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GallantNight

Acne scar plan new post

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Could you please help me identify my scars and treatments for improvement.
Throughout the years I've had 1 dermabrasion, 2 microneedling sessions and 1 subcision without any filler. So far no improvement.20180714_185140_1531612464726.thumb.jpg.6facc2e11c02da3bd4fbeeca454237b0.jpg

1 minute ago, GallantNight said:

Could you please help me identify my scars and treatments for improvement.
Throughout the years I've had 1 dermabrasion, 2 microneedling sessions and 1 subcision without any filler. So far no improvement.20180714_185140_1531612464726.thumb.jpg.6facc2e11c02da3bd4fbeeca454237b0.jpg

I have many more pics in different lighting but I'm having trouble uploading them

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Could you please help me identify my scars and treatments for improvement. Throughout the years I've had 1 dermabrasion, 2 microneedling sessions and 1 subcision without any fillers. So far no improvement

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You have textural boxcars and mainly surface rolling scars, I do not see deep fat loss. These are harder to treat as they are textural in nature.

Dermabrasion is for texture and is not done first (this is more like the erbium resurfacing and it takes multiple treatments, many don't do this anymore because it's painful and can be messed up (Side effects).

Microneedling you can do at home as a treatment with small amounts of improvement (between treatments).

One always needs more than one subcision. In your case I would do cannular subcision throughout the cheeks.

If you wish you can use threads of prp, ha filler, or sculptra. The sculptra stimulates collagen with the other treatments. Filler in your case will give smaller results as it works best on pits but it can add overall volume which you could use in the cheeks to make the cars look better. I would do 3 sessions when the filler runs out do it again.

I would do RF microneedling only on the scarred areas, you can do this between the subcisions 3 months apart, or whenever you have time and money.

I don't see TCA cross helping you here.

I would then do erbium resurfacing, you may need more than one or a deep peel. Always work on texture last. 

Because you have ethnic skin you must do tretinorin, retin-a, or differin nightly when not treating, and a cream with konjac and albutin to prevent discoloration in ethnic skin types. 

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4 hours ago, beautifulambition said:

You have textural boxcars and mainly surface rolling scars, I do not see deep fat loss. These are harder to treat as they are textural in nature.

Dermabrasion is for texture and is not done first (this is more like the erbium resurfacing and it takes multiple treatments, many don't do this anymore because it's painful and can be messed up (Side effects).

Microneedling you can do at home as a treatment with small amounts of improvement (between treatments).

One always needs more than one subcision. In your case I would do cannular subcision throughout the cheeks.

If you wish you can use threads of prp, ha filler, or sculptra. The sculptra stimulates collagen with the other treatments. Filler in your case will give smaller results as it works best on pits but it can add overall volume which you could use in the cheeks to make the cars look better. I would do 3 sessions when the filler runs out do it again.

I would do RF microneedling only on the scarred areas, you can do this between the subcisions 3 months apart, or whenever you have time and money.

I don't see TCA cross helping you here.

I would then do erbium resurfacing, you may need more than one or a deep peel. Always work on texture last. 

Because you have ethnic skin you must do tretinorin, retin-a, or differin nightly when not treating, and a cream with konjac and albutin to prevent discoloration in ethnic skin types. 


Which filler would you think is best for me and would they all prevent retethering? Would it be okay to do infinRF if there's still filler?

How many sub+filler do you think I need?

Is it a okay to do  InfiniRF right after subcision add filler a week later and do this every three months? 

Is the skin preparation only for laser or is infini also a risk?

Lastly, would you recommend fully ablative erbium for my skin type?



 

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Scuptra is quite popular for those with your case type and age. IT provides collagen stimulation. It can be expensive and is not a spot filler - volumizer, but a mass filler for the whole area. HA is also fine, consult with the Dr what is available locally. I don't believe your issue is only re-tethering. I think it's textural, wide spread scars, and hard to treat since they are surface oriented. Filler will not give you glass smooth skin, ... You must treat over time to get improvements with multiple things. 

IF you do sculptra a set of 3 injections is done. You can space them out if you wish.  You can do 3-4 cannular subcisions even if you only do filler on the 3 or 4th.

Yes you can rf microneedle with filler, it stimulates it. 

Both, your doing this nightly konjac/albutin / tretinorin as it also helps with the scarring some. You stop during treatment a week before till you heal. 

Yes you can do erbium resurfacing as stated above, it's finding the right Dr for your skin type that has experience. You will have more down time due to ethnicity and hyperpigmentation. They may need to do more than one if conservative. Do NOT start with this, many drs will try that as you have not done the necessary work prior to resurfacing, think of a road with potholes before repaving. 

We are incredibly slow to heal, treatments are typically spaced out 3 months apart. 

 

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If I get sculptra after a subcision and infinRF combination (I've read it gets absorbed after 48 hours) would the scars retether with no spacer left? 

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15 hours ago, beautifulambition said:

IF you do sculptra a set of 3 injections is done. You can space them out if you wish.


You might not need 3 injections of Sculptra when you pair it with Infini. Only if you go solo with Sculptra. Also it's up to the doctor's discretion whether you need all 3 or less. Some do, some don't, depending on the severity of fat loss. 

@GallantNight I suggest 1 session of Sculptra 4 weeks prior to getting the Infini. The combination of the two works really well.
 

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10 hours ago, GallantNight said:

If I get sculptra after a subcision and infinRF combination (I've read it gets absorbed after 48 hours) would the scars retether with no spacer left? 

No it will not. Whoever published that is not very knowledgeable. It's used in HIV patients for fat loss in the face to give you a idea what it can do in extreme cases. Where your right is the saline goes away and collagen is further stimulated over month in the upper tissue layers. The PLLA will act as a spacer for subcision, if injected correctly. 

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Went to a derm (who didn't do angled lighting) who first suggested 4 co2 laser sessions. After I brought up subcision and filler he modified my plan to 4 combined treatments of subcision co2 plus HA filler. Thoughts?

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@GallantNight This Dr does not sound like a acne scar specialist. Just someone who owns a laser and pushes treatments that make money. Please consult, even if you have to pay with 3 Drs. Pick the one who seems best to address your questions and concerns (questions to ask are in the faq). Not the razzle dazzle or machine marketing. You are in control of your treatment, you can goto one dr for subcision and filler and another for laser. You don't have to stay with one. Just because they can do it does not mean they are a expert at acne scar treatments. This is what standard Drs do, throw co2 laser at it. Work on raising the pits before worrying about laser or texture. The body is slower to heal, and does not like mega treatments. When we compound treatments, the swelling hides what the Dr has done, you cannot see what works and does not through the healing process. 

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On 7/19/2018 at 5:36 PM, GallantNight said:

What is the difference between "regular" subcision and multi level subcision?


Basically, NOKOR is used to re-enter the same scar at different depth.


 

On 7/16/2018 at 6:38 PM, GallantNight said:

Do you know an acne scar specialist in Texas by any chance?


Not everyone can do subcision. You'll want to go with someone who has a long history under one's belt. If you can afford to travel, I suggest you visit Dr Rullan in San Diego. Give his office a call or an email explaining your situation and the reply you got on RealSelf. I'm sure he'll lead you in the right direction.

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17 hours ago, Sirius Lee said:

.  He agrees with this sentiment and the moderated content is professional training only not the general public. 

17 hours ago, Sirius Lee said:

If you can afford to travel, I suggest you visit Dr Rullan in San Diego. Give his office a call or an email explaining your situation and the reply you got on RealSelf. I'm sure he'll lead you in the right direction.


Unfortunately at this moment flying for scar treatments is not an option. I was thinking of explaining (or showing the video of) the procedure to dermatalogic surgeons near me who don't specialise in acne scarring and see if they can perform this procedure on me. Is that something I can do? 

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@GallantNight There is a Dr in Texas who does scars, I forgot the name as I only saw it mentioned once. Perhaps use the search feature and look at posts on Texas. I am sure you can call around and find someone who can do sucbision or find a dermatology teaching college that has a clinic. Most people do not want to be a Dr's first patient with a procedure. But if your daring, educate your Dr and maybe they can do the procedure for you. Nurses often know how to do these things if they inject using cannulas, ... they just need to be more aggressive with more passes under the scars. 

BA

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I sent dr rullan my pictures and this was their reply


"After reviewing your pictures the best choice would be a phenol peel. The second choice is what you mentioned. Subcision, Microneedling and Cross TCA. 
The phenol peel there is at least 2 weeks down time with this procedure, however this would be a one time procedure, where the other three procedures you will need at least 3 treatments and the results still will not be as good as one treatment with the phenol.
Dr Rullan suggest a combination treatment for your types of scars. He suggests doing subcision with CROSS TCA and Microneedling. Scars should be treated from several different angles. These treatments treat the scars both beneath the surface as well as above the surface and it  also helps treat the scars horizontally and vertically to deal with the scar tissue below. You will need at least 3 sessions of this combination of treatments. You may still need filler after for any stubborn scars."

BA, what do you think? Could a phenol peel "do the job"?  And also why do you think he recommended TCA cross in the 2nd option plan as you said I don't think Cross would do much.  Thanks

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@GallantNight Hi there again. I think a phenol peel could help but why resurface the road (as a example), before filling the pot holes. Your scarring is severe, and we have some fat loss.

Rullan is good, with all due respect there are many paths to the same goal. I am not one to recommend mega treatments. Our body does not like to be sandblasted and we take a very long time to heal (months).  Rullan is probably thinking you will fly in so do as much as possible. 

First of all you can buy a derminator for a very cheap price, ... do that at home. Even between treatments you can stamp the scars and put on retin-a / differin / tretinorin nightly. I know Rullan does microneedling and prp but in my opinion this is not as strong as rf microneedling which is more comparable to CO2 laser. Especially in a case like yours with lots of fibrous and tethered scars. 

I would start with subcision at the very minimum and some 1-2 vials of sculptra, ... Why sculptra. Because you have scarring throughout the cheeks temples, ... we need to fill for collagen stimulation, not for volume at the beginning. RF needling or low desnity high power co2 (either or) would stimulate the sculptra. You can fill for volume (HA Filler) of individual pits on your 3 or 4th subcision.

I do think a phenol peel is a good option for you but not at the beginning. Make since with the above (prep work to raise the scarring first over time). 

I do think "Phenol" Cross (others call it tca cross) - he is a expert at peels is a good option. You could even do this your first treatment. Paint on or spot peels to the bigger boxcars, and phenol cross to the smaller ones. This would lift the scar beds of those scars. For your case do your subcsisions and tca cross together when you fly in. 

Rullan does not have rf needling. So find a local medspa (Texas) to do rf needling or co2 3-7% density and the highest power. 3 treatments. 

Allow time to heal, 3 months between, ... you will see what works for you and reassess (everything is optional when you have time and money, some only do one treatment a year). 

Leave the biggie of a deep phenol peel for the end. Use this to resurface. 

So we agree cross and subcision to start, ... I just am not a big fan of prp and microneedling. 

@Obi wan Take a look please at this case of scars, Thank You.

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I seldom post anymore, but when I saw your pictures I had to say something.  Your pictures mirror what I was dealing with.  I did 5 treatments of Fraxel Repair, and saw an 80% improvement.  Proper protocol for Fraxel Repair must be followed or you will not achieve good results.  Very, Very few people on here have followed proper protocol so you will hear from critics who do it their way without success.  You must be treated at high megajoules, and multiple times or you will not be satisfied.  If you look at my signature you will see that I was treated each time at 70 mj - 60%.  The first treatment I was so swollen as to be unrecognizable, but that subsided in a couple days.  I went through the grandaddy of all skin peels with dermabrasion and regular CO2, with no improvement.  I look at it this way if you had a block of wood with a dent in it how much would you have to sand the wood to get it level with the dent.  There is only so much skin that can be peeled off.  If you do research you must used the words Fraxel Repair or people will automatically defer to Fraxel Restore, which is useless.  You mentioned Texas, well I had mine done at the LaserLight Skin Clinic in OKC.  http://laserlightsc.com/ 

 

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4 hours ago, DudleyDoRight said:

, and saw an 80% improvement

we really need your before and afters.

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4 hours ago, Candy Says said:
8 hours ago, DudleyDoRight said:

, and saw an 80% improvement

we really need your before and afters.
My befores do not show the scars the way the OPs do.  That is why I replied to this post.  Hers are so similar to what mine were that I felt I had to chime in.  Even my current pictures do not show what I see, but you know we are our own worst critics.  If I posted my Facebook picture you would see nothing.  I am going for a facelift in January and I may post then if I come out looking like George Clooney.  LOL The skin laxity removed with the facelift could well bring me to 100%.  Plastic surgery is not generally for acne scars, but Fraxel Repair has brought me to the point where even the slightest tension on the skin erases all shadows.  Fraxel Repair may well have taken me to 100% alone, but I got involved in something else in 2011 that pulled me away.  Now I am 71 and in need of the facelift anyways.
I don't have a need to satisfy you or anyone else on this forum to prove what I know is true.  I am here to help the OP.  I lived through an era where Dermabrasion was the only option, and I did that with no results much like the OP - that was 1966.  About 30 YEARS later they came out with CO2 laser and I did that with no success.  I lived with the agony of acne scars longer than many of you have been alive with no hope in sight.  Around 2007 Fraxel Restore was introduced and I was set up to have that until the doctor came back into the room and said that it would not help me.  Over 40 years of hoping for something and I was back to square one.  About 2008 Fraxel Repair came out and I was lucky enough that a plastic surgeon in my area had one of the few machines in the country, and I had my first treatment, and I got about a 20% improvement, but that was after 40+ years of no improvement.  After my 2nd treatment my improvement jumped to about 50%, and I thought OMG something is working.  Each subsequent treatment resulted in about a 10% improvement to bring me up to 80%.  I have been through wars that you can't even imagine, and only Fraxel Repair worked.

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@DudleyDoRight Hello again. Chiming in here because you shared so much hope. I have few questions if you don’t mind, as I am thinking about Fraxel Repair. I have a few rolling scars in particular that really bother me. Is it ok to go to my regular dermatologist for fraxel repair (I believe he does this)? Or should I seek out any particular doctors? Any words of caution or advice for someone looking into it?

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Rolling scars. We really don't know how much fibrosis there is under your skin, but there are lots of tethers. Subcsion is very hard to master. Given the extent of scars, may I suggest blunt subcision. If its a few tethered scars - sure Nokor can help, but you have lots at different attachment points. Scars are orientated vertically and obliquely. Combining say RF microneedling with subcision , 3-4 sessions would be advisable. Rullan probably best for the job. Most good guys won't put filler till the end. Why? Because if you tethers are broken down, and you can stimulate collagen over time - only the truely atrophic areas need to be filled. Also the poster has a ethnic skin type and cannot have overly high energy levels.

** Its not the method nor the device/settings, but the specialist behind the procedure that will give you the best results. Blasting scars with high energy does nothing but give side effects or added cost. Manual methods always win out.

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On 10/3/2018 at 10:10 PM, okmichelle said:
@DudleyDoRight Hello again. Chiming in here because you shared so much hope. I have few questions if you don’t mind, as I am thinking about Fraxel Repair. I have a few rolling scars in particular that really bother me. Is it ok to go to my regular dermatologist for fraxel repair (I believe he does this)? Or should I seek out any particular doctors? Any words of caution or advice for someone looking into it?
You must find a doctor who will treat at the proper level, or you will not be satisfied.  If the doctor starts talking about 40 mj just walk away because that will never work.  Doctors don't expect you to know about megajoules.  I went to a plastic surgeon who specializes in lasers.  That was the link I provided in an earlier post.  If my memory serves me right 70 mj penetrates the skin to the depth of 1.2-1.4 cm., and that is deeper than most acne scars.  Take out a ruler to see just how deep that is.  I do not believe it works so good on ice pick scars. If you can imagine a dermaroller that actually ablates the skin drilling tiny holes that then heal together tightening the skin, and promoting collagen growth.  My skin would actually continue to improve for about a 6 month period.  It was 2 non-acne scars that I could pinpoint the location of that proved to me Fraxel Repair was working.  They virtually disappeared after my first treatment.  I was knocked out with Demerol for my first treatment.  After my 2nd treatment my improvement jumped from 20% to 50% and I was hooked.  The last 3 treatments showed about a 10% improvement each time.  The doctor was pleased after the first treatment and she was amazed after the 2nd.  Fraxel Repair was brand new when I started getting treatments so even she did not know what to expect.  Do not expect 'One and Done' because that is not how this works.  Choose you doctor wisely, and I have given you some ammunition with which to talk to the doctor.  7 years since my last Fraxel Repair and I can still feel a little tightness on my cheeks and it feels good.  The whole thing is that it draws the scar closed.

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On 10/2/2018 at 3:50 AM, beautifulambition said:

I would start with subcision at the very minimum and some 1-2 vials of sculptra
I found a spa near me who does sculptra and InfiniRF. Do you think it's okay to do sculptra with an estetichian or should I stay in San Diego until swelling goes down and get injected by Rullan? Thanks

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@GallantNight Are you sure she is not a nurse? Nurse's are expert injectors normally as they do this all day long. Never heard of a estetichian being able to do this procedure as it's not legal normally. 

It does not matter who does your dilute Sculptra injections, you don't have to stay in SD and can find someone nearby to you who is a Nurse or Dr. Just make sure they inject "deep" throughout the cheeks and scars areas and don't pool the Sculptra in one area. The Infini may be fine if she has done hundreds to thousands of procedures including your type of issue. You don't want to go to shallow and don't want to go to deep. Have her go over settings with you. While you can inject Sculptra under inflamation I would wait till it's gone down.

BA

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