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JamesTan

28 year old with acne scarring on cheeks

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Hello, I’m a 28 year old mixed race (Asian, Latino) with acne scarring on my face, notably my cheeks. These scars make me have no self-confidence, and I’d do anything to get rid of them.

I have tried lasers (CO2, profractional, and erbium) as well as fillers (Bellafill and Sculptra) with limited success.

I went to the doctor considering subcision, and they said I have ice pick scars that require excision and recommended both subcision and excision. They also said that both can subcision and excision will cause a linear scar.

I have a few questions:

- What type of scarring do I have? When I look in the mirrror, to me it looks like a combination of rolling and boxcar. I was told boxcar scars by a PA about a year ago, and I was told icepick by a different PA today.

- Do you recommend subcision, excision, or both? If both, should I do one first? I was thinking about just excising one scar as a test run and then coming back for more if the results are good.

- What are realistic risks (scarring or making things worse) with subcision and excision? I was originally thinking just subcision because it seemed lower risk, but maybe I’m wrong.

- Do you have any recommendations for a good acne scar specialist in central Florida? I’m in Tampa, but I’m a bit worried because the place I went to today specializing in skin cancer (not acne scarring). They didn’t touch my skin or ask me to animate my face, etc. I’m willing to travel if needed to seek the best care

 

Any advice is greatly appreciated. This is legitimately ruining my life, and I want to turn my life around. Thank you in advance for any help.

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You definitely need subcision.

In Florida the man to see is Steven F Weiner. A plastic surgeon.

The success of subcision is extremely operator dependant.

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@JamesTan Hi There You have Rolling scars, box cars, and icepicks, mainly superficial scarring with not fat loss. Asian and Latino, ... Dr Rullan would be a Good Dr to see for this as he treats ethnic patients.

Ah the standard they blasted you with laser and probably made everything worse, and now your looking for something to fix the scars. Manual methods should always be done first before ever considering laser. Bellafill and Sculptra had limited success, .... hmmm. Sounds like your expectations are not matched with what was provided or your looking for a different treatment outcome than the Dr thought they would give you. None of these treatments will give you glass smooth perfect skin, ... you should expect only 50% improvement after several treatments, and it all depends on your healing capabilities and the Dr's skill. 

That being said you need 3-8 subcisions, with filler, to work on your scars. This is a big one that was not done right. Laser is only for slight surface texture not the scarring you have which has some pitting. Subcision does not produce linear scars. Excision does, and you do not need this, so I don't know why it was considered. 

You do have ice picks but this isn't the biggest issue I see. Do 3-8 sessions of this with your subcisions. 

Subcision has the least "risks" compared to any treatment and the most to gain, especially for your scars. I won't even consider excision as that would be silly making linear scar lines all over your face, but there is punch excision which is different. I don't see you needing this unless nothing works, any time there is surgery like excision which is done by a plastic surgeon for best results it can heal poorly. Subcision is not the same and they can use a cannula on you with minimal insertion points.

 RF needling I would do those between your subcisions I mentioned above. This works great on box cars.

You can end with a deep peel from Rullan, or fully ablative erbium resurfacing ((I see you did one before, but before you corrected the acne scar pits, takes a few)).

Dr Steven Weiner is in Florida and is good. 

Use this nightly:

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)! 

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Thank you so much for the advice and evaluation. Yeah, the clinic I visited yesterday recommended excising 15 lesions on my face. Sounds like I should run away fast!

Wow 3-8 subcisions! Spaced how far apart, you think?

I’ve been doing some research and the doctors I’m looking at right now are:

- Dr. Lawrence Kass in Clearwater, FL - specializes in eyelid and facelift surgery but also does acne scarring and is active on RealSelf and has discussed acne scarring. 1 hour drive from me

- Dr. Sandove in Gainesville, FL - I saw you recommend him in another post. 2.5 hour drive from me

- Dr. Weiner in Santa Rosa Beach, FL - You both recommended him recommended here, and I’ve seen him recommended by Dr. Lim on RealSelf (though Dr. Lim also recommended Dr. Emer, and he was the one that did lasers and fillers on me with limited results). 6 hour drive

I want to juggle seeing the best doctor with also being realistic. If I’m going to need 3-8 treatments of subcision as you recommend, I probably have to consider locality more

Do you have any thoughts on Dr. Kass vs. Dr. Sandove vs. Dr. Weiner?

Thank you so much again. It’s really refreshing being able to talk with someone that cares.

 

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@JamesTan

Hmm the chicken or the egg. Dr Sandove mainly does fat transfer for acne scars, He does Sculptra as well, and HA filler I would imagine. He is a plastic Surgeon. But I have also had some patients who were not overly pleased with the results. Of course fat is invasive and very unpredictable, unlike filler.

I would start with Dr Weiner, perhaps you only need a few sessions, space it out and then the drive isn't so bad. He is a great Dr. Also treats your skin type. The other poster went off my recommendation for him. He is a top 1% acne scar Dr. But he is big into Bellafill. Which I cannot stand. But as you already had this it isn't a problem if he uses it with the other treatments. You can always tell him HA filler and he will do that instead. 

Don't get me started on Emer, ... one of the worst. See the FAQ, pinned at the top of the scar treatments sub, goto the bottom, find him. I have had to fix so many of his screw ups, all about the $$$$$$$$$$. I know Lim went there, but means little to me. Razzle Dazzle - Emer "Hollywood." 

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Thank you, beautifulambition! 

I’ll call Dr. Weiner’s office and set up a consultation. Sounds like it’s worth the drive.

I’ll also do a consultation with Dr. Kass because he’s so close, and it can’t hurt to hear multiple opinions.

Will report back with results when I go forward with anything.

Much appreciated and have a good weekend.

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Posted (edited)

Update!

  • I canceled the treatment appointment with the cancer dermatologist that wanted to do excision + subcision. I didn't like excision as a treatment plan, didn't like that they had a PA evaluate me (instead of the doc), and didn't like that the doctor's specialty was in cancerous mole removal (non-cosmetic).
  • I went to see Dr. Kass - he as a cosmetic surgeon who specializes in cosmetic surgeries like eyelid surgery and facelifts with moderate experience treating acne scarring. I liked that he examined me personally and was realistic about expectations (told me not to expect 100%).
  • I sent my photos to Dr. Weiner and am waiting back to hear from him.

Dr. Kass recommended the following to me:

- Subcision

- Silikon 1000 filler (2-3 treatments)

- Nano Fat Transfer

- PRP

- Croton Oil Hetter Peel

(he wanted to do all of these on one day with 1-2 follow-ups for extra Silikon 1000)
 

If I went with Dr. Kass (main advantage is that he is driving distance from me), I'd probably do everything except the nano fat transfer - heard some risks about that and don't think it's worth it. Still doing some research and waiting to hear from Dr. Weiner before I make a decision.

 

What are your thoughts on Croton Oil Hetter Peel, and Silikon 1000 vs. Bellafill or other types of fillers? @beautifulambition I've heard you recommend HA fillers to people - would Silikon 1000 be a good idea, in your opinion?

Also, let me know if there are any specific questions you recommend I ask to the doctor. They said I could send questions in an email, and I like to do my due diligence.

Thank you for your help and support.

Edited by JamesTan

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@JamesTan Nano fat does not have a good track record with acne scar suffers, ... many absorb the fat after a few years, I like Sculptra better for this, less invasive. I am not a big fan of Silikon 1000 or Bellafill. But if your going to do Bellafill goto Weiner he trains other Dr's how to inject this. Not a fan again of either product, have had to help to many people 5 years after with complications, migration, biofilms, encasulated granulomas reaction, etc. Sil is not approved by the FDA for scars - it's off label and notice very few Drs do it for a reason. Bellafill is approved. Permanent is permanent good and bad. Acne scar suffers often heal poorly which is another concern.  30 years are you going to like the filler where you placed it, etc. Money saving wise your not with a permanent filler, as it takes many sessions. Dr Weiner would be best for permanent filler.

OF course I recommend HA filler, it's replaced by your bodies collagen, it's naturally found in the skin. That is the point of it's ussage, sub, and a spacer, .. .collagen.

Crotton Oil Hetter is a deep acid peel for surface texture, only done at the end of treatment. IF you want to do all this, I gave you a plan, but of course the Dr has different ideas $$$$$ he will do everything at once if you let him, this is not how we heal. 

You really need subcision. 

There is a list of questions to ask Drs in the FAQ pinned in the scar treatments sub at the bottom there top of the practitioners.

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Thank you, BA. I have decided to move forward with Dr. Weiner and will be seeing him for my first treatment in the next few weeks.

He recommended:  subcision, Genius, and filler-HA/Bellafill

 

Will update as my journey progresses!

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