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dauphin

treatments for my shallow-ish acne scarring?

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Hi everyone,

I've recently begun the process of treating my acne scarring seriously, and would really be grateful if anyone on this forum with experience going through acne scar treatments could help provide some advice and reccomendations for things I should do. I believe my scarring is on the shallower side(objectively speaking) so no significant fat loss or large atrophy, and I'm wondering which treatments would likely give the best results. I have a lot of smaller scars on my right side which resemble 'nicks' in the skin, almost as if fingernails dented it, as well as what look like small irregular holes like commas and periods (lol) which I dont think are big or deep enough to be considered true icepick scars, and some small shallow line-scars running across the skin. Whereas on my left side I seem to have broader scars which look like patches of grey under lighting and are very noticeable despite almost being the same level as the regular skin around it, as well as some 'nick' type scarring on my temple. (pics below)

Would tca cross and subcision benefit me at all(I believe there are some subcisable areas) or would I have to rely almost entirely on the more expensive or harsher energy treatments like Infini and laser for a more 'resurfacing' purpose? Or better yet, would it be possible to achieve significant improvement(80%+) using at-home tca peels and dermastamping? Essentially, I'm quite lost on the route I should take, and am very concerned about the unwanted effects of laser and the tca-peel-dermastamp-alternate method, specifically the possibility of additional scarring and orange-peel texture. I've been to 2 dermatologists so far and one has reccomended about 3 sessions of infini at about 1.3k each session(stating that my scars are too shallow for tca or subcision) while the other has reccomended subcision with filler for 2k total(focusing on the broad shadowy areas of the cheeks) along with possibly laser afterwards(im really hesitant due to the high cost of just one session of subcision with filler that may not even have permanent effects).

I guess im mainly wondering which clinical treatments would actually effectively target my type of scarring, and subsequently whether I ought to try to do the tca-peel alternating with dermastamping method by myself over the long term(a year or two) to try to smooth out the texture and milder scars, due to my concerns about their safety and effectiveness.(people do sometimes report dermastamping and tca peels giving them more scarring or making their skin worse, although the reasons are unclear and Im unsure whether it can be avoided by simply following proper methods).

I hope those with experience could share more, especially those with shallower type scarring or those who've had results with the tca peel-microneedling method. When I do eventually begin treatments, I'll try to share my results and thoughts here if I see any significant changes(for better or worse). I've lurked for quite a while on this forum but only now have I finally mustered the guts to actually try to do something to fix these scars which actually bother me quite a lot. 

Thanks everyone!

 

Right side:

1.png.80461903a0e61f0fbd05c765d2190963.png

2.png.49fe4344ae424d3e4409ac631778565e.png

(I think the bottom scar would be good for subcision?)

(Also what exactly are those small irregular holes in the skin that almost look like pores? Are they scars and would it be possible to improve them?)

Left side:

3.png.696147bb32692567c5db9908854bd3a1.png

4.png.214b1d01286ef094d2dfd37cf94cd755.png

5.png.fbd578e852356b47c43da91e3e9694c0.png

 

(Tried to find good lighting to highlight the scars)

 

Edited by dauphin
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As you may already know a picture is worth a thousand useless words. I can see your scars but, unfortunately, I can't really make out the depth. Can you please make another snap using the suggestion as follows?

Consider taking a picture using the angle-lighting approach like the one shown in the picture below. This will create a heavy shadow that will accentuate the scar for better evaluation. This can be done by pointing a bright light perpendicular to the angle of the lens. So if you're shooting the side of the face, you would point the light from either the front or the back of the face.

image.png.e235ad914ccddcb765af7612633aeacc.png

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Hey @Sirius Lee

Sorry for taking so long to reply :p

Maybe something like this?

Left:

1.png.3c8fc506062b1da38cffae20696dcf30.png    2.png.ad840b438d6e9824a223155f3cb19cb8.png3.png.6cab75210e6c70530b5ade5dc55cea1c.png

I guess there's a group of them concentrated around next to the mouth area and another group below the cheekbones?

 

Right:

5.png.f9ac6c53c1bc5803f5feaefa8d7afbda.png4.png.744d31a61647f06febc3c1ac66e4e843.png7.png.f2259edb823bd8f794541ab652da3adf.png

 

Here's one under more normal lighting:

6.png.c3c6b52d9e79a85519a539f9354ef8f7.png

I believe the red area highlighted should be the deepest single scar I have.

From the pictures do they look deep enough to be subcisable or require filler? Or more texturable and treatable with just resurfacing and collagen induction?

Sometimes when I run my finger along some of the scar areas I can feel some semi-hardish round lumps under the skin in the middle of the more pliable tissue. Is this what would be called fibrosis? and thus subcisable? or is it something else like an underground pimple or closed comedone or anything more concerning?

 

Also, I went to see another dermatologist who offered a set of 3 rf treatments + subcision before each one for about 3k total, I think I'll go with that since it seems more affordable for what theyre offering. I'm hoping the subcision will raise up some of the deeper scars as well as make sure theres no more tethering while the rf will improve the shallow scars and scarred pores/line-type scars? I'm really hoping that I could get maybe 70% improvement from this and maybe smooth out the rest with peels and dermastamping at home if im still not satisfied.

On a scale of 1-10 how would you rate the severity of my scars?

On a somewhat unrelated note, I kind of feel guilty for spending so much money on something 'cosmetic' (especially since im still a student) and being so shallow but yet at the same time my scars really get me down sometimes and constantly act as a mental burden and almost have a damping effect that seems to hold me back from being really content and happy in the moment. (which i guess might sound really dumb) Has anyone felt anything like this? and how do you console yourself and tell yourself that its okay to do what youre doing :p

 

thanks guys

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Quick update: went for my first treatment over a day ago, so far still healing and face is quite puffy, swollen, and red. Can't see most of my scars now but I guess that is because of the swelling, a few of the deeper scars are still slightly noticeable though. On a side note I seem to have several pin sized dark red dots splattered around my face, I'm not sure whether they are just dried blood or scabbing or wounds and if I should be concerned. Also the subcision entry points are still visible as small red clots on the skin. 

 

Will update in maybe a few weeks or so if anyone's interested. 

Edited by dauphin
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Update: 

Okay, just went for my second session.

Kinda forgot to take pictures right before so I'll have to go by personal estimates.

I think I did see some improvements at the 2 month mark after my first treatment session. Most of the improvements seem to be for the broader shallower scars on the left side though, if I had to give an estimate I would maybe say 20%? Under overhead lighting I feel they are definitely less noticeable. Oddly enough, I feel that they were at their shallowest a few days after my suction routine ended, and in the weeks since then they've kinda deepened again, still not as deep as before though.

As for the more defined and discrete nick-like scars I honestly can't really tell if they've become obviously shallower or smaller. I estimate maybe just 10% improvement? Since in certain kinds of lighting they don't appear as deep or prominent as before.

During my second subcision, I was surprised to hear many of the same 'popping' sounds in the same areas as my first session. I had thought that many of the tethers would have been cut after the first subcision and this time I would hear fewer tethers being cut. This makes me wonder whether I will ever reach a point where popping sounds could no longer be heard at all if one were to try to cut underneath the scars, meaning all of the tethers have been released.

Also, I seem to have developed hard nodule-like bumps under my skin after the procedure. They kinda feel just like hard acne pimples but don't really hurt and somehow seem to mostly be concentrated under the scar areas, especially the more severe areas. Are these the inflammed scar tissue that was cut during subcision? Even before treatments I could sometimes feel semi-hard round lumps under my most severe scar pits, though I've never really been concerned as to what they really are. Are they just scar tissue? and if so, does getting rid of the pits first require getting rid of these lumps? 

 

 

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