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HopeNew

My Subcision PRP and Laser Acne Scar Correction

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I had my second subcision along with PRP and CO2 Laser earlier this month. I went to get a second consultation by a very well known acne scar plastic surgeon and he said the subcision performed on me left other marks! I'm so upset! He said I should of only needed two subcisions to get the desires result. Now I see that indeed there are marks left from the subcision.

This doctor offered to do a subcision with PRP and Infinity for me at a reduced rate. I don't know what to do. I'm so upset!!! It has left more marks where the needles went in to do the subcisions! I need help!!!

 

Before the Subcision 

 

 

Before the Subcision

 

After the Subcision

 

After the Subcision 

 

Taken today two and a half weeks after the Subcision PRP and Laser. I see where the doctor said the marks where left! What do I do now?

 

Taken today. Still have marks and other marks.

 

Here is the valley the doctor pointed out to me. He said he could do another subcision prp and then an infinity on both sides at a reduced rate. I am really upset. 

 

EDIT: Previous photos deleted. 

 

Edited by HopeNew

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Here is the valley the doctor pointed out to me. He said he could do another subcision prp and then an infinity on both sides at a reduced rate. I am really upset. 

 

 

How long would I have to wait for the next subcision from the other doctor? I had my last subcision in early February. Is this a DISASTER???? Or is there hope???

 

And how am I supposed to go back and tell the doctor friend of mine that these valley marks were left? He's an awesome doctor and really did me a big favor.

The lighting is more dramatic making the scars look worse than in regular lighting.  But I did not see those valleys before the subcision.

Edited by HopeNew

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Here is a photo taken in regular lighting. Can you see where the needles from the subcision were entered? I don't know if that's from the first subcision, the second subcion, or if I always had them.Perhaps you can check from the first photo. 

My partner can't understand why I am obsessing over this.

regularlight.jpg

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I'm so very disappointed because after the swelling went down I can now see that my scars look no better maybe even worse due to the two or three new indentations from the subcision needle.I don't know what to make of all this.Perhaps I am no seeing the improvement! I don't know! 

I fear I have more marks now than I did! I am really upset. Maybe it's the lighting.

 

Edited by HopeNew

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On the nose is where I had the TCA Cross. The doctor who I had look at it says I should have another one. Now I am not sure. I am 58. Do I still have the ability to fill in collagen.

The second is where I had a punch excision. At first I was very happy. But there is still a hole there just not as large as it was. The other doctor who saw it said I should have a tca cross done there. But someone else said I shouldn't do that.

TCACROSSEXCISSION.jpg

 

@beautifulambition I started the new thread with the photos. Sorry if it's long. As you can read I am in a bit of a panic. I only hope it's a panic that is being blown out of proportion by me.

Edited by HopeNew

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After looking over my photos again and taking a photo in the same type lighting I see that that mark was there before I had the subcision done. This makes me feel a bit better.

But the Alstin products are making me break out. So I have to get a new product. If anyone has suggestions on moisturizer and sunscreen that don't cause breakouts I would greatly appreciate your feedback.

beforeandafter.jpg

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@HopeNew It seems like this is really affecting you. I believe you said above your in a bit of panic.  I don't see anything above that is worth panicking above. Treatment will need to be done over time, ... there is no medical emergency. As such the worry and anxiety is not good for your mental health, and it would be best to concentrate on something distracting. There is therapy through a smart phone app called Talkspace which you can do through various forums or the phone. Or get someone locally. Acne scars make not only external scars but internal scars that should be dealt with, and supported. 

Ok The scars, there is a lot to respond to here. 

Firstly I do not agree with your Dr doing subcision, prp, and co2 laser all at once. We do not heal like this, just blasting the face with laser. Laser is used at the end of treatment not at the beginning, ... you also had the excision surgery. Lots of things to try to heal all at once.  Your 58 so healing is going to take time. Hence you need to be conscious of doing all of that at once. At your age collagen is slow to build and you will not get the results of someone younger quickly. At 58 you need to get over dilute Sculptra throughout the cheeks and temples. 

Firstly I do not agree with your Dr doing subcision, prp, and co2 laser all at once. We do not heal like this, just blasting the face with laser. Laser is used at the end of treatment not at the beginning, ... you also had the excision surgery. Lots of things to try to heal all at once.  Your 58 so healing is going to take time. Hence you need to be conscious of doing all of that at once. At your age collagen is slow to build and you will not get the results of someone younger quickly. Subcision without filler of course this would not be effective, re-tether and not be effective especially at your age. At 58 you need to get over dilute sculptra throughout the cheeks and temples. You have age related fat loss and slower formation of collagen, this is natural at your age. This is why ladies and gents get plastic surgery aka a face lift at that age to make the skin tighter and everything looking more youthful w, some filler. If your scars are distensible ( you can pull them apart) then filler will help.  The plastic can tell you all he wants you only need 2 subcisions, but I don't see how he can guess this, many of our members need many subcisions, and of course filler, ... have him treat it if he can promise 2 treatments. He must also offer aftercare and to support his promise as I am not being paid to manage the Dr's decisions. I tell posters often to goto a few Dr's and pick the one you feel best about who can promise you the treatment you desire, ... but they need to be honest, at 58 it's not going to be perfect skin. You will get a % of correction. Talk to him about acne scar treatments vs getting a face lift (he is a plastic surgeon). 

I would never do rf needling and subcision in the same treatment on someone your age. I would have you wait 3 months in between individual treatments and see how you heal. It will be slower. Filler will be a big part of subcision. You are going to general Dr's who just want to do energy devices. Again we do energy devices after manual methods are done ie. subcsiion with filler, cross, and excision. 

This is a slow process, even slower at your age,... depends how you heal ... it may not be successful at 58 to the degree you imagine. I do know the filler will be a big part of fixing those scars on the temples and cheeks.  

If the arrows are the supposed marks where the needles were used with subcision, then you either still have swelling, filler was placed improperly, or some needs to be placed there to smooth out the transition in the face. IF the plastic you saw can fix it goto him. This isn't a big deal, unless your a poor healer and then any treatment you do besides filler will "leave marks." You do know you heal over 3 months of subcison, it's not instantaneous, .. .when he did all those treatments together that is where something "can" go wrong. 

Your after subcision pictures look better than your first "before" pics, so I don't know what you mean. This is standard swelling after a procedure. 

The solution is very easy, on the cheeks with the valley aka fat deficiency that I saw before in the pictures, ... just different lighting with the after. You need filler to correct the depression. So yes you may need more subcision and filler. This isn't a one and done thing unless you get a face lift and have down time for months.  

 

I see no disaster with your subcision, you needed sculptra done with it to work on the contours of your face, ... this must be done with another subcision throughout the cheeks and temples. You wait 3 months between treatments, the face will even change over that time as it heals, ... so May or June. you can always get the filler injected throughout now if you wish, and do another subcision in 3 months. 

You go back to your friend, ... this is why I never treat with a friend, ... he did this to experiment on acne scar patients and get more experience. Very nicely, ... say could you please inject some filler for me and here is the issue and show him the pictures. You of course will have to pay for the filler but he can fix it. Or you go elsewhere, the choice is yours. This is not a big deal and can be fixed. 

Here are your choices as this has taken me a ton of time to respond to. Chill, get some filler (now or latter), do another subcision in 3 months after you evaluate how you healed. 

Of course the scars went down and you see no improvement, ... why do you think we use fillers. To grow collagen. Subcision without this does nothing for many. 

Do more punch excisions if you wish, yes you may need to do a few, ... it depends how you heal. you do know once you do these you need to laser the area as the texture is off right? Many in your case get a deep peel at 58 with down time for texture and wrinkles. DR Rullan and other Plastic Surgeons do this with Phenol. Called a deep peel. We do these at the end after all the manual work. 

For sunscreen physical only sunscreen with zinc, you can get something tinted if you wish and all that cerave or cetaphil for wash, vanicream products.

 

Use nightly: Retin-a or tretinorin(prescription), or Differin (Target/Walmart), The Ordinary Granactive Retinoid (if you can't get the above). Cureology(USA) & Yoderm(USA) provides online prescriptions with customized skin care creams for your concerns, those in UK Dermatica provides the same thing. Apply a moisturizer when your face is dripping wet. Wait 5 minutes for it to dry, and then apply the tretinoin. This cuts down on irritation, you can also skip days of application if it's irritating and you need to build up %. This provides skin turnover - new collagen. To prevent (reds & browns from all Dr-treatments to ethnic skin or to work on current skin discoloration), try PCA hydroquione free gel for Hyperpigmentaion (Amazon) or Cureology/Dermatica includes this in their products if ordered. Using this prevents hyperpigmentation from treatments. Hydroquinone has side effects for some people, natural option as listed above is better or ingredients kojic acid/Konjac and skin lightener ingredients, like Niacinamide by The Ordinary is great for pores and discoloration as well. The Ordinary, Cerave, Eucerin, Dr Sam Bunting Flawless Cleanser, and Acne.org's products are all great options for moisturizers and cleaners without fragrance / dyes / allergens. Sunscreen is a must (for the sensitive use zinc only physical ones)! 

It will take me 24-hrs to respond as this took me quite a bit of time. The Dr's should support there work as this is what they are paid for. I do agree many Dr's are general and don't know how to handle scars or aesthetics. But I see from your 2 min ago pic, ... you now know as I said you had this and need filler. 

 

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@beautifulambition thank you once again for your amazing response.

Should I get  over dilute Sculptra (is that the correct way of saying it)? injected during or around the same time of the subcision? Or can I get it weeks or months later? Does Sculptra grow collagen permanently? Or is it just a filler? How long does it last?

 

Thanks again

 

EDIT:After rereading your response above it looks as though you think I should have done the Sculptra along with the subcision. So I need another subcision along with sculptra? Or can I just get sculptra?

The doctor said I should hold off of the tretinoin for a while after the laser. 

Edit: @beautifulambition I know my photos look much better after the subcision and laser procedure. But now I look horrible. Of course, that's me under a strong light. I know I look better without that strong light. It's absolutely horrifying, because I had no idea my acne scars were that many and that bad until I took these honest photos. My partner cannot understand  my obsession. I can. 

Edited by HopeNew

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@HopeNew After my subcision, I have one noticeable small mark where the needle entered on one side. It doesn't bother me too much, since I know it will get better over time, and it's very small. It looks a little worse because it's hyperpigmented.

Subcision takes a lot of time to heal. I still had some bruising and slight pigmentation issues one month after subcision. I know it's hard, but definitely try to chill a bit. Otherwise, you'll just drive yourself (and your partner) crazy! ;-)

Edited by superburrito

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3 hours ago, superburrito said:

@HopeNew After my subcision, I have one noticeable small mark where the needle entered on one side. It doesn't bother me too much, since I know it will get better over time, and it's very small. It looks a little worse because it's hyperpigmented.

Subcision take a lot of time to heal. I still had some bruising and slight pigmentation issues one month after subcision. I know it's hard, but definitely try to chill a bit. Otherwise, you'll just drive yourself (and your partner) crazy! ;-)

@superburrito oh my goodness! My friend,  you have no idea how much I needed to read your reply right now. My wife has been so mean, she has no empathy, no understanding of my pain over this. She can be just so cruel over my obsession. I know it's not healthy to have an obsession over this but I do. I have tried so hard since I was a teenager not to get scars from acne. I should have never stopped taking antibiotics. If I didn't stop I would not have acne scars on my face. Yes, they would have been on my chest and back. But not on my face!

So tomorrow I go to the other dermatologist and decide if I will get a new tca cross on my nose. Should I?

I called the doctor who gave me the subcision and they said the indentations from the cannula go away. I hope they are right. I don't know if these marks came from the subcision or not. All I know is that the well known doctor who saw them kind of told me the other doctor did my subcision wrong. And now I am going nuts! My wife doesn't understand. Maybe he didn't do it wrong. 

So I have to wait? Then I will wait! I will chill. Keep talking to me cause I need someone  who understands. :D 

Edited by HopeNew

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@HopeNew glad I could help! For TCA cross, since it’s only been a few weeks, definitely wait awhile for the next session.

It takes months for skin to fully heal and collagen to form. Keep in mind that with TCA cross, it can temporarily make the scars appear bigger, so it'll look worse before it will look better. Phenol cross doesn’t have this same issue, but I only know of Dr Rullan in San Diego that does this.

Obsessing over scars is definitely understandable. I’ve been there. One thing I’ve done is to set my expectations relatively lowish with a goal for modest improvement, rather than a miracle. I’m not expecting my skin to ever be smooth like a baby butt, but I think it will look better with patience and time.

The other thing I realized is that managing uneven pigmentation, acne breakouts, and generally taking better care of my skin has helped my face look better overall. In other words, I’ve started to work on other things that can be easily, cheaply controlled, in addition the expensive scar treatments. 

Here’s my basic skin routine:

Evening

  • Sam Bunting's facial cleanser (it's non-foaming and fortified with 5% Niacinamide)
  • Curology with the following formula:
    • Tretinoin 0.05% (prevents and treats blocked pores and improves skin texture)
    • Azelaic acid 4% (reduces bacteria, helps to keep pores clear and also fights redness and hyperpigmentation) 
    • Zinc pyrithione 0.25% (antimicrobial with dual action against bacteria and fungus)
  • The Ordinary's Alpha Arbutin 2% + HA (for additional control of hyperpigmentation, I may try one of PCA pigment gel's instead)

Morning

  • Sam Bunting's facial cleanser (face is already clean from the night before, so I use just a little bit of product here)
  • The Ordinary's Vitamin C 30% (I skip this sometimes if I'm lazy or in a rush)
  • LaRoche Posay's tinted mineral sunscreen (the tint helps the skin look more even)

 

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A few questions. I am stopping alastin restorative skin complex because it makes my skin turn red as if it's having a rosacea flare up, and is making me break out a little. Does this stuff really work in cleaning out old collegen? I can try to take it less. I there something else I can take? Remember, I had subcision, prp, and c02 laser.

Is it normal to break out after subcision and laser?  I am starting to do the suctioning less because I feel my skin needs a rest.  It looks like the scar under my mouth got larger? Maybe it didn't I don't know.

Maybe I will be very happy after months go by and collagen grows in. I hope so. I do believe the doctor did not have much experience doing subcision. So I don't know if the other doctor, Dr Rapaport, who claims I only need two subcisions along with prp and infinity is right or not. I'm confused. Do I go to the doctor I know who has less experience or the much more experienced doctor who might just want my business? I don't know... I'm confused and concerned.

@beautifulambition I got my subcision on February 8th. The doctor who performed it looked at me about a week later because he was going away. I originally had April as a follow up, but am concerned so I made May 6th as a follow up. Is this too soon? Should I wait for him to look it?  

I also want them to take the same type of photos from the same lighting they did in their office before I had the acne scar work done.

 

 

Edited by HopeNew

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@HopeNew

You can get normal sculptra, I just call it over dilute sculptra because of the dilution of the saline in the product.

You can get it directly after subcision, unlinke HA filler which the swelling must go down first, or wait till the selling id down and do it, ... choice is yours. I would not get it months later or it will retether in a few weeks after. 

Yes Sculptra does grow "some" collagen permanently, but at your age those who get it will top up with a vial or two after the intial course as needed. But it lasts a long time. IT's a biosimulator, not a volumizer, ... so there will be the initial reaction of slow collagen build, do not freak out. It goes from the saline to the collagen being built over months. We use HA filler for a volumizer to individual pits. 2-5 years, ... but be aware at your age again you will need to top it up as necessary, but that is optional. For every decade it's normally another vial's worth to the treatment. 

Yes part of your issue was no filler with or after subcision, hence you state the "valleys" or atrophy. I would get another subcision with it.

Treatment takes 3 years for acne scar suffers, ... it's not zap your face and then it's all better. Many Dr's try to tell you this, but it's not the way it works. It will be slower at your age to heal as you know.

I would lay off the obsession which is BDD or Body dysmorphic disorder and do something else so you don't obsess. Otherwise it will drive you made. Hence the therapy suggestion.

It's up to you if you decide to do tca cross, ... it may heal poorly, I cannot say. With your age and the nose is a difficult area to treat. Be aware that anything done there will widen and as such you will do a laser peel in a few months when it heals to soften the texture. I am not a big fan of rapapport, ... I wrote in the FAQ my thoughts on him. He is headstrong on blasting one with energy devices and doing multiple things at once. We simply do not heal like this. Regarding your friend who is a Dr. I would not goto a general practitioner for any of this. But the choice is yours. We have a list of Dr's again pinned at the top of the scar treatments main sub, goto the faq, and then the bottom find New York or New Jersey Dr's. 

You need time to heal, at least 3 months, so freaking out about it won't fix it. You can do another subcision and some filler if you want to correct it a bit sooner if you wish. 

I don't understand what you mean take to clean out collegen? Sounds like BS marketing talk to me. I don't like the alastin product you used at all. Many only use vaseline for the first period of healing and then their normal sensitive skin routine. Sadly no cream will do much of anything besides tretinorin when you heal more. 

IT can be normal to break out. Or it can be a flare up of acne or bacterial infection. It's probably from your Alastin, causing a flare, stop using it. Talk to  the Dr about a antibiotic if you feel you need it after a few weeks, but some pimples can be normal. They are supporting you, that is what your paying them for, aftercare ;-) 

Give your skin a rest then, this hyperfocusing isn't going to help you, ... it's a slow process to heal, lots of ups and downs.

Without filler I don't feel you will be happy, so Rapapport is wrong. Your biggest complaint is atrophy, fat loss, and volume, ... hence Sculptra. PRP is just for quicker healing, I don't like his treatment plan personally. Goto the FAQ pick a few Dr's around you and do a consult, pick the one you like, there are several around you on the list.

Your Dr is a general practitioner I think you said. I think you should see someone with more experience. Again it takes 3 months  to heal.

 

 

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@beautifulambition thanks for your valuable feedback.

By the way, the doctor who worked on me is board certified in Cosmetic Laser Surgery and Internal Medicine. He works in this field. Sorry if I miswrote and made it sound that he was a general practitioner. Maybe he is I don't know. He's not a plastic surgeon or a dermatologist... 

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I just got back from the dermatologist. It was a positive experience. This dermatologist did a TCA Cross on my nose, and a punch excision on the side of my nose in late January.

She said the TCA Cross on my nose did work. I hope I can believe her. She did see growth. She also said I should hold off until I am fully healed from all of the work I have had done from the subcision, prp and co2 laser. I was still swelled up and red. She also said I don't have to worry about cannula insertions like the other doctor got me all panicked up about. She did see one insertion point on one side. The other side was a valley that was already there according to the photos above.

She said she could definitely see an improvement in my acne scars on my temple areas. She took photos of my first visit there, before I had the subcision, prp and c02 laser done on the first week of February. It made me so happy to hear her say she could definitely see an improvement, and asked her to reassure me she was not just saying that to make me feel good. She assured me the improvement was good. She also encouraged me to go back to the doctor I used to have more subcisions performed for more improvement. This was a relief because the other doctor only had negative things to say. It's funny how that works out sometimes. 

 She had her assistant take photos today so I could compare them with the photos she took in late January. They are posted below. 

I do see some improvement in the temple area, where is which my acne scars are the worst. However, I'm not at all happy without my skin looks. I would imaging I will need several more subcision done there. In addition to the subcisions, I need a way to even out the pigmentation. First, I would like to eliminate the age spots. Second, I would like to eliminate the redness, if that's possible. I believe I have rosacea so I am not sure how realistic that is. I know I can get laser done to eliminate the veins in my nose, which I hope to do in the right time. But that rough, ruddy complexion, hmmmm... I'm wondering if that is reversible at my age. I hope so. Staying out of the sun is key. 

 

So now the questions are, when do I get my next subcision? 

Oh yeah, she did not encourage me using the Sculptra in my temples because she said that area might not be deep enough, thus creating an overfill. Who knows...

She also said she will wait to do another TCA Cross and Punch Excision after I am fully healed from the rest.

 

 

side1.jpg

Not so sure of the improvement here. The doctor said she could see it.

side2.jpg

side3.jpg

Edited by HopeNew

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18 minutes ago, superburrito said:

@HopeNew, for rosacea, try topical niacinamide. You can get this very cheaply via The Ordinary. I think it's about $6 a bottle.

Thank you @superburrito and now for the reassurance... do you see improvement with the scars? Be honest. :D I have a few more subcisions to do. My partner will be angry. But I have to do this.:) 

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15 hours ago, superburrito said:

@HopeNew, for rosacea, try topical niacinamide. You can get this very cheaply via The Ordinary. I think it's about $6 a bottle.

Thank you @superburrito and now for the reassurance... do you see improvement with the scars? Be honest. :D I have a few more subcisions to do. My partner will be angry. But I have to do this.:) 

@beautifulambition question about suctioning. Should i use the smaller suction cup that fits into the scar or a larger suctioning that fits more outside the scar?

 

How do I best protect my skin from getting more red?

After a few more subcisons and I hopefully get the results I want along with sculptura perhaps, what's the best way to eliminate the dark spots?

Thanks :) 

@beautifulambition question about suctioning. Should i use the smaller suction cup that fits into the scar or a larger suctioning that fits more outside the scar?

 

How do I best protect my skin from getting more red?

After a few more subcisons and I hopefully get the results I want along with sculptura perhaps, what's the best way to eliminate the dark spots?

Thanks :) 

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@beautifulambition sorry for the error in post above... Don't know why that happened. Please see my questions above... or anyone else who cares to answer for that matter. :) 

 

I really am starting to believe that the appearance of my skin is contributing to my inability to get a new job.

Edited by HopeNew

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The left set of photos are slightly out of focus, so I’m having a hard time comparing. The lighting is also a little different too. When we’re the left ones taken? And the right?

Since you had the procedures very recently, the redness and pigmentation issues are expected, and it could take many weeks or a couple of months to resolve. With scar treatments, it’s often trading filling in if scars for temporary pigmentation and redness. 

Prior posts in this thread had suggestions for your concerns around redness/pigmentation.

Niacinamide helps with redness, pigmentation, and also shown to aid in wound healing. For pigmentation, get a skin brightener. Hydroquinone is often the first line of treatment here, but it can be very irritating, so it can make redness worst. You can try other things like kojic acid, alpha Arbutin, azeleic acid. 

PCA pigment gel comes in a version with hydroquinone and one without.

Again, this will take time to resolve, so be patient!

 

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@HopeNew I think again this is not only scars your dealing with, aging concerns, but also internal scars that need to be addressed with a Therapist. Some people are not cut out for the long arduous journey of acne scar work. 3 years of ups and downs, ... lots of healing time.

To recap as this is getting confusing with PM's and private posts, and concerns. You need time to heal 3 months after a procedure, we are talking about a single multi treatment you just had, I discussed what to do above. I help some of the worst scar cases in the world daily, and if you were to come to me and ask what the issue is  I would say mainly age related fat loss. This can be fixed.

I have spent a long time above telling you how but I cannot support your emotionally in the ways you seem to need. Talkspace is a therapy app on any smart phone with unlimited therapy by multiple ways to connect not just texting.   Inability to get a new job could be from various reasons, ... not your acne scars.  

Ok you asked about suction, the smallest size is best, but they do not make supper tinny cups, ... it's really not worth worrying about, get as small of a cup as possible for your scars, often this is the smallest one in the set. I frankly do not see this working for you, ... it seems you have overly sensitive skin and Rosacea. As such this will trigger that to get worse, bruising, redness, prolonged haling (as it takes time when your older). I would have just gotten filler and not worry about it. Don't suction this time, and next get some Sculptra.

No amount of cupping will change fat loss. Dark spot I gave you a plan above using the hyperpigmentation creams. If you need this personally addressed ask the Dr to use a vascular laser (you need this) on you. Niacinamide & Susncreen will help with the redness, but if you have Rosacea you need to see a normal dermatologist and discuss treatment options, cream, pills, etc. Vascular laser can also help, but it will take time.

Please don't expect magic with Sculptra, ... they say a vial for every decade to give you a idea, it's a ongoing thing.

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I just had my new drivers license photo taken because I had to renew my license. My skin differently look more even! Without a doubt I see a big improvement. Now I know this is a combination of the moisturizer, sunscreen and C02 Laser. Although, I am sure the subcision has helped my indentations that difference would not show up on my license photo. But all in all, I'm kind of astonished how much younger my skin looks in comparison to all the other photos I had taken over the last 15 years.  The only problem is my face looks a bit bigger! LOL! I don't know if it's because the photo was taken closer up like the lady said, or because I gained weight, or because I am still a big swollen from the laser procedures back in early February. But all in call, I am astonished how much better the tone of my skin looks. 

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Is it safe to use moisturizer AND sunscreen all in one after subcision and laser? Or is it smarter to use them separately? 

Sorry I just created a new thread asking the best kind to get. But I remembered I should have asked this too so I am posting it in this thread.

 

:) 

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I use a separate moisturizer and a sunscreen on top. I think I put in my routine with suggested products earlier in the thread. 

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