You have pinkish spots on your cheeks, have you had procedures done on you before?

@neofoxSo I can better help you what is your main concern with your skin. There are multiple things going on here. Also what have you tried previously? I see scarred pores, papuals, minor box cars (textural), icepicks.

I don't see any major fat loss.

For icepicks they can do tca cross and for the chicken pox or box car bigger scars do paint on or spot tca to the individual pits.

This case reminds me of your case. He had multi pass co2 3-7% density and the highest power. I would also do a few picosure sessions for your skin discoloration issues.

OR

Another metod is the case study with your skin type, ...goto the faq, then case study link toward top (proof), then find the case study where they had a skin type similar to yours.

Thank you for you time and you respond , good video but we dont know the result of this procedure
Sorry this all skills i have try:
-5 infini radiofrequency
-3 fraxel laser
-4 microneedling (sometime with peels prxt33)
-2 tca cross
-1 erbium
-1laser qswitch
-1 laser nd yag
-X vi peel and other peeling
- 5 Led
-1filler restylane
-test dermabrasion on forehead
-test excision ( bad idea)
I think people will laugh when he see all procedure i have done for light improvement

IF you tried all the above ^ and had zero improvement. You have either a healing issue or auto-immune condition going on where your skin constantly scars. If a test dermabrasion, all that laser, etc... didn't work, I don't see what would as your skin is not responsive to treatments. It seems laser and resurfacing did nothing for you. I do see plaquing and papual issues of the skin. There are no deep pits per say. Your biggest issue is color irregularity PIE / PIH. Have you tried several sessions of picosure. Has your Dr given you any steroid / prescriptions? Any health issues?

This could be something like "follicular macular or perifollicular elastolysis," which is not related to acne scars per say but fibrosis.

You can try cannular subcision with prp for healing.

Perhaps we can get @Obi wanto recommend something as well for this complicated case.

I see just little improvement in some area , but not in the two area arround my nose...
the problem is half of the skills have done , by unexpericence dermatologist scar not expert , they just have device and they never try this before (for exemple infini , it was first time he do in dark skin so the setting was not good maybe, fraxel laser need more session than 3 to have result but its to expensive )
i have done my last treatment 16july, erbium,qswitch,tca cross... and use cicalfate in the scars
cannula subscion? Which area?

Hi Neofox, I would get recommendation from more than your current dermatologist (2nd opinions). I feel this could be causing you issue. They are not specialized with scars and "trying"" things on you which could cause your skin more harm than good. I also do not feel this is traditional acne scarring, from the condition of the skin. There has been over treatment done here (treatments that destroy the skin). Do things to heal & regenerate the skin. Have you been checked for fungal infection?

Have you tried castor oil and comfrey which are healing and Over the Counter.

The reason I said prp with subcision is there are minor pits and prp stimulates healing. Or they can do injections.

You may be past the curve of those who are susceptible to treatments. IT's time we step back, see the condition of the skin, and heal the damage without creating more.

Perhaps @Obi wanCan take a look at this complicated situation with "another" set of fresh eyes.

Thank you for you message
no never check infection fungial ( each time i see a doctor they never said you have infection..
nop never try the two product only castor oil for beard
you are right its time to heal the skin
so every tonight i will put a little castor oil in my skin
thanks

Have you tried regularly applying retinoids and glycolic acid? I've had great results with regular use of tretinoin on the texture of my skin and pores. They also used to have a rough quality, not dissimilar to your situation.

11 hours ago, Raster said:

Have you tried regularly applying retinoids and glycolic acid? I've had great results with regular use of tretinoin on the texture of my skin and pores. They also used to have a rough quality, not dissimilar to your situation.

Yes i have try mene et moy 30% acide glycolique and dermaceutic retinol 1.0 its no go deep scars , and after 3 mouth the skin feels old and tight.
i cannot put everthing sometimes aloe vera, retinol,aha , now castor oil ... its difficult ahah

Ok the war is finish
so anyone have pumps after put in a face the castor oil

Anyone are recommended product peeling like acid mandelic or pyruvic or other for skin color, texture , pore

@neofoxask @Rasterhe said he has similar skin and similar conditions to yours. He did peels that worked above ^.

With respect, you have had too many 'trial and error' treatments. See your left cheek - subtle hypo pigmentation. Its NOT the treatment, but how its performed, namely treatment is one thing, but the person behind it makes the biggest improvement or difference. Looking at your pictures, there is no denying this is a hard case. A good specialist will see what is going on under your skin. We can see- visualise what is on skin, and like BA says, you do have textural changes. My suggestion is a trial of saline subcision to see what releases - and combine this with low density CO2 laser. Wait 6-8 weeks in between sessions, add topical retinoids 1 week post laser. Do this 3-4 times then repost. Remember the subcision will tell us what is going on under your skin. A good specialist will 'scrape' the dermal layer. This does a few things -1. breaks any bonds that hold your scars down 2. Manually stimulate collagen remodelling and initiate a cascade of scar remodelling. 2 entry points, 22 G Cannular with 2-3 mls of saline can cover one cheek. I think in your case 70% improvement can be achieved but over 18 months. Pick scars, linear scars- TCA CROSS, and I do agree with PICO in your skin type.

I wonder i what timeframe the treatments were done?

Can you recommend a specialiste? I can pay the price , i see three time dr Emil , for the next treatment , he recommend an agressive erbium, should i accept or see an other expert?

Hi @neofox,

I see fivepossible solutions here:

1) Have Emil contact Dr Lim to discuss your treatment. He has said on Realself ("I believe") he's willing to help other Acne Scar Specialists.

2) Show Emil Obi Wan's recommendation and have him follow this protocol.

3) Your willing to "pay the price," Fly to AUS and be treated by Lim.

4) Have you considered seeing Dr Chu as well for a second opinion. Or other plastic surgeon's who specialize in your skin type for another opinion.Bring along what Obi Wan Said as a recommendation.

5) Do nothing.

I would not do anymore erbium laser (this is for the end of treatment)...at this point,I don't see it beneficial to your treatment "currently," follow Obi Wan's subcision (optional CO2) trial recommendation above ^. Picosure is different as it's for pigment issues not texture. Your case is "very" complicated at this point with so many treatments. This is why a trial of treatment was proposed ^, to see how your skin reacts and you heal.

Hi @beautifulambition
thank you for you recommendation,
i have question How Obi wan he know lot of skills about expert acne scaring ? if I show this the doc can say who is this guy he is doctor! No?
Its just question , no bad things
who is prof chu? I dont found review about him
thank you

@neofox
You must be treated by a Dr and I gave a few recommendations above. If you have any doubts post on realself.com (it's free) and get the advice of Drs. Please be aware much of this advice is standardized and not specialized to scars or your needs, sometimes Dr Lim responds there. I also advise people to get 2-3 consultations even if you have to pay or do not go with the provider (plastic surgeons or dermatologists) for your acne scars, this will make sure your secure with the care you receive.

Dr Chu or Professor Chu, is a Dermatologist in London, he taught Dr Emil and hundreds of other Derms. He does not believe in lots of laser or filler,... his costs are very cheap for sub/tca-cross/microneedling/prp ... This is the standard package he does. Emil has taken his training with further treatments.... and also does things like laser and other aesthetics procedures. It's very tough to find acne scar specialized providers in Europe.

Thanks a lot my friend , How many times do you recommend between each treatment ?1 mouth or 3 mouth?

Chu or Emil ... will say 1 month apart. I would do 3 months (... tell them I will call back to schedule). I would try out Chu, prp could be very beneficial to you over time with the subcision. Again he does not do picosure or resurfacing, ... you could do that elsewhere or locally.

The body is exceptionally slow to heal.

Hey be back ! Im gone try a session with Emil , i will update when its over

Hi guys !! Its new update after a procedure by Emil with tca cross , laser Co2 (high power , lower density) and mixed of subcsion , cannula and filler .

this is not perfect but a real improvement , i will continue a treatment with him,

i havee in you proof, @beautifulambition that a combination of tca and microneedling can help me ? 

I never do a tca peeling ( only tca cross)

@neofoxI don't know what you mean by this can you clarify : " I havee in you proof,@beautifulambitionthat a combination of tca and microneedling can help me ? I never do a tca peeling ( only tca cross)." We don't just do one procedure, ... have to do a few. You are being treated by Emil now, what does he say is next.

BA

Sorry about this case

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996784/figure/F4/

I will see Emil in march for the same treatment