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ProbableLorry

Need help determining proper treatment for my acne scars

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So I went on an accutane cure when I was 16 due to severe acne and it got rid of most of my acne. However afterwards I was left with a lot of scars on my face, especially in the temple and forehead area. My dermatologist had me wait a year before laser treatment, and now I've completed 1 out of 3 treatments (6 months between each treatment) with co2 fractional laser.
I am now 18 years old and the scars haven't really improved all that much. I know it's a lenghty process but I just feel like there must be more that I can do to speed up the healing process. I live in Norway where society covers most medical bills, so therefore the dermatologists have tons of clients to take care off, and very little time to consult with them to get the proper treatment aimed at them.
I use effaclar duo plus every night and effaclar H moisturizer in the morning as told by my dermatologist. My dermatologist haven't suggested me anything else, and now im just waiting for my laser treatment. Is there anything else I can do in the meantime to help it? What should my daily skin care routine be? I am also unsure about what kind of scars I have, but I think it's boxcar scars. Here are some photos of my scarring
Forehead:
IMG_0783.thumb.JPG.fc45af6fa931d267bdcf594070837a88.JPG

Left Temple:
IMG_0786.JPG.795f0a033d88a42eb4cedbe33211ecf6.JPG

Right temple:
IMG_0785.thumb.JPG.165b2fcf803d60bb0c5c399df239c8b8.JPG
Nose:

IMG_0784.thumb.JPG.49a74e82bc36115dfcab40feaedea185.JPG
(Sorry if these ain't the best photos, but the iphone 6 camera ain't the best. I can try take some better photos if it's needed)

As you can see, the scars are most severe on the temple area, and thats because I have very sensitive skin and my acne caused wounds in that area. These scars are really destroying my mental health, so please help me with some advice. Thanks for reading, I appreciate all advice.

 

IMG_0782.JPG

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2 hours ago, ProbableLorry said:

I was left with a lot of scars on my face, especially in the temple and forehead area.


The forehead and the temples are the hardest to treat. Your chance of improvement is very low. This is mainly due to low volume of collagen/fat. The more you have, like in the cheek, the better the outcome. So do keep that in mind and don't become too discouraged if you get less than expected.

 
2 hours ago, ProbableLorry said:

My dermatologist had me wait a year before laser treatment, and now I've completed 1 out of 3 treatments (6 months between each treatment) with co2 fractional laser.


With all due respect to your derm, but the use of laser is a poor choice for the forehead and the temple region. I would suggest getting these treatments in the following order:

1) Botox
2) Subcision using a cannula
3) Combination of Sculptra (for the temples) and Infini
(Note: 1 Sculptra injection suffices per Infini treatment. Sculptra needs to be injected 4 weeks prior to Infini. This is ony for the temples. HA filler should be used for the forehead.)

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^^ I didn't even think about the forehead being a tough place to heal, but that makes sense!

Have you ever tried a derma-roller? It has micro needles (doesn't hurt) that exfoliate the skin and trigger collagen production to fill in the scars. (It also helps the products you use - ie: BP - absorb better)

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22 hours ago, Sirius Lee said:

Thank you very much for the input! I do have a few questions about your adviced treatment plan if you don't mind answering. Do you think laser is that poor in my case that I should just cancel it, or should I continue it in addition to the treatment you recommended?

Im also very new to this forum so im a bit unsure about what all those things are, so where can I get those treatments? Are they commonly found in private clinics, or do I probably need to travel outside Norway to find a doctor who has the treatment? Also, will the results be permanent as I thought fillers like botox just gave temporary change?
And one last question. Do you think my scars are boxscars or a mix of different scars?
Thanks again for helping me out!
 
48 minutes ago, klessard said:

^^ I didn't even think about the forehead being a tough place to heal, but that makes sense!

Have you ever tried a derma-roller? It has micro needles (doesn't hurt) that exfoliate the skin and trigger collagen production to fill in the scars. (It also helps the products you use - ie: BP - absorb better)


I haven't tried that no, but I've heard of it. Is it safe to do it by yourself even though you have sensitive skin? I have been thinking about starting to exfoliate my skin so this might be a good option for it. Also, what do you mean with "BP". Im new here and don't know all the abbrevations yet.

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@ProbableLorry thank you for posting, welcome.

I would suggest starting with the FAQ - the very first post on this fourm - top of scar treatments. Goto the various sections.

What he is saying is the forehead is hard to treat because of vascularity (veins) and thinness of the skin (not as fatty like a cheek). You can get improvement but it will take many treatment, ... over time and cost money.

You are young and I know these things can be expensive and overwhelming. IF you want to DIY at home get a dermastamp or I recommend Derminator and stamp monthly between treatments. If you can afford it what Sirius is saying is rf microneedling is better and more effective for this type of scarring (this is instead of c02 laser - grids). There are many brands.

Subcision is hard to do here and many Dr's will not do it (veins) but that would also help. Have someone take a small needle and do standard subcision to try to work on some of the scars, ... we cannot really use filler safely here but PRP - growth factor from blood can be used, Dr Chu London does this and sub. Or Emil in Denmark.

You will need laser but I would not start here. I would do 3 courses of subcision first and consider at home stamping for a while or rf microneedling, then I would see how I do and move on to tca cross, and tca paint on (this goes in the bigger pits). I would finally do a few fully ablative erbium laser resurfacing for the texture, No grids. 

Do things when you have time and money - treat over year(s) as you save up. At home things can be done like dermastamping, peels, and nightly retin-a, tretinorin, or differin with some improvement. But it will take many treatments (not as effective as the other treatments ""only"" in this area).

No you do not want to use "BP" - Benzoyl peroxide on scars. Please tell every Dr you have sensitive skin, as tyou can have side effects. This is why manual methods like PRP and subcision are best first + Dermastamping/Derminator at home. 

There are lots of Drs in Norway but no specialist who treats acne scars that I can think of. Denmark is close to go see Dr Emil.

Regarding filler you are mistaken, ... this is not a beauty treatment, we are keeping scar from re-tethering, but this is not used in the forhead, prp is better here or saline or botox. 

BA

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8 hours ago, ProbableLorry said:

Do you think laser is that poor in my case that I should just cancel it, or should I continue it in addition to the treatment you recommended?


How scar revision should be approached is similar to road construction. You fill the potholes first and than repave the surface afterward, not the other way around. But with laser, you're essentially resurfacing the skin without first filling the pits. Not a good idea. I would definitely cancel the remaining treatments (for now). As already mentioned above, laser will come handy later. But concentrate on elevating the pits first.

 
8 hours ago, ProbableLorry said:

Im also very new to this forum so im a bit unsure about what all those things are, so where can I get those treatments? Are they commonly found in private clinics, or do I probably need to travel outside Norway to find a doctor who has the treatment? Also, will the results be permanent as I thought fillers like botox just gave temporary change?


As @beautifulambition mentioned, there are reputable doctors abroad who specialize in acne scar revision. However, there really is no need if you plan to get the procedures that I suggested. Botox and fillers (both Hyaluronic and Sculptra) are injected everywhere in the world, including Norway. Cannula is already widely used to inject those fillers. Radiofrequency devices, including Infini, will most likely be available in medspas. First, I would ask your dermatologist whether he or she would be willing to do subcision using a blunt-tip microcannula while injecting fillers. Also call medspas around you for RF devices. There are many RF devices besides Infini.

Will the results be permanent from Botox? No, Botox is used mainly to loosen up the years of sustained muscle contraction from the scars. This will, however, enhance the outcome from other treatment like subcision. How much collagen your body is able to produce will ultimately determine its sustainability.

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Hey, it's interesting because I was on accutane at 16-17 years old and I also have the exact same type of scars in the exact same areas of the face. I've searched for all the right treatments and along the way finding out what works and what doesn't work (which is A LOT of bs/useless treatments)

Knowing what I know now....

First, keep good hygiene, clean pillows, clean towels, use room temperature water and cold water when washing.

What I would do for a daily skin routine is:
- Use a daily face wash ( I use Clean & Clear Night Relaxing, it cleans but doesn't irritate my skin)
- Use a moisturizer for your face, & have an SPF moisturizer for the day time so you can protect your face from the sun (I use aveeno products, find one you like and stick to it)
- Use a retinol cream at night(there's a proper way to start by using it once a week and gradually build your way up)



I think using a retinol cream is the most important thing I would do in the mean time knowing what I know now. If I were to go see a professional, the only treatment I would seek is  subcision. I wouldn't waste my time having the office try to sell me something more.

I'm currently treating my own scars after seeing a professional.

Hey, good luck and be very patient like a tortoise. Live your life in the meantime. My scars have improved and your scars will too. 
 

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On 19.7.2018 at 4:31 AM, beautifulambition said:

 
Thanks for the thorough information, I just did some research on dr. Emil and I'll consider visiting him in the future. I will definitely inform my derm about laser being the wrong treatment for me to start with and cancel it.

I assume that effaclar duo + contains BP, and therefor I should switch to retin-a instead? (btw, is that something I need a prescription for, or can I just go ahead and buy it?)

I'll look into the manual things I can do at home and try start subcision treatment when I got more money.
Thanks again for the information, I really appreciate the help.
 
On 19.7.2018 at 9:34 PM, Sirius Lee said:

How scar revision should be approached is similar to road construction. You fill the potholes first and than repave the surface afterward, not the other way around. But with laser, you're essentially resurfacing the skin without first filling the pits. Not a good idea. I would definitely cancel the remaining treatments (for now). As already mentioned above, laser will come handy later. But concentrate on elevating the pits first.

 
As @beautifulambition mentioned, there are reputable doctors abroad who specialize in acne scar revision. However, there really is no need if you plan to get the procedures that I suggested. Botox and fillers (both Hyaluronic and Sculptra) are injected everywhere in the world, including Norway. Cannula is already widely used to inject those fillers. Radiofrequency devices, including Infini, will most likely be available in medspas. First, I would ask your dermatologist whether he or she would be willing to do subcision using a blunt-tip microcannula while injecting fillers. Also call medspas around you for RF devices. There are many RF devices besides Infini.

Will the results be permanent from Botox? No, Botox is used mainly to loosen up the years of sustained muscle contraction from the scars. This will, however, enhance the outcome from other treatment like subcision. How much collagen your body is able to produce will ultimately determine its sustainability.

What you say about laser makes a lot of sense and I'll definitely cancel my laser treatment as I mentioned earlier.
Hmm, your treatment plan seems a bit more bearable since im still in school and it might be possible to do it without travelling outside my country. I'll ask my derm if she offers that, otherwise I'll see if any private clinics offers it.
Sorry if this is a stupid question, but what is a medspa? Is it what it sounds like, a spa for medicine? If so I am not sure we have that in Norway.
Also, thank you for helping me out!

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On 19.7.2018 at 10:18 PM, Insearch said:

Hey, it's interesting because I was on accutane at 16-17 years old and I also have the exact same type of scars in the exact same areas of the face. I've searched for all the right treatments and along the way finding out what works and what doesn't work (which is A LOT of bs/useless treatments)

Knowing what I know now....

First, keep good hygiene, clean pillows, clean towels, use room temperature water and cold water when washing.

What I would do for a daily skin routine is:
- Use a daily face wash ( I use Clean & Clear Night Relaxing, it cleans but doesn't irritate my skin)
- Use a moisturizer for your face, & have an SPF moisturizer for the day time so you can protect your face from the sun (I use aveeno products, find one you like and stick to it)
- Use a retinol cream at night(there's a proper way to start by using it once a week and gradually build your way up)


I think using a retinol cream is the most important thing I would do in the mean time knowing what I know now. If I were to go see a professional, the only treatment I would seek is  subcision. I wouldn't waste my time having the office try to sell me something more.

I'm currently treating my own scars after seeing a professional.

Hey, good luck and be very patient like a tortoise. Live your life in the meantime. My scars have improved and your scars will too. 
 


First of all, happy to hear that someone in a similar situation as me has been able to improve, and good luck with further improvement. I am already quite consistent with keeping a good hygiene and such, but I'll definitely get even stricter.
I have a few questions if you don't mind answering
You use the cleanser at night, right? how often should I moisturize? Does the spf moisturizer replace sunscreen, even in the summertime, and does it matter much which one I choose, as my derm has recommended me a specific sunscreen to use for acne prone skin cause it doesn't clog the pores.

how strong is the retinol cream you use, and do you use it daily now, or is it too strong to use daily even after build up? Also, do you exfoliate your skin?

Thanks for your input!
  Edited by ProbableLorry

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17 hours ago, ProbableLorry said:

First of all, happy to hear that someone in a similar situation as me has been able to improve, and good luck with further improvement. I am already quite consistent with keeping a good hygiene and such, but I'll definitely get even stricter.
I have a few questions if you don't mind answering
You use the cleanser at night, right? how often should I moisturize? Does the spf moisturizer replace sunscreen, even in the summertime, and does it matter much which one I choose, as my derm has recommended me a specific sunscreen to use for acne prone skin cause it doesn't clog the pores.

how strong is the retinol cream you use, and do you use it daily now, or is it too strong to use daily even after build up? Also, do you exfoliate your skin?

Thanks for your input!
 

No problem, that's good to hear about your hygiene. I was never good at that until recently.
Yeh, I use my cleanser day and night and whenever I need to wash up. During and after accutane I had really dry skin so I used moisturizer day and night as well.
I use the regular aveeno daily moisturizer for my body and face at night and I use the SPF 15 one on my face only when I'm out and about. I don't think it matters which one you use but I like aveeno spf 15 since it doesn't make my face look greasy. 

As for retinol cream, I use the .025% cream at night and it's twice a week. I'm still working on building up to use it more often. I don't intentionally try to exfoliate my skin anymore unless I feel like there's a lot of buildup.

I do OCM(oil cleansing method) with SnowWood mineral oil since I get a lot of sebum filaments on my pores especially my nose area and after I do that is when I sometimes take a microfiber towel and wipe my face to exfoliate before using a cleanser.

I'll keep you updated on scar treatments since we have the same scars in the same areas. Right now I'm treating my temple areas and one side is 70% improved already even after the swelling has come down. The other side where I have a lot of pitted scars needs more treatments. Then I'll have to focus on my forehead and cheeks. I want to post pictures when I get 90-100% permanent improvement. Looking back I can see how a retinol cream would have helped if I had used it from the start, which is why I recommend it to you. 
  Edited by Insearch

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