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arug

correcting for scars from phenol

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I had phenol in 1993 which turned my skin into a weird, horrible, webbed, orange-peel mess with enormous pores. I consulted with numerous derms and plastic surgeons who advised that CO2 or Erbuim-YAG were not indicated. The risk of additional scarring was too great.

So I did home peels, tretinoin, dermarolling, and then got busy with work and didn't think about it so much.

In 2010 I had 83 cc of fat transferred from my knees to my face. That was the best my skin ever looked, but it didn't last. I think I retained maybe 10% of it, and mostly on the perimeter of my face (which was not treated with phenol). I've been advised that I probably have vascular abnormalities in the phenol treated areas. This might make fat retention impossible!

Recently the Halo laser with PRP has been recommended to me. I have an appointment for Nov. 1. This can be used at 30% ablative and nonablative in scar mode.

But other experts have recommended the following:

"CO2 LOW DENSITY would outperform the erbium at 100 microns, 
additionally the use of 1927 non ablative in high density setting " (Davin Lim)

"Infini plus minus lasemd." (Steven Weiner, who is a 6 hour drive away from me).

I am also starting to dermaroll again. I have a 1.5 that I use every 6 weeks. I also have a derminator on the way.

Does anyone have any suggestions? I've attached a pic.

BTW, I'm 55 now, going on 25 years of misery.

 

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Goto Dr Weiner and have him speak with Dr Lim. They are friends and often see each other. 

Weiner's plan could work as well, he is the ambassador and trainer for Infini. Note your issue will not be fixed in 1 session. It will take several over time.

Lim's plan works with low density laser 3-7% and the highest power. 1927nm is Fraxel and good for large or scarred pores. 

You looked good with the fat transfer as volume hides all these issues that scars and aging can show.

It all depends on how you heal. Allow 3 months after each treatment to evaluate what works, it's progressive. 

Ba

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Thanks, BA. I've also corresponded with Dr. Jason Pozner. He's not an acne scar specialist but he is one of the practitioners who writes papers on new devices. I am not sure if he has LaseMD but he has both Halo and Infini RF. He thinks Halo will be fine.

How is it that Infini RF can outperform the derminator? They say something about control but they are not specific. I am somewhat afraid of all the heat and degrees of freedom associated with this device. If I lose more fat from Infini RF, I might get contour irregularities even as the surface becomes smoother. Have you had Infini RF yourself?

There is a part of me that is very skeptical about all these devices, because I have been hearing it for decades: "This new one is better. This new one can help you." But we keep hearing about people who incur new damage.

I had phenol to correct for dermabrasion scars. I had only very mild acne scarring prior to the dermabrasion. Dermabrasion made it much worse, and phenol made it orders of magnitude worse. So I am skittish.

The plastic surgeon who put fat in my face told me not to waste my money, just to get more fat.

The worst I have read about Halo is that it didn't do anything. I haven't read about people reporting new scars from it. But I have read about some people reporting worse skin after Infini RF.

Sorry for all the questions.

I wrote to Dr. Weiner but he seems reluctant to interact in detail.

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Hey first of all, your skin is not bad by any means, i can see u have some texture issue but that isnt bad giving the light and the zoom of the photo
i would recommend you look for CO2 laser treatment for your case and to avoid mechanical procedures like dermabrasion.
u can create a routine using BHA's and tretinoin for a long-term improvement but thats a shot in the dark
i really think for texture issues CO2 lasers are the best if done by a good expert
and just to remember, your skin is GOOD, good luck best wishes

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Yes, I have been using tretinoin for about 35 years. I don't have any sags and I am 55. I do wrinkle under the eye area when I put tretinoin or tazarotene there but it resolves quickly. Plus I've been very diligent with sunscreen/hats, etc. From a distance people think I have exceptional skin and it's probably true for my age group (I live in a high insolation area where a lot of people wreck their skin before age 40). But when I put on my glasses and look closely under certain lights, whoa. I wish I could disappear when I see the details that linger. I still remember how painful those first five years were. I seriously considered suicide.

I did make some progress in the first ten years with my topicals and dermaroller and peels (light TCA, mid-strength gycolic, jessner's, 20% salicylic). But I have never made progress with the texture and huge pores, or the weird webbed effect in my perioral area where the scarring is the worst. I have scarring deep into the reticular dermis and regular use topicals can't touch that.

I'm nervous about C02, was told I was not a candidate because the risk of additional scarring is too great.

And those devices: doctors pay a lot for them and then they have to not only push these devices but also pass the costs on to the patients.That would be ok if they worked but you have to pay whether they improve you, don't improve you, make you worse, or make you so much worse that you want to jump off a tall building.

Edited by arug

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I think you need a combo of Volume throughout the cheeks through something like Sculptra or Voluma for volume, PRP can work on skin that needs some healing. Dr Lim often recommends 1927nm fraxel and 3-7%density co2 laser with the highest power. If you don't use volume (I see volume loss showing more texture), and some laser ... how will you replace this texture.

I am not a big fan of Ponzer, Weiner is much better, but I am sure you can goto him. Just because they speak on forum boards does not mean they are good. Some loose the zest to treat besides $$$$$ and energy device machine endorsements $$$$$$. 

Halo is just erbium, mixed with fraxel. Infini shrinks pores through heating the sebaceous gland (Sebum - oils, pores, etc...).

Infini is a energy device as such is like a laser, Derminator is a microneedle. 

Infini is fine in experienced hands, ... Weiner trains many Drs on this machine. 

Fat gave you volume hence fillers that stimulate collagen/ volume Sculptra or Voluma.

You can always do Infini (3 treatments spaced 3 months apart - Drs do not agree with me on this, ... laser takes 6 months to heal from and see results - they want quicker $$$). Then do Halo if needed. 

No Dr will give you detail over email, they are not paid for their time and patients price shop. 

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Thanks, BA. Yes, you nailed it. I sent my pics to Dr. Weiner and he says my biggest problem is volume loss, not scarring. He does not want to interact with me further until I am actually in his office.

Edited by arug

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I had Halo Pro today. Not sure of the settings. It can reach a depth of 100 microns. I think in the hands of the right practitioner it might accomplish something. Not sure if that applies to my practitioner.

Practitioner (a PA) said the settings were moderate. I need to be moderately presentable on Monday.

I was not prepared for the smell of burnt flesh. It felt like lots of tiny rubber bands popping over my skin and it was unpleasant but not overtly painful. I could have taken higher intensity but I was afraid of risking additional scarring and prolonged recovery.

The PRP was amazing--as soon as it was applied any burning or itchy sensation disappeared.

I'm not sure that this one session will accomplish anything.  It doesn't look like I will have any swelling. I'm currently covered with petrolatum and the itchiness is significantly diminished 10 hrs post procedure but there will be breakouts to contend with over the next few days. My skin has zero tolerance for occulsives but with procedures like this they are necessary to prevent scabs and additional scarring.

It was $1100 for full face and PRP.  If it doesn't do anything I will see Dr. Weiner in 6-8 weeks for Infinit RF.

My prediction is that this Halo Pro will not improve the deeply scarred areas but will provide modest improvement elsewhere.I hope that it does better than that. 

My PA said she would be more agressive next time but I'll pass unless she offers me a deep discount.

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Reporting in 6 weeks after the procedure (fractionated erbium). My left side is very much improved, buy my right side, which was more depleted to begin with (unfortunately our asymmetries get worse as we age), not as much. I'm not sure if I am still experiencing microswelling. 

Recovery was a piece of cake. I was back to work in four days, still a bit swollen and red but not overtly so.

I can still see my pores but they are not as huge and the webbing is also much reduced.

My practitioner was very pleased and wants to repeat the procedure aggressively (with a discount). She has C02 also, which she said she could use on spots. I don't think she has the nerve to use high energy, low density over all the problematic areas. I am not sure that I have the nerve, either.

I got more filler today as well as botox around my chin and mouth (the worst scarring is there) and there is a huge improvement after those. Botox makes a very big difference when you have orange peel texture on the chin and around the mouth and filler smooths everything out. 

She also wants to do ultherapy on me (with a discount). We discussed skintyte first, but ultherapy goes deeper and has the potential to do more good. It's probably still more expensive than infiniy or genius RF. She thinks it will be safer than RF, maybe because she has experience with it.  I don't know if anyone has had success with ultherapy here but despite the horror stories I think it has potential to do good for the scars deep in the reticular dermis in the hands of a motivated and skilled practitioner. I imagine it can provide some leveling visible at the surface but would be best combined with other modalities.

I could go to Dr. Weiner instead next time but I am comfortable with her. Everything she has done for me so far has been successful.

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I am pretty sure I have the same texture too and I believe it’s the result of years of laser (IPL) and harsh chemicals on my face. Accutane shrunk my pores in my 20s but my acne and the pores came back after I stopped. I’m wary of anyone suggesting lasers or peels to correct the orange peel anymore.

I see some improvements! Please us posted on your progress. 

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I'd say maybe 50% improvement from the nose down and 20% from the nose up. But that's just the left cheek. Right side did not improve as much--I have a lot less fat on that side so every defect shows up more.

The chin and forehead did not improve as much but there was more improvement on the left than the right.

I am reading Dr. Weiner's blog entries on Ultherapy and Infini and I probably will go with him and Genius next time. He quit using Ultherapy and for good reasons.

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