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Hi,  

im wondering if anyone can advice me what treatment should I go for. I did about 6 times of fractional co2. I’m thinking of going for tca cross or infini or ematrix 

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Edited by thisistroublesome
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8 hours ago, thisistroublesome said:

im wondering if anyone can advice me what treatment should I go for. I did about 6 times of fractional co2. I’m thinking of going for tca cross or infini or ematrix.


DO NOT TREAT THE WIDER SCARS WITH TCA CROSS. IT WILL MAKE THEM WIDER.

Your cheek looks as if it's still in the recovery phase. When did you have your last laser treatment? It takes up to 6 months for full collagen synthesis to take effect and you do not want to disrupt the flow by prematurely getting another treatment. Another issue is that 6 laser treatments would have thinned your skin quite a bit. What was the time span for those 6 lasers? Was it all done within a year? Two years? Histologically speaking, thin skin leads to less than optimal outcome, mainly due to poor blood circulation.

Anyway, it's always better to fill the pit before you resurface the top. I suggest you initially go with INFINI + SUCULPTRA combo. When the scar beds have risen enough, then you could go with TCA PEEL to smooth the surface.

  Edited by Sirius Lee

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2 hours ago, Sirius Lee said:

DO NOT TREAT THE WIDER SCARS WITH TCA CROSS. IT WILL MAKE THEM WIDER.

Your cheek looks as if it's still in the recovery phase. When did you have your last laser treatment? It takes up to 6 months for full collagen synthesis to take effect and you do not want to disrupt the flow by prematurely getting another treatment. Another issue is that 6 laser treatments would have thinned your skin quite a bit. What was the time span for those 6 lasers? Was it all done within a year? Two years? Histologically speaking, thin skin leads to less than optimal outcome, mainly due to poor blood circulation.

Anyway, it's always better to fill the pit before you resurface the top. I suggest you initially go with INFINI + SUCULPTRA combo. When the scar beds have risen enough, then you could go with TCA PEEL to smooth the surface.

 
 Thanks for the suggestion. I have sensitive skin. Thats why it looks a little red at times. 

It was done across a period of 3 years. I thought fractional co2 laser treatments help with collagen growth. How does it thins the skin ? Does that means i shouldnt do anymore of fractional co2 laser. Will the skin grow back to the original thickness over time?

I did a little research on infini. Some reviews i read says infini treatments leaves some holes on the face due to the needles piercing the surface of the skin. Have you tried infini before ? Does it leaves marks ? Or thins the skin 

How many tca peels will Be necessary?

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5 hours ago, thisistroublesome said:

I thought fractional co2 laser treatments help with collagen growth. How does it thins the skin ? Does that means i shouldnt do anymore of fractional co2 laser. Will the skin grow back to the original thickness over time?


Yes, CO2 does stimulate collagen--just enough to fill wrinkles. Unless you have superficial scars, that's not be enough. Wouldn't you agree after 6 treatments? Anyway, it's been documented that too many laser treatments will lead to the overall thinning of the dermis (eg. enlarged pores is one of its major symptoms). Only way to thicken the already thinned skin is through skin tightening and collagen stimulation.

 
5 hours ago, thisistroublesome said:

I did a little research on infini. Some reviews i read says infini treatments leaves some holes on the face due to the needles piercing the surface of the skin. Have you tried infini before ? Does it leaves marks ? Or thins the skin 

How many tca peels will Be necessary?


I've gotten several Infini in the past. For about a month, give or take, you will be left with red grid marks (both lines and holes). But they will disappear over time. Your skin will be more sensitive after the treatment.

The number of TCA peels required depends on the % concentration used.

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1 hour ago, Sirius Lee said:

I've gotten several Infini in the past. For about a month, give or take, you will be left with red grid marks (both lines and holes). But they will disappear over time. Your skin will be more sensitive after the treatment.
 

The red grid marks (both lines and holes) will last for a month or longer ? will my skin be permanently sensitive or only during the period of recovery 

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@sirius lee Did you end up getting good improvement from your Infini treatments?  IIRC it was ages ago but did you end up maintaining those results or did they go back to normal to a certain extent?

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12 hours ago, thisistroublesome said:

The red grid marks (both lines and holes) will last for a month or longer ? will my skin be permanently sensitive or only during the period of recovery 


Since you've already received so many lasers, you should be just fine. It's usually those with virgin skin that reacts the worst. Anyway, redness and grid marks are expected up to 4 weeks. Sensitivity wise, well, any invasive treatment will make your skin sensitive for a while. But again, you'll be good in a few weeks.
 
2 hours ago, thepwhisp said:

@sirius lee Did you end up getting good improvement from your Infini treatments?  IIRC it was ages ago but did you end up maintaining those results or did they go back to normal to a certain extent?


Overall, I see about 60% improvement. Scars are still visible but much better than before (much softer). Even the most visible ones have responded pretty well. What was a boxcar is now a shallow rolling scar.

Here's what I would like to point out for those who are thinking about getting Infini or similar invasive treatment. Prep your body by taking supplements at least 3 months ahead of the treatment. This would be like collagen producing vitamins like A, C, E, as well as amino acids like Lysine and Proline. All of these will help you heal better. I also strongly suggest Serrapeptase, which I believe played the biggest factor in the outcome.

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5 hours ago, Sirius Lee said:

Since you've already received so many lasers, you should be just fine. It's usually those with virgin skin that reacts the worst. Anyway, redness and grid marks are expected up to 4 weeks. Sensitivity wise, well, any invasive treatment will make your skin sensitive for a while. But again, you'll be good in a few weeks.
 
Overall, I see about 60% improvement. Scars are still visible but much better than before (much softer). Even the most visible ones have responded pretty well. What was a boxcar is now a shallow rolling scar.
You grid marks last longer for infini as compared to co2 ? the marks from co2 only lasted for about a week in my case.

how many infini did you have to go through ? 

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3 hours ago, thisistroublesome said:
You grid marks last longer for infini as compared to co2 ? the marks from co2 only lasted for about a week in my case.

how many infini did you have to go through ? 

I had 3 Inifini. Maybe it's just me. Or maybe you have a thicker skin than me (no pun intended). It's probably different for everyone. Anyway, the bigger pressing question shouldn't be about whether there will be holes in your face but how much collagen can be stimulated so that your scar pits will be filled. Right?

Okay, enough said. It's your call. I wish you good luck.

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@Sirius Lee  Thank you 60% sounds great.  I will definitely prep my body for the treatments.  I have a lady near me who does endymed intensif and shes about 40 minutes away give or take.  Do you think this is comparable to Infini?  There is also a doctor who is one of the best with infini about 3 hours away.  Do you think it's worth getting the infini over the intensif?

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58 minutes ago, thepwhisp said:
@Sirius Lee  Thank you 60% sounds great.  I will definitely prep my body for the treatments.  I have a lady near me who does endymed intensif and shes about 40 minutes away give or take.  Do you think this is comparable to Infini?  There is also a doctor who is one of the best with infini about 3 hours away.  Do you think it's worth getting the infini over the intensif?

The easy answer you hear all the time is that Infini is insulated and Intensif is not...so Infini must be better. Well, not really. In your case, however, I would think Intensif will be more helpful for those shallow icepick scars.

However, I'll also add as a reference what Dr Lim has to say about the two.

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You don't work on icepicks with a rf microneedling device. TCA Cross or punch excision are the treatments for this. He will be another patient who says I have grids who will not go away, ... I have damage to my skin for months, my skin is worse. Especially Intensif.

He is not Caucasian and even then ... rf needling is not for icepicks.

You must be careful with ethnic skin. Again Dr. Lim's advice if for Caucasian's.

Intensif  is not indicated for ethnic skin types "especially" because it's un-insulated. Hence a no no. Infini is for "all" skin types. Even Black. Intensif Lim often mentions for thick scar tissue (little with penetrate - severe cases), why hurt his skin when his defects are minor. 

 If we get the scars to a monomorphic state (similar) we do erbium yag to those areas.

You can do tca cross, Picosure is made for ethnic skin types. Normal Microneedling with prp. You can spot peel (very dilute) until you fix the pits. Some areas look like they could be subcised (his scars). Cannula subcision (with prp) would help alot throughout the area of scarring (for texture, spot subcision for deep pits). 

@Obi wan Please take a look at this, want your prospective.

 
I would go with a focused approach "only" to the scars in question.

What is your main concern OP we will tailor treatment (boxcars, or icepicks and large pores)?
 


 

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Well, OP's atrophic scars will definitely benefit from RF, regardless of which he uses. It's also worth noting that his icepicks are very shallow, more like enlarged pores than outright icepicks. In that regard, the non-insulated tip would be better suited for surface treatment from the coagulative damage to the epidermis.


BTW the claim that Infini is more colorblind to ethnic skin, leaving less erythema than other treatments, is completely overblown. Don't fall for that crap. Even Lim says repeatedly that Infini is notorious for its carbon buildup. Personally, I've had a series of several Infini already and I've always been left with grid/red marks for extended period of time, up to 2 months at times. I too am ethnic in every sense of the word.


 

Edited by Sirius Lee

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On 26/05/2018 at 5:16 AM, beautifulambition said:

You don't work on icepicks with a rf microneedling device. TCA Cross or punch excision are the treatments for this. He will be another patient who says I have grids who will not go away, ... I have damage to my skin for months, my skin is worse. Especially Intensif.

He is not Caucasian and even then ... rf needling is not for icepicks.

You must be careful with ethnic skin. Again Dr. Lim's advice if for Caucasian's.

Intensif  is not indicated for ethnic skin types "especially" because it's un-insulated. Hence a no no. Infini is for "all" skin types. Even Black. Intensif Lim often mentions for thick scar tissue (little with penetrate - severe cases), why hurt his skin when his defects are minor. 

 If we get the scars to a monomorphic state (similar) we do erbium yag to those areas.

You can do tca cross, Picosure is made for ethnic skin types. Normal Microneedling with prp. You can spot peel (very dilute) until you fix the pits. Some areas look like they could be subcised (his scars). Cannula subcision (with prp) would help alot throughout the area of scarring (for texture, spot subcision for deep pits). 

@Obi wan Please take a look at this, want your prospective.

 
I would go with a focused approach "only" to the scars in question.

What is your main concern OP we will tailor treatment (boxcars, or icepicks and large pores)?
 


 

Right  now, my scars are the main concerns. I am not so much focused on pores. Would you still recommend infini or tca cross or tca peel or fractional co2 treatment ? I went to a dermatologist recently. and i was told tca cross has a risk in damaging my skin rather than actually trying to heal it as my pitted scars ain't that deep. i might end up with worse scaring. She also mentioned that infini has a risk of leaving holes on my face due to the needles. she is recommending me ematrix. but from the reviews i read in acne.org, it seems like ematrix isn't an effective treament. 

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With respects this is quite a straight forward treatment if someone has expertise in the management of acne scars in ethnic skin types. TCA CROSS is the treatment of choice. Hands down. Remember you can titrate the concentration depending on the scar type and skin type. The wider scars should not be treated with the traditional TCA CROSS, but can be improved with the TCA Paint technique, using a much lower concentration . In your case 60-80% focal TCA with either the traditional toothpick or osmotic needle delivery. If you are Asian you will PIH, no doubt about that. To quote Prof CL Goh in Singapore - ' you are trading your scars for pigmentation that will go away after 2-3 months, this is not negotiable'.  Like BA said, your PIH can be treated with the usual creams, or PICO, then should you want further improvement once your scars are shallow, you have the option of erbium. As BA mentioned once the scars are monomorphic and shallow enough, fully ablative erbium will get you at least another 80% improvement from where you are now. eMatrix is best used for mild and early scars. Simple TCA to the deepest scars followed by lasers will give you the biggest improvement. I wish you well. This is a specific video from one of Lim's early cases, this lad's scarring is much worse than yours- taken into context, he is of Asian heritage. 



 



 

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