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johnchristoph

question about Dr rullan treatment

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Hello,  I was offered erbium/subsicion/filler for my treatment with dr rullan.  I have read that some people said he is not the greatest with filler/laser.  Should i avoid this and just get subscision?  is he really that bad with it that he will botch my face or is it just that other people can potentially be better. i am pretty sure he cant be that bad that there is a high risk of complications if hes a scar specilaist though i could be wrong.  

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9 minutes ago, johnchristoph said:

Hello,  I was offered erbium/subsicion/filler for my treatment with dr rullan.  I have read that some people said he is not the greatest with filler/laser.  Should i avoid this and just get subscision?  is he really that bad with it that he will botch my face or is it just that other people can potentially be better. i am pretty sure he cant be that bad that there is a high risk of complications if hes a scar specilaist though i could be wrong.  

I dont think he'll botch your face as he's a pretty experienced doctor. But IMO don't go with filler in your first treatment.

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how come i shouldnt do filler?  i am getting subsicion done and he said i had some atrophic scarring. also its temporary rather than permanent (ive never had filler so i wouldnt do permanent first)

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Done this treatment a couple of times. Filler after subcision is a must otherwise the scars would just reattach.

The erbium Laser it's up to you. I think it isn't strong enough to do anything significant but that's my opinion. It's cheap enough to try if it's your first time. I think it cost 1/5 of the total cost or something.

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Filler with subcision has been pretty standard for awhile, and it's his bread and butter technique.. so wherever you read that "he's not good with filler" doesn't make sense. He just published a paper of this combo with hundreds of patients. When it comes to filler the goal isn't always to plump up scars. When done with subcision, it's been proven to induce collagen production which improves the permanent result. That's why it's very popular to do with subcision these days. This is different than getting a temporary injection to plump up the scars. If you do that when they are tethered, you can get a "donut effect", so the subcision steps need to come first

Rullan has been doing this for a really long time and seems to have a great reputation, I would feel very comfortable getting treatment with him. I have no idea how often he does Erbium, but he clearly has Erbium in his office, which means he probably treats all kinds of things with it (not just acne scars). If you're worried about a higher risk of side effect by doing it with him, I highly doubt that he would suddenly have no idea what he's doing because he's treating an acne scar instead (which is obviously what he is reknowned for)

When it comes to Erbium and Rullan, I think what they might be saying is IF you had to choose a doctor to do ONLY Erbium or laser (say at the end of your treatments for texture), you would go to someone who's main treatment modality is Erbium. That would mean they are the BEST at that. But those docs might not be great at subcision or the peels that Rullan does. 

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Rullan doesn't do subcision and filler (as a spacer) as his standard treatment combination. I've attached his standard treatment plan. He recommends his "trio", spaced out every 1-3 months, and then eventually fillers for a better overall cosmetic result. The tumescent anesthesia does a good job of preventing re-tethering from what I hear. Of course, depending on the case, if the patient has extensive atrophy or wishes a dermal filler, he might start with a filler too.

But I don't know where this theory of subc+filler repeatedly for deep scars came from. I'll ask Rullan about that when I see him.  Dr Lim also recommends for deep atrophic scars fillers or fat injections, not subc+filler repeatedly until you fill in the dent and don't need a filler any more. No consensus mentions it either.

 

Screenshot_20210326-104558.jpg

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@gynoscarHave you done it with dr rullan or u just mean you've done sub/filler/laser?  how effective was your treatment would you say? also is juvederm for volume or collagen production?

@Rickyduds Thank you.This is what I thought as he probably has done this numerous times so has to be well versed in it.  The filler i would be getting is juvederm. is this for volume or collagen induction? 

@Marumi Yeah ive heard that he usually does cross but he offered me the sub/filler/erbium.  I guess i dont need cross or he didnt want to include for whatever reason.  He is also going to do some vbeam laser for some redness.  I'm not sure where the theory came from but i have heard that if it is deep atrophic scarring, usually its tethered so subsicion is needed and if its deep scarring, usually its due to fat atrophy so fillers are needed because too much collagen was lost to be replaced. 

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3 hours ago, johnchristoph said:

@gynoscarHave you done it with dr rullan or u just mean you've done sub/filler/laser?  how effective was your treatment would you say? also is juvederm for volume or collagen production?

@Rickyduds Thank you.This is what I thought as he probably has done this numerous times so has to be well versed in it.  The filler i would be getting is juvederm. is this for volume or collagen induction? 

@Marumi Yeah ive heard that he usually does cross but he offered me the sub/filler/erbium.  I guess i dont need cross or he didnt want to include for whatever reason.  He is also going to do some vbeam laser for some redness.  I'm not sure where the theory came from but i have heard that if it is deep atrophic scarring, usually its tethered so subsicion is needed and if its deep scarring, usually its due to fat atrophy so fillers are needed because too much collagen was lost to be replaced. 

I hope you get the improvement you desire. Keep us updated on your progress. I'm also interested in treatment with Dr Rullan, but I think that he'll recommend the deep peel because I've already done combination treatments and now I'm left with a cluster of boxcar scars which didn't respond well to anything else on top of some textural issues, no tethering.

I'm genuinely curious about the subcision plus filler. Some say do this repeatedly and the deep scar will level out. Others say I should stay away from fillers because I need to get the edges of the scars effaced beforehand with laser or with a deep peel and raise up the scar as much as possible before I can think about filler. Anyway, Juvaderm is longer lasting I think. Enjoy the improvement!

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On 3/27/2021 at 6:40 AM, johnchristoph said:

@Rickyduds Thank you.This is what I thought as he probably has done this numerous times so has to be well versed in it.  The filler i would be getting is juvederm. is this for volume or collagen induction? 

I have no idea, you'll have to ask Dr. Rullan :)

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On 3/27/2021 at 7:02 AM, Marumi said:

I hope you get the improvement you desire. Keep us updated on your progress. I'm also interested in treatment with Dr Rullan, but I think that he'll recommend the deep peel because I've already done combination treatments and now I'm left with a cluster of boxcar scars which didn't respond well to anything else on top of some textural issues, no tethering.

I'm genuinely curious about the subcision plus filler. Some say do this repeatedly and the deep scar will level out. Others say I should stay away from fillers because I need to get the edges of the scars effaced beforehand with laser or with a deep peel and raise up the scar as much as possible before I can think about filler. Anyway, Juvaderm is longer lasting I think. Enjoy the improvement!

Good point! I’m wondering the same as well. First time ever hearing you’re supposed to do sub + filler, sub + filler repeatedly. 
 

I’ve done subcision with him 3x now and CROSS two of those times and he didn’t offer or suggest doing filler yet. I’m thinking it’s the final thing as icing on the cake once it’s been filled to a degree. 
 

Curious to know what other people say bc I’m planning on returning for another subcision + at home suction treatment soon

He did say it may be time for filler during my last visit so I may ask more about it. 

Edited by LotsToLearn
Edit: Fill suggested during last visit
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I had filler and subcision done with rullan. I was left with a few bumps but it wasn’t crazy noticeable. Only one was rather noticeable but it wasn’t a permanent filler so it dissolved on its own. The only thing I found weird is that he injected the filler before the subcision. 

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@Marumitbh im not sure. I think subscision forsure helps because if a scar is tethered, there is no way to "untether" it without subscision. you prob wont know if you need filler unless you go to some doctor you can trust and they give you an honest opinion. 

@LotsToLearn How did your treatments work out? did you notice it helped or anything. and not sure why he recommended filler. this is on my temple too.

@Acnescarssuck123did you notice your treatments helped? and wym by bumps. like small white heads or something? or is it like lumpy 

also if anyone sees this (i dont know if im supposed to just type this or @ everyone in this thread lol..) but is there high complication rates for subscision/filler/or erbium. I know people have said you can go blind or cut an artery in the face with subsicion but they never said how likely this is. also developing a hematoma.  Just curious if I should be worried about anything (like a 1% chance anything bad happens) or its like 30% chance that things can go even worse.  Also with filler migrating or granulas or erbium casuing fat loss and what not.  Should i be worried at all or for the most part im pretty fine

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13 minutes ago, johnchristoph said:

@Marumitbh im not sure. I think subscision forsure helps because if a scar is tethered, there is no way to "untether" it without subscision. you prob wont know if you need filler unless you go to some doctor you can trust and they give you an honest opinion. 

@LotsToLearn How did your treatments work out? did you notice it helped or anything. and not sure why he recommended filler. this is on my temple too.

@Acnescarssuck123did you notice your treatments helped? and wym by bumps. like small white heads or something? or is it like lumpy 

also if anyone sees this (i dont know if im supposed to just type this or @ everyone in this thread lol..) but is there high complication rates for subscision/filler/or erbium. I know people have said you can go blind or cut an artery in the face with subsicion but they never said how likely this is. also developing a hematoma.  Just curious if I should be worried about anything (like a 1% chance anything bad happens) or its like 30% chance that things can go even worse.  Also with filler migrating or granulas or erbium casuing fat loss and what not.  Should i be worried at all or for the most part im pretty fine

Subcision is best for rolling scars. Rullan uses a cannula to avoid hematomas. Had it done and subcision was the easiest treatment to recover from by far. I was ready to go out in public in a few days. Some people may take longer due to more bruising and swelling. During the procedure, it seems like he's ripping your face off, but you are anesthetized so there's no pain, just a weird sensation. He's not aggressive with Erbium so there's a low chance of complications.

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2 hours ago, johnchristoph said:

@Marumitbh im not sure. I think subscision forsure helps because if a scar is tethered, there is no way to "untether" it without subscision. you prob wont know if you need filler unless you go to some doctor you can trust and they give you an honest opinion. 

Yeah I agree with you but it can be difficult to get an honest opinion from a dishonest doctor. Rullan however seems trurtworthy - one of the reasons I would like to continue my scar treatment with him.

As to your questions about complications from procedures, all these can happen but are usually doctor dependent. In the experienced hands of Rullan, I wouldn't worry so much. Subcision is safe. Fat loss can happen only if the dr goes too deep or too aggressive and burns the fat, which Rullan doesn't do. Blindness from fillers in extremely rare and occurs most often when you get the filler injection at a med spa or by someone who doesn't know the facial anatomy and has no proper qualification or training. There is some risk of late onset inflammation of the filler weeks even months after the injection, which may happen if you get sick or have a vaccine, but that's the nature of fillers and doctors can treat it. HA fillers are the safest. Don't get filler if you have tendency to develop kelloid scars 'cause you might end up with a lump. 

 

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4 hours ago, LotsToLearn said:

Good point! I’m wondering the same as well. First time ever hearing you’re supposed to do sub + filler, sub + filler repeatedly. 
 

I’ve done subcision with him 3x now and CROSS two of those times and he didn’t offer or suggest doing filler yet. I’m thinking it’s the final thing as icing on the cake once it’s been filled to a degree. 
 

Curious to know what other people say bc I’m planning on returning for another subcision + at home suction treatment soon

He did say it may be time for filler during my last visit so I may ask more about it. 

I am not questioning filler as volumizer which is needed if you have deep scars which just won't raise up with other treatments, or if you have extensive atrophy that goes to the fat layer. Sometimes you cannot get good results without fillers. 

But as you said, Rullan doesn't seem to agree with the theory that subcision with filler (as a spacer) is needed to get results or stimulates more collagen, just like Prof Chu didn't agree either. I am just wondering why two of the best scar docs wouldn't do it, if it was so beneficial?? Certainly they are not stupid. Chu was even of the opinion that subc + filler would impede the collagen growth and he flat out refused to do filler when I asked him out of curiosity and strongly advised me not to get it done. 

I'm saying theory because it has not been proven in any medical study that subc+filler gives better results than subc alone, which is odd. So many fillers on the market, so many filler manufacturers! They should be testing which filler gives better results with subcision by now but they haven't got even 1 study to show the combination gives better results. 

My rolling scars lifted without a filler after a 5 subcisions, unfortunately my box car scars didn't respond so well. These I am trying to improve now. Curiously, some ppl say boxcars with defined edges don't like to be filled because the filler somehow 'gathers' at the edge giving a dounut like effect so you first need to smooth the edges before you get filler. I will ask Rullan about it for sure.

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@Amanda Hallsounds like a lovely experience lol... anyways i should be good thanks for the heads up though

@Marumii was going to get the covid vaccine. should i try to do it before the procedure rather than after? never heard of vaccines being bad so this is interesting.  also i am asian so i tend to have hypertrophic scars. do you mean where the needle is injected a scar would be there or a scar would raise from the filler? also in regards to your discussion about boxcars and fillers it is interesting as i do have some boxcars and supposedly cross is really good for this but he didnt recommend it to me.  i dont know if hes putting filler here or just subsizcing but will know when i get there.  also, maybe the pictures weren't the best and he didnt realize it was still box car scars or maybe i thinned down the edge enough because i do use retinoid. not sure 

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4 hours ago, johnchristoph said:

@Amanda Hallsounds like a lovely experience lol... anyways i should be good thanks for the heads up though

@Marumii was going to get the covid vaccine. should i try to do it before the procedure rather than after? never heard of vaccines being bad so this is interesting.  also i am asian so i tend to have hypertrophic scars. do you mean where the needle is injected a scar would be there or a scar would raise from the filler? also in regards to your discussion about boxcars and fillers it is interesting as i do have some boxcars and supposedly cross is really good for this but he didnt recommend it to me.  i dont know if hes putting filler here or just subsizcing but will know when i get there.  also, maybe the pictures weren't the best and he didnt realize it was still box car scars or maybe i thinned down the edge enough because i do use retinoid. not sure 

If you can, get the vaccine before the treatment. Many dermatologists that I follow have talked about this because of the covid vaccine recently. A guy on the forum had problems with a Radiesse filler, has a lump which doesn't go away, and as we read , you shouldn't get permanent filler if you've had kelloid scars before. But HA fillers are safer I guess. Ask Rullan. He'll know best. I was just wondering about boxcars and fillers because I'm trying to find a doctor and the best treatment for them. I don't want to go the trial error route doing ineffective or too risky treatments. Rullan is probably the best scar doctor, I'd follow his recommendation. If you had a virtual consult, when he sees your scars in person, he might do something else. 

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I’m not really sure if I had improvement. If I did it was minimal maybe like 10% but it was my first and only treatment I have had done so maybe more might get better results? The bumps were small filler bumps wasn’t they dissolved over time as it was a HA filler. Rullan seems to do subcision and filler often so if you go to him the procedure should be smooth he’s experienced and has put many hours in. After the subcision I was extremely swollen for about 3 days. 

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Hello,  I thought I would update you guys on the situation.  Overall, the procedure was painless and comfortable.  The after care in and of itself was fairly easy.  I am waiting for the results as I just had this 3 days ago so will update u guys on that.  The erbium was fairly conservative (which I am ok with as my skin isnt that bad so dont want to risk complications)  so I have no scabbing but just peeling/redness.  I have read online that swelling from subcision can last from 2 days all the way up to 3 weeks (I had cannula so I dont think it will be swollen past 3 weeks like a TL or Nokur).  I also had erbium but its vague on how long the swelling would last as there are different settings, passes, etc.  Its hard to tell whether the results are from swelling or the Juvederm but I guess time will tell.  Does anyone know how an approximate time in which I could tell?  Obviously at 6 months most of the swelling should be gone but maybe something like 1-2 weeks?

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7 hours ago, johnchristoph said:

Hello,  I thought I would update you guys on the situation.  Overall, the procedure was painless and comfortable.  The after care in and of itself was fairly easy.  I am waiting for the results as I just had this 3 days ago so will update u guys on that.  The erbium was fairly conservative (which I am ok with as my skin isnt that bad so dont want to risk complications)  so I have no scabbing but just peeling/redness.  I have read online that swelling from subcision can last from 2 days all the way up to 3 weeks (I had cannula so I dont think it will be swollen past 3 weeks like a TL or Nokur).  I also had erbium but its vague on how long the swelling would last as there are different settings, passes, etc.  Its hard to tell whether the results are from swelling or the Juvederm but I guess time will tell.  Does anyone know how an approximate time in which I could tell?  Obviously at 6 months most of the swelling should be gone but maybe something like 1-2 weeks?

I had subcision with rullan and my swelling lasted about 10 days. If you just had it done 3 days ago there most definitely will still be swelling from the sub.

Edited by GuyGaGa
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On 3/30/2021 at 11:26 PM, Marumi said:

I am not questioning filler as volumizer which is needed if you have deep scars which just won't raise up with other treatments, or if you have extensive atrophy that goes to the fat layer. Sometimes you cannot get good results without fillers. 

But as you said, Rullan doesn't seem to agree with the theory that subcision with filler (as a spacer) is needed to get results or stimulates more collagen, just like Prof Chu didn't agree either. I am just wondering why two of the best scar docs wouldn't do it, if it was so beneficial?? Certainly they are not stupid. Chu was even of the opinion that subc + filler would impede the collagen growth and he flat out refused to do filler when I asked him out of curiosity and strongly advised me not to get it done. 

I'm saying theory because it has not been proven in any medical study that subc+filler gives better results than subc alone, which is odd. So many fillers on the market, so many filler manufacturers! They should be testing which filler gives better results with subcision by now but they haven't got even 1 study to show the combination gives better results. 

My rolling scars lifted without a filler after a 5 subcisions, unfortunately my box car scars didn't respond so well. These I am trying to improve now. Curiously, some ppl say boxcars with defined edges don't like to be filled because the filler somehow 'gathers' at the edge giving a dounut like effect so you first need to smooth the edges before you get filler. I will ask Rullan about it for sure.

Good points. Yeah, I noticed that my box scars are not responding well to the subcisions. Any tips on working on those scars? I'm seeing Dr Rullan on Thursday and I'm going to just do just subcision alone for now. 

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On 3/30/2021 at 9:16 PM, johnchristoph said:

@Marumitbh im not sure. I think subscision forsure helps because if a scar is tethered, there is no way to "untether" it without subscision. you prob wont know if you need filler unless you go to some doctor you can trust and they give you an honest opinion. 

@LotsToLearn How did your treatments work out? did you notice it helped or anything. and not sure why he recommended filler. this is on my temple too.

@Acnescarssuck123did you notice your treatments helped? and wym by bumps. like small white heads or something? or is it like lumpy 

also if anyone sees this (i dont know if im supposed to just type this or @ everyone in this thread lol..) but is there high complication rates for subscision/filler/or erbium. I know people have said you can go blind or cut an artery in the face with subsicion but they never said how likely this is. also developing a hematoma.  Just curious if I should be worried about anything (like a 1% chance anything bad happens) or its like 30% chance that things can go even worse.  Also with filler migrating or granulas or erbium casuing fat loss and what not.  Should i be worried at all or for the most part im pretty fine

They've been good so far! The box scars have not been responding as well so I need to look into ways of working with those

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17 hours ago, LotsToLearn said:

Good points. Yeah, I noticed that my box scars are not responding well to the subcisions. Any tips on working on those scars? I'm seeing Dr Rullan on Thursday and I'm going to just do just subcision alone for now. 

I will try to get the edges effaced by a laser or abraded with a peel. 

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Just did a round of filler and then subcision with Dr Rullan today. Yeah, he suggested filler this time and did it before the subcision like @Acnescarssuck123 said. I did ask his assistant about using filler as a spacer vs volumizer so that she could ask him but he forgot to answer. 
 

I did make sure I asked him whether I can suction at home after this and he said I can. Only downside is that since you can no longer microneedle, I wonder how I can take care of texture at home in the meanwhile. 

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