Hi there!
To preface, I used to have cystic acne. It™s under control for the most part now (I breakout on occasion now, but no cysts). This summer, I got my first cysts after many years. I was eating a ton of chocolate, in addition to stress. But more importantly I was shaving against the grain for a few months and got a few ingrown hairs which ultimately became cystic. You can see the dark discoloration on the center of my left cheek - that™s the remaining ingrown hair. I need to see if I can get some tweezers to remove it. I took the pictures with my iPhone both with and without flash. I can take some additional with directional lighting if needed. Same thing happened near my right temple above the cheek.
Prior to coming back to the US in spring, I saw a dermatologist in London who did NOT use directional lighting in examination. 80% TCA cross and subcision was recommended for my scarring initially. I™d been instructed to be on a regimen of Tebiskin cleanser and lightening cream for about 8 weeks to prevent any PIH during treatment. So far I™ve done 4+ weeks in the summer and just resumed the lightening cream for two additional weeks. I™m originally from London, but am currently in the USA (just outside Chicago in Indiana). I saw one derm in Chicago and they did NOT use angled lighting to examine my scars.
Any recommendations for the best derms in the US/UK as I travel between them would be greatly appreciated 
I understand it will take several years for treatment but I would like to start ASAP. To my current knowledge Tony Chu is the man to see in London. Additional if there are any recommendations for anyone in the Chicago/Boston region that has experience with my Fitzpatrick skin type it™d be even more appreciated!
I have a couple of boxcar scars on my nose, but the majority seem to be shallow icepick and rolling/tethered scars - what would your suggestions for treatment be?
Thank you so much!!
P.S. I was brought here by Davin Lim™s YouTube channel!
All Pictures are in Imgur link:
Hi there,
Thank you for contacting us.
You have severe scarring. Widespread rolling scars and box cars. PIE/PIH - Discoloration. You seem to have a ethnic skin type.
The biggest treatment that will help you is cannula subicsion throughout your whole cheeks and temples. You will need (4 >sessions). I would get Sculptra 1-2 vials throughout the whole area as a spacer when you get your first subcision. Then after you can get HA filler "as needed" to individually treat. There is a lot of scar work to break up here so be prepared they miss some areas. Retreat when the filler runs out or every 3 months.
I would do RF needling 3-4 sessions, space this 3 months apart and you can put them between you subcisions.
Note if you need a added boost they may do 3-7% CO2 with the highest power to your box cars, they should only treat the borders to soften them ( this is optional rf needling may be enough).
If you wish you can do TCA Cross on the icepicks (a few sessions).
You can do several tca peels once you lift things for texture or fully ablative erbium resurfacing.
This is a 3 year plan, treat as you have time and money, Everything is optional. Please space your treatments 3 months apart.
You have ethnic skin with hypierpigmentation, you can do a few sessions of picosure or a vascular laser to work on this. Please use nightly differin(target)/retin-a/tretinorin and a konjac and arbutin cream for cell turnover and to prevent pigmentation.
We have a list of Drs I am in the process of updating. Chu is good for London, he does not do filler or energy devices, you can mix and match your drs - see the list and research, you always want to do manual methods first (subcision,cross). When calling around ask specifically for a cannula subcision treatment, do not let them do laser first!
Thank you SO much BA. It really has been tough psychologically.
Is cannula subcisionsame as using a NOKOR needle? What are the differences?
Also are there any advantages to using Sculptrain the beginning? I have been losing a lot of weight, and am unsure how this will affect my scars/fillers if I get something like Sculptra before I reach my target weight. I've already dropped 40lbs, with another 40-50 to go.