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captainplanet

Ugly all my life - and getting uglier with age with wrinkles and scars now (labelled pics attached)

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For the first time in my life, I feel slightly more financially stable, and want to do more for my scars. My bucketlist wish is to die with somewhat smooth skin, like the 'afters' in the gallery here. Possible?

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Pls see pics below.

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2016:
Did TCA peel using MUAC. I had a 12.5%, which I layered two or three times max. To my shock and horror, my skin seemed to collapse. In one area, a large crater of 0.5cm and a few mm deep developed. Luckily after a month, this shrunk a little but still noticeable (see pic). Then, a long linear scar developed across between my eyebrows! Threw out the peel.

I don't know if it's the TCA peel but subsequently, I developed: hypertrophic scars (small, raised, hard colourless bumps), and maybe a facial wart (larger, brown, raised bump).

2017:
I went for 3 sessions of RF microneedling using Intensif. My doc also did some quick subcision. By my second session, I saw 50% improvement on the extreme sides of my cheeks.
I then had some fillers and Botox as I have terrible nasolabial folds and even my lips are flattening out with wrinkles. This probably shows how deficient my system is.

2018:
5 weeks ago, I went for Infini RF, inspired by Davin Lim's videos and success stories here. No results yet.

I thought I could overlook my scars, but as wrinkles, collagen loss take place, I'm getting uglier by the day.

If you look at my history, I have grown old with acne.org. I go through periods feeling ok, but in recent years, I've noticed I'm ageing terribly as now my face not only has scars but wrinkles too. This is really putting a ...dent...in my esteem.   
This community has evolved a lot since I started browsing this page, and I would very much appreciate knowledgeable members to give a helping hand here. @beautifulambition
Thank you!Slide1.thumb.JPG.4a3973a2852c1d53e27042e7c8f249b3.JPGSlide2.thumb.JPG.b17d7b2e04671c8fe7af7c3c92829c9e.JPGSlide3.thumb.JPG.8abcd1c4f1d2c61b6a768a7883e77cbc.JPG

Edited by usherer
Couldn't add pics initially

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Hi there,

Your scars are severe as you know. I suspect you have sensitive skin. Something bacterial, or heal poorly hence the MUAC. AS you know any time we do a peel or procedure we open our skin up to opportunistic bacteria. Your skin was not having the peel. Good to know. Please be under the care of a DR who can support you, as it sounds like you have one currently or find another if they are not effective enough in your care. 

This isn't a one and done sort of situation. We need to do ongoing treatments as you have heavy scars. Many treat over 3 years. Everything I say is optional, treat as you have time and money. Allow 3 months between treatments. 

***** You heavily need more sessions of cannular subcision. In your case we are talking 4 or more sessions. I would possibly inject overly dilute sculptra throughout your whole area of scarring deeply. CO2 or RF needling will stimulate collagen growth.

We also need to do some laser work to break up all those scars (fibrotic). I don't think RF needling will be enough. Consider co2 laser (just to the scars).

I would not have applied a peel to you, but instead done individual paint on also called spot peels (for more on this see the faq - top post of the acne scar sub, acid section, mega post link, paint on) ... some Drs also call it tca cross inside the box car scarbed floor. If you have a fear about this do a test spot on some pits and see if they raise up.

Finally I would do a erbium fully ablative resurfacing as you have widespread scars, ... we have to raise them first as much as possible. 

Yes scars age you prematurely.  Some have auto immune like conditions that make them loose their fat. You counteract this with filler 1-2 a year. This will hide some of the scars too with enough volume to the cheeks. Perhaps your prone to hypertophic (raised) scarring post procedure, ... let your dr know about the peel and what happened. 


There is hope, ... just don't expect glass smooth skin. Subicsion will help a lot. You got 50% one procedure, ... see that is a good result.

Buy a derminator or dermastamp and stamp the skin between Dr treatments. 

Use tretinorin or differin nightly with a konjac and albutin cream.

BA

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If you want to become aggressive then jump to Fraxel Repair.  It is an ablative CO2 laser that penetrates to a depth of about 1.2-1.4 CM.  Your scars don't go that deep.  It is almost impossible to get good information on Fraxel Repair because everybody keeps diverting to the non-ablative Fraxel Restore just because it has little down time.  Little Down Time = Little Results.  If you hear someone just saying Fraxel just walk away.  If they don't say Repair you don't want it.  I have been the biggest advocate of Fraxel Repair for a long time, and if you look at my signature you will see that I have done it 5 times at the highest settings.  It was the best thing I ever did, and everything else I tried was a total waste of time and money.  You must be treated at high megajoule or don't do it at all.  I did 70 mj, but a lot of doctors want to dial it down to 40 mj and that just does not work.  I actually just found my old Laser Links - a lot will probably be outdated because I did this almost 9 years ago.  I tried to delete the link below with no success.
I don't discuss the treatments BeautifulAmbition speaks of above, because frankly I have been out of the game for a while and I am not up to date on what he mentions.  He is certainly well informed.  I am an Old Fart now at 71, and I am going for a facelift in Costa Rica in January with Dr. Lev.

Edit By MOD: Posted repeated link - Advertising to Dr

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@beautifulambition, thanks for your quick response. It was very late in Australia by then, so I could only reply now. I've embarked on a search for cannula subcision in Melbourne. Regarding your suggestions, here's my responses for what it's worth:
Sculptra, CO2 laser - Will look into it
Spot peels - Too scarred (metaphorically and literally) by the TCA experience to want to consider it at this point. 
Erbium - Worried about side-effects and downtime. Will consider the fractional lasers as a substitute
Fillers - Have been thinking about it as my skin is also wrinkled and dehyrdated. I also want to get Botox. Will get these done after 2 subcision sessions, as I read your advice in the forum that the fillers, if injected in shallow scars, will be affected, so best to do Infini/subcisions before them.
Dermastamping - Did that for four years (forgot to include above) when I was trying to save money and wanted to do something about scars. I couldn't tell if there was any impact. Who knows..maybe my skin would have been even worse by now without it? 
Differin - Effective for when I had pimples, but no impact thereafter
Kojic and arbutin - Using a kojic soap now. Any recommendations for products?

@DudleyDoRight Thanks for sharing your experience! I will consider Fraxel - but I can't afford the Repair treatment, and its recovery time needed. I will look into other Fraxel treatments!

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Usherer, do not do anything but Fraxel Repair - Restore and Dual are useless and a huge wast of time and money.  I was scheduled to get restore and then the Plastic Surgeon came back in the room and told me that it would not work for me.  Desperation can lead you to do things you will regret later.  If you are not going to do Fraxel Repair then don't do any other Fraxel treatments!!

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There is no escaping the passage of time, therefore, there is no escaping aging. If you think now is bad let us think 10, 20, 30 years ahead? How are you going to react? You (all of us) must learn to accept that we are going to get old, and look old. 

 

Edited by ChildhoodDreams

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 I am so sorry you're feeling low about yourself. May I ask how old you are? You look very young with full cheeks & lips. Maybe you have harsh lighting in your bathroom? This always affects my self esteem. I went on vacation last week and the florescent bathroom lighting made me want to cry. 
Your scars look pretty shallow to me. There are people with far worse.
And your nasolabial folds are barely existent! Plus that is easy to improve with a bit of filler every once in a while if it bothers you. I really don't see the "aging" that you speak of. But I know from experience it's hard once I get into this negative mindset that you're in. I think you are being to hard on yourself and I have noticed when I do this to myself it really serves no purpose other than to make me depressed. 
I'm no scar expert. I have done microneeding, microdermabrasian (not really for scarring, just for skin tone) and recently tried TCA cross. I'm not really sure anything has worked that well. Microneedling, maybe, but when I did it I didn't take good enough b&a photos to really determine the outcome. You said you got 50% improvement, well that is encouraging.
Trying various treatments your skin is likely to improve but the most important thing to work on is your self esteem and your outlook. Hope you feel better about everything soon.

 

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8 hours ago, ChildhoodDreams said:

There is no escaping the passage of time, therefore, there is no escaping aging. If you think now is bad let us think 10, 20, 30 years ahead? How are you going to react? You (all of us) must learn to accept that we are going to get old, and look old. 

 

This true and that is why I am going for a facelift in January.  That is also why I posted links on another thread about facelifts.  Many younger people on here do not realize that they may someday be doing the same thing. 

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@usherer I am sorry you do not need a facelift here. This is way overkill. Facelifts can also cause complications, be extremely expensive, and are not appropriate for the young, even athletically fit middle aged patients. I have helped thousands of patients and I know you can get results with the above. These issues must be considered separately not together: aging and skin laxity and acne scar issues.

Filler is a more appropriate solution to fat loss of atrophic scarring. There are long lasting options if one likes the vocalization it provides. Even in Face Lifts they still use filler at a additional cost for this purpose. 

There seems to be some parties who post at this site now who are pushing treatments and are dealing with Aging which is not related to acne scarring. All that can be said is Acne scars can cause pre-mature aging if not corrected by the above means or "over" corrected (usage) by energy devices. Acne scars can be treated conservatively, targeted to the scar type, and the main complaint. Thus as seen below if one has a facelift they must "also do all of the above treatment recommendations" as "a facelift does not address surface irregularities" or damage to the dermal and sub - cutaneous layers of fat - just excess skin laxity due to the aging face.

A further complication with facelifts for acne scars are many are dealing with auto immune like conditions and poor healing results. You see this even from acne scar treatments. Treatment is all about how you heal and your bodies response. If your body is chomping up fat due to lupus, no facelift for laxity will fix this. You will be skelator with stretched skin.

If one watches Dr Lim's Anatomy videos you will see a facelift will not correct scarring alone and, he still after doing one in extremely bad scar cases has to do several other acne scar treatments. Watch this video, warning gruesome. If one knows anything about Face lifts this is why a acne scar patient is complicated and can have issues with a face lift (the scar tissue is fused to the skin). Further treatment is needed to treat the scars on top of a facelift of laxity. 

 

All of the treatments I mentioned above are backed up by data to give you percentage of improvement (see the FAQ - top post of scar solutions sub, first post, "proof" link). There are several white papers there to address scar improvement and treatment that back up what I am saying.

After looking at your photograph, I don't believe a facelift is the answer to your acne scarring. The only ones who will "beefit" from a facelift  have extreme destroyed sub-cutaneous fat and also have significant tissue laxity excess.

- Louis W. Apostolakis, MD - Facial Plastic Surgeon

Facelift surgery is used to improve laxity in the skin and muscle of the face (particularly the lower face).  Facelift does not directly address surface irregularities of the skin.  Acne scarring is best treated with combination treatment such as manual methods, excision, laser, and resurfaacing of deep scarring followed by laser resurfacing at a later date.

- Earl Stephenson, Jr., MD, DDS - Facial Plastic Surgeon












Please be patient and allow 24-hrs., Due to Dr Lim's recent endorsement of this forum and heavy traffic we are overwhelmed with PM's and new poster. I am trying to help everyone.

Thank You,

Ba

 

@Obi wan Please give your feedback on the subject of facelifts and acne scar treatments.

 

 

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Yes but the problem is like myself you have exhausted all procedures - lasers, fillers, excision, grafts etc and it still looks the same....what do you do next??????  facelift with fat grafting????

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I am not trying to sell any physician see who you want. It's the practitioner and not the laser or device that matters. You see Dr Lim or Dr Taylor in Utah. They can do more extreme surgical treatments. It is how you do the treatment that matters and not ... oh I did X,Y,Z. I get you. I help many people who everything failed. Many times they healed poorly - auto immune, had improper treatments by spotty Drs who were money hungry, or the plan was to blast the face and not logically follow a plan for treatment. If we do everything at once, .... many don't heal well that way. If we just blast a bunch of energy devices, ... well they might get scar tissue as the body also does not build collagen this way. Many I have seen need filler and subicsion. But instead their drs push bullshit treatments. Filler will push out the scar and made them soften.   I have many patients who only do 1ml of filler when they needed Sculptra throughout and several syringes of HA filler to the pits, ... you see there was not enough volume. How can 1ml be for major fat loss. 

Now if you have age laxity then yes get a face lift plus all the treatments above.

 If you want to get a facelift, please let us know how it went. It may be right for your "individual" concerns and condition. I am trying to help... many people here. For many who post on this forum a facelift would be not needed excess, needed on a episode of "botched" TV show with plastic surgeons and those wanting aesthetic boosts... Any time we cut or do surgeries we can cause more scarring (benefits must out-way side effects). Aging has two major components people have issue with fat/bone loss, and laxity of tissues. Minor laxity can be fixed simply with fillers and subcision.  Scars become more prominent by old Dermal Grafts (this old procedure caused scarring to get far worse), aging, attachment causing 'idiosyncratic scarring' which causes issues (see Instagram video below). These cases need aggressive subcision, due to the poor dermal condition-attachment and depletion of fat (filler needed) of their skin. I have seen people over peel and use so many energy devices, stacking, ... to many treatments they deplete all their fat and cause more tethering (Aging). Manual methods of scar work are still the best methods of correction.

Warning Possible Gruesome Video Below <I do not endorse the below - would not do on my friends or family>

Dr Taylor in Utah ( ""taylor liberator"") uses a very strong form of subcision which is like a undermining facelift specifically for scars. This is a very strong treatment and not for most people's scars. Also much more expensive $$$$$ than other treatments. He is literally blasting the face with several things at once. This is only for the most extreme cases, the body does not heal like this (allow proper time and separation between treatments unless you tried everything else) - there are risks to healing here. I would not send 99% of patients here due to side effects and possible issues, ...risk. But for the extreme 1% sure it ma be worth it.
 



The biggest issue I see also is scarring from dermal grafting, it can literally fuse the skin and make fat disappear. It needs a strong surgical undermining of the areas plus sub and filler. We need to think about stimulating collagen and not pulling taunt alone. 

I am not here to dissuade anyone from a facelift again, I Am here to say it's overkill for most cases and one has to do additional treatments for scars as well with the fracelift (multi - treatments), not a one size fit's all. They still use filler after as we loose it as we age,... still laser your face, or peel, etc.


The below man had HIV fat loss also called facial lipoatrophy. All that was injected is Sculptra.

Dermal Fillers St. John's, NL | Dermal Fillers in St. John's, NL A1A 1X7 | The Lazer RoomSubcision plus filler experience - Scar treatments - Acne.org Community

Perhaps @Obi wanWill give us more perspective from his side of thinking, always good to get multiple opinions, ... He normally posts on his time zone.

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@ChildhoodDreams  I’m not trying to stop the natural ageing process. My skin, already scarred, is exacerbated with wrinkles, and I look much older than my age. Also my enlarged pores, scars and wrinkles are in some places joining up, and I find that scary.

@Candy Says Well, if their treatments are effective.

@okmichelle Thank you for empathising. I’m in my late 30s. I’ve got fillers for my cheeks and lips, which is why they don’t look half as bad – at one point, I had wrinkles around my lips. I will have to do a bit of filler every couple of years. It’s hard with the photos to capture everything, especially when I was fired upone late night to do this post. I might try again in better lighting conditions. I have pronounced forehead wrinkles on one side, which I’ve been covering with bangs. And now, the other side has wrinkles too. I honestly haven’t seen people my age with wrinkled lips and forehead. I avoid mirrors where I can. I have warm lighting in the entire house so I always feel happy at home, and crushed the minute I am in an underground train or in a mirrored lift.

I was quite thrilled with the rf microneedling + mild subcision, and mistakenly thought it was the rf that did the wonders (since I’ve done Infini and didn’t see the same results). Microneedling didn’t help much, it was the rf energy (and subcision) that made a difference.

Facelift – I actually started thinking about this last night as my eyelids are drooping, and I’m having to open up my eyes to see. I’ll work on my scars first as I just want to look into a reflective surface and not be shocked. I can’t imagine the people who have to look at me under harsh lighting. I must look like Freddy Krueger to them. At least I can avoid looking at myself – they have to look at me when speaking to me. Good to know that fillers and subcisions can help with laxity and scars at the same time!

I actually haven’t been successful contacting doctors for subcision. Last night I emailed eight or so, and about three came back saying they don’t do the treatment. Will continue…

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@captainplanet You do not need a facelift. LOTS of subcision, and you do need filler for volume. We need to get you the right treatment. See all those boxcars. Paint on TCA/Spot peels (see the faq- top of the acne scar sub, first post, tca section, mega link, find paint on for more info). Would help you. This is not a TCA peel or tca cross though some drs call it that (diffrent method). Dr Rullan does this excellent with acids. 

The borders of your scars need angled CO2 not up and down, angled, just to the border of the scar to soften them. 3-7% density and the highest power. RF microneedling will not cut it in your case alone. Dr Rullan might do dermabrasion using a diamond bit to the border and phenol to the scar floor. 

If you really want to cut the chase travel to Dr Lim as your case is harder.

BA

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Hi, @beautifulambition, I managed to find a doctor who has access to several devices and makes me feel comfortable. Her recommended plan for me is:
- Fractionated CO2 laser, and/or
- Pico laser

with subcision, and to followed by filler after these are done.
I saw her patients' photos - great success with CO2 laser, but I read of side-effects online, and also found that Davin Lim etc use Picolaser. I will go ahead with Picosure laser and subcision for now until I feel more confident. Thanks!

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@beautifulambition I have checked that my doctor (new one, as I moved interstate recently) (or perhaps her nurse), will be using Picocare 450.
 

One of my thoughts has been that I have to use CO2, as you suggested (she suggested fractionated CO2), however reading about the side-effects of both CO2 and fractionated CO2, and recalling how my skin reacted badly to TCA where others' didn't, I think slow and steady is the way to go for me. If 1 CO2 laser treatment is equivalent to 2 Pico laser treatments, I will get somewhere, right?

She has also suggested Retin A for me but I remember in my younger days, that made me peel and get oilier. Should I still give it a go, or opt for weaker Retin A like Differin, which was ok (no effect) for me? Edited by captainplanet

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@captainplanet Cool picosure or picoway treatments.

We are not doing traditional co2, ... They would angle it to treat the walls of your various pits. I agree you have sensitive skin. But we are not talking traditional co2 settings. Density 3-7% and the highest power. That is quite low. If you feel it may be to strong have them spot test on a few first. I really think you need a experienced Dr. Lim, Dr Taylor, or Dr Rullan. Why because your case is complicated. 

You can always piosure and subcise several times at home. You desperately need subcision and filler throughout the cheeks, I would use sculptra on you and a cannula.  This is important before any laser (CO2 specifically -(subcision). The difference is here technique, and the sub and filler. I know you did rf needling already. 

I would also have you dermastamp the scars at home in between. 

All this is optional, but we have to be aggressive to make change. You may be happy with the results form just subcision and filler as manual is always better to start.

I would have you use whatever tretinorin made you peel and flake. Mix it with moisturizer 50:50 and see how that works. If not apply every 3 days. 

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thanks, @beautifulambition, for taking the time to advise!

The doctor will be doing the subcision, and have her nurse do the Picocare 450 (not Picosure) treatment. According to the nurse, they have been trained to do it perpendicularly, not at an angle, and at high power, there will be scabbing and a long downtime of five days (same as the Fraxis fractionated CO2 laser).

Davin Lim is in the same country, but I can’t afford to travel to him, plus his rates.

I’ve tried subcising myself, and am quite freaked out about accidentally cutting off some nerves. I spent 4-6 years dermastamping and didn’t see improvement, perhaps cos my skin is not good in the first place – so you’d encourage me to continue?

So, considering what this doctor can offer, and your suggestions, I’ve created this strategy. Can you see if the frequency is okay for building collagen/healing, and the effects won’t cancel out each other?

In chronological order:

First, 1 Picocare laser with subcision (If I don’t scar from this, I may get another one after 2 weeks)
Second, 2 RF microneedling (at 2 weeks’ intervals)
Lastly, 2ml fillers
Tretinoin every 3 days throughout this entire period and beyond
Dermastamping throughout this entire period and beyond??

 

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@captainplanet Wow this is way to rushed. The body does not heal like this. We don't blast it with treatments. You need to be waiting 3 months between treatments. Any good aesthetics Dr will tell you after laser/energy devices your body is healing for 6 months to a year. The only treatments you can do sooner are at home DIY treatments. 

Why do picocare the same day as subcision which causes inflammation and remodeling of collagen and needs time to heal (3 months).

No we do not do rf needling in 2 week internals - 3 months apart.

You have severe scarring. Whatever Dr came up with this plan is trying to push quick treatments, swelling to hide your scars (and they can make more money off you), and get you out of their hair. How would you know what worked and didn't or how your body responded to treatments. Why is laser being considered first, you do this towards the end. You need 4 sessions of ""aggressive"" subcision all over your cheeks. If you push this stuff you will not get results. I really do mean this is a marathon not a sprint. Many treat over 3 years. There is no one and done, ... that's where they come here and are upset nothing worked for their Drs quick package. 

You make the timeline 3 months or more between treatments. You need again ""aggressive"" subcision spaced out with the other treatments in between.

Dr Lim could make your payments next to nothing with medicare supplement. Please goto him, even if you can do one/two things a year.  The nurse knows it sounds nothing about scarring. Standard settings and we stamp laser all over the face- fail. Even if you do subcision and filler locally and do laser work with him it would be better.

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I second BA.  Each treatment I had by Dr Lim was charged $200 due to the medicare rebate.  It is so worth it and he has a passion for acne scar treating.

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On 10/19/2018 at 1:59 PM, 1Orangedog said:

I second BA.  Each treatment I had by Dr Lim was charged $200 due to the medicare rebate.  It is so worth it and he has a passion for acne scar treating.

Hi @orangedog, what treatment did you get?
@beautifulambition and @orangedog, I might write to Dr Lim's clinic and get a quote, and then figure out logistics if it comes to that. But from what I understand, Medicare rules have changed, and only keloid scars gets rebates now, and those would have to be photographed and documented, so there's no way around it.

@beautifulambition, thanks for your concern, hope you understand that I created the strategy by myself. Sorry if there was any miscommunication. The doc had suggested laser and subcision at the same time - though she did say it's best to do it every week or two. It's me not being able to afford downtime that I thought I could do RF first then laser when i have time.

I'm also contacting Prof CL Goh - hope CL is "Chee Leok" cos that's who I contacted! lol

cheers
 

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Medicare rules only apply to Dermatologist and Plastics. If you do not require a referral your doctor is not a Specialist. Rebates apply to the treatment, nothing has changed as of Nov 1st regarding scar revision. If you are in Sydney, see Dr Shawn Richards. Very experienced in treating skin type 1+2, if you are in Victoria, see the guys that taught Lim- Prof Greg Goodman, or Dr Phillip Bekhor. There are other specialist in Australia, see who is closer to you. If you need hand holding do not see Prof Goodman, as he is job centric and very good at this. Prof. Goh is a hand holder, conservative but very very experienced in treating ethnic skin types. Wishing you well. 

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Yes nothing has changed. Get the doctors referral to lim.
i started early this year. 4 subcisions and laser at same time.  The last treatment was the most aggressive and I had pethideine.  I bruised for two weeks.  Have seen such an improvement.
in the words of Nike just do it.
 

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