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Hey Guys,

I found this forum today and I am relieved in a way I can speak to like minded people because my general friends/family do not understand what I go through on a day to day basis.

In my teen years I suffered severe acne. Parents took me to a dermatologist, took accutane for the time needed. Yes it was a temporary fix. But what came afterwards was what has affected me for years and still to this day it kills me to see everyone around me with nice skin and I have been unlucky. 

Being a 20 year old with fat loss in cheeks is a very rare occurence. Some dermatologists said it was the accutane, others said its my "genes". Not ONE family member of mine has what I have. 

At 22 years of age I moved states to get better medical advice and start a pathway to treating my scars/fat loss/large pores. After going to apparently the best dermatologist in the area, I started undergoing a treatment plan which consisted of a few co2 laser sessions. With high hopes I did everything right, after 8 weeks there was very little improvement and no collagen reproduction whatsoever. Tried a second co2 after 12 weeks, same result. Very little improvement. As a matter of fact I believe I may have lost more fat. After a few weeks I got hyperpigmentation. Did a series of peels with same thing again, little improvement. Did another cycle of accutane, little improvement and horrible experience. 

Last year I decided to go to a different dermatologist. They tried to fill my face up with fillers and botox for the forehead and cheeks. Botox worked for a while. A month to be exact. Only 1ml each side was put into my cheeks. Little improvement but they definitely underestimated how much I needed to fill my face up. 

Now at 27 I have gone to another dermatologist yet again. I have started a new treatment of co2 laser but they have done a subcision treatment and a tca peel in certain areas. I am being hopeful with this new treatment but with my past experiences its playing with my mind. The day after co2 my face looked so full. if only that was a permanent look :/

I am after other possible treatments that have been proven to work if this fails. I have spent easily over $15000 in just treatments alone only to see the same face in the mirror everyday without improvement. Some of the users here complain about a couple of scars here and there. I would kill to have what other complain about on here. I have attached pictures of my scars, this is 1 week post co2 (today)

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CO2 will not get you to where you want to be. I can deeply sympathize with you. Your major issue is rolling scars with fat atrophy or loss. I would not have done CO2 at all. Sadly all those treatments could have made your fat loss worse. 

I would do the following based on the pictures posted:
* Subcsion with filler. IF they have done subcision are they using a nokor needle. Are they using filler? I don't see the filler doing the lifting. For this type of fat loss one can do well with either voluma in large quanities or sculptra throughout the cheek, and later HA for surface touch up. Fat grafting is another option if you like the look of filler I would go this direction for longer results. 
* I would space around your subcisions when the filler goes away RF microneedling, there are many brands. This would protect your epidermis and stimulate the sculptra. You would need 3 treatments of this. I would do Infini RF on low settings, level 4 or under. They must feel your skin for thickness in the area of treatment so they do not go to deeply. They must be VERY CAREFUL of the depth (you of course can skip this is you want - optional). 
* I would then do a deep TCA Peel for surface texture that goes to the reticular dermis, this is sedated. OR several medium strength tca peels, ... less side effects than using laser (plastic surgeon can do these or a derm). Another option is erbium resurfacing. Unlike your co2 this is only for surface texture and is ablative. 

Your major treatments to keep up are filler and subcision.

Because of your skin type I would use skin bleaching or whitening cream with things like albutin or hydroquinone. Also retin a or tretinorin nightly, ... Differin is sold OTC at Target. This will keep from hyperpigmentation.

There is a point in treatment of diminishing return of outcome. I don't think you are there yet with filler and subcision luckily. 

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Recommendation : Fat grafting or Sculptra, subcision

I honestly think that you've done enough lasers.  They only do so much, and CANNOT generate the kind of volume it takes to fill out a face.  

I agree with your assessment that you have quite significant fat loss.  In a case like this, I think fat grating would be appropriate because of the sheer amount of volume you need.  One or two syringes won't be enough, as you've already found out.  I'm only guessing, but it'll take something like 10-15ml of fat each side to see some significant filling of your face.  That kind of volume with fillers would be insanely expensive.  Fat is the way to go here.   Be aware though that not all the grafted fat will survive.  That means you may have to do 2-3 rounds of fat grafting to fine tune things. 

The good thing with fat grafting is that whatever does survive, will likely be permanent.   Once you have a good foundation with fat grafting, then you can target the individual indentations that remain with subcision / fillers.

So what I would do is:
-Several rounds of fat grafting and then reassess where you are at
-Subcision to lift remaining indentations
-Use fillers to target individual large indentations
-Discontinue any more lasers for now.

Edited by dazzed

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Research on your scar revision specialist. As other wise people on this thread have already mention, CO2 lasers (or any lasers) will not get a good result for your scar type. Lots of dermatologists do push laser only because they have purchased an expensive machine. 

You have come to the right place, as you will find lots of good information here and helpful members. My main tip is research a reputable scar revision specialist. Don't just go to someone close to you. It is your face and money! Best of luck. 

Edited by ScarRight

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Thanks for the advice so far... keep them coming. So my derm is set on this specific treatment plan of doing 2 lasers with subcision followed by fillers afterwards. I have mentioned about the fat grafting in the consultation but he wants to focus on getting the scars minimised first then focus on filling afterwards. I have told him that with this latest treatment that's 3 laser sessions already. How do I go about trying to cancel out the next laser and move straight into the filling stage? 

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2 minutes ago, victor71 said:

Thanks for the advice so far... keep them coming. So my derm is set on this specific treatment plan of doing 2 lasers with subcision followed by fillers afterwards. I have mentioned about the fat grafting in the consultation but he wants to focus on getting the scars minimised first then focus on filling afterwards. I have told him that with this latest treatment that's 3 laser sessions already. How do I go about trying to cancel out the next laser and move straight into the filling stage? 


You can simply cancel. If you do not feel comfortable, or you think they're better treatment options out there or better doctors, just cancel. He can't force you against your will to do lasers. Unless you have already paid for them? Many scar revision specialist can use fillers, so seek a second opinion if this dermatologist isn't keen to give you fillers without the lasers. 

Personally, if I had your scar type and volume loss and the dermatologist recommended three laser sessions, I would run out of the office and find someone better. However, that is me personally. It is your money and face, so do lots of research (Which I'm sure you are doing since you are here) and only do something you feel comfortable with. Weigh the potential risks with the potential rewards. Does it sound like a good choice? Do what you think is right for you. 

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Mate, honnestly your skin looks harmonious. Mine is worse than yours (my scars are still red). But anyway, most people don't understand what it's like to see your face dramatically change. It's such a relief knowing some people know my struggle.

But honnestly man, it looks harmonious, could be really worse

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Your face, your money.  You call the shots.  Do not let him coerce you into paying thousands for lasers (to line his own pocket) when you know they're not what's going to give you the results you want.    There's a reason they keep pushing you to lasers, because it's the highest priced procedure in their menu.   

You are an EQUAL collaborator in treating your skin.  

Edited by dazzed

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If I were you I'd go find another derm.  If you have the money for lasers you have the money to fly anywhere in the country/world to see the best subcision + filler doctors.  People here will give you advice on the best doctors nearby so finding one should be no issue.  

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With your permission, may I regurgitate what I wrote elsewhere on just how damaging CO2 can be, not to mention that it doesn't work (in most cases).
 

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9 hours ago, mickidepaname said:

Mate, honnestly your skin looks harmonious. Mine is worse than yours (my scars are still red). But anyway, most people don't understand what it's like to see your face dramatically change. It's such a relief knowing some people know my struggle.

But honnestly man, it looks harmonious, could be really worse


The side shots the scars look okay but the texture and definition I have front on its shocking. I would be more than happy to have at least some cheeks to say the bare minimum I can deal with the scars 

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46 minutes ago, thepwhisp said:

If I were you I'd go find another derm.  If you have the money for lasers you have the money to fly anywhere in the country/world to see the best subcision + filler doctors.  People here will give you advice on the best doctors nearby so finding one should be no issue.  


If this is the case, I'm want to know if anyone knows of a trustworthy and honest dermatologist in Brisbane/Gold Coast in Australia. I have been to 4 derms so far, Its tiring going to the doctor's to get a referral then wait various months just to get seen let alone get a treatment. 
47 minutes ago, Sirius Lee said:

With your permission, may I regurgitate what I wrote elsewhere on just how damaging CO2 can be, not to mention that it doesn't work (in most cases).
 


It is quite scary when you look at it in that perspective but in all honest if they put the laser on the face for that long you would have holes left right and centre. Luckily for my skin colour the settings they use (or so they claim) are much lower than what they would use on someone with fair skin because of the higher risk of hyperpigmentation. 

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7 hours ago, victor71 said:

The side shots the scars look okay but the texture and definition I have front on its shocking. I would be more than happy to have at least some cheeks to say the bare minimum I can deal with the scars 

I agree, volume will immediately and dramatically make your face look better.   The first thing someone sees with your case is the lack of volume in the cheeks.  Look at this picture below.  They also have volume loss, but less than your case.   After fillers / Sculptra, their faces look significantly better even though you can still see the individual scars.   Volume reduces shadowing, which is what draws the eye in the first place. 
 

2016-11-15_040726.thumb.jpg.bc27b90e8446572f9da7fbacad4857fc.jpg

* Source: FAQ - filler section, Written by BA - top of the scar solutions sub.

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On 2/6/2018 at 2:20 PM, Jaspa0411 said:

Did you try Davin Lim or Dr Robert Sinclair?  Both are in Brisbane.


No not yet I'll get in contact with them. Thank you 
On 2/6/2018 at 3:22 PM, dazzed said:

I agree, volume will immediately and dramatically make your face look better.   The first thing someone sees with your case is the lack of volume in the cheeks.  Look at this picture below.  They also have volume loss, but less than your case.   After fillers / Sculptra, their faces look significantly better even though you can still see the individual scars.   Volume reduces shadowing, which is what draws the eye in the first place. 
 

2016-11-15_040726.thumb.jpg.bc27b90e8446572f9da7fbacad4857fc.jpg

* Source: FAQ - filler section, Written by BA - top of the scar solutions sub.


At this stage I'd be happy to get figure A in volume.

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I'm going to need to sell my kidney or liver in order to see Dr lim :smileys_n_people_30: looks like It'll be another long journey yet again 

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7 minutes ago, victor71 said:

I'm going to need to sell my kidney or liver in order to see Dr lim :smileys_n_people_30: looks like It'll be another long journey yet again 


Long waiting list? 

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Doesn't the health care system cover some of this as medically necessary?  Obviously I do not know the finer details of the Aus. medical system, but I have read countless times how patients do get some sort of rebate for scar treatments that qualify.   In the US, all of it is considered cosmetic.   It's unfortunate because severe acne scarring makes it impossible for many people to have a semblance of a normal life. 

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25 minutes ago, dazzed said:

Doesn't the health care system cover some of this as medically necessary?  Obviously I do not know the finer details of the Aus. medical system, but I have read countless times how patients do get some sort of rebate for scar treatments that qualify.   In the US, all of it is considered cosmetic.   It's unfortunate because severe acne scarring makes it impossible for many people to have a semblance of a normal life. 


You still have to wait months and years for universal healthcare aka single payer. This is why people travel from other countries to the USA (or medical tourism) for cash pay procedures because they don't want to wait. Acne scarring is not considered in any country to be "medically necessary" when there are all the others on the waitlist who also want to be treated and have medicare pay the procedure. They also pay higher taxes for these government services. Just because medicare does cover a certain procedure does not mean it's the best treatment for the patients issue ( In his case filler is more necessary than laser). If it was a burn scar victim this is medically necessary. I understand the psychological aspect and the disability it gives to those who hide in their lives not getting out of their houses, etc...  I am not debating this, just stating how insurance sees these things. Look at Canada one can wait for months for basic procedures.  The USA has messed up insurance as well, where we are on our own for many things considered aesthetic procedures, ie. many general derms consider mole removal to be this (It can be cancerous). Burns are considered aesthetic unless one is doing a graft or wound dressing procedure. 

To me when someone says sell a organ, this means the procedure is expensive to them, and he needs filler which is not covered under their medicare. It should be, but then those who have other fat/tissue deficiency would sue for partiality in care. 

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I'm going to book in for subcision and filler soon. Maybe we could document our progress at the same time, it could help with motivation.

I don't believe that accutane causes fat loss. All I know is that without accutane I would be almost 30 and still be dealing with cystic acne. It is a necessary evil so don't blame yourself. Your face probably looked "fuller" after laser due to swelling.

I would also be wary about using public healthcare to address acne scars. I say this because I had Vbeam using public healthcare facilities (NHS) and their laser gave me purpula for months. Others here said that shouldn't have happened. It is much better to shop around, do research on here and on realself.

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I wasn't debating either, just making commentary.  

Edited by dazzed

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I haven't even bothered looking into a derm through the public health system. It would be at least a year minimum wait list. Going through a derm with a referral is still a rather long time waiting. I had to wait 4 months to get a consultation with the derm I'm with now so if Dr lim is getting patients from interstate as well as local my guess is his waitlist would be a while as well. Medicare is a load of crap I got $200 back from a $1700 session. Once fillers are involved Medicare doesn't cover at all. 

2 weeks post laser, scars are still looking the same ( in my head ) but can anyone clarify if I'm experiencing hyperpigmentation? Or too early to tell as it's still in healing phase. Ive attached some close ups. I'm seeing the derm on Monday for a follow UP.... 20180208_104150.jpg20180208_104430.jpg20180208_104358.jpg

Edited by victor71

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This last photo is one of the areas where they did the subcision. In my eyes scars haven't lifted and still looking depressed. All I feel is little scar tissue bumps where they did it...

20180208_120844.jpg

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