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boxthatboxcar

Second opinion on my professional advice

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I went to a dermatologist a week ago who recommended 1 subcision + 6 non ablative fraxel sessions for my scars. The fraxels cost a lot (CAD 600 per session) but I am really keen on the subcision, so I am confused as to how to proceed. I understand that subcision only cuts off the tethering and I will definitely need something to resurface the scar. I was wondering if  could switch that with cheaper but  professional dermapen micro needling instead. Does subcision + 6 derma pen sessions sound like a reasonable plan for my type of scars? Should I at least try one session of the fraxel and then continue with the micro needling every month? (One fraxel is all I can afford, so Im trying to be as systematic about it as possible). Im attaching pictures for reference as my previous post got deleted by acne.org.

Important info: I have brown ethnic skin (that appears lighter on photographs, so please don't be deceived)

 

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You mostly have a combination of boxcar and rolling scars. Between the scale of 1 and 10, I would rate them around 7. Considering their severity, you require something more aggressive than "light" (dermapen) or "non-ablative" (laser).

  

3 hours ago, boxthatboxcar said:
  1. I went to a dermatologist a week ago who recommended 1 subcision + 6 non ablative fraxel sessions for my scars. 
  2. I was wondering if  could switch that with cheaper but  professional dermapen micro needling instead. Does subcision + 6 derma pen sessions sound like a reasonable plan for my type of scars?

1. YES to subcision and NO to laser. In fact, you will need more than 1 subcision. I would say at least 3 sessions for now. Laser, especially non-ablative laser, will be of no use for your scars whatsoever. You will be better off treating them with TCA instead.

2. Dermapen will not help in your case. Dermapen is a good choice for addressing wrinkles and very shallow scars, but totally ineffective against deeper scars.

 

* Why would you need so many laser treatments, especially non-ablative lasers for your type of scars? The fact that your doc recommended such a nonsense tells me he is not worth your salt. Don't waste your money. Go find yourself someone who is more qualified.

 

 

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I have another question - Im thinking of starting TCA peels with a clinic next year but this month I have a simultaneous subcision+ micro needling booked. Since the dermatologist is not injecting a filler, I would like to do suction/chinese cupping after the procedure but how long should I wait after the micro needling to start?

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4 hours ago, boxthatboxcar said:

I have another question - Im thinking of starting TCA peels with a clinic next year but this month I have a simultaneous subcision+ micro needling booked. Since the dermatologist is not injecting a filler, I would like to do suction/chinese cupping after the procedure but how long should I wait after the micro needling to start?

First, you should ideally wait 3 months in between treatments. This is about how long it takes to form collagen and any premature treatment will only hamper this. So I would book your TCA sometime in March.

Second, this is very important. Make sure what you are getting is NOT a standard TCA peel (eg. low strength TCA). That is completely useless and just a waste of time and money. What you need is a TCA cross, which utilizes higher TCA strength (usually from 70% to 100%). Ask the clinic what TCA concentration is used and what the procedure entails.

Lastly, will you be getting RF microneedling or the non-energy microneedling? If it's RFM, you will likely ooze and scab for the first week, so I'm not sure whether it's a good idea to suction in the first week. If you were getting only subcision, or sub + dermapen, then you can suction immediately. But I'll let others with more experience weigh in on this.

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Yeah, I think Im doing only subcision+dermapen this month. I don't want to get into energy devices this early in my scar revision journey. Thank you for the info on TCA CROSS. Im going to enquire about TCA cross options at my next dermatologist visit.

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Hi everyone, an update on this thread. I got my first subcision today with tumescent anesthetic. The anesthetic is wearing off but I feel like the scars look just the same. I have a micro needling session scheduled for tomorrow and I intend on suctioning from day after tomorrow. Is there anything I am doing wrong? I see a lot of people on this forum show swelling for a few days before the scars appear again so I am not sure if there is anything I am doing wrong. Can scars retether in a span of hours?

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17 minutes ago, boxthatboxcar said:

Hi! I live in Montreal :)

Thanks for the info! The reason that ask is that my derm has offered me the similar treatment plans when I have started my journey. Good luck on your treatments! 

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27 minutes ago, boxthatboxcar said:

Oh, did you start your treatment or are still considering your options?

I've started my treatments from the end of 2019. For now, I have had 5 Fraxel Restore, 2 subcision, 2 fillers and 1 TCA. Probably seen around 30% improvement, which is not very prominent.  I can see the difference from the B&A photos, but cannot tell from the mirror itself. May be I am seeing myself every day in the mirror and I've already forgot how did I look before. 

I am considering taking 1-2 Fraxel Repair treatments for more improvements. TBH, I think Fraxel Restore is a gentle laser, which won't work well for moderate/severe scars. 

 

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3 hours ago, Jack817 said:

I've started my treatments from the end of 2019. For now, I have had 5 Fraxel Restore, 2 subcision, 2 fillers and 1 TCA. Probably seen around 30% improvement, which is not very prominent.  I can see the difference from the B&A photos, but cannot tell from the mirror itself. May be I am seeing myself every day in the mirror and I've already forgot how did I look before. 

I am considering taking 1-2 Fraxel Repair treatments for more improvements. TBH, I think Fraxel Restore is a gentle laser, which won't work well for moderate/severe scars. 

 

Restore is just $ for the doctor when it comes to scar treatment.

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7 hours ago, Amanda Hall said:

Restore is just $ for the doctor when it comes to scar treatment.

There's a reason that I select Restore at the very beginning. I have some keloids on my back, therefore, the doctor didn't wanna risk to use Repair.

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Do you have any subcision after-care tips? I feel like my scars look exactly the same and it has only been 24 hours since my subcision. I see everyone has post-subcision swelling that gives a false-positive result for a week or two. It feels a bit underwhelming, tbh.

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1 hour ago, boxthatboxcar said:

Do you have any subcision after-care tips? I feel like my scars look exactly the same and it has only been 24 hours since my subcision. I see everyone has post-subcision swelling that gives a false-positive result for a week or two. It feels a bit underwhelming, tbh.

Do you use cannula for subcision? If so, it is not supposed to introduce tons of swelling. Also, I think it depends on if the doctor performs a full-face  and how aggressive it goes. You can try use Vaseline on the incisions and keep the face moisturized and might suction from day 3 (Some people suggest it to prevent re-tethering, but there's no strong science behind this modality. )

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3 hours ago, boxthatboxcar said:

Do you have any subcision after-care tips? I feel like my scars look exactly the same and it has only been 24 hours since my subcision. I see everyone has post-subcision swelling that gives a false-positive result for a week or two. It feels a bit underwhelming, tbh.

If may just be that the scars were never really tethered and volume loss is the issue.  I notice smaller shallow pits especially tend to look the same even when I am swollen.  Did you hear a significant amount of popping?  It is also your first subcision so you aren't going to see much of a difference.  I didn't really start noticing improvement until my third. 

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Yes, the subcision was from cannula. It was both my cheeks and I did hear popping on both sides. 

That's reassuring to know that my response might be normal. Ill start cupping tomorrow for a week. 

I was supposed to have a derma pen treatment today to supplement yesterday's subcision but my aesthetician cancelled my appointment because she is worried she might have contracted COVID-19. I am contemplating like just running my 0.5 mm dermaroller on my cheeks (even though I know its nowhere close to the 2.5-3 mm the aesthetician would have used).

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I see your right cheek is not that "wavy" anymore, which I think is because your tethered scar issues have been cut. Your boxcars won't be improved a lot by only subcision especially you only have one done, since it is intended for tethered rolling scars only. Other scars need other methods.  

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The ones with the clear hard edge are boxcars that will not improve immediately with subcision because they are due to volume loss. The best way to treat these in my personal experience is TCA cross to smoothen out the edges as much as possible and eventually filler in those areas.

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On 12/18/2020 at 5:16 PM, boxthatboxcar said:

What would you recommend (other than TCA CROSS and micro needling) for these scars?

You can try either RFM or laser. Personally speaking, I prefer ablative laser instead of TCA cross or any other ACIDs. The reason is simple. The doctor can control laser way better than ACIDs and it is much more accurate than ACIDs. ACIDs is liquid, and you can barely control where it goes when it touches the skin. 

You can use ablative lasers to sand down the edges so that they can blur into normal skin. Also, if you scars are in the early stage, like less than 3 months old, RFM can produce good results as well. 

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8 hours ago, boxthatboxcar said:

A picture update of my left (1st) and right (2nd) cheek. I personally feel like there has been no improvement ..

Well, you didn't exactly expect a huge improvement with only one round of subcision, did you?

That's not to say we don't feel you. We've all been there. Feeling down and even humiliated. Even after spending all this time and effort, let alone money, you see little to no improvement. I get it. But you need to be realistic. You need a plan.

First, you need to understand what subcision is. It's sole purpose is to sever the scar fibers and thus lift the scars that are held down. If there are no scar fibers, however, there won't be anything to lift. And that in itself can be a good thing.

Knowing that you have no tethering, let's take this up to the next level. You have a lot of boxcars with very defined border. I'm not gonna sugarcoat it. They're about 7 (between 1 and 10). If you've been reading what I've written about boxcars, you would know that it's not the scar pit but the edge that accentuates the scar. From certain angles, your scars stand out more like a sore thumb, doesn't it? This is due to the light bouncing off these edges. Hence, first and foremost, you need to get rid of those edges

As I outlined in my previous reply (look above), you need TCA Cross. This will effectively flatten those edges over time. How much improvement can you expect? Who knows, it depends on your healing cofactor. Everyone heals differently. But if you stick around long enough, I figure it would bring you down from 7 to at least 4 or 3. How many treatments in all? Again, I cannot say for sure, but you'll need to repeat the treatment every 3 months for at least (I'm guessing) 2 years to see any noticeable improvement. You will see improvement, that I can guarantee. But you need grit and stamina. It ain't gonna happen overnight. 

 

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