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Hey friends,

I‘m very desperate and I need your help. Acne started when I was 21 and left me with scarring now turning 23 being on isotretinoin (20mg) at the moment. Had clear skin to that point and don‘t really know what suddenly triggered some cystic acne.

 

Well, seems like there are no pimples currently coming up - but I really want to get rid of my scarring. And Im tired of researching for the best treatments or doctors - I need some help from specialists like you.

 

Also please recommend dermatologists in Germany, Austria, Switzerland and surrounding ...

 

This is my scarring in the worst possible lighting.

 

Thanks for your help. It sadly got me from being full of energy to very depressed.

 

 

205C8B11-18C4-4639-95FB-77A604E3F310.jpeg

FBF26E34-D0C1-4625-9512-D47F3865CAEC.jpeg

 

 

Theres still alot of redness underneath the skin.

I‘m currently thinking about doing a Subcision treatment without fillers a week or so before doing a Fractional Co2 Ultrapulse treatment.

Do you think this is the right plan?

 

Wish you all the best.

 

832E5885-64E7-45A1-A48F-61FE4EA29AD4.jpeg

E5582845-5B9A-4AAE-861E-019763092108.jpeg

Edited by triggerklion
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6 hours ago, triggerklion said:

I‘m currently thinking about doing a Subcision treatment without fillers a week or so before doing a Fractional Co2 Ultrapulse treatment.

Do you think this is the right plan?

You have a combination of rolling and boxcar scars. Subcision would not be bad start. This will effectively cut any scar bands bound down to the bottom.

Next, you will want to get rid of any scar borders. This is especially more pronounced for boxcar scars (see below for scar comparison). As the light bounces off the edge, a shadow is created around the scar, making the scar more visible. There is a couple option for minimizing scar edge. This can be done with either TCA or ablative laser. 

 

 

image.png.77494ce00ec24a424c61375ca2a451e8.png

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2 hours ago, Sirius Lee said:

You have a combination of rolling and boxcar scars. Subcision would not be bad start. This will effectively cut any scar bands bound down to the bottom.

Next, you will want to get rid of any scar borders. This is especially more pronounced for boxcar scars (see below for scar comparison). As the light bounces off the edge, a shadow is created around the scar, making the scar more visible. There is a couple option for minimizing scar edge. This can be done with either TCA or ablative laser. 

 

 

image.png.77494ce00ec24a424c61375ca2a451e8.png

Thanks alot for your help and information!

I think I‘ll go for the ablative laser then - as I think TCA cross could be too harsh for my skin during isotretinoin. I can try that later. And do subcision before that treatment.

Sadly there are no known specialists nearby, so I just have to go with dermatologists that offer Co2 treatments. Anything I need to be aware of? Is there any laser that brings extra good results?

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34 minutes ago, triggerklion said:

I think I‘ll go for the ablative laser then - as I think TCA cross could be too harsh for my skin during isotretinoin. I can try that later. And do subcision before that treatment.

 

Oh, my mistake. I thought you were off isotretinoin for some time. If you're currently on isotret, then you shouldn't be getting an ablative laser. You need to wait at least 6 months. Subcision is fine though.

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4 minutes ago, Sirius Lee said:

Oh, my mistake. I thought you were off isotretinoin for some time. If you're currently on isotret, then you shouldn't be getting an ablative laser. You need to wait at least 6 months. Subcision is fine though.

I read that there is no problem with having fractional Co2 treatments while being on low dose isotretinoin.

- isn‘t this true?

I also got tattoos (which is not recommended because of the healing process) and everything was fine.

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Just now, triggerklion said:

I read that there is no problem with having fractional Co2 treatments while being on low dose isotretinoin.

- isn‘t this true?

Fractional is okay. Ablative is not. Here's an illustration between the two treatment. As you can see, ablative involves a complete vaporization of your outer tissue.

 

image.png.722b00a7e3938fc1e48dafdec96af34c.png

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1 hour ago, Sirius Lee said:

Fractional is okay. Ablative is not. Here's an illustration between the two treatment. As you can see, ablative involves a complete vaporization of your outer tissue.

 

image.png.722b00a7e3938fc1e48dafdec96af34c.png

Thanks for your Illustration. Any help means alot to me at the moment.

 

Will fractional ablative treatman get rid of red-dots and other pigmentations caused by acne?

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1 hour ago, Sirius Lee said:

Fractional is okay. Ablative is not. Here's an illustration between the two treatment. As you can see, ablative involves a complete vaporization of your outer tissue.

 

image.png.722b00a7e3938fc1e48dafdec96af34c.png

Looking at this graphic one would think that fully ablative is safer than fractional ablative simply because it is not deep enough to cause issues to the deeper layers. It's what doctors like Dr H in London keep telling at least. It would be nice to hear the opinion of other specialists too whether they can corroborate or not, because lasers do seem to give improvement. 

 

This is very interesting to me because I haven't seen lots if doctors who do full ablation..They all seem to prefer fractional ablation for some reason. 

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6 hours ago, Sisi90 said:

Looking at this graphic one would think that fully ablative is safer than fractional ablative simply because it is not deep enough to cause issues to the deeper layers. It's what doctors like Dr H in London keep telling at least. It would be nice to hear the opinion of other specialists too whether they can corroborate or not, because lasers do seem to give improvement. 

 

This is very interesting to me because I haven't seen lots if doctors who do full ablation..They all seem to prefer fractional ablation for some reason. 

I‘ve also been reading about different opinions. Like one ablative treatment gives the improvement of 3 fractional but on the other side I‘m reading that fractional gives better improvements.

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38 minutes ago, triggerklion said:

I‘ve also been reading about different opinions. Like one ablative treatment gives the improvement of 3 fractional but on the other side I‘m reading that fractional gives better improvements.

Me too. And I don't know what is better. The studies on laser improvement that I have read on Pubmed ( Dr Drey advices to look everything up on pubmed, not on Google because on Google you may come across biased opinions) show improvement from fractional lasers. Also Dr Emil and Dr Lim seem to use fractional mostly judging by their posts on social media. But it also makes sense that if you get full ablation some shallow scars might disappear, I don't know. According to Dr Lim you get the biggest collagen boost (collagen remodelling to fill deeper scars) with fully ablative CO2 lasers. It's interesting what's the source of this info though. 

I'm going to visit Dr Emil soon and will ask him about this, what his opinion is and will tell you.

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2 hours ago, triggerklion said:

I‘ve also been reading about different opinions. Like one ablative treatment gives the improvement of 3 fractional but on the other side I‘m reading that fractional gives better improvements.

The only comparative study of different types of lasers in the treatment of acne scars of 2016 shows among other findings that:

1.)Three consecutive fractional ablative laser treatments are as effective as a single treatment with resurfacing lasers, with shorter social downtime periods and less adverse effects.

2.)All three lasers fully ablative CO2, fully ablative Erb:Yag and fractional ablative laser show improvement of the scarring; only the nonablatve fractional doesn't. 

3.)The fully ablative CO2 laser treatments are associated with more redness and pigmentation complications. In this regard fully ablative Erbium lasers are safer than fully ablative CO2 lasers. 

https://pubmed.ncbi.nlm.nih.gov/26880620/

 

1 hour ago, Sisi90 said:

Me too. And I don't know what is better. The studies on laser improvement that I have read on Pubmed ( Dr Drey advices to look everything up on pubmed, not on Google because on Google you may come across biased opinions) show improvement from fractional lasers. Also Dr Emil and Dr Lim seem to use fractional mostly judging by their posts on social media. But it also makes sense that if you get full ablation some shallow scars might disappear, I don't know. According to Dr Lim you get the biggest collagen boost (collagen remodelling to fill deeper scars) with fully ablative CO2 lasers. It's interesting what's the source of this info though. 

I'm going to visit Dr Emil soon and will ask him about this, what his opinion is and will tell you.

 

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8 minutes ago, BlueMaloney said:

2016 yılı sivilce izlerinin tedavisinde farklı lazer türlerinin karşılaştırmalı tek çalışması, diğer bulgular arasında şunları göstermektedir:

1.) Üç ardışık fraksiyonel ablatif lazer tedavisi, daha kısa sosyal aksama süreleri ve daha az yan etki ile yüzey yenileme lazerleriyle tek bir tedavi kadar etkilidir.

2.) Üç lazerin tümü, tamamen ablatif CO2, tamamen ablatif Erb: Yag ve fraksiyonel ablatif lazer, yara izinde iyileşme gösterir; sadece nonablatve kesirli değil. 

3.) Tamamen ablatif CO2 lazer tedavileri, daha uzun kesinti süresi ve daha yüksek komplikasyon oranı ile ilişkilidir. Bu bağlamda, tamamen ablatif Erbium lazerleri, tamamen ablatif CO2 lazerlerden daha güvenlidir. 

https://pubmed.ncbi.nlm.nih.gov/26880620/

 

How many non ablative fractional laser (e.g. Icon palomar) is equivalent to 1 fractional co2 treatment?

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1 minute ago, colorful said:

How many non ablative fractional laser (e.g. Icon palomar) is equivalent to 1 fractional co2 treatment?

I don't know. I just researched this on the above site and found the study, read only the abstract. Maybe this is answered in the full text. 

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25 minutes ago, BlueMaloney said:

The only comparative study of different types of lasers in the treatment of acne scars of 2016 shows among other findings that:

1.)Three consecutive fractional ablative laser treatments are as effective as a single treatment with resurfacing lasers, with shorter social downtime periods and less adverse effects.

2.)All three lasers fully ablative CO2, fully ablative Erb:Yag and fractional ablative laser show improvement of the scarring; only the nonablatve fractional doesn't. 

3.)The fully ablative CO2 laser treatments are associated with more redness and pigmentation complications. In this regard fully ablative Erbium lasers are safer than fully ablative CO2 lasers. 

https://pubmed.ncbi.nlm.nih.gov/26880620/

 

 

I think the only option here is to try it out and see how our skin reacts. I don‘t care about the downtime. But seems like I can‘t go for a fully ablative laser during isotretinoin 20mg course.

 

So it will be fractional ablative treatment and I heard the Lumenis Ultrapulse Laser would be the best option here - am I right?

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14 minutes ago, triggerklion said:

 

I think the only option here is to try it out and see how our skin reacts. I don‘t care about the downtime. But seems like I can‘t go for a fully ablative laser during isotretinoin 20mg course.

 

So it will be fractional ablative treatment and I heard the Lumenis Ultrapulse Laser would be the best option here - am I right?

You have fresh scars and fair skin. I think the fractional ablative treatment would work well for you but please consult with your doctors. They will know best. Lumenis Ultrapulse is a good laser.

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2 hours ago, BlueMaloney said:

The only comparative study of different types of lasers in the treatment of acne scars of 2016 shows among other findings that:

1.)Three consecutive fractional ablative laser treatments are as effective as a single treatment with resurfacing lasers, with shorter social downtime periods and less adverse effects.

2.)All three lasers fully ablative CO2, fully ablative Erb:Yag and fractional ablative laser show improvement of the scarring; only the nonablatve fractional doesn't. 

3.)The fully ablative CO2 laser treatments are associated with more redness and pigmentation complications. In this regard fully ablative Erbium lasers are safer than fully ablative CO2 lasers. 

https://pubmed.ncbi.nlm.nih.gov/26880620/

 

 

This is pretty much what the scientific literature has to say on lasers and acne scars currently. All lasers apart from the non-ablative ones are supposed to yield some degree with improvement, the fully ablative ones having bigger risks for complications. Btw, I haven't come across the study that compares the collagen remodeling as stimulated by the different types of lasers, but I'm just a patient and am not 24/7 on these scientific sites. It would be interesing to read why Lim and H believe the fully ablative co2 by lumenis gives the biggest collagen boost - based on science, personal experience, etc., or what exactly? 

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7 hours ago, BlueMaloney said:

You have fresh scars and fair skin. I think the fractional ablative treatment would work well for you but please consult with your doctors. They will know best. Lumenis Ultrapulse is a good laser.

Seems like dermatologists in Austria and Germany are shut down cause wie are in Lockdown. So my only option is to find someone in Switzerland - and I don‘t have specialists  to talk to at the moment. Just you guys.

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1 hour ago, triggerklion said:

Seems like dermatologists in Austria and Germany are shut down cause wie are in Lockdown. So my only option is to find someone in Switzerland - and I don‘t have specialists  to talk to at the moment. Just you guys.

There is a doctor in Switzerland. Dr Clara Boudney, trained by Dr Rullan. She does subcision and peelings if I remember correctly. 

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9 hours ago, BlueMaloney said:

There is a doctor in Switzerland. Dr Clara Boudney, trained by Dr Rullan. She does subcision and peelings if I remember correctly. 

Oh that‘s a super helpful information, thank you!

 

So you think she‘s a good option? She also does lasers.

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3 hours ago, triggerklion said:

Oh that‘s a super helpful information, thank you!

 

So you think she‘s a good option? She also does lasers.

You are welcome. I remember a forum user was very glad with the results she had with Dr Boudny. She also does phenol cross.

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Hello!

 

I‘m back with some questions. I went to inform myself about treatments at Mrs. Boudneys but she didn‘t want to perform fractional Co2 during my isotretinoin circle ...

I then reached out to another good rated doctor which does Lasers and Microneedling (No Subcision, No Peelings, ...) and she said the best treatment for my scars would be INFINI RF.

I‘m now not very sure if that‘s the way to go ... also I‘m scared of the needles making me break out again and/or leaving gridmarks. 

What do you think? Is it good to go with INFINI RF - what are your expiriences.

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