@PerfectionistHi"perfectionist" - since I saw the username just want to mention that with all of the treatments below, if you heal well you will get 50% improvement. Many think their skin will be glass smooth. If you get more than that % great.

I see all kinda of things going on, ... why is the skin red on your chin, rash, or PIE(redness), post acne. Acne needs to be under control before treating or it will be a constant struggle of new scars. See a dermatologist for this.

Hi @beautifulambition, 

Thank for your response. I had a couple of questions for the answers you gave me:

1) I am considering to get treatment for my PIE (either Picosure / Picoway or Excel V / V-beam as you mentioned), how much time should I allot between sessions?

2) I am currently planning to try out microneedling & TCA peels while I spend some more time to research on the more costly procedures so I can get the most value for the money I spend on the procedures. If money wasn't an issue, are there any procedures that you would suggest other than subcision for my acne scars (I know you mentioned RF needling and fractionated co2 laser, but would you still recommend these if money wasn't an issue and what else would you recommend)?

3) Which areas and scars on my face would benefit from subcision?

4) I am currently using (The Ordinary - Retinol in 0.2% in squalene) and plan on using (The Ordinary - Retinol in 0.5% in squalene) so that I can gradually get my skin accustomed to using retinol. Is this a correct approach? For Retin-A, I see that are 3 concentrations ( 0.1%, 0.05%, and 0.025 %), how should I plan my usage schedule for these different concentrations so that I can ultimately use the highest concentration while avoiding too much irritation?

5) I currently have most of my acne under control (which is why i'm considering scar revision). Is the redness you're referring to the area that is enclosed by the white circles in the attached photos? (The area inside of the blue circle still has some hypertrophic scars that I'm still working on fixing which are hard to see visually, but with touch it is easily noticeable). I had severe keloidal scarring there about a year ago which has now been reduced to hypertrophic scarring according to my dermatologist. I used scar away silicone sheets and had cortisone injections in that area and have some slight atrophy in the area as a result of the cortisone injections. The redness from the keloids/hypertrophic scar might be the redness you're referring to. Over the past couple of years, the redness in that area has not decreased. I wanted to get rid of the redness in that area immediately, but would the redness of my hypertrophic scars in that area be gone if I used (Picosure / Picoway / Excel V / V-beam)? That is the only thing stopping me currently from getting treatment for the redness.

6) For "PCA hydroquione free gel for Hyperpigmentaion", should I be using this daily, before treatments such as subcision, or after treatments?

7) You mentioned I should be using Retinol daily, how should I incorporate vitamin c serums and Niacinamide into my routine? I mainly use a gentle cleanser in the morning (COSRX Low pH Good Morning Gel Cleanser), a moisturizer, and sunscreen in the morning. Followed by the same cleanser, either a BHA (to clean out my pores since I used to have cystic acne) or a moisturizer at night.

@PerfectionistSo sorry have 100 messages today to answer and you have several questions. Goto the Dr of your choice and have them use directional lighting on them, feel the skin, observe the scarring, consult. It's best if you see a few drs and pick the one you like best even if you have to pay for consults.

** 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.

___________

@beautifulambition

Thanks again for the response!

I plan on getting consultations from several doctors before proceeding with the medical procedures. Could I layer vitamin c on top of a moisturizer to decrease irritation (Similar to the plan you suggested for Retin-A)? Also, do you have any recommendations for vitamin c?

@PerfectionistYes as most Vit C serums are water based, ... if the moisturizer is not 100%oil based. Try it out, works for many.

Recommendations, ... The Ordinary is cheap, or Amazon - look at the reviews.

@beautifulambition

Thanks for the response! I havea couple more questions.

1) I can't seem to tell if my redness is either PIH or PIE. Can Picosure treat the redness caused by both of those?

2) I recently got an email consultation with Dr. Rullanand I was recommended a phenol peel as the best choice and the second choice being: (Subcision, Microneedling and Cross carbolic). I've read some of your previous responses on different threads concerning phenol peels. It seems like your philosophy is to treat the atrophic scars with (subcision/RF needling, etc) first and then doing a phenol peel at the end. Are my atrophic scars shallow enough that a phenol peel would be all I need or does it look like I should fix the atrophic scars first?Thanks!

3) I'm currently doing microneedling and will use vitamin c more frequently to help my skin's collagen production. Would taking collagen supplements also help my skin's collagen production?

Thanks!

@Perfectionist

1. You have both PIE and PIH.

2. Good goto Dr Rullan, he specializes in your skin type. I would treat first with subcision, phenol cross, and the microneedling, ... then do rf needling in between at any med spa or derms office, more sub. I gave you a whole plan above. Do the Deep peel only at the end, when your raise things as much as possible if you wish. That is the one area we disagree on, ... I treat as much as possible before deep peels / texture. You need sculptra or a filler!!!!!!

3. Sure if you wish, this won't be magic though, every little bit helps. It mainly helps during healing. Again filler!

@beautifulambition

My derm prescribed meTazorac (Tazarotene) because she said it would be much stronger. Should I have gotten the Tretinoin or would Tazorac fit my needs? Thanks!

@PerfectionistThis is fine. I just wanted to make sure you were using something for cell turnover.

Hi @beautifulambition

Could you take a look at my questions below and my new skin care routinewhich is catered towards increasingcollagen production, fighting hyperpigmentation/erythema, and reducing hypertrophic scars?

AM

1) Gentle PH cleanser

2) Niacinamide

3) Moisturizer

4) Physical SunScreen

PM

1) Gentle PH cleanser OR Benzoyl Peroxide Cleanser

2) I choose one from the following everyday and alternate:AHA (10% Glycolic Acid form Acne.org),Tazarotene(Tazorac), or Vitamin C

3) Moisturizer

4) Silicone Scar Sheets on hypertrophic scars

Questions

1) How long should I wait before putting on the Moisturizer after putting on theNiacinamide in the AM?

2) I recently purchased the PCA Skin (pigment gel HQ free) product. I plan on using it every night, how should I incorporate this into my routine? I was planning to use it after(Step 2) of my PM routine. How long should I wait before putting it on after Step 2? Also, how long should I wait, after applying the PCA skin gelbefore applying the moisturizer?

3) Do glycolic acid peels increase the production of collagen?

4) For Step 2 of my PM routine, I currently use only one of them every day. Are there any products from Step 2 that I could use together during my PM routine?

Thanks!

How are you finding the ScarAway? Silicone gels are great, but I personally wouldn't use them on my face. They are sticky and would most likely cause breakouts. I use them for a raised red scar on my knee that was caused by injury.

@PerfectionistLooks fine, ... it depends on how your face reacts. Products are highly individualized, be sure to do test areas before applying all over on new products.

Questions

1) Until it dries

2) You can skip the moisturizer if needed but try it out and see how it works. That is a lot of actives. You can remember do retin-a/tretinorin once or twice a week if needed, don't have to do these things nightly.

3) Yes, but mainly we use them for PIE/PIH to stimulate healing as your skin purges the old layers, ... collagen is built.

4) Retin-a and the PCA gel, c and acids are well acids so you might want to skip the mentioned comboproducts those days

Welcome

7 hours ago, ScarRight said:

How are you finding the ScarAway? Silicone gels are great, but I personally wouldn't use them on my face. They are sticky and would most likely cause breakouts. I use them for a raised red scar on my knee that was caused by injury.

Hi ScarRight,

The ScarAway Silicone Daily Discs work really well for hypertrophic scars. You will see results after the first day for newer hypertrophic scars.I previously had big raised hypertrophicscars due to severe cystic acne.

I first used cortisone injections (done by my dermatologists), that worked but caused some atrophy. I used ScarAway and most of them are all gone. They are really effective. You can cut the discs accordingly to the scar to save money. I got mine off eBay

Thanks @beautifulambition

For 4) Are you saying that the day that I use retin-a, I should use PCA gel as well? And that that for Vitamin C days, I should just use that as the only active and for AHA days, I should juse only use that as the active?

Could I use pca gel on days other than the days that I use Retin-A?

Thanks!

@PerfectionistI am not saying anything 100%, ... you need to spot test your skin and see what you can handle. You have ethnic skin, I do not know your reactions. You may be able on the same night to do PCA and the retinoid, w or w/out a moisturizer. You can put on Vitamin C when your not using the retinoid or during the day if you wear sunscreen. See what you can stack together and not, some may be able to do everything, but be aware this can lead to dermatituts if your skin get's angry from too much. You do not need everything nightly, rotate or stop one and start another.

Sure I see pca and retinoid working together.

BA

@beautifulambition

Thanks for the response. I was wondering what is your opinion ontranexamic acid? I haven't seen much about it on this site. I heard it's good for discoloration and was wondering if you have used it or read any papers on it?

@PerfectionistHi there, ... tranexamic acid is being used off label for melasma. It's a alternative to hydroquinone. We have several alternatives already with a track record, and of course devices. Also natural methods of treating hyperpigmentation without the side effects. I don't know where you located but this may be a trend in your country, Asia/ South Asian countries try things sooner without approval.I won't recommend it though until it has a proven track record, .... Dr's can use anything off label. I would urge you to seek a skilled dermatologist if your going to be trying experimental skin treatments as you can make things worse. I don't see this as being a key part of your treatment of scarring.

Quote

J Res Med Sci.2014 Aug;19(8):753-7.

Topical tranexamic acid as a promising treatment for melasma.

Ebrahimi B¹,Naeini FF¹.

Author information

Abstract

In recent times, tranexamic acid (TA) is claimed to have whitening effects especially for ultraviolet-induced hyperpigmentation including melasma. The aim of our study was to evaluate the efficacy and safety of topical solution of TA and compare it with combined solution of hydroquinone and dexamethasone as the gold standard treatment of melasma in Iranian women.

MATERIALS AND METHODS:

This was a double-blind split-face trial of 12 weeks which was conducted in Isfahan, Iran. Fifty Iranian melasma patients applied topical solution of 3% TA on one side of the face, and topical solution of 3% hydroquinone + 0.01% dexamethasone on the other side two times a day. The Melasma Area and Severity Index (MASI) and the side effects were evaluated at baseline and every 4 weeks before and after photographs to be compared by a dermatologist were taken. The patient satisfaction was documented at week 12.

A repeated measurement analysis was used to evaluate the changes in the MASI score before and after treatments. A significant decreasing trend was observed in the MASI score of both groups with no significant difference between them during the study (P < 0.05). No differences were seen in patients' and investigator's satisfaction of melasma improvement between two groups (P < 0.05). However, the side effects of hydroquinone + dexamethasone were significantly prominent compared with TA (P = 0.01).

This study's results introduce the topical TA as an effective and safe medication for the treatment of melasma.

Comment in

• Efficacy of topical tranexmic acid in the treatment of melasma.[Dermatol Ther. 2016]

25422661

PMC4235096

@beautifulambition

Thanks for the response! I am based in the USA. I went to a dermatologist yesterday to get some more of the stubborn hypertrophic scars treated with cortisone injections since the Scar Away patches weren't working for those. The dermatologist recommended "SkinCeuticals Discoloration Defense Serum", the active ingredients are3% tranexamic acid, 1% kojic acid, 5% niacinamide, and 5% HEPES. I got some free samples and tried some of it yesterday night. I'll stop using it until more studies in favor oftranexamicacid are shown. Thanks!

@PerfectionistIf it's in a formula by skinceuticals it's fine. Look at the other ingredients they are good and act on hyperpigmentation as well. I thought you were going to use it as a sole treatment. Continue the serum if you like it as you need something for your skin type to prep for procedures or you will hyperpigment. There is also the PCA gel hydroquinone free on Amazon. Perhaps you have Melasma as well and that is why they suggested it, ... I cannot test as I am not face to face, if so I can see why they suggested. The other ingredients are well studied and work for hypeprigmentation.

@beautifulambition

I am planning to get IPL instead of PicoSure done (even though PicoSure is recommended for my skin type). The quotes for PicoSure in my area are $500 per treatment. When looking on groupon for IPL treatments, I am seeing that IPL is less than $100 per treatment. I already purchased thePCA Skin Pigment Gel HQ Free and am planning to use that to prep my skin. What are your thoughts on this?

How would I incorporate IPL into my treatment plan,I am microneedling once a month.I have yet to start the TCA peel because I am still hesitant and trying to make sure I understand your acid peel guide before proceeding. Thanks!

@PerfectionistCool, PCA Gel is fine then. Of course Picosure would be more expensive that is a million dollar laser. IPL is a cheap device. you get what you pay for. IPL, can have very little results for some people. Give it a try I suppose since it'scheap. I would never pick procedures because they are cheap. You need to go for a practitioner that is experienced over picking a device to do something (they are just one of many tools). IT really is how your skin reacts. V-beam is pretty affordable if you cannot get results w/ IPL, many don't realize you need many sessions of them. You need to start prepping your skin with the retinoids, pca, and niacinamide before treatment, several weeks, and then after you heal continue again nightly.

@beautifulambition

Thanks for the response! I am currently looking around for vbeam treatment and you are right, it is significantly cheaper than picosure. Are there any things I should look for in a laser practitioner such as certifications to help my decision?

@PerfectionistSounds good, and your welcome! No anyone including a nurse can do V-beam. Ask the following questions. How many of these procedures have you done, ... how many have you done with someone of my skin type, do you have pictures I can see of patients who have had them. Can I use aggressive settings with more bruising and less treatments or I want less down time and will do many treatments to get treatment.

@beautifulambition

I believe I developed dermatitis, my skin has been really irritated and red recently.I stopped all actives and just use a cleanser,moisturizer, and sunscreen.

Do you have a recommendation for products for the face that will help for dermatitis on the face?Thanks!