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Lmk5

Forehead & Chicken Pox Scar Recommendations - Botox / Filler / Sub / Laser

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Hello,

I’ve followed this board for some time, but still not 100% sure what is the best option for these scars on my forehead. What kind are they? Has anyone had success treating scars on the forehead? They look not too bad in some lighting/angles, but others (like in pics here)- yikes. I’ve had them for about 7 years... suffered from terrible cystic acne off and on for many years. Never picked at them, yet they still left indents in my skin. Still very self conscious about them and beginning to think about treatments. Thank you in advance!

Edited by Lmk5
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5 hours ago, Lmk5 said:

I’ve followed this board for some time, but still not 100% sure what is the best option for these scars on my forehead. What kind are they? Has anyone had success treating scars on the forehead? They look not too bad in some lighting/angles, but others (like in pics here)- yikes. I’ve had them for about 7 years... suffered from terrible cystic acne off and on for many years. Never picked at them, yet they still left indents in my skin. Still very self conscious about them and beginning to think about treatments. Thank you in advance!


Scar type is rolling scar. But they look tethered, meaning anchored to the dermis (or likely muscle in the case of the forehead). Your best bet is to get Botox injection followed by a couple rounds of subcision. Botox will help with the horizontal wrinkles as well. Lastly, ablative erbium laser will soften the overall appearance. 
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same boat here , mine are a worse and i still dont know how to deal with that .previously had 5 endymed rf microneedling...  .  derm keep pushing to try pixel  ablative co220180316_060649291_iOS.jpg

Edited by Eyeback
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27 minutes ago, Eyeback said:

same boat here , mine are a worse and i still dont know how to deal with that .previously had 5 endymed rf microneedling...  .  derm keep pushing to try pixel  ablative co2


Yeah, unfortunately, the forehead scars are the least responsive to any types of treatment. The reason is that there just ain't enough collagen in the forehead as other parts of the face. That is why the cheeks responds really well to RF microneedling, while the forehead almost next to none. Be that as it may, you also exhibit tethered scars similar to OP, so you'll need to address that first by getting them subcised. I suggest you get botox, wait 2 weeks, then go in for subcision. Depending on the outcome, adding ablative erbium laser after the subcision will help give a smoother appearance.
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22 hours ago, Sirius Lee said:

Scar type is rolling scar. But they look tethered, meaning anchored to the dermis (or likely muscle in the case of the forehead). Your best bet is to get Botox injection followed by a couple rounds of subcision. Botox will help with the horizontal wrinkles as well. Lastly, ablative erbium laser will soften the overall appearance. 
Thank you so much for the information! I will look into these options. Much appreciated :) 
22 hours ago, Eyeback said:

same boat here , mine are a worse and i still dont know how to deal with that .previously had 5 endymed rf microneedling...  .  derm keep pushing to try pixel  ablative co220180316_060649291_iOS.jpg

Sorry you have to deal with this too. I don’t think yours look bad! I guess we will always be our own worst critic. Completely sucks after already dealing with years of hell with cystic acne to be left behind with reminder scars :( 
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I have similar scars on my forehead. I use my hair to cover. I would prefer to have a fringe as a male rather than expose those scars to the public eye. Mine are more ice pick in nature, with a few of the larger ones rolling /tethered. I also use dermablend to help conceal. Luckily my scars on my cheeks are nowhere as bad. 

I'm also very lucky I'm in my mid 30s and I have very thick hair. Going bald won't be a problem. I guess it's relative, as some may think acne scars look bad, but they're many blokes out there who are just as self conscious going bald or having a receding hairline. 

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QUESTION: 
Can you subcise scars in the glabella region?

I am reading and hearing conflicting information on this. Chu allegedly said it is too dangerous to subcise in this area (to another poster).

(I have one in the frown line area. Chu said it does not seem tethered and so it should respond to needling over time. However, it's been there for almost a decade and I have been needling for couple of years and it is not responding at all so I would love to have it subcised to see if/how it responds.)
 

Edited by eva_li
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On 16/03/2018 at 2:10 AM, Sirius Lee said:

Scar type is rolling scar. But they look tethered, meaning anchored to the dermis (or likely muscle in the case of the forehead). Your best bet is to get Botox injection followed by a couple rounds of subcision. Botox will help with the horizontal wrinkles as well. Lastly, ablative erbium laser will soften the overall appearance. 
thank you for your response . is there a reason why you would choose ablative erbium rather than ablative fractional co2 ? i'm reading everywhere  that co2 goes deeper and is still safe because its ''fractional''.
 
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7 hours ago, ScarRight said:

I have similar scars on my forehead. I use my hair to cover. I would prefer to have a fringe as a male rather than expose those scars to the public eye. Mine are more ice pick in nature, with a few of the larger ones rolling /tethered. I also use dermablend to help conceal. Luckily my scars on my cheeks are nowhere as bad. 

I'm also very lucky I'm in my mid 30s and I have very thick hair. Going bald won't be a problem. I guess it's relative, as some may think acne scars look bad, but they're many blokes out there who are just as self conscious going bald or having a receding hairline. 

I’m the same. I have slight scarring on my one cheek but not nearly as bad or noticeable as the scars on my forehead. I’ve thought of getting bangs to cover as well...except I hate the way I look with bangs :-/ but that would definitely be the cheapest option, haha! We will see. Does dermablend help?
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10 hours ago, Eyeback said:
thank you for your response . is there a reason why you would choose ablative erbium rather than ablative fractional co2 ? i'm reading everywhere  that co2 goes deeper and is still safe because its ''fractional''.
 

But does it mean CO2 is more effective than erbium? I think not. Anyway, I'm not advocating for either one. I think lasers are the least effective treatment when it comes to acne scar revision. It should always be your last treatment option (here I agree with @beautifulambition). That's because it's only good for correcting SURFACE irregularity, such as shrinking enlarged pores and smoothing out boxcar edges. As such, I see no reason for "deep penetration". Moreover, "fractional" doesn't necessarily mean it's more safe―let alone effective. It just means there's less collateral damage since you're removing only portion of the skin. I've seen a truckload of side-effects from CO2 patients. (Okay, I exaggerate a bit but there are disproportionately more side-effects associated with CO2 than erbium laser.) With that said...


It's been documented that each erbium pass removes only 25-30 µm of tissue while the CO2 removes whopping 50-100 µm with each pass. Also with the erbium, the laser gets absorbed by collagen whereas with the CO2 it vaporizes the water within the dermis. Each erbium pass generates the same amount of ablation, whereas the pulsed carbon dioxide generates a decreased vaporization depth with each pass because the water content gets reduced.


Nevertheless, an interesting article came out last year stating that "a low-level carbon dioxide laser accelerates wound healing by promoting the proliferation and migration of fibroblasts."
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Hard to treat area. Why> 1.5 mm between skin and periosteum or bone. In this space- skin, or epidermis, then dermis, then fat, then muscle, then periosteum then bone. Lots of blood vessels in this area. Remember guys, its anatomy of the area, Google it. - Supraorbital and supratrochlear aa, then run deep then go superficial. Chicken pox scar done in video shows only part of complexity and does not apply largely to acne scars. See a good specialist for 1. Manual microneedling / dermastamp, not with machine, not with motor but with hand. Crunching of scars when vertically broken.  2. Subcision as above in a very acute angle, with or without Botox to relax the muscle tension 3. More manual subcsion with saline or even PRP.  4. @Sirius Lee erbium depends on the specialist and the lasers. Lim uses 220 plus microns per pass - over clocked (override settings - freestyle resurfacing, few do this on feel alone) Sciton (as he demonstrates in many videos), but this is NOT the answer for scars in this area -3 good passes and you are in muscle, not a good idea. Co2 Fractional can give a "small" marginal improvement. 5. What works best as BA said is the Korean method after subcsion, dermal filler on bone to elevate the entire area. Its calculated risks, but works well. Difficult area to improve, but see the right guys, you will be fine ...

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Thanks for all the replies. I’m a newbie when it comes to treatment options and just trying to find what would be best/safest. So from what I’m gathering from all of this, forehead is a difficult to treat area? :(

@beautifulambition - you said RF microneedling is a safe option for rolling scars?  Realistically, I know my scars will never completely go away, and I’ve accepted that. I would be thrilled if there’s something that would even just make them appear smoother/reduced. 

Thanks again everyone! I’ve been a long time reader on this board, but always nervous to post pictures feeling self conscious. Thank you all for the input!

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@Obi wan As always, great stuff. I completely agree that this area is fraught with danger and it's better to be safe than sorry. With regards to the ablative erbium laser, it was really meant as a final touch following subcision + botox--not a treatment to itself. Anyway, I thought Lim did something similar with much success in one of his videos (can't recall if it was from Youtube or his Instagram). 
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