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whiterabbit

Done lots of subcision + filler - advice needed (pics)

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Hi everyone,
I'll try to make this long story short: I've had 6 subcisions (cheeks) in total since early 2019. My scarring is mixed but my focus has always been the rolling scars since they are so centered on my cheeks, and especially my left cheek, which makes my skin looks so much worse IMO.

So, I tried subcision without filler first, then with HA fillers (Revolax and Skinbooster), but fillers didn't show any improvement or it was very insignificant, the swelling the first days fooled me big time. But anyway I waited a few months until I went for my next subcision, so it could heal and hopefully produce some results in time.

Let's skip to my latest two subcision sessions which were done in september and october, with a different doctor than the one I went to before. I know it's only one month and some would say it's too short between sessions, but I've done the waiting before as I mentioned, and this time I wanted to try a different approach. So in september I had subcision of both cheeks, which felt very effective and I was very swollen. My doctor also injected diluted Radiesse and sent me home. Everything good, but the filler wasn't meant to volumize, just for collagen stimulation.

I went back one month later for subcision only on my worst scar, which is a pretty widespread kind of rolling scar on my left cheek that has caused some volume loss. This time my doctor let me mark the area myself and he did a little subcision just there before injecting Juvederm. He told me after that it was injected superficially, which kind of made me think that it would not work as a barrier against retethering, or am I wrong? It looked volumized and great afterwards apart from being red and kind of uneven from swelling. The scar was really gone but of course I knew this was not the final result. Now, it's been a week, and my swelling is gone and so is most of my bruising. The filler also went away from the scar it seems, and I have this feeling that the filler might have settled around the scar which is now making my scar look more pronounced (the dreaded donut effect). Do you think it's more likely the filler settled around the scar, or is it retethering that happened and "pushed away" the filler (if that's even possible)? I'm not sure how soon retethering actually happens after subcision. Also, I've always seen the rolling scars on my cheek disappear when pulled, and this is supposed to indicate non-tethered scars from what I've heard.

The thing is, I think I can see some improvement in the areas surrounding my deepest rolling scar, but the "main" scar looks deeper to me, especially IRL. So hard to take good photos that show this. Or do you think this is simply because the areas around it improved and the area that didn't improve now stands out more? It feels like it's hard to judge your own progress, despite obessing about your skin so many hours of the day...

Do you think I need more Juvederm specifically under that scar? Or is the area too large? Do you think my doctor was right to inject it shallowly? I'm sorry about the many questions, but I would appreciate your thoughts about all this and if anyone has had the same experience after fillers.

Left photo is before two sessions with Radiesse and Juvederm. Right is one week after latest session.

 

Edited by whiterabbit
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Well I am not a doctor, but  Is your doctor acne scars expert ? If not , find one, if he s  , then ask him to try something else or find another doctor, if your scars didnt get better after 6 subcision  well they probably wont get any better with this method, maybe try filler for volume, and Microneedling RF , peels or laser for superficial scars, if u have Icepicks they will only respond to TCA.

Find a good doctor thats pecializes in acne scars revision and ask him about his opinion.

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30 minutes ago, Miro said:

Well I am not a doctor, but  Is your doctor acne scars expert ? If not , find one, if he s  , then ask him to try something else or find another doctor, if your scars didnt get better after 6 subcision  well they probably wont get any better with this method, maybe try filler for volume, and Microneedling RF , peels or laser for superficial scars, if u have Icepicks they will only respond to TCA.

Find a good doctor thats pecializes in acne scars revision and ask him about his opinion.

Thanks for your reply.

Unfortunately no, my doctor's not an acne scar expert, and I've already switched doctors, but the main problem is that I live somewhere where there are practically no acne scar experts. Sure, they do acne scar treatments on the side, but there are no true specialists – and also they charge ridiculous prices for their treatments. I opted for subcision because I've learnt that it's the safest thing to do for these kinds of scars and better to start with than lasers etc. Also, you're suggesting filler, which I stated that I've already done.
But I am contemplating laser, something like fractional ablative erbium because I think it's the safest for my skin type while possibly still giving me some kind of results in time. Have you had lasers done?

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Well there should  be list of recomended drs somehwere on this site , you should find someone as near to u as possible 

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What I see that this scar is similar to mine on the cheek and it has quite definitive edges. I managed to have a good improvement with tca paint 20%/erbium laser on the edges only. After the edges get smoother the filler injected under this scar will make it look better.

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The magnification and the lighting are a little different between the two pictures. If you look at it closely, you will see that the picture on the right is a bit larger (closer) and brighter, therefore it gives a better (or worse??) view of the scars.

Anyway, I don't believe your scars are a good candidate for subcision. They're too shallow and don't look at all tethered in my eyes, although I could be wrong. 

I would work on sanding down the scar edges as suggested by @Sibel. That alone should give a good overall appearance. TCA wise, I suggest 50% applied to individual pits, especially boxcars and icepicks.

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12 hours ago, whiterabbit said:

Thanks for your reply.

Unfortunately no, my doctor's not an acne scar expert, and I've already switched doctors, but the main problem is that I live somewhere where there are practically no acne scar experts. Sure, they do acne scar treatments on the side, but there are no true specialists – and also they charge ridiculous prices for their treatments. I opted for subcision because I've learnt that it's the safest thing to do for these kinds of scars and better to start with than lasers etc. Also, you're suggesting filler, which I stated that I've already done.
But I am contemplating laser, something like fractional ablative erbium because I think it's the safest for my skin type while possibly still giving me some kind of results in time. Have you had lasers done?

I hear you about the doctors. No good scar doctor anywhere near me,although I live in a metropole. They are arrogant and overpriced and I think my best bet would be to travel to a scar specialist when the pandemic settles and see what they would suggest. I have also tried subsicion once without,the second time with filler, but I am not satisfied with the results.

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18 hours ago, whiterabbit said:


But I am contemplating laser, something like fractional ablative erbium because I think it's the safest for my skin type while possibly still giving me some kind of results in time. Have you had lasers done?

Look find best possible laser specialist and consult with him, Fractional CO2 or Erbium is very safe treatment, but every device is as good as its operator . Many people had great results with lasers when it comes to scars that are not deep and are not tethered. 

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15 hours ago, Sibel said:

What I see that this scar is similar to mine on the cheek and it has quite definitive edges. I managed to have a good improvement with tca paint 20%/erbium laser on the edges only. After the edges get smoother the filler injected under this scar will make it look better.

Thank you Sibel. That sounds very logical. I'm glad you had improvement. I agree with you that the scar edges seem to be more defined. That's probably why that scar always catches my eye, particularly under some lighting.

10 hours ago, Sirius Lee said:

The magnification and the lighting are a little different between the two pictures. If you look at it closely, you will see that the picture on the right is a bit larger (closer) and brighter, therefore it gives a better (or worse??) view of the scars.

Anyway, I don't believe your scars are a good candidate for subcision. They're too shallow and don't look at all tethered in my eyes, although I could be wrong. 

I would work on sanding down the scar edges as suggested by @Sibel. That alone should give a good overall appearance. TCA wise, I suggest 50% applied to individual pits, especially boxcars and icepicks.

You're right about the pictures being a little different. I probably zoomed in on the second picture trying to make it look similar. It sure is difficult to capture the same kind of light/angle in pictures.

Also, thank you for the advice. I think I have to agree with you about subcision because clearly I have reached my maximum improvement point or it didn't do much for me from the beginning. Hard to say.

6 hours ago, BlueMaloney said:

I hear you about the doctors. No good scar doctor anywhere near me,although I live in a metropole. They are arrogant and overpriced and I think my best bet would be to travel to a scar specialist when the pandemic settles and see what they would suggest. I have also tried subsicion once without,the second time with filler, but I am not satisfied with the results.

Exactly the same situation here. Yes, I agree with you that we're better off traveling to a scar specialist because otherwise we're probably just wasting money, time and energy. I'm sorry you weren't pleased with the results from subcision, I totally feel you.

I've been thinking about seeing Dr Emil Henningsen eventually as it's pretty close to me and he seems very competent. I will surely update this thread when and if I do.

Edited by whiterabbit
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On 10/12/2020 at 2:04 PM, Stef3000 said:

I have the Same Problem and I think that Radiesse caused this 

I’m sorry to hear that.

I was fine after Radiesse, since it was diluted and used as spacer. But the Juvederm didn’t really do much at all for me, it rather seems like it accentuated my rolling scar. It’s all a guessing game though and it’s pretty exhausting.

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Just wanted to do a little update.

I went back a week ago since I had a small amount of remaining filler to use up and wasn't happy with the results. I think being swollen from subcision last time made it difficult for my doctor to inject precisely where the rolling scar was. I have always done filler in the same session as subcision, which might be why I've never liked the outcome. So now a week has passed from the second injection and I do like what I see. My rolling scar is less defined and I barely notice it now, which makes me really happy because this has never happened before. :)

Let's see how long this lasts and whether it will return to its original appearence or improve even after the filler is gone.

Here's a photo I took today.

 

Edited by whiterabbit
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17 hours ago, whiterabbit said:

I have always done filler in the same session as subcision, which might be why I've never liked the outcome. So now a week has passed from the second injection and I do like what I see. My rolling scar is less defined and I barely notice it now, which makes me really happy because this has never happened before. :)

Thanks for the update. This perfectly illustrates my point that, after subcision, you should NOT get filler immediately but wait at least a week or until the swelling goes down. You will have much greater outcome, as is the case here.

Edited by Sirius Lee
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Hi again,
Thanks for your replies. ^_^
I wanted to give an update since it's been a while. My scars don't look as good as just after my last subcision+filler, but I still think it's an improvement from before which is very positive, even if it's very subtle. It just doesn't seem as harsh as before to me. During 2021 I will be trying something else, maybe TCA CROSS for my boxcars and something for overall texture.
 
Here's a fresh picture.

 

Edited by whiterabbit
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Hi whiterabbit, i was planning to do smthg for my acne scars as i’m also have severe rollong and boxcar scars. i went to a doctor for an advice on how to treat my rollong acne scars and recommendations was:
a) subcision + filler + RF microneedling
b) eCO2 laser + subcision

so based on your experience, subsicison & filler should be separated into 2 sessions? same goes to RF microneedling or laser? i would like to know what is the after care skincare after your treatment? Thank you

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6 hours ago, Upset Lady said:

Hi whiterabbit, i was planning to do smthg for my acne scars as i’m also have severe rollong and boxcar scars. i went to a doctor for an advice on how to treat my rollong acne scars and recommendations was:
a) subcision + filler + RF microneedling
b) eCO2 laser + subcision

so based on your experience, subsicison & filler should be separated into 2 sessions? same goes to RF microneedling or laser? i would like to know what is the after care skincare after your treatment? Thank you

Hi upset lady!
Since I have only done subcision and filler really, I can't say anything about the other treatments. Hopefully someone else here can answer that. But yes, when it comes to subcision+filler I genuinely feel that the outcome was much better because I went back for more filler after the swelling from subcision had settled. So personally I would say space them apart if you can. For me a week was enough for the swelling to go down.

Also, after subcision and filler you don't want to touch your face much since it will be a bit sore and swollen, especially the first couple of days and you also don't want to risk moving the filler. My aftercare is simply cleansing (very gently) in the AM and PM with a mild cleanser like Bioderma Sensibio Cleansing Foaming Gel and just moisturize with something like Avene Cicalfate. So personally I do take about a week off from acids and tretinoin after treatment, until I feel my skin is back to normal. Also helps to elevate your pillow a bit the first few nights after subcision (helps against swelling) and try to sleep on your back.
Hope that helps you!

Edited by whiterabbit
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@whiterabbit, thanks for your reply...May I know what type filler are you injecting? I do heard that some filler might swift as time goes by and i'm worry once I started the filler I will need to topup from time to time if required. Did you encounter filler moving from one place to another? and the scars will came back after some time

You do mentioned that 2021 you will be undergoing TCA and what is the reason of choosing TCA instead of other laser/microneedling treatment which might help also? Hope to hear from you soon

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@Upset LadyI’ve had diluted Radiesse injected for collagen stimulation and Juvederm as spacer. I’ve tried other fillers before but so far Juvederm has given me better results.

No matter what HA filler, your scars definitely come back after a while, so you will have to top up, but my understanding is that this differs a lot depending on level of injection/filler amount/injector’s skill/how soon your own body absorbs the filler.

About my future treatments – I have boxcar and ice pick scars that might respond to TCA CROSS and make them less defined. Maybe also laser for scar borders as Sibel suggested here earlier. But I will need to see a specialist for that, hopefully Dr Henningsen when restrictions are lifted. Also I think laser might help overall texture and large pores.

Edited by whiterabbit
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On 12/25/2020 at 3:09 PM, whiterabbit said:

@Upset LadyI’ve had diluted Radiesse injected for collagen stimulation and Juvederm as spacer. I’ve tried other fillers before but so far Juvederm has given me better results.

No matter what HA filler, your scars definitely come back after a while, so you will have to top up, but my understanding is that this differs a lot depending on level of injection/filler amount/injector’s skill/how soon your own body absorbs the filler.

About my future treatments – I have boxcar and ice pick scars that might respond to TCA CROSS and make them less defined. Maybe also laser for scar borders as Sibel suggested here earlier. But I will need to see a specialist for that, hopefully Dr Henningsen when restrictions are lifted. Also I think laser might help overall texture and large pores.

With doctor die you Visit ? 

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13 hours ago, Stef3000 said:

With doctor die you Visit ? 

He’s not really a known doctor or acne scar specialist. He mostly does fillers. I live in Sweden and there are no true acne scar specialists here.

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