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Pianina

Severe rolling/box scars, what to try next? (Pics)

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These are my scars in the worst possible lighting - usually they don't look so bad in daylight or softer lights, but my bathroom light can bring the worst out of them as it makes them drop shadows. I'm mostly concerned about my cheek and not so much about my temples and the area around as they are not so visible when my hair is down. 
What I've done for them so far - 4 fraxel Re:store treatments in 2015, very minimal improvement for a huge price here in Stockholm. Right now I use dermastamp once a month and apply The Ordinary Granactive retinoid nightly. I take a break from Retinoids once a week to go a AHA/BHA peel, also from The Ordinary. I'm thinking to try dermapen, but I'm afraind I'm gonna throw away my money again. Buying Derminator or Dr.Pen Ultima A7? But again, maybe my scars are way too deep for that and I'm gonna lose money? 
Terrified of doing any strong peels. My skin doesn't normally react well to those, even the AHA/BHA i do at home (the irritation was there even before using retinoid). 
Should I try laser again? Any other that is more effective than Re:Store? Subcision also sounds terrified knowing my skin is slightly active still, though I don't get cysts anymore. Smaller acne is still there once in a while 

56927270_846648572339299_5583261642881236992_n.jpg

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@Pianina Thank you for posting those pictures.

Ok looks like textural scarring, rolling / orange peel, hyperpigmentation, scars over muscles around your mouth (movement) - perhaps some botox to soften the scar are over the muscle there.

Ok we will concentrate on the cheek and not the temples, I would do some treatment for hyperpigmentation here.

Ok you did 4 fraxel restores, what were the settings, this is very important, how did they administer the laser, what was the result after you did the laser, ... was it better for several months or it just did nothing,?

Do you have reoccurring scars with  PCOS. This can hinder healing of scars.

IF you have a dermastamp, ... don't bother with a dermapen. Buy a derminator and do this at home/DIY if you wish, this is a at home treatment. Dr's over charge for this with minimal % of results. You won't loose money doing this at home, its the cost of one treatment at many Dr or Spa. You need other treatments as well and do the needling between them monthly. But I am concerned with your doing this as it can make your skin worse if your sensitive or heal poorly. Clear and brilliant would be better it's a very gentle laser they can even put on max and just use on the scar area, beams are small and energy is less than most lasers, down size is your need many of them.Have you considered ematrix or sublative rf, this is non abaltive and  just works on the scar areas, there is also tixel which is popular but it's a very very light treatment.

You may loose money, I cannot say, ... scar work comes down to how you heal, sensitivity, other health concerns that hinder that, side effects, etc.The more sensitive you are the lower the settings they use or treatments and this you have to do more with minimal results (they know they could hurt you otherwise). 

Your case is extremely hard, ... if we cannot use aggressive treatments we cannot get major improvements, ... then the sensitivity and healing factors (you mentioned about peels, etc).

You need to goto a Dr and discuss these factors (even if you have to consult a few Dr's or plastic surgeons and choose one) like breaking out still, sensitivity, etc. Yes we do not want to break out while treating. But Dr Emil in Denmark could do cannula subcision and avoid the spots with infection. This also would be more sensitive than Nokor subcisionr or many other devices.

You need several subcisions 3-8 of them. W. some ha filler. 

I would also do rf needling, this will protect your dermis and is not like needling your doing at home between. More like a laser that protects the top of the skin, 4 treatments spaced between the subcison. If he did do laser I would do it on a very low density setting because of your sensitivity and just do a test spot and see how that heals.

Please please let any dr you see know all these factors or they will blast you with lasers and make it worse.

Ok so we cannot do acid peels for texture with higher % which works on texture, and fully ablative laser resurfacing sounds out. Unless you can do several lower percentage acid peels.

If I were in our shoes I would do several subcisions with a cannula, and perhaps some filler. 

Vascular laser for the hyperpigmentation on the temple

Then maybe try some rf needling and decide on the other treatments which are gentler.

Again your case is complicated and they must try things to see how you respond and heal, do test spots.  

 

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Thanks for your answer, Beautifulambition. 
 

58 minutes ago, beautifulambition said:

Ok looks like textural scarring, rolling / orange peel, hyperpigmentation, scars over muscles around your mouth (movement) - perhaps some botox to soften the scar are over the muscle there.

I attribute a lot of those scars to BP that I've been using excessively for years (5% strength). Now that I have stopped using it, my new spots seem to heal without leaving a scar. 
 

48 minutes ago, beautifulambition said:

Ok you did 4 fraxel restores, what were the settings, this is very important, how did they administer the laser, what was the result after you did the laser, ... was it better for several months or it just did nothing,?

The last two were on high settings, although I don't know which wavelength. The 4 procedures were done in a span of 7 months, Sep-Apr and I healed pretty well, there was a lot of skin shedding and the improvement that I saw was around 15% but not more. The texture was quite gritty (not very noticeable) for about a year but then went back to normal. Redness didn't stay for long
 

53 minutes ago, beautifulambition said:

Do you have reoccurring scars with  PCOS. This can hinder healing of scars.

I have PCOS but I haven't noticed any major issues with healing, except maybe hyperpigmentation that doesn't seem to go away for months or sometimes up to a year. But wound healing is pretty ok, recently had some surgical procedures done and everything healed ok. When I needle at home, the reddness from needling are gone the next morning, even if i draw blood. 

 

1 hour ago, beautifulambition said:

You need to goto a Dr and discuss these factors (even if you have to consult a few Dr's or plastic surgeons and choose one) like breaking out still, sensitivity, etc. Yes we do not want to break out while treating. But Dr Emil in Denmark could do cannula subcision and avoid the spots with infection. This also would be more sensitive than Nokor subcisionr or many other devices.

I don't seem to find cannula subcision in Stockholm (to travel to Denmark would be a bit tricky), or does it just mean that the filler will be injected at the same time? If so, then I think there are places here when it can be done 
 

1 hour ago, beautifulambition said:

would also do rf needling, this will protect your dermis and is not like needling your doing at home between. More like a laser that protects the top of the skin, 4 treatments spaced between the subcison. If he did do laser I would do it on a very low density setting because of your sensitivity and just do a test spot and see how that heals.

Do you think it's better to start with fr needling? Subcision is so terrifying. I'm afraid it will make me breakout, the area I'm treating is a bit weird, seems like there are some kind of nodules under the skin, not even sure how to describe it. Some bumps that aren't really breakouts. 
 

1 hour ago, beautifulambition said:

Ok so we cannot do acid peels for texture with higher % which works on texture, and fully ablative laser resurfacing sounds out. Unless you can do several lower percentage acid peels.

Yeah, my skin doesn't seem to like acid peels. I do The Ordinary AHA/BHA peel, sometimes it goes well, but sometimes there's irritation. I think it also has to do with constant overuse of BP throughout the years. I hope it will get better the longer I go without using it. I used to go to a Exuviance salon for peels, which would result in irritated skin, although it wasn't completely terrible, but the texture wasn't very nice afterwars, tiny bumps in places. But I think when some more months without BP pass by I will try some stronger peels at home


 

Oh, and how about a face lift for scars? My scars flatten out when I pull my skin up at the ear. Could this work well in combination with some fillers? 

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@Pianina Thank you for your detailed response.

Ok stop all exfoliants, anything harsh, even peels if BP has caused you to have this. Lookup online Google, Repair Moisture Barrier. That could be part of the reason there with inflammation and sensitivity. We have to way something that resurfaces your texture, without causing you more issues (ongoing swelling). You may have to use a steriod with treatment and as we talked about doing spot tests before doing the whole area. Dr's will just blast you for the $$$$ so take control of what you want.

We use 1927nm these days on the full density but we do 22 passes over the scars, I don't like the other wavelength laser 1500nm. It's not a cure in itself and for some people it can make the skin worse as discussed above in my reply. We have stronger tools like deep peels, or fully abaltive laser resurfacing. You would need a combo with something else like subcision as you have more severe rolling scars than just texture alone. 15% cannot say if it was the physicians skill, number of passes, or healing issues. But yes 15% is pretty low, especially if you did multiple of them, 7 months, that is pretty bad, I suggest 3 months between any Dr's treatment, way to quick. 

Ok so you heal, just slowly, I don't think you had the proper procedures (manual treatments) to do the laser, thus also limiting results.  

They are not going to advertise "cannula" that is like a surgeon advertising their tools. You would have to call and ask the dermatologists if they do cannula type of needle subcision and how many a month. Yes a expert injector "might" be able to do it but there is a learning curve, and they are experimenting on you, it is different to inject scar free skin (Easier) then deal with scars. You could give it a try and see how you do once.

You can do rf needling but that alone will not fix your issue, I would also subcise you first. Energy devices alone will give a percentage of results.

Subcision should not be terrifying, it's safer than any energy device and it's under you skin solving many of the issues we discussed. Nodular cysts can be part of acne or pebblestone scarring, they are injected with steriod if fully formed. The cannula will not disturb them if the Dr is experienced. 

There is irritation with any peel. I just know to deal with that texture I would want to do J plasma, Sciton Fully ablative erbium laser peel, or a deep peel. But I understand the down time is long. Think of what was used before this and is still available I am sure by you, dermabrasion with a rotating bit for texture issues. 

I would start with subcision they are very safe for your case and do several of them. But if you want to start with rf needling the choice is your ;-)

 

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Wow, thank you so much BA, so many amazing advice, I'm definitely gonna look into skin moisture barrier, issues was anyway planning to buy The Ordinary's squalane, and now I read that it's good for repairing the moisture barrier. I'm also using snail cream and niacinamide serum right now (though usually not together and not on the retinoid days), and have noticed some positive changes in my skin. It is getting more plump.
I have decided to take your advice and start with subcision, have contacted a couple of legitimate clinics for a price suggestion, before I book a consultation. 
Do you think I should still buy the derminator and do that in between as well? 

I found some old picture before and after Fraxel (the first two were before, and the last one, in 2015 was after 3 sessions). I think my scars looked a bit better back then, but I have actually had many blemishes along the way and drenching the area in BP so it got a bit worse.  

post-195265-0-56939100-1423820887.jpg

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@Pianina Glad to help. Ok, ... Derminator. The choice is yours. I would only do it on your worse scars in between - Dr's treatments, I don't want to cause you more harm, you can always buy a manual stamp try it out and move to the derminator if you do ok. 

I do see improvement between the pics, perhaps it's the change in the light / angle ... softening. But they softened atrophy, hence subcisions, ... I just posted another post on this. It's my road analogy. They don't put a new surface on the road before the fill in the potholes right. So we don't want to soften atrophy before correcting the deeper issue volume loss and collagen building. Subsiisons are something many Dr's skip and it does not benefit the patient. Sure they may be right when it is a more superficial textural issue but why start there. BP for some people causes more harm than good, it can be caustic. 

Wishing you well on your treatments. If you find someone who does subcisions let me know, ... so few sources in the EU. 

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@MikeComplection Who are you? Are you a Dr, Med Spa Owner, Device manufacturer, Nurse, Cosmeceutical Scientist, Treating physician, Esthetician. None of these people are allowed here in our site rules. Your brand new and giving advice like your a authority. Why are you classifying her scars and telling her the treatment she needs, are you now in charge of her care and health concerns? She did peel and do laser, ... by the way Ellman is a terrible laser (outdated).  

As such @Pianina  I must remind you that you need to follow your Board certified Dr's advice and not random person on the internet. 

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I am terrified to do subcision. So afraid it would cause cysts. My acne is still active and nothing I do gets in completely under control. I mostly get very small pimples, but sometimes bigger ones too (right now having one blind painful pimple on my "good" cheek and two tiny whiteheads on my scarred cheek). I cannot see any correlation with breaking out and anything else I do in my life, they happen 100% randomly. But I would like to treat the severe scarring on my cheek anyway, just with someone that can't cause cysts and give me more deep scars. Dont know what to do. Have canceled my visit to Igor Safonov who does subcision, because I'm so so afraid. 

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@Pianina Understandable your would be concerned about your acne. Dr Emil and Dr Safanov are not that far away. Perhaps consult with both. They may be able to give you a antibiotic while your treat and address your concerns about active acne. You could always do a test area of treatment and not the whole treatment. Sadanov is more surgical, and Emil uses more modern methods of treatments, both are good and can do subcision. They can handle someone with acne, please voice this concern and make them address it to you during consult. Sadnov does $50 consult through Email and pics I believe. 

You can always explore with a nearby Derm hormonal acne, get blood tests done and see if that's a issue for you. Some first try zinc soap, leave it on and wash off after 5 mins or a BP foaming acne soap leave on 5 minutes and wash off see if that works, you can spot treat as well. Some people's acne is not acne it's actually fungal try Nizoral shampoo same 5 minute routine. 

 

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