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SEVERE Acne Scars , Fat loss AND Depressions : Treatments ??

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Suffering from acne scars due to accutane dosage last 2 years ...

mainly , rolling and boxscar : temples and cheeks

Some of the pictures were after subcision treatments , How should i go from here ?

and what kind of treatment is suitable and how long for good improvement ??

 

Thanks

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@TF- Hi there, I don't know how this got put in the wrong forum, ... it should be in the main scar treatment sub. I will move it there.

Firstly you do not have severe acne scars ... I have helped thousands, ... daily I see worse cases than yours. I know they big you and that's all that matters.

Good you did some subcision so minus that out of the below treatments, ... they missed certain areas like your temples, etc it looks like.

I don't see any fat loss with your subcision bruises so no idea, ... use some filler as needed after the subs.

You have icepicks, rolling scars, and boxcars, with hyperpigmentation. No major atrophy, mainly superficial - textural. Many areas of good skin.


Never start with laser treat the deeeeepest problem and move to surface resurfacing.

* I would do 3-8 sessions of cannula subsision to your scars, this will help you most, ... they can do a bit of filler after or you can do Chinese Cupping (Amazon) for a whole month (with cupping yes you bruise, so be prepared if you take this route, you can vary the suction strength, wear a concealer over the area like dermablend). A buffer keeps things from re-tethering.
* TCA Cross for icepicks can be done at the same time as subcision

* I would do rf needling to your scars, ... this helps rolling / boxcars (4 sessions or more)

* CO2 laser if you need a boost in low density and high power setting.

* For texture we lastly do Sciton fully ablative laser resurfacing, notice I said ablative, non-ablative with do nothing for your scars , OR several TCA peels (perferable), or a deep peel on the scar areas only. You have sensitive skin discuss this aspect with the Dr you goto, talk about steriod shot to the hip, doing a test area, and aftercare. This works once you raise your pits, but there is down time.

* You can try this first and do this at home for several months to save some cash or between your Dr's treatments, everything is optional... buy a dermastamp or derminator (google it) and stamp them monthly. You will be treating with the Dr every 3 months - the above things, regardless of what they tell you, the body is incredibly slow to heal and they want $$$$ quickly, observe your progress of what works). Once a month your dermastamping and you can alternate with do glycolic peels at home. Treatment for many takes 3 years, everything is optional. Treat as you have time and money (for some that's only 2 things a year), it's a slow process again with most of it related to how you heal and what works best for you, do more of that.  

* For redness / discoloration we do pulse dye laser, or something like picosure, picoway. Laser resurfacing (Above) and Q switch is used if the pigmentation is not responding after several treatments. Alternatively you can try first peels for discoloration or hyperpigmetnation.

* Nightly before and after treatments until the issue is taken care of:

Use nightly: Retin-a or tretinorin(prescription), or Differin (Target/Walmart), The Ordinary Granactive Retinoid (if you can't get the above) or Avene or Osmosis (I am not a big fan of their other products) "Retinaldehyde" product (for sensitive skin). Cureology(USA) & Yoderm(USA) provide monthly - 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 (or do 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/Yoderm/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, Avene, 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, La Roche).

Checkout the main scar treatments sub, find the FAQ pinned on top there, goto the bottom, there are Dr's or call around and ask who does cannula subcision or nokor subcision (needle type) to dermatologists and or plastic surgeons, consult a few before you decide who you like, even if you have to pay as treatment is expensive, better like them. Ask how many subcisions they do a month and if they treat your skin type. If they just do laser run they will just blast you and not solve your issue. Please Note I do ongoing support by PM for complex cases / questions, daily - you can message me there. Please be patient as I can get over 100+ of the worst acne scar cases to help.

Disclaimer: Information and support is not meant to diagnosis, treatment, or cure any health or mental condition and is not a substitute for professional face to face medical care  (consult with a few Dr's and pick your favorite one). Posts are for informational purposes only, please consult your personal health care practitioner before engaging in anything discussed.

 

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Yes , thank u for ur reply

1 hour ago, beautifulambition said:

@TF- Hi there, I don't know how this got put in the wrong forum, ... it should be in the main scar treatment sub. I will move it there.

Firstly you do not have severe acne scars ... I have helped thousands, ... daily I see worse cases than yours. I know they big you and that's all that matters.

Good you did some subcision so minus that out of the below treatments, ... they missed certain areas like your temples, etc it looks like.

I don't see any fat loss with your subcision bruises so no idea, ... use some filler as needed after the subs.

You have icepicks, rolling scars, and boxcars, with hyperpigmentation. No major atrophy, mainly superficial - textural. Many areas of good skin.


Never start with laser treat the deeeeepest problem and move to surface resurfacing.

* I would do 3-8 sessions of cannula subsision to your scars, this will help you most, ... they can do a bit of filler after or you can do Chinese Cupping (Amazon) for a whole month (with cupping yes you bruise, so be prepared if you take this route, you can vary the suction strength, wear a concealer over the area like dermablend). A buffer keeps things from re-tethering.
* TCA Cross for icepicks can be done at the same time as subcision

* I would do rf needling to your scars, ... this helps rolling / boxcars (4 sessions or more)

* CO2 laser if you need a boost in low density and high power setting.

* For texture we lastly do Sciton fully ablative laser resurfacing, notice I said ablative, non-ablative with do nothing for your scars , OR several TCA peels (perferable), or a deep peel on the scar areas only. You have sensitive skin discuss this aspect with the Dr you goto, talk about steriod shot to the hip, doing a test area, and aftercare. This works once you raise your pits, but there is down time.

* You can try this first and do this at home for several months to save some cash or between your Dr's treatments, everything is optional... buy a dermastamp or derminator (google it) and stamp them monthly. You will be treating with the Dr every 3 months - the above things, regardless of what they tell you, the body is incredibly slow to heal and they want $$$$ quickly, observe your progress of what works). Once a month your dermastamping and you can alternate with do glycolic peels at home. Treatment for many takes 3 years, everything is optional. Treat as you have time and money (for some that's only 2 things a year), it's a slow process again with most of it related to how you heal and what works best for you, do more of that.  

* For redness / discoloration we do pulse dye laser, or something like picosure, picoway. Laser resurfacing (Above) and Q switch is used if the pigmentation is not responding after several treatments. Alternatively you can try first peels for discoloration or hyperpigmetnation.

* Nightly before and after treatments until the issue is taken care of:

Use nightly: Retin-a or tretinorin(prescription), or Differin (Target/Walmart), The Ordinary Granactive Retinoid (if you can't get the above) or Avene or Osmosis (I am not a big fan of their other products) "Retinaldehyde" product (for sensitive skin). Cureology(USA) & Yoderm(USA) provide monthly - 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 (or do 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/Yoderm/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, Avene, 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, La Roche).

Checkout the main scar treatments sub, find the FAQ pinned on top there, goto the bottom, there are Dr's or call around and ask who does cannula subcision or nokor subcision (needle type) to dermatologists and or plastic surgeons, consult a few before you decide who you like, even if you have to pay as treatment is expensive, better like them. Ask how many subcisions they do a month and if they treat your skin type. If they just do laser run they will just blast you and not solve your issue. Please Note I do ongoing support by PM for complex cases / questions, daily - you can message me there. Please be patient as I can get over 100+ of the worst acne scar cases to help.

Disclaimer: Information and support is not meant to diagnosis, treatment, or cure any health or mental condition and is not a substitute for professional face to face medical care  (consult with a few Dr's and pick your favorite one). Posts are for informational purposes only, please consult your personal health care practitioner before engaging in anything discussed.

 

Yes , thank u for ur reply

 

Currently , im having fat loss atrophic in temples mainly and some in cheeks

boxscars and rolling mainly on cheeks and temples

Done few subcisions , microneedling and fillers

 

Next procedure / Treatment : would like a big improvement for once then go back to routines

 

Would u suggest fat grafting to make at least 50% improvement ??

or just microneedling n subcision for now ?

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@TF- Thank you for your additional pictures, ... you definitively do not have severe scarring. After helping thousands of cases I can say this confidently. Again they bug you and that is what matters. 

  1.  It concerns me ... your Dr's subcision, they have left untouched certain areas. For instance the temples were not done at all. I do not know what method they are using or the type of needle, this would be helpful. But again you need 3-8 subcisions WITH "filler" spread out 3 months apart, ... many take 3 years to do treatments. Some cannot afford many Dr's treatments and thus space out treatments when they have time and money, ... once or twice a year until they are satisfied. 
  2. Was filler used either directly after or when the swelling went down a week or so after your subcision, this is vitally important to the results or you will have re-attachment. You can also Chinese Cupping (Amazon) for a month daily after your subcision, ... this does create some bruising (be aware).
  3. This is a marathon, not a race, as such, you need to be patient. Are you doing your dermastamping (or even better the Derminator  w/ the single needle attachment to your box car borders/walls "google it") at home monthly between your every 3 month Dr's treatments, ... alternating those with glycolic peels.  
  4. You are going to need rf needling and laser done to work on your box cars either between several sessions of subcision or after your done with those. Mono treatments won't fix your issues.
  5. This is not fat loss in the temples, ... these cases the temples are always thin and close to the bone, there is attachment of the scarring there and some loss of dermal tissue. Over dilute Sculptra can be used there as a buffer, over dilute radiese, or even some HA filler. RF needing is also helpful and laser here, ... you will have to deal with texture as I outline in the above plan for you at the end (chemical peel or deep laser peel). 
  6. I would never do fat, of course you can try it if it's popular in your country, ... it can be lumpy, not easily placed for scars (migrates), does not last and the body can absorb it, is invasive compared to a collagen stimulating filler, and must be re-injected (people do not realize the hassle). If your Dr is over confident in it's use and has great results go for it. Many of the Dr's use filler now because of it's cheaper overall cost and intended use, a temporary stimulating spacer. 
  7. Your not going to see a big improvement from any one procedure. Many here get only 50% after they do all of their above treatments in your plan, ... this is realistic, I am not selling you anything. If you get more this is great and that can happen if you heal well. Nothing will give you 50% improvement alone. But yes filler will help after your subcisions, and you will need the energy devices as I described.
  8. I suggest you follow the plan I laid out above, more subcisions, more tca cross, you have many icepicks that were not treated, some filler which was not used, and you need energy device work for your textural box cars. 

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14 minutes ago, SimpleMutton said:

You call that severe scarring?

Yes

Most of temples and cheeks covered with scars..

People do notice when i interact

How is it to you?

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That's mild scarring and some hyperpigmentation

Severe scarring is when your entire face is covered by scars 

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On 6/3/2019 at 11:03 PM, SimpleMutton said:

That's mild scarring and some hyperpigmentation

Severe scarring is when your entire face is covered by scars 

Oh i see..

Mine is not all covered but textural and fat loss is a problem

Might go for fat grafting 1x next week and will update pictures later for reviews

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On 6/3/2019 at 9:43 PM, beautifulambition said:

@TF- Thank you for your additional pictures, ... you definitively do not have severe scarring. After helping thousands of cases I can say this confidently. Again they bug you and that is what matters. 

  1.  It concerns me ... your Dr's subcision, they have left untouched certain areas. For instance the temples were not done at all. I do not know what method they are using or the type of needle, this would be helpful. But again you need 3-8 subcisions WITH "filler" spread out 3 months apart, ... many take 3 years to do treatments. Some cannot afford many Dr's treatments and thus space out treatments when they have time and money, ... once or twice a year until they are satisfied. 
  2. Was filler used either directly after or when the swelling went down a week or so after your subcision, this is vitally important to the results or you will have re-attachment. You can also Chinese Cupping (Amazon) for a month daily after your subcision, ... this does create some bruising (be aware).
  3. This is a marathon, not a race, as such, you need to be patient. Are you doing your dermastamping (or even better the Derminator  w/ the single needle attachment to your box car borders/walls "google it") at home monthly between your every 3 month Dr's treatments, ... alternating those with glycolic peels.  
  4. You are going to need rf needling and laser done to work on your box cars either between several sessions of subcision or after your done with those. Mono treatments won't fix your issues.
  5. This is not fat loss in the temples, ... these cases the temples are always thin and close to the bone, there is attachment of the scarring there and some loss of dermal tissue. Over dilute Sculptra can be used there as a buffer, over dilute radiese, or even some HA filler. RF needing is also helpful and laser here, ... you will have to deal with texture as I outline in the above plan for you at the end (chemical peel or deep laser peel). 
  6. I would never do fat, of course you can try it if it's popular in your country, ... it can be lumpy, not easily placed for scars (migrates), does not last and the body can absorb it, is invasive compared to a collagen stimulating filler, and must be re-injected (people do not realize the hassle). If your Dr is over confident in it's use and has great results go for it. Many of the Dr's use filler now because of it's cheaper overall cost and intended use, a temporary stimulating spacer. 
  7. Your not going to see a big improvement from any one procedure. Many here get only 50% after they do all of their above treatments in your plan, ... this is realistic, I am not selling you anything. If you get more this is great and that can happen if you heal well. Nothing will give you 50% improvement alone. But yes filler will help after your subcisions, and you will need the energy devices as I described.
  8. I suggest you follow the plan I laid out above, more subcisions, more tca cross, you have many icepicks that were not treated, some filler which was not used, and you need energy device work for your textural box cars. 

Yes

I currently have done sciton ablative laser

Whole face bleeding : how long is the downtime normally??

 

And 

 

Should i do more of ablative or go back to needling ?

 

Got a package of 2/3 x ablative from doctor every 3 months

 

Thanks

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@TF- It depends on the patient and how quickly they heal, some it's 2 weeks and some it's several months. In ethnic patients such as yourself it can be longer. I would not have done the fully ablative package without taking care of the underlying scars first individually. 

You can go back to needling after ablative but it's going to take you a while to heal before you can do so. You must be healed first!

I don't know if you read what I put above but we treat individual scars first with manual methods, the deepest issue first, then we worry about resurfacing at the very end. Otherwise we have not addressed the underlying box cars. So in a way it's out of order.

Sounds like they want to sell you a package if they are just doing this every 3 months. That can be quite harsh, ... healing time from Ablative laser if  done aggressively can lead to 6 months or more of healing.

 

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May I just say that accutane does not cause scarring. Inflamation does. Not accutane. I think accutane is best you did to prevent more scarring.

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On 7/12/2019 at 12:36 AM, beautifulambition said:

@TF- It depends on the patient and how quickly they heal, some it's 2 weeks and some it's several months. In ethnic patients such as yourself it can be longer. I would not have done the fully ablative package without taking care of the underlying scars first individually. 

You can go back to needling after ablative but it's going to take you a while to heal before you can do so. You must be healed first!

I don't know if you read what I put above but we treat individual scars first with manual methods, the deepest issue first, then we worry about resurfacing at the very end. Otherwise we have not addressed the underlying box cars. So in a way it's out of order.

Sounds like they want to sell you a package if they are just doing this every 3 months. That can be quite harsh, ... healing time from Ablative laser if  done aggressively can lead to 6 months or more of healing.

 

08EDCE6D-E33B-406D-ACF9-114CE7893A6F.jpeg.ad11ace8db3c1f063d70ab3c4ec4c1a5.jpegE614BF8A-17BC-4331-AB9C-C32E0B9C09B8.jpeg.8a9697d4367b80995f2bbc14e3c25c74.jpegDEA35D91-F4E4-4669-8770-EF20F1FC32CF.jpeg.4a619f4a07425dde63f30b970dc7c9af.jpeg

 

Hi , this is my current situation

after several subcsion , ablative and ( injections to hypertrophic scars )

 

what is my next stepp?

and what should i do for hypertrophic scar on my jawline ??

 

THANKS

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@TF-

This is a marathon not a race. You can stop at any time.

I see some areas that could still use some tca cross,

You posted in may ... you must have done a quick succession of subcisions together -  we are waiting 3 months between them to promote healing, ... so more are needed. I see areas that are not sufficiently subcised like the temples. Was filler used...

RF needling for your box cars

CO2 laser to the jaw scars w/ steriod drip & co2 to the box car. The jawline will never be perfect, flatten them as much as possible, work on the PIE or redness with laser.

Picosure or picoway for hyperpigmentation and texture.

Finally a resurfacing procedure - fully ablative laser resurfacing, don't see why this was done first, it'd done lastly for texture.

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Posted (edited)
2 hours ago, beautifulambition said:

@TF-

This is a marathon not a race. You can stop at any time.

I see some areas that could still use some tca cross,

You posted in may ... you must have done a quick succession of subcisions together -  we are waiting 3 months between them to promote healing, ... so more are needed. I see areas that are not sufficiently subcised like the temples. Was filler used...

RF needling for your box cars

CO2 laser to the jaw scars w/ steriod drip & co2 to the box car. The jawline will never be perfect, flatten them as much as possible, work on the PIE or redness with laser.

Picosure or picoway for hyperpigmentation and texture.

Finally a resurfacing procedure - fully ablative laser resurfacing, don't see why this was done first, it'd done lastly for texture.

Ohh i see...

What about steroid injections to the scars ? is it harmful if done too much , done a few times already..

or IPL photofacial instead ??

 

 

 

for me , right side of jawline improved a lot , in realtime : its almost flawless , just looks bad at angled photos

Edited by TF-

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@TF- 

It can be harmful. In regards to possibly making atrophy. But if your Dr is good he will know the appropriate smaller amount to use. 

IPL while it can work for some is not as good as laser for pie/pih. Give it a try if you wish. Ask how experienced your practitioner is. 

Great, glad to hear your jawline has improved a lot, ... that is what we hope for 50% improvement after many treatments. I see improvement. The only thing I really see is a discoloration/ redness issue. Your jaw does not look like it even needs "more" steriods (this is a international site there are many they can use), ... it does need again pulse dye laser for discoloration. Less is more, ... inject to much and get side effects. I hope your going to a Dr familiar with hypertrophic scars, as a ordinary Derm is clueless. 

See a acne scar specialist!

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For the hypertrophic scars, ask your doctor or find one that does steroids mixed with 5-FU.  When you use 5-FU together with steroids, you can use a lower concentration of steroids, which will minimize the risk of atrophy.   The steroids will help to flatten the scar and the 5-FU will stop cell division, so the scarring won't grow back.  

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On 8/6/2019 at 7:59 AM, beautifulambition said:

@TF- 

It can be harmful. In regards to possibly making atrophy. But if your Dr is good he will know the appropriate smaller amount to use. 

IPL while it can work for some is not as good as laser for pie/pih. Give it a try if you wish. Ask how experienced your practitioner is. 

Great, glad to hear your jawline has improved a lot, ... that is what we hope for 50% improvement after many treatments. I see improvement. The only thing I really see is a discoloration/ redness issue. Your jaw does not look like it even needs "more" steriods (this is a international site there are many they can use), ... it does need again pulse dye laser for discoloration. Less is more, ... inject to much and get side effects. I hope your going to a Dr familiar with hypertrophic scars, as a ordinary Derm is clueless. 

See a acne scar specialist!

what do u mean by jawline cannot be perfect ?

can it be visually better soon? in a few treatments

now it seems lumpy and red , affects my face overall complexion

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@TF- Most acne scar patients do not have realistic expectations of treatment outcomes. If you are happy with the direction and healing of your treatment, that is all that matters. Hypertrophic scarring is a ongoing condition. Yes it can be visually improved in several treatments. Lumpy is steriod shots for the "lumps." Red you can do your ipl or pulse dye laser. Over treatment can make a area red as well and time is needed to heal.  

Buy some tinted moisturizer or tinted sunscreen and put it over the area, or a concealer like dermablend. 

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On 8/11/2019 at 8:05 AM, beautifulambition said:

@TF- Most acne scar patients do not have realistic expectations of treatment outcomes. If you are happy with the direction and healing of your treatment, that is all that matters. Hypertrophic scarring is a ongoing condition. Yes it can be visually improved in several treatments. Lumpy is steriod shots for the "lumps." Red you can do your ipl or pulse dye laser. Over treatment can make a area red as well and time is needed to heal.  

Buy some tinted moisturizer or tinted sunscreen and put it over the area, or a concealer like dermablend. 

Hi

From what i achieved after 8 months of treatment is less scarring and superficial texture

 

but volume and fat seems to be the big reason and my face is not symmetrical after having acne for years..

how to fix it ? 

631F5505-1975-4884-986A-95A3CAB613DD.jpeg

69EAB98F-587B-4477-9B0F-4AE9D92FC6E9.jpeg

93F86D0E-841D-452E-824E-E8B9A3AF560C.jpeg

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@TF- Hi there, what specifically are you referring to? your pictures show great volume in the cheeks, no major atrophy, ... a big improvement from the above before pictures. Perhaps see a provider who does filler if you think you need more, as I don't see anything in the pictures you provided. Less is more, ... I would not over treat and balloon the face. IF your referring to the slight and no one would notice this contour of the left and right cheeks, ... go get some HA filler and have them fix this. I don't even notice it really. 

Superficial texture, you can do a chemical peel or a fully ablative erbium laser resurfacing. 

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Everyone has natural asymmetry in their face.  Literally no one is symmetrical, and I do not note any significant issues in your new pictures.  I think you look good and age appropriate.   Don't go down that rabbit hole of thinking there is something wrong with the shape of your face, because there isn't...

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16 hours ago, beautifulambition said:

@TF- Hi there, what specifically are you referring to? your pictures show great volume in the cheeks, no major atrophy, ... a big improvement from the above before pictures. Perhaps see a provider who does filler if you think you need more, as I don't see anything in the pictures you provided. Less is more, ... I would not over treat and balloon the face. IF your referring to the slight and no one would notice this contour of the left and right cheeks, ... go get some HA filler and have them fix this. I don't even notice it really. 

Superficial texture, you can do a chemical peel or a fully ablative erbium laser resurfacing. 

 

oh yes , i think a bit of filler is good enough , yea will do subcision and filler again soon

 

From my pictures above , can my side faces cheeks , temples be realistically improved? not hoping for smooth face like before but a almost smooth is what i want..

im a guy so a bit of scar wont matter as nobody have flawless skin without makeup but im hoping for the best result possible

 

Is there hope? im gone through 7-8 months , i need some motivation or target for me to reach

 

thanks for helping me

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@TF- You have hope, ... look at the before and after's there is a change in your scars for the good. Many would only wish for this to happen. I fear you have some obsession of perfection and if you do not get it will be hurt. Acne scars have a internal part as well - suffers often have internal scars that must be dealt with as well. There are smart phone apps for this like Talkspace for support, that help realign goals. 

That being said yes some filler by a expert injector can help with volume irregularity. I don't see it as a major problem and when I first looked at the pic I was having a hard time seeing it, ... very subtle. 

Where is the problem with the temples, I don't see it, are you stating you want more volume here with filler. Perhaps it's the pictures provided and not seeing scars. 

Can you help me by describing in detail what exactly bugs you, ... because it's hard for me to know exactly what you are looking for. No one will ever have glass smooth skin, this isn't realistic, ... so what's the target goal or concern (prioritize that)?

Sounds good do subcision and some filler again. This picture of your temples shows more subcision and filler is needed.

08EDCE6D-E33B-406D-ACF9-114CE7893A6F.jpeg.ad11ace8db3c1f063d70ab3c4ec4c1a5.jpeg

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18 hours ago, beautifulambition said:

@TF- You have hope, ... look at the before and after's there is a change in your scars for the good. Many would only wish for this to happen. I fear you have some obsession of perfection and if you do not get it will be hurt. Acne scars have a internal part as well - suffers often have internal scars that must be dealt with as well. There are smart phone apps for this like Talkspace for support, that help realign goals. 

That being said yes some filler by a expert injector can help with volume irregularity. I don't see it as a major problem and when I first looked at the pic I was having a hard time seeing it, ... very subtle. 

Where is the problem with the temples, I don't see it, are you stating you want more volume here with filler. Perhaps it's the pictures provided and not seeing scars. 

Can you help me by describing in detail what exactly bugs you, ... because it's hard for me to know exactly what you are looking for. No one will ever have glass smooth skin, this isn't realistic, ... so what's the target goal or concern (prioritize that)?

Sounds good do subcision and some filler again. This picture of your temples shows more subcision and filler is needed.

08EDCE6D-E33B-406D-ACF9-114CE7893A6F.jpeg.ad11ace8db3c1f063d70ab3c4ec4c1a5.jpeg

Yea theres good improvement since the start of accutane for me

 

But , for personal reasons , rolling scars n tethered scars is more prominent ..

In the pic is not shown very clear like 3D , i have quite shallow scars and no deep ice picks but quite broad rolling scars and tethered and that makes the assumption of loss volume or loss fat but its just anchored scars

 

 

Thats why , im still down , low self esteem and finding the ultimate treatment for that problem 

Fix my rolling and atrophy

then my face would be so much better 80-90% healed and thats what i want after 2 years of battling scars..

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@TF- I have to be very direct. Perhaps there is a difference in communication between wherever your located internationally. 

It is not my job to fix your scars, ... your paying your Dr thousands for this, this is what they need to do for you. Please discuss these concerns with them. 

We do not make your scars disappear, they will always be there. We soften and improve them. 

80-90% is a unrealistic expectation, ... most only get 50% improvement after many treatments. You will never have glass smooth skin, this is not realistic. If your depressed and you state you have low self esteem, it would be best if you saw a therapist, ... scars are internal and external, ... there is a app called Talkspace for therapy on your smartphone.

I see no major fat loss, no atrophy, ... you have surface textural scars. The temples above look like they need subcision and filler. For TEXTURE - you will need rf needling and laser done or a Chemical peel to resurface the scars. Icepicks and smaller box cars need tca cross. Discuss this with your provider. 

I can't give better advice without a better picture of the scars creating shadows. Use a flashlight or directional light. 

Your skin is better than most of the severe scar cases I help daily, as such it's superficial scarring. 

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