@UnusedNylonHi there box cars and rolling scars on the temples and cheeks.

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Hey thanks a lot @beautifulambition, its good to have a plan again, I was feeling pretty low without a course of action.

I'll buy the kojic and differin and start using today. And spend the next year doing 3~4 cannular subcisions, I'll check if I can find sculptra, if not probably using Radiesse again.

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You could have underlying Fibrosis which would need a deep strong co2 laser like ultrapulse, ... it depends on the feel of the skin.

Ya, in that Radiesse/cannular subcision I've done in the past, there was a lot of "cracking" in the skin. Should I do the laser before or after the 4 subcisions?

Only if they cannot move the cannula though the skin then get ultrapulse done, otherwise you can just do it after. In cases like this the skin is so tethered down subcision is hard without laser,

BA

So I had a consult with my dermatologist today and we agreed on cannula subcision,which I'll be doing in May since he wants at least a year apart from my last one. He gave me two options:

1. Same as the last one, cannula subcision with Radiesse.
2. Or divide the Sculptra in two and do two cannula subcisions with half vial of the Sculptra in each with one month apart.

His reason to divide the Sculptra is because, by his explanation, Radiesse works for a year with one treatment, but Sculptra needs 3~4 monthly sessions to get the same results. Since I'm paying for the vial, this option would be 3~4 times more expensive, but as I said I want to do as many subcisions as possible, he can divide one vial for two sessions. So, both options would cost me more or less the same.

Of course I want to do as many subcisions as possible so I'm inclined to pick the second option. And I'm definitely don't want to wait a year between treatments, so maybe I can repeat the Sculptra 3~4 months after the second treatment. Would like some opinions?

PS> I've been using differinandkojic licorice cream and its definitely helping the skin, especialythe redness.

@beautifulambition

@UnusedNylonDef the Sculptra, so many success stories lately doing this with over dilute(saline), sculptra and aggressive subcision. Last's a long time too. 😉

@beautifulambition I'll be doing subcision with Sculptra next month so I want to talk with my derm about this "over dilute (saline)thing". First, I'll try to convince him to use the full Sculptravial and repeat the procedure every three months (now he wants to do it monthly with half vial).

About this over dilute saline, is it somewhat common for dermatologists to use it? The Sculptra vial recommends to reconstitute with5ml of sterile water, from what I understand the saline should be added after this reconstitution right? How much saline should be added to the mix?

Maybe I'm just wrong and the Sculptra should be reconstituted with saline directly (no sterile water added), then how much saline?

Not sure if the doc will want to do that by my recommendation if it isn't that common to begin with. So I want to know a little more to discuss this with him.

Thanks again for the support @beautifulambitionI'll add some pictures in 20 days or so before the procedure.

@UnusedNylonOk great.

Over dilute means Saline or sterile water same thing, one just has preservative. The Dr know's the dilution ratio, I cannot tell you this for your case as I am not injecting you. The vial is prepared 72 hrs ahead of time in the office if they know what their doing. Over dilute means more water than normal. So that it's not too strongly injected under all the scars. We are not using this for volume but as a layer under the scars, make since. Volume is done by HA filler inlatter subs on to individual pits.

Wait are you doing this yourself, ... 5ml sounds like your trying this on yourself (I don't know any Dr who uses that small of amount - asking for problems), this is nuts. Any Dr knows this is a bad dilution amount you gave me.

The questions your asking me sounds like a non certified Dr is injecting this on yourself, these are basics. If they do not know them they should not be doing this on you can cause serious problems.

Ask for more saline than normal, that is all, it's very simple.

Most Dr's are arrogant and will not follow anything I say, as such it's up to you to negotiate with them and make sure they do what you wish, ... if he won't dilute it it's your choice.

Please make sure this Dr knows how to inject Sculptra, ask how many times they do it per month, ... if they are just injecting it ... it could be terrible. Difficult substance to inject.

One day before sculptra. @beautifulambition

I'll put the picture of just one hour after the procedure. Looking forward for your help again @beautifulambition, thanks.

@UnusedNylon

Type of Scubsiion don't even know what that means, using vague language. He could be doing anything. Or just injecting Sculptra which is not subcision. It's not a modern form of subcision, what? Dermal tunneling is injecting filler, this is not modern. I don't know that your Dr can do subcision if he thinks, what you said above. Find someone who can, remember you can treat with Sculptra, and then do scubsion elsewhere. What... distilled water, this is verrrrrry dangerous. This is not medical to use "distilled water." I don't even know if you had Sculptra, sounds like he just injected you with distilled water. Did you see a vial with white liquid in it and the SCulptra label? Perhaps we have a language difference, ... they sure don't recommend "distilled water" which is not sterile to anyone. No Saline is used because that is what is supposed to be used with all injections, or they can use sterile water for injection called various things world wide, not "distilled water." The results look good but this is swelling for the water. Remember, this will go away, and then slowly if Sculptra was really used collagen will build over 3 months and after for years.

I would find someone better for subcision

It was "sterile water", sorry about that, it was my mistake.

We did subcision, but the term he used was "dermal tunneling" and not "cannula subcicion", still he used a cannula and had to put a lot of strength to go through the skin, for every hole he draw like 5~10 lines and did the subcision on those lines. It was pretty satisfying hearing the sounds of the skin "breaking up". And he injected a little diluted Sculptra in every one of those lines.

Yes I did saw the sculptra vial. It is a good clinic and I know the people there pretty well. My confusion was if there was any difference between "dermal tunneling" and "cannula subcision", I think it is just different terms for the same thing then since you found the pictures to be good, etc..

About the saline thing unfortunately he said he can't used because it isn't approved by the maker of sculptra.

Anyway, I'll be doing this procedure again with the other half of the Sculptra vial in 25~30 days. I'll put some pictures before and after that.

Thanks again @beautifulambition, you're awesome helping everyone

@UnusedNylonIT's exactly what I thought, semantics or the wrong terms used. You had cannula subcision(he is calling it tunneling, ... call it whatever they wish) and he used sterile water, that is fine. It's his preference on that one. So yes everything was done as it should be, now for the healing and the results.

Pictures in 30 days won't mean anything as you will still be under swelling which can last for 3 months after injection, hence the healing period. We will know best after that time. I know he is doing the 2-3 total Sculptra standard treatment close together, but this is not how we do scubcision for acne scars (this is fine though now for Sculptra), ... after that wait the months between treatment when you do your 8 total subcisions. Just a fyi 😉

Hey @beautifulambitionhow're you doing?

So I talked with my derm and he said my skin is firm and almost don't have more tethers (but definitely have some still) so he recommended erbium 2940 (ablative)so we can start working on the top layer of the skin (mainly the rolling scars).

Just to remember you I'vedone 3 subcision total, 2 with sculptra (half vial each) and long before that 1 with radiesse. I also have done multiple dermarolling and voluderm sessions.

What do you think about this laser? Should I do some more subcision and then consider it again maybe?

Let me know if youneed some pictures. Thank you again.

hey, how are u doing? improvement?

@UnusedNylonVery busy, ... thanks for asking 😉

Hmm without pictures I don't know what he means by start working on the rolling scars, filler and subcision should have lifted them a lot. The laser would just be for texture.

Ok on the treatments... did you do rf needling and co2 laser, or we are just doing Erbium ?

Without pics I cannot say on ... if more sub is needed, but you know if your scars are lifted enough to your liking, Some need 3-8 sessions of sub.

Don't laser unless were only dealing with slight texture. should be a final step before peels.

Yes some pics would be helpful

@acnescars2000 @beautifulambition

Sorry for the delay. I think the skin definitely feel better to touch since I started (its not too loose anymore) but not sure if I can see huge improvements visually, maybe a little but nowhere close to where I expect, but again I'm not in a hurry and any improvement is better than nothing.

I did voluderm, not sure if this is considered rf needling, but I think it probably is. I never did laser before and the derm wants to do this erbium 2940 ablative, he also have co2 there but didn't recommended it for me.

I think I probably need more subcision anyway, but the derm said we could continue doing it after the laser so to get a improvement on the overall texture first (especially the rolling scars in the cheeks). I'm thinking about getting more 2 subcision with sculptra and then doing the laser, but not sure what do you think?

Here is the requested pictures taken yesterday

@UnusedNylonHi there thanks for including the pictures.

You have atrophy or fat loss, rolling scars, box cars, icepicks.

You will need lots of subcision and in your case I would consider Suclptra post cannula subcision or dilute Radiesse. Your biggest improvement is going to come here, then you can treat your surface texture.

Regarding a Dr in Brazil, I don't think I have anyone. Check the FAQ pinned to the main scar treatments sub, goto the bottom of that for hints how to find someone in Brazil. I would look for someone who can do cannula subcision

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