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Suggestions for acne scar treatment plan

Posted (edited)

I was hoping to get some suggestions for a treatment plan based on my scarring.

I'm in my mid twenties and started breaking out last August. Tried a few topicals and doxy with no luck. Hopped on Accutane in May and the acne has drastically improved. Currently I am taking 80 mg daily (weight is 155 lbs), and so far side effects have luckily been under control. 

I saw a Dr. Davin video suggesting it was beneficial to start scar treatment while on Accutane (paper he references https://www.lasersandlifts.com.au/wp-content/uploads/2017/09/Acne-scar-guidelines-2017-Part-2.pdf), but others recommend against it. Any insight here as it pertains to my scars would be appreciated. I understand that my best bet is to get a consultation with a legit doctor (current derm does not provide scar treatment), but I would like to have some knowledge going into the appointment. If my best bet is to wait post Accutane, I would still appreciate scar treatment advice based on what you see. 


Thanks for the help! 


Left Side                                Right Side                                      Forehead  

Edited by pew

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@pew You need to wait until your Accutane has finished. 6 months after you finish is when you can start treating. The skin is fragile and will heal a lot over the next year after you finish. This is normal as it builds collagen and heals.  You need to consult with 3 drs who specialize in acne scars and are not just general practioners. Pick the one you like best. Their plans will be diffrent, probably lots of laser as that's a quick money maker. Ask for b&a pics.

The biggest issue I see with you is PIE or hyperpigmentation issues making your scarring more apparent. 

You can treat this now with pulse dye laser and or picosure or picoway if good for your skin type. This does nothing for scars which are the actuals pits and indents but will help a lot. Start here in your case. It takes many treatments. 

6 months after accutane.

You have lots of icepicks, surface box cars, and some rolling scars. This is widespread. Treatment can take up to 3 years and is slow. Collagen is slow to build.

Lots of TCA Cross work is needed in your case. Perhaps some subcision, hard to tell in your pics without the shadows and feeling the scars. These can be done at the same time. All treatments are 3 months apart for Drs.

I would do some rf needling sessions for your box cars.

I would do low-density co2 laser on your and the highest power.

Finally, do something for the texture (Always last). Several tca peels, or several hyperpigmetnation peels, perhaps a fully ablative laser resurfacing. 

* 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.

Please note, I offer more "customized" and ongoing consulting through Private Messaging.


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@beautifulambition Thanks for the direction and all you do for the community. Do you have a patreon?


I was also wondering if the nightly routine you've suggested is ok to start while still on accutane. Once again, appreciate your time and help. 

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@pew Feel free to PM me and we can discuss. Thank you for your gratitude.  

Let's discuss the Accutane and products by PM - let me know approx dosage and time you have been on it or when you're complete it.


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