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bay1014

Need help with boxcar/acne scar treatment! -L.A.

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Posted (edited)

Hey everyone,

I was hoping to get some help on a treatment plan for my boxcar scarring and another scarring. I'm currently in Los Angeles (without the LA budget lol- so the more affordable the better!)

A little background- 3 years ago (8/2016) I went on BC  (IUD-Mirena) and it destroyed my skin. A year later (9/2017) I finally took it out. Around (10 or 11/2017) I went into Dr. Rosenberg (Beverly Hills) for a Groupon laser tattoo removal. During the tattoo treatments, Dr. R came in to give me a spiel about my skin (my skin looked AWFUL) and if I was doing anything to treat it. I was mentally vulnerable and desperate and somehow ended up purchasing a 5-6 A/C Dual and 4-5 Pico Sure package that the office manager said I should do... in hindsight, clearly I should NOT have bought this considering it wasn't even the dr recommending it lol but I digress. I ended up using up all the A/C dual which did absolutely nothing and 1 Picosure laser. Nothing worked so I decided I was going to go on Accutane. 

2/2018-7/2018 I was on 40 mg of Accutane. It completely cleared my skin with minimal side effects. 1/2019 I went back to Dr. Rosenberg's office to finish up my Picosure since I figured I already paid for it. The RN who was going to treat me wasn't sure why I was doing Picosure since it wasn't going to help since I didn't have hypo-pigmentation (or was it hyper-pigmentation) but that I had acne scarring. The same office manager came in and was shocked that someone sold me the Picosure package (lol shocker it was him) and graciously let me switch out the 4 remaining Picosure for 2 Venus Viva treatment.

 

I was hoping to get a general game plan for the best way to treat my scarring. I just saw that Dr. Rullan is highly recommended. I will have to reach out to figure out the price range since money is tight. 

Many thanks in advance!

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Edited by bay1014

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@bay1014 Yes you have textural box cars, icepicks, and some discoloration 

Affordable, go see Dr Rullan for his subcision, cross, and needling, that is the cheapest in southern California. You will need a few of these. He treats you skin type. Even if you can afford once or twice a year. He will most definitely want to Phenol peel the entire skin, I would not do this until the end, it's for texture (many treat over 3 years, improve the scars as much as possible before peeling). 

You want some pulse dye laser for the red PIE (Dr Pien treats your skin type and is in Hollywood), rf needling is cheap (Rullan does not do this) and can be done at any med spa spread out cheaply over year(s).

At home you can do glycolic peels and the derminator or manual dermastamp to the box cars. The derminator has a single needle attachment. Try to treat the border of the scars. You can do these treatments between Dr's based treatments (once a month), ... Dr's based treatments you wait at least 3 months between treatments, or if on a budget, when you can.

Sounds like the wrong setting were used by the previous Dr with no regard for your skins reaction and no prep (See below for before and after prep, start using this nightly now).  Yes picosure is for hyperpigmentation, but it also stimulates collagen. I would have used Ematrix or subaltive rf on you.

Yes with picosure you need many of them, and they must go hard enough to treat, but sounds like you have sensitive skin and that is the wrong direction they treated you with. 

Venus Viva isn't the best, ... it's wanna be rf needling, but without the protection for your skin type. But if you have to do it because of the package go ahead. See if you can switch it to Pulse dye laser for PIE or wounding post acne or Ematrix - sublative rf.

 

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@beautifulambition 

Hi! Just wanted to give you and anyone else who stumbles upon this post a small update. So I just got an email back from Dr. Rullan's office ( I had sent them an inquiry just before posting on the forum). 

Like you guessed, Dr. R suggested the Phenol peel as the first option at (estimate $6K) and it would need to be done only 1x with a 2week downtime. 

And then the second choice is a combination of Subcision, Microneedling and Cross carbolic ($1250/per time with an estimated of at least 3 treatments). 

I definitely don't have the $$ or the 2 weeks downtime so I'll most likely be going with 2nd choice + your at home suggestion. 

I was wondering what the difference between a TCA cross and a cross CARBOLIC?

Thank you!

 

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@bay1014

Yes they make more off of the chemical peels, but we do these at the end. I tell patients to do subcision and cross with him, possibly filler and  rf needling elsewhere before considering the peel which should be at the end of treatment. It's just for a %of  surface texture. 

TCA Cross, widen's scars, is commonly used, easier to grasp for a surgeon. Rullan is a Chemical Peel expert training other Dr's. As Such he uses Phenol which heals quicker, does not widen scars, and hyperpigment as much on skin types. But it's hard to master. Same end point, raised scar floor for icepicks.

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@beautifulambition

Gotcha, okay thank you!!

Sorry one last question, so during TCA cross when it widens the scar:

1. Will the scar ultimately become bigger? 

2. the “widening” of the scar I’m assuming then makes it easier to make it more “even/ raised” texturally? 

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