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Shelly399

What treatment would work best for these craters??

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I have these very deep and ugly scne scars from having cystic acne starting from the year 2018. I’m mostly clear now with a few breakouts here and there. I just want to feel better about myself as I have become so depressed because of this. I used to be so hapoy before and then my life just went downhill after getting terrible skin. Its bad enough to deal with cysts but now I have the scars to remind myself of the trauma. All derms I have been to look at me with pity and I feel like I will never have “normal” skin again. They reccommend dermarolling and laser resurfacing but I feel like subscision is better. How serious do they look on a scale from 1-10 and how much improvement do you think I should be after. It sucks that I have this but hopefully I can get my skin back go normal.

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Edited by Shelly399
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11 hours ago, Uhghatethis said:

Look into TCA or Phenol Cross. Wish your the best. 

How deep would you say these scars are? Do you think there is much hope for much improvement? Obviously it won’t go back to fully smooth.

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Honestly, I would look into dermal grafting, or punch float/punch excision. Boxcar scars are very difficult to treat. The icepick scars would benefit from TCA Cross (you would need a series of at least 3-6).

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2 hours ago, Starlite said:

Honestly, I would look into dermal grafting, or punch float/punch excision. Boxcar scars are very difficult to treat. The icepick scars would benefit from TCA Cross (you would need a series of at least 3-6).

Can you get dermal grafting done at a normal derm’s clinic?

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Hi love,

i feel your pain, I too suffer from left over acne scarring on both cheeks that is left over from years of cystic hormonal acne.

I am working closely with a dermatologist who specializes in acne scar treatment. She had a treatment plan laid out for me. I have mostly boxcar scarring (deep and shallow box type scars) and ice pick scars (these I was told are more difficult to treat)

she wants to start me out with an ablative co2 laser to target the deep and shallow box car scarring. This will heat and remove the outer layers of skin, which will regrow and be smoother but not perfect. I was told with the current technology it is possible to reach 50% improvement. This is coming from a doctor who has 30 years experience with treating acne scars.  Each treatment is only $500 for acne scarring patients which is very low , but we will have to get more treatments done than say someone who is going in for “aging rejuvenation”.

she then wants to try radio frequency co2(this does not harm the outer layer of skin but sends heat deep under the skin to “restructure” the scar tissue so to speak) it also helps formulate collagen for firmer skin. 
 

after we try those, she wants to use either tca cross (this is a technique where they apply an acid on specific ice pick scars and it is supposed to “close the gap” so to speak ) I was told I may need a few of these. She also recommended picosure laser for this type of scarring.

once we plateau at 50% improvement I will then consider dermal fillers for any scarring that is left over. 

I will be documenting all of my progress with photos and commentary and number of treatments etc on my page if you want to follow.

 

I wish you all the best on your journey. Although we can’t go back to the way it looked before we can improve the way it looks to live a more fulfilling life. 
 

 

-A

 

 

 

Edited by Lookingforimprovement01
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On 4/8/2021 at 1:29 AM, Shelly399 said:

Can you get dermal grafting done at a normal derm’s clinic?

I wouldn't, or at least, I would make sure that it's a specialty of that dermatologist. 

 

Maybe try the TCA cross for all scars. After the series is finished, your ice pick scars will be significantly better more than likely, and you can gauge how much it also helped the boxcar scars? That's what I would do, if you're worried about money. Because dermal grafting is expensive and comes with risks. 

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57 minutes ago, Starlite said:

I wouldn't, or at least, I would make sure that it's a specialty of that dermatologist. 

 

Maybe try the TCA cross for all scars. After the series is finished, your ice pick scars will be significantly better more than likely, and you can gauge how much it also helped the boxcar scars? That's what I would do, if you're worried about money. Because dermal grafting is expensive and comes with risks. 

For the largw boxcar scars that I’m mostly worried about, would you reccommend subcision or punch excision? What results should I expect? Would it improve my skin much? I’m hoping to do laser after that then to smoothen things out. However my derm is telling me to do 3 sessions of dermarolling followed by three of laser? I dont know if his approach is good to be quite frank.

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It depends on your budget. Punch excision or elevation would be best for boxcar scars. At least see how TCA cross would work (3-6 sessions minimum). Honestly, your derm sounds like they don't have experience treating acne scarring if they're suggesting dermarolling to start. That's for superficial scarring imo. 

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4 hours ago, Starlite said:

It depends on your budget. Punch excision or elevation would be best for boxcar scars. At least see how TCA cross would work (3-6 sessions minimum). Honestly, your derm sounds like they don't have experience treating acne scarring if they're suggesting dermarolling to start. That's for superficial scarring imo. 

Did you go through any of these procedures yourself? Would I be able to see what you have experienced while using these procedures? I’ve heard that sometimes TCa cross doesn’t work at all.

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12 hours ago, Shelly399 said:

Did you go through any of these procedures yourself? Would I be able to see what you have experienced while using these procedures? I’ve heard that sometimes TCa cross doesn’t work at all.

I've both done TCA cross on myself (I would not recommend this. I was desperate!) and had it done with a doctor. I noticed that in certain areas there was more visible improvement than others. And it took AT LEAST two crosses before I started seeing improvement. So you would really need to commit to at least 3 before you noticed a difference. 

 

Of course, TCA cross supposedly only helps icepick scarring. You can always try it on boxcar if it makes a difference. If it were me and I were paying for cross anyway, I would try. Everyone's skin is different.

 

I received subcision and got the best improvement for my rolling scars. The boxcar scars got more shallow, but because of the border of the scars, they're still quite noticeable, especially in certain lighting. I only have a couple of those type of scars and that wasn't my primary concern though.

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Posted (edited)
17 hours ago, Starlite said:

I've both done TCA cross on myself (I would not recommend this. I was desperate!) and had it done with a doctor. I noticed that in certain areas there was more visible improvement than others. And it took AT LEAST two crosses before I started seeing improvement. So you would really need to commit to at least 3 before you noticed a difference. 

 

Of course, TCA cross supposedly only helps icepick scarring. You can always try it on boxcar if it makes a difference. If it were me and I were paying for cross anyway, I would try. Everyone's skin is different.

 

I received subcision and got the best improvement for my rolling scars. The boxcar scars got more shallow, but because of the border of the scars, they're still quite noticeable, especially in certain lighting. I only have a couple of those type of scars and that wasn't my primary concern though.

Do you have any before/after pics? What percentage improvsl would you say works for subcision+filler/punch excision

Edited by Shelly399
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I would encourage you to do your own research. There are plenty of great recommendations on this sub for acne scarring, depending on the scar type, sometimes with pics. Of course, you can always just go with what your derm recommended. Good luck. 

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I've had 2 laser treatments and 4 full face chemical peels. 10 years later I still have my deep ice pick and boxcar scars. I'm dealing with texture issues and hyper pigmentation from the laser treatments. If I could go back and do it all over again I would have started with tca cross and punch excision. The laser and chemical peels have caused orange peel skin texture all over my face. It's better to treat individual scars first or you risk damaging healthy skin around the scars. You might want to do a test patch to see how your skin responds to certain treatments.

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On 4/8/2021 at 12:36 AM, Starlite said:

Honestly, I would look into dermal grafting, or punch float/punch excision. Boxcar scars are very difficult to treat. The icepick scars would benefit from TCA Cross (you would need a series of at least 3-6).

What about box cars that are already shallow? 

 

And can you recommend a derm who does punch excision. 

Edited by dirigo39
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Before you shell out the money, I'd strongly encourage you to try a 3rd option. It's a gentle peel called "Pitted Scar Removal Peel with Hyaluronic Acid" on devotedthings. I started using it about 2 months ago and it has greatly improved my acne scars. The website has legitimate before and after pictures (mine will be uploaded this week I think) so you can see for yourself! I was about to start saving for laser 2 months ago and decided to try this out just in case (it is so much cheaper to buy these products I figured worst case scenario I would just lose out on a hundred bucks), and am so grateful I won't be needing to spend thousands on laser anymore. Those before and after pictures did it for me, especially when I saw some reviews that had worse skin than me. 

Edited by Ishayat
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Please look into tangential fully ablative laser to hit the boxcar edges. That would give you the most improvement, your boxcars are looking bad due to edges. Once the edges are ablated then the scar will blend in. I did it and it gave me the most results for boxcars.

for ice picks go for phenol cross atleast 3 to 5 sessions or tca cross make sure to do one or two first and check that there is no scar widening. You can try punch excision as well but make sure to get only 1 or 2 to see how you heal and combine it with laser in the same session. This will most likely heal with no linear scar from excision.

Edited by getsmart121
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I think you're right. You look like a good candidate for subscision. Your doctors are likely not familiar with that procedure and that may be why they're hesitant to recommend it. Show your research to your doctors and when they perform the procedure make sure they fan the needle. A couple of days after subscision, suction the treated areas. Microneedle in between subscision or consider chemical peels. 

Punch excision seems too risky for your type of acne scarring. I think your scars are too shallow for this procedure. It may be that you end up replacing one type of scar with another. 

Good luck!

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15 hours ago, getsmart121 said:

Please look into tangential fully ablative laser to hit the boxcar edges. That would give you the most improvement, your boxcars are looking bad due to edges. Once the edges are ablated then the scar will blend in. I did it and it gave me the most results for boxcars.

for ice picks go for phenol cross atleast 3 to 5 sessions or tca cross make sure to do one or two first and check that there is no scar widening. You can try punch excision as well but make sure to get only 1 or 2 to see how you heal and combine it with laser in the same session. This will most likely heal with no linear scar from excision.

 

Do you know a doc who can do  tangenetial laser ?

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19 minutes ago, dirigo39 said:

 

Do you know a doc who can do  tangenetial laser ?

There is one in Salt Lake City Utah, the dr name is mark b Taylor. I went there for the treatment. But I am looking for a second session locally after seeing very good results on the boxcar edges. I hope I will be able to find someone in texas

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