@asianman81Thanks for posting, I see surface box cars, some ice picks, and discoloration.
Scar treatment is painful, perhaps ask for more anesthetic.
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Thanks for your reply.
I found coupleplaces that provideacne scar treatment in Austin, TX.
1. erbium laser, C02 laser and some peeling.
https://www.buckinghamfacialplastics.com/procedures/acne-scarring
2. CO2 laser,Subcision, TCA, and many others.
https://www.sanovadermatology.com/services/conditions-treatments/acne-scarring/
But my worry is that I heard that TCA cross can make it worse (deeper and wider).
Something like this
https://www.realself.com/question/vancouver-bc-normal-scars-significantly-worse-weeks-post-tca-cross
Are there any alternative (safer) methods?
Say 50% improvement over 6 month, I will be really happy.
Thanks!
@asianman81Thank you let me know your experience once you goto the Dr that is the most helpful. Most general derms will blast your face with laser, that isthe easiest and quickest way for them to make money. Manual methods like subcision and tca cross are always best before energy devices. I would consult with both if they are your only choices and see what they say. TCA Cross is fine and even if it makes your scars "wider", it makes the scar floor bed raised, then your resurface or do laser, we are swapping scars for texture to treat. Safer methods actually the methods after this are more harsh, like cutting them out - excision. IF you want to start out slow and don't want to try tca cross, you can try rf needling. The analogy here is a road, you fill the pits before laying the surface layer right. Hence dealing with the individual scars - tca cross. Fly and see Rullan in San Diego who is a acid expert ( teaches Drs) in ethnic skin if your skill afraid, he uses phenol which does not do this.
Thanks for your reply.
There is only one place that offers RF microneedling in Austin TX.
https://www.rejuvenateaustin.com/secret-rf-micro-needling/
Based on Google and Yelp review, they don't have any experience with acne scar treatment.
How about microneedling with PRP? Is this as good as RF microneedling?
Sanova has RF microneedling. I did microneedling with PRP elsewhere and didn't find it all that beneficial for my majority rolling scars. I have not had RF microneedling, but did recently have my first of 2-3 subcisions with Dr.Mamelak at Sanova, and did note that they have it there. They also do TCA Cross, I asked to have this done later, but I don't know if they have alternative methods for darker skin.
@BunnyEarshow was your experience with Dr. Mamelak? Does he seem knowledgable, skilled, and honest?
@grandor, I was just this moment looking through threads here on scar specialists and what to look for in one. I DO think he seemed knowledgeable, he did use touch to feel for fibrosis, in fact he had several helpers-some were just there to learn, but otherswere actively manipulating my skin while he subcised. However, he did not use any special lighting to really see the scarring, which is something I read to look for on here. He also wouldn't subcise the scars just near my inner eyebrow area, because he felt the riskoutweighsthe benefit. Additionally, hewas not open to using a suction device-he mentioned he had tried that before and had some overcorrection which created different problems. He did say we could do PRP injections, but that he didn't like to use filler after subcision because it can mask scars he would otherwise see during subsequent subcisions. He did say he prefers to do elos sublative lasers between subcisions to smooth everything out and further enhance results/ collagenesis.
All of that said, I am somewhat annoyed, becauseI actually did see him about two years prior to consultfor possible subcision at which time he recommended ematrix laser treatments instead (I had already done 6 microneedling with prp sessions, though not with RF, elsewhere the year before).Also, from what I've read in articles (not on here, I haven't scanned this place for ematrix info yet), several passes should be made with the ematrix wand over the scarred areas (as many as5 passes). The person who he had do my laser treatment did one pass on the whole face and only one additional pass on areas I specifically pointed out to her, so I'm not certain if I received all of the benefit I could have from the 4 ematrix sessions I underwent.
I did tell him that I already did ematrix and I wanted to be more economical, because from what I've read Elos Sublative isn't much different (he says it's better). He said we could do the subcision alone or I could decide later in the next 3 months, so anyresidual swelling from my first subcision goes down completely and the collagen regeneratesas much as it's going to, if I wanted to try the Elosbefore my next subcision.
For the record, in my largest scar I did see some improvement (he says I will continue to until month 3, which is why he waits). Prior to subcision it was about the size of two U.S. Quarters, with shallow but varying depths and irregular borders (it was several scars merged together creating a very broad depressed area on my left cheek right where a nice juicy fat pad should be ). The entire middle portion of that scar is nowflush, though the rest of that particular scardidn't raise much at all so far. As for the rest of my face, somescars seem to have been totally eradicated with just the one treatment, which took place a month and a half ago, while others went back to looking exactly as they did before. It was $700 for the one round, and I absolutely feel it was worth it and that I am seeing results that, while the results do vary from scar to scar, I'm overall pretty thrilled with.
Tangentially, in the thread I was reading before I read your response to my earlier comment, I was just learning about the Liberator Subcision method. I still have to price it all out and do further research on safety and efficacy, but between the microneedling with PRP, the ematrix, and this last subcision plus whatever future shot-in-the-dark treatment costit might be more cost effective to go all out and travel to have this done and hopefully be done with it once and for all.
@BunnyEarsthanks for the reply and thorough review of your experience. All in all, it seems like he is pretty competentand willing to use manual methods (Even though you mention he did push laser earlier on). I think time will tell with your current subcision, as results should keep improving - if you see improvement in just a month and a half, it should continue to get even better. I think it's honest that he didn't subcise near the eyebrow, since that is a dangerous area (risk of blindness, if optic nerves are severed), and he was careful to avoid it.
I'm considering visiting sanova for tca cross, as I have mild acne scarring (mainly ice picks and boxcars). Bummer that he doesn't use angled lighting, as I think that is what scar specialists do. Sounds to me like he is a good derm, but not necessarily a scar specalist. What RF microneedling device do they have?
If you do travel, I recommend Dr. Rullan in San Diego - it's a bit of a flight from austin, but he is a very good, honest doctor who has tons of expereince doing subcision. He is also very affordable, and prices fairly. Only crappy part is flying back with your face looking awful after treatment.
Thanks for your input, @BunnyEars
I scheduleda consultation with Dr. Mamelak tomorrow afternoon.
I will let you guys know.
Just check sanova web site. I don't think they have INFINI, but they do have elos plus.
https://www.sanovadermatology.com/services/cosmetic/laser-skin-rejuvenation/elos/
Not sure microneedling + elos plus will be as good as INFINI.
@asianman81"Not sure microneedling + elos plus will be as good as INFINI." RF needling typically is better, for you that would be at a shorter depth. But your scars are not that deep to begin with, you have a lot of surface boxcars. As such co2 laser at 3-7% densityand the highest power might be a better option or you or erbium resurfacing. Ematrix - which is built into Elloscan be a good option for a light treatment but here in the states we do not have the same and higher setting as other countries for this device ie 100mj/pin, as such it is not as effective as just doing laser or rf needing. I would not even bother with microneedling unless you do it at home in between your dr based treatments, buy a derminator it's cheap. RF needling is like a laser NOT like generic microneedling. Start with your manual methods, they are hardest to find in Drs: cross, subcision if he feels he can do it, move onto energy devices if you need a boost.
@asianman81They do have Infini RF microneedling. It's on special from time to time in their emails, and in their pamphlets in office. If it's not on the website it's an oversight.
Hey guys,
Just talked to Dr Mamelak.
Overall, I'mhappy to hadconsultation with him.
Although. he didn't touch my face (This may bebecause my scars arenot that deep mostly), but he seemedknowledgeable, and was nice.
I told him I'm interested in havingRF microneedling, but he didn't suggest, may be because,Itold him that I had Fraxel laser in 9 years ago, and it was really painful.
Here is his first suggestion.
1 or 2 TCA cross for deep scars +Sublative laser (RF) 4 times (Package).
I told him that I'm kind of worry about the TCA cross, and asked alternative (safer)treatment.
Then he suggested 5-6 times Microneedling (Skin Pen) and the Sublative laser.
He also told me that he never had any issues with TCA cross, so I'm leaning toward to TCA + Sublative laser.
I will probably call him tomorrow or next Monday to schedule initial treatment.
What do you guys think?
Thanks!
Thanks for following up. Your scars are very shallow, so not sure if tca cross or tca paint is better technique. Does he know about the paint method? (applying lower concentration tca multiple times to shallower boxcar scars)
I've never heard of sublative laser, so can't give advice on that. But microneedling is very safe and usually affordable. Not a bad idea to do it, either at home or with a doctor. @beautifulambitioncan advise more on this
Keep us posted on what you deicde to do!
Hey @grandor, he saidthat he will apply it on only deep scars using toothpick or needle.
Regarding the sublative laser, itsfrom Syneron company, which i never heard about.it's purpose is resurfacing & tightening and stimulating collagen.
@grandor@grandorSublative laser does nothing for scars. Now vascular laser is great for discoloration and or acne treatment.
""I told him that I'm kind of worry about the TCA cross, and asked alternative (safer)treatment. -Then he suggested 5-6 times Microneedling (Skin Pen) and the Sublative laser." - First of all sublative rf is not a laser. It's a energy device for surface issues and it works on some and not on others. Dr Lim uses it for treating early scars. Doing microneedling to me ispointless as one can do mironeedling at home(Derminator),no pain no gain. He could try a combo of tca cross, sublative rf on you, this is not laser again, if you need laser then get it down the road for a boost since your afraid about the pain. Neither procedure is that painful, option A. We just have to see how your body responds, remember healing is exceptionally slooooooow. I would do picosure or a q-switch laser on you as you have hyperpigmentation.
BA
what is the cost? i went toMamelak 2 years ago and paid 700(? i think) for 1 session of tca cross. he definitely was trying hard to push for sublative laser (2k for each session or something absurd). i asked if he had any pictures of previous patients, he said itviolates patient confidentiality and just gave me the marketing pamplet for the laser. he charged 75 for consultation and didnt honor that deductionfor the first tca treatment. definitely not worth it. if i were you, i would just book an appointment with rullan. flight from austin to san diego can be as cheap as $200 round trip and rullan's cost is ~1200 for microneedling, subcision, and cross.
@beautifulambitionthanks for your input . All my scars are like more than 10 years old...so the RF sublative is not worth for my scar?
He told me thatTCA + sublative will give very good improvement for my scar.I think the RFsublative he was suggesting is eMatrix.
Hey @gynoscar, price was almost same as you. I wasalso considering to see Dr. Rullan, but thing is I need to flight back to Austin after treatmentwith swelling face...I'm still thinking. Thanks for your input.
4 hours ago, asianman81 said:One more question.
I'm considering to flight to San Diego to see Dr Rullan.
TCA or Phenol CROSS and Eribium resurfacing can be done in same day?
My flight to SD and back was on the same day. I went to the SD airport right after seeing Rullan. Face was very swollen, red, was bleeding a bit but Rullan's assistant gives you a mask to cover up. You would only need to show your face when checking ID from TSA, then you can put it back on. I'm not sure about eribium, but rullan did microneedling, subscision,phenol cross, and PRF same day for me. I suppose you can ask.
ematrix won't do anything for you. it is only for early scars. i have tried it twice since i was convinced the doctors knew best but was disappointed by the results -0% improvement. if you think ematrix would do something, then ask for pictures of improvemnts, my guess would be they have none.Mamelak isn't a acne scar expect, Rullan is. Rullan has been doing it for years and the price is a lot more fair.
@gynoscar thanks for your input again.
I will contact Dr. Rullan tomorrow, and will ask for online quote. I don't wanna take day off for just consulting. 
Yeah, I'm seeing a lot of threads that talk about ematrix, and mostly it works for young scars.
I'm sorry but I have two more question,
How long did it take for your face back to normal? Say, if I get the treatment on Friday, can I go to work without wearing a mask on Monday? (I may do same treatment combo like you did).
What was improvement? Are you happy about the result?
Thanks again!
I only did 1 treatment so far. The deepest scar has shown great improvements, but the others not so much. I would say around 10-20% improvement so far. I am happy with the results so far (although my scars are a lot worse than yours).I am planning to do it 2 more sessions. As for time, it takes about a week to be completely normal. Most of the scab would have fallen off by the 5th-6th day. Scabs are dramatic looking on day 1-5. Obvious swelling on the face would last for at least 3 days.
@gynoscarhow was your tca cross experience with mamleak? Besides the ridiculous cost, did you see any improvement, and did he target all the scars you wanted him to hit?