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Hi, 

 

I have scarring from cystic acne that I had as a teenager / young adult. These are deep atrophic scars that I would charitably classify as unimaginably severe. I have never seen acne scars this deep, disfiguring, and horrifying on another person. I am extremely depressed about them and I cannot get anything done because a very large amount of my free time is spent taking pictures of my face from all angles or in the bathroom with a set of mirrors examining the damage from all angles and crying. 
 

I have been quoted some really huge amounts of money to start to fix the damage and I suppose my question to you all is, would it be worth the money and risk? It would take me several years to save enough to be able to afford a treatment that would make a noticeable difference. Is there any reason to even do so? I cannot even leave the house on some bad days because my obsession is so severe.
 

Is it a better idea to see a psychiatrist and try to get over these? I cannot imagine being comfortable with them... the entire left side of my face doesn’t even look human. Am I mentally ill or is it really that bad? 
 

The strangest part is that for a decade, my scars didn’t bother me much. I knew I had them, but didn’t consider them very bad and they had no impact on my mental health or life. I always thought I had decent skin since the acne cleared up. But now, obviously, it’s nearly all I can think about. 
 

I think they really are quite horrible. Very disfiguring and unusual. I cannot believe nobody ever told me to cover them up - I can only imagine how scary I must look to other people and I feel like I shouldn’t walk around in public anymore without an open apology to everyone who has to look at me. 
 

Any input is welcome, thanks. 

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3 hours ago, 313178_1443948907 said:

The strangest part is that for a decade, my scars didn’t bother me much. I knew I had them, but didn’t consider them very bad and they had no impact on my mental health or life. I always thought I had decent skin since the acne cleared up. But now, obviously, it’s nearly all I can think about. 

We've all been there at one point or another. Even if you try, it's difficult to not take notice of these scars. Just the thought that you have these scars constantly gnaw at your psychological bearing. 

 

3 hours ago, 313178_1443948907 said:

I think they really are quite horrible. Very disfiguring and unusual. I cannot believe nobody ever told me to cover them up - I can only imagine how scary I must look to other people and I feel like I shouldn’t walk around in public anymore without an open apology to everyone who has to look at me. 

Don't be too hard on yourself. They might be disfiguring (for now) but it's not too late to fix them. The important thing is to keep your head above the water and have positive outlook in life.

Another critical thing to keep in mind is to have a roadmap. Knowing where you want to go and how to get there will be immensely helpful in the long run.

As far as your scars are concerned, you mostly have boxcar and rolling scars (see pic below). There are a few deep atrophic scars.

For treatment, you initially will want to get subcision to cut any tethered scar bands. This will help lift those scars that are held down. Second, I suggest TCA Cross for individual boxcars with prominent scar border. You must understand that scar is visible thanks in large part to SHADOWS. And the shadow made by scar borders. After the scar edge has been relatively flattened, you will likely need to get facial fillers.

Lastly, you will need multiple treatments, perhaps over many years. Some treatments can be done at home, some cannot. So you'll need to prioritize.

Hopefully, this will get you started.

 

 

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Hi there, 

I'd say there's a huge part of acne scaring that is associated with how we perceive our own self because most other people don't really care all that much, they are mostly preoccupied with how they themselves look rather than how other people look except if they're looking for a relationship like a love partner I guess. Some people are shallow no matter how you look. I can tell you that some of the most handsome people with perfect skin out there also can feel like they should apologize to others because they have a lot of jealous enemies. 

I know it's hard but you shouldn't worry about other people and having to excuse yourself over that lol, I'm sure you weren't all that serious anyway.

I've had some acne scaring too in my life and some places I noticed that are harder to treat then others are place like the temples and the area between your ears and where your face starts, it's almost untreatable for some reason...

The pictures you linked were mostly taken under some very harsh lightings and in all honesty it's not all that bad. Some of my scaring does look like yours but at 40 I can honestly say that it doesn't bother me like it used to. You really have to learn to get over it but that doesn't mean you shouldn't try to do something about it if you feel like it.

I had some procedures done on my face over time and it always takes  a long time (sometimes years of healing) to be able to tell if it changed something or not. 

Some of your scaring have that sharp edgy look and I also had those. I think what helped me with that (if you don't want to start with harsh measures) would be to use a pumice stone like this one here. What I used to do is rub it on my face like once a week and let it heal a bit with some soft moisturizing to help collagen growth.

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This is made to be rubbed on the body, not necessary on the face but I used it on the face anyway and I seriously think it helped overtime with softening the sharp edges.

Good luck with whatever you're a going through keep in mind that most people with scars will experience some psychological effect related to it so you're not alone, millions and millions of people are out there suffering with this.

 

 

 

 

Edited by aFriendIfYouWant
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5 hours ago, 313178_1443948907 said:

These are deep atrophic scars that I would charitably classify as unimaginably severe. I have never seen acne scars this deep, disfiguring, and horrifying on another person.

I agree that these scars are slightly severe, but remember that's only in the most extreme lighting. The vast majority of the people aren't going to zoom into your face and nitpick. I'd definitely not classify them as disfiguring or horrifying.

 

5 hours ago, 313178_1443948907 said:

I cannot believe nobody ever told me to cover them up - I can only imagine how scary I must look to other people and I feel like I shouldn’t walk around in public anymore without an open apology to everyone who has to look at me. 

We often think that everybody is watching us and analyzing every single flaw of ours, but trust me the vast majority of the people don't really care. The fact that nobody ever pointed out your scars is proof of that. We often tend to be our worst critics. Neither you nor anyone needs to apologize for anything.

 

One very important thing you'll eventually need to come to terms with whether or not you treat your scars is "acceptance". Accepting that your scars are here to stay and a chances that you may not see that much improvement. Some people see just 20%, while others get 50% or even 90% improvements. This is often the hardest part, there is no magic bullet treatment for acne scars. It all depends on how every individual reacts to treatments.

Remember we all have imperfections, some people are born with Type 1 Diabetes and need to keep injecting insulin all their lives, many are born with genetic and physical deformities, some are born blind, deaf, dumb etc. Not trying to minimize your struggles but what I wanted to point out is that we all have our own imperfections and the first step often begins with accepting them.

 

Regarding treatments, I agree that you should try out subcision first for your cheeks, you might also need some fillers. TCA cross should help for your boxcars on your temples. Avoid docs who just blindly want to laser your face without doing these treatments first.

 

Lastly, If you want inspiration here's an amazing story of Ernesto, IMO his scarring was more severe and widespread than yours but he still had a positive attitude about life and kept going. Last, I checked he was quite successful, runs his own company and a is public speaker.

 

 

 

 

 

 

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Man don’t be sad and keep your head up!!!! Your scars can definitely improve!!! If you have no money, you can try at home treatments that will boost collagen production, try dermapen (you can buy one, for example dr. Pen, and try doing it at home) + you can try TCA at home you probably need also subcision, it will be okay:) 

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honestly, i don't think your scars are that bad. your skin texture is good, and that's lucky not everyone has. I think with the right treatments (especially subcision+filler) you will have great results. Good luck

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Thanks, everyone. All of your thoughts and comments are really helpful to me. I am feeling somewhat better today! But I know the ups and downs are real, so I will keep re-reading your responses when I feel down. 

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I would like to give an update. I have been using adapalene .1% (differin) for about two months. I have also been using a pumice stone for very gentle exfoliation. (Be very careful! I removed too much and it was bad... the adapalene makes skin very sensitive). I can’t tell if there is much of a difference compared to my older photos. What do you all think? 
 

I think major surgery for fat grafts and very deep sanding are the only things that could help me now. Some of the holes in my face are so deep that to fully level the scar looks about imposible.
 

This worries me because it’s the horrible shadows that are my biggest cause of misery. I cannot control who sits or stands near me and at what angle and they might be absolutely scared or sickened by what they have to look at if the light is wrong. If I could get rid of the shadows I could get back to real life and be content. The shadows make my face look like it’s dead and decaying, like a piece of roadkill. I am so miserable. 

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2 hours ago, 313178_1443948907 said:

I would like to give an update. I have been using adapalene .1% (differin) for about two months. I have also been using a pumice stone for very gentle exfoliation. (Be very careful! I removed too much and it was bad... the adapalene makes skin very sensitive). I can’t tell if there is much of a difference compared to my older photos. What do you all think? 
 

I think major surgery for fat grafts and very deep sanding are the only things that could help me now. Some of the holes in my face are so deep that to fully level the scar looks about imposible.
 

This worries me because it’s the horrible shadows that are my biggest cause of misery. I cannot control who sits or stands near me and at what angle and they might be absolutely scared or sickened by what they have to look at if the light is wrong. If I could get rid of the shadows I could get back to real life and be content. The shadows make my face look like it’s dead and decaying, like a piece of roadkill. I am so miserable. 

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Did you see a dermatologist yet? Your skin looks great. There is a lot of potential for improvement. You look fairly young from the shape of your neck so improvement shouldn’t be impossible. Visit a dermatologist and see what can be offered as a response to your scarring. 
 

But to your point, yes scarring can take a severe toll on positive thinking and self-esteem. I have been down that rabbit hole quite a bit but it wasn’t the best use of my time. I say time because time is the only thing that is quite relevant to me and it’s the only thing money can’t buy. So while it is okay to sulk about your appearance, I wouldn’t give it much thought. You look great with the little bit that I can see from the photos you shared. I’m sure there is a giant world inside of you that is bursting with insight, emotion, wisdom, and love. I say this because as humans in the civilized and industrialized world, we fixate on your looks more so than ever before. If you stare at a mirror long enough, you will find all kinds of “flaws” that aren’t really flaws. The power of the mirror or camera is to capture life, but not to pick it apart. I want you to enjoy life and enjoy being yourself, no matter what you see in the mirror because that’s the best piece of words I have lived by. I highly doubt the people who love you say “gosh, it’s impossible to love [insert self] with scars!” No, people love you for you, no matter what you look like. So please take this one piece of advice from me or the internet and listen to it... you are beautiful and worthy of love no matter what you look like. Don’t let this world eat you up from the inside out. Don’t pick yourself apart. You are so much better than that. So that’s the main and first thing I want you to swallow down and remember for the rest of you life because this is the only way to move forward and find peace with yourself: you have to accept the things you cannot control and learn to move forward despite the odds... there is no time for “woe is me”. Life is quite literally a blink of time in the span of this endless universe.

Don’t. Give. In. 
And definitely Don’t give up. 
 

Nevertheless, progress is possible. The pursuit of Perfection is the beginning of misery so don’t wish for it. Instead, focus on improvement. If this is your bottom, It can only go up from here, right? That’s what I tell myself. All this is what I tell myself and you know what???? I enjoy life so much more now. I’m not carrying around this heavy personal burden on my shoulders that I once saw as the end of the world for me. Nope! Not me! I won’t let it take anymore time or happiness from me.  If you ask of me, I’m just here, living. Yeah I have scars, but I also have a million other traits and the rest of my life ahead of me with new things to experience and learn from. I don’t see a bluejay crying about why it is not orange, or pink or yellow. The bluejay just keeps living, and quite happily actually. 
 

So hang in there. Look on the bright side. You are fucking wonderful. 

Edited by Dontgiveupitsonlyscars
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On 5/12/2021 at 1:50 PM, Dontgiveupitsonlyscars said:

“I say time because time is the only thing that is quite relevant to me and it’s the only thing money can’t buy.“

Speaking of time... I thank you very much for taking so much time to write such a thoughtful and encouraging post. 
 

I have seen several dermatologists and plastic surgeons for consultation. The consensus is that subcision wouldn’t help me because nothing is tethered with fibrous bands, everything is quite mobile. My problem is that the flesh underneath my skin is simply gone, it was all destroyed by the immune response to my cysts. They could be up the size of a large grape and take many weeks to heal. 
 

One surgeon I visited with claims he can make a huge difference with fat grafts. But it’s very expensive at around 10k. I have only about a quarter of that amount saved so far and I have to find ways to stay sane while I live through the amount of time it will take to get the remainder. This surgeon also said to stay away from all types of lasers and micro needling because in my case they will do basically nothing. 
I can’t say I’m very interested in temporary fillers either. 

I don’t really know why I’m posting. If I can ever afford the grafts I will update you all on if they help or not. Anyway, thanks again everyone. 

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8 hours ago, 313178_1443948907 said:

I have seen several dermatologists and plastic surgeons for consultation. The consensus is that subcision wouldn’t help me because nothing is tethered with fibrous bands, everything is quite mobile. My problem is that the flesh underneath my skin is simply gone, it was all destroyed by the immune response to my cysts. They could be up the size of a large grape and take many weeks to heal. 

Well, I beg to differ. Atrophy and tethering go hand in hand. I would not write subcision off so quickly. I usually am pretty critical of subcision when it comes to those with superficial scars, but folks with severe scars will definitely benefit from it. I suggest you get at least 2 treatments of subcision. Seriously, in this game, you need to be open-minded, otherwise you will find yourself at a dead end pretty quickly.

 

8 hours ago, 313178_1443948907 said:

One surgeon I visited with claims he can make a huge difference with fat grafts. But it’s very expensive at around 10k. I have only about a quarter of that amount saved so far and I have to find ways to stay sane while I live through the amount of time it will take to get the remainder. This surgeon also said to stay away from all types of lasers and micro needling because in my case they will do basically nothing. 
I can’t say I’m very interested in temporary fillers either. 

That's like the tail wagging the dog. You need to get rid of the scar edges first. As you already know, it's the SHADOW that accentuates the scar and shadows are made by the scar edges. As long as there are prominent edges, no amount of filler will help. On the contrary, it will only makes the scars more visible.

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On 5/13/2021 at 5:55 PM, 313178_1443948907 said:

Speaking of time... I thank you very much for taking so much time to write such a thoughtful and encouraging post. 
 

I have seen several dermatologists and plastic surgeons for consultation. The consensus is that subcision wouldn’t help me because nothing is tethered with fibrous bands, everything is quite mobile. My problem is that the flesh underneath my skin is simply gone, it was all destroyed by the immune response to my cysts. They could be up the size of a large grape and take many weeks to heal. 
 

One surgeon I visited with claims he can make a huge difference with fat grafts. But it’s very expensive at around 10k. I have only about a quarter of that amount saved so far and I have to find ways to stay sane while I live through the amount of time it will take to get the remainder. This surgeon also said to stay away from all types of lasers and micro needling because in my case they will do basically nothing. 
I can’t say I’m very interested in temporary fillers either. 

I don’t really know why I’m posting. If I can ever afford the grafts I will update you all on if they help or not. Anyway, thanks again everyone. 

You are here to express yourself, find potential solutions from people going through the same thing you are going through and to be heard. I’m here for the same reasons. I’m here to listen. I’m here to inspire. I read a post not to long ago about someone wanting to take their life over scars, it broke my heart. That’s my mission here, my little tiny effort to give kindness and hope to people deeply struggling emotionally with their appearance after acne. Perhaps I’m quite dramatic and sensitive to it all, but I care. I care about this. So... yes, keep talking and walking us (or me) through your journey. I am here for this. We all are, I think. 
 

as for fat grafts, you could negotiate with the doctor who told you about it or find another doctor for fat grafts and negotiate the price. Fat grafts are quite common in places like Korea for example, where acne scars are very common among Korea and a lot of the doctors are super educated in the whole area of acne scars. Try looking up “fat graft acne scars” on YouTube to see videos on it. Also, I will just say this and this is my opinion, but I would argue that lasers and treatments for your scars would help to stimulate collagen and thus help your outcome for when you do get fat grafts even more. Or even alone. That’s my opinion. But time and money is an issue so I understand this. Always negotiate with every doctor on treatments, and really give it your all. They rather have some than none of your money, it’s the truth... it’s business. 
 

And by the way you do not need any treatments. You do these for the potential change but even then you still look great. 
 

I hope to hear from you!

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I would give subcision a shot like Sirius said. However, I'm not a doctor but I've had disagreements with dermatologists and plastic surgeons, so this is just based on my experience and from seeing what people write.

TCA Cross would seem helpful but that's a long journey with multiple treatments.

For some of the bigger crater scars, consider excision from a plastic surgeon. You're replacing one scar with another, but in many cases, the new scar will look better. There are cases in which the new scar is a little depressed though. But I think it's worth it. You can do laser treatments to improve the appearance of the new linear scar.

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I have now had two rounds of genius Radiofrequency micro needling with prp and subcisions on my whole face. Here is a current picture. There is definitely some progress but unfortunately for the big, deep scars, filler is the only option. My doctor wants to use Bellafill but I cannot find a single good review of it. Most people are telling me to stay away from Bellafill because of the risks. Maybe HA fillers will help? I was told that HA fillers can help to build permanent collagen in the depressed areas. I don’t doubt this but… collagen is not what I’m missing…. What I am missing is an entire half of my face, including the deep tissues….. the damage to the deeper tissues looks so bad that I don’t think any amount of only collagen can make a noticiable difference. The two rounds of treatments I have done have made a nice improvement in some lighting situations, and I’m very grateful for that. In fact, believe it or not, when the light is just right, it barely looks like I have scars there at all anymore. However, in angled lighting (unfortunately the most common situation in my life, it seems) then the real extent of the scars can be seen. Good lighting plays a nice trick and hides the depth of the atrophy. Not sure what my next step is but overall I am less anxious and depressed. Some days are much better than others. I just hope that what I look like on average now is not always what I see in this picture. But I only think about the worst possible representation of these scars when I think about what I look like. A day at a time… I can’t decide if another round of genius rf, subcision, and prp will be worth the enormous cost considering that I will have very little effect on the deep scars. I think that without a filler I am stuck with them forever. Does anyone have a review of Bellafill? Everything I’ve heard says it that it will betray me in several years and need to be surgically removed leaving even worse scars than before. But I don’t know what to believe. 

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Hey man. I had Bellafill injected for my acne scars and honestly don't recommend it. It's permanent and extremely difficult to remove. I know a few people that have gotten it and it leaves your face rounder. Not sure if you have sharp features with a thin face. I lost some of my face sharpness. Definitely try the other fillers that dissolve first! One thing I learned from my experience is that scars take time and it should be seen as a journey. 

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NO FILLERS, PLEASE!!!

So when you fill your scars, for awhile it will look fine but then all of the scarring will retether and the filler will squeeze to areas with no scarring. That's what happened to me and no, the filler doesn't go away in a few months. It can last for years!

In short fillers will make your face look worse!!!!  I am looking into subcision myself. Try to find Mr. Matt's old threads and posts.  He never filled his face and ultimately he was able to smooth out his skin as if he never had scarring. He used mainly peels and subcisions.

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6 hours ago, Urbanite said:

NO FILLERS, PLEASE!!!

So when you fill your scars, for awhile it will look fine but then all of the scarring will retether and the filler will squeeze to areas with no scarring. That's what happened to me and no, the filler doesn't go away in a few months. It can last for years!

In short fillers will make your face look worse!!!!  I am looking into subcision myself. Try to find Mr. Matt's old threads and posts.  He never filled his face and ultimately he was able to smooth out his skin as if he never had scarring. He used mainly peels and subcisions.

What if you do fillers and multiple subcisions? 

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@313178_1443948907

 

I suggest you get a few more subcisions before getting any fillers. 

For fillers, I highly recommend you go with a collagen stimulating filler like Sculptra, which can last over 2 years, rather than a temporary volumizer like Juvederm. Bellafill is not a bad idea to consider IMO, should Sculptra work out for you. They're both collagen stimulators, although Sculptra isn't labeled as a "permanent" filler.

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On 2/11/2022 at 2:15 AM, Urbanite said:

NO FILLERS, PLEASE!!!

So when you fill your scars, for awhile it will look fine but then all of the scarring will retether and the filler will squeeze to areas with no scarring. That's what happened to me and no, the filler doesn't go away in a few months. It can last for years!

In short fillers will make your face look worse!!!!  I am looking into subcision myself. Try to find Mr. Matt's old threads and posts.  He never filled his face and ultimately he was able to smooth out his skin as if he never had scarring. He used mainly peels and subcisions.

sculptra?

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You definitely saw some good improvement from the prior two things you did. I haven't heard that many great things about permanent fillers, but I'm not knowledgeable on fillers and only what I read. It might be sort of per case basis. But you may want to test an area first with temporary see how it handles it for up to a year. Sculptra, maybe fat transfer should be kept in mind. Sculptra might be a good option because it seems to last longer 18-36 months but might also grow volume or material back along with subscision. 

Totally feel your pain in regards to the shadows and lighting. For me sunlight is the absolute worst when it flickers and casts shadows and so on. Angles too of course which also have shadows. Had a real look today driving versus these barely noticeable house mirrors with stable lighting.

 

 

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On 2/11/2022 at 10:20 PM, Candy Says said:

with bad doctors only. Good professional will make scars look better with fillers. Many people can't produce enough collagen on their own, or scars can be too deep for human healing capabilities in general,  so fillers are necessary. 

i feel like the risk of migration in tiny pockets on face is inevitable , especially if an area of high movement. 

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2 hours ago, JudgmentPuzzleheaded said:

i feel like the risk of migration in tiny pockets on face is inevitable , especially if an area of high movement. 

Probably depends on the damage (whether the layers allow for streams underneath to escape over time) or how the scar is shaped, and/or the doctor's talent.

Honestly if subscision does generate collagen or some growth and the scar isn't too deep (your personal experience notwithstanding) that might just be the best option with temporary's. Maybe he should just get a whole lot of subscision on the deeper ones and inject temporary fillers and try to do the medium term approach to improvement. 

Or just throw a more permanent filler in several of them such as sculptra 18-36 months along with the subscision. 

 

Edited by harmlessboy1441
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One confusing aspect of this is again, the lighting. Here are two examples of photos taken from random angles on the same day and time as the previous pictures where it looks really bad. It’s mind blowing how bad they can look vs. how good they can look from a different angle. I wish it looked like a consistent average. Makes me wonder if the scars are really bad and revealed by certain lighting, or not that bad and amplified by certain lighting. The worst is seeing the reflection in tinted store windows or an iPhone screen. If that’s closer to reality then I am amazed. But it seems like the better the camera and more candid the photo, the less bad the scars look which is a good thing. I think I will do another round of subcision, genius rf, prp, and half the usual amount of HA filler on the deep crater scars. Then in a year I will rev-evaluate where it’s at. At least in that case the HA filler can be dissolved if there is a problem. Thanks for all the replies. 

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