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aspirin

Has Fraxel improved a lot over the past 8 years (especially for Asian skin types)?

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I had Fraxel done in 2010. I have a variety of scars (severe icepick, boxcar, rolling all over my face). IIRC I had ~10-20% improvement for 6 sessions. Not much improvement on the icepick, but I did see improvement with the rolling and boxcar. I was thinking about doing Fraxel again. I am Asian (Type III on Fitzpatrick scale) and the clinic I went to would not give me the strongest treatment.

So I guess I'm wondering:
1) Has there been much improvement in Fraxel technology since 2010?
2) Is it worth it if I'm not able to get the strongest treatment?
3) For Asians here, would you suggest another treatment that works well for Asian skin? The only treatment I'm not interested in is fillers.

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7 hours ago, aspirin said:

1) Has there been much improvement in Fraxel technology since 2010?
2) Is it worth it if I'm not able to get the strongest treatment?
3) For Asians here, would you suggest another treatment that works well for Asian skin? The only treatment I'm not interested in is fillers.


1) No
2) No
3) Yes. Depending on the type of scars you have, you can elect to get subcision, RF microneedling like Infini. as well as TCA peel or cross.

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20 hours ago, Sirius Lee said:

1) No
2) No
3) Yes. Depending on the type of scars you have, you can elect to get subcision, RF microneedling like Infini. as well as TCA peel or cross.

Thank you!

Added info: I'm currently using Retin-A 0.1%. I finished a 3rd round of Accutane in February. Money isn't an issue.

More questions, sorry:
1. Do most people usually do all their procedures at one clinic? There are places in my city that do RF microneedling and other places that do TCA cross, but not both.
2. Is there an order that's generally accepted for scar treatment? Like subcision first, then microneedling, then fraxel, or something like that?
3. Are there only limited amounts of times a procedure can be done? Like can I only do subcision X amount of times before it becomes a bad idea?
4. I saw in another thread that 3 months is the recommended time between procedures. Do people get other procedures done during those 3 months (e.g. home TCA) or is it just sit-and-wait?

Here's some pictures of my worst side (I should've taken them somewhere with harsher shadows and my camera sucks, but this is basically what it looks like...I'm gonna take better pictures later). The sides of my forehead, my entire chin area, and my cheeks are the worst. My entire face has a very rough texture (orange peel, enlarged pores, lots of redness in the middle, just very...lumpy).
20180526_104445.thumb.png.4f32183a2d804eb458dfbff6c911f3cb.png20180526_104324.thumb.png.ab204dff3c19026f2b2ed54a691f6741.png

 

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1 hour ago, aspirin said:

1. Do most people usually do all their procedures at one clinic? There are places in my city that do RF microneedling and other places that do TCA cross, but not both.
2. Is there an order that's generally accepted for scar treatment? Like subcision first, then microneedling, then fraxel, or something like that?
3. Are there only limited amounts of times a procedure can be done? Like can I only do subcision X amount of times before it becomes a bad idea?
4. I saw in another thread that 3 months is the recommended time between procedures. Do people get other procedures done during those 3 months (e.g. home TCA) or is it just sit-and-wait?


1) It shouldn't matter as long as the operator/practitioner is qualified.

2) Yes. You want to fill the pits as much as possible first before sanding the top, much like a road construction. Before you can repave the road, you need to fill the potholes first. 
  • For rolling and boxcar scars: 1) Subcision for deep atrophic scars; 2) RF microneedling for medium indentations. So subcision should be continued for deep scars until they're "medium grade", then move to RF like Infini.
  • For icepick scars: TCA cross.
  • Resurfacing: Once the scar beds have risen enough, you can sand any surface irregularity like the boxcar edges with either ablative erbium or TCA peel.

3-4) No. You can get as many as you wish as long as it's working*. However, it's a good idea to give at least 3 months (ideally 6 months) to allow collagen remodeling to take place. A lot of doctors will push you to repeat treatments at 6 week interval. That is too soon, and will only disrupt the process. From my own experience, there was a huge difference in improvement when I got treated after 6 weeks vs after 6 months. I saw nearly no improvement after 6 weeks. I would also advise against doing DIY treatments during the 3 month period.

* How much improvement you will get from any treatment largely hinges on your body's healing ability. While that depends on a lot of limiting factors like diet, environmental toxins, and genetics (well, no shit sherlock >_<), taking good supplements at least 3 months prior to the treatment helps IMO. Some of the supplements I suggest are vitamins C and E, zinc, and fish oil.

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23 hours ago, Sirius Lee said:

1) It shouldn't matter as long as the operator/practitioner is qualified.

2) Yes. You want to fill the pits as much as possible first before sanding the top, much like a road construction. Before you can repave the road, you need to fill the potholes first. 
  • For rolling and boxcar scars: 1) Subcision for deep atrophic scars; 2) RF microneedling for medium indentations. So subcision should be continued for deep scars until they're "medium grade", then move to RF like Infini.
  • For icepick scars: TCA cross.
  • Resurfacing: Once the scar beds have risen enough, you can sand any surface irregularity like the boxcar edges with either ablative erbium or TCA peel.

3-4) No. You can get as many as you wish as long as it's working*. However, it's a good idea to give at least 3 months (ideally 6 months) to allow collagen remodeling to take place. A lot of doctors will push you to repeat treatments at 6 week interval. That is too soon, and will only disrupt the process. From my own experience, there was a huge difference in improvement when I got treated after 6 weeks vs after 6 months. I saw nearly no improvement after 6 weeks. I would also advise against doing DIY treatments during the 3 month period.

* How much improvement you will get from any treatment largely hinges on your body's healing ability. While that depends on a lot of limiting factors like diet, environmental toxins, and genetics (well, no shit sherlock >_<), taking good supplements at least 3 months prior to the treatment helps IMO. Some of the supplements I suggest are vitamins C and E, zinc, and fish oil.

Thanks for answering all my questions so far!

If I were to get subcisions for rolling/boxcar, should I get it at the same time as the TCA cross for the icepick (since they're affecting different parts of my face)?

I'm planning on going to the plastic surgeon who did my Fraxel as she seems to be the only one who does TCA, subcision, and PRP microneedling.

Do you have a post about the supplements you take for scarring? I think you mentioned in another thread a supplement that started with 'S' but I can't remember what it was. I already have most of the supplements you mentioned, just need to buy some vitamin E :smileys_n_people_82:

I feel like I shouldn't be optimistic, but the posts on this board show so much more improvement now compared to back in 2010...

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35 minutes ago, aspirin said:

1) If I were to get subcisions for rolling/boxcar, should I get it at the same time as the TCA cross for the icepick (since they're affecting different parts of my face)?

2) Do you have a post about the supplements you take for scarring? I think you mentioned in another thread a supplement that started with 'S' but I can't remember what it was. I already have most of the supplements you mentioned, just need to buy some vitamin E :smileys_n_people_82:


1) You can get both Subcision and Cross at the same time or separately. It really doesn't matter since each focus on different scar types. 

2) Serrapeptase. It's basically a proteolytic enzyme that breaks down protein, which is what scar tissues are made of. You must take it in empty stomach. It should be discontinued for 1 week prior to treatment and about 3 weeks after treatment. For more info, just google it.

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1. No 
2. No 
3. Yes. RF microneedling. With the pictures posted, some subcision will be of benefit..
 

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Because that is the standard guideline by Infini - Lutronic. Most doctors are laser Drs and know nothing about why they do what they do. Set the settings, do the treatment, collect the reward, and be sponsored by the medical energy device company. Bank $$$$.

What about all those standard guidelines by laser companies that it cooks, it cleans, causes no damage, does miracles, and will fix everything. The doctor then parrots off the advice they were trained to say, set's the settings. When you come back with a side effect like I have fat loss, or it caused more scars they say hurry get another laser your skin is remodeling and needs more treatment. Lets throw some more energy on it. The person then finally get's fed up with a smaller pocket book and deals with the lasting side effects. They think to themselves. I should have thought about this more, ... allowing myself more time to heal, having more involvement in the treatment, done a test spot or area.

One can get treated with Infini weather 3 months or a year apart if it suits them, it really depends on your individual skin, condition, ability to heal, quickness of recovery, diet, underlying conditions, etc. Ethnic patients who over-treat (or settings are to high) can get PIH and say devices ruined their skin.

You will need subcision and filler to get optimal Infini results with pitting, which already stimulates collagen prior to Infini.

We personally here don't care if you get it every day if you want. IT's your face ruin it any way you wish. We had one persona doing laser once a week till they had un-reparable scars by one of those experts you linked from Real Self who only cares about $$$$ using as many devices as possible at once and getting you to buy a big package.

When you have a surgery, ... do they tell you to take it easy, heal, and give it time or do they say oh no go back and get another surgery right away as that can cause damage.

Laser, Infini, subcision, ... they are all surgeries that stimulate collagen by causing damage and thus your bodies ability to heal.  Most doctors know they have to add more fire while the flame is hot so to speak or they will loose you. If you wait around and have bad results  after one treatment (waiting the proper time it takes to heal), so they stack as many as possible so your in a never ending state of inflammation and healing. Collagen takes 6 months to heal and is very fragile. Histology proves this regardless of what device is used. We don't jack hammer the face after we just had surgery. IF you have time constraints then do your treatments closer together, it's your body after all. I cannot tell you the countless posts on this foum I have had to respond to with Infini freak outs of it caused grids, it caused scarring, it ruined my face, ... it changed the texture, ... it's taking forever to heal. These are people who are told the standard lie that it is a no down time procedure and you will be healed in a few days. They take months to heal. They then evaluate when is going on. When there is to much busyness and constant action, no one can really tell what works and what does not.

Why do you suppose they make you wait 6 months after Accutane for healing. Why do they say your laser treatment will get better over time a year after it was done. Or a face lift will only improve.

IF Dr Weiner wants to do it every month because after all he is paid by Lutronic so be it. They want to treat you as soon as possible. But it is your choice to allow your body to heal or not. If you can guarantee every person that takes months to heal you can fix then so be it you play expert. You know that long after you have Infini your still remodeling right, and it get's worse before better, there is a decrease in collagen and then a building phase of slow repair.

Dr's also tell you to get filler every few months, do you follow that, it's not necessary but it is expensive. $$$$.

This is where I would error on the side of caution.

 

 Why does It Takes 3 to 6 Months to heal after Laser?

What happens in the body during this time, and why are the results continuously improving rather than instantaneous?

 

 

Time to Improvement after Laser

 
Great question. Improvements with Laser are related to collagen formation  and skin contraction.  The initial process of controlled damage causes a fair amount of swelling. Swelling must subside before true healing can happen and can be frustrating to some patients as swelling can persist.  It usually resolves over a period of 2 to 3 months. The grid marks are replaced by new skin. 
 
Thereafter, the improvement seen is related to skin tightening with collagen deposition and remodeling. This process takes a bit longer, up to approximately 6 months.  Unfortunately a bit of patience is regarding technology.

Best of luck.
Dr Goldman - Father of Cosmetic Laser


 

Wound healing is a complex and dynamic process of replacing devitalized and missing cellular structures and tissue layers. The human adult wound healing process can be divided into 3 or 4 distinct phases. Earlier authors referred to 3 phases — inflammatory, fibroblastic, and maturation, [1] which has also been denoted as inflammatory, proliferation, and remodeling — and this is maintained by some authors. [2] In the 4-phases concept, there are the hemostasis phase, the inflammatory phase, the proliferation phase, and the remodeling phase. In the 3-phases approach, the hemostasis phase is contained within the inflammatory phase.

Not only do authors vary the number of phases, but authors also denote differences in the phase descriptors used as: hemostasis phase, inflammatory phase, proliferation phase, and remodeling phase or hemostasis phase, inflammatory phase, granulation phase, and maturation phase. [3] Therefore, certain phases have more than one name, such as remodeling or maturation and proliferation or granulation.

The granulation tissue phase in wound healing is directed by the fibroblast. It produces matrix, collagen and elastin, GAG's and proteases that stimulate dermal remottling (17). At the same time, angiogenesis begins with endothelial cells migrating directly into the wound during the granulation tissue phase. The neo-vascularization is necessary for collagen remottling and the final phase of fibroplasia. Collagen and elastic tissue remottling begins at the conclusion of granulation tissue phase after reepithelialization occurs and is responsible for the manufacturing of new dermal collagen and the changes in texture of the skin. It, thus, begins at the second week post-operatively and may continue as long as four to six months. Persistence of fibroplasia with neoangiogenesis can account clinically for the prolonged erythema and prolonged improvement in texture over this period of time.

Always be upfront and honest with your provider about your medical history and any medications or supplements you are taking. For instance, if you are prone to cold sores or fever blisters, laser treatments may induce breakouts. Acne medications that contain isotretinoin (i.e., Accutane) and various other medications can lead to poor healing or scarring from laser resurfacing, while common over-the-counter products like aspirin can increase the risk of post-procedure bleeding.

Common over-the-counter products like aspirin can increase the risk of post-procedure bleeding; other meds can lead to poor healing or scarring after laser treatments.

Diabetes and other chronic conditions (Auto Immune) can also impact safety and results with laser resurfacing. Those who are prone to scarring can have adverse side effects (Acne Scar Patients), You should also quit smoking at least 2 weeks prior to and after laser treatments to avoid complications with healing and provide your body with the best chance for optimal results. Diet, histimine response ( allergies), and your ability to heal can have a major role in good recovery. Infections also must be monitored. 

The laser surgeon should follow his patients during the post-operative period regularly to monitor healing and thus prevent complications.

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2 hours ago, damnscars said:
@Sirius Lee 

Sirius, why do you always say that you should always wait 3 months or more between Infini RF sessions? Your advice goes against what I've seen professionals say. Both Stephen Weiner and Katherine Dee say the opposite - that you should wait 4-6 weeks, not longer, so that the fibroblasts are still "revved up". And Stephen Weiner is generally regarded as the best Infini RF practitioner in the U.S. See their answers to the RealSelf questions below:

https://www.realself.com/question/charlotte-nc-minimum-time-infini-rf-treatments-treat-acne-scarring
https://www.realself.com/question/switzerland-ch-infini-rf-time-intervals-procedures
https://www.realself.com/question/california-hot-springs-ca-long-full-results-infini-rf-treatment-spacing

My non-famous Infini RF practitioner also says you should do it every 4-6 weeks, with no more than 3 months between sessions. Of course she's not a doctor, but I've been pleased with my Infini results.

So you've had another treatment in 6 weeks as advised by your doc? Has that been very recent? If so, document your progress by taking a lot of pictures because now I suggest you wait 6 months and get another treatment. By doing so, you can make comparison between the two.

I personally have no vested interest in coming here and volunteering my time and effort to discourage people from repeating treatments in less than 3 months. I speak solely out of experience. When I had my first treatment, I saw a pretty good result up to, well, 6 weeks when I stepped in for another treatment. Then it all stopped. You would think it would have revved up the collagen production even more, but no, everything came to a screeching halt. I saw little to no improvement from that second treatment. Then, against all conventional wisdom, I waited 6 months and got the same treatment. What do you think happened? There's no point for me to even state the obvious.

Anyway, I'm not your nanny, let alone your doc. I've never made a claim that what I stated are professional advices. I can only give you my honest opinion. The bottom line is that it's your call.

 

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