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Riderz1337

Need some advice for my Acne Scarring - seeing an esthetician in a week

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I posted this in another forum section but it didn't get any replies so I figure I'll post here as well.

 

Need some advice on how I should be dealing with my acne scars. I used to have really bad acne in high school and I did a terrible job of taking care of my skin. Thing is I haven't really had any pimples for years now (maybe the odd one here and there but nothing major). Now I'm left with a ton of scarring on my cheeks. It's been like this for years with no signs of going away. It's a bit difficult to see in the pictures but the redness is more noticeable in person. 

I am seeing an esthetician next week (place is called Qesthetics in Richmond Hill Ontario) and I've been reading up a bit on Picosure laser. At first I was thinking about Fraxel but it seems way too intense and the down time is not something I am able to accommodate with work and whatnot. I did previously do three sessions of micro needling at the same place but I noticed zero change in my skin. 

I also notice that when I stretch my skin the scars fade a bit... Not sure if that matters at all. 

I guess I was just wondering if you guys thought it was worth it to go through with Picosure laser at this point in time and if anyone has had any experience with it in the past. 

 

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@Riderz1337 Thank you for posting.

I see boxcars, icepicks, large pores, textural scarring, and a few rolling scars.

* I would do several sessions of subcision. As they are textural I wold not do filler unless your practitioner feels you need it. You can use Chinese Cupping (Amazon), for a month after on the areas subcised instead.

* TCA Cross to the icepicks, and some of the smaller box cars.do tca paint (3 layers of tca after one dries then another at a smaller percentage). This is done with your subcision

* Picosure can help a little with texture, but will not get rid of your scars, it's great for your skin type for collagen formation and some discoloration. 

* Several sessions of rf needling between the subcisions above, great for the cheeks / boxcars

* CO2 laser low density 3-7% at the highest power to the box cars.

* Several TCA peels, or a fully ablative erbium resurfacing for your texture at the end.

* At home dermastamp the boxcars and rolling scars or get a derminator and do this one month between treatments

* Everything is optional, stop when you want, wait 3 months between Dr's treatments, and do the dermastamping 1 month apart at home between.

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 (one or two days a week) 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 options  are better with ingredients like: kojic acid/Konjac, Alpha Arbutin, Niacinamide by The Ordinary is great for large pores, discoloration, and inflammation. The Ordinary, Cerave, Eucerin (QV Skincare in AUS), Dr Sam Bunting Flawless Cleanser, La Roche-Posay (sensitive), and Acne.org's products are all great options for moisturizers and cleaners without fragrance / dyes / allergens. The Three most important things one can use are: Vitamin A skin turnover (retinol, retinaldehyde, retinoid), Vitamin C Serum which makes collagen, and a sunscreen (zinc oxide physical for sensitive skin - DRMTLGY Active Sunscreen, Elta MD Physical).

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Posted (edited)
10 hours ago, beautifulambition said:

@Riderz1337 Thank you for posting.

I see boxcars, icepicks, large pores, textural scarring, and a few rolling scars.

* I would do several sessions of subcision. As they are textural I wold not do filler unless your practitioner feels you need it. You can use Chinese Cupping (Amazon), for a month after on the areas subcised instead.

* TCA Cross to the icepicks, and some of the smaller box cars.do tca paint (3 layers of tca after one dries then another at a smaller percentage). This is done with your subcision

* Picosure can help a little with texture, but will not get rid of your scars, it's great for your skin type for collagen formation and some discoloration. 

* Several sessions of rf needling between the subcisions above, great for the cheeks / boxcars

* CO2 laser low density 3-7% at the highest power to the box cars.

* Several TCA peels, or a fully ablative erbium resurfacing for your texture at the end.

* At home dermastamp the boxcars and rolling scars or get a derminator and do this one month between treatments

* Everything is optional, stop when you want, wait 3 months between Dr's treatments, and do the dermastamping 1 month apart at home between.

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 (one or two days a week) 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 options  are better with ingredients like: kojic acid/Konjac, Alpha Arbutin, Niacinamide by The Ordinary is great for large pores, discoloration, and inflammation. The Ordinary, Cerave, Eucerin (QV Skincare in AUS), Dr Sam Bunting Flawless Cleanser, La Roche-Posay (sensitive), and Acne.org's products are all great options for moisturizers and cleaners without fragrance / dyes / allergens. The Three most important things one can use are: Vitamin A skin turnover (retinol, retinaldehyde, retinoid), Vitamin C Serum which makes collagen, and a sunscreen (zinc oxide physical for sensitive skin - DRMTLGY Active Sunscreen, Elta MD Physical).

I appreciate you taking the time to write this up. 

The clinic I plan on going to say they use the Palomar Starlux 500 fractional Lux 1540. Are you at all familiar with this device and is it something you recommend using? 

https://www.qesthetics.com/fractional-laser-resurfacing-toronto/

I'm seeing it has fairly low reviews on real selfs website. 

Edited by Riderz1337

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@Riderz1337 I am not a big fan of that laser. I don't think laser alone will fix your scars. Sadly some Dr's blast you when you walk in the door. Look for sucbsion and or filler, tca cross, before you consider lasers. You can go anywhere and get CO2 laser, Fraxel 1927nm, rf needling would be much better than that laser to start with between your subcisions.

Do not rely on energy devices alone, ... always do those many manual treatments first. The better known laser is Fully Ablative Erbium Resurfacing by Sciton (some do many peels). That laser is older.

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Posted (edited)
7 hours ago, beautifulambition said:

@Riderz1337 I am not a big fan of that laser. I don't think laser alone will fix your scars. Sadly some Dr's blast you when you walk in the door. Look for sucbsion and or filler, tca cross, before you consider lasers. You can go anywhere and get CO2 laser, Fraxel 1927nm, rf needling would be much better than that laser to start with between your subcisions.

Do not rely on energy devices alone, ... always do those many manual treatments first. The better known laser is Fully Ablative Erbium Resurfacing by Sciton (some do many peels). That laser is older.

Do you by any chance know of any good clinics or doctors in Ontario? It's honestly so overwhelming with the amount of skin care clinics there are and it's tough to weed out the bad ones. 

I was looking at this doctor who seems to have a good reputation https://www.realself.com/find/Canada/Ontario/Toronto/Facial-Plastic-Surgeon/Philip-Solomon 

And his website says the use the specific laser you mentioned in your post, as well as things like subcision. No mention of TCA though. I know I'm asking you a lot but I appreciate any help. 

https://www.solomonfacialplastic.com/facial-plastic-surgery/acne-scar-treatment-toronto/

 

Hey disregard my question for doctor recommendations. I see you have a thread where you have recommended several doctors one of which being Phillip. 

 

Edited by Riderz1337

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@Riderz1337 Sadly I do not, I get complaints that many CAN cosmetic derms and plastics are not that good. Start searching yelp.com or whatever review site for ratings, go on realself.com and see if there are any there. Be aware some Dr's pay for good reviews. Call and ask if they do subcision with a nokor needle or cannula, this will tell you a lot. How many patients per month, ask this. IF they don't then they are clueless laser Dr's. Make sure they treat your skin type, ask for pictures. Call the local dermatology school (college), ask who you can see. Many from CAN travel for treatment. 

Philip Solomon is already on the list in the FAQ, did you look at that, ... pinned to the top of the scar treatments main sub, bottom of that.

 

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Posted (edited)
5 hours ago, beautifulambition said:

@Riderz1337 Sadly I do not, I get complaints that many CAN cosmetic derms and plastics are not that good. Start searching yelp.com or whatever review site for ratings, go on realself.com and see if there are any there. Be aware some Dr's pay for good reviews. Call and ask if they do subcision with a nokor needle or cannula, this will tell you a lot. How many patients per month, ask this. IF they don't then they are clueless laser Dr's. Make sure they treat your skin type, ask for pictures. Call the local dermatology school (college), ask who you can see. Many from CAN travel for treatment. 

Philip Solomon is already on the list in the FAQ, did you look at that, ... pinned to the top of the scar treatments main sub, bottom of that.

 

Yes I noticed his name on the FAQ. I set up a consolation with him for this Thursday to see what he recommends for me. His website makes no mention of TCA Cross and he also seems to use Bellafil after subcision but you mentioned filler most likely won't be necessary for me. Will update once I have the consultation. 

And which is supposed to be "better" for subcision? Cannula or needle? 

Edited by Riderz1337

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@Riderz1337 Does not matter, depends how you heal, his technique "skill" and if you scar from basic procedures like a needle being used. Cannula is of course less invasive but less Dr's do it (very few do sub to begin with). You can do a test spot if you wish to see how you respond to a area of treatment.  

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Just a quick update. 

I had my consultation today. What was recommended to me was Fractora Radio Frequency micro needling (approx 3-5 sessions 400$ a session only on my cheeks) and then after that they said depending on how well my skin reacts to the treatment they were recommending something called Micro Laser Peel (800$/session) and/or PRP treatments (1800$ for three sessions).

 

I inquired about subcision/fillers but when they took a look at my skin they said it does not seem very necessary for that (especially fillers they told me it would be a waste as it would only be used on very few spots) 

At this point I'm going to take a few days to think about it. I would have to plan ahead as they told me the Fractora treatment requires at least 2-3 days of down time so I'd have to plan it in advance where I take time off work. 

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@Riderz1337 Fractora is horrible, one of the worst devices, many better devices out there, seen some bad side effects from this unit.

Micro laser peel will not fix your scars. This is a laser Dr who just want's to blast you as I mentioned above, many of them are general Dermastologists. Find someone who does manual methods I stated above.

You do need filler, this person is a _____, I would not see them, very uneducated, you clearly have areas that need subcision. IF you do not want filler do Chinese Cupping (amazon for a month after.

I would not do Fractora again, but do what you want. This Dr does not sound like the best. Please consult a few others (that can do subcision), before deciding.

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4 hours ago, beautifulambition said:

@Riderz1337 Fractora is horrible, one of the worst devices, many better devices out there, seen some bad side effects from this unit.

Micro laser peel will not fix your scars. This is a laser Dr who just want's to blast you as I mentioned above, many of them are general Dermastologists. Find someone who does manual methods I stated above.

You do need filler, this person is a _____, I would not see them, very uneducated, you clearly have areas that need subcision. IF you do not want filler do Chinese Cupping (amazon for a month after.

I would not do Fractora again, but do what you want. This Dr does not sound like the best. Please consult a few others (that can do subcision), before deciding.

I'm definitely on the verge of just giving up at this point. I can't seem to find a doctor that will look at my skin for more than 10 seconds or look at it in different lighting to see all the deeper scars. I even said during my consultation that some of my scars are deeper when you look at it in different lighting conditions and the consultant just basically nodded her head and moved on. 

I had one doctor straight up say nothing can reduce/fade my scars and ended the consultation in 30 seconds, and then I have other ones where the first thing they recommend is lasers. 

I'm probably going to take a break for now and give up my search on finding a good doctor. 

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@Riderz1337 Look for a Dr that does subcision. Your going to general Dr's who have no clue. Specifically book for subcision and tca cross. If they don't know that that is, or don't know what type of needle they use to do it, or how many times a month they do it (Call the receptionist), waist of your time. Call around and ask. They can even take the filler needle and subcise while using a bit of filler. That person you mentioned is stupid. You can buy .5ml of filler if needed, they just cannot be bothered. 

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