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Rickyduds

Acne scars - am I good candidate for fillers?

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Hello,

I'm 33, living in New York and trying to improve my acne scars. The pictures are 6 weeks after a second round of subcisions/TCA cross, and I had my third round today, all with Dr. Novick. Filler was used in all of the subcisions, but the purpose wasn't for volume but to stimulate collagen (from my understanding - in any case it's not for volume). I've also done ~5 fraxel treatments about 5 years ago, but that didn't help much. I plan to continue doing TCA cross for the ice pick scars, and I was hoping for advice on treating the deeper scars.

1) Are fillers alone a good idea for volumizing my deep scars (particularly left cheek)? Subcision seems to be gradual and costly, so I want to make sure I'm not missing one that has more bang for my buck. After seeing some photos on this website's forums (particularly the journey in the link below), it seems to be a much bigger instant improvement.

2) I noticed one user waited until his ~5th subcision with Dr. Rullan before adding filler. Is there a need to wait until after multiple subcisions, or can filler be added at any time?https://www.acne.org/forums/topic/370654-still-cant-get-rid-of-scars-after-two-full-fraxel-treatments-and-accutane-pics-included/?do=findComment&comment=3623006

3) Is Dr. Novick known for injecting fillers to improve scars? He seems to be very good but I haven't discussed this at all with him (I wasn't aware this was possible until browsing around just now). 

4) Any suggestions for improving the color of my scars on my left cheek, assuming they get leveled out? He recommended microneedling today, but to wait and see how I respond to subcision (he actually talked me out of doing it at the same time today to potentially save my money in case I'm happy with just subcision!). 

Thank you so much! 

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1 hour ago, Rickyduds said:

1) Are fillers alone a good idea for volumizing my deep scars (particularly left cheek)? Subcision seems to be gradual and costly, so I want to make sure I'm not missing one that has more bang for my buck. After seeing some photos on this website's forums (particularly the journey in the link below), it seems to be a much bigger instant improvement.

The short answer is no. You don't want to inject fillers where there are prominent scar borders. It will only make your skin look lumpy. 

1 hour ago, Rickyduds said:

2) I noticed one user waited until his ~5th subcision with Dr. Rullan before adding filler. Is there a need to wait until after multiple subcisions, or can filler be added at any time?

It depends on how the filler is used. When used as a "spacer" after subcision, it is to prevent scars from re-tethering. If, on the other hand, it is used as a "volumizer", it is for elevating scar pits. 

Like I already answered in (1), if you want to volumize, you first want to minimize the scar edges as much as possible.

 

My suggestion is to continue with TCA cross to flatten the scar edges further. Once the scars look like those on your left temple, then get fillers to raise the indents.

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12 hours ago, Rickyduds said:

Thanks - so are you saying I should stop doing more subcisions for now? I'm currently only doing TCA on the ice pick scars

 

There's no point of getting subcision unless you show tethering. Those who have tethering are usually those with deep scars. If you have yet to see any big improvement from 2 rounds of subcision, you probably won't see any with 3, 4 , or 5.

Apply TCA to both icepick and boxcars. With boxcars, it's the scar borders that you want to eliminate. They're the ones that make the scars stand out. If you do enough TCA over time, usually 7-8 applications (that's about 2 year span), your boxcar edges will become more flatter (much like what you see on your left temple). At that time, you can get dermal filler to elevate any depressions to even out the skin texture.

 

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Thanks so much. And what about the pigmentation? In particular, the two scars that stand out on my left cheek near my beard line, and also my left cheek has a general redness to it. Would you go for a particular laser or something else like microneedling? How many treatments would you guess that would take? 

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3 hours ago, Rickyduds said:

Thanks so much. And what about the pigmentation? In particular, the two scars that stand out on my left cheek near my beard line, and also my left cheek has a general redness to it. Would you go for a particular laser or something else like microneedling? How many treatments would you guess that would take? 

You can try a vascular laser like Pulse Dye Laser. Not sure how many since everyone is different.

You'll want to avoid microneedling. It will only worsen the problem.

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