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shei514

CO2 laser in treating acne scars - ultrapulse & Subcision of Acne Scars W/ Dr Lim Dr Rullan and Other Drs - Success Story in Progress

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Hi everyone! I’m a 22 year old female seeking acne scar treatment after having acne for 10+ years. For years I have hated myself and my skin and now I’m finally taking action. I'm currently seeing a dermatologist right now (Dr Davin Lim in Brisbane) and have my next laser treatment in APRIL/EARLY MAY (so really soon!) To date I've tried fraxel (to no avail), fully ablative laser resurfracing (erbium), fractional laser resurfacing (CO2 Core Laser) as well as filler/subcision. The reason for my post was 1) to answer any questions for those seeking scar treatments and 2) show people my scars. Fraxel and erbium were performed by dermatologists/nurses here in New Zealand where I am based. After feeling disappointed, I flew to Brisbane to see Dr Lim. This is where I’m at now. To date, he has used subcision and CO2 core laser in treating me (some filler too for my left cheek). 

My left and right cheeks are of concern to me. On my left cheek I have considerable rolling scars. There are a few smaller boxcar and ice pick scars on my left too but predominantly rolling. On my right side, I have boxcar scars and there are two in particular that are quite bad. 

This will take time, I know, and I will update everyone as I go through my scar revision journey. 


 

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1 hour ago, shei514 said:

 I'm currently seeing a dermatologist right now and have my next laser treatment in APRIL/EARLY MAY (so really soon!) To date I've tried fraxel (to no avail), fully ablative laser resurfracing (erbium), fractional laser resurfacing (CO2 Core Laser) as well as filler/subcision.


I'm sorry to be the first one to break the bad news but laser will NOT work for your scar. Laser is for resurfacing the top. In your case, you need (more) subcision. How much improvement did you see from the previous subcision? Do you know if NOKOR was used?

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@shei514 This is not the worst scarring or the most severe I have seen. Look at some of the guys in Scarless healing their whole body has scars to keep things in perspective. I understand it bugs you.

Sirius is right. The treatment your derm offered was not right. He just blasted you with a bunch of lasers. 

The one laser I would have put on you is vascular for discoloration. The second pic your skin is very red and that is the worst part. 

You are a short and cheap flight NZ-AUS from one of the worlds best acne scar doctors Dr Lim, I would contact him as your derm seems clueless sorry to say.

You have textural rolling scars. 

You need a combo of Nokor subcision for pits, and prp/saline/fat/filler could hide the scars with volume- Dr Lim calls this cannula subcision (all options to act as a spacer with cannula throughout your cheeks for texture. 3 of these treatments are needed.
I would do 3 treatments of rf microneedling between when your filler runs out and needs topping up - 3 months apart.
I would then do a deep (sedated) acid peel for texture or erbium resurfacing just to the cheeks (fully abaltive and deep). PRP is your fried for healing.
I don't see CO2 helping you at this point unless you have some stubborn pits that do not response you can do 5-7% density and full power to those individual areas to breakup the fibrosis.

Do not start with more laser, your not ready for textural work yet. Because of the order of the lasers used the skin may be more resistant to treatment as it has been blasted. 




 

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1 hour ago, beautifulambition said:
@shei514 This is not the worst scarring or the most severe I have seen. Look at some of the guys in Scarless healing their whole body has scars to keep things in perspective. I understand it bugs you.

Sirius is right. The treatment your derm offered was not right. He just blasted you with a bunch of lasers. 

The one laser I would have put on you is vascular for discoloration. The second pic your skin is very red and that is the worst part. 

You are a short and cheap flight NZ-AUS from one of the worlds best acne scar doctors Dr Lim, I would contact him as your derm seems clueless sorry to say.

You have textural rolling scars. 

You need a combo of Nokor subcision for pits, and prp/saline/fat/filler could hide the scars with volume- Dr Lim calls this cannula subcision (all options to act as a spacer with cannula throughout your cheeks for texture. 3 of these treatments are needed.
I would do 3 treatments of rf microneedling between when your filler runs out and needs topping up - 3 months apart.
I would then do a deep (sedated) acid peel for texture or erbium resurfacing just to the cheeks (fully abaltive and deep). PRP is your fried for healing.
I don't see CO2 helping you at this point unless you have some stubborn pits that do not response you can do 5-7% density and full power to those individual areas to breakup the fibrosis.

Do not start with more laser, your not ready for textural work yet. Because of the order of the lasers used the skin may be more resistant to treatment as it has been blasted. 


Yes, I am seeing Dr Lim. I saw a dermatologist before him but what he's done is: subcision (first visit), CO2 core laser (second visit) and subcision + filler (third visit). For my fourth, he's planning to do CO2 core again as well as subcision (not sure about filler but I presume so). 

 

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Have you seen some good improvements from these procedures (compared to the baseline of course)? 

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Hey everyone - decided to make a post as I'm currently healing from a laser procedure performed last Friday (27/04). I have severe (mainly) rolling and boxcar scars. I've tried erbium (twice), fraxel (4x) and CO2 core laser (1x), I've also had subcision and filler performed on my cheeks. Before all this, I was on accutane for a year. So if anyone has any questions, let me know! I'm going to post pictures right now as I'm healing and what I looked like before. I know people are a bit skeptical about lasers as am I, I must admit. The laser I was treated with is CO2 ULTRAPULSE. I'm from Auckland but was treated in Brisbane, Aus. The cost for one treatment was $1400 AUD by Dr. Lim. 

I went to the clinic on Friday, got numbed up, had injections, etc. The procedure itself was only about 10 minutes and the pain was about (7/10). Immediately after, I bled and continued to bleed the following 4-5 hours post-op. My face started to swell on the second day post-op. Now I'm about 3 days post-op and the swelling has gone down, but obviously I'm in no position to leave the house as I'm very very red and yuck looking. I'm not sure how many treatments I will need as obviously this is very touch and go. But the doctor did say I would see a lot of improvement this time around. The ULTRAPULSE from what I understand, is more aggressive which is needed in order to get through the fibrosis I have.  I will update if anyone is interested. 



Post op: 

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Edited by shei514

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Thank you for sharing your journey.  You've done quite a few procedures.  What is your assessment of your past procedures?  Have they given you noticeable improvement?  

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1 hour ago, dazzed said:

Thank you for sharing your journey.  You've done quite a few procedures.  What is your assessment of your past procedures?  Have they given you noticeable improvement?  

Tbh, fraxel wasn't good and the improvement was insignificant. It's just not a strong enough laser for my scars.  I had improvement with Erbium. Subcision + filler works and is instantaneous without downtime. I've had a noticeable improvement for sure with everything though - definitely not a waste of money. I've also been to multiple dermatologists where the equipment was lacking and they had no idea what to do with my scarring but I feel I'm on the right track now lol.

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What is the difference between CO2 core and CO2 Ultrapulse? Did the doctor inform you why this would be different than CO2 core?
You have wonderful eyes btw, i think that's the first thing people will notice when looking at you :)

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Were all your previous treatments with Davin Lim? Or just the laser treatment from last Friday? I'm really keen to hear about your experience, because I do live in Australia and I'm considering seeing him. 

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** I have merged topics. Please post everything here as it get's confusing.

To all who are reading this she had treatments by other Dermatologists in New Zealand, ... she is now seeing Dr. Lim who did Ultrapulse. As I responded above treatments can do absolutely nothing if done poorly. Ultrapulse is a very strong laser so Dr. Lim must think she has alot of fibrosis that cannot be helped by traditional methods until it's dealt with. I would never tell anyone to do multiple laser treatments first but many patients do this as Dr's push this. This is why qualified practitioner's who specialize in acne scars are so much more effective than standard derms who try to do treatments for severe cases. Dr Lim is one of the few specialist Dr's who can be trusted with energy devices for treatment (other's do standard settings for everyone).

I need to remind here your scars are not her scars, your ability to heal nor your health is completely different, there is a lot more involved than how things looked to acne scars which are individualized. What works for one person may not work for another. One may heal poorly or not respond to treatments.

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9 hours ago, ScarRight said:

Were all your previous treatments with Davin Lim? Or just the laser treatment from last Friday? I'm really keen to hear about your experience, because I do live in Australia and I'm considering seeing him. 

no, i've only start seeing him since August 2017. He's done filler, subcision, CO2 core and ultrapulse on me. Everything else was performed by other derms. 
4 hours ago, QuanHenry said:

How many subcisions have you done?

2.
13 hours ago, eva_li said:
@shei514 who performed your previous Erbium and Fraxel treatments ? Was it Davin Lim too?
No, those treatments were not performed by him - they were done in New Zealand.
11 hours ago, incepticon said:

What is the difference between CO2 core and CO2 Ultrapulse? Did the doctor inform you why this would be different than CO2 core?
You have wonderful eyes btw, i think that's the first thing people will notice when looking at you :)

I'm not sure what the logic behind the different lasers was to be honest. But from what I understand, ultrapulse is far more aggressive and is used for very severe scarring. Hey, thanks! :) 
3 hours ago, 420blazeitfgt said:

make sure to keep that skin MOIST

hahaha DEFINITELY. :P 

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Have you noticed any improvement since August 2017, since you started seeing Lim. Is he good at explaining all the different types or treatments and lasers? 

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1 hour ago, ScarRight said:

Have you noticed any improvement since August 2017, since you started seeing Lim. Is he good at explaining all the different types or treatments and lasers? 

Yeah, definitely. Here's a procedure he performed on me - subcision before and after. 

IMG_2162-2.jpg

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3 hours ago, beautifulambition said:

Ultrapulse is a very strong laser so Dr. Lim must think she has alot of fibrosis that cannot be helped by traditional methods until it's dealt with. I would never tell anyone to do multiple laser treatments first but many patients do this as Dr's push this. This is why qualified practitioner's who specialize in acne scars are so much more effective than standard derms who try to do treatments for severe cases. Dr Lim is one of the few specialist Dr's who can be trusted with energy devices for treatment (other's do standard settings for everyone).


Not to mention that Ultrapulse was the very FIRST GENERATION laser used for skin resurfacing some 20 years ago. Ironically, however, this is still considered by many derms as one of the best, if not the most powerful, lasers on the market.
2 hours ago, shei514 said:

i've only start seeing him since August 2017. He's done filler, subcision, CO2 core and ultrapulse on me. Everything else was performed by other derms. 


Nobody will dispute that you're in good hands with Dr Lim. He knows his craft well and I wouldn't want to second guess his judgment. But you've already had so many laser done on the face in such a short span of time that it kinda makes me feel uneasy. First, people who undergo many laser treatments usually end up with massively thinned out skin, leaving them with an orange peel-like texture. Second, there seems to be a high correlation between thin skin and poor results. 

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Ultrapulse is a very old laser, however it remains as Gold Standard in the treatment of fibrotic scars and burns. The Ultrapulse is super high powered and like @Sirius Lee stated first generation old fashioned. They still retail for ...wait for it... RRP $1/4 million dollars- that is no misprint, that is the asking price. FYI - Co2 laser non- FDA non-TGA start from $8,000. CORE and other lasers about $60,000. The only reason Ultrapulse exist is due to the fact that is very high powered - the only laser that can deliver 160 watts in a short pulse duration, hence it sits in a market that has no rivals. As BA mentioned, in patients with subdermal fibrosis - namely scars that can be felt deep in the dermis, no other laser will go down to that depth (without pulse stacking). Infini RF, Vivace, and even Intensif will not go through fibrotic scars. These scars are so thick that needles actually 'kick back ' into the device. I am sure there must be some logic as to why this doctor chose to use this laser in this patient. Time will tell... keep us informed. Remember laser, unlike subcsion is a active way of stimulating collagen, and results best seen at 3-5 months. All the best.

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1 hour ago, Obi wan said:

Ultrapulse is a very old laser, however it remains as Gold Standard in the treatment of fibrotic scars and burns. The Ultrapulse is super high powered and like @Sirius Lee stated first generation old fashioned. They still retail for ...wait for it... RRP $1/4 million dollars- that is no misprint, that is the asking price. FYI - Co2 laser non- FDA non-TGA start from $8,000. CORE and other lasers about $60,000. The only reason Ultrapulse exist is due to the fact that is very high powered - the only laser that can deliver 160 watts in a short pulse duration, hence it sits in a market that has no rivals. As BA mentioned, in patients with subdermal fibrosis - namely scars that can be felt deep in the dermis, no other laser will go down to that depth (without pulse stacking). Infini RF, Vivace, and even Intensif will not go through fibrotic scars. These scars are so thick that needles actually 'kick back ' into the device. I am sure there must be some logic as to why this doctor chose to use this laser in this patient. Time will tell... keep us informed. Remember laser, unlike subcsion is a active way of stimulating collagen, and results best seen at 3-5 months. All the best.

Well he asked me what lasers were used on me in the past. I told him. He then said we would want to take a step FORWARD and use something more powerful to see results. He told me ultrapulse is one of the most powerful lasers and is used in the treatment of burns. 

18 hours ago, incepticon said:

What is the difference between CO2 core and CO2 Ultrapulse? Did the doctor inform you why this would be different than CO2 core?
You have wonderful eyes btw, i think that's the first thing people will notice when looking at you :)

I actually just remembered the conversation I had with him - sorry I've been so all over the place lately and forgot entirely! I told him about my laser history and he told me we would want to use something more powerful than the lasers beforehand to get results. He then explained to me that ultrapulse is a really powerful lasers and one of the best for severe bad acne scars (mine). He doesn't want to perform subcision, filler/anything else AT ALL just yet until I'm recovered. So it will be a few months before I can contemplate returning for further treatment. 

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props to you. travelling for treatments really suck. i have been flying to get treatments done as well, so we are in the same boat :)

Edited by keving100

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Hey everyone - wanted to post an update. I saw Dr Lim on Thursday before I flew home. He said he would like to do one more ultrapulse treatment in THREE months time. He said I’m healing well and can expect up to 80 percent improvement once everything is all done. I’m still red right now, but that’s ok. I thought I would post some pictures he took while I was in his office/clinic. He said the reason why he used CO2 core instead of ultrapulse is simple: ultrapulse is far more aggressive, uses more energy and isn’t his FIRST choice unless the scars are severe enough. He said I was on the borderline of excision but he said he has been really impressed with my skin and how it has healed so far 

ill go back in October once I’ve saved more but yeah he said in a couple of months I should see even more improvement as my skin will produce more collagen, etc. 

 

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Incredible improvement, im truly baffled, the texture of your skin, especially your right cheek is so much better!

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