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Hello everyone,

Introduction: I am a 27 year old female. The first zit appeared on my face when I was eleven. Since then it has been a continuous battle. I have seen good and bad days. While a doctor had advised me to take Accutane to knock it out for good, I decided against it given the side effects. Retina - A (0.025%), Clindamycin and general avoidance of dairy products seems to be keeping things somewhat under control (touchwood, I am going to say that a lot). I have some acne scars that are ten years old (very few).I was pretty clear before 2014 with the use of the same medicines. I thought my skin will be fine and hence stopped using these. In 2015, due to stress and poor eating habits, I started breaking out again. I was able to control that with the same topical medicines in around January this year. Now, I want to work on the scars. I have been told by dermatologists that it is a good idea to use tretinoin all over the face for the rest of my life to help with age, texture and further incidents of acne.

Doctor: I have an appointment with Dr. Morganroth soonish (I live in the bay area). I was supposed to have been done by now (February) but he was traveling (which I was not aware of, I had taken the appointment back in November) and I was not comfortable about getting it done by his substitute. Hopefully he will be there on my next appointment and I can be done with one round of treatment. He was a nice man and answered my questions. 

Treatment modalities: I think I have a mix of rolling, ice pick and box scars. I failed to ask this to Dr. Morganroth. He said he will do subcision but not TCA Cross. He said it can lead to bad complications and the results we see could be the best cases. I asked him if he would be able to subcise all the scars. He said no, some of my scars are linear in structure. I am not sure what that means. He added that I can expect 25% improvement but some have seen 65% or more. I plan to do about two rounds of subcision before June.

Supplements: I take three capsules of Hair, Skin & Nails vitamins every night. Every morning I drink about 400 ml of kale leaves, 1 tbsp flaxseed, 1 tbsp Vit C powder, 1 scoop of collagen peptides, a squeeze of honey, a splash of apple cider vinegar and some water all blended together. I also drink about two cups of green tea everyday.

Topical medicines and cosmetics: bp face wash, clindamycin, a gel moisturizer, sunscreen in the morning. Salicylic acid face wash, tretinoin at night. I don't use makeup at all, primarily because I have no idea how to use any neither do I know what will suit my skin type. I use some eye cream as the are around my eyes tends to get very dry. 

Pre-treatment: The substitute doctor advised me to stop using retin A for about two three days after the treatment to avoid possible sensitivity issues. Apart from that he said I can continue to live the way I do normally.

Post-treatment steps: I have bough a Chinese cupping set and hope to suction once the insertion points have closed.

Any advice or ideas are very welcome. In the attached photo you will see active acne. But this photo was taken in November last year. I have residual scars now. I would love to know your opinion on what kinds of treatments would help. I am particularly thankful to this forum for giving me hope, :) Thank you. and to @beautifulambition for always being so patient and answering questions.

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The following are more recent photos:

MVIMG_20180226_182550.jpgMVIMG_20180226_182601.jpg

Edited by ohwellletstry
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I think the linear scars he is referring to are the kind of long ones you have in the middle picture on what would be -I think- your right cheek. They are long and perhaps would not do well with subcision- but I think subcising around them would fix a lot of the depth, because it is being pulled down by the tethering around it. I have similar scarring to yours and I am hoping to do ~2 or 3 subcisions, followed by infini rf, and then TCA peels and microneedling. I am looking forward to seeing your results... also in advance sorry if this message is all wonky, I realized I was SUPER tired midway through writing it but I wanted to let you know that I am rooting for you!!!

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@ohwellletstry Thanks for writing that up. Hard to tell in those pics, hard to see the cheeks zoomed in of the cheeks, scars make shadows with directional light like a flashlight. Yes I do think the plan of action for your boxcars is subcision w/ possibly filler. Other than that I cannot tell what is going on based off the pics. Boxcars do well with RF microneedling have morganroth do Infini RF - 3 treatments spaced out (3 months between). You can do a few medium strength tca peels or fully ablative laser resurfacing to finish.

Space it out and allow the body time to heal. Regarding linear scars hard to tell from the pics, where are they, then I can advise better? 

BA
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@ohwellletstry
Sorry didn't get the tag from your original post. 

1) How much time... If you do it with filler as I recommend, you would go get subcised again when the filler round out and do another round of filler. If you do only chinese cupping or suction method (Amazon) then you can do it every 3 months.

2) I would not excise your scars. You replace a scar with another one. I would try tca cross and if this fails then you can look into excision. TCA cross raises the scar bed and makes the icepick more superficial. Then it can be resurfaced. 
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I got my first subcision done today. The doctor came in and marked my 40 worst scars. He took my opinion on if I agreed with his idea of my worst scars, something that I really appreciate. Then the nurse injected the areas to be subcised with Lidocaine. I think she had to go get an extra bottle because she had to inject me so many times. Perhaps I am too sensitive? She was really nice and asked me if I was doing okay. I asked the nurse if I could take Advil for pain after. She said that Advil acts as a blood thinner, so Tylenol is a better choice. However, I had taken an Advil yesterday for menstrual cramps, which, she said, explains why I was oozing more blood than is usual.
Then the doctor came in and subcised my scars. I didn't hear any popping sounds so to say, but did feel things breaking. Or maybe that's just psychological. I have been asked to use a very gentle and non-medicated face wash for about seven days. 
I plan to start suctioning on Day 3.
I didn't do fillers this time, mainly for financial reasons. However, as per @beautifulambition's suggestion, I will bring this up with him on my follow-up visit.

There is no pain right now. I was feeling a lot of discomfort all this time (about an hour since the process was completed) but am feeling better now (touchwood).

Edited by ohwellletstry
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I started suction today, using a Chinese cupping set that I bought of Amazon. I have suctioned the subcised areas, and held the suction pump up to a count of ten. As expected, the area immediately became dark due to a rush of blood. Suctioning was not uncomfortable at all. I intend to do this everyday.

The chicken pox scar on my forehead looks quite the same even after the subcision. Same goes for the deepest icepick scar next to my nose. The doctor did not subcise the other icepick scars.

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@ohwellletstry That's the point to induce your bodies ability to fill the area with tissues/ collagen. Increase blood flow to the area. If you have any hematomas stop suctioning immediately and massage the area daily until it resolves. Take a asprin. This will cause more bruising with the cupping so be aware this is only to resolve possible hematomas (you mention hypertrophic scars) - ... no a few people get hematomas but they resolve over time. Your other choice is of course filler but it's more costly, no bruising, but you have to wait till the swelling subcied to be filled for most doctors. If your are prone to hematomas / keloids DO NOT DO CUPPING!

You can use ice just like you would if you get a bruise elsewhere any of these at home remedies can work, just don't disturb the underlying tissue by destroying collagen. Makeup is your friend. 
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32 minutes ago, beautifulambition said:
@ohwellletstry That's the point to induce your bodies ability to fill the area with tissues/ collagen. Increase blood flow to the area. If you have any hematomas stop suctioning immediately and massage the area daily until it resolves. Take a asprin. This will cause more bruising with the cupping so be aware this is only to resolve possible hematomas (you mention hypertrophic scars) - ... no a few people get hematomas but they resolve over time. Your other choice is of course filler but it's more costly, no bruising, but you have to wait till the swelling subcied to be filled for most doctors. If your are prone to hematomas / keloids DO NOT DO CUPPING!

You can use ice just like you would if you get a bruise elsewhere any of these at home remedies can work, just don't disturb the underlying tissue by destroying collagen. Makeup is your friend. 
Thank you. I didn't have much bruising till yesterday. Things had started turning yellow in fact. I think I slightly overdid the suction last evening (about four passes 4 seconds each)other and have cupping marks as well as bruising. Some of the deeper scars have started to get re-depressed thought I *think* to a shallower extent. I don't feel any hard lumps under my skin yet.  Edited by ohwellletstry
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There's a new indentation I see, like a linear scar, possibly a nokor entry point scar. Is there a chance this may resolve itself or something I can do to get it resolved at this stage? It's been ten days since subcision. 

Also, when can I start micro needling? Thank you :)

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@ohwellletstry
The notifications on the new website update are a bit wonky. PM me if you need.

The indentation should heal fine, is it red? Do you heal normally when you get a cut (If not you would know)? Put some triple antibiotic on it, or honey and aloe vera. Grease for peace. La Roce makes some good products as well.  You can always do a appointment with a derm to check it out if your concerned.

I would not microneedle until everything has resolved (unless you want to needle the other areas which are not healing). If you needle to quickly you could disturb the new collagen that is being formed. At least a month is a good bet.  
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Hard to put a number to it but it's definitely better than before. I had 26 scars before, now I have 8 that still need (more) correction. So I would say perhaps ((26-8)/26)*100%? I plan to get another subcision early next year. 

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5 hours ago, ohwellletstry said:

Hard to put a number to it but it's definitely better than before. I had 26 scars before, now I have 8 that still need (more) correction. So I would say perhaps ((26-8)/26)*100%? I plan to get another subcision early next year. 

That sounds pretty darn good considering you have only done one treatment. Well done.

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@beautifulambition thanks for your guidance so far. I just turned 29, and had met with Morganroth last year before moving out of California. I live in Virginia now, and he recommended that I see Steven Rotter and get another round of subcision done. It will be my 3rd. He thinks it will help.

I also think I need skin resurfacing for textural issues. I asked Morganroth if Infini RF is a good idea. He advised against it and said Fraxel is better. 

Here are my questions:

- is Fraxel resurfacing a good idea for textural issues? 

- does Fraxel work on ice pick scars? I know CO2 resurfacing does but I am brown and apparently my skin type is not safe for that. 

- Morganroth advised against TCA for my icepicks, again because of the colour of my skin. What are my other options for TCA Cross?

Thanks so much as always. 

 

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@ohwellletstry Hi again! can we get updated pictures to update the treatment recommendations. I do not know if he is sponsored by Fraxel, could be. Regardless we can go off the updated pictures of your scars. 

A deep peel (plastic suergon) is also as good as a fully ablative laser resurfacing - scition erbium. These are the things that really do something for textural scars but there is down time.

Regarding Fraxel It can work on the mild fourms of surface issues. I use it often for large pores. 1927nm - 22 passes is the best lser to use by Fraxel, their CO2 repair is not that good. But this sometimes does not take care of the issue fully. 

I will think about Dr's around your area to treat you once you respond with updated pics.

Fraxel does not work on icepicks, tca cross does. 

co2 is safe for brown skin, it depends on the skil of the provider. I would see a provider that specializes in ethnic skin, there is a plastic in the East Coast who is pretty good will have to lookup name. He is in the FAQ, pinned to the main scar treatments sub, search for ethnic in that post towards the bottom. 

That is silly about tca cross, ... do you know it was originally developed by Koreans who hyper pigment easily. He could not be bothered to treat your skin type. 

Dr Rullan in San Diego does specialize in your skin type. 

Welcome!

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@beautifulambition on my right cheek is a big boxcar scar which Morganroth said would improve more with another subcision. On my left side are these ice pick scars next to my nose, and a boxcar scar that has improved but could use more improvement. 

 

On my left cheek are some rolling scars, not too big. I also have linear indentations; I am guessing they are narrow boxcars.

 

I have just showered, so they are red. But I do have some redness. Morganroth had warned me though; he had said that will take a while to go.

 

Thanks so much.IMG_20190704_173441-01.jpeg.a20e7f93d0686db3fa307fd53078f4b1.jpeg

IMG_20190704_173036-01.jpeg

AirBrush_20190704173158.jpg

Edited by ohwellletstry
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@ohwellletstry I would be doing paint on tca to that spot, I don't know if he has the skill to do that. I know Dr Rullan does in San Diego with phenol Cross. Paint on uses a lower % of tca to paint the boxcar scar bed only with a few coats.But if Morganroth said he can get improvement with sub, do that. CO2 laser is often used for scars like yours on the border walls to soften things. Also you can derminator or dermastamp the boxcar walls/borders monthly to soften them. 

If I was treating you I would do tca cross to lots of your scars.

Linear indentation can be paint on technique, and some laser at a latter time. 

I would not do Fraxel in your case, I would do fractional co2 low density and high power. Fraxel does not take care of anything but the most minute surface issues. RF needling also helps box cars and  can be done at any med spa.

Virgina, see Dr Joe Niamtu is good in Virgina, and Dr Kosari is good, we have a few providers on the FAQ for Virgina you can consult with see the FAQ pinned to the main scar treatments sub, bottom of that.

Do a few consultations and pick the Dr you like best, ask lots of questions about treating your skin type.

 

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