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eva_li

Acne Scars - My Journey - Subcision

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Dear all,

After a couple of years of silently observing (and learning so much) around here, I have finally decided to join in and share my story/upcoming journey of acne scars revision.

First of all, let me share the pictures of my scars. As you can see, I have them both on the cheeks (mostly around the mouth, quite untypically) and forehead.
The mouth area worries me the most as the dense scarring creates wrinkly, saggy, uneven and aged appearance.
DSC_0282crop.jpgDSC_0283crop.jpgDSC_0288crop.jpgDSC_0281crop.jpg


My acne scars treatments history:
- Biostimulation laser (red light therapy) – hardly did anything but I was new to this and this was what my aesthetician recommended so I went with it
- Countless sessions of dermarolling ( 0.75-1mm roller) 
- Several sessions of dermapen (1-2mm) in the last ½ year –  I believe effects of which are really visible over time!

I have been avoiding lasers so far – after reading experiences of fellow acne scarring sufferers it really doesn´t seem to me as an effective treatment.  I am also scared of volume loss as a negative side effect. I am already starting to lose volume in my cheeks (sunken cheeks run in my family) and I have read that sometimes fat loss is a side effect of laser treatments. But I am certainly gonna research and educate myself more on this complex topic in the future.
___

SUBCISION
Now, I have read a lot around here on subcision and decided I want to give it a shot since it is a treatment that really makes sense to me (releasing the scars) and since I have seen some amazing results. Unfortunately, I live in a country where no one performs it (actually there is no one specializing in acne scars in the whole country) but since I live in Europe, I saved up money and am travelling to Denmark in 2 weeks.

Obviously, I haven´t had a consultation with the doctor yet (mid-January) as he doesnt do them via Skype but I am really hoping he will find me a suitable candidate for subcision and will perform the treatment right away. Also might combine it with TCA cross.
If I do get subcision, I plan to do suction afterwards. Already ordered suction devices from owndoc and also a cupping set.

Apart from documenting and sharing my journey here after I am done with the treatment (pictures), I would also like to ask you a few questions regarding your opininon about my scars (what types, what treatments you think might help me) and about subcision in general.

Subcision–related questions:
1) Is there something I should/could do prior to subcision - with regards to skin care routine, dietary supplements - to prepare my skin and improve the results?
2) Is there something I should definitely avoid? (i.e. what ingredients in skin care, what supplements)
3) What can I do after the treatment to improve the results? I am planning to take collagen + HA supplements + enzymes that improve healing (they are recommended after surgeries but also illnesses in general to help the organism to jump start immune system and healing)
4) I am also planning to do practically the same routine as I do after dermapen – treat the skin with HA serum, peptide serums, or growth factor serums (not at the same time :)) maybe one thing in the morning, another in the evening) – to stimulate the repair process and collagen production. Is this desirable after subcision too, or it works differently?
5) Is dermapen session helpful like a week before and maybe 2-3 weeks after subcision? Im even thinking I might do PRP.
6) Will suction still be safe even if I do TCA cross along with subcision?


I am sorry that this post is SO LONG – I actually really tried to be concise and structured since there are so many topics and questions and thoughts I have around acne scars.

Thanks so much to anyone who is willing to share their comments and ideas.

Edited by EagleEva

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1.) in prep. for subcision , I recommend taking Vitamin C and zinc pills as zinc promotes healing, and vitamin c is necessary for collagen production. I would also recommend getting a topical like Vaseline or aquaphor to keep the needle wounds moist after subcision. Prescription retinoids are always great to have as well. 

2.) You really don't need to avoid anything that isn't obvious (i.e. acid peels, steaming the face, drying topicals.)

3.) Your methods are great- we can't really give much advice on this because the greatest component to acne scar treatments is the body's own healing. Some people sleep extreme amounts during healing and they seem to get great results. 

4.) you could continue those treatments, though I do honestly believe peptides are quite harsh after subcision and/or microneedling. Subcision is only a few needle holes as opposed to many injury zones in microneedling, so the products don't get that added absorption. 

5.) It depends on the depth- too deep too close to the subcision treatment could do more harm than good. It's best to stretch out treatments rather than do so many close together. In my opinion, I would not get needling done so close after subcision, because your face should still be swollen and bruised at that point if you've been suctioning correctly. 

6.) Do not suction near or on the TCA cross sites. This will break the scab and start the wounding process all over again, potentially worsening the scar. 

Edited by Petsme

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I live in Denmark, actually just 100 km away from Emil Henningsen's clinic.  About two weeks ago i posted this thread:  Wherein i explain my situation. To cut it short, i've got 3 weeks left of my 9 months long accutante journey. And i also consider undergoing subcision+tca. If you look at the link, you'll see that my scars are worse, but situated on the cheek. 

Did Davin Lin personally recommend Emil Henningsen to you? I would really love to follow your journey, since i needed some opinion on Emil Henningsen. I've watched his videos on youtube and examined his webpage http://emilhenningsen.dk/ thoroughly. I think you are in good hands with him since he has trained under doctor Chu and his specialty is acne scar revision. 

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11 hours ago, EagleEva said:

Apart from documenting and sharing my journey here after I am done with the treatment (pictures), I would also like to ask you a few questions regarding your opininon about my scars (what types, what treatments you think might help me) and about subcision in general.


Perhaps you have a crappy phone like me and those are just bad pictures. But you only have a few scars that might benefit from subcision. The majority are too shallow and you'll not see much difference IMO. Subcision is great for deep scars because it will be quite noticeable. Even 50% would be a big improvement. But not so for shallow scars. If you had a good result with Dermapen, then I suggest you go for Infini or Intensif, which are dermapen on steroid (or radiofrequency).

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6 hours ago, Sirius Lee said:

Perhaps you have a crappy phone like me and those are just bad pictures. But you only have a few scars that might benefit from subcision. The majority are too shallow and you'll not see much difference IMO. Subcision is great for deep scars because it will be quite noticeable. Even 50% would be a big improvement. But not so for shallow scars. If you had a good result with Dermapen, then I suggest you go for Infini or Intensif, which are dermapen on steroid (or radiofrequency).


thanks for your response, Sirius.
The pictures are actually made with camera, even DSLR one, hehe. I attempted to capture the scars in the "worst possible" overhead lighnting but now I can see that the contrast is way too big somewhere -  I have dark shadows casted over some parts of my face and in those shaded area you cannot see much.
But yeah, perhaps you are right and most are not that deep. I actually agree that the bigger issue is how many there are and how close to each other, hence the wrinkly appearance, and also that they are spread across almost all my face (unlike people who have them only on very limited confined areas: temples, cheekbones, etc.)

REGARDING INFINI: 
This is something that I truly have a hard time understanding. I see INFINI being recommended around here A LOT. But radiofrequency microneedling, ie. infini, the very same technique and "machine", is being used very often for dissolving fat and tightening double chin. I already expressed how scared I am of fat/volume loss in face. Isnt this a huge risk with INFINI? What if I get it and start losing fat in my cheeks? As I understand it, radiofrequency is often used for dissolving fat cells, isnt it? Thanks for sharing your views.
And by Intensif, do you mean EndyMed Intensif? Never heard about that, gonna look into it. Edited by EagleEva
typo

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17 hours ago, Petsme said:

1.) in prep. for subcision , I recommend taking Vitamin C and zinc pills as zinc promotes healing, and vitamin c is necessary for collagen production. I would also recommend getting a topical like Vaseline or aquaphor to keep the needle wounds moist after subcision. Prescription retinoids are always great to have as well. 

2.) You really don't need to avoid anything that isn't obvious (i.e. acid peels, steaming the face, drying topicals.)

3.) Your methods are great- we can't really give much advice on this because the greatest component to acne scar treatments is the body's own healing. Some people sleep extreme amounts during healing and they seem to get great results. 

4.) you could continue those treatments, though I do honestly believe peptides are quite harsh after subcision and/or microneedling. Subcision is only a few needle holes as opposed to many injury zones in microneedling, so the products don't get that added absorption. 

5.) It depends on the depth- too deep too close to the subcision treatment could do more harm than good. It's best to stretch out treatments rather than do so many close together. In my opinion, I would not get needling done so close after subcision, because your face should still be swollen and bruised at that point if you've been suctioning correctly. 

6.) Do not suction near or on the TCA cross sites. This will break the scab and start the wounding process all over again, potentially worsening the scar. 


Thanks so much for your reply, Petsme, really appreciate it!

1) I thought topical retinoids are one thing that should be avoided immediately before and a couple weeks after invasive procedures? (I have a retinol serum with  0,3% Retinol  that I bought just recently but rather for the first fine lines)

6) OK. Maybe it would be best then not to cimbine subcision and TCA. Because from what I understand, subcision without suction is kind of useless? How long, in your experience, TCA cross sites heal? (I had a all face chemical peel done like twice, it was I think around 30-40%, I was healed in few days (around 4 maybe))

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I suggested topical retinoids as an add-on treatment for when you're not healing to increase normal collagen fibers. I should have been more clear!! As in, it could be used a day after microneedling or a few days after subcision (whenever the open wounds heal.) Also, retinols are very weak retinoids that rely on an enzymatic reaction in the skin to convert it to retinoic acid. The amount of active ingredient you are really producing is usually very small unfortunately- if possible, getting a prescription retinoid would be the best option for noticing results in fine lines :) 


I have not had TCA cross so I cannot comment on my personal experience, but many people here have had long-term wounds (scabbing for 2 weeks, redness for over a month.) remember TCA cross usually uses 100% TCA and makes a deep burn wound. 

Best of luck!!!

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IT will take several days for you to heal from TCA Cross. You will have redness on the wounds. They are using stronger acid. IT takes many treatment, not a one time peel. You can put makeup over it. Collagen is never quick takes up to 3 months to build. Your lifiting your scars with cross.

Regarding Infini the answer is easy. Just like a laser it can be used for many different treatments / uses. It depends on how it's used and what it is used for. For fat you go very deep and high energy, for acne scars they do no. This is why it's critical they know how to use the machine, and feel your skin. I suggest you get filler done before you get infini and your subcision. Infini was not approved for fat loss, it can be used off label for this. 

Subcision with filler (start with one, do the rest when you need top up between below).

Infini or Intracel RF microneedling  (several)

TCA Cross (several)

Peels for texture (several).

The lines you speak of and nasolabial fold problems are all fat loss related, you need filler for volume. Many get sculptra for this, but you can also do HA injections as well. 

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On 03/01/2018 at 7:14 PM, beautifulambition said:

Regarding Infini the answer is easy. Just like a laser it can be used for many different treatments / uses. It depends on how it's used and what it is used for. For fat you go very deep and high energy, for acne scars they do no. This is why it's critical they know how to use the machine, and feel your skin. I suggest you get filler done before you get infini and your subcision. Infini was not approved for fat loss, it can be used off label for this. 

Subcision with filler (start with one, do the rest when you need top up between below).

Infini or Intracel RF microneedling  (several)

TCA Cross (several)

Peels for texture (several).

The lines you speak of and nasolabial fold problems are all fat loss related, you need filler for volume. Many get sculptra for this, but you can also do HA injections as well. 

Thnaks so much, @beautifulambition!

I will try to look for someone experienced with INFINI around here. What peels for texture do you recommend - the standard AHA peels?

After the first subcision I wanted to do only suction actually since it will be the first time so I can see what the subcision does without fillers. (Now, the TCA cross complicates the suctioning plan, I will have to figure this one out :/ )

The thing with filler I don't get is: are they supposed to be only temporary (I mean, I KNOW they are) or is this theory that fillers will actually re-start the process of filling the indent with your own collagen really legit? I saw some people here are proponents of this theory. If it doesn't work like that, ok,  it's still a great method, but I wanna try all the other possible treatments first to see how much my own body is capable of filling on its own. Later on, I might go for it. I am sorry, I am sure you answered this question a hundred times, and I really tried to read about this on here, but I still feel there isn't a consensus on what the fillers actually do or don't do. Do they just fill in the hole and dissolve later or do they promote your own healing? I am dying to know the asnwer, literally...
(However, some areas on the face are not so great for fillers due to risk of blindness... the nasolabial fold area, or glabella are in the top 5 so ...:( )

 

Edited by EagleEva
tmi

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1 hour ago, beautifulambition said:

I suggest you get filler done before you get infini (and subcision).


Very good suggestion. People should always get filler before Infini IMHO. With subcision, though, they should wait. Otherwise, there's a high risk of disrupting the filler with the needle. 

The reason for the filler (in my mind at least) is that collagen begets more collagen. This is why the temple and the forehead, areas with the least amount of collagen, pose as the most problematic area. They respond very poorly to any type of treatment.

 
5 hours ago, EagleEva said:

REGARDING INFINI: 
This is something that I truly have a hard time understanding. I see INFINI being recommended around here A LOT. But radiofrequency microneedling, ie. infini, the very same technique and "machine", is being used very often for dissolving fat and tightening double chin. I already expressed how scared I am of fat/volume loss in face. Isnt this a huge risk with INFINI? What if I get it and start losing fat in my cheeks? As I understand it, radiofrequency is often used for dissolving fat cells, isnt it? Thanks for sharing your views.
And by Intensif, do you mean EndyMed Intensif? Never heard about that, gonna look into it.


As BA mentioned, the fault of fat atrophy is more to do with the operator than the machine itself. Nobody in their right mind will stick 3.5 mm length needles in your face (well, unless one is an idiot). Also keep in mind that even subcision carries a high risk of fat degradation. If the needle is inserted too deep and hit the fat, there will be atrophy. Be that as it may, we've come a long way from the days of Thermage, which was notorious for leaving patients with fat/volume loss. The needles on the older generation machines would heat up the suface of the skin, thereby causing a thermal injury in a fractional manner much like laser. Infini, on the other hand, has insulated needles that penetrate the skin at variable depths, depending on the area treated and the results desired. 

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5 minutes ago, Sirius Lee said:
Very good suggestion. People should always get filler before Infini IMHO. With subcision, though, they should wait. Otherwise, there's a high risk of disrupting the filler with the needle. 

I thought BA meant subcision WITH filler and then Infini.
So the hypothesis here is that having a filler (HA based most likely) already under my skin will improve the results of Infini treatment? What needlelength is best (for cheeks, for forehead) in your opinion?
 
7 minutes ago, Sirius Lee said:
Also keep in mind that even subcision carries a high risk of fat degradation. If the needle is inserted too deep and hit the fat, there will be atrophy.

Now Im freaking out. I had no idea. I hope at least TCA doesn't come with this risk.

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45 minutes ago, EagleEva said:

So the hypothesis here is that having a filler (HA based most likely) already under my skin will improve the results of Infini treatment? What needlelength is best (for cheeks, for forehead) in your opinion?


I dunno about others but that's what I think. As for the length, it depends on how much cushion there is. Cheeks have the most meat, so you can go as deep as 2.5 mm. The forehead and temple have the least, so it would be ideal to dial the setting down to aroun1.25 mm.

 
46 minutes ago, EagleEva said:

I hope at least TCA doesn't come with this risk.


Well, TCA can in theory leave you with a serious chemical burn if not handled properly. There have been cases where patients ended up in the emergency room with a serious burn to their face. But these are very rare, so no need to freak out.

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OKAY everyone, so yesterday (Monday) I had my 1st subcision.

The overall experience at the clinic was very good and the doc himself is a very, very nice person. He seemed to really listen to me and all m concerns. 
The only thing that kinda surprised me was that his first suggestion after assessing my scarring was TCA cross locally + LASER.  His first choice would be Erbium, second CO2. I told him fair and square that I don't want laser, not right now for sure, possibly ever and that I am actually really interested in subcision and thats why I traveled to see him. Even though it wasn't something he suggested himself  without me directly asking for it, he agreed that it could improve some of my scars, he agreed it was a beautiful and effective method and agreed to perform it.

After I told him I am planning to suction, we excluded the TCA cross method for now since obviously, it would be risky to suction around TCA sites and my scars are super close to each other so it would be next to impossible to avoid them...

Then I got somewhat scared (the fact that I am an anxious and panicky person does not help here. or maybe it does, cause I am cautious?) and decided I want to try subcision on only a few scars, see how my body takes it, and come back in a month or two for more. We also agreed we will try to do the forehead which concerns me much too. To my disappointment, he reiterated 2 or 3 more times that he thinks that I (my type of scarring) would benefit the most from a laser. (I looked it up today again, and even Dr. Lim says everywhere that forehead doesn't respond well to lasers and he prefers subcision n fillers, the saline n botox method he s playing around with now, RF Infini, etc etc.) He also told me that he has never heard about fat atrophy from laser...isn't that weird?
So.....No, I didn't feel he was forcing me into lasers, he wasn't pushy and respected my decision, but he definitely didn't let go of the idea easily.

Fun fact: I asked him about saline injections. He never heard about the fact that some docs use it as a spacer/buffer. He seemed skeptical at first but he listened to me with interest, then he stood up and took a bottle of saline from a shelf and said ok, we can try that if you want :D So he is obviously very open to experimental stuff.

Anyway, we didn't do that- eventually, we did just subcision on the lower part of my lower face, but in my case that's quite a number of scars anyway - he couldn't tell the exact number but  estimated 5-7 on each side. There's still the upper half of the cheeks untouched and whole forehead.

My plan now is to follow the subcision-suction protocol and start suctioning on Wednesday (tomorrow).

PICS (from crappy phone camera)

IMMEDIATELY AFTER SUBCISION

image1crop.jpgimage2crp.jpg

4 HOURS LATER - THIS SCARY BUMP DEVELOPED ON ONE SIDE as if I got into a fist fight 
image4crop.jpg

THIS MORNING - BUMP GOT SMALLER BUT IS STILL THERE 

PLEASE PLEASE, GUYS GIVE ME AN ADVICE... do you think I should suction even over the "bumped" area? I don't wanna wait for longer than 3 days since The Study said that people who waited for 5 days or more had much milder results. On the other hand... triggering the spot and induce bleeding or I don't know whatelse sounds really scary.( I don't know what to do... Thanks!


I'll keep you updated once I start suctioning.
Peace.

Edited by EagleEva
typos

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@EagleEva This all seems normal. One can swell and get red after subcision. IF the bump continues (you mention it went down this is a good sign). See him again and he can give you a steroid especially if your prone to keloid scars. That being said this is all normal stuff after subcision. What I have read about him he does like Laser, but as you said is respectful if you decline. Your the one running the show so tell him no if you don't want it. Erbium would be better than CO2 definitely if you do go that path, but peels will get you to the same place, ... typically this is done at the end for texture.  

Does he do sedated TCA or phenol peels? 

Of course he will not say he has heard of fat loss, ... possibly a sales tactic or he won't admit to any issue. Maybe he runs the settings so so low it does not cause issues but costs $$$ for extra treatments, who knows. He does seem conservative in his video's laser settings (below). Maybe it has never happened to him.

You can always get more subcision done with him if saline Chinese cupping works well for you & TCA Cross, .... you can go elsewhere for rf microneedling (you may be fine without that step now seeing more pics, you can save this for latter if you needed more), finish your tca cross and subcision work, then resurface with filler in the cheeks before you do so..

I know he is good with filler, if the saline / cupping does not work well. I really see filler working on that right cheek in the pic it seems to have some fat loss. 

IF you do wish to go the laser path (erbium resurfacing) please have him do a specific area test spot while he's doing another treatment if it concerns you. Then you can see how you do. 

No do not suction over the bump area until it goes down more, you can ice it if you wish.  Any non bumped areas you can suction. If you start bleeding you don't have to suction and can wait some more, it's not scary, you just hold some tissue on it. 

Looks good so far!

 

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@beautifulambition thanks for reaction. the bump is going down. I am actually icing a lot. 

I will go for a filler at one point but first subcision + suction alone. Next time saline + suction. Then probably filler.
Yeah, I can see my cheeks are fat deficient but I think that they would have been this way anyway, severe acne or not. I just always had rather hollow/skinny face. My father has one too:) But I will try fillers at one point for sure.

Will check with him about the deep peels. He will probably offer laser one more time :D

I actually wanted to do RF Infini in like 3-4 weeks! Do you think it is unnecessary? If not Infini, then at least Derminator...? I feel like I wanna take this winter time to do as much as I can, use the momentum, before I let my skin alone in summer for some healing time.

 

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@EagleEva I think you should do 3 subcisions (you can save the last one if you wish till down the road). I think you should do your TCA cross that will take a few, he could probably do that in the places he is not doing subcision next time.

When I originally saw your pictures I thought about RF needling and getting some improvement on the large pores and temple scars. It's cheap in Europe one person quoted $300ish a session for Intracel. I don't know does he have this device, his website is not clear about this. So if it's affordable and you can find it, sure go for it after cross. 

Your scars are very surface oriented and as such I think you will get lots of improvement with subcision, tca cross, and a peel.  You can stop at any time your satisfied. You don't have to do something. 

Your scars are surface oriented so a peel or erbium resurfacing might work just fine. I always am on the side of peels before laser, some do laser and that is fine as well. I just try to get people the maximum improvement possible. I do not know his skill with laser (This is why I suggested a test spot next time somewhere on the face to see) . Some just do erbium fractional and not the ablative (over riding the settings) style Dr. Lim does. I know you would get a good result with A deep TCA peel or Phenol before the summer. Let's take it in steps.

Do the subcision and tca cross sessions, and well see what is next after weather deep peel or rf needling. Just update here and I will try to help with next steps.

He can subcise your forehead scars too. I was unclear what you said above concerning that, if he would do that. 

BA

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@EagleEva I also plan to visit Dr. Emil in few months so I am very happy to see someone's progress with him. I have few questions for you;
Is Dr. Emil using direct light when doing examination of scars?
What is the total cost of Subcision? Did he suggested filler with subcision?
Did he told you how many sessions of subcision will you need?
And finally how long did you stayed in Dennmark? I don't know for how long to reserve hotel there and Dr is not doing consultation over skype so I am not sure what he will suggest for my scars/ only subcision or laser also

Thank you in advance:)

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Emil is good. He was trained at the NHS with Prof Chu, so his subcision is point to point. Multiple entry areas - as in the video. Now, forehead area is very easy if one is experience. A good specialist will go vertical first, 3 injection points, hear the crunch of collagen bonds breaking then inject Botox. Not a lot, only 1 unit per scar. This will give an improvement of 20-30% permanently. The Botox prevents muscle contraction whist the vertical entry of the needles break bonds. If this does not work, filler and tangental subcision- higher risk as Dr Lim mentions, due to blood vessels in the area. One has to be vvv experienced in this due to the arterial supply and the depth, go 0.2 mm too deep, and filler in say a supraorbital artery can lead to blindness. A safer approach would be saline with suction. As for lasers and Infini, etc... feel the depth between skin and bone? Not much correct. If one uses even a 0.5 mm needle its deep, and even with insulation, it will leave grids for awhile. Tricky area, but easy if specialist knows how to approach this. If Emil is in doubt, have him email Dr. Lim, he keeps in contact with several of us Drs. All the best. 

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23 hours ago, beautifulambition said:
When I originally saw your pictures I thought about RF needling and getting some improvement on the large pores and temple scars. It's cheap in Europe one person quoted $300ish a session for Intracel. I don't know does he have this device, his website is not clear about this. So if it's affordable and you can find it, sure go for it after cross. 

Your scars are very surface oriented and as such I think you will get lots of improvement with subcision, tca cross, and a peel.  You can stop at any time your satisfied. You don't have to do something. 

@beautifulambition Yes, in my country RF Infini costs around 300 USD. But that's only per single session - you almost always get a fair discount if you buy 2-3. Is it much more expensive in the US? On the other hand, subcision here is quite pricier I find...
Still,  I really wanna do some Derminator rolling now (that is after I am finished with suction) - I bought myself Derminator for Christmas and really wanna try it out :D A bit of needling cannot do me any harm I suppose.))

You recommend I get several TCA cross and you also think I have rather superficial scarring - I though TCA cross is specifically for deep scars? Emil marked only a few of my scars for TCA cross... However, I really wanna try it out and I think he will do as I wish...

Yes, he agreed to do subcision on my forehead too. He said he will use a different- tinier- needle though. He used an actual Nokor on my cheeks and stated that Nokor is not suitable for forehead.

 

@useruser222 send me a PM please for more private stuff.

However, he did use a truly horrifying overhead lightning to assess my scars - which is good of course.
Of course he spoke about the possibility of fillers but absolutely agreed with me that it is reasonable to try the first one(s) without fillers.

Edited by EagleEva

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On 17/01/2018 at 11:55 AM, Obi wan said:

Emil is good. He was trained at the NHS with Prof Chu, so his subcision is point to point. Multiple entry areas - as in the video. Now, forehead area is very easy if one is experience. A good specialist will go vertical first, 3 injection points, hear the crunch of collagen bonds breaking then inject Botox. Not a lot, only 1 unit per scar. This will give an improvement of 20-30% permanently. The Botox prevents muscle contraction whist the vertical entry of the needles break bonds. If this does not work, filler and tangental subcision- higher risk as Dr Lim mentions, due to blood vessels in the area. One has to be vvv experienced in this due to the arterial supply and the depth, go 0.2 mm too deep, and filler in say a supraorbital artery can lead to blindness. A safer approach would be saline with suction. As for lasers and Infini, etc... feel the depth between skin and bone? Not much correct. If one uses even a 0.5 mm needle its deep, and even with insulation, it will leave grids for awhile. Tricky area, but easy if specialist knows how to approach this. If Emil is in doubt, have him email Dr. Lim, he keeps in contact with several of us Drs. All the best. 



Thanks for your insights.

You reminded me - Emil mentioned he also does DERMAL TUNNELING and suggested that we do it next time. I actually read very little about this method so took it as a homework to look into it.
 

The saline + suction is what I d like to do next time.  I ll ask him next time about the saline/botox in forehead but I feel weird "lecturing" him about all the methods I read Davin Lim does ... He's the professional after all.
And as for the filler incidents: I am actually scared about the embolism/blindness stuff quite a lot. But it cannot happen with saline right? Saline is natural to our body and won't block a vessel. This is at least how I try to comfort myself.... With a bit of luck, the saline will stay for a few days and then I will suction the hell out it. Edited by EagleEva

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@EagleEva That's cheap for RF Microneedling. Here it's a thousand or more a treatment. So yes get that done. Subcision costs are about the same, filler being more costly.

Why not wait on the dermiantor until closer to summer, and do all the DR treatments now. Derminator can be used for upkeep at home. You want to do one treatment a month, especially the doctor type ones. 

No TCA Cross is for shallow or deep icepicks, small boxcars, and rolling scars that have a defined border. It lifts the scar bed up. IF Emil found some to do great do those (cross), then subcise the rest and do your saline suction, and finalize with a deep sedated peel or several TCA peels.

Great subcision on the forehead is needed and rf microneedling with also help (both). Yes smaller needle is fine here.

Tunneling is the simple act used with a needle or cannula during filler, it's retro grade releasing substances or making dermal tunnels. That's fine about saline, ... if he normally does filler it's just something else to try (he normally does filler). IT's not that he does not know what he is doing, it's your having him try things he is not used to doing. Dr's do similar procedures once they get a pattern.

Your not lecturing him if you discuss ObiWan's treatment suggestion. He is used to injecting botox in the forehead I am sure, it's just a combo treatment most doctor's don't do because of the added cost I think. You will not get embolism or blindness from filler or saline, both are biologically found in the body, they can dissolve filler, any doctor worth his salt know's anatomy. He is a expert injector and used to injecting all around the face. See the video above, he expertly injects filler, for acne scars.

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Thank you so much for sharing this.  I live in Europe and have thought about traveling to be treated by Dr. Emil.  I wish you the best in your scar treatment.

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On 28/01/2018 at 0:48 PM, useruser222 said:
@EagleEva any updates:)?


Hey hey, thanks for thinking about me.

Oh well.

So tomorrow's gonna mark 2 weeks since my 1st subcision. Initially, I wanted to post some pictures during the first week, maybe on day 5 or so but I changed my mind. I knew the swelling would be just so deceiving. And I was right.

In the first week, the subcised area looked really hopeful. I have been suctioning r e l i g i o u s l y since day 3 - first 5 days maybe even 3-4 times a day, then since I went back to work, only 2-3 times, now like 2 times a day. 

Now that the swelling is down I can see pretty much all of the scars went back. Probably not completely as deep but...still. I am rather depressed about it. I know that people with subcision threads often said that they saw biggest improvements in week 3-5, however that were those who did not suction. Those who did suction often never saw their scars going back down. (I am consciously not saying re-tethered because I read that actual re-tethering will happen after first few weeks so Im assuming (hoping) they cant be re-tethered yet?)

PLUS, at that spot where I had the hard lump, a small under-the-skin lump remained. It is not visible from the outside, only when I touch it and push it. The fact that I suctioned over it probably did not help. (I was just so scared not to. I thought it s the only thing that can help keep the results).
Now I stopped suctioning over it and I generally don't care it's there - just wanted to check if it isn't harmful or dangerous in any way? What it is even? I mean the hardened tissue... One thing I know for sure is that I don't want a steroid injection.

I will take some pictures tomorrow with a camera under the same light I used in the baseline pictures/the first post so you can see for yourselves. Edited by EagleEva

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The problem with subcision is thst shallower rolling type hardly respond to it,filler is required,you will find that suction will do little for them type.also,even the deeper will try to retether.

i did my own subcision and used a cheapo cupping set off ebay,just the hand pump and from day one i did it for around 5secs on each scar,i did this for around 10 days.the scars are still there but not as noticable but they healed for sure noticably,end of week 3 but definately at end of week 4,i resubcised them 2 days ago and am doing same suction.

you will basicly find it hard to rid the scar totaly,some might but the idea is to do subcision more times and get more lift in the scar so you can use a different method to smooth it away.

i suppose also skin thickness,healing time and how you heal is important.

your gonna have to wait and heal so realy week 4 was the week i noticed more healing/improvement but a few have almost disappeared.

i will update my tca thread hopefully with noticable results.
:)

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