Thank you for your patience. Due to Dr Lim's Endorsement of this forum we have higher traffic than normal. Response will be 24-hrs.

Yes you do have severe scars.

I see a problem with treatments that are not targeted to your scars. Many just throw laser at it and that is not how a top acne scar Dr - 1% would treat.

Ok so I see fat loss, A Linear Scar that is deep and wide. Textural issues. Rolling and box cars.

Yes ... you do need subcision! Possibly 4 or more sessions. Filler will be needed. Space them out when you need a top up from filler again. You need Volume, so several mls of HA or a vial or 2 of Sculptra and then your last subicsion individually fill the puts with HA filler.

Between your subcisions...You will need paint on also called spot peels (3 layers to only the floor) of each box car and that long linear scar. This will take several sessions.

I would do angled co2 to the box cars, and that linear scar... 3-7% density at the highest power, and fractional traditional laser to the beds of the scars. We need to soften the transition on the box cars. Many providers do not know to angle the laser for this. You may also need rf microneedling in conjunction (optional), depending on what is available.

As you have severe scars you will need a deep peel by a plastic surgeon, .. not light acid peels, ... or fully ablative erbium resurfacing for the texture issues once we raise and smooth the scars.

Treat as you have time and money, scar work is never quick it's a marathon, ... allow 3 months minimum between treatments, many treat over 3 years. Everything is optional. I would see Dr Lim, Dr Rullan, or Dr Taylor as you need more agressive treatment.

Use retin-a/differin/ or tretinorin nightly.

I Want you to buy a dermastamp or derminator and stamp only the scars between Dr performed treatments.

I see red PIE, ... V-beam or picosure is the appropriate laser to deal with vascular issues.

Thank you for responding! Im not quite sure where to begin. Should I get the subcision first or start with some TCA cross peels. Are there any special instructions or the subcision e.g. needle type, length etc. Another factor would be that I will start trying to get pregnant in two months( had a Myomectomy in May, so Dr. Advised me to wait for 6 months before trying) I have heard that peels and laser are out of the question when pregnant. Please suggest what I should do in this two month window I have. Its been a week since I have started using a tretinion .05 at night. I alternate with some AHA and BHA serum. The pimples have reduced since the last few years but my skin tends to get closed comedones where I have scars and on my chin. I wish I could get Dr Lims help but unfortunately I live in a different continent.

@Pearl1983, BA has given good advice, but I just wanted to jump in here and say that you should FIRST get your active acne under control. I see you are still breaking out, and trying to "fix" scars without first addressing the inflammation from current acne is a fool's errand.

Please take a look at your diet, and lifestyle - for me personally, cutting down oils, increasing vegetables (cruciferous and leafy greens in particular), maintaining a frequent exercise regimen (sweating), and reducing smoking/alcohol all helped in curbing my acne. You can also look into topicals and prescriptions if you address all the lifestyle changes, and it doesn't completely resolve the acne.

Once acne has gone down, subcision and microneedling / peels will help. DO NOT stamp or needle active acne, that will make things worse. Good luck!

@Pearl1983Yes you can do subcision if trying to get pregnant, but it's up to the Dr's discretion. No there are no special instructions with subcision.

If the Dr says peels are out of the question, then TCA Cross is out of the question as it uses acid at their discretion.

I can give you a plan PM me.

You may have to wait for the majority of treatment until you have your baby.

Hi! I am new here, and see this is an older post, so not sure if this information is relevant to you at this time. However, I am female, and hadcystic acne from the time I was 13 until about 55.

i noticed that you were talking about getting pregnant, and wanted to relate my experience. While trying to get pregnant, while pregnant, and while nursing, there is very little you can do for your skin. You can not be on antiobiotics, and especially can't use Accutane. Most topicalprescriptions are not allowed, including Vitamin A acid gel/cream. The only thing I could do when pregnant, was get cortisone injections into the cysts. Several doctors advised me that my skin would improve when pregnant, but it did not. In fact, the changing hormones resulted in many more outbreaks throughout my entire time pregnant and breastfeeding.

i mention this just so you are aware, and so you can determine when you wantto become pregnant.

i do wish you the very best in your hopes both to improve your skin, and to begin a family.

Take Care!