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dragonn

Fully ablative erbium laser- technical question

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Hi all!
I underwent fully ablative erbium resurfacing 1 week ago for my boxcar scarring. After 6 days I was fully peeled and barely pink, not the raw redness I expected after an aggressive fully ablative treatment. I was most looking forward to the smoothing out of the sharp, jagged edges of my scars. I understand collagen remodeling takes months but I assumed even though the depression from the scars would still be there, the shoulders would be softened and less demarcated. All of my scars look the same- same shape, same sharp borders. Am I wrong in thinking they would morphologically look different immediately after treatment if they were in fact shaved down? Or does the ablative portion take time to appreciate just as the filling up from the bottom with collagen production? Feeling really defeated and undertreated. 

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Sounds like he/she did not go deep enough. you would be red for many months. This could be because they were afraid you had sensitive skin, wanted to do multiple procedures, are not experienced with resurfacing and set it and forget it laser peel Dr, did fractional grids and not fully ablative resurfacing, were afraid you had ethnic skin, charged you for a peel and not a "deep" resurfacing procedure (ask how many mm or um they went down on the skin). Goto a different Dr, or try to communicate these concerns to your DR. Many Drs own Erbium and few can do a proper deep resurfacing, hence why I suggest a deep sedated peel w/ a plastic often to get under the scars, more Drs can do this.

Let your DR know this before anything. Sounds like you had a peel for beauty treatments. 

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I do have ethnic skin and he explained the hyperpigmentation that will follow, etc but you are right that he still did not go deep enough. I think he assumed I’d prefer to have less downtime/PIH and went lighter when in reality I don’t mind staying in for 2 weeks and have discoloration for upwards of a year if it means results. Very frustrating!

Given the light laser peel, how long should I wait for my skin to recover before I can go back for more aggressive resurfacing? 

Edited by dragonn
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10 minutes ago, dragonn said:

I do have ethnic skin and he explained the hyperpigmentation that will follow, etc but you are right that he still did not go deep enough. I think he assumed I’d prefer to have less downtime/PIH and went lighter when in reality I don’t mind staying in for 2 weeks and have discoloration for upwards of a year if it means results. Very frustrating!

Given the light laser peel, how long should I wait for my skin to recover before I can go back for more aggressive resurfacing? 


Laser should ALWAYS be your last option. It just doesn't have a proven track record to date compared to other treatments like subcision. Anyway, you should plan your treatment with filling the pit first and then sanding the upper surface. Post a pic and we'll be happy to assist.
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I’ve attached a pic of my scarring on my worst cheek looking its worst in that lighting. Based on my research it seemed fully ablative laser was the best option for me (numerous shallow but sharply defined scars lying in the same plane a la Dr. Davin Lim). I’ve also seen amazing before and after photos with my same type of scarring, in white papers and at the derm’s office that I chose. It just seems that he didn’t go deep enough if ablative results (sanding down scar shoulders) should be seen before collagen remolding :(

0BD7282F-B0A2-4EF1-BC92-A059D20F09B8.jpeg

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I think many people mistake small scars for shallow scars. These scars are very small, but they are not that shallow. I've made the same mistake. The scars don't even need to be just shallow, but extremely shallow for it to work.  I've had a fully ablative co2 laser a little over a year ago and unfortunately, it barely did anything. And I thought, despite there being a lot, the majority of my scars were shallow as well. But apparently, I was wrong. 

Your recovery does not sound right to me either. I had to stay indoors for at least a month, makeup wouldn't sit properly on the skin to camouflage it until after 3 months. And now, 14 months later, I can still see the redness. When I exercise, the treated areas still turn bright red. And there is nothing wrong with my healing capabilities, this is just the effect of the laser. Now co2 is slightly more aggressive than erbium, but still, the difference is not that big. 

The upside though is that scars that did not respond to other treatments now do respond a lot better, so it has not been entirely for nothing.

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Yes, they look a bit deep... almost icepick-like. I have similar scars, and what HAS worked was cannular subcision to the individual scars. Almost like single needling. 

Edited by Raster
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9 hours ago, keving100 said:
@dragonn  What brand of laser did your doc used? Sciton Contour TRL?
Do you mind sharing the name of your doc too?
He used the sciton erbium laser in full ablation mode. I’m not sure if the exact model is the contour trl. I currently do not want to share his name publicly due to my dissatisfaction but will PM you his info if you’d like!
9 hours ago, arte90 said:

I think many people mistake small scars for shallow scars. These scars are very small, but they are not that shallow. I've made the same mistake. The scars don't even need to be just shallow, but extremely shallow for it to work.  I've had a fully ablative co2 laser a little over a year ago and unfortunately, it barely did anything. And I thought, despite there being a lot, the majority of my scars were shallow as well. But apparently, I was wrong. 

Your recovery does not sound right to me either. I had to stay indoors for at least a month, makeup wouldn't sit properly on the skin to camouflage it until after 3 months. And now, 14 months later, I can still see the redness. When I exercise, the treated areas still turn bright red. And there is nothing wrong with my healing capabilities, this is just the effect of the laser. Now co2 is slightly more aggressive than erbium, but still, the difference is not that big. 

The upside though is that scars that did not respond to other treatments now do respond a lot better, so it has not been entirely for nothing.

The doctor and his nurse I met with separately during pre-op both told me my scars were mostly shallow and on a superficial level. When showing me before and afters in the office they had cases with great improvement and told me that in the before pics the other patients had deeper scarring than me. Perhaps this was to get me to go through with the resurfacing?

I am skin type IV so I understand he couldn’t go too deep but I definitely expected recovery closer to what you described. What other treatments have you tried since? Better response gives me hope that this was not all for naught. 
9 hours ago, Raster said:

Yes, they look a bit deep... almost icepick-like. I have similar scars, and what HAS worked was cannular subcision to the individual scars. Almost like single needling. 


I definitely have icepick scarring but it doesn’t bother me as much as the broader boxcar scars. I’ve not researched much into cannular subcision. What type of improvement have you seen if you don’t mind? Shallowing of boxcar scars? I know mine are not tethered. 
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5 hours ago, dragonn said:

The doctor and his nurse I met with separately during pre-op both told me my scars were mostly shallow and on a superficial level.


That's what they all say. :) 

I agree with others that your scars are a bit deep for laser. You need to volumize those pits first, then sand the hard edges down with laser.
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