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Scar Treatment Plan Sacramento Area

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Hey fellow scar victims, I'm new here


I was wondering if I could gain any advice or get any suggestions on how to deal with my acne scarring. As a quick background, I'm a 22 year old white male, with Grade 4, or bad Grade 3 acne scarring. I believe (correct if I'm wrong, that's why I'm here) that after much research, I have icepick / boxcar scarring on my temples, with rolling scars / tethered / box car / mixed scars on my cheeks. The treatments I have received thus far started about 4 months ago when I received a fraxel Co2 ablative resurfacing, and since then I have microneedled 4 times (3x with .5mm, 1x with 1.0mm). I havent seen much improvement from the microneedling,  I was wondering really where to go from here ... these cause a lot of issues for me both professionally and personally, and am curious as for how to obtain some realistic results, and what i should expect.


For restrictions, anything with a ton of down time is out of the questions at this point in my life, and I am really hesitant to be treated by lasers or any sort of filler. I had a bad experience with the co2 laser (mostly my fault for not having done ANY research prior), and am looking for something more cost friendly and manual. Since getting the laser, I have done tons of research on both this site, realself, as well as through hope inspiring videos starring  (my frickin hero) Dr. Davin Lim.


All this being said here's what I'd like to know.

1. How realistic is it to expect dramatic results using DIY at home treatments? - I've seen some success stories doing the TCA cross method, some people going as far as to clear a scar with one treatment! I currently dermaroll with a pretty shallow needle, but I was planning on working myself up to 1.5mm possibly 2.0mm, and am curious as to if this could have a dramatic effect at all? Would dermapen be more effective?


2. If not, what sort of treatments should I pay for (I am on a budget) and where should I get them? It seems the consensus around the bay area is that good doctors are hard to come by, and they often cost a lot of money. Does any know someone that is an exception to this rule?

If @beautifulambition could shoot me some advice I'd be forever greatful (lets give around of applaus to this champ btw)

Pics to come soon

Edited by Emotionallyscarred

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@Emotionallyscarred Lots of box cars, and some rolling scars, w/ icepicks. Fat loss mid cheek. 

"The treatments I have received thus far started about 4 months ago when I received a fraxel Co2 ablative resurfacing, and since then I have microneedled 4 times (3x with .5mm, 1x with 1.0mm). I havent seen much improvement from the microneedling,  I was wondering really where to go from here ...""" That is a problem the Dr did the traditional blast it with laser which does nothing. Microneedling is great in between Dr based treatments, but not as the main cheese. You should be using retin-a/tretinorin/ differin (OTC target) nightly for cell turnover. 

Ok the biggest thing is no subcision was done and you lots of it! This should been the first line of defense. I would see if you can find someone who can do cannula subcision though if they do Nokor that will do as well. Because of your grade of scar you may need 4 plus sessions. Space them at least 3 months apart or whenever the filler runs out. You will get filler after your subcision when the swelling goes down. 1-2 vial of over dilute sculptra would be good as you have widespread scarring but you can also do a HA filler as spacer post subcision. If you want to do permanent Bellafill they love to push everywhere. Please do HA filler at least a couple of times and like it ;-) We are using it to make your own collagen so temp is fine with sub. 

Check if the dermatology at UC Davis does subcision, I know it's a teaching hospital. Sue Kilmer's laser clinic- she's knowledgeable with lasers but pushes fraxel ;-/ (Fraxel won't work for you) ... is in Sac but she does not do any manual methods and can be expensive. 

TCA Cross can be done with the subcision for your icepicks.

In between your subcisions I would do rf microneedling as you have lots of box cars. Typically 3-4 sessions. Find this at Drs and Med Spas

You might have to bump up treatment with co2 laser 3-7% density and the highest power for those boxcars. This is if your not satisfied with rf needling.

You can finish with several tca peels or fully ablative erbium resurfacing laser peel. 

Everything is optional, many treat over 3 years, ... space all treatments 3 months apart even if the Dr says every week. The body is slow to heal, you want to see what is working and not. You can needle monthly and do glycolic peels at home in between treatments. Everything I said can be on a budget, space it out, subcision is cheap and tca cross, ... even if you do one a year. Laser is most expensive. RF needling even med spa's have. The higher the grade of scars, the more treatment needed. You doing tca peels at home and needling will do very little until Dr based work is done with subcsision first. 


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sorry for for the delay in the response! Ive been very busy. I took the advice you gave and got subcision/cross/microneedling with Dr Rullan back in early February 2019.  The picture show where I’m at as of last week. I chose harsh lighting and tried to cause the light to create a shadow to really see the state of my scars. A few comments/questions. 


1. I now understand what you mean by fat loss mid cheek. while the cross/subcision really softened the ice picks/boxcars it really highlighted the lack of fat in my cheeks. Hence the large dark shadows created when directly under a lighting source. I have a session scheduled late October with Rullan doing a vial of sculptra with my next treatment. Due to travel/time constraints I’m getting this injected on the same day as my surgery - is this advisable?


2. A little hesitant with the HA filler as I know it needs to be reinjected a few times a year. Will this be necessary to achieve my desired results? 



3.  I’m planning on getting radio frequency microneedling after my sculptra injection - I believe you  mentioned in other posts that this will increase the volume build of the sculptra. How does his work? 


4. After my next operation - I’m thinking of one every 6 months - is this too far between surgeries? Would 3 or 9 months give better results? 







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HOLY **** MAN! That's after 1 treatment of Rullan??? I see a ton of improvement, maybe 20-30%  and I am being honest when I say that I am shocked at how good that turned out you must be a hyper responder. Your temples look amazing. I would like to see a pic without hat and outside, for fair comparison. 

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i really appreciate it! Any positive feedback really helps as most people don’t understand the struggle a lot of us go through just getting our scars to look marginally better. 

that being said The results are not as durastic in person but I would agree with a 20% improvement on the boxcars/icepicks. 


Here’s some photos of me in the day light - once again I tried to create shadow in the pictures here - so you will notice they look worse than the initial photos. It’s also worth mentioning that I took them at a much brighter point in the day. So overall the lighting/angle is far worse than the baseline. 


The issue now I believe is fat loss in th cheeks. Hoping sculptra will help with this 



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@Emotionallyscarred Sounds like you pretty much know what will improve your atrophic rolling scars.

I would do several sessions of subcision + Sculptra, build that up on the cheeks. A vial a time or a full course is closer together. Treat every 3 months for subcision so you can judge healing, collagen is slow. Towards the end of subcisions, do HA  for individual pits on top. 

The temples need sub as well and some Sculptra.

Some of the smaller boxcars could use tca paint on (3x layers) to the scar beds

I would rf needle, ... between your subcision sessions alternate, that works great for the smaller box cars.

CO2 laser if you need a boost low density and high power. 

Finally do something for the surface texture like ERbium fully ablative resurfacing, Jplasma, TCA peels, or a deep peel, the choice is yours. 

At home between your treatments every 3 months or more do derminator single needle attachment to the scar walls to soften them up. Alternate with glycolic peels. Monthly. 

Your doing a retinoid nightly good.

All this is optional, stop any time you want. Do the manual methods first even if you can afford 2 subs a year and sculptra. 

Filler for atrophy throughout the cheeks and temples will help a lot.


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@beautiful ambition 


sounds great thanks again for the advice! I only know what to do based from this site and people like you. Doing God’s  work lmao can’t say thank you enough


I will probably be looking at treating every 6 months (with rf in between) and see how I respond. will post updates as I see progress! Next coming in October

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