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GuyWithScars

Has anyone combined subcison, fractional CO2/erbium laser and/or RF microneedling in the same session?

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Has anyone combined all 3 in one treatment and can share if they had long lasting side effects? Or at least 2 of the 3? I've been recommended to combine all 3 by an acne scar expert for severe acne scarring (all kinds), and I've noticed online that a few derms do this as well. Supposedly all 3 are treating different layers of skin so it's safe. 

I've noticed a lot of derms combine subcision with laser or RF microneedling for acne scars in one session. Browsing these forums people seem to be frightened of combining treatments, so I'm curious what the basis is for this? I haven't found an acne scar dermatologist who has said online that this is a bad idea or riskier (please share if you have!). I've consulted with a few derms and have followed quite a few acne scar expert social media posts, and it seems to be a very normal thing to combine at least 2 of the 3. 

 

 

Studies of fractional ablative CO2 combined with RF microneedling (THIS WAS ADDED AFTER DISCUSSION BELOW)

The first one is a small 2014 split face study comparing fractional CO2 on one side of the face vs fractional CO2 plus RF microneedling on the other side. The side of the face with the combination healed faster and had less side effects than the side with CO2 only. Small sample size but it still shows it MIGHT be better to combine. 

Here is a second a Turkish retrospective study of 72 patients showing safety and efficacy of fractional CO2 combined with microneedling RF. As mentioned by realself doctors, they anecdotally noted that the side effects of the CO2 laser seemed to be lessened (although they didn't directly compare to using laser alone, so not the best evidence scientifically). Interestingly, patient satisfaction was higher in darker skin types. 

The third one is a 71 patient Korean study showing that you can treat fractional CO2 + microneedling RF in patients on Accutane safely and effectively. 

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Of course you're not going to hear a derm say that. They want you to spend as much money as possible in one sitting. 

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Let's pretend money doesn't matter for a second and that we're not expecting a cure, just improvement. What I am asking is: 

1) Is combining all 3 better than doing 2 of the 3 of them in one session? Is combining 2 better than 1? 

2) Is there more risk of complications than doing them separately? 

I've done a search on RealSelf for the infini + fractional CO2 combo and it seems like Weiner, Rappaport, Lim, Emer, and others say they do this routinely. A few of them said it was a bad idea in 2015-2016 and then changed their mind afterwards, so that shows they changed their opinion over time and haven't just been money hungry. I can't fathom that all of them are that money hungry to deceive people. Apparently they have to turn down power settings on both modalities though, so I'm guessing the advantage is that you're improving different layers of skin at the same time, but the disadvantage is that you aren't targeting each layer as strongly as you would if you separated them. Links below. 

 

2015-2016: Overall verdict was not recommended (yay =1, nay = 5, maybe = 2)

The nay verdict is mostly based on one question for using CO2 and Infini on an Indian skin type. The verdict is complicated by the fact that CO2 is often not used due to PIH risk, so not sure how that factored in. It seems like it had more to do with the actual combination though than using the CO2 on an Indian skin type. 

YayRealSelf poster's doctor (2015)

NayWeiner (2015), Ransom (2016), Lim (2016, overall not recommended but would combine for certain scars), Karamanoukian (2015, but would do if separated by 24 hours)

Maybe: Duplechain (2015), Brown (2015)

 

2016-Present: Overall verdict is it's recommended to combine (yay =7, nay = 2)

YayWeiner,(2016, 2018),  Lim (2020 - his "favourite combination"), Emer (2016, 2016), Rappaport (2018, 2021), Laura (2018), Ray (2019), Manoharan (2018)

NayMiller (2018), Key (2019)

 

https://www.realself.com/question/big-indian-ny-acne-scars-there-benefit-combining-laser-and-infini

https://www.realself.com/question/bay-area-ca-infini-rf-combined-fractional-co2-session

https://www.realself.com/question/pakistan-pk-combine-fractional-co2-laser-rf-microneedling-prp-acne-scars

https://www.realself.com/question/oklahoma-city-infini-rf-co2-combination

https://www.realself.com/question/usadel-de-combine-fractional-co2-laser-resurfacing-fractional-rf-microneedling

 

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2 hours ago, GuyWithScars said:

Let's pretend money doesn't matter for a second and that we're not expecting a cure, just improvement. What I am asking is: 

1) Is combining all 3 better than doing 2 of the 3 of them in one session? Is combining 2 better than 1? 

2) Is there more risk of complications than doing them separately? 

I for one have been against these "cocktail" treatments. Other than subjective after-the-fact opinions, there's no scientific evidence to support that multi-modalities are better than single modality.

First, even if it yields improvement, you would NEVER know for certain where it came from. 

Second, the risk for complication will of course increase. Even though it's a controlled injury, more injury you introduce, the more possibility there is for unintended complications.

Lastly, this isn't just about money. It's also about dashed hopes. For those with medium to severe scars, they peg their hopes on these treatments. Don't mislead them. Don't manipulate them.

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2 minutes ago, Sirius Lee said:

Don't mislead them. Don't manipulate them.

True, NOBODY should promise miracles. This is a separate issue about setting expectations. I have no doubts that scars can be improved though, and in general more aggressive is higher risk of temporary side effects but better results. 

28 minutes ago, Sirius Lee said:

there's no scientific evidence to support that multi-modalities are better than single modality.

Sorry to disagree, but this simply isn't true. I just did a quick google scholar search. Here is one paper showing CO2 + subcision is better than subcision alone. Here is another small split face study comparing RF microneedling vs subcision + RF microneedling. Other papers that showed combinations are safe and effective are here (TCA+subcision+fractional CO2) and here (Taylor subcision + fractional CO2 + TCA).

25 minutes ago, Sirius Lee said:

First, even if it yields improvement, you would NEVER know for certain where it came from. 

If subcision is better for some types and laser or RF better or even complementary for others types, doesn't it logically make sense that combining is better? If you have 1 type of scar, that's different. I'm talking about some who has all kinds, which is usually the case it seems. Also, other than possibly spending more money than necessary, why do you care where it comes from if results are better? I understand money can be a huge issue for people though :) 

13 minutes ago, Sirius Lee said:

Second, the risk for complication will of course increase. Even though it's a controlled injury, more injury you introduce, the more possibility there is for unintended complications.

True. But the question is, is the risk of complication higher than if you did each treatment separately? I haven't found any evidence that risk is much higher by combining, and all of these derms seem to do it without major issues that people vent about. If someone has found contrary evidence, please share! Also, aren't most complications going to resolve by themselves within 6 months worst case? The complications are probably not going to be worse than the scars looked themselves.
  

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19 hours ago, GuyWithScars said:

Has anyone combined all 3 in one treatment and can share if they had long lasting side effects? Or at least 2 of the 3? I've been recommended to combine all 3 by an acne scar expert for severe acne scarring (all kinds), and I've noticed online that a few derms do this as well. Supposedly all 3 are treating different layers of skin so it's safe. 

I've noticed a lot of derms combine subcision with laser or RF microneedling for acne scars in one session. Browsing these forums people seem to be frightened of combining treatments, so I'm curious what the basis is for this? I haven't found an acne scar dermatologist who has said online that this is a bad idea or riskier (please share if you have!). I've consulted with a few derms and have followed quite a few acne scar expert social media posts, and it seems to be a very normal thing to combine at least 2 of the 3. 

 

 

Combining treatments in one session isn't a bad idea. Often the different treatments address different type of scarring so that you get a better overall result with minimal downtime(imagine the downtime if you do laser, subcision and tca seperately). I've done 4 treatments combined together since I have all kinds of scars and I haven't suffered from any complications whatsoever. I'd say the risk you take with combination treatments depends the safety of the single treatments. If you combine low complication rate procedures, you'll be fine. 

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1 hour ago, Marumi said:

Combining treatments in one session isn't a bad idea. Often the different treatments address different type of scarring so that you get a better overall result with minimal downtime(imagine the downtime if you do laser, subcision and tca seperately). I've done 4 treatments combined together since I have all kinds of scars and I haven't suffered from any complications whatsoever. I'd say the risk you take with combination treatments depends the safety of the single treatments. If you combine low complication rate procedures, you'll be fine. 

Thanks - that's helpful. Did you do RF + CO2 + subcision? Or TCA + subcision + laser?

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4 hours ago, GuyWithScars said:

Sorry to disagree, but this simply isn't true. I just did a quick google scholar search. Here is one paper showing CO2 + subcision is better than subcision alone. Here is another small split face study comparing RF microneedling vs subcision + RF microneedling. Other papers that showed combinations are safe and effective are here (TCA+subcision+fractional CO2) and here (Taylor subcision + fractional CO2 + TCA).

Thanks for the links. I don't know if you've read those papers, but there are some serious questions that need to be addressed. Out of the 4 studies, only 1 (taylor liberator) had a relatively large sample size. Not only were they small in sample, but the patients were treated on multiple occasions, eg. subcision today, RF micro 2 weeks later and repeated again few weeks later, etc. Taylor liberator was a single session study, but it was "retrospective, uncontrolled, unblinded study."

5 hours ago, GuyWithScars said:

If subcision is better for some types and laser or RF better or even complementary for others types, doesn't it logically make sense that combining is better? If you have 1 type of scar, that's different. I'm talking about some who has all kinds, which is usually the case it seems. Also, other than possibly spending more money than necessary, why do you care where it comes from if results are better? I understand money can be a huge issue for people though :) 

Fair enough. But what makes you think getting them all in one session is more effective than getting them separately?

But lets suppose that the cocktail approach is in fact yields better result than going solo. The question then is how much of a difference? Would 25% be big enough of a difference to justify getting the cocktail? Also how do you know if that 25% didn't come from only one of the two (or three) treatments, and not from the combination? You say you don't care, but why wouldn't you? If you did, you can plan your treatments more methodically rather than resort to trial and error.

 

Anyway, you're free to do whatever you want. After all, it's you money and your face. But I've seen too many disgruntled people who received multiple treatments only to find out they got far less than expected.

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1 hour ago, Sirius Lee said:

Thanks for the links. I don't know if you've read those papers, but there are some serious questions that need to be addressed. Out of the 4 studies, only 1 (taylor liberator) had a relatively large sample size. Not only were they small in sample, but the patients were treated on multiple occasions, eg. subcision today, RF micro 2 weeks later and repeated again few weeks later, etc. Taylor liberator was a single session study, but it was "retrospective, uncontrolled, unblinded study."

I think it's really hard to have a good study actually comparing combinations of treatments for acne scars that isn't funded by a device company, and perhaps they don't have an incentive to have clinical trials to combine multiple treatments. So while your criticism of the studies is fair, and in an ideal world we would do thousand person split face studies comparing treatments, I just don't think it's realistic to expect that. The Taylor liberator study took over 10 years for 100 patients, and it was retrospective. Imagine how long it would take to convince 100 people to treat one side of your face one way, and the other side another way? So I think as patients we have to go with the best we have available, which is these small studies which seem to be backed by the clinical experience of acne scar experts.

1 hour ago, Sirius Lee said:

Fair enough. But what makes you think getting them all in one session is more effective than getting them separately?

I don't know for sure and definitely wonder this. On one hand, there may be a synergistic effect when you use multiple modalities because you're treating different layers of skin with each device. But on the other hand, I've read that the settings are turned down on each individual device, so while you're treating multiple layers, you're treating each layer less intensely. I'm purely speculating though, I don't have a medical degree. 

What DOES seem clear is that because combinations always seem to be recommended, they probably give better overall results to your general face than one session of a single type of treatment because they are treating multiple scar types at once (assuming you have a lot of different scar types). The upside is that, as Marumi mentioned, there is less overall downtime compared to doing each session individually. This is personally more important than money - I want to keep my treatments private from friends and work.

The downside, as you brought up, is that you don't know which treatment worked better for you, so you might be wasting money. I don't see anything wrong with this approach either. I just get a sense of fear mongering about combining treatments on this forum and I wasn't sure why which is why I made my post :

1 hour ago, Sirius Lee said:

But I've seen too many disgruntled people who received multiple treatments only to find out they got far less than expected.

Yeah that isn't good. People should be aware that just because you're being more aggressive in combining treatments doesn't mean you aren't going to need multiple sessions.

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Worst case complications are not gone within 6 months. PIE + PIH, maybe gone. Other complications not so much.

 

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6 hours ago, GuyWithScars said:

Thanks - that's helpful. Did you do RF + CO2 + subcision? Or TCA + subcision + laser?

You can't combine RF and CO2 in one session from what I've researched. No dermatologist in their right mind would do it. I've had a combination treatment and as long as I get results I don't mind not knowing EXACTLY which treatment brought which results percentage wise because I know I have all kinds of scars, and I need all treatments, like TCA cross for my ice picks, subcision for the rolling scars. Besides, in terms of money, it is often less expensive to have the combination treatment as each treatment on its own costs more, doctors usually have some kind of reduced "package" price.

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9 hours ago, Marumi said:

No dermatologist in their right mind would do it

Maybe you missed it, but in my original post 7 out of 9 doctors on realself recommended it

 

12 hours ago, Guest said:

Worst case complications are not gone within 6 months. PIE + PIH, maybe gone. Other complications not so much.

What are these other complications? Can you give common examples?

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13 hours ago, GuyWithScars said:

Maybe you missed it, but in my original post 7 out of 9 doctors on realself recommended it

Do they explain why they combine Infini & Co2 laser, and does it make sense? 

What's the point in doing microneedling and co2 laser in the same sitting? They work on the same principle - breaking down scar tissue while stimulating collagen in the following months. RF microneedling is like a mild non-ablative laser in terms of effect. 

 

Maybe the above doctors just want to charge you more?

Or they are getting paid to promote the Lutronic RF devices? Have you thought of that? 

The mentioned doctors are very big in promoting themselves on Realself but always fail to provide quality photos. Before you get anything done by them, let them show you before and afters of patients treated with this combination to see the better results for yourself. Anybody can come up theories about how scars should be treated best - documented results is what matters. But please not the BS photos of Lim, done immediately after the treatment where you cannot possibly see any real results!

 

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9 hours ago, Marumi said:

Do they explain why they combine Infini & Co2 laser, and does it make sense? 

If you read my post it's because they treat different layers of skin and each are better for different scar types. All I'm saying is IF you would do the treatments separately for your scar types, it seems like based on RealSelf, many doctors would recommend to them together so it's not a crazy thing to combine

9 hours ago, Marumi said:

Maybe the above doctors just want to charge you more?

Maybe, I can't prove that they can't (nobody can). But that also doesn't prove that they are only doing it to charge more. If your view of the world is that 7 out of 9 doctors only have this opinion to steal your money, then I don't think there's any way that I can prove to you with any existing arguments that this is a good treatment. And don't say scientific data because we're never going to have a perfect study on this. You can't just say "it's because they're corrupt" just because more treatments cost more. If anything, as you mentioned, it's cheaper because you usually get a discount by combining treatments! If it's cheaper to combine treatments (overall), does that mean the 2 out of 9 doctors are corrupt because separating them costs more? 

Secondly, if you read my post, 2 or 3 of those doctors changed their opinion between 2015 and now on whether it's a good idea to combine. That shows that either all of them decided around the same time to become greedy thieves, or they were following new evidence (more likely!). 

9 hours ago, Marumi said:

The mentioned doctors are very big in promoting themselves on Realself but always fail to provide quality photos.

All of them? I'm guessing you're only talking about a few of them. I'm not going to deny that there's misleading photos out there, but please let's stick to the topic. Even if we remove Lim, that's 6 out of 8. Your argument of "you can't trust all 9 of these doctors because some of them provide misleading photos" I don't think makes sense.

 

10 hours ago, Marumi said:

Anybody can come up theories about how scars should be treated best - documented results is what matters

Cool, where are your documented results that combining them is proven to be a bad idea? I've posted numerous papers and 7 out of 9 doctors saying it's safe. And only 1 out of the 2 who didn't recommend it said it wasn't a good idea. I showed several papers saying it's OK to do (yes, sample size wasn't great on a few of them but we're never going to get a good study on this). 

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20 hours ago, GuyWithScars said:

If you read my post it's because they treat different layers of skin and each are better for different scar types. All I'm saying is IF you would do the treatments separately for your scar types, it seems like based on RealSelf, many doctors would recommend to them together so it's not a crazy thing to combine

Maybe, I can't prove that they can't (nobody can). But that also doesn't prove that they are only doing it to charge more. If your view of the world is that 7 out of 9 doctors only have this opinion to steal your money, then I don't think there's any way that I can prove to you with any existing arguments that this is a good treatment. And don't say scientific data because we're never going to have a perfect study on this. You can't just say "it's because they're corrupt" just because more treatments cost more. If anything, as you mentioned, it's cheaper because you usually get a discount by combining treatments! If it's cheaper to combine treatments (overall), does that mean the 2 out of 9 doctors are corrupt because separating them costs more? 

Secondly, if you read my post, 2 or 3 of those doctors changed their opinion between 2015 and now on whether it's a good idea to combine. That shows that either all of them decided around the same time to become greedy thieves, or they were following new evidence (more likely!). 

All of them? I'm guessing you're only talking about a few of them. I'm not going to deny that there's misleading photos out there, but please let's stick to the topic. Even if we remove Lim, that's 6 out of 8. Your argument of "you can't trust all 9 of these doctors because some of them provide misleading photos" I don't think makes sense.

 

Cool, where are your documented results that combining them is proven to be a bad idea? I've posted numerous papers and 7 out of 9 doctors saying it's safe. And only 1 out of the 2 who didn't recommend it said it wasn't a good idea. I showed several papers saying it's OK to do (yes, sample size wasn't great on a few of them but we're never going to get a good study on this). 

Did you seriously take my legitimate ask for doctors to provide photos of their results and turn it on me, the scar sufferer, to provide proof that combining Infini and co2 laser in one setting is a bad idea? 

It's not on me, as a non specialist, to prove a treatment is bad. It is and has always been on the physician offering the treatment to convince the patient that the treatment is 1.) safe and 2.) effective. Lim, Weiner, Emer and co feel free to prove their theory in documented results, or in clinical trials. 

The best these self proclaimed 1% top scar doctors can offer so far in terms of photos showing results are: only 2 photos of scars out of 100 posts on IG (note both with fillers (!) which means no permanent results) for Weiner; red, swollen photos, taken too early and from a different angle/ lighting for Lim; and almost no before/ afters for Emer. And literally ZERO photos documenting results from a combination RFM+co2 laser treatment!

They might be very vocal promoting themselves on RealSelf and hiring marketing teams to create a top scar doctor's rep, but in terms of concrete results, they show very very little, and what they show is not of good convincing quality. 

Note that the doctors who seem to have predominantly good reviews here on the forum, and who people seem to go see for treatments, aren't the over hyped self promoting social media stars like Lim& co

You cannot possibly have shown a study that Infini+Co2 laser is a safe and effective treatment because there ISN'T any.

In my opinion, which seems to be shared by the doctors who are against this combination in one go, it's too much of a risk to combine two energy-based treatments and by doing so you need to lower the settings anyway which would compromise the cosmetic result anyway. 

 

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4 hours ago, Marumi said:

Did you seriously take my legitimate ask for doctors to provide photos of their results and turn it on me, the scar sufferer, to provide proof that combining Infini and co2 laser in one setting is a bad idea? 

It's not on me, as a non specialist, to prove a treatment is bad. It is and has always been on the physician offering the treatment to convince the patient that the treatment is 1.) safe and 2.) effective. Lim, Weiner, Emer and co feel free to prove their theory in documented results, or in clinical trials. 

The best these self proclaimed 1% top scar doctors can offer so far in terms of photos showing results are: only 2 photos of scars out of 100 posts on IG (note both with fillers (!) which means no permanent results) for Weiner; red, swollen photos, taken too early and from a different angle/ lighting for Lim; and almost no before/ afters for Emer. And literally ZERO photos documenting results from a combination RFM+co2 laser treatment!

They might be very vocal promoting themselves on RealSelf and hiring marketing teams to create a top scar doctor's rep, but in terms of concrete results, they show very very little, and what they show is not of good convincing quality. 

Note that the doctors who seem to have predominantly good reviews here on the forum, and who people seem to go see for treatments, aren't the over hyped self promoting social media stars like Lim& co

You cannot possibly have shown a study that Infini+Co2 laser is a safe and effective treatment because there ISN'T any.

In my opinion, which seems to be shared by the doctors who are against this combination in one go, it's too much of a risk to combine two energy-based treatments and by doing so you need to lower the settings anyway which would compromise the cosmetic result anyway. 

 

JOHN GOLDENMOUTH SPOKEN, couldnt say it better , thumbs up !!!

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6 hours ago, Marumi said:

Did you seriously take my legitimate ask for doctors to provide photos of their results and turn it on me, the scar sufferer, to provide proof that combining Infini and co2 laser in one setting is a bad idea? 

No, of course not. I don't know how one could come to that conclusion based on what I said. But if you're going to make claims against it and potentially misinform the public from a treatment that could very well be in their best interest, you better back it up. So far, you haven't and have just complained that all scar doctors are corrupt and can't be trusted (but we should trust you in saying we shouldn't trust them). I presented several scientific papers and 9 doctors, and only 1 of them said it was a bad idea. You are making bold claims that have no basis other than the fact that you don't trust certain doctors, which may or may not be warranted. Even if we discredit the 3 you mentioned, that's still 1 out of 6 saying it's a bad idea, and 4 of 6 saying it's a good idea (1 didn't comment). Where is the basis for saying it's a bad idea? Where is the data? What medical expert weighed in on this? 

 

6 hours ago, Marumi said:

You cannot possibly have shown a study that Infini+Co2 laser is a safe and effective treatment because there ISN'T any.

Scroll up and learn to click on links in my first post, for the last time. 

 

6 hours ago, Marumi said:

In my opinion, which seems to be shared by the doctors who are against this combination in one go,

Who are these doctors and how do you know their opinion? Why do they feel that way? You're all talk again with no proof or explanation. I legitimately would like to know if other doctors have said it's a bad idea, which is why I started this thread. I frankly don't care about your opinion unless it's based off of something you read or heard from a reliable source. If this combination is dangerous for risk of side effects, people should know, but you need evidence. The only evidence we have in this thread says it's safe. 

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1 hour ago, GuyWithScars said:

No, of course not. I don't know how one could come to that conclusion based on what I said. But if you're going to make claims against it and potentially misinform the public from a treatment that could very well be in their best interest, you better back it up. So far, you haven't and have just complained that all scar doctors are corrupt and can't be trusted (but we should trust you in saying we shouldn't trust them). I presented several scientific papers and 9 doctors, and only 1 of them said it was a bad idea. You are making bold claims that have no basis other than the fact that you don't trust certain doctors, which may or may not be warranted. Even if we discredit the 3 you mentioned, that's still 1 out of 6 saying it's a bad idea, and 4 of 6 saying it's a good idea (1 didn't comment). Where is the basis for saying it's a bad idea? Where is the data? What medical expert weighed in on this? 

 

Scroll up and learn to click on links in my first post, for the last time. 

 

Who are these doctors and how do you know their opinion? Why do they feel that way? You're all talk again with no proof or explanation. I legitimately would like to know if other doctors have said it's a bad idea, which is why I started this thread. I frankly don't care about your opinion unless it's based off of something you read or heard from a reliable source. If this combination is dangerous for risk of side effects, people should know, but you need evidence. The only evidence we have in this thread says it's safe. 

Would you stop already? We all understood that you are "working for a dermatologist, a plastic surgeon, and a medical device company"  and you need to earn your money promoting them and their new favourite treatments, but I think it's safe to say we are all beyond bored with it. We are trying to fix our scars here. 

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1 hour ago, Marumi said:

Would you stop already? We all understood that you are "working for a dermatologist, a plastic surgeon, and a medical device company"  and you need to earn your money promoting them and their new favourite treatments, but I think it's safe to say we are all beyond bored with it. We are trying to fix our scars here. 

Way to dodge the question about what your opinion is based off of. Should be a pretty simple answer shouldn't it? 

I'm a guy with scars getting treated in 2 days (sub, RF + erbium) and was trying to decide if I should combine RF and laser per my derm's recommendation. I don't have a clue where this quote is from. I don't work for anything in dermatology, but have a science background. I've gone down the rabbit hole because people like you spread misinformation and fear mongering about combining treatments when you clearly don't have a clue what you're talking about, and then people like me trying to find the best scar treatment become very confused instead of listening to a scar expert

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I've only done sub and Cross at the same time. I think you'd be fine doing sub and Cross, RF, or lasers during the same treatment. I wouldn't suggest RF and lasers simultaneously though.

Is it better to combine treatments? For time and money saving purposes, absolutely. It's hard to take time off from anything to get treatments done. Do the procedures play off each other so the combination is better? I have no clue and don't want to guess. 

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Fractional(non-ablative) lasers and RF Microneedling operate on similar principles and are largely equivalent, namely that they leave the epidermis intact and operate underneath using heat to cause collagen remodeling . 

So if you're getting them both together, essentially it's like getting two RF Mirconeedling in one session. I personally would never do them both together since it's a waste of money. I'd rather just do Sub+RF Micro or Sub+Frac laser and schedule the remaining session of RF Micro or Frac laser 3-4 months down. Also RF Micro if you're getting Infini/Genius is quite painful and my whole face swelled up like crazy. I definitely wouldn't be able to do a fractional laser in the same session.

Now if you're talking about Fractional ablative laser, this vaporizes your top layer of your skin(in fractional columns). Multiple treatments are needed because it is fractional.Generally people do this treatment at the end of their acne scarring journey after their scar pits have risen up.  

Finally you have ablative(non fractional) laser resurfacing, it will vaporize the whole epidermis. Downtime is around 6 weeks. This is like getting a phenol peel. Also usually done after all other scar treatments.

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4 hours ago, GuyWithScars said:

I'm a guy with scars getting treated in 2 days (sub, RF + erbium) and was trying to decide if I should combine RF and laser per my derm's recommendation. I don't have a clue where this quote is from. I don't work for anything in dermatology, but have a science background. I've gone down the rabbit hole because people like you spread misinformation and fear mongering about combining treatments when you clearly don't have a clue what you're talking about, and then people like me trying to find the best scar treatment become very confused instead of listening to a scar expert

Well, in that case, the best thing for you to do is to get the treatments and find out for yourself if what we say is in fact fear mongering (aka bullsh*t) or not. Needless to say, a lot of people here have already gone down the rabbit hole you mention. If you don't like what we have to offer, just make the plunge and find out for yourself.

Just don't forget to update us in 6 months time.

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3 hours ago, facial said:

Now if you're talking about Fractional ablative laser

Yep - talking about fractional ablative + microneedling RF. This diagram is basically what I have in my head. Fractional laser on the far right, microneedling RF on the far left (except imagine them only treating with the deepest depth instead of all 3 depths). With tumescent anaethesia from subcision having a "balloon"-like effect, by inverse square law (energy dissipating with distance), there should be less energy deposited to the subdermal layers than without the anaesthesia (which isn't being treated). In my mind (with no medical degree), doing one of them (RF or laser) at the same as subcision makes a lot of sense to reduce healing times by avoiding the subdermis with the tumescent anaethesia. Is combining them better than separating them? No idea. But I'm willing to listen to the doctors to find out because it doesn't appear to be dangerous (at least in the right hands).

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3 hours ago, facial said:

Generally people do this treatment at the end of their acne scarring journey after their scar pits have risen up.  

That makes a lot of sense in general to do at the end. In my case I have a bunch of different scar types, so I figure I might as well improve as many as possible if I'm going to have downtime. I'm not going for perfection, just as much improvement as I can before summer without damaging anything

 

30 minutes ago, Sirius Lee said:

If you don't like what we have to offer, just make the plunge and find out for yourself.

Not insulting anyone in particular, so I hope I didn't offend. I just don't see any evidence to suggest that it's a bad idea to combine treatments other than people's layman opinion here without evidence. Based on the wisdom of separating treatments here, I was expecting to hear stories of people combining treatments that went horribly wrong, but that hasn't happened yet. I also didn't find any on the forum myself. And I also could only find 1 doctor (out of 9 on realself) who said she wouldn't do it. Unfortunately you go with the information you have available. 

If I'm still around in 6 months I'll keep you guys posted

 

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8 hours ago, GuyWithScars said:

Way to dodge the question about what your opinion is based off of. Should be a pretty simple answer shouldn't it? 

I'm a guy with scars getting treated in 2 days (sub, RF + erbium) and was trying to decide if I should combine RF and laser per my derm's recommendation. I don't have a clue where this quote is from. I don't work for anything in dermatology, but have a science background. I've gone down the rabbit hole because people like you spread misinformation and fear mongering about combining treatments when you clearly don't have a clue what you're talking about, and then people like me trying to find the best scar treatment become very confused instead of listening to a scar expert

You have a science background but cannot differentiate between an expert opinion like in the links you've added with the Realself comments in your first posts and real papers? It's very hard to believe. None of actual the papers you gave to Serius Lee later in the thread is about combining RF microneedling with a co2 laser. I replied you your question, stating my opinion about this combination for this is what we are supposed to do here -discuss things- and all of a sudden I am fear mongering and confusing people so that they need to see a scar expert?  Which scar expert do you have in mind? BA maybe? Because you are him, under yet another burner account? 

I base my opinion on the opinion of the doctors who oppose the RFM+laser in one go combination, the fact that there isn't a single paper about it, and the fact that even the doctors you mentioned cannot show a single photo of a patient treated with the combo, and there isn't a thread here about it either.

And please do share the paper that shows that RF microneedling+ablative laser is safe and superior to one of these treatments done alone? But you cannot, because there isn't any. Even the doctors you are trying zo promote here haven't mentioned even one case treated with such a combo in one sitting (yes, I look at their social media from time to time, and follow the threads here and know this).

Of the doctors who answer you can do this combination, one specifically mentions it is best to do Infini and the co2 laser in separate sessions to minimize the risk of complications, others also mention it's advisable to do them within 24 hours, and yet others say you can combine them, but their answers don't specify if it is just in general, or in the same sitting. 

Only 1 or 2 doctors I think have shared their treatment protocol of performing RFM& ablative lasers together. And, of course Dr Lim, who in 2016 changed his mind 180 degrees and started pushing heavily his Lutronic energy devices. He even went so far as to say that Infini is better than fractionally ablative lasers, when all the scientific papers that examine energy-based treatments come to the conclusion that RFM is comparable in terms of results to a non ablative fractional laser, which of all laser modalities yields the least improvement on scars, compared with the fully ablative or the fractionally ablative laser. ( I have read all the scientific literature on scars years ago, and I keep up with the current meta analyses and reviews, and just want to wish you good luck trying to find me a study about the superior results of RFM+co2 lasers ;) ).

Besides, even Dr Lim who said in a video how energy devices are better than lasers still uses mostly the fractionally ablative co2 laser, judging by his IG posts. It's all on his IG, it's all for everybody to see. Also, Lim doesn't have a single post there about someone getting RFM& co2 lasers in one sitting, despite promoting it on RealSelf as his "new fave " treatment. How come? What Lim says, and what Lim does always seem to contradict!

 

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16 hours ago, facial said:

Fractional(non-ablative) lasers and RF Microneedling operate on similar principles and are largely equivalent, namely that they leave the epidermis intact and operate underneath using heat to cause collagen remodeling . 

So if you're getting them both together, essentially it's like getting two RF Mirconeedling in one session. I personally would never do them both together since it's a waste of money. I'd rather just do Sub+RF Micro or Sub+Frac laser and schedule the remaining session of RF Micro or Frac laser 3-4 months down. Also RF Micro if you're getting Infini/Genius is quite painful and my whole face swelled up like crazy. I definitely wouldn't be able to do a fractional laser in the same session.

Now if you're talking about Fractional ablative laser, this vaporizes your top layer of your skin(in fractional columns). Multiple treatments are needed because it is fractional.Generally people do this treatment at the end of their acne scarring journey after their scar pits have risen up.  

Finally you have ablative(non fractional) laser resurfacing, it will vaporize the whole epidermis. Downtime is around 6 weeks. This is like getting a phenol peel. Also usually done after all other scar treatments.

I'm extremely skeptical of the results that non-ablative lasers yield. Had that done by two different doctors and two lasers and I saw no changes. One doctor even had the audacity to say, "Your skin looks better!" at my next visit. Uhh, he didn't even take pictures and how would he know when my next appointment was months from my treatment! I hate when doctors say this. I've had three doctors tell me my skin looks better after treatment. It's utter BS.

Infini treatment is extremely painful. You'll need Pronox if you do your entire face. Or some kinda sedative. Numbing creaming doesn't really do as much as you think. That's how much it hurts. When I did it the first time, it was more bearable. During my second time, it was ridiculously painful. I'm not sure if the doctor changed the settings (he probably didn't). Can't explain why it hurt way more the second time.

10 hours ago, Marumi said:

You have a science background but cannot differentiate between an expert opinion like in the links you've added with the Realself comments in your first posts and real papers? It's very hard to believe. None of actual the papers you gave to Serius Lee later in the thread is about combining RF microneedling with a co2 laser. I replied you your question, stating my opinion about this combination for this is what we are supposed to do here -discuss things- and all of a sudden I am fear mongering and confusing people so that they need to see a scar expert?  Which scar expert do you have in mind? BA maybe? Because you are him, under yet another burner account? 

I base my opinion on the opinion of the doctors who oppose the RFM+laser in one go combination, the fact that there isn't a single paper about it, and the fact that even the doctors you mentioned cannot show a single photo of a patient treated with the combo, and there isn't a thread here about it either.

And please do share the paper that shows that RF microneedling+ablative laser is safe and superior to one of these treatments done alone? But you cannot, because there isn't any. Even the doctors you are trying zo promote here haven't mentioned even one case treated with such a combo in one sitting (yes, I look at their social media from time to time, and follow the threads here and know this).

Of the doctors who answer you can do this combination, one specifically mentions it is best to do Infini and the co2 laser in separate sessions to minimize the risk of complications, others also mention it's advisable to do them within 24 hours, and yet others say you can combine them, but their answers don't specify if it is just in general, or in the same sitting. 

Only 1 or 2 doctors I think have shared their treatment protocol of performing RFM& ablative lasers together. And, of course Dr Lim, who in 2016 changed his mind 180 degrees and started pushing heavily his Lutronic energy devices. He even went so far as to say that Infini is better than fractionally ablative lasers, when all the scientific papers that examine energy-based treatments come to the conclusion that RFM is comparable in terms of results to a non ablative fractional laser, which of all laser modalities yields the least improvement on scars, compared with the fully ablative or the fractionally ablative laser. ( I have read all the scientific literature on scars years ago, and I keep up with the current meta analyses and reviews, and just want to wish you good luck trying to find me a study about the superior results of RFM+co2 lasers ;) ).

Besides, even Dr Lim who said in a video how energy devices are better than lasers still uses mostly the fractionally ablative co2 laser, judging by his IG posts. It's all on his IG, it's all for everybody to see. Also, Lim doesn't have a single post there about someone getting RFM& co2 lasers in one sitting, despite promoting it on RealSelf as his "new fave " treatment. How come? What Lim says, and what Lim does always seem to contradict!

 

I'm in agreement. Dr. Lim's video about Infini and how he praises RFM led people down the wrong path. Maybe he was getting paid under the table by Lutronic and he was just spewing BS to hype up the machine and technology.

I've gotten Infini done twice and wouldn't do it again. Didn't see noticeable results. My scars are mostly boxcar so please keep that in mind - maybe if I had some shallow rolling scars, I would have seem some improvement. Recovery is not 3-4 days despite what every doctor will tell you. Infini also hurts like a bitch. 

 

Edited by Amanda Hall
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