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hellohello1234

I don't think my scar treatment has worked... looking for suggestions!

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Posted (edited)

Hi,

 

This is my first post on this forum. I've been lurking around for quite some time now, mr. matt has been a great inspiration. When I was younger I didn't care much about my looks but sadly I'm very insecure about my looks now. This has been worsened by frequent acne breakouts and the fact that I'm about to hit 30.

I've had problems with acne since I was 18 and I've been on isotretinoin thrice since then. A breakout at around 24 left me with significant scarring and I'm still on isotretinoin but I haven't had a breakout for at least one year now. I'm doing 10mg a day for another 1 month and then 10 mg a day only on the weekends for 6 weeks. There's a recommended dosage that I need to complete and I'm not taking any chances. Luckily, my scars are limited only to my cheeks but where I can't hide them by growing a beard.

I've had the following treatments done to make my scars better - 2 * CO2 laser ( one with PRP), 2 * derma roller.

I feel there's still a lot of scope for improvement and I'm looking for suggestions. PFA pictures of my scars.IMG_6797.jpg.bc9a2a65bb894f2db127240884826f9f.jpg

The following is my left cheek. I think I only have icepick and box type scars here.

IMG_6761.JPG.1b2874a34ea04b4224cfb0f0a06e7cb7.JPG

The following is my right check, I hate the dent there. Subcision has been suggested to fix this dent but I've been told that I can't expect 100% improvement which I think is fair.
IMG_6762.JPG.cdce7fee3b9bd1a0fba4a90599585c85.JPG

  

My doctor has suggested 2 * MNRF, one with PRP, 2 * CO2 laser with TCA, Subcision in between. 

My doctor is really stressing on the laser and MNRF, I'm not sure CO2 or PRP brings much difference but I'm curious about MNRF. Any derma roller only makes my face look puffy for three days and then there's no difference. Can anyone please recommend a treatment plan for me please? Also how many session and how much improvement can I see?

I'll use this thread as a log of my journey. 

Thanks in advance! 

M

IMG_6762.JPG

Edited by hellohello1234
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Posted (edited)

Those scars look tethered, and their category (mostly rolling) would support this notion. To determine for yourself, if you pull/stretch your skin, do the scars completely flatten out? If they don't, they're tethered, which by the way, is not a niche thing; its very likely they would be. 

What does that mean? subcision is certainly above all, the treatment necessary, before anything else. Every acne scar specialist will support this. For me, subcision has been a life-changer. 

I suggest you read into subcision and understand what it does, but essentially it breaks up bands that are tethering your skin down. What is most critical here, is that other treatments simply won't be nearly as effective on scars that are tethered - because they are bound underneath your skin. Save your money regarding laser until you have had at least 3 or so subcisions. Why 3? Because with only 1 your derm might miss some bands, and additionally these bands can reform. Beyond this purpose, subcision is a great stimulate of collagen growth.

This is all supported in academic papers, as well as dermatologists on youtube etc that will tell you the exact same thing. If you can't find this info or nobody else links them, when I have some more time I can find such literature so that you can share it with your dermatologist - who I imagine may not necessarily be an acne scar specialist? If he has started with laser over subcision, because that is rare in any case, at least among the most respected. That said, everyone's skin is different, but the fact your treatment hasn't worked so far further supports my notion you are being treated with the wrong stuff first.

For the record, I had similar type of scarring to you, but more severe I think. Not a dermatologist though, remember to do your own research.

Also, you will have to check what is safe on isotretinoin too.

Edited by Flooressence
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Thanks a lot @Flooressencefor your reply. I'm really tempted to now look for a new doctor who's done subcisions before. 

If you don't mind me asking, how much improvement did you see? How long did it take? What was your treatment plan like?

Also, how much improvement do you think I can expect? 

Yes, please do send those academic papers when you have time. Thanks again for your reply!

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Posted (edited)

Its really hard to gauge the level of improvement, I need to find more old pics for comparison. I posted some pics in a thread a few days ago, you can look in my profile and find it. But its very hard to match the lighting, angles, etc. Once I have some more treatment I'll go through all my old phone backups and try and do better comparisons. I've also got some new scars with age and stuff (skin worsens as you age too). However, to answer your question, different scars have had different results - some are probably 50-80% better, others only slightly, notably ones with deep fat loss - much deeper than yours, so not to worry.

I really just can't give an overall %, its too hard.

I only really started properly treating my scars early 2020... a bit over a year ago. Also I only got my first subcision maybe 9 months ago. I've had 4 now. I have a 5th on the 30th. My dermatologist isn't an acne scar specialist and uses outdated subcision technique/equipment, but I take what I can get. 

The thing is, collagen formation is a 3 or so month process, you don't really wake up one day and notice the results. Its like with ageing, you don't see yourself age each day - until you look at old photographs or whatever. I feel like my skin has been getting better each month though, like I still am seeing the effects of the prior treatment all the way until the next.

This post is getting a bit superfluous, so let me dot point the rest:

In regards to how much improvement: yours are shallower than mine, no major fat loss, I can only estimate you could get maybe 80% improvement in a year, depending on the dermatologist.

The important thing to take away is that subcision is still the gold standard treatment of acne scars, you will find that browsing here, watching youtube dermatologists (e.g. davin lim being the biggest), and reading literature. My subcisions aren't by a specialist and my scars are deeper - so my results will be different to yours.

My treatment plan now is mostly just subcision every couple of months and I use adapalene 3-4 nights a week. I've had microneedling maybe 6 times but its not really that great, a lot of it was before any subcision so I didn't see any results, perhaps it helped in some ways. My next step is combination treatments, then filler.

Edited by Flooressence
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Thanks a lot for sharing!

Quote
15 hours ago, Flooressence said:

Its really hard to gauge the level of improvement, I need to find more old pics for comparison. I posted some pics in a thread a few days ago, you can look in my profile and find it. But its very hard to match the lighting, angles, etc. Once I have some more treatment I'll go through all my old phone backups and try and do better comparisons. I've also got some new scars with age and stuff (skin worsens as you age too). However, to answer your question, different scars have had different results - some are probably 50-80% better, others only slightly, notably ones with deep fat loss - much deeper than yours, so not to worry.

I really just can't give an overall %, its too hard.

I only really started properly treating my scars early 2020... a bit over a year ago. Also I only got my first subcision maybe 9 months ago. I've had 4 now. I have a 5th on the 30th. My dermatologist isn't an acne scar specialist and uses outdated subcision technique/equipment, but I take what I can get. 

The thing is, collagen formation is a 3 or so month process, you don't really wake up one day and notice the results. Its like with ageing, you don't see yourself age each day - until you look at old photographs or whatever. I feel like my skin has been getting better each month though, like I still am seeing the effects of the prior treatment all the way until the next.

This post is getting a bit superfluous, so let me dot point the rest:

In regards to how much improvement: yours are shallower than mine, no major fat loss, I can only estimate you could get maybe 80% improvement in a year, depending on the dermatologist.

The important thing to take away is that subcision is still the gold standard treatment of acne scars, you will find that browsing here, watching youtube dermatologists (e.g. davin lim being the biggest), and reading literature. My subcisions aren't by a specialist and my scars are deeper - so my results will be different to yours.

My treatment plan now is mostly just subcision every couple of months and I use adapalene 3-4 nights a week. I've had microneedling maybe 6 times but its not really that great, a lot of it was before any subcision so I didn't see any results, perhaps it helped in some ways. My next step is combination treatments, then filler.

 

 

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That's awesome that you are educating yourself on this stuff and getting various opinions. What's most important is that you are under the care of a qualified and experienced dermatologist or plastic surgeon who specifically specializes in scar treatment.

If it were me, I always tell people that I would get at least 2 opinions. I might even get 3. Then you can compare between doctors and see which you feel best going with. A huge red flag is if they change their opinions based on what you mention, so keep that in mind. You want someone who's opinion is solid and based on their thousands of hours of experience with acne scar treatment.

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