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Sibel

Long battle, going to Pr.Chu, your help needed

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902E0B6A-A74D-4F54-B52C-1A0E3755791B.thumb.jpeg.c960cb9e793a3e2195853d5b0c90426c.jpeg988762EA-9DED-4AE3-B640-D599087136E0.thumb.jpeg.d9d44e7754a84c5ee4f77df05534dac0.jpeg5B1A798B-E008-4CDB-B896-DAAF5CD9F36A.thumb.jpeg.1403a5543d976f7f43bb786c5decf717.jpeg988CA37A-15CB-4C02-9372-D5B397185F08.thumb.jpeg.283e11a1c1d38d28853338eb9b247409.jpeg6F78E887-894C-4E5D-88E5-82882541A56B.thumb.jpeg.2cb2a4d2236c376b015d4d1f8c036377.jpegB36E9F9B-5A12-4C77-B7EE-D43EBABA94A7.thumb.jpeg.0868edeadc6cc583d3082d7c292e2138.jpegHi everyone, 
I have been reading the forum for a long time, learned a lot of useful info, now I need your advice how bad the scars are. 
I am 45 and been battling with acne and scars since 19,20. I had a hard case of Herpes Zoster on the left side of the face, which left first scars. Then with years the situation got gradually worse coming to cysts in the age of 28. I used all poss treatments and was put on Roaccutane. The first course cleared face, dekolte area and the top of the back and shoulders. Unfortunately it came back to the face after around 8 months and I had to take another roa course. Every time it cleared and then came back around after half a year. I took roa 5 times. The 3D course was long in a small dosage, it helped the most. 4 and 5 were short 2-3 months a year in a small dosage. So I decided if nothing except roa helps so I may stay on it for the rest of my life once a year. Around 38 I stopped, the cysts stopped(hope forever), I still have outbreaks but no road is needed. Roawas my best saver in spite all aside effects. Now the skin is thin and heals badly.
At 28 I have several scars mostly from Zoster but the continued inflammations at the same places just left more scars. The outbreaks inbetween the roa courses added scars. I could not start doing scars treatment while on roa. After roa the skin became thin, sensitive and every even tiny spot left a scar or a mark. The scars bothered me but somehow I partially learned to live with them. After 40 with aging the scars became deeper and more noticeable. I started to see old shallow scars I did not see before. Aging it not easy, aging with scars is awful. I have mostly boxcars and some rolling, the middle of the forehead and upper cheeks, some scars on the nose,these years I had following: 
- Lasers Genesis, Fraxel, Mixto, Erbium, Candella. Done on the scared places. CO2 was not done due to the thin skin and bad experience with others lasers. No improvement. Lasers are for shallow small scars but the risks overcome the pluses, would not do ever again. Temporal results(max 2 years)if any, won’t fill the scar. Developed dry wrinkled skin, pigment, long healing, outbreak after every treatment. No more lasers. The waste of money and time.
 - TCA peel. Just repeated the surface, zero for the scars. 
- Fibroblasts injections(6) did nothing.
- Microdermabrasion- with machine and sandpaper- zero. 
- Lipofilling. Absolute waste. All dissolved after 3m. No grafts survived. Could work for bigger indented areas but not for individual chicken pox alike scars. All fillers are temporal. To fill in the individual scar precisely and not to get the button effectis very difficult. The surgeon was professional and warned me that fat is unpredictable and could fully dissolve. Also he did subcision on the main scars with no effect. He also use dermapen for the better vascularization of the fat which damaged the texture a lot.
- Subcision. One with fat grafts and one with cannula on the forehead with Dr.Huysmann, did nothing, did not return to him because he tried to push me to Erbium in its of the fact I explained why I do not consider lasers any more.
- TCA Cross. Tried on two scarswith Dr.Safonov, together with microdermabrasion. Healed 2 weeks, after the scabs fell off it were much deeper holes. Healed to same state how it was before and became whitish in the middle. 
- Microneedling Derminator2. 6 times on the forehead and 3 the cheeks. With single needling on the main scars and suction. All the scars became wider and more visible. The texture of the skin worsened more, it is  lot like small cuts now. I used tretinoin after the sessions, copper peptide serum, vitC. I use tretinoin regularly in courses.
Now  understand that not much left. I think that subcision was not performed enough or right.
 I wrote to Pr.Chu with pics. He send the treatment plan: PRP+microneedling(FNS dermapen)+Subcision +tca cross for boxcars. All done in one session. The treatments I tried before but not in combination. He does not use lasers and fillers which I am happy about. Although I will need fillers in future I think due to atrophy after lasers and aging.
My concerns: if Derminator made the texture worse so more needling will do more damage?
Subcision: it might worsen the cheek scars... I have feeling that there are no fibrosis tethering the scars, the bottom of the scars is the fibrosis tissue itself....also the places of the scars...very seen very difficult to treat....the same concern tca, after bad experience with 2 scars I am not sure should I go for it againor not....may be try on one scar. What do you think about all that? May be eva_li could advice after her treatment with Pr.Chu. I had the feeling that it is the same treatment for many. In the same time it is not much treatment in general.
I understand that when there are no acne and make up and no close looking my scars are not so seen or more like the pigment. They look very differently in different light. The forehead is damaged, the upper cheeks, the left is more.
After all years I am absolutely exosted from all the restrictions and the major influence of this problem on my life. I constantly have mild depression. Any advice would be appreciated. 

Edited by Sibel
Adding pics

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@Sibel Hi there, yours is a complicated case. I can tell it's causing you mental anguish. Perhaps a therapist or support would be good because that makes up 50% of acne scar suffers pain. 

I can address the scars.

First impression because of age and fat loss, ... you need volume. That means Sculptra throughout the cheeks, and volumized HA filler on top, to pull everything up. See the Face Lift recent post on here to see a picture of fat loss and Sculptra. I know Chu does not do this. So get that done after by someone else. 

A facelift may be necessary (age related loss) as you have laxity of the skin, but filler can help a lot with the fat deficiency of the cheeks. 

Laser will be needed to resurface and stimulate the skin, it works in conjunction of filler and subcision . I know chu does not do this so down the line. 

Forehead's are the toughest to treat. They don't have much fat, arteries and veins everywhere, lots of muscle, and get some percentage of improvement. Botox is necessary in your case to soft then lines and scars (muscle contraction), They can use the botox needle to subcise the scars a bit. PRP have been effective here with micron needling or stamping by Chu....

Filler can be injected by a very trained injector as this is a danger area. Angles CO2 laser could be used on the boxcar borders.

Finally you finish off with multiple tca peels, or fully ablative erbium resurfacing for age related damage and acne scar texture.

Treat as you have time and money, everything is optional, some treat over 3 years, 3 months between treatments is optimal as we heal slowly, subcision is most effective for many with pits. 

Thank you for the kind understanding and patience, due to Dr Lim's endorsement of this forum we have massive new traffic, it may take me 24-hrs to get back to you.

Your biggest issue is volume loss (fillers) and or a face lift, this will fix a lot of the issues. They could even fix the forehead - brow lift during the lift and use fillers, this may be the cheapest alternative, as Chu will not give you massive results your looking for. We are fighting aging damage, and fat loss, with acne scars.

BA


 

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BA thank you lots for the answer. I have already booked Pr.Chu in November so I will try subcision with him. I hope that the main individual scars on the cheeks could be improved with it. The forehead is the worst, at least I can cover it with the fringe.
Yes aging and the volume lost(  I thought that fat grafting would help with volume but no( I I did fat because I thought it was my natural material so it would be better then ha filler. 
I think about Dr.Emil as well because he does fillers. 
What about excision of the 3 scars on the left cheek? I understand that you change to a new linear scar, read all +/- . I asked surgeons, nobody wants to try because of the location. 
Lasers are not the option, as I said waiste of time and money. 
The main point how to lift the bottom of the scar. Sub plus filler or to cut out and make a new linear longer scar.  For volume to inject fillers which is temporal so to repeat lol he time. 
I have seen therapist in times of severe acne.. roaccutane was my best therapist. 
I lived with scars all these years not the best but it is after 40 when the scars really started to hit me and because I believed in lasers so much and zero in the end. 

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very depressiung thread, i have also had backlash from lasers

do you have any before after photos from the needling damage? i thought needling was very safe and was booked in to do it in 2 weeks and this makes me very nervous

the actual scarring doesnt look too severe in depth, i guess you have poor healing and loss of fat but hopefully the prp can help with the healing process

 

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@Sibel I really do think you could use a facelift (excess skin and laxity) subcisions and Sculptra (lots of volume missing). Let's consider the forehead separately as I mentioned above (botox, microneedling to scars, laser, sub).

At the very least I would do several vials of sculptra to the cheeks for volume and some lift. 

Just goto Dr Emil, he does filler. Tell him you need sculptra, this is a for sure, or several Mls of LYFT/Voluma. He will be subcising as well. I think Emil better fits your needs.

Do me a favor, goto another post called need a facelift, where I tell them this person does not. I want you to see the pictures of people with HIV facial lipoatrophy, google image the pics. See what a difference Volume makes to aging.

BA

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Thank you BA so much again. Yes I read facelift post and the difference with fillers is obvious. I understand that as soon as I start doing fillers it is for the rest of my life.
So I start with Pr.Chu, I would like to hear his opinion anyway. Then Dr.Emil with fillers and then facelift. Could you reccomend a plastic surgeon for facelift in Europe?
I am on the point where if the main 3 scars on the left cheek could be improved and face volumized I would be happy. Exosted with lasers, lying doctors and $.
It is not only scars, it is mental pressure, lost time of my life due to disease, best young years, many days spent indoors and looking for cure instead of living, lost opportunities. Spending all resources trying to find the solution but nowhere in the end at 45.
I think people on this forum understand.

I have pics before needling on my home comp, will post later cause I am away now.

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What about Infini? I read and still not sure if it I should consider it. Already got the suggestion in my mailbox from unknown sender)

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@Sibel That is a sensible plan. See the improvement you can get from Chu/ Emil. Perhaps you will be happy without a face lift. I do know I see aging (laxity) and this is where a facelift shines. Sadly I do not know any plastics I would overly recommend in the EU. Several people travel as it's more expensive there. You can seasrch realself.com for reviews, ... local language based forums that talk about aesthetics and procedures. Youtube and search for facelift and the country. Look at their website and the pics. I would get a few consults with the plastic suergons, even if you have to pay. Go with whom your comfortable with. I know Eastern Europe procedures are popular to travel to.

Infini rf is microneedling, ... while this may help some, ... it will not fix your issue which is volume loss and laxity. Subcision and filler is needed most. Worry about texture after that. You can peel or laser with Chu, Emil... Emil has a Erbium.  

The RF needling as I mentioned above would help most with the forehead and co2 laser which could be angles to the scars border to soften them. Emil may use a Erbium laser. Botox is absolutely necessary and some subcisions here.  

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I am not sure about Botox. It was recommended by some surgeons before far grafts.
 I read stories where it could effect eyesight if done incorrectly, even professional could make a mistake. I do not like the fact that I will have to repeat it all the time in this area. Know people with side effects like one brow goes down and lost sensitivity, individual reaction so God knows how mine thin tired skin would react. In the same time I understand it is the only way to fix this area from moving. 
I felt that Infini was not my choice, thank you.
 

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@Sibel Botox is fine, ... thousands/ millions of patients have had it for all sorts of conditions. No one has ever gone blind from it. Just get less units to start if your afraid. You don't have to treat around the eye,... just the upper forehead Frontalis. Botox really does not spread that far with a few units. Maybe you need to ease into it when doing some filler with someone you trust.

Give it a try, ... a few units. The forhead scars would improve a bit. OF course you can try the manual things first.  Ie. subcision, or rf needling. I would consider your issues 2 areas: forehead and cheeks/ lower. Different plans of action.

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IMG_5813.thumb.JPG.642cda78005b20ed5d7dc648bd13f720.JPGJust to add some pics. Before lipofilling and after, the damage after dermapen is seen, tiny lines developed.

IMG_0389.thumb.JPG.118db4e6fe5a35182e5502a1cc4b19d4.JPG

Edited by Sibel

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The first pic is after, the second is before.

In addition the lips were volumized, looked good for a month then fully dissolved.

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Dear BA, I read a lot on this forum for the past month, I read a lot of your answers to different people and what you recfomend, it feels like for atrophic scars the only right way is Subcision with filler. If to study/try each method they bring little to no results. Lasers, different dermos, peeling, injections. So to try to lift the bottom of the scar and then to try to even the borders. And that’s it?

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@Sibel You do not just have atrophic scars, you have aging, bone and collagen loss, box cars and rollings scars.

This is not true, each treatment does bring results, ... I don't know where you got that? It depends how you heal, the treatments you do, ... your needs based on your scars, and your practitioner. If you have unrealistic expectations of perfect glass smooth skin that is not a good mental space to be in. I say with all treatments, healing treatment over time expect 50% improvement. 

You may be happy with just a increase in volume (filler and extensive subcision), see the video below, see the major difference from major volume - filler.  I see you needing several vials of sculptra and something like Voluma. RF needling, ...Laser or a deep peel at the end. 

Scars are on a 3-d plane, ... so yes you do have to raise them before doing surface treatments for texture. But is is of course way more complicated than that .

What is your biggest concern in this pic you provided. I see several things but I need to know what most bugs you.

IMG_0389.thumb.JPG.118db4e6fe5a35182e5502a1cc4b19d4.JPG

988CA37A-15CB-4C02-9372-D5B397185F08.thumb.jpeg.283e11a1c1d38d28853338eb9b247409.jpeg
 

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Thank you BA, with each answer I understand more; what does bug me the most: box cars on the cheeks and how to bring them to the surface, the texture of the cheeks in general and how to improve the overall look and sagging.
So as far as I understand Sub, tca, fillers. 
I have realistic expectations. 50% would be very good. All I tried before did not bring any result. May be wrong doc, may be wrong procedure...I did Sub plus fat grafting and nothing...that is why there are doubts.. I heal badly after roa. 

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Hi Sibel. I think your major issue is you do not have enough volume (AKA Filler). Many buy a syringe or 2, ... in your case you need lots of volume to help deal with sagging and aging. Perhaps a facelift would help as you say sagging and if you stretch your skin to the temples and jowels you can see how it looks with a facelift. Filler can correct a lot of this but it may not be enough. to give you what you want, just a thought. 

I think you need both Sculptra several vials and HA filler if you do go that road first. IF you would rather you can facelift (highest cost) but longer lasting improvement and then consider filler if needed. Either route is fine. Consult with a few plastic surgeon's and see what they say. I know some in the states which are on the list but Europe is much more expensive. Many travel to Eastern Europe for cheaper treatments.  

Fat grafting only lasts about 2 years, also many need many more mls of fat. I have never seen them do extensive subcision with fat grafting, ... the needle is to big. 


IF you heal poorly I would not do to many energy device procedures. I would do more manual things like lots of filler, subcision, tca. 

BA

 

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I went to Pr.Chu yesterday. I was in the waiting room when the nurse came and invited me to put Elma on. I said I was supposed to have the consultation first as it was agreed in prior emails with the secretary. It turned to be that it was procedure day not the consultations. Pr.Chu anyway came to see me, was quick, because there were many patients, said all the scars have to be subcised, that I have mostly rolling scars with the boxcars mixtures when I always thought that I had boxcars. About fillers- all fillers dissolves so no need. Just sub on itself..Dermapen concerns -said that it is necessary to do the whole face 2-1,5 mm, I showed the lines and mentioned Derminator, he said he used FNS Dermapen for a long times and would not advise to do mng at home..about tcaconcerns agreed to do the forehead only, one scar on the cheek, also advised pdo threads. 
The waiting time with Elma was more then 2 hours but I expected that. During the waiting time nurse Kate took the blood for prp. She was very nice and accommodating. First prp was put with the tiny injections, then dermapen performed pushing quite hard, then Sub, high was very painful and I asked for extra anastetic twice. During the procedure I asked questions which were answered in friendly manner so I felt much better. Tca cross was done as agreed 90%, to wash after 10-15 seconds as soon as the white frost appears. 
And pdo threads on the forehead, about 7,8. From diff angles, to make like underlying fence to keep all up. I expected the threads to be put in the cheeks as well but Pr said next time. So forehead prp/mng/sub/tcac/pdo and the cheeks prp/mng/sub/tcac 1 scar.

All swollen today, took pics, to be ownest I expected more lifting of the scars. The edges are the same. I asked this question, Prof said sub should work with this.. 
the pics on the sun show the lines fr derminator..

I should add that I established the dialog with Pr in the end which is important and the nurse was very helpful, also the secretary Jean came in the evening, was friendly called the cab. I did not mention the misunderstanding with the consultation because in the end it was fine.

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The cheeks look awfull, the scars just did not lift at all...and the texture... to do tca spot on all scars?...full tsa peel?...yes fillers later..pdo in the cheeks... all not permanent..
Pr. did not recommend excision because of the new linear scar..
 

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2 hours ago, Sibel said:

The cheeks look awfull, the scars just did not lift at all...and the texture... to do tca spot on all scars?...full tsa peel?...yes fillers later..pdo in the cheeks... all not permanent..
Pr. did not recommend excision because of the new linear scar..
 

The scars that didn't lift right after the subcision with Emil, do look better after several weeks. Be patient :) Edited by Noa27

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Thank you Noa. It looks like skin under the scars is swollen and the scars are on the surface, the boarders have not changed.

The lines from dermapen are obvious, I tried to ask Pr. about poss damage, he just said that u need to do the whole face and that it should not be done at home even derminator..

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Relax, you've had the treatment yesterday. Give things time :)

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Hi thanks for sharing your journey

what was the most painful part? Was it subcision?

will be seeing Pro Chu next year for subcision ad well but I have a very low pain threshold :(

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BA told everything here
subcisions and fillers will probably give you the most dramatic results

Thank you for sharing your story, i never saw a case like this of someone taking accutane for so long, i hope everything goes well for you. Best of luck.

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