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Goolo

Need help please.

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Hi 26 yr old male and I have no idea what to do anymore about my scars. Had bad acne went on accutane for a year and  My dermatologist told me I just needed 3 sessions of microneedling and I’ll be good, well I’ve had probably 8 sessions and I just feel like I’m wasting money at this point if anyone can help me out because my dermatologist obviously can’t just be honest with me and tell me what needs to be done.

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Your dermatologist is not a scar expert and/or is money hungry. We're not doctors here but at least we're not charging you an obscene amount of money and giving you false hope. 

Your scars look like they need subcision to break apart the tethering. For the narrow scars with harsh borders, look into TCA Cross. 

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I think for your specific scars its best to treat the tissue damage first (volume loss / large depressions). The fat should be injected in the cheeks and underneath each rolling scar. I recommend fat transfer because if you've read enough posts on this forum you will see that it takes years for people to see results. Fat transfer is immediate and since your fairly young it's best to do something that will speed up your results now so that you are comfortable in your own skin sooner rather than later. This procedure also requires no down-time if you are able to avoid bruising and swelling, which is possible. The injection sites are passable as breakouts so you wouldn't have to take time off work. 

If you decide to go this route,  point to each scar you want treated and tell the doctor the areas you want fat injected. Doctors, as you've learned from your dermatologist, for whatever reason don't have sufficient experience or maybe lack the imagination required to figure out effective treatments for scars. For example, your derm never considered the fact that yes microneedling induces collagen but not enough to fill the areas where you have significant volume loss. If this were the case no one would wrinkle. Obvious to us but not to them because we do a lot of research on acne scars. Doctors are taught the big stuff - muscles, nerves, medications, sutures, injections, etc. Anything like lasers, fillers, microneedling they learn via a one day workshop. This is why you have to be vocal about what you want - ask how much follow up treatments cost if the fat doesn't take or if not enough fat was injected; or when you get the initial procedure you may want to ask them to inject more fat than they intend to inject to compensate for the fat that may die; you may ask for a mirror during the procedure if done under local anesthesia to make sure you're happy. The point is don't be afraid to speak up and do your research so you don't end up in a similar situation like with your derm. The best thing about fat transfer are the stem cells in it. They cause the cells to turnover so you will have dry skin that sloughs off and then a super glowy even skin tone for months. Pores and scars may also lessen because of this.

Like Amanda Hall stated, doctors are greedy. Fat transfer can range from $3100 to $10,000. Shop around and pick a doctor you are comfortable with because this is a fairly new procedure and not many doctors have experience in it.

The other thing you may want to test out is saline injections if fat transfer isn't possible. Look up Dr. Sire or fat atrophy saline injections for more information. The majority of doctors don't know about this procedure so you would likely have to take your research to a doctor to convince them to do it. Or you can do it yourself if you're brave enough. It takes several injections to see results fyi. Good luck.

 

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Fat dissolves the same as the filler. Fat is injected in deeper layer and does not make any difference to the scars. It may help big indented areas but not individual scars, the fat molecule is too big. 
Look into tca cross. Subcision for the main scars.

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Thank you guys for the feedback I appreciate it. I canceled my upcoming Microneedling appointment with the Derm so I’m not wasting anymore money, luckily it was on the cheaper side and only 175$ per session but still. I made an appointment with a specialist referred through my PCP and I hope I can get on the right path because I think they looks worse then they actually are, my face is extremely soft and my skin is very good with healing so we’ll see what happens. I just knew something was up because my Derm would ask me what we’re doing today instead of actually telling me what needs to be done, I’d be in and out and I feel like she just didn’t care or didn’t know what she was doing.

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1 hour ago, Sibel said:

Fat dissolves the same as the filler. Fat is injected in deeper layer and does not make any difference to the scars. It may help big indented areas but not individual scars, the fat molecule is too big. 
Look into tca cross. Subcision for the main scars.

Fat will not dissolve like filler, but it is injected deeper into the tissue like you mentioned. I closed my eyes during the procedure so I don't know what the needle looked like but she jerked it in very deep to push the fat into different areas of my face and to make as few injection sites as possible. I told her that I wish the procedure was more similar to filler, and she said it was rougher because it was near the muscle. It can help with indented scars if you tell the doctor to target them. The stem cells will also improve the indented scars. I had fat transfer not specifically for scars but the effect it had on my scars, pores, skin tone, and texture was amazing.

From personal experience, I highly recommend fat transfer. I don't need anymore fat at the moment so if stem cells alone are an economical option, I plan to do that. I suspect price is the same though since the procedure is the same so it is on hold for now. I would also like to try PRP because it supposedly has similar effects but I haven't seen many posts about it here. Anyone have a good experience with PRP?

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Namnum: I had the fat transfer as well and yes the general effect for texture and skin was good. Scars looked better but in about 2 months all fat dissolved. If you do several fat transfers then part of it stays but you never know how much. The fat is completely unpredictable. The fat injections do no change the superficial edges of the scars which shades accentuate the scar the most. This is my experience unfortunately. 
prp is a complete waste, had it with Subcision and on its own. Does nothing for the scars. 

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4 hours ago, Sibel said:

Namnum: I had the fat transfer as well and yes the general effect for texture and skin was good. Scars looked better but in about 2 months all fat dissolved. If you do several fat transfers then part of it stays but you never know how much. The fat is completely unpredictable. The fat injections do no change the superficial edges of the scars which shades accentuate the scar the most. This is my experience unfortunately. 
prp is a complete waste, had it with Subcision and on its own. Does nothing for the scars. 

I'm sorry to hear the fat didn't take for you. I did it twice, a month apart, because the first time the doctor was conservative. It ended up not being enough because some of the fat cells did die. The second time she handed me a mirror as she did it. I had her inject twice as much so the right amount of fat would survive. I had one major depression on my cheek from a cyst that the fat filled in. It's been almost 2 years and the fat has survived. This procedure is like any other. The success depends on the doctor. If it's not handled gingerly, the fat will die while it's being prepared or right after injection. After getting it done, I did more research on the procedure. I read that a certain doctor injects saline at the site the day before to make sure the fat survives; another cleans the fat with saline before injection. For me, the solution was to over inject.

I plan to do fat transfer again just for the stem cells. I just wouldn't get as much since my face will be too fat. I never take pictures after procedures but next time I will. I found the change in my skin amazing.

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