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user54321

What kind of treatment do I need for my acne scars?

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Hi,

I have been on a long journey to fix my acne scars. I know I have boxcar scars, although I am unsure if I have any rolling scars. 

I had 3 fraxels in 2011, but that was before I broke out with more scars. I am thinking about getting subcision. The fraxel had a great effect on my cheeks, but not on my forehead.

I am planning to see Dr. Rullan for subcision in San Diego, although I have seen users post pictures of subcision causing skin texture problems afterwards. I think I have serious skin texture issues so I am worried that subcision might worsen it.

What kind of scars do you think I have? What kind of treatment do you think I need? I would appreciate any response. Thank you.

Edited by user54321

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You have both boxcars and rolling scars. Mainly pebbled textural issues.

Regarding your comments on "pictures causing skin textural issues afterwards," one can always do nothing if they are content and afraid of any treatment. Most of these treatments rely on your ability to heal, if that is poor or you have other health issues which effect this, then yes you can have skin texture issues after treatment. The second group your referring to even from our site here had unrealistic expectations of outcome and as such nothing but perfection is what they expected. This is not how acne scar revision goes. It's a long process with it's ups and down, ... most of it psychological.   

Ok good your seeing Rullan.

You need Nokor subcison for your biggest pits and filling with a cannula also known as cannula subcision throughout the cheeks where your scarring is with a spacer like filler, prp, etc... Sculptra can be a good choice in a case like this. You will need 3 or 4 treatments and you wait to top up till the filler runs out.

You also will need RF microneedling. Rullan does not do this. I would goto a med spa or another Dr for this part after you have your initial subcision wait 3 months and then start. This will help especially with the box cars. 3-4 treatments are needed.

Next Rullan is excellent at deep peels you can have this done for your surface texture (Even in ethnic patients) or you can go elsewhere for fully ablative erbium resurfacing. This is for the texture when your scars are more monomorphic or lessened and on the same shallow depth.

Rullan is excellent and you could do all this with him. I know he does Subcsion, traditional microneedling, and he trains other Drs how to do peels.

IF the scars remain stubborn after al that you can try co2 laser at 3-7% density and full power on the toughest spots to break up the scar tissue. This is fully optional.

You can choose what you want to do and don't want to do, just make sure to do 3 months between treatments.

IF you have ethnic skin you must use tretinorin / retin a/ or differin (OTC - Target) nightly with some bleaching cream that has konjic and albutin. This will prevent discoloration. Stop 1 week before any treatments.

The forehead is notoriously stubborn, so time will tell what above works best for you in your plan. The skin is thin, has lots of muscle and very hardy compared to other parts of the face.  

More info is in the FAQ linked below (signature).

 

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59 minutes ago, beautifulambition said:

Regarding your comments on "pictures causing skin textural issues afterwards," one can always do nothing if they are content and afraid of any treatment. Most of these treatments rely on your ability to heal, if that is poor or you have other health issues which effect this, then yes you can have skin texture issues after treatment. The second group your referring to even from our site here had unrealistic expectations of outcome and as such nothing but perfection is what they expected. This is not how acne scar revision goes. It's a long process with it's ups and down, ... most of it psychological.   


Thanks for your incredibly helpful response. For subcision, would you say that the risk for skin texture issues is based more on the patient's healing ability, rather than the doctor's expertise? The reason I ask is because I hear Dr. Rullan is very "aggressive" with his subcision, and I'm not sure if that is something to be wary of when it comes to choosing doctors.
 
59 minutes ago, beautifulambition said:

You need Nokor subcison for your biggest pits and filling with a cannula also known as cannula subcision throughout the cheeks where your scarring is with a spacer like filler, prp, etc... Sculptra can be a good choice in a case like this. You will need 3 or 4 treatments and you wait to top up till the filler runs out.


I was thinking about doing a nokor subcision with Dr. Rullan for my entire cheek area and then using the cupping method. I am on a budget so that could be something to start with before moving onto cannula subcision later. Do you think that would work just as well? 

Thank you again, I really appreciate your feedback! Edited by user54321

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Do whatever you have the time and $$$$ to do, ... you can always wait longer periods between treatments. 

Get a derminator if you don't have money for rf needling and start with that at home. Get some differin from Target OTC nightly. Etc. See the microneedling section of the faq.

Sure you can start with suction. 

You need aggressive subcision, ... your scaring is over the forehead, cheeks, etc. Some of the scars may not be tethered and this is why you need filler with cannula for texture. If you cannot afford it ask about prp or saline as a alternative until you can. I also see rf needling helping you a lot, ... Do this when you can.

Patient's healing capabilities and expectations. The portion of the doctors skill seems less of a thing to me. Perhaps not doing something ie. not doing filler will give less results or too much like these mega session Drs with no time to heal. But it all comes down to health/healing, you will see what works for you.

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21 hours ago, beautifulambition said:

 You need aggressive subcision, ... your scaring is over the forehead, cheeks, etc. Some of the scars may not be tethered and this is why you need filler with cannula for texture. If you cannot afford it ask about prp or saline as a alternative until you can. I also see rf needling helping you a lot, ... Do this when you can.

Patient's healing capabilities and expectations. The portion of the doctors skill seems less of a thing to me. Perhaps not doing something ie. not doing filler will give less results or too much like these mega session Drs with no time to heal. But it all comes down to health/healing, you will see what works for you.


I am traveling to Korea next month and I found a doctor who is willing to do subcision and fraxel on my entire face for a very low price. The subcision needles available are "23G needle, or blunt cannula". I'm not so sure what they mean by "23G needle", and whether that's nokor?  
I am considering this although I am worried about doing this surgery abroad. The doctors work in English speaking clinics in Seoul so I assume I'm in safe hands. 

The study states they used a 24G needle, although there is no information on whether it was nokor or cannula. Do you think it's possible to replicate the results in the study with cannula subcision alone? 

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6 hours ago, user54321 said:

I'm not so sure what they mean by "23G needle", and whether that's nokor?  


Edit by MOD: We do not allow medical information that can performed by posters here. As such Google for more information.  "NOKOR.".

BTW have you done any background check on the clinic? Even though Korea is well known for its cosmetic procedures, there are still seedy clinics that you should avoid. This is especially true for those who charge much less than their competitors.

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23G is a standard needle. The bigger the gauge, the thinner it is. 

Nokor is a large needle (google it). 

Edit by MOD: We do not allow medical information that can be used for others to do surgery's please look up yourself NOKOR and "needles"

 

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@user54321 Low price is never good, .. the most famous clinics in South Korea are the same cost as treatments in the states. Places like Korea, .. a non-trained assistant /unskilled Dr can also do these treatments.

23G is not a Nokor, it's a standard needle. Have them use the blunt cannula and then individually go back and work on the pits, ... if they don't have Nokor then use a standard needle.

Unless your going to Korea I would not consider it. The cost with travel expenses, etc... On the most famous clinics is again the same as the states. 

The study uses a standard needle. We reference this study many times here, ... It's a old one ;-)

Anything is possible. Does not mean the Dr is good, ... he is cheap though. You need multiple subcisions. Not a single treatment. They also have Drs who do Nokor there look at Oracle, Dream, and Renewme they are famous for offering what we already do here and calling it something different. 


 

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1 hour ago, beautifulambition said:
@user54321 Low price is never good, .. the most famous clinics in South Korea are the same cost as treatments in the states. Places like Korea, .. a non-trained assistant /unskilled Dr can also do these treatments.
 
4 hours ago, Sirius Lee said:

Edit by MOD: We do not allow medical information that can performed by posters here. As such Google for more information.  "NOKOR.".

BTW have you done any background check on the clinic? Even though Korea is well known for its cosmetic procedures, there are still seedy clinics that you should avoid. This is especially true for those who charge much less than their competitors.

As a Korean, I agree to these words 100%. Non-dermatologist doctors are also allowed to do the treatments. I am one of the victims. My life has been completely ruined since I got treatments from a non-dermatologist doctor I'd rather call a swindler.

And doctors in this country usually offer exactly same program to all patient, not considering patient's individual scarring.

In Korea, dermatology hospital includes "dermatology" in the name.(FYI, dermatology = 피부과) So the dermatology hospital's name will be something like "XX피부과." You can also find out if the doctor or clinic is the real dermatologist or dermatology on this website. (Written in Korean. So, you have to search it in Korean)
http://www.akd.or.kr/test/test.html
The first option : Search by address
The second option : Search by the name of the hospital
The third option : Search by the name of the doctor Edited by ScarsWillBeHistory

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7 hours ago, ScarsWillBeHistory said:

In Korea, dermatology hospital includes "dermatology" in the name.(FYI, dermatology = 피부과) So the dermatology hospital's name will be something like "XX피부과." You can also find out if the doctor or clinic is the real dermatologist or dermatology on this website. (Written in Korean. So, you have to search it in Korean)
http://www.akd.or.kr/test/test.html
The first option : Search by address
The second option : Search by the name of the hospital
The third option : Search by the name of the doctor


Just use the Chrome browser and have it automatically translate the webpage into english (or whatever your mother tongue is).
7 hours ago, ScarsWillBeHistory said:

As a Korean, I agree to these words 100%. Non-dermatologist doctors are also allowed to do the treatments. I am one of the victims. My life has been completely ruined since I got treatments from a non-dermatologist doctor I'd rather call a swindler.


S. Korea to crack down on unregistered plastic surgery clinics after medical tourist complaints



Check the above article to catch up on how things are panning out in Korea's lucrative industry with phonies clamoring to take their piece of pie. In the last few years, there has been a steady flow of news about how plastic surgeons (and these were doctors from reputable clinics) were allowing nurses and other non-trained (visiting) doctors to do their surgeries. 
 

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Is the “ghost surgery” the subject of legal punishment in Korea?

Recently a controversy has arisen about so-called “ghost surgery” practices, and people have voiced their opinions for legal sanction against such practices, which clearly undermine the foundation of medical ethics. However, there has been a lack of legal basis for punishing those actions. The present study aims to examine which pre-existing legal provisions could be applied to regulate ghost surgery.

In other words, even if other medical professionals are present in the operating room, the operating surgeon who received consent must take overall responsibility for the whole process of the surgery. A surgeon should bear in mind that a violation of such duty can constitute a criminal offense.

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Wow thank you guys for going out of your way and posting all of this information! Especially the information about Korea, I really appreciate it! :) 

I don't think I will get my subcision in Korea now, but I might as well go to the consultation and see what they say. I will probably get my subcision done with Dr. Rullan.  

I'm still considering getting my fraxel done at a clinic in Korea (not a mini fraxel, but a fraxel dual 1550), which has pretty good reviews. I have ethnic skin though, so my biggest concern is the fraxel dual in Korea giving me hyper-pigmentation. 

I'm not familiar with RF microneedling. I've only done fraxels in the past, which were not on full blast due to my ethnic skin. Would RF mirconeedling have better results than the fraxel?

Thanks again you guys! 

Edited by user54321

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Even in the US any licensed doctor can open an aesthetic clinic.   Tons of doctors have left their specialities to open med spas offering filler and Botox and other aesthetic procedures.  They take a weekend course and then call themselves cosmetic surgeons.    They know that the real money is in aesthetics because cosmetic procedures  is 100% out of pocket for  patients.

Aesthetic / cosmetic medicine is the least regulated among all medical specialties.  It's totally the wild West.  Near zero oversight.   

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Just a quick update. 

I went to Korea and got subcision (not sure what kind of needle was used, but it was very thin) with HA filler. I also got a fraxel the next day.

Here's the best part-- the fraxel. I've had three fraxels in the United States prior to this. I have fitzpatrick IV skin, and my fraxels in the past where performed at a low density to prevent hyper pigmentation. Unfortunately I got severe skin discoloration anyways. The fraxels were also extremely painful, I'd rate the pain as 7/10.

My doctor in Korea used an advanced fraxel laser only available in Korea. He told me Korean fraxels are extremely advanced compared to the US and there is no risk for hyper pigmentation or fat loss. He used the fraxel at full power on my face, and I can tell immediately there will be no hyper pigmentation from it. There were virtually no side effects, only redness for a few hours. The Korean fraxel was not painful, I'd rate the pain as 5/10.  It's been a week and my skin looks amazing.

I realize there is swelling after a fraxel so time will tell how my skin turns out. I have lots of bruising and marks from the subcision. The subcision made my scars redish purple-- it now looks like I have fresh acne scars. However the HA filler plumped up my skin; most of my scars are either gone or diminished. There are slight bumps (not visible to the naked eye) from the HA filler-- my scars are totally filled up.

I had a great experience. I will consider going to Korea every year simply to have access to their dermatology. 

I'm also planning to see Dr. Rullan in three months for a more aggressive subcision to continue improvement. 

Edited by user54321

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Wow, congratulations!

As a Korean, I feel great you got a satisfactory result! Would you mind telling me which clinics you went? :)

Anyway, if you like a historical and traditional stuffs, I'd like to recommend you to visit Gyeongju next time. It's located on the east-southern area of Korea, so it will take hours from Seoul.

Thank you in advance...!!

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@user54321  Would also love to know where you went!.   Also what was the pricing for subcision + filler if you don't mind me asking?  Would appreciate it a lot as I'd definitely be interested in a vacation to korea.

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Hi you guys,

If anyone wants to know more information just PM me, and I'll let you know the price and the clinics I went to :)

For the record, I emailed every clinic listed in this article: 10 ENGLISH-SPEAKING DERMATOLOGISTS IN SOUTH KOREA. I think the doctors featured there are all legitimate, and they are very quick to respond with questions. If you visit Korea, I recommend seeing a few of these doctors for consultations in person-- it was only then when I figured out the best doctors/treatments for me. The consultations are very cheap (around $10-$15 for each consultation).

Edited by user54321

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