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superburrito

My acne scars treatment journey: Infini with Dr Weiner and CROSS/Subcision/Microneedling with Dr Rullan [pics!]

Hey all! Newbie here, but nice to meet y'all. I'm embarking on a new journey to improve my scars. I thought I'd start a thread to document my process. I'll my best to keep it updated. I'm hoping my experience helps you in some way.

My scars
I've had some form of scarring for most of my life. First, I have linear scars caused by someone who scratched up my face when I was a kid with long fingernails. Yep, childhood sucks. Second, I have mild to moderately depresses scars from adult acne during early 20s. You're all acne survivors, so I don't need to tell you how much acne sucks. Okay, I'm sure you want photos, so I've attached photos of different angles, that I took recently in one session. These were taken at the request of a doctor for a virtual consultation.

Quick bio
Male, Mid 30s,
Southeast asian, Fitzpatrick IV skin type
Based in San Francisco Area

What treatments have I tried so far?
In my 20s, I tried several rounds of microdermabrasion and a chemical peel to treat my linear scars. It did nothing, except trigger my my adult acne, resulting in more scarring. I had been acne-free before then. Early this year in 2018, I went through three rounds of Sublative RF at a local medspa. The machine used was by Syneron, and a precursor to eMatrix. Overall, this helped to even out my complexion and hyperpigmentation, and it softened the scars ever so slightly.

What doctors have I talked to recently?

Los Angeles
I recently had a consultation with a well-known (and well-marketed) aesthetic dermatologist in Los Angeles. When I received the treatment plan and price quote, I was flabbergasted. The first session involved multiple lasers, a peel, subcision, PRP, Bellafill, TCA Cross, and several hundreds worth of creams. The total for this session was nearly $8000. This plan was just too aggressive for me, both in the number procedures and in the price.

Florida
Like many of you, I follow Dr Dreamy Davin Lim on social media (that accent amirite?), and I've learned a lot about acne scarring. Australia is too far for me to travel, but his website mentions Dr Steven Weiner in Florida. So I emailed him, and he suggested a draft treatment plan of Infini RF, TCA Cross, Bellafill (includes subcision). The ballpark price was much more reasonable to me. Most of his pricing is right on his web page, too. I also see that Dr Lim is a fan of Infini, especially for darker skin tones. So overall, Dr Weiner's plan resonated better me. I also liked that Dr Weiner said he'd have to see me in person to give an exact treatment plan and pricing.

San Diego
Today, I contacted Dr Rullan's office, at the recommendation of @beautifulambition. I am still waiting to hear back from them on suggested treatments. But I know that he specializes in subcision, Phenol CROSS, and peels. I see that many people in the forums here are happy with his results.

What's next?
I have an appointment with Dr Weiner's office next week for Infini RF + PRP. His wife, Sandy, performs the procedure and has a lot of experience with it. I'm pumped but tempering my expectations! I have my flights and hotel booked, and will be taking a couple of days off work to recover.

What's next next?
I had already booked my appointment and flights for Dr Weiner, before learning about Dr Rullan, so it's a bit too late for me to change those plans. But thanks to advice from @beautifulambition, I am now considering treatment with Dr Rullan. I hope to see him in November for subcision and Phenol CROSS, if he thinks those are good options for me. San Diego is also way more convenient for me.

Well, that's all for now. Hope to provide an update soon.
 

4up.jpg

Edited by superburrito
More detail in the title

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I heard back from Dr Rullan this morning, and, so far, he recommends CROSS + microneedling, and possibly some minor subcision. He'll need to make a final determination in person. I have booked an appointment for mid-November. Amy, their aesthetic coordinator, was fantastic to communicate with by email and phone. So far, I have a great impression of the clinic.

Edited by superburrito

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@Vidrar, it's not quoted with a price on his website, but he does mention it in his blog here:

https://stevenfweinermd.wordpress.com/2015/05/24/state-of-the-art-in-acne-scar-treatment-2015/

He also emailed directly to let me know that he does it as part of Bellafill, and it's included in the pricing of the filler. But he also said he can do subcision without Bellafill.

Hope that helps!

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Thanks for all the detail, I’m super interested to follow your journey. I’m in the Bay Area too and haven’t been to find anyone who specializes in scarring here. Was thinking of contacting (likely the same) heavily marketed dermatologist in LA so it’s good to know what kind of treatment plan he goes with. 8k is a bit much for me; I’m hoping to keep this more in the ballpark of 3-4K over time. Anyway, good luck to you! And for what it’s worth, I don’t think your scars look very noticeable! 

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Thank you, @Suze428! Good luck to you as well on your journey!

Yes, this doctor in LA gave me a very aggressive treatment plan with multiple procedures all at once. Note, that the nearly $8k he quoted only covers the first session of treatments. So subsequent treatments would be additional, although not all of the procedures would have to be repeated. The doctor estimated 3-5 sessions needed total. When I calculated it all, it ended up being about $15k at the minimum for the full course of treatments. Not including airfare/hotels. I also paid $250 for the consultation, which I won't get back.

I do feel lucky that my scars appear relatively shallow in many lighting conditions. In other lighting, they look a bit worse. Overall, I'm looking to treat some of the linear and icepick/boxcar scars and even out the overall texture a bit. So I ended up going with a less aggressive treatment plan, and neither Dr Rullan nor Dr Weiner has made a hard sell so far.

I'll do my best to post updates!

 

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Dr Weiner is ethical. He was taught by Lim to do Cannular subcsion with saline buffer .The only thing that concerns me with Weiner is that he uses Bellafill (however he test spots first- this reduces but not eliminates the side effects). Using HA filler as a buffer is safer, but Weiner knows what he is doing. Rest assured you are in good hands with ethical Specialists with experience who treat you with respect and do not up sell. As for the LA Dermatologist, to be politically correct, he is one classic example of up selling and up sizing, his fundamental training in procedural dermatology is good, but the ethics - greed is in question. If you want fake abs, and have 40K to spare... possible see him. He has a brilliant marketing team behind him. 

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Thanks for the extra caution on Bellafill! Indeed, it is scary, and I will definitely not be doing it as a first treatment, if at all ever. This will be a last resort for me, if nothing else works.

Also for my appointment with Dr Weiner next week, since it is my first time seeing him, there is no option to do Bellafill atall, since he requires an allergy test before he will treat acne scars with Bellafill. I will only be doing Infini + PRP.

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Guest

I have seen great results from Bellafill (not from myself) in people that did it.  It is virtually impossible for Bellafill to migrate after 3 months because the PMMA spheres become intertwined with your collagen and are held in place. This is a consensus among many of the doctors I spoke to. The only way for Bellafill to migrate is if you constantly touch your face or sleep on your sides after it is injected.  Silicon is another story because your body tends to build a film around it instead of collagen.  The FDA approval process is very rigorous and the vast majority (90%+) are happy with Bellafill.  The FDA would not approve it if it constantly migrated all over the place. 

With that being said it is a permanent fill and therefore I recommend you go to a doctor with 10+ years of experience.

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That was a study 15 years ago.  Artecoll and Artefill were older formulations.  It is 2018 and Bellafill has a different formulation than Artecoll and Artefill which caused some problems.  I am merely passing on what several doctors I saw have told me.  Doctors do allergy tests for Bellafill for a reason. Also, a vast majority of granulomas can be dealt with a simple steroid shot.  Please actually share studies instead of quoting random numbers from God knows where.  Most people who work in the industry prefer not to say good things about permanent fillers because it hurts their revenue when patients don't come back for their weekly juvederm shot.  I don't know why you feel you are suddenly so much smarter than me but I am a biochemistry graduate student at a top university.  What are your qualifications?  I thought this was an open forum for discussion not your personal soapbox.

Bellafill's 5 year study had a 1.7 percent granuloma rate.  Of these, half came from one facility (poor injection technique).  HA acid fillers have a similar granuloma/ infection rate and they are rarely studied for more than two years.  PMMA fillers have been studied for long periods of time.  Of these granulomas, a majority respond to steroid injections.  That leaves less than a percentage granuloma from actual poor injections.  HA fillers carry these same risks.  I have seen several people go blind or get disfigured as a result of HA fillers on the news.  Worst comes to worse you can get bellafill excised because unlike silicone it cannot migrate into bloodstream.  You already have a scar there anyway.

Edited by Guest

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Guest

When did I say I work in the industry? I never did.  You're reading comprehension needs work I said I was a graduate student in Biochemistry so I know how to read medical studies and make a conclusion because it's what I do for a living.  So if my grandpa has a pacemaker in his heart that's bad because it's not in the body naturally?  What about my grandmother with a metal hip?  It is you that have provided nothing concrete.  Show me a study that shows permanent fillers cause permanent granulomas that aren't caused by poor injection technique or that cannot be fixed by steroid injections.  There are plenty of studies that suggests permanent fillers carry the same risk in comparison to non permanent fillers.  There are people who go blind from HA fillers that are injected improperly.  LOL at you telling me to contact another doctor to find a statement that backs up what you say.  90% of your advice is get subcision and filler.  It doesn't take a magician to suggest that buddy.  You clearly have some sort of inferior complex if you are this threatened by an opposing viewpoint.  

You're asking me to disprove that permanent fillers cause problems.  That doesn't make any sense from a scientific viewpoint.  Why don't you instead prove that permanent fillers cause problems.  That's like saying God is real because I can't disprove it.

Ok LOL.  First of all that study (nasolabial folds) had 1000 people?  Even a study with 30 people can be considered accurate in medicine because it creates a normal distribution.  You clearly don't know much about medical studies or statistics.  Would you please be so kind to explain how this study is cherry picked or not accurate.  As a graduate students who reads papers like this daily FOR A GRADE  I would love to know your opinion.

TCA cross has a risk of causing more scarring.  So does subcision.  So does micro needling.  Does that mean we don't do them? No we take the chance because for most people it helps.  For you to automatically disregard permanent fillers for all people is wrong and spreading false info. Edited by Guest

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My knowledge of Bellafill's history is certainly naive, but I did find a recent academic paper on the subject from June 2018. Here is a link the abstract, and I have pasted the result portion below:

https://www.ncbi.nlm.nih.gov/pubmed/29602240
 

 

Quote

 

RESULTS:

The process of manufacturing and purifying PMMA has played a major role in minimizing adverse events for Bellafill. Postmarketing surveillance data for the 2007-2016 period show that for more than 530 000 Bellafill syringes distributed worldwide, 11 confirmed granulomas (excluding clinical trial data) (0.002% of syringes sold) have been reported. Data on other PMMA fillers are limited and inconsistent. The authors suggest that adverse events are often attributable to lack of proficiency in treatment technique and other factors.

 


The evidence suggests that the latest incarnation of Bellafill is indeed safer than previous versions. But does this mean it is risk-free? Of course there will always be a risk, and it's up to the patient to stay educated and weigh the trade-offs. For me right now, even though the latest version has reduced risk, my reservations for Bellafill have definitely grown because it's irreversible, and that's a pretty big commitment.

One other big reason is simply the cost. One "famous" doctor in Los Angeles quoted me $1300 per syringe. And he claims that Bellafill will actually get absorbed over time. He also claims that if you look under a microscope, it will looks just like skin cells. I have a really hard time believing that plastic will turn into skin. Is this alchemy? (Though I do understand that Bellafill creates a "scaffold" for skin to grow around). I will NOT be getting treated my this LA doctor. I have to remind myself that medical professionals in this field are also business people, and there is of course augments their motivation behind the treatments they propose.

Again, I'm not ruling out Bellafill at all as an option for me down the line. I'll first wait to see the effectiveness of Infini RF + PRP, Phenol CROSS, subcision, and microneedling on my scars. If do end up going for Bellafill, it will be with a thoroughly vetted, ethical, trustworthy doctor. From what I can tell Dr Weiner is pro at this, and Dr Rullan as well. If I was in Australia, I'd seek out Dr Davin Lim for advice as well!




 

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@superburrito Thanks for starting this thread - look fwd to seeing your progress! Dr. Rullan is very kind, and his team is great. You will be in good hands

I also know who you guys are talking about in LA, and I had the same experience. Super overpriced consultation, and just a weird vibe where the dr was late and then rushed out in 10 mins, I just felt like a commodity. And random people came into the room to sell me products afterwards... it felt like a scam end to end.

Curious though, why are folks unwilling to say his name? Is it like voldEMoERt or something lol?

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@grandor I've noticed that his name is redacted in other posts, so I'm staying with this He Who Must Not Be Named trend, haha. I also remember that the contract I signed before the consultation had a bunch of legalese in it. I can't be bothered to reread it, but I didn't want to be in violation of some random clause.

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Because his team of marketers are constantly on the lookout for any negative reviews.  He's been named directly in the past, but they were scrubbed.   He probably sent a cease and desist to Acne.org.  Any one who's been around this forum for a while all know He Who Shall Not Be named is... 

As for BellaFill, I am very familiar with this product and so I'll clarify some things.   

Artecoll was the very first PMMA filler, and that one was indeed a different formulation.  After Artecoll had a lot of negative outcomes, they reformulated it and the 2nd generation PMMA filler Artefill was introduced.   The company actually went bankrupt and then were bought by another.   The new owners rebranded Artefill and called it BellaFill.   This was done specifically to disassociate from all the bad press from the first and second generation products Artecoll and Artefill.  Bellafill is the EXACT same formulation as it's most recent  predecessor Artefill. 

Another point that needs to be made -  Bellafill is PERMANENT.   Do not let anyone tell you it only lasts 5 years.  That is FALSE.  They can only legally say 5 years because that's when they ended the studies, so legally they can only say 5 years of longevity.   But the company knows that the product is permanent.   It is composed of acrylic beads that will never be degraded in the body.  

That said, between Silikon and Bellafill, the latter is a safer choice because it is specifically approved for injection into human skin.   And by most accounts, Bellafill responds to steroid injections if they do cause granulomas.  Silikon does not respond well to cortisone. 

Edited by dazzed

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Hi all, I just had my first treatment with Dr Steven Weiner in Florida, and wanted to share my experience. Overall, it was a fantastic experience with a spotless office and a very warm, welcoming, and professional staff.

Getting to Florida
I'm based in California, so no direct flights are available to Dr Weiner's clinic in Santa Rosa Beach, Florida. The area has two airports, Panama City (ECP) and Destin-Fort Walton Beach (VPS). I originally booked for ECP, but changed it to VPS, because Destin had accommodations with nearby and walkable restaurants and supermarkets. I do not drive so this was important to me. I first flew into Dallas, which took about three and half hours. Then a two hour flight to Destin. Having the connecting flight actually helped, because I was able to get up and stretch my legs between flights.

Transportation
As far as I can tell, the area has no taxis. I got around via Lyft / Uber. Drivers are friendly, and no issues so far.

The clinic
The Aesthetic Clinique is immaculately clean and professional.

The staff
Everyone who worked there was friendly and accommodating. I felt very cared for, and it was really cool to see that everyone got a long and had fun working there

Intake
When I arrived, I was greeted by the warm staff, and was given some water and an iPad to fill out the intake forms. Yay for paperless! I then met Sandy, who was wonderful, and helped explained the process. She also took a couple of sets of photos with a professional camera system that would be stored in the cloud securely. Impressively, I had no wait times, because they do not doublebook clients, unlike most other clinics.

Consultation
Afterwards, Sandy took me to see Dr Weiner for the consultation. Both Sandy and Dr Weiner were present for this part. Dr Weiner looked very carefully at my face in angled lightning, and also stretched parts of it to see what types of scarring I had. He said that I mostly had superficial scarring, boxcars and icepicks. As we talked, Sandy applied the topical numbing cream to my face. Dr Weiner felt that Infini and CROSS were my best options. For Infini, they would only do the parts of my face with scarring, rather than the entire face. Also he said that subcision is not needed for me, because I don't really have rolling scars. Interestingly, he said I might not need Bellafill at all, but that he'll do a skin test on me anyway. The main areas that might need Bellafill are the parts with volume loss in the deeper linear scars. Even though, he is one of the top Bellafill providers, he did not push or try to sell me on it. I decided to proceed with Infini + PRP, and held off on CROSS, because I'm concerned about hyperpigmentation (I have to be in front of a lot of people over the next few weeks). He was totally fine with that. Overall, I really appreciated the more conservative approach. He nor Sandy pushed for aggressive treatments, unlike He Who Must Not Be Named in Los Angeles.

Notes of interest
I asked Dr Weiner his thoughts on Intensif RF and also on Erbium lasers. With Intensif RF, he says the device does not use insulated needs. Which for my skin, means higher risk of hyperpigmentation. He also says Intensif actually has a design flaw, where the needle mechanism isn't even deep enough to penetrate the skin enough, which is why people find the device more tolerable. With Erbium, he says the risk of hyperpigmentation is very high with it, and does not recommend right now for me. But that it would be a last resort if Infini RF doesn't work.

Pre-treatment
I sat in the lounge for about an hour for the numbing cream to absorb. After that, Sandy took me in to sign consent forms, and thoroughly reviewed the treatments with me. She also gave me post-treatment instructions to take home with me, along with samples of an aftercare cream to apply to my face. Next, I was taken to get blood drawn for PRP. 

Treatment: Infini RF
After the blood draw, I was taken to the treatment room where my face was cleaned with alcohol. I was given a vibrating massage toy to hold in my hand and place on my thigh. This was to help distract me from the pain. I was also given a hose to spray cool air on my face as Sandy used the device. Sandy did two passes on my face. The first pass was intense but manageable. On a scale of 1-10 in pain, I'd say it was a 4. I did tear up a little. The second pass was much much more tolerable, which was a relief. The Infini part took about 20 minutes, though I didn't time it.

Treatment: PRP
After the Infini RF, they put a paper mask on me and covered my face in PRP. This was left on for about half an hour to absorb. Even though this was an added expense, I decided to do it to speed healing time, because I will be in front of people soon, and need all the help I can get to heal faster. During this time, they also did the Bellafill skin test on my arm. Btw, Dr Davin Lim did a video on PRP recently here:



Treatment: Healite
After the PRP mask was removed, I was put under a red LED light called Healite for 17 minutes. This was complimentary and also meant to help with healing. It was painless and had a pleasant warm sensation.

Overall time and wrapping up
I arrived a little before 12:30pm and left at 4:30pm. After today's treatments, no one pushed me on any products or further treatments. I met with the office crew to pay for my treatments, and I was done!

Going back to the hotel
I was nervous about calling a Lyft to get back to the hotel, but the driver didn't bat an eye when picking me up or during the ride. I basically looked like I had a sunburn, and in this area, I suppose it must be fairly common.

Overall experience
This is one of the best experiences I've ever had a clinic. I was impressed by the thoroughness and everyone's good nature. The facilities were absolutely clean, organized, and professional-looking. Everyone was thorough, respectable, and personable.


Here's a photo about an hour after treatment. Some of the redness is from the PRP liquid, which is a red color. I was told to leave it on and not wash my face until the morning.

The overall redness and swelling is already coming down for me since I took the photo. (Everyone heals differently, and I generally don't swell too much with injuries.)

infini_day_1.jpg

Edited by superburrito

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This morning, I woke up and washed the PRP off my face as recommended. I also washed off the small amount of dried blood that was at a few of the sites where PRP was injected. Because the PRP was red colored, washing it off reduced the appearance of redness greatly. 

I am still slightly swollen, but I was able to get breakfast at a crowded restaurant without anyone staring at all. And I was able to have a bit of small talk with the guy sitting next to me at the communal table. At this point, it just looks like I have a mild sunburn. I do have a few patches of light brown crusting from where the Infini needles entered my skin, but I don’t think it’s noticeable from afar. It helps that I have brown skin. 

All in all, this has been so much better than when I had sublative RF earlier this year, which left me with very noticeable little brown scabs for a few days. 

I’m making sure to set realistic expectations and don’t expect dramatic improvements with one treatment. My main goal with this first treatment was to make sure I can tolerate Infini RF and heal from the treatment without any complications. So far, everything is looking good, and I’m glad I can be in public after the procedure!

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Hi all, it has been almost 48 hours since my Infini RF + PRP treatment at Dr Weiner's office in Florida. I am now back in California, and the redness has gone down considerably. It's now barely visible. I still have some minimal swelling and some patches of brown grid marks.

I know everyone heals differently, but I'm so very glad that the down time has been minimal with Infini RF. So far, this looks like something I can do on a Friday, and be back at work on Monday without any issues.

I'm looking forward to my next treatment in November in San Diego to see Dr Rullan, which will mainly be CROSS.

Edited by superburrito

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It has been about 72 hours since my Infini RF + PRP treatment. Redness and swelling continues to come down. For those that wear makeup, I imagine this would be pretty easy to coverup.

Brown grid marks are still present in places, but starting to flake off. They'll likely all come off when I shave next. Overall, skin is healing nicely and looks like a very mild sunburn.
 

infini_day_3.jpg

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Hi all, it's been one more day, and I am back at work. The swelling, redness, and brown grid marks are pretty much gone. You'd only notice if looking closely. I'm very to see how my skin looks over the next weeks and months. But I have realistic expectations, since I only did one treatment of Infini RF.

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