Thank you so much for the detailed explanation. That is very helpful. Id like to ask you a question:

1. How soon after subcision would you recommend IF needling or dermastamping?

Thanks again

@Brent21

A month, if your healed up

Thank you again. I'm trying to get a better understanding of why it's okay to do needling while collagen is still forming from a prior procedure. I realize this is less invasive than a doctor's office procedure, but doesn't it still disrupt the newly forming collagen?

Once again, thank you for your help.

UPDATE:

I visited a doctor this afternoon who is veryexperienced in subcision, fillers and laser. His comments were that: 1) He doesn't see any scars that would benefit from subcision. 2) He think a filler without subcision would be the best approachbut would re-evaluate after an HA filler injection. Then, he brought in his experienced injector who agreed with the doctor's assessments (Both the MD and filler commented that my complexion is very good, which does not match my perception).

Theirrecommendation was to inject 1 syringe of Juvaderm, and if the results are desirable, follow up with injections of Bellafill. His injector charges $500 per syringe of Juvaderm and $1000 for Bellafill.

@Brent21

Perhaps the Dr does not understand terminology - subcision is often done with filler (There are different methods of subcision, sounds like he is outdated in his approach), ...

To recap the easiest solution for a Dr is just to shoot you up with filler. This is NOT a good acne scar Dr. I want you to see a few practitioners and compare their plans, pick the one you feel is best.

Thanks for your reply, again. I was referring to normal microneedling. I understand that you only go 1.5-2mm with that, but doesn't it still disturb newly formed collagen if done too soonafter a more aggressive procedure?

Yes, I plan on seeking other opinions. To tell the truth, this is the third doctor I've seen in the last few years asking for subcision. Each claims to be experienced in the procedure (not sure which type), and each has guided me to fillers, trying to convince me that the atrophy ismostly an age related problem.

@Brent21I understand what you are saying. Low mm microneedling .5mm to .75mm should be fine, if your concerned about anything wait 2 months until your start this or don't do it at all. This of course is for acne scar patients. After reviewing your recent posts and your Dr's recommendations who are actually feeling your skin, testing for scarring. I feel you do not have acne scarring and just have age related concerns.

The reason I think it is all related to acne is that the problems arose when I was 21-22 when I experienced lots of acne. Also, the areas of atrophy are consistent with the areas that I had acne. None of the doctors I saw said that I had no scars, but they didn'tusea special light to see the scars.

Many years ago, I had ablative laser treatment and that doctor acknowledged the scarring, albeit he had to look closely before doing so.

I'm scheduled for an RF microneedle session ( with thermal protected needles) tomorrow. Is there a "standard" recommend depth for treating acne scars?

Thank you once again.

@Brent21Perhaps I did not word that right. When 3 Dr's who you yourself said were experienced said it was aging, that gives me pause as they have actually seen you for a consult. I believe your biggest issue, any way you want to parse it is aging, pre-mature aging, etc. When someone has scars, they age you prematurely, compounded are your other age related issues discussed above. Itdoes give me pause they never thoroughly inspected you for scars as you said in the consult. Yes perhaps it's best to see a few more Dr's.I want you to see at least 2 plastic surgeon's as they may be more meticulous not for scars but aging related issues, ... they do facelift's for guys often who have aged. These Dr's do not sound good if they cannot see the issue, ... they want quick money making procedures. IF you had ablative laser you obviously had surface skin issues.

I had a consult today with another surgeon (facial plastic surgeon). His diagnosis is that I have mostly volume loss with some textural issues and did not have much tethering of scar tissue.. His recommendation is either 1) 2 sessions of 2 vials of Sculptra each, or 2) microfat grafting. He says that his experience with grafting is approximately 70% retention rate, and that the grafting is more "controllable" than Sculptra. Also, he personally injects Scuptura for his patients.

I had fat grafting with Subcision. All fat dissolved completely in three months time. Fat is unpredictable. You do not know how much will stay if any. You will not understand before u try it. Alsofat is injected deep.

Fat made the scared area filler so the scars looked smoother and filled. As soon as fat got dissolved the scarscame back to initial point.

Thank you, Sibel. Was your surgeon experienced in fat transfer? Did you also try Sculptra? If so, how did that turn out?

@Brent21This Dr is going in for the sale. Learn to recognize when they do this. He get's more money from you to do Fat grafting than any filler which many practitioners can do. If fat grafting is soooooo great why do so few practitioners do it. It's lumpy, get's absorbed by the body in a few years - is not permanent(in fact it's about the same as Sculptra for many).

It's invasive, ... who wants a painful surgery to get fat, it's not precise to target areas. Many are not aware you need 3 sessions normally to get good results. Very small % actually survives transplant (balloon face to deflated). In the perfect cases it may be long lasting but that is very few.

It is good for deposit in a large amount in one area.

As you said you don't have much fat.

When do I see the best results with fat graft, when a facelift is done and they take sheets of fat(augmenting) to contour the lift not injecting it or processing it.

But by all means if he is the exception to the rule do fat grafting with him, perhaps knows something many other Dr's don't. Perhaps in the future we will see something that is actually a good option with fat in combination with biotechnology, but not today.

In this case, his price for fat transfer is less than 4 vials of Sculptra. With the facility fee and his mandatory anaesthesia it is only slightly more than Sculptura. He claims that fat graft is more predictable than Sculptura, but he didnt have a preference for one over the other.

@Brent21That is not the national average. But if you feel it's a better deal go for it. I outlined the disadvantages above. It's your choice on treatment. The second part is not true at all. Predictable to whom, ... certainly not to most Drs. Maybe to him as he mass fills your cheeks, ... your case is a bit different as you have overall volume loss and I have to help acne scar patients typically here. I actually hear the opposite quite often, fat lost favor when filler's became popular. I wish you well on your choice, they probably both would work for you. I would get some other consults on the Sculptra not just one Dr's quote though to be sure.

I decided on PLLA (Sculptra) injections and had two vials injected today. I certainly have scars, but the swelling/volumizingeffect of the PLLA makes them appear much less prominent. I realize this is temporary swelling. and hopefully will be replaced by collagen stimulated by the PLLA over the next several months.

Since the physician did not subcise any of the scars, I am wondering whether I can immediately do a semi-invasive treatments like RF microneedling while the PLLA starts to stimulate collagen. I think the answer is "no" since PLLAitself seems to relyon inflammation to induce collagen, but trying to explore the possibility.

PLLA seems like such an easy an controllable way to stimulate collagen, I am left wondering why anyone would choose other methods of collagen stimulation like non-ablative lasers or RF microneedling to raise scars.

@Brent21I am glad it went well 😉 Yes it's a slow process, takes many months for collagen to develop. A full course is 3 treatments close together, I don't know if your Dr will do this to top up as necessary.

I would not rf needle immediately. Why. Because collagen is fragile and needs time to settle, attach to the surrounding tissues. Give it a chance to develop. As you said it develops over months.

Sorry, did not see ur question. Yes the surgeon was experienced, Dr.Stillaert Fillip. He suggested to repeat Sub plus fat but I did not go in the end, went to Chu which also was not the best...

No I did not do Sculptra, not yet) may be with Emil may be not.. I feel so fat up now..

BA where I find infothat Sculptra stimulates collagen growth? What resources?

19 hours ago, Brent21 said:

I decided on PLLA (Sculptra) injections and had two vials injected today. I certainly have scars, but the swelling/volumizingeffect of the PLLA makes them appear much less prominent. I realize this is temporary swelling. and hopefully will be replaced by collagen stimulated by the PLLA over the next several months.

 

Since the physician did not subcise any of the scars, I am wondering whether I can immediately do a semi-invasive treatments like RF microneedling while the PLLA starts to stimulate collagen. I think the answer is "no" since PLLAitself seems to relyon inflammation to induce collagen, but trying to explore the possibility.

 

PLLA seems like such an easy an controllable way to stimulate collagen, I am left wondering why anyone would choose other methods of collagen stimulation like non-ablative lasers or RF microneedling to raise scars.

 

 

Looking at your pics, there isactually very minimal scarring. What I do see is cheek hollowing and fat deficiency, which the Sculptra will take care of nicely. I think you're going to see a big improvement once all the collagen is stimulated and you generate volume to fill things out.

@SibelEmil starts this in June, esquire with his office. I have done this way to many times, ... search the scar treatment boards if you need resources they are pinned at the top, and in allthe major posts or Google Sculptra and collagen.

Before a I asked this question certainly I googled) just would be nice to hear your more detailed opinion about Sculptra.

@SibelThere are numerous studies, but these aremy favorites for aging and the use of Sculptra to combat it's effects:

http://geomedicspharma.com/wp-content/uploads/2017/07/4.Facial-Enhancement-and-the-European-Experience-with-Sculptra-Poly-l-lactic-Acid.pdf

https://www.thieme-connect.com/products/ejournals/html/10.1055/s-2004-861758

https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0029-1220648