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Lastchance130

Desperate question on my scar - Acne Scar Treatments While High Dose Accutane

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Hi everyone,

 

I'm on my fourth month of Accutane 80mg/day and my acne scars are really taking a toll on my self-esteem and mind. I have grown to become super desperate in trying to get rid of them as soon as possible. 

First most, how deep and what kind of scars do I have (picture)? I understand that while I'm on accutane I can't have any treatments. Can I possibly just get dermal fillings on these scars as a temporary solution while i wait for my course to finish up?

Thanks in advance!!

 

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  In the interest of being as honest as possible, your scars are more on the severe side.  The majority of your scars are rolling with some boxcars, and are widespread.   You also exhibit volume loss on your cheeks from deeply seated cysts.   Because you are on Accutane, your treatments are limited to procedures that DO NOT leave open wounds that need to heal by secondary intention (left open to heal on it's own).    That means NO lasers, dermabrasion, or chemical peels (with the possible exception of TCA Cross).    

For now, the safest thing you can do is fillers.   Subcision is also possible because the surface of the skin is left intact.   The general rule with fillers is to start with temporary fillers to make sure you like the look and that they work for your type of scars.   Some of the scars will need to be subcised, with filler used to prevent reattachment of the scars and the "donut' effect.   Without subcision, fillers will extrude from the place they are injected to the surrounding areas because the scar tissue is too thick.   

For fillers, stick to hyaluronic acid fillers that are reversible and temporary to gauge their effect.    The sunken cheeks can be lifted with a dense filler with Voluma or Restylane Lyft.   Restylane Lyft is much cheaper than Voluma, so thats one way to save money.   For more surface level / shallower rolling scars, use a thinner filler like Restylane Silk or Belotero for fine tuning.   

When you have more experience with fillers, BellaFill is a permanent filler that can be an option.  But it is irreversible and has risks (granulomas, infections years down the road).   

Please let the board know where you are located to get recommendations for doctors.   

 

Edited by dazzed

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3 hours ago, dazzed said:

  In the interest of being as honest as possible, your scars are more on the severe side.  The majority of your scars are rolling with some boxcars, and are widespread.   You also exhibit volume loss on your cheeks from deeply seated cysts.   Because you are on Accutane, your treatments are limited to procedures that DO NOT leave open wounds that need to heal by secondary intention (left open to heal on it's own).    That means NO lasers, dermabrasion, or chemical peels (with the possible exception of TCA Cross).    

For now, the safest thing you can do is fillers.   Subcision is also possible because the surface of the skin is left intact.   The general rule with fillers is to start with temporary fillers to make sure you like the look and that they work for your type of scars.   Some of the scars will need to be subcised, with filler used to prevent reattachment of the scars and the "donut' effect.   Without subcision, fillers will extrude from the place they are injected to the surrounding areas because the scar tissue is too thick.   

For fillers, stick to hyaluronic acid fillers that are reversible and temporary to gauge their effect.    The sunken cheeks can be lifted with a dense filler with Voluma or Restylane Lyft.   Restylane Lyft is much cheaper than Voluma, so thats one way to save money.   For more surface level / shallower rolling scars, use a thinner filler like Restylane Silk or Belotero for fine tuning.   

When you have more experience with fillers, BellaFill is a permanent filler that can be an option.  But it is irreversible and has risks (granulomas, infections years down the road).   

Please let the board know where you are located to get recommendations for doctors.   

 

Thank you for your reply. I currently live in NYC and am seeing David Khalil, MD.

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@Lastchance130 

Your going to take many rounds of 4-5 cannular subcision throughout the whole cheek and temple, I Would space out your treatments at least 3 months apart. For your type of scars rolling mainly, some box cars and some ice picks, ... I would do 1-2 vials of over dilute Sculptra after your subcision. Further down the road when doing one of the subcision fill for pits using a HA filler, ... you have widespread scarring and as such Sculptra would be a good choice. 

It is up to your providers discretion if they will use filler on you and cannular subcision while on high dose Accutane. You of course need lots of treatments (scars are not one and done and must be done as a plan) once you heal and finish Accutane

Because of your skin type I would get picosure laser which stimulates collagen and works on your discoloration. This can be done while on Accutane. 

Rf needling 3-4 treatments only once you finish Accutane and give 6 months to heal.

You would also need co2 laser at 3-7% density and the highest power to soften some of the scars OR profractional erbium.

Erbium resurfacing is done at the end of treatment for surface texture, or you can do several tca peels. 

Everything is optional, treat as you have time and money, many treat over 3 years, ... please allow at least 3 months between treatments.

_____________

 

I will put this here by another person asking about Accutane and Doing Scar Treatments:

Quote

 

beautifulambition So just making sure.. I can stay on low dose accutane 0.01mg-kg and come off 2 weeks prior to any treatment? :smileys_n_people_9: non or fully ablative.. 

Also, how do I find the proper dose concentration of accutane I need to accumulate in my body before it kicks in?  

 

High Dose = Increased Risk of Potential of Complications in ANY Acne Scar treatment.

""We are talking about ""cannula"" subcision and filler, NOT Nokor. Filler and a cannula will not effect someone on high dose. One can also drop down to low dose and take it as needed if it's ongoing when they need treatments. Of course you don't want to do laser, etc... While on Accutane. The skin is fragile and in a thin / weaker condition and needs to heal/thicken. Non ablative laser treatments can also be done like vascular laser for discoloration (picosure). 

It is always best in my opinion to do the bulk of acne scar treatments (especially energy or acids) 6 months after high dose Accutane. So you have time to heal. While data shows that one can treat while on Accutane, it is Ablative procedures, that can cause harm, side effects, poor healing, new scars, fat loss, etc. Most Drs will not take the risk or manage a person on high dose Accutane properly to make sure they receive appropriate care. If you go to Dr Lim by all means do all treatments while on Accutane for scars, otherwise I find "cannula" subcision and filler appropriate for treatment. It's a calculated risk, and depends on the patient and the skill of the Dr.""...

@HuskyChef Accutane adds risk to whatever treatment your getting. As such I am not your Dr nor treating acne scar specialist taking liability for your outcome, skin quality, health, healing, nor overall evaluation. My point was this to boil down your question. What can I (being you) do for acne scar treatment while on low dose tane. I thus answered with subcision and filler being the safest best (using a cannula). RF needling would be ok with the proper evaluation of your skin and full understanding of the practitioner of the treatments effects. Low density CO2 would be ok, with the above. Vascular laser would be ok for hyperpigmentation. Fully ablative erbium resurfacing WOULD NOT be ok, Mid to deep acid peels the same, nor deep laser treatments like ultrapulse. Why the skin is not ready for these settings and energy usage in most cases. Do I suggest you do anything while on tane, of course not, I cannot make that blanket evaluation. Can it be done, sure with a knowledgeable practitioner who agrees, lots of practitioners would just zap you w/ multi-energy-device-treatments and could cause issues.

Logically low dose Accutane can be stopped at any time and started as needed, it can be taken as a ongoing acne treatment long term, side effects can be mitigated, when you do acne scar treatments you stop taking it and start again once fully healed.

" :smileys_n_people_9: non or fully ablative.." - this comment scars me, it makes me think you think you can do anything, that's not the point of my response. Your practitioner has your liability in their hands and you are now educated to possible treatments. Many practitioners will not touch you until 6 months after Accutane regardless if possible treatment can be done.

There is no proper concentration, for some it's 1000-3000mg-Total for others lower or higher, ... it has to be person-to-person basis of overall response. Low dose mitigates side effects and can be done long term, of course you will not get the benefits potentially as quickly and thus side effects also could be lengthy in occurrence. Why high dose if you don't need it as emergency treatment, research side effects of Accutane to understand this.  

 

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 If it makes you feel any better , mine are worse.  I posted pictures on my profile. Let me know if fillers work for you , I'm going to try them soon.  Be strong and know you're not alone . You're still good looking , so be happy about that. :)

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Please note that after the swelling has gone down and 1-2 months later after subcision and filler the scars come back the same.....I have done it 2 times before it does NOT work

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On 11/21/2018 at 11:10 AM, superburrito said:

Recent studies show that accutane and acne scar treatments can be done concurrently. Here's Dr Davin Lim on the topic:

 

The research states this might be possible to do scar treatments while taking low doses of Accutane. Low dose Accutane is typically 10-20mg a day. I think you would be crazy to do scar treatments while on 80mg Accutane. That is just me. I would wait at least six months.

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@floridagirl1991 I had filler done 3 weeks ago. It helped, looked better but you can still see under lightings.

@ScarRight my dosage dropped to 40mg. I have spoken with Dr. Novick who has also given me the filler a few week ago. He is willing to do the subcision procedure once my treatment is over. I pretty much agreed to it and scheduled an appointment knowing his years of experience :/

@tryinghard123 seriously????! How many sessions did you undergo? Did BA give you a plan to help you? I’m getting anxiety thinking about this possible outcome.

Edited by Lastchance130

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@Lastchance130 Seems I have to chase fires today, ...

I can help with treatments, plans and questions, but I cannot help those who need extended mental support (General Statement).

No scar case is the same, we are not clones, one person could do a million procedures and not be you, your all different ages, ethnic backgrounds, healing capabilities, plans for treatment, outcomes, different surgeons (they treat differently as well), etc, we could go on and on. The point being is never compare yourself to someone else. Sure you can learn from their experience but do we really know every single detail about what was done and why - no.  If someone heals poorly or had a poor Dr they typically hang around here. They have pulled up a bunch of old threads for some reason to get answers. 

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