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eva_li

Acne Scars - My Journey - Subcision

11 minutes ago, runnyeggs said:

What's the difference bet sub with Nocor and cannula+filler sub? I would think the Nocor sub would get more scar tissue released since it's a trangular tip versus the other one being just a needle. The Nocor seems best to cover more surface area. Isnt the whole point to excise the scar tissue and releasing the skin depression?


That depends on where on the face you're subcising and how thick the scar fibers are. You would need to be especially careful when subcising using Nokor where there are major arteries. 

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SO I just had fillers done in my cheek today. Not sure how I feel about it.

No subcision this time since the doc deemed it unnecessary. Fair enough. Some parts look nice and fuller and (almost) leveled out with the rest of my face but some shallower scars which have never been subcised...seem to have stayed. It has been around 10 hours, I am dreading I am having a mild donut effect around some scars. The doctor considered these shallow boscars too shallow for a sub but I feel some subcision even if just with a regular needle should have been done. :(

The filler was Juvederm Volbella, he said it is supposed to last 9-12 months. I asked him whether I could needle over it or have a peel in next months and he was convinced that would destroy the filler. Especially RF needling. He also discouraged me from a deep peel sooner than somewhere in November :-O
Now that's kind of in contrary to what most veteran members here think. (the filler+INFINI combo). 
Is there any legit scientific study on this I could look into?

Oh just one more thing. PLEASE please, any advice on what to do about lumps? I developed two teeny-tiny lumps from the filler. Shall I massage them, is it safe? With ice? With an egg?:D

Dunno, I feel weird and confused now, gonna sleep on it now and will take pictures tomorrow.

______

 

Edited by eva_li

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@eva_li Hey again Eva, thanks for updating us. I just wanted to say that I think the Dr. is correct as I felt like the rest of my filler (I had already had it for several months before my medical needling) was completly gone after the Dermapen. I tried to find some more info about this before and the docs on Realsef pretty much say that Infini is OK with fillers that are injected deeply for volume like Sculptra, but not superficially placed ones like in our case..  Edited by Nina22

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UPDATE:

I feel so disheartened and sad and frustrated at the moment. 

I had filler to my cheeks feel two days ago. And I am looking into the mirror, I am inspecting my face all the time like a crazy person and I literally cannot see any difference.

What I was hoping for was  a little bit more subcision before the filler (not necessarily Nokor). The reason is many of my scars on my cheeks were never subcised (a lot lot of shallow boxscarring/icepick). Only the deeper ones were subcised, twice in the last two and a half months. The doc, however, did not feel more subcision would help me as he saw my scarring is moderate and shallow and sub is only for the deepest scars.

He did not want to subcise on my forehead since he said the scars are not worth the risks of sub in this region. So he did only TCA cross on the forehead (150 EUR for 6 crossed scars :-O wtaf?!)

On the cheeks he went for filler treatment with Juvederm Volbella. I think there must have been a misunderstanding as I thought he would subcise the scars at least w the needle before injecting. But he was just injecting the filler. The scars that have been subcised previoulsy seem somewhat fuller, but not all of them completely leveled out.(But thats just 4-5 scars)

 But the scarring there actually remained...JUST THE SAME. Have not lifted up. I am convinced that there should have been some subcision, even if a mild one. Now it seems the filler probably just spread around the scars. 

What is happening? Should they have been subcised? Or is filler not a treatment for me? People here def recommended it to me.  Obviously I need some treatment for the texture. I know that. But this experience is just so disappointing. And all the money it cost me...
I literally did not expect that a filler, the notorious "instant gratification" tool, will leave me w next to zero change in my looks.


....
Fun fact: The doc recommended me deep peels but CONTRARY TO GENERAL OPINION OF THIS FORUM, he claims that you should do a deep peel first and get rid of the shallow scars and then treat the remaining deep ones with fillers.

 

Edited by eva_li

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Ok lets try to make since of all this. It's complicated. I see marked improvement with the deeper / bigger pits that were subbed. In the very last photo you provided can you do the same angle with shadows made, ... scars make shadows... please.

1) I don't know if your Dr is now Chu or Emil or Someone local to where you live. Last I heard it was Chu who would not subcise it. Have you gotten a second opinion by another Dr? 

2) What was Emil's plan again?

Can you help me by circling exactly what you want improved. You just want voluma in the apple of your cheek and a deep peel for texture, because that is possible. I am not seeing your skin like you are and have trouble knowing exactly what you want, which is most of scar treatment (fixing what bugs you!). I see improvement with the last 2 pics between the deepest pits in earlier pictures you provided. If your biggest concern is texture then yes resurfacing would help you most. Have you done your rf microneedling yet? 

I do not agree with the peel and then treat some more, it just seems backwards to me. We don't paint a house and then fix the places that need wood putty. A road is not  freshly paved and then the potholes fixed. Peel works on upper most texture.

Work I see that still needs to be done. More TCA CRoss can be done, as I see some smaller boxcars and icepicks but you did not seem favorable with the outcome of doing cross, ... I Cannot tell why though. RF needling could help with some of those boxcars - prp might give you some healing you desire, You could use more filler in a aesthetic since to volumize the apple of the cheek. Then do your Deep peel, or fully ablative pro-fractional.  If all else fails CO2 high power (highest) and low density 5-7% just on the scarred areas of concern (optional).  I see where the doctors are at they think it's mainly a textural issue and as such want to do a peel. 

3) I am having a hard time evaluating the pics provided. In some it looks like you have pits. In other's like the recent ones I see absolutely no pitting and a peel would be fine. Scars make shadows.

DSC_0288crop.jpg
DSC_0264.jpg
IMG_0392 copy.jpg
IMG_0680.thumb.JPG.02eb92a80f84ae0e4930eeee949456e7.JPG

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On 4/1/2018 at 3:42 PM, Mjjmands said:

Could you please provide a new photo from profile? Thanks 


Fair enough.
I took pictures under the very same lamp that the first pics in this thread that BA just reposted.
 
Original pics are dated Dec 2016. Since then I had 5 dermapen sessions in the course of 2017.
Mid- January 2018 - first subcision. End of February 2018 second sub  + Dermapen w PRP + TCA cross. End of March 2018 - TCA cross forehead + filler for cheeks.
 
Here go the pics.
DSC_0390 copy.jpg
5ac51cf48ec56_DSC_0393copy.thumb.jpg.76ff0283377190655bf5a63259788a64.jpg5ac51ce320ee2_DSC_0358copy.thumb.jpg.b88e285aa0183d1688f009ff49554bd5.jpg5ac51d047d2bb_DSC_0423copy.thumb.jpg.0161bad2a9cf1119f81fbff1e0cdb2ba.jpg5ac51cff72d0e_DSC_0413copy.thumb.jpg.abd6c7e6eba25e5e40349f565e555583.jpg
 
In the first rant I complaint that the filler did nothing to my shallow scarring. (boxcar type)
Sadly, after few days it became evident that even the deeper pits that had been subcised with a Nokor before (and hence should have responded well to filler?), did not fill in too much.
 
LEFT side is worse. You can see the pseudo-dimple scar is still very obvious (god. how much I hate it). It lifted quite a bit on its own after the subs. I estimate that the added value of filler might be 10-15% maybe?
Similar thing can be said about the deeper scar on right side, near cheekbone. Subcised twice, filled, still indented. Filler helped maybe 30%? I kind of expected more?
 
 I know that treatments are like lottery, depend on many factors, your healing abilities etc. But what really wanted to achieve now was more an aesthetic relief, to feel good in my own skin for a few months. I have seen so many threads on here where peoples scars literally  leveled out with the rest completely after filler. This was what I wanted to have for couple months.(

Can you help me analyze what went wrong here?
a) were the scars underfilled, too little material?
b. should they have been subcised onceagain before injecting filler? 
c) are my scars just not suitable for filler?
d) have I just had unrealistic expectations? I shouldnt have expected that they will fill to the surface?
e) ???

@beautifulambition: It was a "local" doc, few hours drive, but not a flight this time. Didnt find anyone in my actual city. Chu doesnt do (even approve of) fllers. Emil...well, he is more expensive and even further away. His plan with me was first and foremost Erbium laser which kind of put me off tbh :-( But now I feel I probably should have paid him a visit again for fillers. I feel he is most meticulous w the scars and his patients...
TCA cross: I have never said I dont like it! this was just my second time (this time only forehead) and I am planning to try many many  more times before evaluating what it does.
Filler for the apple of a cheek: Exactly what I ve been thinking about! But I brought it up w this doc and even one derm in my city and they both were very hesitant about it, said I still seem ti have enough fat, am still "young" etc. But I too feel it would help me to stretch the fold and smooth out the whole cheek...
 
 

 

Edited by eva_li

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@eva_li Aww girl you’re absolutely beautiful! I don’t see any signs of “premature” aging or sagging. I don’t think your acne scarring made your skin appear aged in the slightest. I get a little bit “irked” when people say that the female face should be this shape or that shape, etc. I think this type of talk is harmful and why so many people walk around looking like desperate housewives now with their face stuffed with fillers.  You also have very gorgeous lips! 

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@UpliftingCat you are so right. Sorry BA, I respect you, but all the fatloss thing.... I don't see it either. As far as heart shaped faces for women... I see plenty of them with a round face, oval, etc. 
I don't know... for me the boundaries on this forum are gone... It's not only about scars anymore, it is now about sculpting your whole face... Nobody is perfect.... 

@eva_li I really appreciate your input and several posts. You look great, there is nothing wrong with you even if you have a couple of scars. Don't get me wrong, but when I read your posts, I sense BDD. Maybe you should consider a therapist. That saying I do not underestimate your feelings and your emotions, but I do think they are not equal to how you really look (to others).

Hang in there girl x

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I completely agree with noa27 and upliftingcat. If you asked me, you are wasting your precious time, which could be spent so much more happily, with so minor things. Many people would die for a skin and face like yours. No one would notice the minor things you think you have on your skin. Please enjoy your life, the hassle to reach some fantasy "perfection" is pointless. 

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Maybe the scars were too superifical for any fillers to begin with? I think laser and Infini is all what is left to try if you still wish so, otherwise as others say your face looks very pretty ^_^

 

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I don't get it why so many people (adults in their late 20s) are unable to accept their mediocrity.
But that's all part of the journey.

Your skin looks normal, nobody will reject you bc of this condition. So I agree that seeing a therapist is a good advice in this case.

And pls, calling someone beautiful usually does more harm than good. No woman (+BDD) buys that, especially when it comes from other women.

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This is not directed at Eva, but the posters who responded to my advice.

I have deleted my advice on field subcision as Novick often uses stretching the skin with filler to hide scarring.


I think I need to remind people here that helping others as a volunteer takes massive amounts of time. I am not paid to give treatment like doctors. I give suggestions which the posters can pick what works best for individual situation and needs. I am trying to help others who have acne scars because I know how debilitating it can be and why posters want to improve their situation. I tried to help here.

I need to remind this forum that none of these treatments are medically necessary and a great portion of the posters are doing things for cosmetic reasons when they could live happy lives without anything being done.

This is why Therapy is so important if one obsesses on perfection and minor issues that become significant barriers in their lives. Treatment is also indicative of the person's perceived flaws, not necessarily how others may see them, ... thus it sometimes is lost in communication or help what the real issue is or the focus. 

Perhaps the 2 dimensional nature of the forum did not show my care nor convey it as brainstorming (remember I cannot see individual scars, feel individual scars, use directional light on your scars, nor can I evaluate the person holistically as a whole to their individual needs and situation, I am doing the best I can with the medium I am provided)...

 I can't please everyone. The pics are not the same type as the ones you provided with directional light and ask for a honest opinion.  As such I do not feel they are indicative of what I was asked to provide or rather fix with your treatment situation. Truly the new pics show no fat loss and you need nothing really, so why even get treatment (nothing is needed - this is a case of BDD better suited for a therapist). The OP looks like a model, I have trouble believing the original pics that were posted at this time (anyone reading this look at the earlier pics and look at the new pics). 99% of people here would love to look like the OP's new pics (the posters have severe scarring doctors can't even fix daylight/directional light/ so they turn to the forums here to fix the issue).

As Emil said all the OP needs a peel.

Quote

This was from my post on Saturday: " I am having a hard time evaluating the pics provided. In some it looks like you have pits. In other's like the recent ones I see absolutely no pitting and a peel would be fine. Scars make shadows."


 

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@eva_li 

I have Never claimed anyone photoshopped pics. I help everyone. I was trying to help you... I mean you asked for my help off the directional lighting pics. The posters here are responding off iphone (not the same quality) daylight pictures stating there is no problems. Scars make shadows. You ask me to fix shadows not iphone selfies or you would not be here right. Everyone here can relate, it's simple to explain. Scars make shadows, we react badly to the shadows, pitting, fat loss, texture. Hence when it's a full light daytime pic with a iphone most people would never notice anything. Now take the same pic at night with shadows or directional lighting. You see the difference. I only provide treatment advice off of what I am offered. I know several Drs who would not treat someone without only using directional lighting pics, they know the tricks lights play, ... even some Drs take before and afters with different lighting to hide the issues. Shadows are the extreme of how we look, they are not a natural daytime look, harsh, angular, and revealing in nature. Most people don't even see yourself as any issue. If I saw you on the street I would think you were a model. Beautiful person, beautiful skin, takes care of yourself, youthful, vibrant! But you did not come here for praise, you wanted a issues fixed. I cannot judge you, I can only help with what am provided and the goal you set to achieve. 

Your issues which you asked for a fix were related to filler, fat, and sculpture of the face. What do you think filler provides volume & sculpture. The area you complain about could be stretched as I outlined avoiding the shadows from texture. So we are dealing with your acne scars.

Dr. Novick calls this field subcision, the act of stretching the skin with textural issues to hide the minor scarring, ... same thing sculpting the face.

As such you look like a model and at this point I don't think you need anything done, ... no fat loss, no issues, perfect skin, ... live your life and be happy. Not worth the bother. You even mentioned it. At this point a therapist for BDD would be more beneficial than the roller coaster of treatments (good / bad outcomes / $$$$) for small textural imperfections everyone has.

Be Well, 
BA
 
Quote

Q: How can lighting effect the appearance of acne scarring?

A: Lighting can have a tremendous effect on the appearance of acne scarring. Some women use silicone primers to fill the scar / pore before makeup or blurring creams, serums, and primers you can get from a makeup store. Your scars will look worse with fluorescent lighting and when not moisturized and plump. Night light and harsh lighting can look worse for many, this is why they put HD makeup (which is thick) on at night. Guys can grow facial hair to cover it, put lots of sunscreen, or avoid sports where they get red and it shows the scars. Pure higher weight serum has bigger molecules,... hyaluronic acid makes your skin moist, low weight HA inflames and plumps the skin hiding the scarring. Use a gel moisturizer over a cream, less break out potential though often the thicker moisturizers plump the cells.

Indirect lighting - shows the true scars (scars make shadows, turn out the lights and use a flashlight) 

2016-07-20_174154.jpg

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@beautifulambition I respect you too and you are absolutely right, my response was an emotional one rather than a technical one.  I try my best to be as scientific and practical as possible when giving advice and explanations on chemical peels but there's another side of me that deeply empathizes with the emotional ramifications other's comments can have on someone regarding an issue they already feel deeply self-conscious about. While I truly appreciate all of the time and work you put into helping this community (including myself) I could tell by Eva_li's response that she felt offended and harshly judged by your comments.  I don't know the age of Eva_li but she looks to be around my age and I know as a young woman, it would be psychologically damaging for someone to tell me that I look prematurely aged.  I do understand you were trying to help and your comments were based on unflattering lighting as opposed to her newest photos, but I think people got hostile towards your response because it seemed like you were remarking on more than just her scars.  My goal was certainly not to villify you in any way but rather to uplift a fellow young woman (pun intended).  I usually don't write emotional responses like that and aim to keep my advice methodical. I hope in the future we can still "tag-team" on advising members about peels.  

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@UpliftingCat Of course, I Want to work as a team. I don't have the bandwidth to help everyone. As such if I every say something offensive please PM me and I will edit it. I now see the OP thought I was commenting on her appearance and not on field subcision (using sculpting techniques  w/ filler to hide scars). I love seeing the world from others points of view. I get caught up in the technical part of helping. I tried to keep the subject about shadows and their effects. I would encourage the posters here to help others in ways I cannot. 

Thank You for your care. She is truly a beautiful woman, who I see no issue with! I would not think twice to offer advice if I wasn't asked to do so with a critical eye. I encourage others who have minor imperfections to not only work on those flaws but the cause of them which can often be explored with a therapist who understands the deeper ramifications and pitfalls. 

We are a team!
BA

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On 1/3/2018 at 12:00 AM, 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).


@eva_li Sorry, I didn't bother reading others' post before me (maybe I should have), but do you remember the above post that I wrote on Page 1 of this thread? Well, I hope you now realize that subcision DON'T work for mild-to-medium scars like yours.

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Haha, yeah, I recalled that already several times @Sirius Lee;) But while majority of my scars are shallow, there are a still fewer deeper rolling ones that the sub helped a bit (the filler did not much). But overall yes, I agree, you were right.
 

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