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Vidhya93

Raised acne scar (Hypertrophic scar)

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Posted (edited)

I am struggling with raised acne scars (hypertrophic I guess). I tried multiple times micro needling and microdermabrasion, but I don't see any difference on those scars. 

I attached pictures of my skin.

Now I want to know the right treatments for my skin and i need a recommendation on some creams/moisturizer as well.

One Doubt:

Currently, I am using salicylic acid to peel my skin, which shows my scars even worse as well as very dry skin, after two days it comes to normal. I just want to know, whether it is a normal symptom for this acid. 

Many many thanks!!!

 

 

 

 

 

 

raised scar 2.jpg

raised scar 3.jpg

raised scar 4.jpg

Edited by Vidhya93
removed picture

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@Vidhya93 This is hypertorphic or pebble stone scarring. you can have the areas injected with a over dilute steriod to flatten them. Then they would do a laser procedure to flatten the remaining texture. You cannot just do laser on your skin or it would be ruined. Another technique is steriod drip and laser at the same time. Electro surgery can scrape them off or excision to cut them out. Surgery of course has more side effects than the first treatment. Stop using acid peels and microneedling, ... this stimulates hypertophic scarring (more of them). Please see a experienced dermatologist or plastic surgeon. 

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Will it be healed by itself sometime in the future? If yes, how long it will take to heal?

Currently, i am living in germany, so its very difficult to find an experienced dermatologist. Any advice on finding the right dermatologist for me, because i have meet already some, but they don't provide any treatments for those scars. They always say microdermabrasion is enough.

 

Thanks a ton!! 

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@Vidhya93 No it won't

Find a cosmetic dermatologist, not a normal dermatologist. They do beauty procedures and have lasers. Sadly many in Germany travel to Dr Emil in Denmark to get treatment, or Dr Anil in the UK. 

Call the office and ask do you do steriod injections for hypertrophic pebblestone scars. Look a the reviews online. Search Instagram, and youtube for hypertrophic scars and ___ (city in Germany). 

No you do not want to microdermabration this. You need to shrink down the scar and then use laser or electro suergery. No peel at home will fix this alone, etc. 

Welcome!

 

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Posted (edited)

Can you explain more about the "steroid drip" method?    Is the drip essentially Kenalog placed topically on the skin and occluded with silicone sheets?  If that's how it's done, wouldn't that further depress hypotrophic scars that may be in the same area?   

Dr. Lim also mentions that it may be effective with microneedling.

 

 

Without traveling to one of the few experts in acne scar revision, It's so difficult to find a qualified practitioner willing to do these type of procedures.   

Edited by Brent21

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I've been trying to find a doctor in my area who is familiar with the "steroid drip" method, using fractional laser or microneedling, but have been unsuccessful.  There seems to be little in the literature describing the method.  Is the drip essentially a steroid like Kenalog 40  placed topically on the skin and occluded with silicone sheets?   I have seen Dr. Lim refer to "injecting" the steroid using the drip method, but it wasn't clear what he was referring to.   

  

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Every derm on the planet knows how to use kenalog or steriod. Look up hypertrophic scar treatments. This is common knowledge. 

Kenalog is even used by general derms to inject cysts, lumps and bumps. 

You won't find massive information as medical terms are used and if the Dr is not experienced they should not be performing these procedures. Ask how many cases have you done of this, ... how often do you do it.

Many with just normal cysts - bumps get kenalog injections.

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Thank you, but I was referring to the specific method that Dr. Lim calls "steroid drip" where he apparently drips steroid at the same time that he uses fractional laser and occludes it for 3 hours.  

There is not much written about this technique, and I am trying to find out a few things:

1) Is the steroid applied to the entire lasered area in the instance of pebblestone scarring, or is it only selectively dripped on the raised scars; and

 2) Can a steroid cream be used as alternative or would this be too thick? 

 

For pebblestone scaring, wouldn't this technique risk thinning the skin between the hypertrophic scars? 

Edited by Brent21

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I saw a cosmetic dermatologist today and asked him about injecting Kenalog into the pebblestone scars. Of the several doctors I've seen in the last couple of weeks, this is the only doctor who fully examined the skin with a magnifying lens and took . He advised against steroid injections because the raised scars are very small and the risk of causing depression outweighs the potential benefit.   His treatment advice is Bellafill and Pico laser, which he recommends over Fraxel.  I can't imagine Pico laser helping much, but he thinks it is appropriate.   This doctor has his nurses administer treatments such as filler and laser. 

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@Brent21 Does not sound like a good Dr at all, but your under his care, and as such must do what he proposes.  You dilute  based on the depth. Bellafill, terrible. Ok so he is one of those Drs. Picosure is not indicated for scars nor is it used for hypertophic scars, it's non-ablative. Go consult a few other Dr's if you need to choose better advice that works better for you ;-)

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On 5/18/2019 at 11:44 AM, beautifulambition said:

@Brent21 Does not sound like a good Dr at all, but your under his care, and as such must do what he proposes.  You dilute  based on the depth. Bellafill, terrible. Ok so he is one of those Drs. Picosure is not indicated for scars nor is it used for hypertophic scars, it's non-ablative. Go consult a few other Dr's if you need to choose better advice that works better for you ;-)

Thank you. I'll keep looking. Several doctors tout the Picosure with the special lens array attachment as effective for scars.  Have you had any experience with the lens array? 

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@Brent21 It's great for collagen production though in your case you have a abundance of that, your body produces hypertophic scars so something like co2 or erbium would be better, secondly it' is touted in Europe right now and Asia Picosure is for scars. It is not. Now if you told me hyperpigmentation sure. It's a moot marketing point, directly from the company. So yes I do have experience and would not use this on your. IT would be pointless for the intended purpose.  The newest combo treatment is co2 laser + picosure in Korea - CO2 doing the bulk of the work. 

Explain to me how a photo acoustic laser can ablate (remove) hypertophic scars - it cannot!

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3 hours ago, beautifulambition said:

Explain to me how a photo acoustic laser can ablate (remove) hypertophic scars - it cannot!

I see what you mean. The doctor tried to explain that laser induced inflammation tends to generally even out skin texture, but that didn't seem correct to me.  Are you referring to fractional when you say co2 or erbium,?

Today I saw another dermatologist who used Kenalog on the two largest hypertrophic scars and recommended TCA peels for the rest.  They also recommend microneedling right after the chemical peel, which seems unusual. 

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@Brent21 That Dr is completely clueless, run!!!!! Most laser's are done fractional today, ... Non fractional is just for the texture at the end. 

Good Kenalog  - Derm, TCA peels ... ok, sounds like he or she is doing everything at once. Just separate it out, the procedure and decline the needling, or do that at home.

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Thank you.  I received the clinical notes from the dermatologist who examined under tangential lighting:

------------------------------------------------------------------------------------------------------------------------------------------- 

1) Generally distensible scarring .   No apparent “tethering”

2) Atrophic, larger rolling trough scars to left cheek.

3) Fraction of a millimeter, raised scarring.

4) Troughing, right pre-auricular cheek.

5) Small cliff  scars –zygomatic cheek, and buccal cheek

Recommendations:

Picosure nanosecond laser for skin texturing and collagen stimulation. Pre-treat raised angulated scarring with  Zoom lens with Focus array.  Steroid Injections not recommended. 

----------------------------------------------------------------------------------------------------------------------------------------------

 

 

 

 

 

Edited by Brent21

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