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Ezemuzu

What to do about giant Nose Scars, please help?

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Here I am back again after 5 years of dormancy. Can you please let me know what I can do about these giant scars on my nose? These pictures are from 5 years ago. Now the scars are a lot deeper and wider. I'm moving deep into my mid-30's and my life is just slipping away like sand through my fingers. Not that I had any life to begin with, but that's another story.

1.jpg.f42db560d9f9d7b863e2ed3bf4760fa5.jpg

Laser is only for superficial scars. I've been thinking about TCA cross but I read on Realself that it only really works for narrow icepick scars and not for the "giant wide icepick scars" like mine. Davin Lim and another derm specifically stated that TCA makes non-narrow icepick scars worse. There was a person with three scars on his nose that had clearly gotten bigger.

So I've narrowed down my options to subcision with filler. Looking into Novick. I'm based in Asia so a trip to USA or Israel will not be easy on my wallet, but if it's effective then I'm willing to spend the money. Is microneedling an option too? Any feedback or comment will be appreciated.

Edited by Ezemuzu
added photo

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Looks like you have a cross between scarred pores and icepicks. 

The nose is not a standard area, ... it's cartilage not traditional skin. 

Your scars do not look giant, so a bit confused by this. Was this Lim's analysis on Realself of you individual case or your thinking yours are giant. 

Yes TCA Cross can be done on the nose, and it does take a few sessions. Scars can look worse though before better so be aware they can become bigger. The point is to raise the scar floor and then Fraxel is highly effective for this or Co2 the nose and resurface it with ERbium or TCA peels. 

The scars are designed to get larger with TCA Cross, ... we are raising the scar floor in order to then laser the surface texture. 

Laser is a tool to deal with scars along with other treatments when necessary, ... no one thing will fix your scars alone.

You can see Lim in AUS or Rulland in SD. I would not see Novick for this. 

Dr's in Korea could also treat this at one of the major dermatology clinic's for visitors as that is closer to you. 

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Thank you BA. I'll look into TCA cross again. It's available locally where I am. Lim actually suggested TCA cross using needle droplets followed immediately by laser. He replied to my question with photo on Realself about a year ago. Realself deleted it for some unknown reason.

I would say my scars do fit into the giant category. The photo above is from 5 years ago and I still haven't seen anyone with a scar like the big flaring one in the middle of my nose. Not out of the dozens of photos I have seen. Now, after 5 years, my scars are much bigger, much deeper. A lot have joined together. Holes are 0.6mm in diameter each.

I thought subcision with filler would work. It really got my hopes high and I was looking into subcision with Botox to prevent vascular events. I then re-read today what Novick wrote and what Lim wrote on his website. Novick says he has "treated quite a few depressed scars on the nose with gratifying results, using subcision to elevate them, often combined with filler to provide immediate improvement". Does he mean ice pick scars or not? Same with Lim on that post (https://www.lasersandlifts.com.au/subcision-acne-scars/). He does not specify whether ice picks are included. I sometimes feel like they purposefully use vague terms. An answer will usually state the type of scar (vague words like depressed or atrophic) then propose a wonder cure (laser, TCA, microneedling, subcision, excision) then when the reader is hooked a caveat is given of needing a face-to-face consultation with a board certified derm and that results vary wildly. In other words, "come see (pay) me". I know this sounds harsh and it's unfair to say this about these truly good doctors, but this is what it looks like from my perspective. I'm not that surprised since a lot of the "modalities" were first described only a decade or two ago and everything is in its infancy.

After reading your post, Beautifulambition, and then reading some stuff on the net it seems subcision doesn't work for icepick scars. But then again I can't be sure. There is an article on a New Zealand clinic website that says subcision does not work for ice pick scars and then just two paragraphs under that it says subcision is used for ice pick scars. Very confused. Maybe I should just start TCA cross with my local derm and save the overseas trip for later but I'm running out of time. It's just too confusing.

Here's the New Zealand article that provides contradictory information on subcision for ice picks:
https://www.medisculpt.co.za/medisculpt-march-newsletter-subcision/
 

Edited by Ezemuzu

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Please Take a look at this post:
  That New Zealand article is flat out wrong. The white papers agree that TCA Cross is very effective to icepicks. How can you subcise something that goes to the bone and is not attached but devoid of tissue. Subcision is for skin depressions (atrophy) held by tethers. Icepicks and scarred pores are not tethers. 

TCA Cross is to raise the scar floor so we can resurface the skin. 

The nose is not again a cheek or temple. 

What would we be subcising with large scarred pores or icepicks, we would stab the sub instrument through one side of the scar and out to the other side of the scar (not releasing anything). 

Yes I think that's smart try tca cross at home several sessions, ... then laser the texture or peel. Co2 fractional / Fraxel is used to vaporize columns or in your case pores and shrink sebaceous units. 

You may dermastamp it at home if you wish to try.

If you don't get results off this, travel to Korea, I linked a clinic in the FAQ (top post).

Ba

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Thank you for the reply BA. You wrote just the type of information I was looking for.

I will do a bit more research and let you know if I have any more comments.

Just to let you know my "giant wide traumatically fused ice pick scar pores" still produce oil and sebum.
 

By the way it seems a bit difficult to compare the following two. Left is the person in the shared post. Right is me. I frankly can't see what this Filipino dude is complaining about. I'd trade just about anything for his nose.

IMG_2542.PNG1.jpg.9146f34a38f9d44add77aab39e04b6fa.jpg

Edited by Ezemuzu

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Your picture is zoomed in, his is farther away. You have shadows, and he has bright light which hides things. Try the TCA cross locally. Remember they can get bigger and you need to repeat treatment several times. Then we laser w/ angled co2 or faxel and erbium resurfacing. If all else fails goto Korea.

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Dear Ezemuzu, I have a couple of scars on my nose which appeared from big cysts and even after many roa courses produced sebum..or stayed clear for half a year and then bursted. I used Soolantra cream and ivermectin solution I got in vet store, just did the applications every evening for an hour. For a month. It helped. I still use Soolntra once a week. Rinofima of the nose could start similar and very much associated with demodex. 
 

And then I did stamping which reduced the scars in half. I even did not post the pic of my nose here because the scars there bother me at the last turn.

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Agree with BA- TCA CROSS, if fine narrow, toothpick, if broader, decrease concentration and osmotic syringe delivery. Most good Specialist would use CO2 angled laser, this will treat the walls of the pick- pores- ice pick scars. 2-3 sessions. The rate limiting factor is your DEEPEST scar. Once raised, fully ablative erbium laser. Nose skin vvvv forgiving. Not a hard job - 6-8 months for 80% improvement. 
Follow BAs guide. Do NOT try TCA DIY with high concentration. Stay safe. Thank you BA. 

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Thanks for replies. I met a local derm last week and she said she uses 30% TCA cross, not peel but actually cross. 

Is this too low for a test spot on my nose? I read it can only give superficial peeling. 100% is definitely aggressive so i won't try that. I'm just wondering if 30% applied with a toothpick by my local derm will provide any lift at all.

Any idea how long the downtime and lift from this will be?

Edited by Ezemuzu

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30% is a peel not a CROSS procedure, unless multicoated. Most dermatologist use Jessners + 35% TCA whole face. TCA CROSS  usually starts at 60-70%, up to 90-100%. Multicoating with toothpick 60% + is still safe, 30% one has to multicoat at least 4-5 times. No practical if one has >50 scars. Will leave it up to you, all the best. 

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I had TCA cross 30% done. The frosting has faded but not completely. I was told not to apply anything on the treated scars for three days. Just leave them dry. After that i can apply some ointments. 

Is it normal to not apply anything on the scars for the first few days? 

Edited by Ezemuzu

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3 hours ago, Ezemuzu said:

I had TCA cross 30% done. The frosting has faded but not completely. I was told not to apply anything on the treated scars for three days. Just leave them dry. After that i can apply some ointments. 

Is it normal to not apply anything on the scars for the first few days? 

i was told to apply spf

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