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Hi so I just recently found out about these posts here and I saw saw that this is a good place for help. So I want to start out by telling you about what I have done so far for my acne scars. I will post photos after I tell you about this. So I had no prior knowledge about acne scar treatments when I first began looking for dermatologists to help me with them. I started off with many fraxel laser treatments, maybe like 6 in all spaced out between months. Like a year ago. My skin would feel so nice and tight because of swelling then go back to normal a few days after every time. Again, I wasn’t knowledgeable then as I have done a lot more research upon the topic now. But since like a year ago I stopped the fraxel treatments because I wasn’t really seeing any results and it was $650 a session. The next thing I tried was recently I’m August (bellafill) I got two syringes in each side of my face which I barely saw any improvements which sucked because I paid like $3,0000. I have seen bad posts about bellafill but also a lot of good ones so I took the gamble. Now that I have seen a lot of what you have been posting I’m kinda worried about it but I haven’t noticed any really noticeable bumps or anything. Although I do feel like some micro beads in my chin area but nothing crazy. Like a few months after bellafill I went back to him and asked him what he thought about subcision because he does that as well. He told me he doesent really see results with subcision. So after that I was kinda like suspicious because everyone talks about how subcision is like the best treatment for acne scars and he is saying he doesent see results. Now I am doing microneedling with prp. So far I have done one session, and am going back tomorrow for another but I’m going to be asking a lot of more questions now that I know a lot about these procesdures. I want to know what you think is the best route for me and what I should probably stay away from. I don’t think I’m going to get any more filler as I don’t want to risk getting any more permanent filler. Please let me know what you think. Also, if you know anyone in Virginia or close to here that is replicable please let me know as I am always looking but the best I have heard is Rullan who is across the country from me. Please someone let me know what my best options are.

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Tough one. They appear to be shallow as in textural, but rolling and a moderate fat loss type texture. I would think micro needling would do nothing frankly. I don't subscribe to that unless it's very superficial and it still might be unwise on damaged skin. The things that would pop out in my head are filler and/or maybe some other things outside what you're talking about.

I have no experience and was looking at it a while ago but maybe there might be more success with "fat filler transfer"? But I have no clue because I only have 1 larger indentation and was hesitant to try it. I also don't know if this might help but maybe a chemical peel of sorts which could tighten or blend the texture/areas maybe. For example the right side is much more shallow than the left. It might be a peel type candidate.

I mean some people with severe damage on here did the harshest peel (phenol peel) and showed significant improvement and blending texture, so I'm starting to come around to maybe peels might help with textural issues.

If you're going to a doctor that has only advised micro needling and a filler that hasn't helped, it's time to find a better doctor and research options more. Because there are improvements out there but it takes time, patience and trial and error.

Edited by harmlessboy1441
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Some low hanging fruit that can be addressed fairly cheap and at home: Dermastamp ( Collagen build ), chemical peel ( Superficial retexturing ), retinol ( Skin turnover speed ).

Understanding common treatments:

  • Subcision - For scars where upper layer is 'tethered' to lower layers of skin causing wavy appearance. ( Evaluation tips can be found online )
  • RF Microneedle - to rebuild collagen layer of skin. ( Plump up skin to reduce look of scars )
  • Dermabrasion/ablative laser - to help even upper layer superficial scarring. ( Ripping off the entire upper layer of skin )
  • Sculptra - Help build collagen. ( Plump up skin to reduce look of scars )
  • Filler - Fill the 'balloon' left by scars to reduce appearance.


So step 1 - Start low hanging fruit. Step 2 - evaluate scars to see what treatments suit you. Step 3 - find qualified practitioner to perform and confirm step 2.

Disclaimer: I have no idea what I'm talking about and am simply restating my understanding of random things I've seen said on the internet. Interpret at your own discretion. :P

Edit: For the love of god please break your text up into paragraphs by the message being conveyed.
 

Edited by orangez
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On 11/22/2021 at 3:26 PM, harmlessboy1441 said:

Tough one. They appear to be shallow as in textural, but rolling and a moderate fat loss type texture. I would think micro needling would do nothing frankly. I don't subscribe to that unless it's very superficial and it still might be unwise on damaged skin. The things that would pop out in my head are filler and/or maybe some other things outside what you're talking about.

I have no experience and was looking at it a while ago but maybe there might be more success with "fat filler transfer"? But I have no clue because I only have 1 larger indentation and was hesitant to try it. I also don't know if this might help but maybe a chemical peel of sorts which could tighten or blend the texture/areas maybe. For example the right side is much more shallow than the left. It might be a peel type candidate.

I mean some people with severe damage on here did the harshest peel (phenol peel) and showed significant improvement and blending texture, so I'm starting to come around to maybe peels might help with textural issues.

If you're going to a doctor that has only advised micro needling and a filler that hasn't helped, it's time to find a better doctor and research options more. Because there are improvements out there but it takes time, patience and trial and error.

Yes I believe I need to explore my options. Thankyou for the help

On 11/22/2021 at 4:07 PM, orangez said:

Some low hanging fruit that can be addressed fairly cheap and at home: Dermastamp ( Collagen build ), chemical peel ( Superficial retexturing ), retinol ( Skin turnover speed ).

Understanding common treatments:

  • Subcision - For scars where upper layer is 'tethered' to lower layers of skin causing wavy appearance. ( Evaluation tips can be found online )
  • RF Microneedle - to rebuild collagen layer of skin. ( Plump up skin to reduce look of scars )
  • Dermabrasion/ablative laser - to help even upper layer superficial scarring. ( Ripping off the entire upper layer of skin )
  • Sculptra - Help build collagen. ( Plump up skin to reduce look of scars )
  • Filler - Fill the 'balloon' left by scars to reduce appearance.


So step 1 - Start low hanging fruit. Step 2 - evaluate scars to see what treatments suit you. Step 3 - find qualified practitioner to perform and confirm step 2.

Disclaimer: I have no idea what I'm talking about and am simply restating my understanding of random things I've seen said on the internet. Interpret at your own discretion. :P

Edit: For the love of god please break your text up into paragraphs by the message being conveyed.
 

My bad def should have broken up the text. Thanks for reading tho

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I think almost any formation of acne scars deserves subcision early on in treatments, and yours I think would definitely fit the type its good for regardless. Its also what you want to get first, to break up any potential tethering and so forth which will facilitate future treatments.

You should definitely wait a bit longer on filler. 

Fraxel certainly can work but there's just so many variables. I've been one of the lucky ones who found it very helpful, I had two sessions with subcision at the same time (previously I had 5~ or so subcisions on their own). My skin was red for weeks, because the laser was done at a high setting.

Ultimately, worked out better than I could have hoped. But that's what I mean about variables - there's strength of the laser settings, operator skill/knowledge, multi-modality aspect (doing it together with sub).

If your skin went back to normal after a few days each time then it sounds like settings were too low. 

Similarly, a very important thing to note that so many people fail to realise is you don't really see results from any treatment for at least 2-3 months IMO, and often can keep on improving for many, many months, 6+.

Therefore I encourage you to keep at it and if you feel disappointed a week after treatment, don't be, and don't judge the treatment at that point either. Be happy knowing your skin will continue to produce collagen and heal for months afterwards. But make sure you are taking care of yourself, keeping skin moisturised, so on and so on.

You will find many overly negative victims here and all over the web who will want to quickly disregard xyz treatment because it didn't work for them, or they went to a shit doctor, or they posted a week after their treatment, or simply they got unlucky and their skin didn't respond too well or overpaid and expected miracles. Just follow what the general consensus + literature recommends to start with before trying anything crazy, of which subcision is definitely a place to begin, perhaps the most critical. No in fact even more simply than that, focus on finding a respected dermatologist who deals with acne scars and follow their advice above all.

Your derm downplaying subcision and saying he doesn't see results from it is a big red flag. I've had subcision from 3 different dermatologists and let me say, there are huge skill gaps between them all. It was very apparent as I found better dermatologists just what I was missing out on. Therefore, I'd suggest your dermatologist does not know how to do the procedure effectively if he/she doesn't see results from it. Let alone the notion that they're ignoring loads of acne scar literature and his/her peers in the field, or perhaps simply has an ego and doesn't bother following what others are doing.

Lastly you could try google terms like acne.org + location + recommendation or also location + subcision and things like that to try find derms.

Edited by Flooressence
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47 minutes ago, Flooressence said:

I think almost any formation of acne scars deserves subcision early on in treatments, and yours I think would definitely fit the type its good for regardless. Its also what you want to get first, to break up any potential tethering and so forth which will facilitate future treatments.

You should definitely wait a bit longer on filler. 

Fraxel certainly can work but there's just so many variables. I've been one of the lucky ones who found it very helpful, I had two sessions with subcision at the same time (previously I had 5~ or so subcisions on their own). My skin was red for weeks, because the laser was done at a high setting.

Ultimately, worked out better than I could have hoped. But that's what I mean about variables - there's strength of the laser settings, operator skill/knowledge, multi-modality aspect (doing it together with sub).

If your skin went back to normal after a few days each time then it sounds like settings were too low. 

Similarly, a very important thing to note that so many people fail to realise is you don't really see results from any treatment for at least 2-3 months IMO, and often can keep on improving for many, many months, 6+.

Therefore I encourage you to keep at it and if you feel disappointed a week after treatment, don't be, and don't judge the treatment at that point either. Be happy knowing your skin will continue to produce collagen and heal for months afterwards. But make sure you are taking care of yourself, keeping skin moisturised, so on and so on.

You will find many overly negative victims here and all over the web who will want to quickly disregard xyz treatment because it didn't work for them, or they went to a shit doctor, or they posted a week after their treatment, or simply they got unlucky and their skin didn't respond too well or overpaid and expected miracles. Just follow what general consensus + literature to start with, of which subcision is definitely a place to begin - no in fact even more simply than that, find a respected dermatologist who deals with acne scars and follow their advice.

Your derm downplaying subcision and saying he doesn't see results from it is a big red flag. I've had subcision from 3 different dermatologists and let me say, there are huge skill gaps between them all. It was very apparent as I found better dermatologists just what I was missing out on. Therefore, I'd suggest your dermatologist does not know how to do the procedure effectively if he/she doesn't see results from it. Let alone the notion that he's ignoring loads of acne scar literature and his/her peers in the field, or perhaps simply has an ego and doesn't bother following what others are doing.

Lastly you could try google terms like acne.org + location + recommendation or also location + subcision and things like that to try find derms.

Thankyou for the response! Very helpful. 

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51 minutes ago, ThirdStance said:

Thankyou for the response! Very helpful. 

Glad you found it helpful, I just looked up where Virginia was (I'm Australian, forgive me) and I remember there was this bloke in Florida who I've only heard good things about. Dr Steven Weiner:

That said, Dr Rullan is supposed to be fantastic and certainly a good choice as well.

On a side note, since costs sound like a concern for you, I would straight up say this on consultation (in a respectful way) and note to any Dr you travel far to see that you're a travelling patient and I think they should be more open to accommodating, not only costs but possibly other ways. For example I've seen Dr Lim here twice in which I had to travel across Australia, and I know he was very thorough and went quite hard knowing I would only be able to come only so often. 

Remember the earlier you treat your scars the better. Like I mentioned in the previous post, make sure you avoid all the people who love being victims and try to downplay xyz treatments (and in some cases, some very sad people falsely claim its impossible to improve scars). The newer scars, the easier they are to treat, and the younger you are, the better your body can heal them. Furthermore, scars will worsen as you age, so hit them now. Think of benefits not only as aesthetics and confidence etc that comes with it but even random things I've heard mentioned such as job employability, not looking too young (or too old) from scars, and I'm sure many other benefits you can think of.

Anyway, if I haven't already emphasised it enough: don't give up. 

My last random tips:

Make sure acne is under complete control not only to prevent further scarring, but when you have a treatment done and then get acne, your body wastes resources trying to fight the inflammation. This is something Dr Lim really emphasised to me and I really put effort into my last two treatments, and particularly the last, and I do feel it helped.

Moisturise regularly after treatments (not just twice a day but every few hours - at least if it feels the slightest bit dry anyway), particularly after things like laser. Moisture is the catalyst for skin healing. There's some studies out there on this e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849435/ 

If you are travelling for treatments, you can try and organise a holiday around it and get it at the end, if it interests you doing so / can afford. 

Lastly, while I mentioned the fact healing and repair is a lengthy process that takes months, don't rush treatments. The supposed rule of thumb is go 3 months between procedures, as this is seemingly the most efficient way to get the most from each treatment (and of course the most for your $). Some treatments may or may not favour shorter lengths, and some even longer, but I'd stick to this rule. I went from every 6 weeks to 3 months and definitely felt like each treatment was far more effective (but it could simply be due to the skin taking much longer than 6 weeks for full results), however spaced too short it can interfere with the collagen remodelling process etc.

Some of these may not apply or be relevant to you but I'll write them anyway.

Edited by Flooressence
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4 hours ago, Flooressence said:

Glad you found it helpful, I just looked up where Virginia was (I'm Australian, forgive me) and I remember there was this bloke in Florida who I've only heard good things about. Dr Steven Weiner:

That said, Dr Rullan is supposed to be fantastic and certainly a good choice as well.

On a side note, since costs sound like a concern for you, I would straight up say this on consultation (in a respectful way) and note to any Dr you travel far to see that you're a travelling patient and I think they should be more open to accommodating, not only costs but possibly other ways. For example I've seen Dr Lim here twice in which I had to travel across Australia, and I know he was very thorough and went quite hard knowing I would only be able to come only so often. 

Remember the earlier you treat your scars the better. Like I mentioned in the previous post, make sure you avoid all the people who love being victims and try to downplay xyz treatments (and in some cases, some very sad people falsely claim its impossible to improve scars). The newer scars, the easier they are to treat, and the younger you are, the better your body can heal them. Furthermore, scars will worsen as you age, so hit them now. Think of benefits not only as aesthetics and confidence etc that comes with it but even random things I've heard mentioned such as job employability, not looking too young (or too old) from scars, and I'm sure many other benefits you can think of.

Anyway, if I haven't already emphasised it enough: don't give up. 

My last random tips:

Make sure acne is under complete control not only to prevent further scarring, but when you have a treatment done and then get acne, your body wastes resources trying to fight the inflammation. This is something Dr Lim really emphasised to me and I really put effort into my last two treatments, and particularly the last, and I do feel it helped.

Moisturise regularly after treatments (not just twice a day but every few hours - at least if it feels the slightest bit dry anyway), particularly after things like laser. Moisture is the catalyst for skin healing. There's some studies out there on this e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849435/ 

If you are travelling for treatments, you can try and organise a holiday around it and get it at the end, if it interests you doing so / can afford. 

Lastly, while I mentioned the fact healing and repair is a lengthy process that takes months, don't rush treatments. The supposed rule of thumb is go 3 months between procedures, as this is seemingly the most efficient way to get the most from each treatment (and of course the most for your $). Some treatments may or may not favour shorter lengths, and some even longer, but I'd stick to this rule. I went from every 6 weeks to 3 months and definitely felt like each treatment was far more effective (but it could simply be due to the skin taking much longer than 6 weeks for full results), however spaced too short it can interfere with the collagen remodelling process etc.

Some of these may not apply or be relevant to you but I'll write them anyway.

Thankyou so much. You made me feel so much better and gave me the hope I needed. Although, I’ve never felt insecure or had low self esteem Bc of my scars. Everyone has something going on in their life and mine happened to be these scars. However it’s good to know there are treatment options. I’m only 20 years old and my scars are very fresh as I had terrible cystic acne only a few years ago that led to these scars. I will check out dr . Weiner and maybe see if I can get something put together. Everything you mentioned was very relevant and Informing. I greatly appreciate you for taking the time to help me.

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What is your height and weight (or body fat percentage)? You probably never hear this one but sometimes, putting on some fat can actually make the face a bit more filled which can make the appearance of scars a bit better.

Now i'm not telling you to go each a cheese cake but maybe I am.

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