or PIH.
4. In essence, my scars are most visible on my front cheeks so I want to know what is the best approach to treat those. TCA Cross, Derminator, Fillers? I'm not sure.

I hope this helps people make the right choice. I really want to thank @beautifulambition and @Robertitoo. @Robertitoo is not active anymore but his post about his journey has helped countless people including me. And, of course, nothing needs to be said about @beautifulambition. I truly thank you sir for amazing advice on this forum. You are helping a lot of people. And I would love to hear your advice on my next steps haha. 

Thank you everyone for reading and I appreciate any help :) Feel free to ask any questions.

Photos are in order (Before -> Day 1-> Day 2 -> Day-7 (Today)):

Left Cheek and Temples:
Before_Left_Cheek.jpgDay_2_Left_Cheek.jpg
Day_1_Left_Cheek.jpgDay_7_Left_Cheek.jpg


Left Front:
Before_Left_Front.jpgDay_1_Left_Front.jpgDay_2_Left_Front.jpg
Day_7_Left_Front.jpg

Right Front:
Before_Right_Front.jpgDay_1_Right_Front.jpgDay_2_Right_Front.jpgDay_7_Right_Front.jpg

Right Cheek and Temples:
Before_Right_Cheek.jpgDay_1_Right_Cheek.jpgDay_2_Right_Cheek.jpgDay_7_Right_Cheek.jpg

Edited by downinthedms

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Appreciate the post a lot, it's good to see real pictures.  I'm currently in a very similar situation with scars in very similar spots.  If you don't mind me asking what did it cost you to have the subcision with Rullan?  Did you have fillers included as well?

I'm currently saving up to see probably either Novick, Rullan, or someone of that stature within the next 4 months.  I've been set on flying to Novick's Israel office for some time but would highly consider rullan if it was within budget.

Appreciate it

 

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Sent you a PM with the prices.

I would highly suggest Rullan but obviously I am biased. I did consider going to Novick because he is actually much closer to me but I think his prices are a little unreasonable, which is understandable cuz hes in NY.  If you're going to his Israel office than I'm sure he is cheaper.

Just wait up for a cheap ticket to San Diego. The AirBnBs and food in Chula Vista is not too expensive either. Also its right on the Tijuana border if it tickles your fancy.

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Thank You for the kind words, that's why we are here to improve you.

Very encouraged by your progress. Let's not celebrate completely yet as Collagen takes 3 months or so to build / do some healing.  It's a good start. Swelling is bliss it looks like one is completely healed. Dr. Rullan seems like a good guy, too bad there aren't more of him all over the country. Novick is good, his prices include filler so keep that in mind, filler is expensive with sub. 

1. Do I need another subcision? IMO, it feels like there are no more rolling/tethered scars left but I am not sure.
A: Yes, often you need 3 or more. They don't get all of them or the body takes time to heal / make new collagen.
2. Ice Picks would be TCA Cross. I actually did 4 spots on my face just as a test to see how my skin reacts (can be seen in Day 7 pics - right front and left front). Those 4 spots ended up turning dark and they are still dark. Is this normal?

A: Yes they will fade with time, hence why I say you can treat a few at a time, or I know many males who use a medical makeup like dermablend from Macy's Nordstrom to put over these spots or Sephora would have a concealer, guys get these after facelifts/ surgeries too. Cross - We are wounding the scar bed so the skin levels out / raises up.
3. I have a lot of pigmentation issues and discoloration. I guess VBeam is the best option for that? Do I need hydroquinone? Can I do anything about it at home right now? I can't tell honestly if they are PIE or PIH.
A: Yes V-beam, excel v, ipl, and or 1064nm are all options for discoloration, you can do this locally to you, even at a med spa. Because of your skin type I would use Retin A or Tretinorin cream with hydroquinone or whitening cream before your treatments a few weeks, and after a few weeks to avoid hyperpigmentation.
4. In essence, my scars are most visible on my front cheeks so I want to know what is the best approach to treat those. TCA Cross, Derminator, Fillers? I'm not sure.
A: I think Infini RF or Vivance RF microneedling could be good for your box cars (takes a few treatments), keep doing the subcision, Filler is only used if you have pitting or fat loss that is a pencil eraser depth or more, otherwise you vacuum, You could do a sedated peel towards the end when you even things out, Rullan is really good at this for darker skin types. 


So keep up the sub and cross, .... possibly do Infini, put some healing time between treatments, then do a peel or multiple peels. 

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Some follow ups @beautifulambition

1. Do I need another subcision? IMO, it feels like there are no more rolling/tethered scars left but I am not sure.
A: Yes, often you need 3 or more. They don't get all of them or the body takes time to heal / make new collagen.
Follow Up: I thought subcision is only good for rolling scars (not shallow boxcar / ice picks), which I don't have as many anymore. It will only make sense for me to do more if it helps with boxcar type scarring as well. So question is, does it help with shallow boxcar like scarring (the kind which I have on my front cheeks)?

2. Ice Picks would be TCA Cross. I actually did 4 spots on my face just as a test to see how my skin reacts (can be seen in Day 7 pics - right front and left front). Those 4 spots ended up turning dark and they are still dark. Is this normal?
A: Yes they will fade with time, hence why I say you can treat a few at a time, or I know many males who use a medical makeup like dermablend from Macy's Nordstrom to put over these spots or Sephora would have a concealer, guys get these after facelifts/ surgeries too. Cross - We are wounding the scar bed so the skin levels out / raises up.
Follow Up: That's good to hear. I was thinking of going and doing all my TCA spots at once but I think doing a few at a time is a better option. Still gotta wrap my head around the wearing makeup part :P

3. I have a lot of pigmentation issues and discoloration. I guess VBeam is the best option for that? Do I need hydroquinone? Can I do anything about it at home right now? I can't tell honestly if they are PIE or PIH.
A: Yes V-beam, excel v, ipl, and or 1064nm are all options for discoloration, you can do this locally to you, even at a med spa. Because of your skin type I would use Retin A or Tretinorin cream with hydroquinone or whitening cream before your treatments a few weeks, and after a few weeks to avoid hyperpigmentation.
Follow Up: I did IPL before but it caused even more hyperpigmentation (Fitzpatrick IV skin type) for me. Haven't done any research on VBeam so will look into it. 
When you say to use Retin A with hydroquinone at the same time, do you mean like Retin A in the morning and hydroquinone at night or do they both go on at the same time together? I guess hydroquinone is only applied on the spots.

4. In essence, my scars are most visible on my front cheeks so I want to know what is the best approach to treat those. TCA Cross, Derminator, Fillers? I'm not sure.
A: I think Infini RF or Vivance RF microneedling could be good for your box cars (takes a few treatments), keep doing the subcision, Filler is only used if you have pitting or fat loss that is a pencil eraser depth or more, otherwise you vacuum, You could do a sedated peel towards the end when you even things out, Rullan is really good at this for darker skin types. 
Follow Up: I did 1 treatment of Intracel RF Microneedling before and did not see much improvement as compared to say subsicion. Is Infini RF any different? If not, I'd rather just do Derminator treatments at home cuz 1 microneedling treatment here in Toronto costs 400$~.

Again, thanks for taking the time to reply to my questions :) Cheers!

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So to be clear Dr. Rullan only subcised with no filler?  Did he mention anything about ways to keep the scars from sinking again?

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You can do filler with him as well, I decided to go the suction route which cannot be combined with filler. Suction seemed more natural too me but more effort. I am a little paranoid about fillers i.e. maybe they inject too much or too less. For my first try I thought suction would be the best option.

If you decide to use filler, make sure you do it a couple days after your subcision though because its hard to place when you are that swollen.

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@Urbanite As discussed before ;-) One does not do filler with subcision if they do not have indents a pencil eraser in depth or more, it leads to bumps. This is especially true with box cars that are surface oriented. Even if you do have indents you can still to Chinese cupping or vacuuming method.

@downinthedms

1. Do I need another subcision? IMO, it feels like there are no more rolling/tethered scars left but I am not sure.
A: Yes, often you need 3 or more. They don't get all of them or the body takes time to heal / make new collagen.
Follow Up: I thought subcision is only good for rolling scars (not shallow boxcar / ice picks), which I don't have as many anymore. It will only make sense for me to do more if it helps with boxcar type scarring as well. So question is, does it help with shallow boxcar like scarring (the kind which I have on my front cheeks)?

FA: Subcision can be good for boxcars and rolling scars, it all depends on the scars, Of course not ice picks. The thing with rolling and sub is you might not need anything else except for filler, with box cars Infini RF microneedling helps or possibly TCA Cross on them. I always suggest a few subcisions, they always miss something or it re-tethers.


2. Ice Picks would be TCA Cross. I actually did 4 spots on my face just as a test to see how my skin reacts (can be seen in Day 7 pics - right front and left front). Those 4 spots ended up turning dark and they are still dark. Is this normal?
A: Yes they will fade with time, hence why I say you can treat a few at a time, or I know many males who use a medical makeup like dermablend from Macy's Nordstrom to put over these spots or Sephora would have a concealer, guys get these after facelifts/ surgeries too. Cross - We are wounding the scar bed so the skin levels out / raises up.
Follow Up: That's good to hear. I was thinking of going and doing all my TCA spots at once but I think doing a few at a time is a better option. Still gotta wrap my head around the wearing makeup part :P

FA: Your not "wearing makeup" your spot treating acne scars that are being treated, big difference.

3. I have a lot of pigmentation issues and discoloration. I guess VBeam is the best option for that? Do I need hydroquinone? Can I do anything about it at home right now? I can't tell honestly if they are PIE or PIH.
A: Yes V-beam, excel v, ipl, and or 1064nm are all options for discoloration, you can do this locally to you, even at a med spa. Because of your skin type I would use Retin A or Tretinorin cream with hydroquinone or whitening cream before your treatments a few weeks, and after a few weeks to avoid hyperpigmentation.
Follow Up: I did IPL before but it caused even more hyperpigmentation (Fitzpatrick IV skin type) for me. Haven't done any research on VBeam so will look into it. 
When you say to use Retin A with hydroquinone at the same time, do you mean like Retin A in the morning and hydroquinone at night or do they both go on at the same time together? I guess hydroquinone is only applied on the spots.

FA: Excel V is used in Asia, V-beam works for some as it has cryo protection, also 1064nm which is non ablative. Yes you can use them both at night or whatever. Retin A is sun sensitive, sun screen. 

4. In essence, my scars are most visible on my front cheeks so I want to know what is the best approach to treat those. TCA Cross, Derminator, Fillers? I'm not sure.
A: I think Infini RF or Vivance RF microneedling could be good for your box cars (takes a few treatments), keep doing the subcision, Filler is only used if you have pitting or fat loss that is a pencil eraser depth or more, otherwise you vacuum, You could do a sedated peel towards the end when you even things out, Rullan is really good at this for darker skin types. 
Follow Up: I did 1 treatment of Intracel RF Microneedling before and did not see much improvement as compared to say subsicion. Is Infini RF any different? If not, I'd rather just do Derminator treatments at home cuz 1 microneedling treatment here in Toronto costs 400$~.

FA: Intracel takes 3 or more treatments, I do not know the settings they were using with you, it also takes up to 3 months to build collagen. Many don't do enough treatments with it. Collagen builds very slowly. I have several Asian friends and that machine worked on their boxcars, perhaps subcision was needed first. But if it doesn't work for you there are multiple variables. Sure use the derminator and TCA spot peels if you wish, also you have tca cross to do before your peeling I forgot. 


Again, thanks for taking the time to reply to my questions :) Cheers!

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On 10/18/2017 at 7:50 AM, downinthedms said:

Thanks man! 

Will post updated pics in a week or so :)

where's your update? just booked surgery with dr rullan.

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Dr. Rullan is really one of the good ones.  I wished I started my journey with him instead of subjecting myself to doctors who often messed my skin up even more.  

For anyone interested in seeing him, I heard that he is actually retiring soon.  So definitely make it a point to see him soon, since who knows when he'll be out of practice.   

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I am not a patient, but I have had conversations with people who are his patients.  That's how I learned he is retiring.  

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Thanks for sharing. Really excellent results from a talented and dedicated doctor. Really good progress- congrats. 

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I will be watching,i did subcision and its now day 10 on some of the scars,day 9 and 8 on others.i been suctioning with a cheapo cupping set off ebay,just using the pump.

i didnt get my whole entire cheek,that for me to do would be sheer lunacy but thats my point of view so i did about 6 on each cheek,most were rolling type of varying depths,sizes etc.

i still got bruising on some but its self induced through suctioning i think.

i see change in some of the scars that have pretty much cleared of bruising although i know i need to wait at least a month.

just be interesting to see what at home vs a specialist results can be.

i am also not promoting doing this yourself at home,its a proper treatment type carried out by drs,i just so happened to do it myself,like others before me and i am not a dr.

looking forward to piccys.
:)

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@downinthedms im so thankful to have came across your post!!! Im looking to schedule subcision with Dr. Rullan as well. Can you possibly pm me with pricing.  I know all cases may be different but itd be amazing to get an idea. How are you feeling about your results so far?

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49 minutes ago, Scarredtodepression said:
9 hours ago, downinthedms said:

Sorry for the late update guys, but here it is :)

IMG_3954.jpg

IMG_3952.jpg

It's unclear from these pics whether there was improvement?

There were improvements on my right cheek and below by right cheek bone, there were also improvements on my left cheek. That being said, the area below my left cheek bone, the texture got screwed up and it went worse than it was.

Would I do subcision again? If I could go back in time, I would only do it on my cheeks and not below my cheek bones. Hope that clarifies.

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