Jump to content
Acne.org
Search In
Find results that contain...
Find results in...
helppls001

Seeking help - completed 6 Fraxel Re:Store sessions with no improvement

Recommended Posts

Hello, I am 26 years old, Asian, with level 3-4 Fitzpatrick skin (light skin, dark brown hair and eyes). I have 9-year-old deep boxcar and ice-pick acne scars on my cheeks + forehead that I'm trying to improve. I've had multiple dermatologists confirm that the scars are not tethered.

 

I've had 6 Fraxel re:store sessions over the last few years but there has been absolutely no difference in my scars. When I started these sessions, the dermatologist assured me that I would see a notable difference after 6 procedures, but nothing has improved.

 

They perform the Fraxel at level 6 (I think level 10 is the max, but they refuse to go any higher than 6 because of my skin type). They've increased the frequency each session: started at 25mJ, then increased to 35mj, 45mJ, 50mJ, 55mJ, and 65mJ respectively for each session. After each session, I noticeably swell up and turn red for ~2 weeks, and after about a month and a half, my skin is entirely back to normal.

 

During my last session, the dermatologist walked in and stated that "Fraxel seems to be having no impact". He then recommended punch grafts for my scars using the skin from behind my ears, which he quoted the price to be around $10k. I am a college student have already spent $7k+ on the Fraxel sessions.

 

I went to 4 other reputable dermatologists in the area for a second opinion. They all stated that punch grafts should not be required for my scars. They said a laser procedure (with the correct settings) should've been enough to improve my scars by around 90%. A few of them mentioned that my dermatologist was probably trying to scam me by using Fraxel settings that were too low to make a difference on acne scars, and then selling me another expensive treatment afterwards.

 

I'm very confused with what to do now - is the reason why I've seen no improvement after Fraxel because the settings have been too low? Should I continue with Fraxel? I am also considering fillers like Bellafill. Would anyone recommend fillers or an alternative treatment in this case?

 

I have attached pictures of my skin below - the first is before Fraxel, and the second is after 6 treatments of Fraxel. The lighting/angle is slightIy different, but you can see the largest boxcar scar has not changed in depth. I would appreciate any advice or suggestions. Thank you!

face2.jpg

 

face1.jpg

Edited by helppls001
Link to post
Share on other sites
2 hours ago, helppls001 said:

I've had 6 Fraxel re:store sessions over the last few years but there has been absolutely no difference in my scars. When I started these sessions, the dermatologist assured me that I would see a notable difference after 6 procedures, but nothing has improved.

Fraxel restore is really meant for wrinkles or very minor scars. Your scars need something much stronger than re:store. He obviously don't know much about scars. High time you search for another derm.

2 hours ago, helppls001 said:

During my last session, the dermatologist walked in and stated that "Fraxel seems to be having no impact". He then recommended punch grafts for my scars using the skin from behind my ears, which he quoted the price to be around $10k. I am a college student have already spent $7k+ on the Fraxel sessions.

Again, the guy seems more interested in fattening up his wallet than your wellbeing. Fire him and move on to another doc.

3 hours ago, helppls001 said:

I'm very confused with what to do now - is the reason why I've seen no improvement after Fraxel because the settings have been too low? Should I continue with Fraxel? I am also considering fillers like Bellafill. Would anyone recommend fillers or an alternative treatment in this case.

You mainly show boxcars. Boxcars are those with prominent edges. It's these edges, when light is reflected, that make them stand out more. The best way to treat boxcar IMO is to smooth the edge using TCA, from 50% to 100%. Once the edges have been blurred and scars appear relatively even, then you can get dermal fillers to elevate the pit. Until then, fillers should not be used. 

Go find a board-certified dermatologist who offers TCA. 

TCA will smooth out the edges over time. You will most likely need 4 or more treatments, each spaced out 3 months apart. Do not rush treatments (like someone said, this is a marathon, not a sprint). That will only hamper collagen remodeling. 

Hope that helps.

 

 

 

Link to post
Share on other sites

Your settings are too low for Fraxel restore. It needs to be at least 50mj to be effective. Also the number of passes are also very important. If you only do 1 - 2 passes, it does nothing to you. Yu need to have at least 8-10 passes.

Also Fraxel restore is meant to be effective for rolling or shallow boxcar scars. It has minimal effect on ice picks. 
Scar treatment is not one and done. You need to combine different treatments to have some improvements.

i have done 4 rounds of restore and 2 subcision and 2 fillers and one TCA. My derm commented that I have about 30% improvement. 

Edited by Jack817
Link to post
Share on other sites

Unfortunately, Fraxel is a very ineffective treatment for acne scars. Has been largely replaced by other modalities like RF microneedling. Look up davin lim's videos.

 

Edited by scarryface
Link to post
Share on other sites

Hi @Sirius Lee, @Jack817, and @scarryfacethank you for inputs. I had a consultation with a new doctor yesterday and he gave me two options:

1) 2 sessions subcision + 3 sessions Genius RF Microneedling (with PRP) ($6000)

OR

2) 1 session subcision + PRP + 1 session Mixto CO2 laser ($2850)

 

His first choice was #1, Genius Microneedling, since he said recovery time would be faster + less chance of hyperpigmentation. However, I'm leaning towards the CO2 laser because of the price point. Also, I'm going to be at home for the rest of 2021 due to the pandemic, so I don't mind the healing taking longer so as long as I can see visible results. 

However, when I asked the doctor about how aggressive he would go with the CO2 laser, he would not give me any technical details regarding the energy, number of passes, or density. He said a 25% improvement would be something he'd be satisfied with, so I'm not entirely sure what to think. He was also very against TCA Cross and says he doesn't perform that due to hyperpigmentation issues in ethnic patients. Also, I should mention that he specializes in Asian and ethnic skin types.

What do you guys think? I'm going to send him an email and ask again about the energy/passes/density he plans to use for the CO2 laser, but I'm not sure he'll give me a technical answer. I know the CO2 laser can yield drastically different results depending on the settings used ("buff and shine" mild treatments vs. aggressive treatments for scarring) so I'm not sure. What would you suggest?

Link to post
Share on other sites
13 hours ago, helppls001 said:

What do you guys think? I'm going to send him an email and ask again about the energy/passes/density he plans to use for the CO2 laser, but I'm not sure he'll give me a technical answer. I know the CO2 laser can yield drastically different results depending on the settings used

As they say "a laser machine is only as good as its operator." 

Frankly, however, I don't think you will gain much improvement from either Genius or the Mixto. You might see some skin tightening from collagen synthesis but they won't help with your scar border, which is what makes your scar look like scar. If you were to get rid of the scar border, you will see just a wavy undulation. At that time, you only need fillers to smooth out the texture.

But with these treatments, no can do.

Link to post
Share on other sites
On 1/29/2021 at 10:16 PM, helppls001 said:

Hi @Sirius Lee, @Jack817, and @scarryfacethank you for inputs. I had a consultation with a new doctor yesterday and he gave me two options:

1) 2 sessions subcision + 3 sessions Genius RF Microneedling (with PRP) ($6000)

OR

2) 1 session subcision + PRP + 1 session Mixto CO2 laser ($2850)

 

His first choice was #1, Genius Microneedling, since he said recovery time would be faster + less chance of hyperpigmentation. However, I'm leaning towards the CO2 laser because of the price point. Also, I'm going to be at home for the rest of 2021 due to the pandemic, so I don't mind the healing taking longer so as long as I can see visible results. 

However, when I asked the doctor about how aggressive he would go with the CO2 laser, he would not give me any technical details regarding the energy, number of passes, or density. He said a 25% improvement would be something he'd be satisfied with, so I'm not entirely sure what to think. He was also very against TCA Cross and says he doesn't perform that due to hyperpigmentation issues in ethnic patients. Also, I should mention that he specializes in Asian and ethnic skin types.

What do you guys think? I'm going to send him an email and ask again about the energy/passes/density he plans to use for the CO2 laser, but I'm not sure he'll give me a technical answer. I know the CO2 laser can yield drastically different results depending on the settings used ("buff and shine" mild treatments vs. aggressive treatments for scarring) so I'm not sure. What would you suggest?

It is your right to ask for the tech details and I don't see a reason why the doctor refuses to provide that.  If the doc doesn't provide it, move to other doctors. 

Otherwise, how will you know if either the setting is too high which is gonna cause lots of side effects or is too low to have any effect? 

Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


  • Personalized Advice Quiz - All of Acne.org in just a few minutes


×