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Gettinggoodskin

Bad Acne Scarring | Need help for the right treatments (images included)

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Hello everyone,

I want to start my scar treatment journey and I have made an appointment to treat my acne scars. After the consult they advised me to do TCA Cross or/and Hybrid Laser. Do you think this is the right approach for my kind of scarring? They also said they can combine both treatments at the same appointment (first laser and then TCA Cross). Is this even possible to do at the same treatment and do others have had success using Hybrid laser/TCA Cross?

Really curious about your experiences and advice.

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I dont not think these scars are bad first of all. I would be happy if my skin suddenly looked like this. These are mild or maybe moderate depending on how zoomed in they are. 

But yea I think that is a good approach. Maybe even try TCA alone. You're probably going to need several treatments though. At first the TCA might make things worse by widening the scar. Eventually the idea is to wear down the edges so the scars are not as noticable. Another option you always have is to avoid treatment since the scars aren't really that bad. 

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Thanks a lot for your reply! I really appreciate it. I didn´t want to exaggerate but i think in real life or full face they do look worse. It just takes a toll on my mental health I guess. I suppose this goes for more people with acne scarring.

Just to double check: I can undergo TCA Cross and Hybrid laser at the same day? :)

Kind regards.

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I am not super familiar with hybrid laser, so I can't say for sure, but it is common to combine energy based and chemical based treatments. However personally, I always refuse having multiple treatments on the same appointments, but only because I want to see which treatments are working and which are a waste, and I am not in a hurry. 

If cost is a concern, I would do TCA first since it will probably be cheaper. 

If you are more concerned with minimizing downtime, simultaneous treatments might be better for you.

Just depends on your priorities

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What type of hybrid laser is this? Not all are the same. CO2 lasers are much more powerful than Erbium lasers, for example. Non-ablative ones don't really do much for scars unless they are extremely superficial.

Many doctors will say that collagen takes months to remodel and yada yada yada. Many of them are not proficient with lasers.

Cross will require multiple (3-6) treatments and patience. 

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7 hours ago, Gettinggoodskin said:

Just to double check: I can undergo TCA Cross and Hybrid laser at the same day? :)

No, you should save the laser for last. Hybrid is supposed to be a combination of ablative and nonablative. Seriously, I have no idea what that means or why they even decided to build such a machine. But you want to use laser to basically stimulate collagen production. So my suggestion is to first use TCA to blur out the scar edge from the top, then come in with the fractional CO2 later to stimulate collagen from below the skin.

1 hour ago, Amanda Hall said:

What type of hybrid laser is this?

It's probably Sciton Halo. I'm beginning to wonder whether we need so many lasers. :smileys_n_people_30:

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12 minutes ago, Sirius Lee said:

No, you should save the laser for last. Hybrid is supposed to be a combination of ablative and nonablative. Seriously, I have no idea what that means or why they even decided to build such a machine. But you want to use laser to basically stimulate collagen production. So my suggestion is to first use TCA to blur out the scar edge from the top, then come in with the fractional CO2 later to stimulate collagen from below the skin.

It's probably Sciton Halo. I'm beginning to wonder whether we need so many lasers. :smileys_n_people_30:

This reasoning (TCA Cross and then lasering at the end) makes sense for lots of people but I'm going to offer a different perspective. Some people want improvement faster than what TCA Cross can provide - this is where lasering in between sessions or whenever that person has time can make sense (to me). Also, if you do an aggressive CO2 laser treatment, you need to take at least a week off of work. Downtime can be up to two weeks. It's extremely hard to take that much time off unless you've accrued many vacation days. So for me, I would laser whenever I can take time off. It was really hard for me to schedule in a fractional CO2 laser treatment when I was going to the office. Then again, if you have lots of scars, TCA Cross is going to leave you with lots of scabs so you should take time off for that so you don't scare your co-workers. The best bang for the buck and most efficient way is to do manual methods first and then lasers at the end. I'm just saying that life does get in the way sometimes.

Oh yeah, I got a fractional CO2 laser treatment done recently. I finished peeling in 3-4 days. It was sooooooo mild. I doubt it's going to do anything for my deep scars. It's more like a microdermabrasion. 

Edited by Amanda Hall
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13 hours ago, Amanda Hall said:

Some people want improvement faster than what TCA Cross can provide - this is where lasering in between sessions or whenever that person has time can make sense (to me).

Not sure what you mean by "faster" here. TCA does require up to 10 days of recovery time, so it is a bit slow in that regard. But, by no means, is it any "slower" when it comes to actual improvement. The problem I see with a lot of people is that they give up too soon. With TCA, you need to be committed for at least 2 years to see a big improvement.

 

1 hour ago, Gettinggoodskin said:

@Amanda Hall, @Sirius Lee did one of you had TCA Cross done? And if so, did it work for you?

Most definitely. I've been using only TCA for the last 30 months, and I see at least 50% improvement. In my view, nothing comes close to TCA. But as I stated above, it requires patience. It won't happen after 1 treatment.

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Wow, that´s great! It takes a lot of time though.. Will you see some kind of improvement after 1 treatment? And do you have similar scars like me? I have an appointment scheduled tomorrow! Will post my progress in this topic so I can keep track and let other people know what to expect :)

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9 hours ago, Sirius Lee said:

Not sure what you mean by "faster" here. TCA does require up to 10 days of recovery time, so it is a bit slow in that regard. But, by no means, is it any "slower" when it comes to actual improvement. The problem I see with a lot of people is that they give up too soon. With TCA, you need to be committed for at least 2 years to see a big improvement.

 

Most definitely. I've been using only TCA for the last 30 months, and I see at least 50% improvement. In my view, nothing comes close to TCA. But as I stated above, it requires patience. It won't happen after 1 treatment.

I saw results from laser treatments after the scabbing came off. Most of the improvement went away gradually because it was due to swelling; however, the permanent improvement comes faster than CROSS. For example, weeks after my crater scar was lasered, I noticed that it was much smoother and more level to the surrounding skin. This remained months and years later. The other scars went from 50-60% improvement down to 5-10% after swelling subsided. But the crater saw immediate and permanent improvement. With CROSS, it takes months and a series of treatments to see the difference. 

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2 hours ago, Gettinggoodskin said:

Had TCA Cross done today! Will post pictures later on. 

If you can, keep the wound moist at all times. Do you know what concentration (%) was used?

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18 hours ago, Amanda Hall said:

I saw results from laser treatments after the scabbing came off. Most of the improvement went away gradually because it was due to swelling; however, the permanent improvement comes faster than CROSS. For example, weeks after my crater scar was lasered, I noticed that it was much smoother and more level to the surrounding skin. This remained months and years later. The other scars went from 50-60% improvement down to 5-10% after swelling subsided. But the crater saw immediate and permanent improvement. With CROSS, it takes months and a series of treatments to see the difference. 

Thanks for clearing that up. I don't know though. Not that I don't believe you but you leave me to question whether it wasn't just that one crater that saw a huge improvement (whereas other craters had little to no improvement). You know, we often see the trees for the forest. 

Even with TCA, especially after 100%, I often see at least 1 or 2 scars that respond really well and the improvement is usually permanent. The problem is that the other scars don't look as good. So I want to drive home the point that it's important to base your judgement on the cumulative improvement rather than on individual scars.

Lastly, 3 years might be considered an eternity for some. But considering how much time you still have left, it shouldn't be that long. What's more terrifying is to go through many treatments only to find out they were worthless.

Oh I forgot to mention that, with TCA, it does look crappy for the first 4 weeks. But it gradually improves with time. So in that regard, you're correct that TCA is slower.

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1 hour ago, Sirius Lee said:

Thanks for clearing that up. I don't know though. Not that I don't believe you but you leave me to question whether it wasn't just that one crater that saw a huge improvement (whereas other craters had little to no improvement). You know, we often see the trees for the forest. 

Even with TCA, especially after 100%, I often see at least 1 or 2 scars that respond really well and the improvement is usually permanent. The problem is that the other scars don't look as good. So I want to drive home the point that it's important to base your judgement on the cumulative improvement rather than on individual scars.

Lastly, 3 years might be considered an eternity for some. But considering how much time you still have left, it shouldn't be that long. What's more terrifying is to go through many treatments only to find out they were worthless.

Oh I forgot to mention that, with TCA, it does look crappy for the first 4 weeks. But it gradually improves with time. So in that regard, you're correct that TCA is slower.

I had several small boxcar scars that looked great immediately after one fractional CO2 treatment but then swelling went away and they went back to normal. However, a year later when I did another one, they got a little shallower to the point where I don't need to treat them anymore. They are still there but much more superficial and I'm happy with them. But you are right - not all scars will respond.... which leads me to this point....

Not all scars are the same. Obviously, an ice pick scar is different than a boxcar and rolling scar. But I believe that a scar on the cheek is different than one on the temple even if they are the same size and shape. In addition, I also think that a scar caused by acne is different than, say, if some object hit you - and they are the same shape and size. This is my personal and unfounded opinion. 

So yes, some of my scars improved due to laser treatments but others didn't. I don't have a large quantity of scars so even a handful of scars that improve comprise a good percentage of overall improvement. 

I've only done TCA Cross once and the dermatologist said she didn't use a high percentage since it was my first time. She also missed most of the scar and I never went back. For all of you out there, sometimes the $5 mirror you use and the lighting in your own house is better than what the doctors have. If you do Cross and have certain scars you want taken care of, communicate this with the doctor. They don't know and can't see everything.

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15 minutes ago, Amanda Hall said:

Not all scars are the same. Obviously, an ice pick scar is different than a boxcar and rolling scar. But I believe that a scar on the cheek is different than one on the temple even if they are the same size and shape. In addition, I also think that a scar caused by acne is different than, say, if some object hit you - and they are the same shape and size. This is my personal and unfounded opinion. 

Good points. From what I've noticed so far, scar pits don't merely get filled. Instead, they change shape. For instance, narrow icepick widens out to become a boxcar. Boxcar will look more like a shallow rolling scar once it loses its hard edge.

Temples and the forehead do not have as much collagen as the cheek. Less collagen means less protein. Less protein means less extracellular matrix that's critical in wound repair. So, naturally, less collagen will yield bad outcome. 

 

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11 hours ago, Sirius Lee said:

If you can, keep the wound moist at all times. Do you know what concentration (%) was used?

The doc said he was using 95%. I find this a bit strange because during our mail exchange another doctor stated that the highest they can go is 50% (due to insurance protocols). But I asked him multiple times and he said it was 95%. 

Which moisturizer should I use? I asked him about aftercare and he said 'just let it heal on its own'.

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I'm thinking of TCA and fractional co2 laser for some small boxcar scars and icepick scars. I have scars similar to yours. I also have few and small scars for many people, but I know how negatively it affects psychology and I understand you. I look forward to your results. @Gettinggoodskin

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7 hours ago, Gettinggoodskin said:

Which moisturizer should I use? I asked him about aftercare and he said 'just let it heal on its own'.

Vaseline or Aquaphor will suffice. However the viscosity is thick and makes it a little hard to apply. In that case, you can mix it with olive oil. Keep the wounds moist at all times for the next 10 days or until the scabs/crusts are gone Good luck. 

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4 hours ago, colorful said:

I'm thinking of TCA and fractional co2 laser for some small boxcar scars and icepick scars. I have scars similar to yours. I also have few and small scars for many people, but I know how negatively it affects psychology and I understand you. I look forward to your results. @Gettinggoodskin

Cross is best for icepick scars. Fractional CO2 is better for boxcar scars. Cross can work for small boxcar scars if they are narrow.

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11 hours ago, Amanda Hall said:

Cross is best for icepick scars. Fractional CO2 is better for boxcar scars. Cross can work for small boxcar scars if they are narrow.

Thank you for your explanation. Some boxcar scars are superficial and small. But one is bigger and deeper. So I believe the fractional co2 laser will work. For TCA Cross, the doctor said she could use 35%. Is it possible to get a good result with this? I think I'll need a lot of treatments.
Another doctor I spoke with said that these are enlarged pores. I can not decide.

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7 hours ago, colorful said:

Thank you for your explanation. Some boxcar scars are superficial and small. But one is bigger and deeper. So I believe the fractional co2 laser will work. For TCA Cross, the doctor said she could use 35%. Is it possible to get a good result with this? I think I'll need a lot of treatments.
Another doctor I spoke with said that these are enlarged pores. I can not decide.

Fractional CO2 lasers have many unsatisfactory reviews, just so you know. But it can also be effective. It really depends on the laser, settings, aggressiveness, and operator. Many doctors don't know how to use the lasers so you just get a basic sunburn treatment. It's also expensive and doctors make good money off of this.

35% TCA Cross could work but it could take a long time. That percentage is low compared to serious treatments. Maybe someone who has done many TCA Cross procedures can let us know their experience.

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17 hours ago, Amanda Hall said:

Fractional CO2 lasers have many unsatisfactory reviews, just so you know. But it can also be effective. It really depends on the laser, settings, aggressiveness, and operator. Many doctors don't know how to use the lasers so you just get a basic sunburn treatment. It's also expensive and doctors make good money off of this.

35% TCA Cross could work but it could take a long time. That percentage is low compared to serious treatments. Maybe someone who has done many TCA Cross procedures can let us know their experience.

Yes, if someone using TCA reads this, please let them know.
I received non-ablative Icon laser and Scarlet Rf treatments. Unfortunately, I did not see any improvement. So now I want to try Fractional CO2 laser. If they have enlarged pores, will it help them too?
I am currently on Accutane treatment. But I also want to heal my scars.

 

17 hours ago, Gettinggoodskin said:

Second day after treatment.

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How long do you expect to wait and get the new treatment? As I read here, recovery takes 7-10 days. Very moisturize and do not neglect the sunscreen. We expect you to take pictures again. Good luck.

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