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Do you think laser or any heat treatments are not for me?

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i have acne scars in texture and discoloration forms. i'm in great dilemma as for the depressed texture, i understand i'd need something like laser but on the other hand i have stubborn discoloration and/or PIE issue. my skin is easily inflamed or getting red. i even get red dot marks from small pimples that stayed for months, not to mention ones from inflamed acne. few PIE even stayed for years


my experience with lasers that makes me think my easily inflamed skin is not suitable for it. FYI, these procedures were done by reputable doctors:

1. V-Beam laser, quite effective in lessening the redness but in higher settings had caused new red lines. this laser is pretty mild in energy level but in purpuric setting, it has managed to improve my quite deep chicken pox scar up to 80%. my doctor was actually pretty astonished by it. i mean have you heard anyone could level up depressed scars just by V-Beam laser?

2. Fraxel laser, burnt for 6months with those criss cross patterns and punctured holes which some still stays up to now. i believe the doctor used mid level energy setting the most but she did not prep my skin with any acid or retinol prior to the laser. Post skincare treatment, she prescribed Stieva (mid level percentage, forgot the number) , a brand of retinol that only worsened the inflammation and condition.  The inflamed skin and criss cross marks was finally settled down after i went to a doctor who prescribed me a mild form of retinol ie. retinaldehyde with plant based formula ,not antibiotics.

3. Pico laser, this is the laser that is marketed towards Asian skin as it's not using and/or causing any thermal/heat as its source of energy. however, this laser is the most uncomfortable i've ever experienced. the doctor used mid level energy setting with 2 round passes. he told me redness should subside within 2 days but up to now, 2 weeks, i still experienced redness in those acne scars and slight splotchy light brown around them. During the laser, i felt like i was hugely slapped and my pain tolerance is pretty high actually. i insert pics of this latest experience with Pico laser

This is the next day pic after the 1st Pico. you could see tiny dot burst blood vessels around it


Left is Before Pico ; Right is 1 week after Pico with redness and splotchy light brown still stays


I take into conclusion that my skin really needs milder treatments but i'm also concern i'd lose the momentum of fixing the (depressed) texture while it's still inflamed and in active self-healing and regeneration process

so now i'm considering microneedling with Dermastamping with PRP.  i read Dermapen bad reviews as it could be too aggressive for some skin. i think dermastamping would be more suitable but concern it might be too slow of a progress in fixing the texture problem. Any input and sharing would be really appreciated

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Hey, have you had your skin checked over by a Dermatologist? Maybe they can tell you what that red mark on the right is. I had the same looking mark on my face and it turned out to be BCC. Don't want to scare you, it's easily treatable.

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@poorbunny888 I see some themes here:

Sensitivity, poor healing, prolonged redness, a Dr who does not know what they are doing. Damage from treatment (see the previous). You posted in the AMVC, these suffer's are prone to poor healing and treatment outcomes. 

Have some of those marks been checked by a dermatologist / biopsied? 

I think you need to see a more skilled and competent derm (or two), ... get a second opinion. Perhaps you need a combo of steriod and pigment treating laser, and if all else we drill down into the pigment and treat. This takes a skilled practitioner, especially with all your complications and I can't say if it's worth it for you especially with your side effects. 

1) V-beam can have high power, you prove this by your comment on chicken pox scars. At wounding levels this helped you body heal these spots.

2) Fraxel, I cannot say how it's done, ... I can say you do not like the results. Perhaps do some acid peels to work on texture as you are not fond of "laser." They even have combo peels for hyperpigmentation that would help you.

3) This is common with pico, especially in the sensitive or higher settings. Yes you do have a pickle. If you treat you can have more side effects, and if you do nothing it's bugging you. The treatments may be causing your issue and you should not undertake them, only spot treat the areas don't treat the whole cheek. 

Dermapen in a AMVC patient would cause more scars.

What steroids were used, topicals, lighteners, pigment chemical peels? Are you prone to Melasma or Rosacea (if so you need something like triluma, etc, consult the derm), I can see this in your case with the responses, as such it's a constant battle. I would get consults from better providers again who do aesthetics. Otherwise you will irritate and cause more scars. Some people just are not candidates for treatment  because of medical conditions and healing. 

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The treatments that i consider doing is manual dermastamping with PRP or perhaps taking something like Nimegen, milder form of roaccutane. Should peeling help too?

So far my skin could not stand Hydroquinoine which i check is one of Triluma ingredient. And so far i don't have any melasma. I'm not sure about rosacea though since i do blush but not the kind of persistent redness. When i laugh, my face could get red as well. All my acne marks are also PIE firsthand before they become PIH. The redness is only in the face.

I don't feel Pico has many great results with acne scars. Most derms used them for tattoos. What do you think? As the derm who did the pico has his forte in Pico laser. Would something like ND Yag might be better for my case?

I don't think it's BCC as they're all from acne and my skin tend to get easily inflamed hence the red marks. The bumps around the PIE is from the usage of the prescribed retinaldehyde. I still get one or two of them up to now and try just using it twice a week.

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@poorbunny888 I am concerned with you doing dermastamping as I stated with AMVC. With this type of condition any sort of treatment can lead to scarring. Give it a try if you wish. 

Peeling in someone who does not heal well and has sensitivity can be really bad, redness and even more scarring. You would have to spot test to see if it causes you a issue. In your case I would goto a skilled practitioner and have them manage your case. Not your currently Dr who does not seem to be aligning with your goals. 

Sounds like you have Rosacea and sensitivity / poor healing. Get this properly diagnosed by a general derm who will do testing. 

Some people are allergic to hydroquinone, ... get the pca hydroquinone free pigment gel.

It is very common in ethnic patients to turn PIE or redness to PIH, especially if there was no prep done with topicals to avoid this. Even the top ethnic skin treating Dr's know it's a battle to deal with PIH, you will get it in those you treat, .... otherwise you don't treat at all. 

Picosure is a great laser in the right population and the right setting. Of course it can be used with Tattoo's - this should prove to you it can work on pigment. But it is not great with PIE. For your issues I don't see it working well, ... it's often promoted in Asian countries to "fix" scars, it will not. ND Yag could be appropriate, ... top Dr's will use more than one laser: pulse dye, nd yag, even resurfacing if the pigment is stubborn. Find a Dr with Social Media or Videos that can better address your problem (with a similar case). In a case like yours with poor healing and sensitivity there will be issues. Skill is more important than the laser, ask for experience with ethnic patients and those with sensitivity. They will turn down the setting for someone like you. Your a complicated case that standard Aesthetic derms will not be able to treat. 

We have a two pronged problem, you need to see a general derm and get diagnosed, ... and you want aesthetic work done by a separate Dr. 


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with my PIE, could I say if there're still redness after the acne flattened, the area is still in the repairing/regeneration mode? and it would be the better time to do treatment? 

for the pigmentation, my derm gives his formulated Vit C (Ascorbyl Palmitate form) that is combined with Tocopherol that really works in lightening up my skin without breaking it out but do little or slow with the PIE.

Also I find that after treatment or exfoliation for example the pic before Pico, the PIE already fades a lot but after the pico the PIE comes back again. also when I do my double toner method with acid toner P50 Biologique Recherche, the PIE on the spots would reddened again. Why is that? Does it mean the area is still inflamed underneath and could cause further acne?

I could see slight texture improvement with the depressed scars now 2 weeks after Pico (which could be temporary micro swelling after laser) but I don't think it's worth it with pigmentation ensued.

I will have consultation and test with the GP for the slow healing. however, the slow healing is only felt on the face whilst the body has pretty much normal healing time. my predict is for using Benzoyl Peroxide 10% facial wash for over a decade. i think it sensitized my skin and strip its barrier. 

Edited by poorbunny888

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"with my PIE, could I say if there're still redness after the acne flattened, the area is still in the repairing/regeneration mode? and it would be the better time to do treatment? " - 3 months, but every body is different. You have sensitivity and slower healing, I have some longer cases. Your Dr must manage this. Have you tried the basics Niacinamide, retinoid, vitamin c serum, light glycolic peels. Your case is complicated and I don't know if you can even handle those. They work for some. It's disconcerting you tried the laser and it did not work, you do know it takes 6 treatments right, ... I don't know if they used the right settings. Yes it's very slow to do this - the topical your derm gives you.

Pico causes wounding under the skin, this is by design. Thus you need time to heal, some take 6 months +.

You do not want to use toners, they cause irritation. You need gentle skincare, light moisturizer, physical sunscreen, light soap.

Pico takes a while to see the results, I Cannot say your end results because that takes months. Could be swelling, takes a few sessions.

Healing is not always external, often with these non-ablative lasers it's internal in the skin, thus you heal 6 to 12 months post laser. 

BP can sensitize the skin for some.


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Nyacinamide products i've tried so far did not produce the result i'd like. i also have tried several retinoid forms and this last one, in the form of retinaldehyde, prescribed by my Derm give better results than the rest though i have to be careful with its usage since overdoing it could cause new purgings. i only apply it 2x a week.  Vit. c + tocopherol serum prescribed by the same doctor is also the only vitamin c giving a good result without purging. Other vit. c i've tried made my skin looked duller and/or caused new purgings. Before all this my skin was already fussy with products but problem free and actually my skincare routine was bare minimum only a facial wash and a moisturizer but i was young too then. If i'd like to start treatment such as needling or another laser, would 2x a week retinol usage sufficient? when i was burnt by fraxel, one of the culprit was my skin was not prep at all with retinol or any other acid form. 

i plan to give a try of dermastamping with PRP to help with the healing process. I know 2 people with autoimmune disease and the results were wonderful on them. one of them suffers from Lupus and has that butterfly rash on her cheek. the rash was gone by 1x microneedling with PRP. i think PRP is good for pigmentation and redness problem but i also read that it could lead to swollen face and purging effect. i don't want to add any unnecessary purging onto the face. I wonder if this is due to any difference in the PRP machine? I browse online and find many clinics offering PRP with huge price differences (being the more expensive is not always necessarily the better). Do you happen to know of a good PRP machine brand or how to differentiate between a good and bad platelet taken out from the machine? 

Yes, i totally agree that lasers especially one with high energy setting could take up to 1 year (with the right skincare treatment) to take into full effect. after burnt by Fraxel, i saw the pox scar kept levelling up until 1 year mark though i get new criss cross pattern from getting burnt by the laser. important to note is to have the right skincare treatment / post laser treatment as well. the redness alone did not subside until 6months until i found this doc who prescribed me the retinaldehyde. unfortunately, his Pico did not really work on me. 

i forgot to mention all these breakouts started from using new hair shampoo since the breakouts is around the hairline. but after i stopped using the shampoo, the skin seems to lose its balance and i feel it's difficult to keep new purgings at bay. i never experienced any acne previously. my complexion was clear and acne free. i wonder why...perhaps it's with the retinol i use but if i don't use them how could i fix the texture problem and prep my skin to start laser or needling treatment?

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@poorbunny888 Everyone is diffrent, you know what topicals you can handle. Topicals give slooooooooooow results. 

Do whatever you can with retinoid, mix it 50/50 with moisturizer if needed. 

Some are very sensitive and cannot handle topicals, they have to do sensitive and basic skincare - few ingredients. 

Yes you must prep before any procedure, I say this all the time. Sometimes Dr's don't enforce this. Something like the PCA hydroqionone free pigment gel may  help more than the other topicals you mentioned (as prep).

There is no empirical data stating PRP/dermastamping does anything for the conditions you stated, nor logically does it make since, but give it a try, won't hurt. 

There are many PRP/PRF all sorts of marketing, Magellan is popular. It's just the concentration of the plasma. Perhaps it will stimulate your body to heal itself.

The shampoo thing could  be a few things... sensitivity, allergy, or fungal acne. Perhaps a ingredient does not work. IF you discontinue and go with bare bones skincare and still the  symptom lingers (could be fungal acne). If it goes away allergy.

Purging is bound to happen with a retinoid or exfoliating skincare. Try a different formulation of the retinoid and see if that helps. 

See above about PCA product ;-)

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