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RiverTheFever

NEED ADVICES WITH SCARRS

 I am 19 years old and have been dealing with severe acne for about the past 4 years. I finally decided to get on accutane in August of 2019 and have just finished the 5 month course 40 mm a day. Right now, my acne is almost completely gone( with occasional non-nodular red bumps that would usually go away in a day) . However, because of the severity of my acne, I have really bad discoloration and scarring left behind. It has a big impact on me because I am in college right now and sometimes I am uncomfortable of making eye contact or getting close to people because of my acne, or something like a individual presentation or speech. I watch a lot of laser dermatologists like Dr. Davin Lim on youtube for solutions and he recommended this org. I am wondering what type of procedures I need for my discoloration and scarring and some recommendations for good doctors. Traveling is on option for me financially but I can only do it during this summer break because of school. Also, at the meantime, is there anything I can do at home like dermarolling, if there is, how may days after accutane? I know I wrote a lot because acne has always been one of my biggest focuses and I would appreciate any help.

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@RiverTheFever I would see Dr Lim since he is a expert in your skin type. But it also can be treated locally or a combo of the two. Lim on breaks and someone locally. 

 

I see icepicks, box cars, and a few rolling scars. Not to much fat deficiency. Discoloration.

** Please Note I offer to acne scar suffers a "more" "customized" (private) consultation than the above general advice. Analysis, answering questions, ongoing support by Private Messaging. Feel free to message me there. Be patient as I can get over 100+ of the worst acne scar cases to help, it "may" take me up to 48 hours to respond.

Checkout the main scar treatments sub, find the FAQ pinned on top there, goto the bottom, there are Dr's or call around and ask who does cannula subcision or nokor subcision (needle type) to dermatologists and or plastic surgeons, consult a few before you decide who you like, even if you have to pay as treatment is expensive, better like them. Ask how many subcisions they do a month and if they treat your skin type. If they just do laser run they will just blast you and not solve your issue.

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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. 

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Thank you so much BA I was also wondering how many days I have to wait before doing any procedures like the ones at home or the ones done by professionals and I heard usually you need to wait six months after accutane before doing anything big, but the summer break is only going to be 4 to 5 months from now. Would that be a huge problem? Or should I consult with Dr. Lim’s office? 

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I agree with BAs management. It is good that you have some baseline pictures.  Many people find it useful to conduct at home acne treatments. This forum, as advised by Lim is probably the best place to seek SAFE treatment that one can undertake at home. The use of DermaRoller to say 0.5 mm can be effective. As you are coming off ACCUTANE your skin will improve in the next 2-3 months. This is the only scenario that I would advice Pico lasers (Picosure). Pico lasers can improve your PIH and decrease pore size, as well as small pits. It can help with general skin texture but it will not treat your rolling scars, box car scars and ice pick scars. In your case, its the 6mm Focus with 3000, 4000 shots. Most laser places will go for the default 8mm and only do 2-3k shots. If done correctly it can improve the general texture of your skin. One proper treatment combined with at home scar treatments will put you in a better place, and improve your confidence. 

With your rolling and box car scars, these can be treated with cannula subcision, and conservative but targeted CO2 laser. Working under your skin's surface is the next step, after improving the top layers of your skin (via Pico, needing). Lim is off for a few months with family illness, however he recommends guys like Weiner and Rullan. Many of his US patients have follow ups with these two specialists in the States. I wish you well. 

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Thank you so much. Your answer was really informative. As for the 0.5mm dermarolling at home, do I need to wait a couple months since my skin is still a bit dry and fragile or it has no problem handling it? And also if I go see Dr Weiner or Rullan do I need to wait at least 6 months before going to see them? (I live in Lexington, Kentucky for UK)

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@RiverTheFever 

I would wait 6 months after Accutane for treatment. As you say your skin is 'fragile," listen to your own intuition. The skin will heal over the next year. Unless they are Dr Lim very few Dr's will take on the liability of your skin in it's current condition until it  had some time to heal. 

Obi is saying in 3 months your skin will improve on it's own, you can .5mm needle then if you wish. The Derminator is great for at home treatment, Google it. 

He is saying you can do Picosure now and gave you the treatment specifications to do so at a nearby clinic. 

Wait for every thing else with Wiener or Rullan.  

I will add some more practitioners to the FAQ in a few days, been busy, perhaps you can see someone local as well. Subcision is the hardest to find. 

You don't want to rush anything to fast with your current skin, or you can make things worse, go slow, I know it's hard. 

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Ok I think I got an idea on what I need to do now. Thank both of you guys for your help, it really means a lot to me. This journey has been really hard for me because I had almost clear skin before I was 15 and just broke out like crazy from there. I don’t know what went wrong or if I could have done anything different to change it so I am like almost obsessed to find solutions. I tried tretinnoin cream with BP but they just did not work at that point. Maybe I should have gone on Accutane sooner but it wasnt really an option for me back then. Anyways, thank you guys so much for your time, it is not easy to get free constructive advices these days. I really appreciate it.

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So update I bought all the stuff that BA put to use at night and I searched the entire town for Picosure laser but only found PicoGenesis Laser. Are the two the same thing? Can I do that right now and why is Picosure laser safe for people who just got off accutane? 

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@RiverTheFever Picoway = picosure = picogenesis 

IF the doctor agrees you can do picosure sure, ... settings were offered above by Obiwan. Many Dr's won't do it though if your healing from Accutane (skin is more fragile for 6 months of healing), ... so see if they will, otherwise wait. The Dr has to take on the liability of your training, your in a healing stage, ... up to them. 

 

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Ok thx BA I called up a local laser dermatology place and a spa that offers the pico genesis laser today and set up a consultation appointment two weeks from now. So I guess I will just wait and see.

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Not going to say anything that can help you with information, but might boost your confidence and hope that everything solves @RiverTheFever. Your scars are not severe and they will disappear!! :D keep on going brother.

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Quick update I just had my first consultation with the place that does pico genesis laser. The surgeon set the procedure six weeks from now since I just got my accutane done like three weeks ago. She said she is probably going to do 4-6 sessions and 350 dollars each session, 2 weeks apart. She also tried to get me into their skincare program but I think that was   her trying to finesse me. But anyways, does the sound legit or a little sketchy. Do people usually go for 6 rounds of pico laser?

Edited by RiverTheFever

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Be very careful in Asia, Singapore, etc... They tell you picosure is used for scars. It is not. It's used for Hyperpimentation and some collagen growth (you need this after Accutane so it will help). Yes you do need a few if you do them. Because of your healing as Obiwan said I think it's good to do a few now. You can stop at any time. Follow the setting for this given above.

But manual methods are always best for acne scars 

 

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Thanks again BA, I live in the states, a medium sized town Lexington, Kentucky cos I am currently an engineering student at the University of Kentucky. Financially, traveling for manual treatments is an option for me but I can only do that during summer breaks because of school. As a matter of fact, I am thinking about traveling this summer to Dr Weiner in Florida or Dr Rullan in Cali. I have been to both of those places and would love to travel to either one and enjoy my deserved break there plus getting the procedures done. What is your suggestion on this matter, they are both good doctors but which one is more suitable for my case? Really appreciate your quick reply, you teach me a lot. Thanks again!

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Hi it’s been a while since my last update now, so I just wanna share my recent skin condition and some of the problems I have been having. It has been about a month and a half since I got off accutane. First of all, the products I have been using are just cerave  moisturizers, sunscreen and differen at night about 4 times a week. My skin and lips are back to normal, not peeling of dryness all the time and sometimes at night a little oily again. My discoloration and even scarring are noticeably improved I think. Overall, it has been good and I am just waiting for my pico lasers to further improve my overall skin quality and all those plans. However, I am worried again recently because I have noticed signs of my oil and acne coming back. First, I have always had acne (cystic bumps) in my hair(pretty uncommon i think) ever since my facial acne got severe. And during and right after my 5 month of accutane, it was always all gone along with my facial acne. However, just about a week ago, it started coming back and I have bumps all over my scalp again. Secondly, I have noticed signs of my facial oil and acne coming back too. It started about a week ago when I was getting little red bumps that would go away overnight. But I got my first under skin red cyst like the ones I had  before accutane about three days ago and it is still here.( I will insert some pics of my face directly under light.) I am really worried rn because I dont know what to do since I am already using differen. Could it be the side effects of differen? I am afraid that my face would break out again before I go to my treatments or even worse after my laser treatments. What should I do? Thank you so much guys for being there for my journey of battling this acne problem. 

 

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@RiverTheFever Differin can make you purge, this is true. But not in the hair of course. Sounds like you did not get enough Accutane or need another course. Speak to your medical provider about this. You can stop Differin and see but obviously this won't stop the issue in the hair. 

You can spot treat your acne with BP or sulfur cream.

Picosure is non-ablative so you can have the laser if the Dr ok's it with acne. But I would definitely get it under control as you don't want new scars.

 

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Ok thx again BA. I think I am just gonna wait and see how it goes because I think the problem mainly is the discoloration and scars. The red skin rash thing on my left cheek was not really acne. I dont know what it was as it was not painful or cystic at all but kinda itchy when I tried to touch it. (Caused by the dryness?) and disappeared over night. The red bump that would not go away is what is kinda worrying me because I have not really had one like that since the beginning of accutane. Maybe it was because I touched it too much (I know it is bad but just cant help it sometimes l) I will wait a couple weeks and see what happens. If the acne shows any sign of coming back, I might go back to my dermatologist and ask for a second round of accutane (bigger dosage as my last one was only 40mg a day for five months). Thx again!

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So, it has been a month since my last update. I just did my first session of the pico genesis treatment. It lasted for about 25 min. I think it was done pretty well and the physician was pretty experienced. I felt  some degrees of pain when the laser was focused on my forehead and nose areas. Anyways, the physician recommended that I can do the pico laser every week instead of every two weeks. She said the recover time for the laser is minimal. She also suggested mixing the treatment with micro needling. What exactly is the best option rn and how many treatments do I have to do before I can see some significant results? 

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@RiverTheFever I would never ever do this once a week. They are trying to get $$$$ out of you. The body does not heal like this. Even if this is a non ablative laser, your putting energy into the skin and now allowing time to heal. How about once a month, why rush something that could give you side effects. 

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Thank you so much BA! I was actually kinda iffy on the laser per week part as well but thought since it is a non-ablative laser, maybe it doesn’t take that long for the skin to heal. And I started pico genesis laser as obi advised and also because I am only 3 months off of accutane and I am not sure if Dr. Rullan would be willing to do any major procedures yet. (Also the school is not over yet so I kinda have to do something local first). I am still planning on visiting Dr Rullan in this summer. Do I need to send him or his office an email of my or something of my specific situation? Also, I feel like accutane is completely put of my system since my face and hair are gettting kinda oily again and I am getting whiteheads around ny nose, forehead, chin areas again with occasional big pimples that would last for a while. I dont know if I should go on a second round of acutane or continue my plan of treating my scars. Honestly, I am happy if the acne stays like this state right now but I am worried I might break out again or get scars from some of the big ones. Appreciate your help BA, I am really trying to learn and perfect my situation as well as possible. I know getting my face to pure is nearly impossible but when I was reading the studies that you posted about acne scars and different procedures I felt really optimistic for once.

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My skin right now directly under lighting. I am getting some pimples again and skin is kinda oily especially under nose area when I wake up.

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Alright I will send Dr Rullan an email when school is over and try to set up an appointment. As for the acne, actually  yesterday, I just signed up for the free one month package from curology that contains a cleanser. And I think they are also going to send to some retinol product to use at night. I think this would get the oil and acne under control. (Hopefully) As far as the laser treatment goes, I can just set up an appointment whenever I want to do it so that shouldn’t be a problem. (I will just set up an appointment a month from now) Thx again BA!  

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