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SutterCane

Looking for a way to get rid of my acne scars

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I was told this would be a great place to post. 

I had really bad cystic acne from when I was about 13 to 23. I eventually found that "Benzoyl Peroxide" was the magic ingredient and kept it under control until March of this year. Then in talking with dermatologists about getting rid of these scars, I was prescribed accutane and (having been off it now for almost a month) I'm confident now that I'm cured.

I've met with two dermatologists so far in this past year. One recommended I take a series of microdermabrasion or a fotona laser treatment, the other suggested 3 or 4 treatments of something called a "Vampire Facial" and then maybe some fillers for some of the deeper scars.

The scars actually don't generally look as bad as they do in the photo. It's just a very HD camera.

I just want to use my time and money effectively, honestly. 

acne scars.jpg

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Those treatments you were suggested will be a complete waste of money. 

Looks like you have a lot of rolling scars, so I'd suggest getting an appointment with a dermatologist that offers cannula subcision. Subcision with filler (or Sculptra) is what you should do before any other scar treatments. I can't say how many you should do, but you'll have to do subcision multiple times with time to heal in-between each treatment (3+ months). CROSS (phenol or TCA) will help with ice pick and some of the boxcar scarring you have. First things first, look into subcision. 

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Your rolling scars are tailor-made for subcision. That will give you the biggest improvement, forget lasers for now you can do that as a last step to smooth out everything.

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Run from those doctors.  They are full of shit honestly.   Any moron who recommends a freaking microdermabrasion is just trying to take your money.  

You definitely need subcision and fillers of some sort to elevate the scars.   Do not waste your money on hokey stuff like Vampire facials.  They don't do jack for scars.  

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For the last 18 months, I've done only TCA and have seen the biggest improvement so far (even for rolling scars, might I add). Honestly, I want to erase everything I've written regarding the most optimal treatments (eg. Infini, subcision, sculptra, etc). Obviously, we've become so enamored by the media hype that we can no longer think out of the box.

 

To the OP, I would suggest you try TCA first (100% TCA for the deepest pits and 50% for the scar edges). Repeat the treatment every 3 months. It's also worth noting that TCA is much cheaper than subcision or any other treatments and your downtime is pretty minimal (7-10 days max). 

 

Good luck.

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13 hours ago, Sirius Lee said:

For the last 18 months, I've done only TCA and have seen the biggest improvement so far (even for rolling scars, might I add). Honestly, I want to erase everything I've written regarding the most optimal treatments (eg. Infini, subcision, sculptra, etc). Obviously, we've become so enamored by the media hype that we can no longer think out of the box.

 

To the OP, I would suggest you try TCA first (100% TCA for the deepest pits and 50% for the scar edges). Repeat the treatment every 3 months. It's also worth noting that TCA is much cheaper than subcision or any other treatments and your downtime is pretty minimal (7-10 days max). 

 

Good luck.

You mean peels , CROSS or paint technique ?  Many people claim that if they used high conc. of TCA cross on something else then Icepicks they had problems or worsened scars 

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TCA wont break up deep fibrotic scars, subcision will. TCA's for icepicks and perhaps box scars. That is the science, and advice from best doctors like Davin Lim. I wouldnt go on anecdotal stories, like the above poster's.

Edited by Vidrar
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8 hours ago, Vidrar said:

TCA wont break up deep fibrotic scars, subcision will. TCA's for icepicks and perhaps box scars. That is the science, and advice from best doctors like Davin Lim. I wouldnt go on anecdotal stories, like the above poster's.

That's where a lot of this gets difficult. As I stated before, I think the lighting and HD camera maybe exaggerates the severity of the scars. But I see people here telling me to disregard and "run away" from the dermatologist recommendations. Not sure who or what to trust in this regard. I honestly just want these scars taken care of. Absolutely the cheapest route would be nice if best, but I'm more looking for the quickest solution, even if it's the most expensive. 

Subcision is something I considered, if it was absolutely necessary. What bothers me about fillers is that I hear they're temporary, and I absolutely don't want to have to re-up for this every few years. I will take the nuclear option over the temporary option or an option that's slow and incremental. 

TCA seems like a nice option because it's cheaper, and there's a dermatologist in town (not one of the two I mentioned) who does it, so I can go there if that's the right call. But honestly I'm sort of just up in the air as far as what sounds right. Every time I ask an opinion and see a new suggestion, I google before and after pictures of said treatment and try to find if there's any that yielded good results that seem to match the topology of my own face.

Can anyone elaborate on why exactly either direction suggested by these dermatologists is wrong or wrong for me?

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TCA will give you hypopigmentation if you do it wrong. Only use tiny drops on ice pick scars.

I'd get subcision and fillers.

Unfortunately a lot of asshole doctors or nurses will refuse subcision and suggest a bunch of other stuff like derma stamping and prp.

Unfortunately here in the UK we have mostly garbage doctors like this but I think I found one who will do subcision.

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15 hours ago, tcahelp said:

TCA will give you hypopigmentation if you do it wrong. Only use tiny drops on ice pick scars.

I'd get subcision and fillers.

Unfortunately a lot of asshole doctors or nurses will refuse subcision and suggest a bunch of other stuff like derma stamping and prp.

Unfortunately here in the UK we have mostly garbage doctors like this but I think I found one who will do subcision.

Do I NEED fillers if I get subcision? Are those two treatments in tandem? 

Again my biggest problem with what I'm hearing about fillers is that they're a temporary fix. I don't want a temp fix. I want a permanent fix.

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@SutterCane If you get subcision, fillers is highly recommended. The point of the filler is to prevent the reattachment of the scars bands AND stimulate collagen production especially if it's Sculptra or Radiesse. Acne scar sufferers are generally poor healers or cannot regenerate enough collagen without a filler, which is why fillers is needed in most cases. You will get some permanent improvement from the subcision and fillers as long as enough collagen is stimulated. 

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On 5/25/2020 at 4:00 AM, SutterCane said:

Do I NEED fillers if I get subcision? Are those two treatments in tandem? 

Again my biggest problem with what I'm hearing about fillers is that they're a temporary fix. I don't want a temp fix. I want a permanent fix.

 

The point of filler during subcision is to help prevent scars from gluing back to the subcutaneous tissue. It acts as a buffer, fibrotic bands are cut during the process, and can fully or partially re-attach if no filler is used. They say it stimulates collagen also, but its main use in subcision is to prevent re-attachment.

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On 5/25/2020 at 1:00 AM, SutterCane said:

Do I NEED fillers if I get subcision? Are those two treatments in tandem? 

Again my biggest problem with what I'm hearing about fillers is that they're a temporary fix. I don't want a temp fix. I want a permanent fix.

Others are merely stating the textbook definition. Obviously, subcision is best used for atrophic fibrotic scars. But the real question is whether subcision is effective in the first place. For a lot of people who have come and gone throughout the years, myself included, certainly didn't think so. Their improvement from subcision was pretty minimal. This is especially for those with mild to medium scars. No doubt, you show some signs of tethering, but does that justify getting subcision and filler? 

People here on this board usually like to regurgitate the same refrain they hear from some of the popular doctors on the web. My own experience tells me not all of these treatments live up to their hype. You need to research this stuff thoroughly and empower yourself with knowledge. Otherwise, you will be blindly following others' advice. You might as well throw your hard-earned money down the drain.

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1 hour ago, Melissa said:

Hello! How are you doing?  

 How many weeks do you wait in between your TCA sessions? 

These are rough generalizations. Obviously, it will need to vary depending on your skin sensitivity.

Up to 20%: 4 weeks.

Between 21% to 35%: 6 weeks.

Between 36% to 50%: 9 weeks.

Above 50%: 12 weeks.

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Bumpin'

Got an Erbium Yag resurfacing done exactly 2 months ago. Was told it'd be about 4 months until I saw the final result. So far not seeing much of a difference, not sure which course to take next.

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8 hours ago, SutterCane said:

Bumpin'

Got an Erbium Yag resurfacing done exactly 2 months ago. Was told it'd be about 4 months until I saw the final result. So far not seeing much of a difference, not sure which course to take next.

Erbium lasers are extremely mild - unless you see a doctor who uses deep settings. I've had several spot Erbium treatments - they're for the most superficial of scars which most of us don't have, otherwise we wouldn't be on this site. Fractional CO2 is more powerful. However, it comes with more risks, longer recovery times, and is more expensive in all practices I would think. 

I suggest that you consider what everyone else mentioned. Cross and subcision are two treatments you may want to undergo before lasers. The reasoning is that you want the scars as flat as possible before getting them lasered. Browse through a ton of threads on this forum and you'll see that manual methods before lasers are the preferred route.

With that being said, I still think lasers will help regardless of where you are in your journey. I've had them done myself and have seen noticeable improvement. However, I did get new scars because of them. If you look on RealSelf, you'll see some people complain about getting new scars, possible fat loss, a change in texture, etc.

But if you're only sticking with Erbium, the risks are lower. At the same time, I think you're just wasting your money for very minimal improvement (if any).

Edited by Amanda Hall
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Your face barely has any icepick or box scars, which is what TCA is best for. Your scars are rolling type scars without sharp or defined edges, at least that is what it looks like to my eyes. The only  (others may disagree) treatment for this is subcision.

From what you've said I would strongly recommend you try to find a doctor who will do Taylor Liberator Subcision. It is very aggressive, a sort of "nuclear option" like you mentioned. Since you have so many scars TL is ideal since all scars can be reached from two incisions, and it is easy for the doctor to find all fibrotic tissue this way, instead of doing another type of subcision with many (but smaller) entry points for each scar.

And since you don't want fillers I think this is best for you, since most doctors do not use fillers with Taylor Liberator. TL is usually used in conjunction with something called tumescent anesthesia, which is basically a fluid that creates a space between the dermis and subcutaneous tissue below it and the fluid contains vasocontrictors that will help prevent retethering.

TL was only invented in 2018 so there is not a lot of people who have had this, so obviously your results are not guaranteed, but everything you said and with the picture you posted are like a road map directly to Taylor Liberator Subcision. 

Edited by Cool.username
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Subcision should NEVER be the first weapon of choice in my opinion. It would be better to get subcision later than sooner because what you once thought was tethered often isn't tethered at all. This would also save you from needlessly getting a "wholesale" subcision.

BTW TCA can indeed improve rolling scars. I've seen it firsthand. You just need to apply lower concentration, usually 50%-70%.

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I definitely agree TCA or any chemical based treatment is gonna be a less intense treatment, but the original poster did mention not wanting a slow or incremental approach. I have seen many posts saying TCA initially makes things worse by widening the scar and only after multiple treatments are you gonna see a good result. Just depends on what a person wants to prioritize. 

And I'm not saying TCA is definitely not gonna work, just that, at least as far as I understand, TCA is best suited towards scar with defined edges, since it wears away the skin chemically. Any treatment might work, but some scars are better suited to certain treatments. 

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On 2/9/2021 at 1:49 PM, Sirius Lee said:

Subcision should NEVER be the first weapon of choice in my opinion. It would be better to get subcision later than sooner because what you once thought was tethered often isn't tethered at all. This would also save you from needlessly getting a "wholesale" subcision.

BTW TCA can indeed improve rolling scars. I've seen it firsthand. You just need to apply lower concentration, usually 50%-70%.

What if a certified derm examines the scar and determines that it's tethered? Would you still prefer TCA before subcision?

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5 minutes ago, Skin Pessimist said:

What if a certified derm examines the scar and determines that it's tethered? Would you still prefer TCA before subcision?

If it were me, I would start with TCA. As the scar improves but it's still tethered (eg. donut effect, etc), I would definitely know and I can get it subcised then. Actually this would be more beneficial since I don't have to subcise more than I need to. 

As I said elsewhere, people confuse trees for the forest. When it comes to the scar, it's not the crater that you see but the shadow created by the scar border. Subcision plays no role in the eliminating of shadows.

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