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darling_

Will RF Microneedling help?

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Hi there!  I wanted some advice on how to treat these deep acne scars.  I was on accutane 7-8 years ago for severe acne. 

I did a round of CO2 Fraxel last year but had a horrible allergic reaction and made my skin somewhat worse so I’ve been scared to do anything else since then.  I think I’m allergic to Aquaphor!  My doctor suggested RF Microneedling instead but would like your advice as well since I’m hesitant to do anything that will make it worse than before. :( I’m also on 0.05% Tret right now! 
 

Also - what kind of scars would you characterize mine as? TIA!

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Edited by darling_
Added more pics (some with makeup to show how it looks)
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From what I can tell you have mainly shallow boxcar scars.  Have you had subcision before?  I think RF Microneedling would help but I would get at least one subcision treatment before or even at the same time just to make sure you have no tethered scaring. 

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1 hour ago, anon09299 said:

From what I can tell you have mainly shallow boxcar scars.  Have you had subcision before?  I think RF Microneedling would help but I would get at least one subcision treatment before or even at the same time just to make sure you have no tethered scaring. 

I’ve never done subcision! For some reason my derm has never suggested it.  I do have lumpy channels of tissue almost underground my skin so that’s so helpful to know!  What do I do if it is tethered scarring? Will it become worse with RF or subcision? 

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1 hour ago, darling_ said:

I’ve never done subcision! For some reason my derm has never suggested it.  I do have lumpy channels of tissue almost underground my skin so that’s so helpful to know!  What do I do if it is tethered scarring? Will it become worse with RF or subcision? 

Dr. Steven Weiner suggests it in this video https://www.youtube.com/watch?v=dyHtp0l0ftA.  He is one of the experts in rf microneedling having done the fda trials for the infini and genius devices.  

 

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6 hours ago, darling_ said:

I did a round of CO2 Fraxel last year but had a horrible allergic reaction and made my skin somewhat worse so I’ve been scared to do anything else since then.  I think I’m allergic to Aquaphor!  My doctor suggested RF Microneedling instead but would like your advice as well since I’m hesitant to do anything that will make it worse than before. :( I’m also on 0.05% Tret right now! 
 

Also - what kind of scars would you characterize mine as? TIA!

Most of them are shallow boxcar scars, as you can see distinct edges around the scars. These are where the light bounces off, thus making the scars stand out more. RF Microneedling can be helpful in creating new collagen. However, it would be better (and probably faster) to just sand down those edges. You can do this by getting TCA or ablative laser.

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13 hours ago, anon09299 said:

Dr. Steven Weiner suggests it in this video https://www.youtube.com/watch?v=dyHtp0l0ftA.  He is one of the experts in rf microneedling having done the fda trials for the infini and genius devices.  

 

Thanks so much, this is so helpful! 
 

11 hours ago, Sirius Lee said:

Most of them are shallow boxcar scars, as you can see distinct edges around the scars. These are where the light bounces off, thus making the scars stand out more. RF Microneedling can be helpful in creating new collagen. However, it would be better (and probably faster) to just sand down those edges. You can do this by getting TCA or ablative laser.

I had a really terrible experience doing CO2 Fraxel (ablative) last year, and had to do rounds and rounds of IPL to get rid of the redness and texture. I had an allergic reaction to potentially the Aquaphor I slathered on (my derm even thinks I may be allergic to the energy from the laser itself - crazy) and made my skin overall worse since I seem to have lost some facial fat and some new indentations from where I got the allergy on my skin :( That’s why my derm is recommending Genius RF Microneedling instead since he was even too scared to do CO2 on me again (he said it doesn’t require me to slather any additional creams on after like laser and a bit more gentle). 
 

Is TCA going to help more than subcision as recommended above? Should I do a mix of both / with fillers or stick with the RF Microneedling?  My currently derm only seems to do lasers and RF Microneedling so was leaning towards that (I wouldn’t have to pay exorbitant consultation fees seeing a new derm in NYC!) but if another treatment will dramatically help more like subcision I’m opening to seeing new doctors, thanks again for all the help, I really appreciate it!

Edited by darling_
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7 hours ago, darling_ said:

Is TCA going to help more than subcision as recommended above? Should I do a mix of both / with fillers or stick with the RF Microneedling?  My currently derm only seems to do lasers and RF Microneedling so was leaning towards that (I wouldn’t have to pay exorbitant consultation fees seeing a new derm in NYC!) but if another treatment will dramatically help more like subcision I’m opening to seeing new doctors, thanks again for all the help, I really appreciate it!

Normally, subcision is better suited for those with medium to severe scars. Obviously, there's a higher chance for the scar to be tethered among those with more severe form. 

TCA is similar to laser in that it removes the dermal layer of the skin. Depending on the concentration used, it is very effective in, say, flattening the scar edges. Just blurring out these edges itself can greatly improve the overall appearance, which RF microneedling cannot do. Once the edges have been faded, you can then go in and treat the remaining depressed areas with RF microneedling (or even filler for fast result). 

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2 hours ago, Sirius Lee said:

Normally, subcision is better suited for those with medium to severe scars. Obviously, there's a higher chance for the scar to be tethered among those with more severe form. 

TCA is similar to laser in that it removes the dermal layer of the skin. Depending on the concentration used, it is very effective in, say, flattening the scar edges. Just blurring out these edges itself can greatly improve the overall appearance, which RF microneedling cannot do. Once the edges have been faded, you can then go in and treat the remaining depressed areas with RF microneedling (or even filler for fast result). 

My scars are pretty similar to those but on different area of my face 

I thought smoothing the edge should be the very last procedure, and I was planning for rf needling prior to chemical peel or ablative lasers

Or did I get it wrong

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1 hour ago, Tory said:

I thought smoothing the edge should be the very last procedure, and I was planning for rf needling prior to chemical peel or ablative lasers

Well, if you've read my posts few years back, that's exactly what I preached at the time. But I now believe that's completely backwards. One reason is that it literally takes forever to create enough of your own collagen to fill the pits, particularly if you have scars with very defined edges like boxcars. It makes more sense to just sand down the edges. It's quicker, more economical and you really have much more options once the edges have been softened. Instead of a boxcar, it now looks more like a shallow rolling scar, which I believe can be better managed. 

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6 hours ago, Sirius Lee said:

Normally, subcision is better suited for those with medium to severe scars. Obviously, there's a higher chance for the scar to be tethered among those with more severe form. 

TCA is similar to laser in that it removes the dermal layer of the skin. Depending on the concentration used, it is very effective in, say, flattening the scar edges. Just blurring out these edges itself can greatly improve the overall appearance, which RF microneedling cannot do. Once the edges have been faded, you can then go in and treat the remaining depressed areas with RF microneedling (or even filler for fast result). 

Thanks so much! So you don’t think I will need subcision? I looked at some videos online of the process and it was pretty scary, I’m extremely pale, prone to bruising and take forever to heal from bruises so would like to avoid if possible. I think I have some tethered scarring, when I push against my skin I feel long “lumps” under it. When I tighten my skin, I can actually SEE the long lump? under it, see attached :(  
 

That has been there ever since my Accutane treatment! Will this go away with CO2/RF Microneedling so I can avoid subcision?  I’ll look into the TCA, thank you!

BC740BCE-EE81-4094-89E6-E9198B58336D.jpeg

Edited by darling_
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24 minutes ago, darling_ said:

I think I have some tethered scarring, when I push against my skin I feel long “lumps” under it. When I tighten my skin, I can actually SEE the long lump? under it, see attached :(  

What you see is a hypertrophic scar. A tethered scar, on the other hand, is an atrophic scar. There will be a depression, no matter how much you stretch the skin, as opposed to a "lump".

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4 hours ago, Sirius Lee said:

Well, if you've read my posts few years back, that's exactly what I preached at the time. But I now believe that's completely backwards. One reason is that it literally takes forever to create enough of your own collagen to fill the pits, particularly if you have scars with very defined edges like boxcars. It makes more sense to just sand down the edges. It's quicker, more economical and you really have much more options once the edges have been softened. Instead of a boxcar, it now looks more like a shallow rolling scar, which I believe can be better managed. 

I see! Yeah it makes more sense to me as well

And when it comes to TCA peel to flattening the edge, what strength do you recommend? 

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13 hours ago, Tory said:

And when it comes to TCA peel to flattening the edge, what strength do you recommend? 

It really depends on the scar type and severity (eg. width/depth). One thing to note is that when used as a PEEL, usually 35% and below, is just that. It is used to peel off the skin and nothing more. This is good for superficial wrinkles. But when it comes to correcting scars, it's rather useless. For scar revision, you need to use 50% and up. You also will need more than one treatment to see a good result.

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On 11/8/2020 at 8:36 PM, darling_ said:

Thanks so much, this is so helpful! 
 

I had a really terrible experience doing CO2 Fraxel (ablative) last year, and had to do rounds and rounds of IPL to get rid of the redness and texture. I had an allergic reaction to potentially the Aquaphor I slathered on (my derm even thinks I may be allergic to the energy from the laser itself - crazy) and made my skin overall worse since I seem to have lost some facial fat and some new indentations from where I got the allergy on my skin :( That’s why my derm is recommending Genius RF Microneedling instead since he was even too scared to do CO2 on me again (he said it doesn’t require me to slather any additional creams on after like laser and a bit more gentle). 
 

Is TCA going to help more than subcision as recommended above? Should I do a mix of both / with fillers or stick with the RF Microneedling?  My currently derm only seems to do lasers and RF Microneedling so was leaning towards that (I wouldn’t have to pay exorbitant consultation fees seeing a new derm in NYC!) but if another treatment will dramatically help more like subcision I’m opening to seeing new doctors, thanks again for all the help, I really appreciate it!

reading your "allergic" reaction sounds really similar to when i got burnt by laser (also by Fraxel). that's not allergic, Aquaphor also contains very minimal ingredients though allergic might still able to persist but very minimal. now the loss of facial fat, may I know how does the loss felt or looked like since the picture does not show that. Does the skin texture above the part that you feel there's a fat loss also compromised ie. coarse texture with orange peel like pores?

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On 11/9/2020 at 4:57 AM, Sirius Lee said:

What you see is a hypertrophic scar. A tethered scar, on the other hand, is an atrophic scar. There will be a depression, no matter how much you stretch the skin, as opposed to a "lump".

Is it though? It probably is scar tissue underneath the skin... that would not be qualified as a hypertrophic scar but simply as scar tissue within the body (Right?!). The stretching makes it more visible because it „pushes the skin against the scar tissue more leaving a visible imprint“ I don’t know how else to describe it but I have these lumps as well (cheek area). When I blow my cheeks up like a chipmunk these lumps become more visible... 

Edit: @darling_ Me too. Before accutane I did not have the scar tissue. 

 

 

 

Edited by SaraTheGerman
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On 11/22/2020 at 5:58 AM, poorbunny888 said:

reading your "allergic" reaction sounds really similar to when i got burnt by laser (also by Fraxel). that's not allergic, Aquaphor also contains very minimal ingredients though allergic might still able to persist but very minimal. now the loss of facial fat, may I know how does the loss felt or looked like since the picture does not show that. Does the skin texture above the part that you feel there's a fat loss also compromised ie. coarse texture with orange peel like pores?

My doctor even though I was allergic to the light from the laser itself lol - it was too crazy so I’m not sure if it was Aquaphor still (I was just guessing!) Fat loss is just it looks overall more “sunken” than before and the deeper scars look more shadowed. My skin was a lot better before I did it. :(  I had the orange peel texture for a month and redness for over 4 months. I was on accutane at over 120mg for over a year so it was super aggressive and permanently changed my skin, so think I heal really slowly! 
 

On 11/22/2020 at 7:20 PM, SaraTheGerman said:

Is it though? It probably is scar tissue underneath the skin... that would not be qualified as a hypertrophic scar but simply as scar tissue within the body (Right?!). The stretching makes it more visible because it „pushes the skin against the scar tissue more leaving a visible imprint“ I don’t know how else to describe it but I have these lumps as well (cheek area). When I blow my cheeks up like a chipmunk these lumps become more visible... 

Edit: @darling_ Me too. Before accutane I did not have the scar tissue. 

I have the same exact scarring. When I had severe nodulal acne on Tane I developed these extremely weird “tracks” of tissue under my skin.
 

I can feel it exactly as you said when I puff my cheeks up. It literally feels like a long hard LUMP about an inch long and like maybe a few mm wide under the skin and causes the skin around it to be slightly depressed hence I thought it was tethering. :( It’s bothered me forever since I can always feel it under my skin. I wonder if it’ll get worse with age as my skin sags... 

Edited by darling_
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Fraxels co2 platform sucks with consumable costs basically being passed down to us patients and overall performance and energy capabilities

 

id recommend to you to get a real deal subscision done to ensure all scar bands are 100% chopped and then proceed with a small spot size erbium or co2 treatment directly on those scarred areas as you seem to have good texture otherwise

 

scitons TRL at low micron with repeated pulse stacks till the skin is vaporized smooth to the eye 

Edited by aestheticseeker
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