@froyoshI don't see why you had 2 ultrapulse sessions with the scarring you had. Sounds like a terrible Dr. See a acne scar specialist, not a general derm who just uses lasers.

You have textural box cars, you need a combo of several subcisions with some filler.

RF needling

** Please Note I offer to acne scar suffers a "more" "customized" (private) consultation than the above general advice. Analysis, answering questions, ongoing support by Private Messaging. Feel free to message me there. Be patient as I can get over 100+ of the worst acne scar cases to help, it "may" take me up to 48 hours to respond.

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.

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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.

@beautifulambitionThanks for your reply!! I probably do not have time for a fully ablativelaser resurfacing, which requires a long down time. I would go for RF needling for several sessions with each have about a week downtime. Do you think that alone can give a good result? (At least, make scars almost invisible).

@froyoshWelcome!

I would be careful stating that rf needling down time is a week. I have some patients with months of down time, it depends on the patient. Try one and see. The down time is not bad compared to other devices.

No I think you need to consider manual methods as well, continue to subcise the scars.

Then do some rf needling.

Some fully ablative laser resurfacing.

This is a slow process. I cannot say what you will respond best to.

@beautifulambition

Hi,

I visited Dr. Steven Swengel for my acne scar treatment and he suggested a plan of Infini/Genius + Profractional with subcision. And I will have 2~3 sessions of them. Does this sound good for my scar types (I updated with more pictures in different light settings)? I would probably ask him to do aggressive subcisions each time as I feel like this would be quite effective. But he said he does not think I need fillers. I heard that subcision+filler is much better for avoiding scar tissues re-tethering, so should I request him to do fillers? Also, he doesn't think TCA CROSS is suitable for my scar types, which I thought that would be effective for those of my severe scars (I did 2 Ultrapulse before, those severe scars are still the worst ones).

Also, during the consultation, he did not use angle light (but he does have a special machine for taking pictures), and he did not touch my skin to feel for fibrosis, did notstretch my skin to see the amount of atrophy, did notask me to animate to see if my scars are tethered. But he said he would doInfini/Genius + Profractional with subcision. Should I proceed to this treatment?

Thanks for your help!!

Tca/phenol cross can help blend the boxcar and ice picks scars with sorrounding healthy tissue and then Subcision to lift overall. High %Glycolic peels or med tca peels for further blending, texture improve and improve overall skin color.

I have very similar scarring and this is my plan starting December.

I'd get another evaluation as your doc seems to be pushing laser/rf. I think going slower is better and more inexpensive

Source: https://www.ncbi.nlm.nih.gov/m/pubmed/25899884/

@beautifulambition

I would stop doing lasers for now and go with manual procedures that lazy doctors don't like to do haha. Do several subcisions with sculptra and phenol or TCA CROSS.Look into rf microneedling after doing these 2-3 times. Space out to give your skin time to heal.

@froyoshPlease contact me by PM in the future, thank you. Better for us to maintain a conversation, privacy, etc. I help 100+ of the most severe acne scar cases daily.I will make a exception this one time as I was helping you on here in detail 😉

It was hard for me to determine your scars through the picture above, without using directional light, feeling them, and having you animate.

Swengel is saying you have dermal scarring only in the surface layers.

He want's to basically resurface you with laser.As he feel's they are monomorphic in depth and nature.

Fully erbium or 1927nm Fraxel are done for this.

He is a gernal derm. So I urge you to get a few more opinions from other Dr's. Of course laser makes him lots of money.

Sadly the bay area does not have the best Derms.

I would see Dr Lopez in fresno for your case, she often treats patients like yourself doing ERbium and she is excellent with those who have ethic skin. Fresno is about 2.5 hrs drive from you. She is in the FAQ.

Regarding filler you do not need it, ... Chinese Cupping would be fine post any sort of subcision if they decide to do it. Again your scars are not deep according to Swengel and textural in nature.

Before seeing any Dr how about alternating dermastamping and glycolic or tca peels at home, ... you of course can do this while seeing a Dr as well.

Ransomalso does rf needling in SF or you can call the referral service Califoria dermatology who price fixes all the derms in the bay area. Ask who does subcision and they will refer you, no one is spectacular.

Consult with Morganroth as well.