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Byebyescars

What type of scars do I have?

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Hello, I am South Asian and in my early 30s. I’ve been dealing with acne since I was in my teens and finally did accutane at 29. I have no acne, but am left with unfortunate scars. Can you please tell me what type of scars I have? I just bought the derminator - will this help with improving them? Should I also do TCA peels? And if so, how should I space these things apart? Or do you folks feel like I need professional treatment - and if yes, what would that be? Any suggestions are greatly appreciated. Thanks :) 

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Edited by Byebyescars

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Professional treatment 100%.  Looks like you have primarily boxcar + some rolling.  You may have a few Icepicks but i'd say primarily the latter.  

I have similar but more mild scars and I play on doing a few sessions of subcision + filler followed up by a few rounds of RF microneedling.

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18 minutes ago, Byebyescars said:

1) Can you please tell me what type of scars I have?

2) I just bought the derminator - will this help with improving them? Should I also do TCA peels? And if so, how should I space these things apart?

3) Or do you folks feel like I need professional treatment - and if yes, what would that be? Any suggestions are greatly appreciated. Thanks :) 


1) You have a combination of rolling and boxcar scars. 

2) Unfortunately, your scars are too deep to be fixed by Derminator or TCA peels. However, they will help down the road once the pits have been raised. 

3a) You need various treatment modalities. However, I think it will be more easier if I grade your scar at the outset and reference the treatments based on that. From 1 to 10, I would grade your scar at 7 (roughly speaking). Scars above 5 requires more aggressive treatment like subcision. Severe scars are usually anchored to the bottom, hence the deeper indentation, and subcision is about cutting those bands. Scars below 5, on the other hand, would require RF treatments. From my own observation, subcision works very well for severe scars but not for mild to medium scars, and vice versa for RF. So you should consider getting a series of subcision (and filler) until your scars have improved from 7 to, say, 4. Then you can switch to RF like Infini.

3b) If you can afford it, I would strongly suggest you add hyaluronic filler with subcision. You don't need to fill every pit, only the deepest ones that you suspect are tethered. Later, when you move up to RF, I highly recommend Sculptra (different type of filler).

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@thepwhisp and @Sirius Lee thank you two for responding so quickly! Shucks, so subsicion + fillers + microneedling is the way to go. Are you folks in the OC or LA area? Do you know of any good surgeons that do subsicion? And how many sessions do you think it’ll take? And realistically what type of improvement should i expect? Sorry for all of the qs... I am new to the site. Thanks.

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Microneedling is definately not a bad treatment for these types of scars, but as sirius underlined, you will need more than that. 
Just keep in mind that you need to wait about 3 months between each microneedling treatments. In theory you can start now, and it definetaly does not interrupt other treatments, quite contrary, it's complimentary.

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Hello All,

I am back! In July I got subcision done with microneedling and prp (per the suggestions, thank you all - I really appreciate your feedback). In September I derminated at home. In October I got another round of subcision and just suctioned after.
For the next round, Dr. Rullan suggested that instead of full on subcision, that I get filler (no suctioning). So my questions now are, based on the pictures below, what do you folks think the next step in my game plan should be? I am a bit confused. Do you all think:
1. I need more subcision + suction 
2. I need filler + subcision (what type of filler would you recommend - and should i get it done the same day as sub?)
3. I wanted to start doing MUAC peels - I am thinking lactic acid or Mandelic may help with the texture issues. Would any of you with experience with peels agree?
4. Any other tips on what you all think would be a good method to help this process along or just an over game plan for the next few months to help reduce the scarring are greatly appreciated.
2018-11-09.jpg.0f57c4858ddc5ae757c9d747a7c04046.jpglast.JPG.011c0acae17565302428f9a1a5b2fa36.JPG
Thank you in advance!

Edited by Byebyescars

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Oh, very little. 10-15% at most. The scars are slightly softer. But that’s why I am thinking more subcision needs to be done... the Dr feels like these are more surface scars, so he wants to proceed with filler leaving no opportunity for suction on the next round. 

Edited by Byebyescars

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@Byebyescars 

Multiple Subcisions are needed In your case 3-4 I would recommend. As Rullan said you need Filler, this is why you have less % of improvement (besides needing more subcision). In your case I would get a vial of sculptra throughout the whole cheek area, over diluted (this is not a spot fill for scarring volume, you will do that with HA Filler on your last subcision). Because of the amount of fat loss you have you may need to consider Bellafill(Permanent) in the future, only if you like the way Sculptra and HA filler(Juvederm Voluma) looks. Why do we get sculptra, to stimulate collagen and to act as a spacer post subcision.  You are fat deficient in the cheeks and this shows the scars more.

Rullan does not do RF needling, please find a local med spa or Dr to do 3-4 treatments of rf needling like Infini. Do this spaced between your subcisions with Rullan.

IF you need a added boost get 3-7% low density CO2 with the highest power multi-pass or Erbium profractional for those rolling scars and box cars.

Some of the scars look like Rullan can Phenol Cross them (smaller box cars) and do some dermabrasion, discuss this with him. 

Finally Rullan is a expert at acid peels for ethnic skin. You can do a few phenol peels once the skin is raised (filler and sub) for surface texture. 

Because of your skin type I want you to nightly use differin(target)/tretinorin/retin-a and a konjac and arbutin cream, this will prevent hyperpigmentation and help with collagen turn over. 

You can at home between treatments derminator / dermastamp once per month the scars or do a Glycolic peel which is good for slight texture in darker skin. We have a peel guide see the FAQ - top of the scar treatments sub, first post, goto the acid peel section, and the mega-link. 

Everything is optional. Treatment takes 3 years for many. Dr treatments need to be AT LEAST 3 months apart even if they say sooner, and at home treatments are 1 month apart. 

The biggest improvement that will help you is more volume filler and subcision. Pull your temples up and see how it will look, ... should look better right.

BA

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Thank you @beautifulambition for your thorough and thoughtful response.
For subcision with filler, should I do the filler the same day as sub or ask to come back a few weeks later after the swelling goes down, so he knows where to fill. He hasn’t been doing individual scar subcision on my face, instead it is one insertion on each side of my face and long sweeping motions - causing the expected balloon type swelling. I just don’t want to be over or under filled because of the swelling. 
Also, for the fillers, you’re recommending that sculptra and ha happen the same day, is that right? 
And for all of the creams you mentioned, (retina, differin, Konjac, etc) - are you saying I wear all of them every night? Or rotate them?
And yes, when I pull my skin up, the scars are significantly reduced :)

Edited by Byebyescars

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@Byebyescars I would do the filler a week or so after when the swelling goes down. He has been doing cannular subcision cool. The one exception to the above is he can inject 1 vial of sculptra throughout the cheek with over dilute saline (not for volume but a spacer).

No Sculptra can happen directly after subcision if you choose that, ... Filler can happen at a later time .. either your last subcision or another appointment for volume. A permanent filler like Bellafill can be considered after a HA filler is used if you like the fill from HA... Permanent is Permanent - Bellafill so be sure you like filled look;-)

retina/ differin/tretinorin are the same thing. Differin is OTC at Target. Pick one. The other are ingredients konjac and arbutin or konjac and hydroquinone many products on Amazon. Yes both together nightly, stop before treatment. You can rotate if they cause you any irritation mix with moisturizer or go a few days between.

Yes the temples test mean you need volume ;-)

 

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