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Atrophica

Deep indentation in the middle of my forehead

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Hi guys

So i've been dealing with acne for years. I've educated myself alot about the skin (i've got a science degree aswell in biomedicine). I've managed to get my acne mostly under control, i still have bacne though. The problem is the scars now. Im turning 25 years old and my skin doesnt heal nearly as well as it used to.. 
My main concern is the deep atrophic scar in the middle of my forehead. It was from a cyst (i've only ever had 1 cyst), which was formed after a chemical peel. Ofcourse I tried to help and get rid of it by applying high concentrate acid meant for warts... Now im left with a deep pit, when you run your finger over it you can feel the atrophy is deep. It is a bit less than a year old.
And the other atrophic scars werent even big pimples or anything, they just dont heal.

I've had several peels over the years, especially this year. TCA for scars, glycolic/salicylic/azelaic you name it. Had a dermapen done 2 months ago and another dermapen session a week ago.
I've spent so much money on treating my skin and my skin is stressing me out.
What else can i do about these atrophic scars, I dont have money for fillers. My main focus is the deep pit in the middle of my forehead as I've already mentioned, it just doesnt seem to be getting any better...

Oh and by the way, when I see someone with acne or bad scarring, I never think they are ugly. I feel for them deeply and appreciate them for what they are. I know we have a tendency to beat ourselves up and see our flaws 10x as worse as they really are... But, we're still here, obsessing over skin.

Thanks 

 

 

 

 

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Edited by Atrophica

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I know for my forehead scars I cover them up with hair. I always have a fringe. Forehead scars can be tricky to treat, but I'm sure Beautiful Ambition will give you some ideas. Best of luck.

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@ScarRight gave you a good hint, I am sure he could have given you a plan as well ;-P

@Atrophica Looks like a combo of boxcars, rolling scars, and PIE or redness post acne on the forehead. I see your still breaking out and this concerns me as treatment could make things much worse. You need to get it under control. I see pustuals, pimples, and closed comedones.

This is concerning "Ofcourse I tried to help and get rid of it by applying high concentrate acid meant for warts... Now im left with a deep pit, when you run your finger over it you can feel the atrophy is deep. It is a bit less than a year old." - See tons of these nightmares on the product reviews of products sold on Amazon. We have a acid peel guide in the top of the scar treatments sub first post called the faq so people don't slap on things that can cause permanent scarring, dangerous stuff.

Dermapen alone will not work on these scars, you could manually at home dermastamp them in between treatments with a Dr. Do not treat the rest of your face with a microneedle / stamp.

Peels don't fix permanent atrophy. 

"What else can i do about these atrophic scars, I dont have money for fillers. My main focus is the deep pit in the middle of my forehead as I've already mentioned, it just doesnt seem to be getting any better..." Ok this complicates things, ... you don't want to spend any money but this will be costly to do work on. I will give you a plan below, but if you cannot afford it then just manually dermastamp the scars and use a tretinorin/differin/retin-a nightly. Again it won't get you to where you want to be.

The forehead is a extremely hard place to treat. Vascularity, muscles, little fat, poorer healing compared to the cheeks, etc. 

Botox, ... Botox softens scars and prevents them from moving, or worsening, especially in the forehead. Their are groupons for botox these days.

Subcision, ... this is the missing item. You need to subcise your small scars with a smaller needle, ... since you don't want to use / pay for filler, they can use saline or prp as a spacer or you will use the Chinese Cupping method after subcision to prevent re-tethering. For how to do it look in the faq under subcision. Subcision is cheap even if you can do 1 or 2 a year. 

Co2 laser angled to these scars (the scar wall), many Drs don't know how to do this, so,... rf needling is another option. But this is expensive.

The biggest concerning thing with your forehead is not scars it's red PIE or wounding post acne. IF it was the same skin color it would not show as much. Vascular laser is used for this and not as expensive as co2, ipl can also be used. Cheaper options are retin-a/differin again nightly, ... you did peels already, other options are in the FAQ under the skin section and PIE.

Sadly I don't think this is a at home procedure sort of thing. While you can dermastamp manually the scars, you need Dr treatments like subcision and energy devices done. There is care credit, medical savings accounts, and credit cards, or do one thing a year slowly. 

You may try a bit of steriod on the red PIE if you wish but only for 2 weeks (hydrocortisone), ... it things the skin.

I don't know your location, but if it's Europe Professor Chu is very cheaply priced for what he does in London. 

 

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@beautifulambition Thank you for replying !! 

I guess we've all made mistakes trying to ''fix things'' , regarding the high conc acid on the cyst
Where can I buy a dermastamp for home usage?
I am living in Sydney right now, but moving to a rural location for 3 months in the 2nd week of january. The australian sun is harsh (i am wearing sunscreen). In april im gonna move back to northern-europe (Estonia), where im actually from. Then i might have more money to do fillers/botox/laser etc.
Right now im not concerned about the small breakouts, they are resolving themselves. 95% of the time i am clear now, but 2 weeks ago i put coconut oil on my skin as an aftersun (mistake), so it clogged my pores. I woke up today and some of the pustules were already gone. 
So essentially I have 1 month to do more extensive procedures. And 1 week has passed since my last dermapen (2.5mm on forehead)
I go to cleanskincare here in Australia. They offer peels, dermapen and RF. They could also give me a prescription for retinA (although it will make me break out, i used it in Estonia)

Any furher suggestions? Thanks !!

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https://australianskinclinics.com.au/laser-pigmentation-redness/

also this, although doesnt specify the laser. Seems affordable right now. However dont know about the down time.

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@beautifulambition  

So yes, my skin was a bit irritated, the redness has already gone down significantly and the pustules are gone. I've got that under control thankfully.
I do not want to try my luck with ablative lasers, im really concerned about what could go wrong. Especially while im here for the australian summer.
I've never seen a place where subcision is offered, its hard to find as i found out reading the FAQ again. But doesnt deep microneedling essentially break down the fibrotic anchor of the scar aswell? Could I do a subcision myself at home (i know sterile conditions, having worked in a lab, but finding such a small needle could be difficult).
Since I only have a month left in Sydney, finding a dermatologist could be difficult and expensive. So I think i have the 2 (professional) options of Cleanskincare and Australian Skin Clinics.
However, just looking at Australian Skin Clinics (https://australianskinclinics.com.au/dermal-filler/) the dermal filler is really expensive. And dermal fillers are temporary aswell right. 
Botox would also just temporarily reduce the appearance and is probably a bit more expensive.
Regarding PIE i still have some hydrocortisone cream left.
Now if you think RF needling would be more helpful i dont mind spending 200 bucks on that, but last time i asked my ''specialist' at cleanskincare, he told me it will cause me to break out.
I wouldnt mind breaking out a bit, if the deep scars improved better than if i did a dermapen.
So since I have many options, what do you recommend? Do some extensive treatments and still buy dermastamp and retinA and use them over the australian summer?

Btw Thank you so much @beautifulambition, you are a true help for thousands of people !! So selfless of you, where can I find your story? 
 

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Are you going to come back to Sydney? Maybe try Dr Adrian Lim. He is based in Sydney and this guy was a mentor to Davin Lim. He actually specialises in scar revision and does procedures often, so it might be worth inquiring about his methods.

If you are moving away from the city I don't like your chances of finding a reputable scar revision specialist in rural Australia. I know, I live in the country a couple of hours from a major city.

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54 minutes ago, Atrophica said:

Im going back to Estonia after rural work, i think. :))

Finding a doctor in the UK might be your best bet. 

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@Atrophica Your welcome.

You can buy a dermastamp at owndoc which is a webstore and they also sell the derminator or Amazon. It's a shame you cannot see Dr Lim is a top 1% acne scar Dr, don't know weather you can use the medicare system if your visiting. Yes, coconut oil in my experience is "can" cause acne. It clogs pores. Peels will not do, dermapen, won't fix this do it at home, rf it depends which type. But you need botox and subicsion. Then get the retin-a and put it just on the dents, try diluting it 50/50 with something. Perhaps your allergic to something in the one you got. I feel from the link your shopping for treatments, this won't fix you, ... often these people are clueless with scarring. They can do awesome botox and fillers. Then go get fractional lasers just to the scars. At the very least do rf needling. Again you really need botox and subcision, ... you can dermastamp the scars yourself at home. Peel or do fully ablative laser at the end, ... this is not a beginning procedure, it's for texture. Of course botox is temporary, but it improves the forhead (muslces, veins, thin skin). It is illegal to discuss doing subcision at home, if you wish to do this please do it in private. I have had to help far to many people and this is a very very dangerous area to mess around. Were talking blindness, nerve damage, muscle damage, infection, etc... Nope microneedling will not break fiberous bands. There are several Drs in AUS on the list offer subcision. Your looking at prices and not treatment. As such find a dr who does subcision. Do not get filler too expensive. Do Chinese cupping yourself to the subcision areas for a month after. You can afford subcision. Did you read what @ScarRight said Adrian Lim u-republic Syd, or Darlinghurst derm. See I cannot help you if you will not help yourself, ... everything is too expansive. So save up and do one or two things a year while stamping the scars at home. You have a acne problem, ... this is why they say break out. Sulfur soap or BP cream on the zits. 

 

Dr Chu is cheap compared to EU prices and can help you, he is in London as well and does Sub. 

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 @beautifulambition
@ScarRight
Just wanna say thank you again. Guys like you put more effort into a patient than most doctors out there.
I contacted Dr.Lim's office, unfotunately they cannot take me in before i leave.
But in your first reply you said that my ''smaller scars need subcision'', so im sure you meant the small deep spots on the frown lines, but did it include the boxcar bigger indentation aswell in the middle of my forehead (my main concern). The small scars are tethered for sure but im not actually sure about the bigger one.
So im gonna get dermastamp, retinA and get RF microneedling done or maybe even RF laser, other treatments im gonna leave for the future.
You mentioned microneedling does not break fibrous anchors of scars, but does RF affect them a bit, just to specify? or any other procedure besides subcision

Anyway thanks again for the plan, keep up the good work, im gonna follow your advice @beautifulambition

Sorry, one last question.
At owndoc, I will get the deepest (2mm) dermastamp, but since i will not be getting subcision, would i benefit from a suction pump?
Also, I have a copper peptide serum, maybe use that aswell.

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@Atrophica Your Welcome.

Scars I was referring to the forehead atrophic ones. You can try Adrian Lim U-Republic SYD or Darlinghurt Derm. Or Chu in London. Don't worry between small and big, ;-) you need subcision. No none of these procedures "break" the fibrous scars - hence subcision.

 I would not get the 2mm, you only need 1mm-1.5mm these are forehead scars and not that deep to begin with. Don't need Chinese Cupping unless you subcise. Peptide serum does not matter but if you have it. 

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Hey guys

just to let u know. Since i last posted i have had a dermapen session and RF microneedling done. 

Back on tretinoin aswell and have had 2 vbeam lasers aswell. 

All in all my skin has improved a bit but the main scar is showing little to no improvement. 

I have an appointment to get subcision done in London this summer. 

I was surprised to hear that prof. Chu does not use fillers. 

In the meantime I am wondering whether there is a point of doing more microneedling+PRP. That plus vbeam is all thats available where im at right now. Vbeam definitely helped the rest of my skin but not the forehead scar really. 

I think the scar has flattened a little bit maybe but ofcourse the loss of volume makes it look like a crater in angled lighting. 

Would like to note that these pictures are taken after i applied retinoid + vitB serum, thats why its so shiny etc

Also posted on realself today, lets see what dr Davin Lim reckons

and thank you @beautifulambition for the information you provided me in the private messages

My psychology and self acceptance has improved a bit aswell. Although the crater still represents everything i hate about my skin

 

But there is hope for everyone, may god bless you guys and girls. Stay positive

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@Atrophica you look much better, I see the improvement.

I would not bother with the Dermapen, no point ... RF needling keep doing treatments.

Did you do Botox here, this helps a lot to soften this area.

They can do subcision but with a traditional needle and saline. They can put some superficial soft filler under that scar. 3-6 treatments are necessary. If it does not respond, excision is done by a plastic surgeon (especially here), a small line can be hidden in the forehead fold from muscle movement. 

So do continue Vascular laser for the PIE - reds, rf needling to soften things, subcision on the scar, with perhaps some filler. Botox. 

Chu does not do filler or treat high risk areas like this. I would see Dr Emil in Denmark, cheap Ryan Air flight, or go elsewhere for filler after his subcision. 

Wlecome - BA

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@beautifulambition they actually declined doing botox for me, even though i insisted. They said it might make it worse, that its for static lines only etc

 

Oh and the dermastamp from owndoc is a disappointment. The needles are huge and too wide spread, thought it was gonna be tight spread and like dozens of thin needles but in reality its like 8 thick needles with massive gaps

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Is subcision safe on the forehead? There are lots of arteries in the area? You mostly see subcision performed on the cheeks, I haven't seen many forehead cases.

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@Atrophica IF they decline you botox go elsewhere, this is crazy. We are not treating just your scar with tox, ... but your forehead for softening, tell them you want the area around the scar softened as well. You realize they use botox on all sorts of scars after surgery right. You can get botox at any med spa locally. I know Rullan would not do this as he is more procedural. Also this is nuts, ... for static lines only (the forehead is not static - anatomy 101), ... then why do we treat crows feat bunny lines, and frown lines, ... those are in motion, whoever told you this _______#[email protected]&%*! 

I would have bought the derminator from owndoc, ... the single needle attachment could have been use to treat the border of that scar there is 9-12 needle attachments. But if you would rather stay with manual, get whatever brand you wish. I compared it to some other's on Amazon and spacing is the same.

@ScarRight Yes subcision is safe on the forehead. Not with Nokor, nor wit traditional methods. Cannula or a small normal needle is ok. A experienced injector has to do this. They even can use the botox needle to break it up a bit. The difference here is we have to stay superficial, and we cannot use massive fillers like other areas. PRP - saline, and if they are very daring a tiny bit of filler can be used (many won't do this). You can dermastamp the scar as well, rf needling it, and laser it. The forehead heals though terribly, you are right, it takes a expert who knows anatomy and treatments to do it. 

You can in fact take the derminator, single needle attachment, and work on the scar border yourself at home, before seeking the elusive Dr who will do this. The best ones I have seen do the forehead are the plastic surgeon's and top 1% acne scar Drs. 

 

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Posted (edited)

@beautifulambition thanks for the answer, you said “

Chu does not do filler or treat high risk areas like this. I would see Dr Emil in Denmark, cheap Ryan Air flight, or go elsewhere for filler after his subcision. 

“ 

A bit confusing, as if he does not do subcision on the forehead (high-risk)? Wouldnt wanna fly there in the summer and get rejected. Not sure whether his receptionist specified the area to him, although i did say forehead subcision. 

I think i’ll try to get 1 more RF microneedling done, gonna take me a 1000km trip but hey if its worth it before actually being able to get subcision done. 

In good hydration and lighting conditions it looks nice and flat, but bad conditions really bring out the atrophy. If collagen synthesis just wont cut it, maybe i’ve lost fat tissue there aswell and the only possible long term fix would be a fat transfer?

Late night ramble from an overactive mind... but you’ve seen it all from acne scar patients i guess. Wish you could see my skin in real life, the pictures aren’t especially good. 

Edited by Atrophica

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@Atrophica I cannot speak for a Dr 100%, but I did remember a few cases he did subcision on the forehead - Emil. Contact them and make doubly sure. I know Chu will not do this.

I would never put fat here, ... possibly a ha filler or a dilute bio stimulating filler Radiesse). Why not fat, lumpy, it can move, body can absorb it. Needs multiple treatments, is invasive, can make the scar look worse and is less "reversible." The cost of micro fat can be the cost of doing filler for years. 

I see some atrophy that will improve if you heal well with Emil treatments. Just a slow process. Time for more specialized treatments.  

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