Happened to me with TCA CROSS, mainly the left side. It's gotten better since I did 3 TCA CROSS and have done 4 phenol CROSS with subcision. I think it's worth to do at least another couple rounds of CROSS, as they should start filling in your scars. Always the risk of widening and scars joining together with CROSS, especially the first several treatments. Still feel like you'd benefit with a few more CROSS and then assess your next move.

16 hours ago, thereishope0708 said:

My question is:should I get more combo treatment (subcision, cross and microneedling/erbium laser) or should I start getting dermal filler?
And if I need to get more cross, should I ask Dr. Rullan to increase the percentage?

The problem is that,unless you don't mind going blind, you can't directly inject filler in the temple. At least not in individual scars. It's very risky.

What was the cross (TCA or Phenol) and what the percentage used? Moreover, was it only applied on the icepicks, or was it applied widely over all the scars?

I think subcision and cross will be better at this stage then fillers. Ask Rullan to have the temples subcised. Also ask for the cross to be applied in the pit of the rolling scars after stretching the skin.

Microneedling, unless it's RF, will be the least helpful so skip and get your money refunded.

19 hours ago, dodgerguy said:

Happened to me with TCA CROSS, mainly the left side. It's gotten better since I did 3 TCA CROSS and have done 4 phenol CROSS with subcision. I think it's worth to do at least another couple rounds of CROSS, as they should start filling in your scars. Always the risk of widening and scars joining together with CROSS, especially the first several treatments. Still feel like you'd benefit with a few more CROSS and then assess your next move.

Good to know.Thank you for sharing your experience. I'd definitely get more rounds of CROSS before filler. Not really sure tho which one is better. for pitted scars. TCA or Phenol Cross?

4 hours ago, Sirius Lee said:

The problem is that,unless you don't mind going blind, you can't directly inject filler in the temple. At least not in individual scars. It's very risky.

What was the cross (TCA or Phenol) and what the percentage used? Moreover, was it only applied on the icepicks, or was it applied widely over all the scars?

I think subcision and cross will be better at this stage then fillers. Ask Rullan to have the temples subcised. Also ask for the cross to be applied in the pit of the rolling scars after stretching the skin.

Microneedling, unless it's RF, will be the least helpful so skip and get your money refunded.

Didn't know that fillers can't be injected on the temples. Glad I asked and thank you for letting me know.

Not really sure what percentage were used because Dr. Rullan didn't inform me. Though he applied it widely over all the scars. How about erbium laser? Would that help?

3 hours ago, thereishope0708 said:

Not really sure what percentage were used because Dr. Rullan didn't inform me. Though he applied it widely over all the scars. How about erbium laser? Would that help?

It's best that you get as much info from the doc before you start the procedure. As a patient, that's your right.

As far as the laser is concerned, erbium is not as powerful as CO2. Still, in a fully ablative mode (not fractional mode), you will be able to see some benefit.

However, I want to be straight up. Your temple scars are too deep and no amount of collagen can be stimulated to fill the hole completely. Your best bet is not the fill the hole but to smooth out the scar edges using chemical peels like TCA or Phenol so that there will be less shadow. It's the shadow that makes the scar more pronounced.

I think the phenol Rullan uses is already 80% or 90%. Increasing it won't help. Are you also getting scultpra after subcision with rullan as well? I had my first one done and I think I do see some improvements after 3 session (only had sculptra on the last session).

I heard from BeautifulAmbition that Subcision and Radiesse could work in the temple region for atrophic acne scars. Not sure if Rullan uses that filler though.

19 hours ago, thereishope0708 said:

Good to know.Thank you for sharing your experience. I'd definitely get more rounds of CROSS before filler. Not really sure tho which one is better. for pitted scars. TCA or Phenol Cross?

 

 

Phenol is preferred for people with ethnic skin like yours and mine, so you're getting the CROSS that's better suited for you.

1 hour ago, dodgerguy said:

Phenol is preferred for people with ethnic skin like yours and mine, so you're getting the CROSS that's better suited for you.

I don't believe that's entirely correct. TCA is considered a medium-depth peel, whereas Phenol is considered a deep peel. Hence, you're removing more skin layer with Phenol than TCA. Needless to say, the more you remove, higher the chance for prolonged hyperpigmentation.

5 hours ago, Sirius Lee said:

I don't believe that's entirely correct. TCA is considered a medium-depth peel, whereas Phenol is considered a deep peel. Hence, you're removing more skin layer with Phenol than TCA. Needless to say, the more you remove, higher the chance for prolonged hyperpigmentation.

We're talking about CROSS and not a full on chemical peel. Speaking from my own experience, better results with phenol CROSS. TCA CROSS was ok, but I wouldavoid it if I got a redo because of scars widening and what looked like some news scars forming with another nearby. I also had longer lasting hyperpigmentation when I did TCA CROSS compared to phenol.

Even Dr. Rullan agrees that TCA CROSS "cuts and widens scars" which is why he doesn't do CROSS with TCA anymore. SoDr. Rullan agrees with me.

You can't just assume because you looked on the internet that phenol is a deeper peel than TCA, "hence"it can cause more harm and damage. I see you give a lot of advice and that's great, but don't make an assumption based on something you read, as opposed to experience and talking to a dermatologist like myself.

I think TCA/Phenol Cross is still going to be the way you should go even though you got a bad experience.If Phenol Cross didn't work, maybe try TCA Cross? I've done Phenol Cross and I've lost a little trust in Dr. Rullan. Some of my scars widened and deepened. Only a few improved. Phenol Cross CAN make your scars worse despite what Dr. Rullan says. I had it applied on most boxcars though I had an ice pick type of scar. Wide ones are riskier. This all begs the question: is Phenol better than TCA and is it worth traveling to see Dr. Rullan for anything other than subcision?

In my opinion, Erbium is a waste of money for your pitted scars. RF microneedling looks promising and has theoretical benefits but there are probably other members more informed but that's just my two cents. Subcision could help but I don't think it's going to be a miracle based on your type of scarring.

Thank you all for the feedback guys! Will keep you posted on my progress. I have decided to do more subcision and cross with Dr. Rullan this coming September.

Is it okay if I skip the microneedling though?

I've followed lim quite a bit. He is convinced most work can be done with subcision andTCA. Still to this day I don't understand how he does TCA paint but he seems to always get good results with it. If there was a set in stone method for paint I would have already tried it.

IMO i have some very similar scars to yours. The first thing I plan on doing at home when I grow the balls is start messing with TCA in lower%. Obviously this is a DO AT YOUR OWN RISK but from what i've seen there are balances involved.

TCA paint looks super appealing imo. You could also do what @Sirius Leesuggested and stretch the scar way open and only hit the base. I plan on testing some TCA in the near future @Sirius Leehave you had good results from stretching the scars open and hitting the very very base? This was sort of what I was thinking about for a while. Lower % tca as test runs but only hit the base of a few of my boxcar scars. Would love to hear your thoughts.

On 8/3/2020 at 9:39 PM, thereishope0708 said:

Thank you all for the feedback guys! Will keep you posted on my progress. I have decided to do more subcision and cross with Dr. Rullan this coming September.

Is it okay if I skip the microneedling though?

I never did three treatments on the same visit. When I was doing subcisions, I only did it with CROSS. Did that combo three times. I also did CROSS + microneedling x1 and CROSS + erbium x2. I know it's a bit cheaper if you do three on one visit, but I cared more about healing and recovery. It's really up to what you think is best for your skin after doing your research and going through these treatments. So my answer would be yes, it would be ok to skip microneedling, as it does very little to nothing for deep atrophic scarring.

2 hours ago, thepwhisp said:

TCA paint looks super appealing imo. You could also do what @Sirius Leesuggested and stretch the scar way open and only hit the base. I plan on testing some TCA in the near future @Sirius Leehave you had good results from stretching the scars open and hitting the very very base? This was sort of what I was thinking about for a while. Lower % tca as test runs but only hit the base of a few of my boxcar scars. Would love to hear your thoughts.

That's what I've been doing for the rolling scars. It's definitely been helping. Be sure to start at the low end and then gradually take it up to where you can tolerate.

One thing to remember is to not rush things. For maximum collagen production, 3 monthbreather is a must IMO. Also be creative by working with different strengths. You don'thave to apply 100% all the time. It could be 70% or even 50%. Eventually you'll get a feel for what works and what doesn't.

@Sirius Lee Do you think I could try the same method with boxcar scars? Was thinking about stretching and sort of zapping the very base of the boxcars with 50%.

5 hours ago, thepwhisp said:

@Sirius Lee Do you think I could try the same method with boxcar scars? Was thinking about stretching and sort of zapping the very base of the boxcars with 50%.

Boxcar usually has a pretty well-defined scar edge, so there's no need to stretch it. With Rolling scars, the edges aren't as apparent. Nevertheless, the whole point of using the TCAon anything other than Icepickis not to fill the pit but to smooth down the hard edges. After all, it's these edges that makethe scars stand out.

Also don't expect any miracle after 1 treatment. Even for a minor boxcar, you need several treatments.