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Icedcoffeelatte

What treatment should I get for these scars?

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Hi! 
 

Could someone tell me what type of scars these are? And what treatment I should get? I went on accutane over a year ago and I haven’t gotten a zit since then, so, the scars I have are fairly old. I’ve done 6 sessions of microneedling after I finished the medication. However, I’m wondering whether I should try a different treatment or if I should just continue with the microneedling. I’ve certainly seen improvement although it’s not as dramatic as I’d like it to be. I live in British Columbia and it takes over a year to see a dermatologist in the city I’m in, which is why I decided to go ahead with microneedling at a cosmetic clinic, assuming it’s the best option. As other options at these cosmetic clinic’s, I’ve only really seen lasers listed as treatment for acne scars. I’ve been using 1% retinol, vitamin C + E Ferulic acid, 3% tranexamic acid with 1% kojic acid, niacinamide, Alpha arbutin, Azelaic Acid, Lactic acid and sometimes AHA 30% + 2% BHA peel as at home treatments  

 

 

 Any suggestions would be great. 

Thanks!

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Edited by Icedcoffeelatte
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Your scars are very mild. I would personally just keep up with your current skin care routine. If you do want scar treatments then I'm sure someone more knowledgeable could help you out. Your skin texture and tone look good.

Azelaic Acid is fantastic! I use that, along with tretinon and it seems to work well for improving skin tone.

All the best.

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2 hours ago, Icedcoffeelatte said:

 I’ve done 6 sessions of microneedling after I finished the medication. However, I’m wondering whether I should try a different treatment or if I should just continue with the microneedling.

You have shallow boxcar scars (scars with distinct borders). The scar in the middle with the depression looks tethered. 

If you want a quick fix, I would suggest you get dermal filler like Juvederm. You could ask the injector to subcise the scar while injecting the filler. It won't give you 100% improvement but a big leg up from the current situation.

Eventually, you'll need to eliminate the scar border. It is  the SHADOW created by the scar border that actually accentuates the scar. This is why in certain lighting your scars look much worse and in others they're less visible. This can be done using either TCA cross or ablative laser.

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47 minutes ago, Sirius Lee said:

You have shallow boxcar scars (scars with distinct borders). The scar in the middle with the depression looks tethered. 

If you want a quick fix, I would suggest you get dermal filler like Juvederm. You could ask the injector to subcise the scar while injecting the filler. It won't give you 100% improvement but a big leg up from the current situation.

Eventually, you'll need to eliminate the scar border. It is  the SHADOW created by the scar border that actually accentuates the scar. This is why in certain lighting your scars look much worse and in others they're less visible. This can be done using either TCA cross or ablative laser.

Awesome, thanks!! Unfortunately, TCA cross isn’t available where I am. I’m a little reluctant on ablative laser as I’ve heard it isn't suitable for darker skin. Do you think non-ablative lasers would be helpful? And do you think I should stop with microneedling? 

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14 minutes ago, Icedcoffeelatte said:

Do you think non-ablative lasers would be helpful? And do you think I should stop with microneedling? 

Fractional CO2 can be effective when delivered at high power and low density (5%). Laser should be angled at the scar border. 3 passes recommended.

Microneedling is okay. Just don't expect that it will fill your scars.

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With darker skin, the doctor just can't be as aggressive otherwise you'll have prolonged erythema/hyperpigmentation or other side effects. So you may need more treatments at a slightly less aggressive intensity.

The narrow and deep craters should be tackled with Cross. Unless you know what you're doing, see a doctor.

It takes a year to see a dermatologist in Canada? Wow. Takes days or weeks here.

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15 hours ago, Sirius Lee said:

Fractional CO2 can be effective when delivered at high power and low density (5%). Laser should be angled at the scar border. 3 passes recommended.

Microneedling is okay. Just don't expect that it will fill your scars.

Do you think 1 or 2 treatments of Fractional Co2 would be enough? 

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If you're talking about improvement, yes - at the right depth because your scars don't look that bad and you don't have many. Your crater boxcars will not completely fill up but they may be improved to the point where you're satisfied. This is where TCA may be better. The consensus is that TCA Cross should be done before lasering because Cross will "lift" your scars up, if you will. Also, TCA can hit the scar sideways whereas lasers have a harder time doing so - this is according to a doctor.

I mentioned this in another point but you can't just say fractional CO2 and think it's the same for everybody. 1) How deep is your doctor going to go? Usually the more aggressive, the better results but higher risks and longer recovery. 2) What type of laser is it? Does it have the power or right wavelength? 3) How good is the doctor? Is he/she experienced or is the laser just another moneymaking tool? Most doctors will give you the same spiel for why lasers work but they probably just read off of a pamphlet and go to a few lectures.

Couple of other points..... non-ablative lasers are not going to work.... also, be prepared mentally for dealing with hyperpigmentation/erythema if your doctor is aggressive.

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8 minutes ago, Amanda Hall said:

If you're talking about improvement, yes - at the right depth because your scars don't look that bad and you don't have many. Your crater boxcars will not completely fill up but they may be improved to the point where you're satisfied. This is where TCA may be better. The consensus is that TCA Cross should be done before lasering because Cross will "lift" your scars up, if you will. Also, TCA can hit the scar sideways whereas lasers have a harder time doing so - this is according to a doctor.

I mentioned this in another point but you can't just say fractional CO2 and think it's the same for everybody. 1) How deep is your doctor going to go? Usually the more aggressive, the better results but higher risks and longer recovery. 2) What type of laser is it? Does it have the power or right wavelength? 3) How good is the doctor? Is he/she experienced or is the laser just another moneymaking tool? Most doctors will give you the same spiel for why lasers work but they probably just read off of a pamphlet and go to a few lectures.

Couple of other points..... non-ablative lasers are not going to work.... also, be prepared mentally for dealing with hyperpigmentation/erythema if your doctor is aggressive.

Ahhhhhhh, you’re right. Yeah,  this makes me not want to get ablative mainly because it won’t be a doctor performing the laser. It’ll most likely be a ‘skin technician’. I just got an appointment with a dermatologist for August but I seriously don’t want to wait that long. I might have to just stick to microneedling even though the results are so minimal but it also feels the safest. Also, we don’t have TCA in my city so that is out of the option. 

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43 minutes ago, Icedcoffeelatte said:

Do you think 1 or 2 treatments of Fractional Co2 would be enough? 

Most likely no. But, as already pointed out, it is highly operator-dependent. More skill the operator has, the better the outcome will be.

13 minutes ago, Amanda Hall said:

I mentioned this in another point but you can't just say fractional CO2 and think it's the same for everybody. 1) How deep is your doctor going to go? Usually the more aggressive, the better results but higher risks and longer recovery. 2) What type of laser is it? Does it have the power or right wavelength? 3) How good is the doctor? Is he/she experienced or is the laser just another moneymaking tool? Most doctors will give you the same spiel for why lasers work but they probably just read off of a pamphlet and go to a few lectures.

Well, in our case, we're not going down into the deeper dermis. Instead we'll be limiting our focus on the surface. Hence, we're going in at low density on highest power.

But you're right. You gotta find the right doc who knows his beans.

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23 minutes ago, Icedcoffeelatte said:

Ahhhhhhh, you’re right. Yeah,  this makes me not want to get ablative mainly because it won’t be a doctor performing the laser. It’ll most likely be a ‘skin technician’. I just got an appointment with a dermatologist for August but I seriously don’t want to wait that long. I might have to just stick to microneedling even though the results are so minimal but it also feels the safest. Also, we don’t have TCA in my city so that is out of the option. 

Funny thing is that microneedling gave me new scars! The med spa that I went to wasn't cheap at all and the nurse was pretty aggressive. I ended up bloody and with new scarring. It could partly be because I didn't properly take care of my skin afterwords by moisturizing and keeping the wounds moist. The nurse went VERY aggressively.

I'm not trying to discourage you from getting laser treatment done. Some people on this forum know that I'm an advocate for lasers if you're willing to take the risks. The biggest gains I got are from laser treatment. It's just no walk in the park. I took the chances because I didn't like my scars. I may get a few more Cross treatments and peels but I intend to do at least several more laser treatments just on a few spots.

Maybe my eyes are bad but I only see one really deep scar. Excision is a possibility but please do your research on that. The other scars should see improvement with Cross or lasers.

Can you drive to the US and get something done? :) 

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17 minutes ago, Amanda Hall said:

Funny thing is that microneedling gave me new scars! The med spa that I went to wasn't cheap at all and the nurse was pretty aggressive. I ended up bloody and with new scarring. It could partly be because I didn't properly take care of my skin afterwords by moisturizing and keeping the wounds moist. The nurse went VERY aggressively.

I'm not trying to discourage you from getting laser treatment done. Some people on this forum know that I'm an advocate for lasers if you're willing to take the risks. The biggest gains I got are from laser treatment. It's just no walk in the park. I took the chances because I didn't like my scars. I may get a few more Cross treatments and peels but I intend to do at least several more laser treatments just on a few spots.

Maybe my eyes are bad but I only see one really deep scar. Excision is a possibility but please do your research on that. The other scars should see improvement with Cross or lasers.

Can you drive to the US and get something done? :) 

Oh I see. What type of laser was it? I think the clinic I’m interested in here uses an ultrapulse C02 laser. Not sure if that’s a good one or not. Did you get chemical peels, fraxel laser or IPL laser for your boxscars? I guess I could go somewhere else in the province to get TCA although, I was hoping to stay where I am instead of travelling during recovery/covid. 

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2 hours ago, Icedcoffeelatte said:

Oh I see. What type of laser was it? I think the clinic I’m interested in here uses an ultrapulse C02 laser. Not sure if that’s a good one or not. Did you get chemical peels, fraxel laser or IPL laser for your boxscars? I guess I could go somewhere else in the province to get TCA although, I was hoping to stay where I am instead of travelling during recovery/covid. 

That's the laser that got me gains. Now you have to make sure your doctor know how to use it. :)

I've done chemical peels but those are for extremely superficial scars. It's also been said that in conjunction with microneedling, TCA peels can help but I wouldn't be too hopeful unless the scars are really shallow. Fraxel is older technology according to Dr. Lim. Could work but I have no experience. IPL is not for scars. It's mostly for pigmentation and it's not meant for darker skin - too risky unless your doctor knows how to manipulate a few settings so you don't get burned.

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On 2/17/2021 at 5:26 PM, Amanda Hall said:

That's the laser that got me gains. Now you have to make sure your doctor know how to use it. :)

I've done chemical peels but those are for extremely superficial scars. It's also been said that in conjunction with microneedling, TCA peels can help but I wouldn't be too hopeful unless the scars are really shallow. Fraxel is older technology according to Dr. Lim. Could work but I have no experience. IPL is not for scars. It's mostly for pigmentation and it's not meant for darker skin - too risky unless your doctor knows how to manipulate a few settings so you don't get burned.

Thanks, i appreciate your input! 

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On 2/17/2021 at 2:22 PM, Amanda Hall said:

If you're talking about improvement, yes - at the right depth because your scars don't look that bad and you don't have many. Your crater boxcars will not completely fill up but they may be improved to the point where you're satisfied. This is where TCA may be better. The consensus is that TCA Cross should be done before lasering because Cross will "lift" your scars up, if you will. Also, TCA can hit the scar sideways whereas lasers have a harder time doing so - this is according to a doctor.

I mentioned this in another point but you can't just say fractional CO2 and think it's the same for everybody. 1) How deep is your doctor going to go? Usually the more aggressive, the better results but higher risks and longer recovery. 2) What type of laser is it? Does it have the power or right wavelength? 3) How good is the doctor? Is he/she experienced or is the laser just another moneymaking tool? Most doctors will give you the same spiel for why lasers work but they probably just read off of a pamphlet and go to a few lectures.

Couple of other points..... non-ablative lasers are not going to work.... also, be prepared mentally for dealing with hyperpigmentation/erythema if your doctor is aggressive.

Quick question for you why do you think the boxscars wont completely fill up? I know a lot of people don’t trust Dr Davin Lim but his statement is that isolated ice pick scars & boxscars can completely heal 95%. Especially on her since she has shallow scars? Or does it just depend on someone’s healing capabilities? 

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7 hours ago, Marygm96 said:

Quick question for you why do you think the boxscars wont completely fill up? I know a lot of people don’t trust Dr Davin Lim but his statement is that isolated ice pick scars & boxscars can completely heal 95%. Especially on her since she has shallow scars? Or does it just depend on someone’s healing capabilities? 

The deep one won't fill up all the way because I have one like yours. The shallow one however.... you may actually be very satisfied. Not all of my shallow ones were improved, but the ones that did look muchhhh better. Lasers have a hard time treating ice pick scars. Not saying those scars won't improve, but you may not be satisfied with the amount of improvement. Lasers only shoot downwards, not sideways to attack the scar like TCA can. 

95% improvement? Yeah right. His 95% is probably 45% to me. Everyone has different scales. However, my 45% could be 75-90% to you. With that being said, 45% is reallllllllly good to me.

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13 minutes ago, Amanda Hall said:

The deep one won't fill up all the way because I have one like yours. The shallow one however.... you may actually be very satisfied. Not all of my shallow ones were improved, but the ones that did look muchhhh better. Lasers have a hard time treating ice pick scars. Not saying those scars won't improve, but you may not be satisfied with the amount of improvement. Lasers only shoot downwards, not sideways to attack the scar like TCA can. 

95% improvement? Yeah right. His 95% is probably 45% to me. Everyone has different scales. However, my 45% could be 75-90% to you. With that being said, 45% is reallllllllly good to me.

Damn.. so basically not even the most shallow scars can ever go away.. Thank for clarifying. 

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7 hours ago, Marygm96 said:

Damn.. so basically not even the most shallow scars can ever go away.. Thank for clarifying. 

If you have that mindset, you might as well give the doctors your life savings. Anybody who think scars can be erased is living a pipe dream. You'll also never be happy if get close, but not close enough. 

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1 hour ago, Amanda Hall said:

If you have that mindset, you might as well give the doctors your life savings. Anybody who think scars can be erased is living a pipe dream. You'll also never be happy if get close, but not close enough. 

Your right. Thank you for replying. I also wasn’t seeking perfection because well we’ll never get that. But I appreciate your sincerity. 

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29 minutes ago, Marygm96 said:

Your right. Thank you for replying. I also wasn’t seeking perfection because well we’ll never get that. But I appreciate your sincerity. 

Just trying to knock some sense (or extra) into you. I wasn't trying to be mean or anything! :) But if you don't have a realistic approach, you are going to waste money but also get frustrated that some treatments won't help you.

So Dr. Lim says certain scars can improve 95%. We've already established that his grading scale is different than everyone else's. Also, other people's scars are different than yours. You also heal differently. What about Dr. Lim's other patients? He's gotten many bad reviews from patients and they didn't get anywhere close to 95%. What all this means is that you can't compare your potential results to results of his best cases or you'll be disappointed. Remember that doctors only tell you about their most successful outcomes.

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18 hours ago, Marygm96 said:

Quick question for you why do you think the boxscars wont completely fill up? I know a lot of people don’t trust Dr Davin Lim but his statement is that isolated ice pick scars & boxscars can completely heal 95%. Especially on her since she has shallow scars? Or does it just depend on someone’s healing capabilities? 

i remember a user claiming that 95% is possible depending on the scars. if they are superficial enough i believe that a deep peel can take care of the rest after some treatments

 

 

 

 

 

 

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40 minutes ago, cosmonaut said:

i remember a user claiming that 95% is possible depending on the scars. if they are superficial enough i believe that a deep peel can take care of the rest after some treatments

I can guarantee that almost nobody on this forum has scars superficial enough to almost disappear. Sure, if you get a papercut and there's a very shallow scar, maybe it can be removed with microdermabrasion. The scars that you see in all of the pictures here are much deeper. 95% improvement? Like I said, 95% could be 45% to someone else. Ask 500 people on this forum. I'll bet only one (if you are lucky) will say he/she got 95% improvement from any treatment for mild to severe scars.

I'm not saying that you won't be satisfied with your improvement. I've had several boxcar scars that were lasered and the result was excellent. I decided that I didn't need further treatment because it was not as visible to me and that I had a life to live instead of worrying about something people couldn't see from beyond 1 foot. If I had to rate the improvement, I'd say 50%.

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46 minutes ago, Amanda Hall said:

I can guarantee that almost nobody on this forum has scars superficial enough to almost disappear. Sure, if you get a papercut and there's a very shallow scar, maybe it can be removed with microdermabrasion. The scars that you see in all of the pictures here are much deeper. 95% improvement? Like I said, 95% could be 45% to someone else. Ask 500 people on this forum. I'll bet only one (if you are lucky) will say he/she got 95% improvement from any treatment for mild to severe scars.

I'm not saying that you won't be satisfied with your improvement. I've had several boxcar scars that were lasered and the result was excellent. I decided that I didn't need further treatment because it was not as visible to me and that I had a life to live instead of worrying about something people couldn't see from beyond 1 foot. If I had to rate the improvement, I'd say 50%.

thank you for your perspective. but as i said in some cases it may be possible, if they are superficial enough. im not disputing that there are other cases here where such an improvement wouldn't be possible. i particularly know people with 90%  of improvement in less than a year of treatment because the scars were superficial. i understand that it is important to keep expectations realistic. however, in less severe cases, it may be possible. especially if they are on the same plane. a friend of mine got 60% on some scars just with tca cross (2 sessions). others had scars that almost disappeared. im not saying that this person had this improvement, but that there are satisfactory results for this type of scaring

 

 

 
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1 hour ago, cosmonaut said:

thank you for your perspective. but as i said in some cases it may be possible, if they are superficial enough. im not disputing that there are other cases here where such an improvement wouldn't be possible. i particularly know people with 90%  of improvement in less than a year of treatment because the scars were superficial. i understand that it is important to keep expectations realistic. however, in less severe cases, it may be possible. especially if they are on the same plane. a friend of mine got 60% on some scars just with tca cross (2 sessions). others had scars that almost disappeared. im not saying that this person had this improvement, but that there are satisfactory results for this type of scaring

 

More power to ya then. I wish everybody could see that much improvement! :)

Keep us updated on your treatments and let us know how much they improve.

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Question...I've had Fraxel 1550 many times with little to no result...I have depressions in my skin that are rolling and boxcar scars. I am thinking that fully ablative laser would help lift them. Will try TCA cross first. Would CO2 laser be a good choice for fully ablative laser to try to fill in / raise the depressions in my skin? 

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