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grandor

To continue RF microneedling or change strategy?

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Hi all,

I've undergone one session of RF microneedling about 2 months ago to treat my scars.  I saw very minimal improvement (maybe 5% after all the swelling went away), and was actually left with some grid marks that are hopefully still resolving.

Wanted to throw my pictures up here and see what you all thought -- especially the veterans like@beautifulambition @Obi wan @Sirius Lee

Should I continue with 3-4 more sessions of Intracel as my doctor recommends, or should I discuss other options with him (tca cross, full facial peel, etc)? I'd like to avoid are lasers and fillers, if possible. I self-assess that I have all 3 types of scars, with mild-moderate level of scarring. Hopefully can get 70-80% improvement after all is said and done.

Thanks once again!

Edited by grandor

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Hey, I think you have mostly icepicks that should respond well to TCA Cross. Do you have a picture of your before photos? I think your skin in general looks pretty good aside from the icepick scars.

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@grandor

Some of those boxcars you can subcise and use some filler on. That should have been done first. There is a lot of TCA Cross icepick work that needs to be done. Infini in itself will not fix things without the prep needed. You don't do peels until you do your tca cross work, subcision, and rf needling. Also rf needling takes a while to show results. For your scars it would work well on boxcars but not the icepicks (cross). IF all else fails as a final treatment, low density 5-7% and high power co2 can be done or Fraxel.

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You have several types of scars that should be addressed individually. Remember, the treatment should adjust to the problem, not the other way around. (Avoid clinics that sell you packages without even a proper check under angled lighting.)

Echoing the post above: TCA cross for your ice pick scars and subcision for box scars. These two procedures can be performed in one session as well, ask your specialist. You can have it done maybe 2-3x in your case, each a month apart to allow recovery. This combination works very well for your type of scarring.

 

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Jane Delfino, I would personally give more than one month between TCA cross and subcision applications. Your body needs time to heal and people with acne scars are not great healers, plus you need time for the body to stimulate collagen. 

Thoughts? 

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Thank you all for your advice!

@Raster I don't have any good before pics, but the change was very minimal -- if anything it may have smoothed out the edges on the big boxcar / rolling scars.  I'm not sure I would do the procedure if I could go back and change my decision.

@beautifulambition @Jane Delfino I thought subcision was mainly for rolling scars? I prefer not to do fillers, so would that limit my % outcome I can get? I will get CROSS though, good advice.  My ice pick scars are fairly small, but hopefully that will improve some of the textural issues.

What order should all these be done in?  Right now, I see it as CROSS -> microneedling -> low acid % facial peels

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23 hours ago, grandor said:

I've undergone one session of RF microneedling about 2 months ago to treat my scars.  I saw very minimal improvement (maybe 5% after all the swelling went away), and was actually left with some grid marks that are hopefully still resolving. Should I contiue...??


I wish one session of RF microneedling would be enough but, unfortunately, that is not the case with current line of treatments on the market today, whether that's RF, subcision, laser, etc. With that said, I want to echo what BA has already stated earlier, namely, the deep boxcars you exhibit is better suited for subcision + filler rather than RF treatment. Getting those filled first should be your priority. Only then should the RF microneedling be considered.

Acne scar revision should really be about "filling the pit" FROM BELOW. The only reason why there's a pit in the first place is because of collagen/fat depletion that lies, again, under the skin. If you think from that angle, getting the right treatment shouldn't be that difficult IMO.

BTW how "aggressive" was the RF? I've heard countless testimonials from those who felt their derm/plastic underdelivered because they didn't go aggressive enough. So I took note and explicitly told my doc to go aggressive when I got my Infini. As a result, the downtime was much longer than the 5-days I was initially told. But who cares, if it could make my scars less visible, eh? 

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@Sirius Lee Yeah, I know my expectation was too unrealistic for just 1 treatment done -- I had read about great outcomes from others like yourself from just 1 or 2 treatments, and was hoping "magic" would happen as well, but alas we all heal differently (and various idiosyncrasies with how the doctor uses the instrument).

Only thing about your advice is that for some reason, I feel opposed to injecting foreign substances into my skin, and would like to avoid fillers. Not insulting anyone who chooses to use them, because hey - your body is yours. I just have this weird preference - will this affect the outcome I can realistially achieve, or are there other ways to treat the deep boxcars?

Re: aggressive-ness: I believe the setting was Intracel Level 5, with 2 passes each of 1.5mm and .8mm. The doc said that this was quite aggressive. I think the .8mm in shallower areas (zygomatic bone) was the cause for the visible grids I still have 2 months later :/ so got both unimpressive results and long downtime

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Hyaluronic acid fillers aren't really "foreign" though because they're exactly identical to the kind your body produces, except they were bioengineered in a lab.  

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If you don't want fillers, you can try suctioning. The problem with subcision though, is that the fibers cut are often "sticky" and have a tendency to reattach without something preventing that.

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If you want my honest opinion you look like the perfect candidate for TCA cross.  If I were you i would grab some TCA and try like 1-2 of the icepicks and see what happens..  

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TCA CROSS hands down. Just be careful of the broad scar on your cheeks. You can paint the linear scars with TCA, and they will come up just fine. Make sure you do not spill, and ensure that only deep narrow scars are treated. Given your skin type, you will PIH, so space 6 to 8 weeks apart. 3 sessions, and then post up your pictures. As a stand alone, it will give you the best results. Of course all the other treatments, e.g.. erbium fractional, Co2 fractional RF, dermal fillers with subcision etc... can improve things further, but TCA first. Most cost effective and effective treatment for these scars. Take care. 

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Thanks all for the advice - I'll take your feedback and do CROSS first.

Should I try to do this myself, or visit a doctor? Anyone have any tutorials / guides on how to safely attempt this procedure on one icepick, so I can do a test scar?

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@grandor
It's In the FAQ under tca peels, click the link and read the whole first page. Lots of reading ;-)

For your skin type I would let the doctor do the first time, then you can decide if you want to do it at home or not and observe. Please use hydroquinone and tretinorine 3 weeks before to avoid discoloration. It will stay red after you do this, so get some concealer if this is a issue for you.

https://www.acne.org/messageboard/topic/361029-acne-scar-qa-faq-library-of-popular-threads/

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Good advice -- I'll read the FAQ again, I know I've read it before but time to reread relevant section : )

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Echoing what BA has to say, it would be very wise to let a scar expert do this - given your skin type. You will have PIH, this is not negotiable if you want results. A specialist can tailor the concentration of TCA to give you the balance between improvements and permanent discolouration. 

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Thanks for the reply @Obi wan - will go to a doctor nearby who can do TCA cross, and will follow up with pics of results as they improve.  When you say permanent discoloration, do you mean that TCA improprly added can create pigment changes that never revert? I thought PIH would eventually fade away, given time

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@grandor Don't live in fear. He is telling you to goto a specialist for your skin type to avoid this, who can tailor the treatment. Someone who can deal with discoloration. Instead of doing it at home and having discoloration. Any good doctor can deal with this. Or use vascular laser on you. You MUST prep before any treatment as I said above with tretinorin 3 weeks and hydroquinone then again after you are healed. It will be red the spots, remember I said to use concealer while your healing as any wound is.

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