Is not to bad. I had scars like yours. Mine got better with subcision, and i also wont to do filler later on. Contact a doctor who knows about scars. A mod on the forum can probably answer better than me.

1 hour ago, newbie1 said:

Is not to bad. I had scars like yours. Mine got better with subcision, and i also wont to do filler later on. Contact a doctor who knows about scars. A mod on the forum can probably answer better than me.

How many times did you go in for subcision? Alsohow much did the treatment cost, if you don't mind me asking?

@allen_33"Financially, laser resurfacing treatment isn't a viable option for me at this time, also I am skeptical about it's efficacy and potential to cause more damage to my skin." - Ok You can do TCA Cross on your icepicks, and some subcision cheaply even if you have to do one or two a year for finances.

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Disclaimer: Information and support is not meant to diagnosis, treatment, or cure any health or mental condition and is not a substitute for professional face to face medical care (consult with a few Dr's and pick your favorite one). Posts are for informational purposes only, please consult your personal health care practitioner before engaging in anything discussed.

@beautifulambitionIn my case what would be the difference between using Cannular or Nokor needle for subscision, is one cheaper? I know it might be hard to tell from just the photos but how many sessions do you think I might need? Due to my budget,I am looking to tackle each issue with my skin, one at a time. From what I have gathered so far subcision will likely show the most scar improvement overall compared to any other treatments, correct me if I am wrong.Once that scarring is taken care of, like you said, I could move ontoTCA/RF needling. The icepicks are noticeable but what bothers me the most about my skin is the texture. On days where I have used tretinoin the night before and moisturize I am pretty comfortable with the appearance of someof my scars. The scarring on my right cheek looks noticeably worse than the left cheek in those pictures due to angle/lighting butit is actually my left cheek that I am most insecure about. I am sort ofhaving trouble differentiating which scars of mine are rolling, boxcars, icepicks or just a combination of them.

Important detail I feellike I should add isI am in the Southern California area and plan to book a consultation with Dr. Rullan to see what would bethe best course of action.

@allen_33Cannulasubcision would be better, you have widespread scarring. Cost does not matter, that depends on the doctor. I have heard some needing 4 sessions of subcision, it depends on how you heal. Ok Budget- do one or two subcisions a year if you can. Subcision will help you. Well it's not taken care of, you could mix your rf needling and tca cross between subcision sessions. Long process. Ok goto Dr Rullan great. He can do cross and subcision in one session(That's how he does it), He does not do energy devices so do that at a med spa.

BA

@beautifulambition

Here are some more pictures with different angles and lighting. Granted I have moisturizer on here, the scars look more shallow.

If I did consecutive subcisions would I get fillers after each one, also which type of filler would be the best for my scarring? Sorry for bombarding you with questions. At the end of the day I will likely defer to the doctor's recommendation but I thought this would also be a good opportunity to educate myself. 

If you think subcision would yield the best results I will follow the treatment plan you laid out for me. Does subcision improve only rolling scars or can it improve boxcar scars as well? Reason I ask is cause It looks like I have a lot of boxcars/icepicks that could be touched up which would improve the overall appearance. Does it matter the order in which I get these treatments, like if I were to get microneedling/TCA/Acid peels done now?

Lastly I am a pretty anxious person and while there has been many success stories there has also been a few cases where these treatments have not made a difference or have even damaged the patient's skin further. Regarding subcision, do I run any GREAT risk of my superficial scarring getting worse due to a complication in the procedure or healing process? I have heard Dr. Rullan can be aggressive.

If I were you , from my experience stay away from lasers . You have really good surrounding skin tissue , I ruined mine with laser. I also wouldn't do peels or tca . Imo . I mean you can if you want to but tca messed my skin up more too. I'm not a poor healer really. I'd try fillers if I were you. I'm going to try them soon. Good luck and keep us posted. Don't let this ruin your life and keep you from living.

@allen_33No you don't have to get filler after each one, ... some you can do Chinese cupping(Amazon), or you can subcise with filler still in the cheeks without a issue. Please wait at least 3 months between subcisions. Some only subcise when they need a top up in filler(so longer). You have scars all over so I would do over dilute Sculptra, thoughrough the cheeks under all the scars. It's not a volumizer, ... it will make new collagen, when you do your rf needling it will stimulate more collagen as well. Latter on in the subcisions, you can do ha filler to the individual pits, only if you wish,but not until several are done.

Subcision can improve both rolling and box cars, especially cannular subcision, but you also need several other things as subcision alone won't do it. As I laid out in the plan above. Energy devices work best for box cars as well. Your most severe scars are box cars, not icepicks unless were talking about the tiny pores.

You mean the rullan special with tca cross and subcision people often do, that is fine, do you manual stuff first. He does not do good laser or rf needling, ... find a med spa by you to do rf needling once you do the subcision and sculptra.

Frankly any time we touch the skin there can be side effects right. It depends how you heal. Subcision will not harm you, tca cross will make some of the scars wider, but the point is to make them wider, and after many procedures we then do a acid peel or laser resurfacing(rullan just does peels, erbium laser resurfacing you would get elsewhere).

Subcision is relatively harmless. Do several Rullan treatments, if you are not getting enough improvement, discuss with him exscisions wich are surgical closures, this really depends how you heal but is effective. I would do the rf needling between the Rullan apts. 3 months between all appointments.There is nothing to be afraid of with Rullan. If anything you need to see what works best for you to heal. The ones who did not do well, had poor healing or did not do enough treatments. Many start with him, then do energy devices closer to home - elsewhere.

You have Ethnic skin so be prepared you will need more treatments as they don't want to go to hard on your skin type. Use the differin/tretiorin nightly and the whitening cream as I said above.

@beautifulambitionCould Dermapen/traditionalmicroneedling be an alternative to RF needling, to stimulatecollagen production after subcision+fillers? There is a spa nearby that offers Dermapen facials that I wanted to get done before coming here for help. Also if fillers are not necessary after each subcision, would it be best to get it on the first session or later sessions? Would it be a fair statement to say that not getting fillers with your subcision defeats the purpose of getting subcision done in the first place? As it helps prevent retethering of the scars, stimulates collagen production, and volumizes the skin for a better overall appearance. On that note does each fillerwork the same by providing a spacer for collagen to form under the subcised area?

I feel like TCA cross will be my final treatment if I ever do decide to get it done. My priorities seem to be treating the Boxcar scarring/pits/rolling scars as like you said those are my most severe scars.

So3 months between subcisions. How long between subcisions and microneedling?

@floridagirl1991

That is a good point you bring up regarding the surrounding skin tissue. Thisspeaks to my concerns about possibly damaging my skin further through these abrasive treatments. Over the years I have sort of just learned to live with my skin and the mentalburden has become an integral component to my life and my identity. I appreciate the advice and kind words, it means a lot.

The struggle and pain that many of us have endured throughout our lives, as a result of acne is incredibly disheartening. This condition can be extremely debilitating, disfiguring and I wouldn't doubt has a strong causal link todepression and other mental illnesses.

I saw your thread and I wish you the best of luck in treating your scars. It seems like you have exhausted your options but skin rejuvenation is a long and grueling process. Fillers have shown tremendous results in restructuring the underlying skin tissue and inducing collagen formation, look to get that done definitely.

@xander_33No one is like laser, the other is like well manual needling. One you do at home, the other you don't. I would never goto a spa and get normal microneedling. Rf needling sure if they were good. Anyone can dermastamp at home. When you get filler is up to you, ... you can do Chinese cupping instead if you wish. Probably at the beginning and the end. No many don't get filler, but there is a high rate of tethering or saying it's not doing much as they don't do this step. We are not volumizing at all, we are using it as a spacer. Volumizing is using HA filler towards your last subcision in the individual pits. You don't even need that much for a spacer.

IT depends what your talking about, rf needling 3 months apart, or any dr treatment, at home, just a month apart, you can do this while waiting.

After years of research and contemplation - looking into various treatments, consulting with numerous doctors and financially planning to pay to get these procedures, I got my first subcision done!

This thread is about a year old but I thought I would dig it up again to share my progress with the rest of the community.

I have widespread acne scarring across my face and back. Over the years I have familiarized myself with my scars and have researched extensively the medical literature, information on this forum, and have consulted with many physicians. I have a mixture of all the scars from hypertrophic - keloid, atrophic - rolling, boxcar scars, icepicks. 

I decided to begin my acne scar treatment journey by getting subcision done because of the widespread atrophic scarring. I have divots and pits on my cheeks and temples that I felt needed to be addressed first before I decide to treat the boxcar and icepick scarring.

I am not sure how many treatments I will need but most likely at least 3, due to the depth of the scars. I got saline subcision done with Nokor and Cannula needles.

I will post pictures soon of my scars post-subcision. If you have any questions let me know.

The procedure began with them numbing my face with topical cream and injecting a mixture of lidocaine and epinephrine in the areas they were subcising. This took about 15 - 25 minutes. My pain tolerance is relatively high but this seemed to be the most painful part.

I was then given Arnika a plant based vitamin, which I believe is used to help with the bruising and healing process.

The actual subcision took about an hour, it was hard to tell the technique the doctor was using but they seemed to target individual scars as well as multiple scars by gliding the needle under the skin. As others users have mentioned it sounded like rubberbands being snapped or cardboard being cut under the skin. A jagged-tugging sound. Alot of pressure was being applied by the nurse to stretch out and hold the skin while the doctor severed the fibers.

Right Side:

Left Side:

Update: Its been about 10 days since my subcision. The swelling has gone down entirely I would say. I am still cupping at least twice a day on my cheeks/temples. I do notice some improvement it is hard to quantify but maybe 15% - 25%. My temples softened a bit and I had a large linear atrophic scar on  my right cheek that I feel improved the most. My skin texture overall looks more smooth and soft. I kind of got my hopes up with how great my skin looked the first couple days after the treatment when I was all swelled up, but now that it has settled I can see my boxcar scars returning and honestly a bit disappointed. I am not sure if the scars are retethering or if it is just the boxcar scarring which didn't resolve itself. I have read that the collagen remodelling process takes some months so maybe these are not the final results, hoping for the best.

On the bright side, having seen the results of my first subcision I am able to narrow my treatments and target specific scars that I think might benefit from other treatments. I think I might get one more subcision done in 2 months and then look to treat my boxcar scars with TCA/RF. My doctor recommended multiple sessions of Intracel (RF microneedling) but I am still doing more research on this treatment, I am a bit hesitant to get RF microneedling done as I have seen mixed reviews.

Would appreciate other people's input on which direction I should go with my treatments.

Thanks for the update. I'm following this thread!

Will be cancelling my appointment for my 2nd subcisionand look to consult with a derm about getting TCA cross done for my icepicks/boxcar scars, as those have been bothering me the most lately.

In about a weekit will have been 3 months since my subcision and I believe there has been a 15%-25% percent improvement in some of my atrophic scarring.

For the longest time I have been against lasers because of the reviews I have seen and my ethnic skin type, howeverlately I have seen more people advocating for laser treatments like CO2 fractional, I might inquire about duringmy next consultation as this is another modality for treating boxcar scars. Thoughts?

CO2 is supposedly not particularly effective against icepicks.

@xander_33that much improvement from one subcision is great honestly. You will have to go back for more especially if it worked out for you in the first place. Following this thread too. Thanks for updating us.

On 2/26/2021 at 11:33 PM, Guest said:

CO2 is supposedly not particularly effective against icepicks.

Yeah I am considering getting lasers just for the boxcar scars and overall texture.

For the longest time I have disregarded laser treatments as an option for my scars. I thought the consensus was that lasers were ineffective for severe, atrophic scarring. The risks and side effects were not worth it, people complained about worsening scars and skin texture post treatment, howeverI am seeing more and more people advocate for laser treatments each day. I was under the impression that they should only be used further down the line of your scar treatment for overall texture and superficial scarring.

The info I havegathered from other posts on hereare that non-ablative lasers are a waste of time and ablative lasers can have good results with the right handling and settings.

I am wondering if I would be a good candidate given the types of scars and I have and my ethnic skin type as I know lasers can cause complications like hyperpigmentation, PIE, etc.

Also when should one consider lasers over manual treatments like subcision, cross, and microneedling?

Been a couple months since my last subcision. Wanted to update this thread. For this second subcision I went to a different practitioner. Treatment was the same as last, saline-subcision however only a cannula was used this time to sever the bands from underneath. Also saline was injected simultaneously as the scars were being subcised as opposed to afterwards. I'm satisfied with the second subcision and I would say the overall improvement from both my treatments is 20%-25%. I feel as this is as much improvement I am going to see in the rolling and atrophic characteristics of my scarring. Because a cannula was used downtime and bruising was less. Followed same protocol for suctioning as I did my first subcision.

I am looking to target my boxcar scars and icepicks next with TCA/Phenol Cross or lasers. I am having a hard time biting the bullet on these treatments as I have heard of risks of scars worsening and widening.

@xander_33Thanks for posting your updates! I just joined and am learning a lot. Your progress is very encouraging. Why did you switch doctors if I may ask? Would you say the subcision is better at on dr. than another?

I just read your thread. Your scars remind of mine inthe beginning of my journey in 2017. I got lasers, RF microneedling,TCA,superficial peels, subcision and temporary fillers here and there.

Consider adding Lactic acid, glycolic acid or AHA acid to your routine. I use the ones from the ordinary. I started a year ago on that routine. I say this because having skincare routine that turns over cells and promotes collagen on a consistent basis may help the texture of your scars over time in addition with any resurfacing laser or treatment you get. For myself, I use lactic acid once or twice a week, aha once a month and glycolic acid 10% and glycolic acid toner 7% from the ordinary. I still havent developed an actual routine by day and time yet because Im lazy. But when you use these new acids, dont use vitamin a Derivatives such as Tretinoin or tarozarc in the same day, it will irritate skin and we dont want irritation because it is counterproductive to collagen production and cell turnover. Try to research how to incorporate acids at home. Also consider using vitamin c. So the routine could go like this for example

Monday: AM vitamin c and moisturizersunscreen; wash face with gentle cleanser that is non-irritating.PM vitamin a product such as tretinoin or tarozarc. Sleep.

Tuesday: AM: vitamin c and moisturizer sunscreen. PM use lactic acid or AHA/glycolic acid. Follow directions of product on label on whether to wash off or leave on. Use vitamin e oil or moisturizer and go to sleep.

Wednesday: AM: vitamin c and moisturizer sunscreen. Use gentle cleaner. Apply your vitamin a product. Go to Sleep.

and repeat process. Pretty much on/off with the vitamin a and acids. Obviously dont use this skincare when you get the treatments, talk to your doctor/derm about when to continue your vitamin a and acid routine.You will probably think this is too much to incorporate or you will adjust your skincare to include them. It depends on your motivation.

It might take years for your texture and scars to remodel to result that you are comfortable withso patience is needed. You will see some scars disappear or become smaller and you will see other scars stand out. Thats what Im currently dealing with. I try to do a procedure every three months ideally but if Im busy I try to do one every 6 months. This is my schedule. I try to adhere to schedule so I dont go crazy, I want to make everything automatic for me so that I dont think too much about how my scars arent completely gone. Try to keep your realism and sanity, and most of all, try to keep your humanity. You are more than your scars and you dont ~need~ to improve then. You are still worthy regardless. Repeat this to yourself when you feel low. Dont forget to enjoy life. You wont be in your 20s again or 30s. Dont let it slip by you. Your scars will likely persist here and there but your youth will not. So yeah, all in moderation, ok? I hope this helps you in some way.

22 hours ago, HistoricalProblem said:

@xander_33Thanks for posting your updates! I just joined and am learning a lot. Your progress is very encouraging. Why did you switch doctors if I may ask? Would you say the subcision is better at on dr. than another?

I switched doctors based on a few factors such as pricing and technique. It is hard to say whether or not one doctor was better than the other, both doctors were very knowledgeable and experienced. First subcision with the nokorfelt more aggressive and of course the downtime was longer due to heavy bruising associated with nokor. Second subcision wasn't nearly as aggressive but just as thorough, felt like there were less fibres being severed the second time around. I noticed the most improvement after the second subcision but it's possible that the results from my first subcision hadn't settled yet, collagen growth takes time.Subcision is one of those treatments that likely you're going to need more than just 1, because of the high reattachment/retethering rate. Again I didn't use filler and opted to suction after my treatment.

My perspective is subcision is relatively straightforward and if you can find a doctor even remotely experiencedat a cheaper price tag, you should look to get it done with them. Of course there are intangibles like finding a physician who really cares and is willing to hear out your concerns, needs and desires that should be factored when into your decision.It just all depends on your situation and finances. I try to be strategic with how I get these treatmentsand realistic with the outcomes.If you have the money, then I say go for it, assuming you've done your due diligence and research into the treatment and the doctor performing it. People have spent tens of thousands of dollars to treat their scars, in an effort to regain their confidence and life back.

@DontgiveupitsonlyscarsThanks for the uplifting comments. I have accepted that my scars will never completely disappear but I would be satisfied with even a 40% - 50% improvement in my scars. Over the past fewyears I have mostly learned to live with my scars and have built confidence through pursuing a life dedicated to fitness, benefittingboth my physical and mental health. Through exercise I have managed to improve my appearance and also it has just been therapeutic.I have my days, occasionally I will find myself looking into the mirror incessantly and feel depressed or discouraged but I try to channel that energy towards something more positive. While I would do anything to get rid of my scars, at the same time these scars have been a defining characteristic for me as an individual and have contributed greatly to my personal development. All the hardship has really given me a new perspective and appreciation for life.In fact this entire experience has motivated me topursue a future in medicine, where one day I hope to work as aphysician in dermatology andbe able to serve those around me, putting to practice all the knowledge I have gained throughout my life as a result of dealing with acne scars.

I used to follow a skincare routine,applying moisturizers, AHA, BHAs, sunscreen, exfoliates daily but I stopped many of these things as I became more comfortable with my skin. However I want to pick it up again, as there are surely ways outside of cosmetic intervention that I can use to improve my overall appearance and ensure the health of my skin longterm. The last product I used on my skin routinely was retin A/retinols but have stopped using those since I started getting procedures done, as I didn't want to risk hindering the healing process or have it interfere with the procedure itself.

10 hours ago, xander_33 said:

@DontgiveupitsonlyscarsThanks for the uplifting comments. I have accepted that my scars will never completely disappear but I would be satisfied with even a 40% - 50% improvement in my scars. Over the past fewyears I have mostly learned to live with my scars and have built confidence through pursuing a life dedicated to fitness, benefittingboth my physical and mental health. Through exercise I have managed to improve my appearance and also it has just been therapeutic.I have my days, occasionally I will find myself looking into the mirror incessantly and feel depressed or discouraged but I try to channel that energy towards something more positive. While I would do anything to get rid of my scars, at the same time these scars have been a defining characteristic for me as an individual and have contributed greatly to my personal development. All the hardship has really given me a new perspective and appreciation for life.In fact this entire experience has motivated me topursue a future in medicine, where one day I hope to work as aphysician in dermatology andbe able to serve those around me, putting to practice all the knowledge I have gained throughout my life as a result of dealing with acne scars.

I used to follow a skincare routine,applying moisturizers, AHA, BHAs, sunscreen, exfoliates daily but I stopped many of these things as I became more comfortable with my skin. However I want to pick it up again, as there are surely ways outside of cosmetic intervention that I can use to improve my overall appearance and ensure the health of my skin longterm. The last product I used on my skin routinely was retin A/retinols but have stopped using those since I started getting procedures done, as I didn't want to risk hindering the healing process or have it interfere with the procedure itself.

All your words I highly resonate with. I also thought about pursuing dermatology but I found another field that really seems to fit me. I have accepted my scars for the most part, but there is also an undying drive to continue improving and progressing. Perhaps it's my deep focus on a mission to the point of severe obsession. Just like you, I workout. I actually am very prideful of the gains I have made at the gym. Not to brag but my body is my biggest accomplishment. This takes the pressure off myself to have "perfect" skin. I thank and also curse my obsessive drive. I am constantcompetitionwith myself. Most times, I am a workhorse. I do not stop looking for improvements and answers in anything that I do. As a result, I get defeated and exhausted regularly and begin to attack myself when I don't see the results I have been hyping to myself for so long. But, ahhh, life. This is the constant tuggle-of-war. To remain centered and rational and yet also optimistic to be the best version of myself that I can be. I just want you to know that I understand this entire struggle with theself.

Have an appointment scheduled next week with Dr. Rullan for phenol cross. The aim is to target the boxcar and icepick scars across my cheeks and temples.

I am considering getting one more subcision to sever any tethers that might have reattached from past subcisions. Afterwards I don't think I will see much more improvement from this modality. The next step in my acne scarring journey might be multiple cross treatments for the icepicks/boxcars andlasers, phenol peel, RF microneedling for overall texture.