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MP28

What treatments?

I’ve made a couple posts regarding me doing at home treatments and using retin-a. What would you all advise me as far as a complete treatment plan otherwise? My main issue that really bothers me is this texture or scarred skin, I don’t know what it is, below my other more obvious pitted scars. My skin would look so much better if it wasn’t for this scarred skin sitting beneath the more atrophic scars, but i’m not sure if this is easier or harder to treat.

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52 minutes ago, MP28 said:

I’ve made a couple posts regarding me doing at home treatments and using retin-a. What would you all advise me as far as a complete treatment plan otherwise? My main issue that really bothers me is this texture or scarred skin, I don’t know what it is, below my other more obvious pitted scars. My skin would look so much better if it wasn’t for this scarred skin sitting beneath the more atrophic scars, but i’m not sure if this is easier or harder to treat.

 

I thought you were interested in DIY. Have you changed your mind?

If you prefer to get professional service, you can opt for either 35% TCA or 1927 nm Fraxel laser. You will likely need 2 or more to see real results (for texture only, not scars).

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No, I have already gotten two treatments with Rullan. I am happy with my last trio treatment with temporary fillers that time. So far even though I do have some filler lumps my boxcar scars look better. however my rolling scars and especially texture really bother me. I figured I’d approach that a different way. I do feel like it’s also improved with this second treatment, however I need some more guidance on what this scarring actually is. Is it truly textural or more just loss of tissue/scarred skin? Can I expect really good improvement here compared to typical atrophic scars? thanks! 

 

I should also add that a couple of these pictures were before my second treatment with Rullan, I just felt that they displayed the scarring i’m talking about better.

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4 hours ago, MP28 said:

No, I have already gotten two treatments with Rullan. I am happy with my last trio treatment with temporary fillers that time. So far even though I do have some filler lumps my boxcar scars look better. however my rolling scars and especially texture really bother me. I figured I’d approach that a different way. I do feel like it’s also improved with this second treatment, however I need some more guidance on what this scarring actually is. Is it truly textural or more just loss of tissue/scarred skin? Can I expect really good improvement here compared to typical atrophic scars? thanks! 

 

I should also add that a couple of these pictures were before my second treatment with Rullan, I just felt that they displayed the scarring i’m talking about better.

They're scars. The forehead area is harder to treat but it can be done. I think a fractional CO2 treatment would help. I had one boxcar on my forehead improved. It was wide but not that deep. Fractional CO2 made it shallower and I can only see it if I have the light angled a certain way - regardless, it's shallower and I've forgotten about it.

There are several deeper boxcar scars that lasers probably wouldn't be able to hit. Did you get Cross done on those by Dr. Rullan?

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Yes I did get cross on both sessions. To be honest though I feel like I only have 2/3  notable boxcars and the rest are more linear I guess you would call them? Also some rolling scars. Like i mentioned though I would barely mind my scarring if it wasn’t for the widespread “texture” beneath. Do you see where I’m talking about?

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This lighting is bad enough to make perfectly good skin look bad, however I think it displays my rolling scars and maybe minor loss of tissue where the “texture” appears to be? Thoughts? I’m thinking it would be ideal to go get my 3rd and/or 4th trio session with Rullan, and then possibly move on to a couple  of RF microneedling sessions, and then maybe laser at the end, but I’m not sure. Will also likely use tretinoin nightly and light TCA peels once a month between treatments. I do believe part of my scarring is due to a bad microneedling session a couple years ago, that was either too deep or I just didn’t let heal properly. Hopefully something like Genius will minimize this risk if I decide to do any kind of needling again. I am 19 so hoping for the best. Any guidance is appreciated!

Thanks!

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On 9/18/2020 at 12:29 PM, MP28 said:

I do believe part of my scarring is due to a bad microneedling session a couple years ago

This is very possible. Remember, there's very little skin in the forehead. From the surface to the bone is only about 1.5 mm. In between is the fat layer. If you carelessly puncture holes in this region, you'll end up with craters from fat atrophy. I believe this is what happened to your 19-year forehead.

  

On 9/18/2020 at 12:29 PM, MP28 said:

Will also likely use tretinoin nightly and light TCA peels once a month between treatments. I do believe part of my scarring is due to a bad microneedling session a couple years ago, that was either too deep or I just didn’t let heal properly. Hopefully something like Genius will minimize this risk if I decide to do any kind of needling again. I am 19 so hoping for the best. Any guidance is appreciated!

Again, note that forehead is very different from other areas of the face. It's composed of little collagen and mostly muscle. So even the slightest wrinkle or scar will stand out due to muscle tension. To minimize the tension, Botox is strongly advised.

Avoid microneedling, including RF microneedling like Genius, on the foreahead!

Edited by Sirius Lee

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10 hours ago, Sirius Lee said:

This is very possible. Remember, there's very little skin in the forehead. From the surface to the bone is only about 1.5 mm. In between is the fat layer. If you carelessly puncture holes in this region, you'll end up with craters from fat atrophy. I believe this is what happened to your 19-year forehead.

  

Again, note that forehead is very different from other areas of the face. It's composed of little collagen and mostly muscle. So even the slightest wrinkle or scar will stand out due to muscle tension. To minimize the tension, Botox is strongly advised.

Avoid microneedling, including RF microneedling like Genius, on the foreahead!

Good to know. I did microneedling all over my face at a med spa and not only did I get new scars on my cheeks but I may have gotten bigger pores and wrinkles/lines on my forehead. The pores could have been from RF microneedling as well or from something else....... I'm not sure because I only looked really closely at my skin about a year or two ago. Wrinkles/lines..... I'm guessing from a multitude of treatments. I did have a shallow boxcar on my forehead that was smoothed out moderately by fractional CO2. Healed up pretty quickly.

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I've looked into your previous post, has your swelling subsided yet? What made you choose juvederm instead of sculptra?

Edited by gynoscar

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13 hours ago, Sirius Lee said:

 

Avoid microneedling, including RF microneedling like Genius, on the foreahead!

3 hours ago, Amanda Hall said:

I did have a shallow boxcar on my forehead that was smoothed out moderately by fractional CO2. Healed up pretty quickly.

You cant say avoid this treatment avoid that treatment. Everyone is diff., there are people that have bad experience with laser and people that claim it saved their skin, that can be said about any treatmen. Every treatment has its risks.

F.e. many people here say avoid lasers, never do laser on forehead it does nothing, and look Amanda got improvement.

I got very nice improvement with subcision + filler on my forehead, and then with Genius RF + subc, so far so good .

I think its important do to online research, gather as many informations as you can and find doctor that specializes himself in scars revision or acne scars revision.

You can go just for consulation with dr., ask for some pics - before after   , ask people here about their experience with certain doctor and do treatments with doctor u trust . Only doctor will see u in person and can "feel" and touch your skin, no online consultation can replace that .

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12 hours ago, gynoscar said:

I've looked into your previous post, has your swelling subsided yet? What made you choose juvederm instead of sculptra?

I’ve heard your not supposed to do sculptra on forehead, or at least Rullans office doesn’t. My boxcars look much better with juvederm still.

On 9/19/2020 at 2:31 PM, Sirius Lee said:

This is very possible. Remember, there's very little skin in the forehead. From the surface to the bone is only about 1.5 mm. In between is the fat layer. If you carelessly puncture holes in this region, you'll end up with craters from fat atrophy. I believe this is what happened to your 19-year forehead.

  

Again, note that forehead is very different from other areas of the face. It's composed of little collagen and mostly muscle. So even the slightest wrinkle or scar will stand out due to muscle tension. To minimize the tension, Botox is strongly advised.

Avoid microneedling, including RF microneedling like Genius, on the foreahead!

What do you advise I do? Do I actually have fat atrophy? Even though I think i had a bad experience with microneedling it was with a random nurse so part of me feels ok about pursuing genius with an experienced qualified person. Doesn’t the genius do a good job at puncturing the right depths? Lastly, can I expect improvement in fat atrophied skin without doing anything crazy like a fat transfer? I don’t believe my scars are serious enough for that. I did show Rullan a picture of this underlying “texture” or fat loss i guess, below my couple boxcar scars and he said he was glad i showed him this different lighting and that it would entail going between muscle and bone. Which I assume was deeper than my first subcision. 

Edited by MP28

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12 hours ago, Miro said:

You cant say avoid this treatment avoid that treatment. Everyone is diff., there are people that have bad experience with laser and people that claim it saved their skin, that can be said about any treatmen. Every treatment has its risks.

F.e. many people here say avoid lasers, never do laser on forehead it does nothing, and look Amanda got improvement.

I got very nice improvement with subcision + filler on my forehead, and then with Genius RF + subc, so far so good .

I think its important do to online research, gather as many informations as you can and find doctor that specializes himself in scars revision or acne scars revision.

You can go just for consulation with dr., ask for some pics - before after   , ask people here about their experience with certain doctor and do treatments with doctor u trust . Only doctor will see u in person and can "feel" and touch your skin, no online consultation can replace that .

I think people said avoid lasers because they have legitimate risks. I have written in many posts that lasers have risks so they need to be considered with caution. Lasers can create new scars (I got new scars), cause PIE/PIH (happened with me), and possibly cause fat loss (this is debatable). However, I saw some benefits. The shallow scar on my forehead was blended in nicely so I was happy. 

As far as pictures go, many doctors don't take pictures. This could be because of time constraints or because they don't want to show possibly the lack of results from their treatments. Who knows. 

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19 hours ago, Amanda Hall said:

I think people said avoid lasers because they have legitimate risks. I have written in many posts that lasers have risks so they need to be considered with caution. Lasers can create new scars (I got new scars), cause PIE/PIH (happened with me), and possibly cause fat loss (this is debatable). However, I saw some benefits. The shallow scar on my forehead was blended in nicely so I was happy. 

As far as pictures go, many doctors don't take pictures. This could be because of time constraints or because they don't want to show possibly the lack of results from their treatments. Who knows. 

Well what is the solution to fat loss? Does multiple subcisions help? As I mentioned, after my last subcision and filler my boxcar scars are shallow enough to not bother me. What does bother me is my rolling scars and this volume loss/texture. It would be great to tailor treatment to that, but i’m not sure what to do.

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5 minutes ago, MP28 said:

Well what is the solution to fat loss? Does multiple subcisions help? As I mentioned, after my last subcision and filler my boxcar scars are shallow enough to not bother me. What does bother me is my rolling scars and this volume loss/texture. It would be great to tailor treatment to that, but i’m not sure what to do.

Theoretically, subcisions help rolling scars but you can only get so much improvement after so many subcisions. Fillers should help but that means you'll need more. I will leave advice to more experienced people because you have already tried the treatments I would suggest.

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5 minutes ago, Amanda Hall said:

Theoretically, subcisions help rolling scars but you can only get so much improvement after so many subcisions. Fillers should help but that means you'll need more. I will leave advice to more experienced people because you have already tried the treatments I would suggest.

Yes however I did juvederm for the isolated boxcars, and nothing necessarily to address volume loss. I’ve only had 2 subcisions

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On 9/20/2020 at 12:38 PM, MP28 said:

What do you advise I do? Do I actually have fat atrophy? Even though I think i had a bad experience with microneedling it was with a random nurse so part of me feels ok about pursuing genius with an experienced qualified person. Doesn’t the genius do a good job at puncturing the right depths? Lastly, can I expect improvement in fat atrophied skin without doing anything crazy like a fat transfer? I don’t believe my scars are serious enough for that. I did show Rullan a picture of this underlying “texture” or fat loss i guess, below my couple boxcar scars and he said he was glad i showed him this different lighting and that it would entail going between muscle and bone. Which I assume was deeper than my first subcision. 

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In the picture, you can clearly see the round craters forming wavy lines across the forhead. I suggest you compare this to pictures taken before the treatment. That's the only way to know for sure if fat atrophy is present.

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9 minutes ago, Sirius Lee said:

970A900D-642F-42F5-9614-C4325BD77634.jpeg

 

In the picture, you can clearly see the round craters forming wavy lines across the forhead. I suggest you compare this to pictures taken before the treatment. That's the only way to know for sure if fat atrophy is present.

As in if there’s improvement from the second treatment with Rullan I likely don’t have fat atrophy? The microneedling that i think damaged me was a couple years ago, by the way. I’m not sure what you mean?

Edited by MP28

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1 minute ago, MP28 said:

As in if there’s improvement from the second treatment with Rullan I likely don’t have fat atrophy? The microneedling that i think damaged me was a couple years ago, by the way.

A couple thoughts to ponder.

First, a loss of volume from fat atrophy doesn't normally fill in by itself. 

Second, scar treatment will likely help form new collagen, which will help with the atrophy. However, it probably isn't enough to fill it completely. You need to resort to dermal filler for a complete fix. 

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So how does fat atrophy compare to tissue loss? Or is that essentially the same thing when it comes to scar treatments? Also i’m not sure what filler  to get since this atrophy is more shallow and wide spread rather than individual boxcars. Lastly, in subcision we use fillers as a buffer on boxcars, but how do we keep widespread rolling scars from rethethering? 

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On 9/21/2020 at 1:59 PM, MP28 said:

So how does fat atrophy compare to tissue loss? Or is that essentially the same thing when it comes to scar treatments? 

I guess fat atrophy could be considered as a tissue damage. Funny you mention it though because scar revision itself is probably the single biggest tissue damage IMO. 

Anyway, you need to understand there is very little skin on the forehead. As I stated above, there's roughly only 1.5mm of depth from the surface to the bare bone. That's not a lot. So any scar or crater will likely be attached to the fat or the muscle. The muscle, upon exertion, will pull on the scar. Hence, it makes to relax the muscle by injecting botox.

 

1 hour ago, MP28 said:

Anyone have any solution to possible fat loss? Or anyway to build volume in the forehead?

As for the missing collagen, there isn't much you can do. Since there wasn't much collagen to begin with, no amount of treatment like subcision or microneedling will be able to produce enough collagen to replace the void. The only viable alternative is to use filler.

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2 minutes ago, Sirius Lee said:

I guess fat atrophy could be considered as a tissue damage. Funny you mention it though because scar revision itself is probably the single biggest tissue damage IMO. 

Anyway, you need to understand there is very little skin on the forehead. As I stated above, there's roughly only 1.5mm of depth from the surface to the bare bone. That's not a lot. So any scar or crater will likely be attached to the fat or the muscle. The muscle, upon exertion, will pull on the scar. Hence, it makes to relax the muscle by injecting botox.

 

As for the missing collagen, there isn't much you can do. Since there wasn't much collagen to begin with, no amount of treatment like subcision or microneedling will be able to produce enough collagen to replace the void. The only viable alternative is to use filler.

Well,  with that said do you believe my case will benefit from a couple more trio sessions with rullan, than possibly a couple genius sessions with Weiner down the road, tretinoin nightly? Also what filler am I to use for more of the wide spread rolling scars? Juvederm has worked for my boxcars, but not sure what filler to do for widespread forehead scarring.

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14 hours ago, MP28 said:

Well,  with that said do you believe my case will benefit from a couple more trio sessions with rullan, than possibly a couple genius sessions with Weiner down the road, tretinoin nightly? Also what filler am I to use for more of the wide spread rolling scars? Juvederm has worked for my boxcars, but not sure what filler to do for widespread forehead scarring.

Well, if we're talking only about your forehead, I honestly don't think treatments from either Rullan or Weiner will be all that useful. None of those treatments have yet to yield much improvement for forehead scars (just search the previous posts on this forum). I would instead recommend getting Botox and then filler (both Juverderm Volbella or Restylane Silk will do). But then, it's your call.

That's about it from me on this subject. Good luck.

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On 9/23/2020 at 2:53 PM, Sirius Lee said:

Well, if we're talking only about your forehead, I honestly don't think treatments from either Rullan or Weiner will be all that useful. None of those treatments have yet to yield much improvement for forehead scars (just search the previous posts on this forum). I would instead recommend getting Botox and then filler (both Juverderm Volbella or Restylane Silk will do). But then, it's your call.

That's about it from me on this subject. Good luck.

Thanks for the input..honestly while my scars still get me down, especially  my boxcars have greatly improved in 2 sessions with Rullan. I’m sure the forehead is indeed harder to treat, but considering i’ve seen improvement I haven’t lost hope and optimism. I may go to Dr. Weiner next to see his opinion.

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