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Hello Everyone, 

So here is a brief but interesting breakdown of my journey with acne. 

I am currently a 35 year old male and up until I was about 25 years old I only struggled with the occasional pimple (or two), along with hyperpigmentation. Unfortunately, something changed as I turned 25 and I would now get the occasional CYST instead. Fortunately though, these cyst's almost never left major scarring or atleast not that I noticed.

Around two years ago, my stress levels skyrocketed due to work related issues. And just like that, with no warning whatsoever, I was now, for the first time in my life, at the ripe age of 32, suffering from a face full of cystic acne. I tried everything, from Benzoyl Peroxide to Ice, Salicylic Acid, and hot compress. Nothing seemed to even remotely help. I eventually got fed up and visited a dermatologist and insisted on a Cortisone shot (The dermatologist was initially recommending clindamycin) for a couple cysts that had been lingering for a while. 

This, as you may have already assumed, was the worst decision I possibly ever made. I was left with some serious dents around both sides of my cheeks in additional to the grade 1 scarring the other cysts left. 

Knowing my skin like I did, I always knew no cream or potion was ever going to really resolve this. I eventually, somehow, managed to figure out  that there was a correlation between my chronic constipation (maybe caused by my high stress levels) and the cystic acne I was struggling with. I did some research online and started taking probiotics along with psyllium husks almost daily and boy did that acne clear up!

Thankfully, I have now been completely acne free for the last couple of years!

That said, I am left with a few box scars along with 2 deep dents from the cortizone shots (I hope that's what the derm used). I've previously had 3 seating's of Infini RF,  1 seating of E-Martix, 6 months of constant Retin-A, and hyaluronic acid filler twice (Mostly for the dents from the Cortizone Shots). I've definitely seem some improvement/ progress, however, the dents haven't completely filled in (even post the fillers) the skin around the site almost seems scarred/ bruised permanently.  Please help!

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I am truly very sorry this happened. Man, it must have been distressing.

The dents seem to be causing the most distress. You mentioned you had fillers, but was subcision done first? If it wasn't, you either need to get your derm to do it, or get another derm who could. Also the bruising from cortizoid injections are very very common. Lasers can fade those.

However, there is a difference between a dent caused by cortizoid, or a dent caused by acne. A pic here may help us identify which it is.

 

 

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11 hours ago, SkinnyStrong said:

I am truly very sorry this happened. Man, it must have been distressing.

The dents seem to be causing the most distress. You mentioned you had fillers, but was subcision done first? If it wasn't, you either need to get your derm to do it, or get another derm who could. Also the bruising from cortizoid injections are very very common. Lasers can fade those.

However, there is a difference between a dent caused by cortizoid, or a dent caused by acne. A pic here may help us identify which it is.

 

 

Thank you for your response SkinnyStrong. So, I should have mentioned that I've also had subcision done prior to the fillers. I am assuming you mean CO2 fractional lasers? I will post some pictures soon. 

While I wait/ decided, I've decided to give Tretinoin a shot again. Do you think I'll see any progress?  I've been advised I may potentially see better results with differin?  

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45 minutes ago, Acnescargone said:

Thank you for your response SkinnyStrong. So, I should have mentioned that I've also had subcision done prior to the fillers. I am assuming you mean CO2 fractional lasers? I will post some pictures soon. 

While I wait/ decided, I've decided to give Tretinoin a shot again. Do you think I'll see any progress?  I've been advised I may potentially see better results with differin?  

Ah, thank you for the carification. Yes, CO2 lasers work well for getting rid of hyperpigmentation.

Hmmm, you did try Retin A/Tretinion before. Was it ineffective? What I understand is that both Retin A and Differin are for active acne. I used both. My cystic acne was bad. They made no difference, in my opinion. Only oral medication helped. 

 

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On 1/14/2020 at 4:05 PM, SkinnyStrong said:

Ah, thank you for the carification. Yes, CO2 lasers work well for getting rid of hyperpigmentation.

Hmmm, you did try Retin A/Tretinion before. Was it ineffective? What I understand is that both Retin A and Differin are for active acne. I used both. My cystic acne was bad. They made no difference, in my opinion. Only oral medication helped. 

 

So the idea here was to try and see if the Retin A would maybe help blend in the dent (I mentioned that it still looks bruised/  discoloured even after the fillers). 

By the way, I should probably also have mentioned, my derm used a Cannula for the subsicion. Would a Nokkor have made a significant difference? Some of the rolling scars do seem tethered - I am not so sure about the one box scar I have.

Funny enough, and this may be just my own experience, I have come to notice derms either don't want to do subcision or aren't completely comfortable doing it.  Has anyone had a similar experience? 

My apologies for not having posted my pictures on here yet - I hate taking pictures after the acne!

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10 hours ago, Acnescargone said:

So the idea here was to try and see if the Retin A would maybe help blend in the dent (I mentioned that it still looks bruised/  discoloured even after the fillers). 

By the way, I should probably also have mentioned, my derm used a Cannula for the subsicion. Would a Nokkor have made a significant difference? Some of the rolling scars do seem tethered - I am not so sure about the one box scar I have.

Funny enough, and this may be just my own experience, I have come to notice derms either don't want to do subcision or aren't completely comfortable doing it.  Has anyone had a similar experience? 

My apologies for not having posted my pictures on here yet - I hate taking pictures after the acne!

Hey, no worries about the pic. It was just a suggestion. If uncomfortable, you really don't have to.

I heard cannula gives better results but so far that's what I've read from some reports, reported by some members here, and of course, mentioned by Dr Davin Lim on his YouTube. I have no experience with cannula, so I'm sorry I can't answer.

I know my derm used to heavily promote subcision a decade ago, but now seem to lean towards RF microneedling as his main tool. He doesn't not do subcision anymore, but it's a lot less. I wonder why too. It might be evolving techniques, and since microneedling can sometimes do a somewhat similar job to subcision, they now delegate subcision to much deeper scars.

Retin A might help with the discoloration, but I've not known it to be effective for it.

 

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