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Urbanite

My Visit with Dr. Novick

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I went to see Dr. Novick this week.  He wants to do a "light" subcision (?) and fill my cheeks with Voluma.  I didn't think there was a "light" subcision but it sounds reasonable.   Then he said after about six weeks, he'd go back and subcise individually the ones that were still visible.

I was surprised to hear he thinks suction is a complete waste of time.

My face looks like the RaptorPilot who left the forum -- lots of rolling scars like a padded quilt.

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Since another member was asked by Novick to not divulge costs, I won't as well.  However,  I didn't think the cost was excessive.

Mind you, the subcision he was talking about was NOT individual scars.  It seems to be a generalized swiping of the entire area pre filler from one incision point.  He said it's something done quickly.  I'm trying to confirm with another member/patient if this is the case.

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Novick seems pricey but hes doing all your subcision and filler. Rullan separates out the price. Filler can be pricey. If your in Europe or the USA, and goto his Israel office he charges quite a bit less, as he avoids all the fees from the gov / insurance / etc. What I do not know is if Novick will do sub without filler, no one can confirm as they all get filler done, that would be more in line with Rullan. Also remember a plane flight to SD and lodging, food, your time, can add up quickly.  

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Inclined to agree with him regarding the suction part. I don't know how much it helped for me but so far at least my scars have not retethered so always better safe than sorry.

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^Dr. Novice was ADAMANT that he provided filler after the light subcision as a "biostimulant" only.  I asked him this very directly. He feels his subcision is enough and he doesn't believe in retethering.

He also added the he wanted to treat both cheeks because he believed from studies that individual pimples do more than just harm the skin under them but spread cellular damage across a much larger area, causing facial depression.

Edited by Urbanite

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I just went to Dr. Novick this morning and he suggested pretty much the same treatment for me, subcision of both cheeks and filler and then the individual scars later. I opted to just have him do subcision and filler on the two scars that bother me the most. I heard the tethers being cut on the one scar (alot of clicking noises) didn't hear anything on the other. I gotta admit I'm pretty nervous right now hoping everything heals up ok. The scar that I heard the tethers being cut is pretty much level and just red, the other one looks almost like a big blood blister and I have a lot of redness on most of my cheek. 

 

 

Edited by Horus

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@Urbanite do you realize I said the same thing above as Dr Novick (I have studied all his paper we are in agreement), biostimulant is why filler is used after subcision, not understanding where your going with this...

What did you ask him directly that isn't covered here in our discussion exactly, perhaps there is some data points missing here. He is providing a overall base or augmenting your cheeks on both sides, makes since. He is spacing our the filler as Horus said first with sub (remember I always say to wait on filler for the individual scars till the swelling goes down). He might have his method to inject your individual case, we are all different but overall it's the same thing with similarities in the process.


@Horus This is standard to have bruises, blood pooling etc. It will dissolve over time. Use some Arnica Montanna if you wish to help with the bruising. 

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^Dr. Novick basically said suction is useless except as a placebo and that he can subcise and not inject and the scars would not retether.  He said he uses filler with subcision for "best effect."

My concerns are his "light" subcision and spreading Voluma across both cheeks.  I don't want donuts, more unevenness . . . . the Voluma scares me.

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Hi Urbanite, this is exactly what I have said for some time, look at my track record. I say the same thing, were in agreement ;-P

Possibly @Obi wan also comment on this filler + Subcision and re-tethering. 

If you would read my FAQ, top of the acne scar sub you will see under subcision I talk about filler there. I also realize it is not the best idea as I often warn others to not do filler + Nokor subcision with swelling on the same day (it can lead to bad results, swelling must go down). Of all of the subcisions I was part of when doing aesthetics and my own subcisions I can tell you they will re-tether if you do nothing. Maybe you are lucky and your body won't do this but most peoples end up re-tethering if ... " he can subcise and not inject and the scars would not retether. " Again it's up to you to do what you want. There is massive data showing that filler does help "biostimulate" the body to heal these depressions, and some people have to do it yearly as they age (we age and lose fat, thus we must correct the skin which can make acne scars look worse over time without some help) OR  because of the way they heal.

We and several other doctors offer suction as a alternative because there is also data that "it can" work for some people. It helps create  scar tissue under depressions... No everyone has money for filler, nor do they want it in their cheeks, or do they have the scar type to require it (aka surface scars can end up making bumps with filler and thus it's not "necessary"). Maybe you are one of the types with surface scars and do not need filler or suction. This is a possibility if your scars are light and textural. I can't say it's a placebo because it can make hematomas which are very much a real thing (not fake science), but I can say it does not work for some people as it takes a lot of upkeep and your body may heal not optimally. He is saying he does not like that method and for that I respect him, but what if I am a poor individual and can't do filler, will he still treat that person and their condition, he includes filler with his sub prices so probably not. Again priorities for different kinds of people.

Different doctors have different ways of treating things, Dr. Rullan / Rappaport / etc loves suction and he likes filler for the "proper scar types." Goto a board certified Dr that cares about you and they can fix the issue a variety of ways / methods. 

Doughnuts are only created when one does not subcise the tethers, and are easily corrected by cutting those bands. Nokor is especially good as it swipes all those bound down areas. The doctor can always dissolve if there is doughnuts the HA. He is spreading it throughout the cheek for a base so I don't see this happening. I would have to look at your scar type again but light textural scars would not do as well with spot treatments, spreading it through the cheek or augmentation would be better. 

I am verry happy for your treatments and that you were able to see Dr Novick! Lets hope for success. |::Siava:

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^I appreciate your lengthy post.

Right now I'm at a stalemate.  Dr. Novick was really pushing for "light subcision" and then filler in the SAME session.  For me he saw enough sagging that he felt I needed a fill. That's why I think while he says "subcision" he's not really going to do that, but I don't know what he will do prior fill.  His fee per dent is what you stated before for that range of service so how can he do my whole face with filler for hundreds, if not thousands, less as "light subcison" + filler?  I'll try to email him that question but when asked in person, the answer was vague.

Edited by Urbanite

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I hope you don't mind @Urbanite I pasted your org post and my suggestion. Gets to confusing otherwise (see below). I still think your best bet would be to do the filler he suggested and a strong peel. He can do acid peels, spreak to him about doing something to resurface the skin. I don't see you needing sub from the pic either unless you have a different pic. I don't see deep pitting. Hence he wants to Augment the cheeks.
It looks like texture issues. You may be happy with filler and a peel(s) alone. I think Infini RF could help you but that is highly optional and he does not do it. Your other option besides peels is laser resurfacing and it would take several to go deep enough, Fractional treatments might not work and you would need something like profractional to go deep enough in the dermis under the texture (down time, possible hyperpigmentation). You don't have to be stuck on the Novick plan, you can get a second opinion or see two doctors (ie. hundreds of thousands). Your case from the single pic is not the usual pitting fix, it's overall textural issue. 

____________________________________________________________________________________________
 

I would look into Infini RF or Vivance rf miconeedling over standard microneedling for you, Also You might want to try Tca peels first as this is highly textural (it will take a few). Collagen takes time, please give it some more weeks. Also hopefully you are using tretinorin nightly, buy it off ebay it will help with cell turnover.

 

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On 10/19/2017 at 9:06 PM, Urbanite said:
I went to see Dr. Novick this week.  He wants to do a "light" subcision (?) and fill my cheeks with Voluma.  I didn't think there was a "light" subcision but it sounds reasonable.   Then he said after about six weeks, he'd go back and subcise individually the ones that were still visible.

I was surprised to hear he thinks suction is a complete waste of time.

My face looks like the RaptorPilot who left the forum -- lots of rolling scars like a padded quilt.

When he said 'light' subcision, he probably meant subcision with the syringe needle (not NOKOR) which he will use to inject voluma

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This method is well known. Original papers in 1995 just used a tribeveled needle, since then many methods of subcision have been described- subcision with 19 G by Goodman, subcision with 30g with Lim and co., and of course Nokor Subcision. Some use nothing, other with PRP, others with saline, some use filler, others autologous blood. Some want suction, some want bleeding (small and controlled haematoma), some report pressure dressings for 24 hours. More papers you read, more methods you see, the more you understand. There is so much variation in this technique. Personally I would trust Dr Novick. His logic is that once the bond are broken the filler acts as a spacer. Lim calls this ' the spacer technique of subcision, I am sure many good acne scar specialist do, like Novick and many others. I think Novick will realise if there is too much fibrosis, adding more filler will donut your scars. From there options are 1. Stop the filler.  2. Channel- i.e. Subcise using the lipo technique to break up the scars 3. Use a less thick filler so it flows and integrates. I am sure a man of his vast vast experience will know what to do when scar acts a certain way, and mitigate any side effects before they occur. He is well known to treat scars based upon anatomy and physiology of scar types, and does not rely on lasers and energy devices to achieve the outcome. 

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Alas, if it were only a matter of texture.  My camera blurs selfie images so I took some better images non selfie.  You can see lots of deep scaring.

 

Left_1.jpg

Left_2.jpg

Right_1.jpg

Right_2.jpg

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^I sent the above pics to Dr. Rullan.  He wants to perform regular subcision. The cost for that and an airline ticket to San Diego would be about same as Dr. Novick's treatment.

Now I have to decide what to do!

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Would suggest you get a shave!

if you gonna get your face treated might as well expose all of it and treat all of it while your at it.

keep us posted when you get the surgery performed.
|::)

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18 minutes ago, Urbanite said:

^Ha! The beard covers nothing except good skin!

Leaning towards Dr. Rullan.

Lol! Same here. My beard area and forehead are the only places I have good skin on my face. It sucks! i've often wished all my scars were in my beard area so i could just grow a beard and be done with it instead of going through all these procedures. But nope right where my beard stops growing, the scars start. 

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