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electrolysis scarring

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This is a little different, but I'm told that electrolysis scars are often similar to acne scars. I figure it doesn't hurt to ask.

I'm half-Chinese, half-Caucasian, probably between a Fitzpatrick III and IV.  Early/mid 30s. I naturally have orange-peel skin, although the pores are starting to shrink due to estrogen injections.

I'm a trans woman (that is, I am transitioning from male to female) who has been getting electrolysis to remove her beard hair. Electrolysis is a method of hair removal which involves sliding a thin filament into each hair follicle and applying an electric current. The type of electrolysis I've been getting, galvanic electrolysis, results in the formation of caustic lye in the base of the follicle, disabling the follicle. Unfortunately for me, the first electrologist I saw severely overtreated me, and I'm left with two types of scarring

1. Shallow pits along the corners of my upper lip. In some cases, the pores appear to have joined to create a little crevice or fissure. I hesitate to call them "ice pick" scars, as they only appear to be maybe 0.2 mm deep, although some appear to be very shallow boxcar scars. I would call some "atrophic pinhead scars", perhaps. I've been getting microneedling treatments through my endocrinologist (who specializes in trans care and sees a fair amount of scars from electrolysis -- which is why she offers treatments), and they've been somewhat helpful. Also, I've continued to have electrolysis done, and the treatments (when done correctly) do have a rejuvenating effect on the skin. (One type of electrolysis is essentially the Infini RF device, but a single needle manually controlled by the operator.)

2. Hypopigmented dots, no more than a millimeter in diameter, starting from around the temples/ears and extending down along the jawline. There are hundreds of these, with such a density that they aren't obvious except in diffuse sunlight (in which case they light up) or if I stretch the skin and point at them. These wouldn't bother me except that they trace the exact outline of where my beard once was. If they were more evenly spaced across my face, they wouldn't be an issue. I'm not clear if this is post-inflammatory hypopigmentation that is taking months and months to resolve, or regions where the microcapillaries have been damaged (as with a VBeam), or just run-of-the-mill scar tissue. I've accepted that my treatment options for these are limited. The dots, they don't bother me nearly as much as the upper-lip pitting.

3. While I'm at it, I have some old acne scars along the temples, and some atrophic scars along the cheeks which could probably be treated with subcision and filler to start. I'll post pictures when I can.

I live in Los Angeles, CA, and am willing to travel for treatment. I've seen a number of people here already for consultations:

- Jason Emer (well, an assistant, because it was free, Beverly Hills). I'm aware of his questionable reputation here, but I went to see him at the recommendation of Davin Lim's office. I was pushed hard on Fraxel + Fractora and some expensive prep creams. Got some questions that were a little forward (Why do you do this to your face? sort of things). On the plus side, very LGBT friendly.

- Raffy Karamanoukian (Santa Monica). Very pleasant and down-to-earth. Spent a lot of time one-on-one speaking with me. Recommended a few Venus Viva RF treatments for the upper lip and cheeks with some microneedling that I can do at home with a Dermapen. For the dots, a combo of VBeam (to take some color out of my skin to blend the dots) and a non-ablative laser (I forget which) followed by sun-exposure to induce pigmentation. He seems to think the white dots are due to a lack of vascularization, and he's optimistic about making them appear not so obvious. With regards to the upper lip, he's not so optimistic. On the other hand, his treatments are extremely affordable. Dr K gives the impression of someone who listens to my concerns, doesn't oversell or push anything, and is very happy to talk serious dermatological science with me. Strongly discouraged any sort of laser.

- Michael Persky (Encino). Soft-spoken and pleasant. Extremely non-judgmental, although I got the impression that he was a bit uncertain of how to respectfully handle a trans person. (I'm used to that.) Seemed to only offer Fraxel lasers: re:pair, re:store, and Dual. He also seems to think that the solution for the dots is to mildly lighten the surrounding skin.

- Christopher Zachary (UC Irvine Medical). Also recommended by Davin Lim's office. Never got the impression that he actually was listening to me. Spent a lot of time talking about laser hair removal, to the extent that at various points in the conversation, I was unclear whether we were talking about a non-ablative resurfacing laser or about laser hair removal. Patronizing (I think I used the phrase "punctate hypopigmentation", and he responded with something along the lines of "Wow! Look at you! You've got the lingo down!"). Left feeling uncertain about what the next steps were. I think fractional non-ablative laser of some sort.

- Jen Chow (Arcadia). I just went to see him because I know him personally. He recommended that I look for someone offering erbium laser resurfacing, and not to set my expectations particularly high. For the white dots, makeup. (I'm a makeup artist as well, so that's not him being snide -- just realistic)

Thoughts or recommendations?


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@aurora_ardsley Wow lots to digest above. I don't really like any of those practitioners, perhaps goto Raffy Karamanoukian if you wish, the choice is yours.

Regarding your conditions, I cannot analyze what is going on until I see some pictures and especially with directional light or a flashlight making shadows.

Electrolysis is not infini rf. More like Electrosurgery perhaps. You get these issues with that procedure by overheating the follicle causing scarring and damage or someone with poor skills, or the machine is terrible. Used to read a Electrolosis forum for practitioners forget the url. 

Regarding pores, dots, orangepeel, hypopigmentation, etc.... I can best address these when I see some pictures. Every Dr will sell you with what they have to make $$$$$ on, the cure may not be energy devices, but that is often when they throw at you. Go to whomever can give you the most attention and has the best skill. OF course with Emer that comes at a very very high price (ongoing).

It's best if I cross reference the above with pictures. Otherwise I am just guessing.

IF you want to goto someone with a ton of lasers, and experience with them, but it will be costly.  http://AMAskincare.com  She - the Dr is very qualified. Not advertising for her but you seem to be in that area. 




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Thanks. I'll take some photos tomorrow. I'm reading the FAQ, and will also get a consultation with Rullan in San Diego. It's worth the trip, and I need to visit some friends down there anyhow. If I decide that RF microneedling is in my future, I may head out to Dr Weiner. My hometown is in the southeast.

The website you've been on is probably Hairtell.com  It's got some good information; also some misinformation.

I should note that while electrolysis scarring is usually deep due to thermal damage from overtreatment, I've been receiving galvanic electrolysis which doesn't produce any heat. Now, I have possible scarring from chemical burns as a result, but it's unclear how deep the scarring is. It may all be superficial. My skin was also slathered in BLT ointment, which may have sent the current up to the surface of the skin rather than down deep in the follicle. This would explain a lot of the pigmentation problems I have, and also why so much needed to be applied to get a good release.

And thank you for the AMA recommendation. I've been mainly going by Realself and Yelp reviews, which are obviously not unbiased sources of information. I'm much more willing to trust someone like Dr Pien who explicitly discusses East Asian and Fitzpatrick IV skin types on her website.

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Below are some resources to checkout, one link and two other posts on reddit. IF it is scarring from Chemical Burns, ... Rullan is a great Dr as he is a chemical peel expert. Pien would be good for close treatments with your skin type. I always say for those with ethnic skin goto someone who has or has a history treating  that skin type as they should know how to treat it. Rullan is great with ethnic patients as well.




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