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needhelp1234567

Subcision and laser resurfacing hyperpigmentation

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Need good advice and support - I had subcision and Fotona laser done on my cheeks, nose and chin over a week ago. I wanted to improve my orange peel skin texture and scars and I've done other stuff such as microneedling, non ablative lasers and TCA but they made my skin worse. I did a test area prior and it healed fine from 5th day onward. By day 8 it was back to normal. 

The scabs fell as expected around day 4-5 but they left fresh red marks that I feel are getting progressively darker and redder. The derm said use hydroquinone after the crusts fell off and apply arnica. I have been doing it nightly and have been using mild cleanser and moisturizer (Vanicream and Cicaplast balm B5 just arrived today).  Derm said not to worry as they will fade, but I can't help but feel something is wrong this time around because my doctor friend said that if by week 2 there is no improvement that it could be hard to get rid of.

Are these permanent? Also does anyone have suggestions for skin care? I read that psoria gold can be helpful for post laser issues, but the cream won't arrive until next week. 

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I can understand your desire to try to improve the orange peel. I feel like I have it from some weird stuff or aging or something going on and I am sort of sad about it too as it looks shiny, puffy and pores are prominent. It's mainly why I don't shave.

I don't think laser is really something I'd necessarily rely on for orange peel but I don't think it necessarily would hurt either it depends on how it's done, your reaction to it and so on. It's good you tested it but still, sometimes going too deep or ablative or a doctor doing it in a wrong manner could produce adverse results is my guess. I personally don't know if those scabs (to be honest to me they look like burn marks) are a normal reaction or not.

Hyperpigmentation may fade but then again it may not. It really depends. Hypopigmentation is pretty much permanent as the melanin is disrupted, but hyperpigmentation may fade it totally depends on the injury and interruption. 

I would imagine you're uncertain and are in a saddened state that it may have made it worse, I get that, and I'm sorry all those things didn't work. TCA in my opinion really is too hit or miss and has a high degree of complications, and micro needling is worthless.

I'm going to yield the question to laser experts and/or products after laser experts if any want to respond. Do you mind me asking did a derm or plastic surgeon do the laser? To me it actually looks like burn marks maybe he was too aggressive or something but that doesn't necessarily mean it won't fade, just that he tried to burn the texture to produce a better result if possible. 

If you want my opinion maybe you should save the money and try to get expert opinions like Rullan in CA or Dr. Mark Taylor in Utah or even Dr. Lim in Australia if you're monetarily blessed. 

Skin care might vary between just vaseline or maybe some more pure protectants. No lotions in my opinion, nothing too chemically. Not sure a product will aid much but I really don't know. 

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Thanks for your response.

I had the procedure done by a board certified dermatologist. I made sure to do my research and she has a good reputation across the board for cosmetic procedures and needles so I felt I could trust her.

I am so dismayed by the hyperpigmentation because the test area was complication-free and I figured that my experience would be similar but it's not. At this point I just want my skin to revert back to its original shade. My biggest concern is if it's vascular damage due to subcision (since the red areas are where the scarring was that she needled) of it's burns so I can address it asap. I reached out to the doc via text and she told me that they'd fade but I feel rather uneasy about it since I'm almost nearing week and I'm simply not seeing progress unlike when I google day by day pictures of people who have had successful laser resurfacing.

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1 hour ago, needhelp1234567 said:

I reached out to the doc via text and she told me that they'd fade but I feel rather uneasy about it since I'm almost nearing week and I'm simply not seeing progress

Not buying it. I had dermabrasion done and my doctor did really well on my cheeks (80%+ on depth) but in reality he created two shallow but large spots that hypopigmented and are large. He said "oh that'll heal well don't worry". Not even close it didn't change in size one bit. Basically it was a blunder and doctors say stuff like that sometimes when they either don't know or hope for the best. I don't really blame him s he did fantastic on my cheeks but screwed up there, so yeah lol...

I'm not saying she's wrong or it won't fade, I'm just saying I doubt she knows for sure, to a high degree I doubt it.

That said, I don't know if vascular damage would be it, but the black marks to me almost look like burns. I don't know if the subcision + the laser in the same spot simultaneously did something damaging or if it was just her laser going very much more aggressive. But day 7/9 looks a whole heck of a lot better than day 1-4 so all you can do is really give it time.

If you are that nervous about complications I would probably suggest you go to a few more derms but this is complicated stuff. Most derms I know could misdiagnose a cup of coffee, know what I mean? So I'm just keeping it real. Some might have some thoughts but no derm will know the extent probably. A plastic surgeon with lots of experience might be your best bet but I'm sorry to say monetary and going to well reviewed experts are both necessary.

I get that you did your research but sometimes even experienced dermatologists don't have the expertise, judgment or what not. Only plastic surgeons of major experience know a lot about major acne scar things.

I'd probably give it a few weeks, maybe use some basic very pure stuff like vaseline just when you can tolerate it maybe for hours at a time thin layer (don't sleep on it as you'll breathe it in and it itches after a while at least when I used it after my steroid). Not sure any product will aid this. You could try some cream (not lotion) burn ointment maybe, or very pure healing product but I'm just guessing on this and really don't know, but if it's a pure "for general use on all skin" then you could try something like that.

In the end, you gotta go see more derms or get expert help from a plastic surgeon to get the right treatment but try to find some good derms to ascertain any damage but I warn you most just don't know enough from personal experience. I went to 5 derms after my steroid and none gave me proper advice, had no clue. My face burned for like 6 months and they had no clue. I would not go to anyone but an expert plastic surgeon if I were you. I know the finances suck but gambling on crap like you got isn't worth it. Do the best gamble next time.

Aside from that, all you can do is also give it time. I wouldn't trust what the derm is texting you. "Don't worry it will fade" is probably code for either an unexpected or unpalatable outcome and she's distancing or hoping it self corrects. That's my gut. Keep a record too (pictures/notes) just in case I guess wouldn't hurt. If she did anything weird or something that nobody should've done it might just be good to document it wouldn't hurt.

Hey if you need to talk or anything I'm usually on every other day feel free to throw a mail.

 

Edited by harmlessboy1441
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I think it's the shade of the pics that make it look black but in reality the scabs were dark brown/red. The test area was actually similar. It dried up to a dark red so it is black-looking in the pics.  I would liken it to a knee scrape type of injury - it wept fluid for a while which eventually stopped, congealed and eventually became a scab. By day 4-5 the dried scabs thickened and fell off when I washed my face. It was unavoidable. My nose scab immediately fell off by day 3 I think? and it was red underneath and got alarmed but I do have a scar there and I'm certain she subcised it. 

Unlike the test area, the full face procedure was incredibly painful. My pain tolerance is high and I would say the intensity of pain is unbearable the first 8-10 hours. It lessened to 3/10 by bedtime. The soreness continued for a few days until the scabs fell off. Right now, my face is pain-free. The areas that are red are mostly my box scars, except for a round red spot close to my neck. The close up pictures of course look worse than seeing my entire face, but it's still disheartening because it's not the results I want for now.  Basically, what it looks like is I had bad acne that left red marks all over my cheeks. My right side is *almost* normal but it's my left cheek (pictured) that's problematic, and the spot on my nose.

I get what you're saying about the doctor not fully knowing what's happening and it makes me nervous. I know that I'm still a few days away from two weeks, and it could take up to a month to really know the extent of 'if it will get better or not,' but it's wreaking havoc on my mental health not knowing what the end result will be. 

As for the doctor, she's been incredibly communicative and encouraging thus far. She doesn't strike me as the type of doctor that abandons patients when thy come across complications. I just don't want to come across as crazy impatient so I'll wait until next week to bug her again but I'm praying I'll see some lightening during the weekend.

I would like to know why you prefer going to a plastic surgeon vs a dermatologist. I've gotten conflicting advice about this - I've actually been to a ton of different doctors and haven't met anyone with the same bedside manner as this current doctor.  Also, I'd be interested to know if you've had marked success addressing the oversight previous derms have done on your skin. 

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13 hours ago, getsmart121 said:

Just start applying cerave resurfacing retinol. The marks should fade in a month

My derm said not to use retinol.

Will this work with PIE/PIH?

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I had a phenol cross, laser, subcision and fillers done at Dr Rullan. The cross and laser made my face look really bad. The areas where the cross was done turned very light pink. Then they turned dark red and was very bad looking for about 6 weeks. Then when the skin turned over it looked much better.

So expect 4-6 weeks of hyperpigmentation and redness at least. It will improve over time as your skin cells shed and build new ones.

Not sure why your doctor said not to use retinol but it helps skin turn-over and is generally the best skincare product.

Hydroquinone might be better used for like 1 month before the procedure to get it absorbed into your current cells. After you're red, all you can do is use retinol so those cells fall of faster and be replaced with new non-red ones.

 

Also for laser treatments, usually you should use an occlusive like Vaseline or Aquafor for up to 5 days. This moisturizes your skin and prevents the scabs, letting the skin heal faster. Scabbing is bad.

Edited by Stardust123
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8 hours ago, Stardust123 said:

I had a phenol cross, laser, subcision and fillers done at Dr Rullan. The cross and laser made my face look really bad. The areas where the cross was done turned very light pink. Then they turned dark red and was very bad looking for about 6 weeks. Then when the skin turned over it looked much better.

So expect 4-6 weeks of hyperpigmentation and redness at least. It will improve over time as your skin cells shed and build new ones.

Not sure why your doctor said not to use retinol but it helps skin turn-over and is generally the best skincare product.

Hydroquinone might be better used for like 1 month before the procedure to get it absorbed into your current cells. After you're red, all you can do is use retinol so those cells fall of faster and be replaced with new non-red ones.

 

Also for laser treatments, usually you should use an occlusive like Vaseline or Aquafor for up to 5 days. This moisturizes your skin and prevents the scabs, letting the skin heal faster. Scabbing is bad.

Thanks for your comment. 

I used Aquaphor for 4-5 days starting from the day of the procedure until all the dead skin fell off.

After that I started slathering my face with Vanicream and Cerave lotion. The doc advised me to reapply hydroquinone at night since day 5.

I was using the cream prior pre procedure every 3 days for a few weeks. Around day 7 post procedure I noticed red marks weren’t subsiding. She told me to use Rhofade during the AM (which I couldn’t because it made me itch) and to add arnica along the hydroquinone in the PM which I’m not using because it’s in a gel form and it pills on my skin if layered with the other creams. I’ve only been applying a thin layer of hydroquinone and using the cicaplast balm generously all day.

Currently on day 12 and not much change. The craters look bigger and more visible which is discouraging. I don’t think this is hyperpigmentation but instead, I’m leaning towards PIE because the redness sort of blanches when you press on it. Did you do combined treatments? Mine was done together. I have retinol here - I’ve used over the counter Obagi in the past and got Altreno a year ago, they have the tendency to make me red so I need to ask her if they are safe to use. I have mild rosacea which further complicates things. 

Was your redness due to PIE or PIH? Was it unchanged for 6 weeks and did it suddenly just fade? I don’t know what I should expect because my test area was so painless and resolved in a week,

Pic taken earlier, the lights in the room are yellowish - as you can see, skin is still blotchy and red and the scars look more visible.

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My procedure was a combo treatment done at the same time. I had a phenol cross (like TCA cross), subcision, then fractional Erbium laser.

Your progress seems the same as mine. The skin turns darker, little scabbing, and fall off in about 5 days from the laser. Then it was mostly fine, except for the areas where cross was done. The cross areas started out light-pink or whitish on day 1, then progressively got darker and redder. They looked really bad for 2-4 weeks. Eventually I think the skin turned over and the color went back to normal after around 6 weeks.

So week 1 light colored, week 2 red and darker, weeks 3-4 still red, weeks 5-6 less red and eventually back to normal. Wear a tinted sunscreen or makeup to cover up the redness.

There are other factors such as ethnicity, skin type, etc. If you're getting redness from retinol it might mean you're using it too often or without moisturizer. You can try using it every other day, and apply moisturizer 30 mins afterwards on top. Proper usage of retinol will make your skin peel and feel softer. Using it for 1.5 months or more will turnover the cells with newer cells.

 

Was your Fontana laser fully ablative or just fractional?

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9 minutes ago, Stardust123 said:

Was your Fontana laser fully ablative or just fractional?

From what I know the Fotona Dynamis is ablative for laser resurfacing and scar treatment although it has fractional capabilities for milder peels. I unfortunately threw the information paper that the derm gave me.  The laser site says it uses Er:YAG technology. 

When did you start using retinol after the procedure and did you use retinol or retinoid?

Were your red spots similar to mine? My bigger subcised scar has a more purple/red color and the rest are just, well - red. I would compare it to the discoloration after having cystic acne. 

I think the spot on my nose (not pictured) is inflamed on the side too, making the subcised scar look bigger and deeper than it is.

What you said makes sense for cell turnover but the derm texted me no retinols! very firmly.  I am trying to get a follow up appointment next week after day 14 but it'll probably be challenging as she's fully booked for weeks on end. 

I am fair multi-ethnic Asian (half Chinese) and my skin type is very, very sensitive and prone to pigmentation and scarring. 

Thanks so much for your post, you are giving me some reassurance. I've suffered damage in the past due to botched procedures so this is quite an emotional and scary time for me.  But patience I think is what I need to employ for now as I'm only nearing week 2 and it seems that I have a long way to go.

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I think you just had fractional laser. You might've had grid marks and the area turned darker and the skin fell off after 5 days.

I used Obagi cream tretinoin 0.1%. I stopped using it 1 week before the procedure, and I waited 1 week after to start using it. Although maybe it's recommended to not use it until 2 weeks+ after. I also used some PCA gel with kojic acid that's supposed to act similar to hydroquinone for about 4 weeks before the procedure, it didn't help with hyperpigmentation.

With these aggressive procedures you will get hyperpigmenation or dark spots eventually from subcision entry points. The skin will heal on its own and takes time. I'd give it to 3-6 months before trying other procedures.

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Posted (edited)
18 minutes ago, Stardust123 said:

I think you just had fractional laser. You might've had grid marks and the area turned darker and the skin fell off after 5 days.

I used Obagi cream tretinoin 0.1%. I stopped using it 1 week before the procedure, and I waited 1 week after to start using it. Although maybe it's recommended to not use it until 2 weeks+ after. I also used some PCA gel with kojic acid that's supposed to act similar to hydroquinone for about 4 weeks before the procedure, it didn't help with hyperpigmentation.

With these aggressive procedures you will get hyperpigmenation or dark spots eventually from subcision entry points. The skin will heal on its own and takes time. I'd give it to 3-6 months before trying other procedures.

If I remember correctly she did multi-wands and multiple passes so I will have to ask the derm when I get the chance. I'm not really sure what she did because I was woozy with the pain after the first few minutes.  I barely remember half of the things I said that day and I was given topical anesthesia and injected numbing in 6 areas. 

The subcision alone was painful, then she did the first laser pass that was extremely hot and made my skin raw. The second step felt like hot points akin to microneedling, then she did lighter additional passes in the end (around 3x).  

In one of my derm's IG videos she used some wand to target the depressed scars after previous steps, which I'm sure she did with mine. Your suggestion regarding retinoid is definitely noted. I will ask the derm to get clearance if she can prescribe me a mild one. She said I need at least 2-3 sessions to see improvement which should be spaced 4-6 weeks (obviously too soon for me). I don't think I have the confidence (in her and myself) to do it again until I am sure my pigmentation will resolve. After I told her about my red spots, she said that for my skin type - my treatment should be spaced out every 2 months.  Although she mentioned something previously that I shouldn't wait too long for another session (like 6 months) as skin progress might be lost - don't know if there's any truth to that. 

Edited by needhelp1234567
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Just an update on this, I asked my doc and she said that she didn't use fractionated laser on me. She used a combination of ablative and non ablative in 'conservative' settings.

Derm also said the discoloration isn't due to hyperpigmentation from subcision. It's due to the energy device not being tolerated in some areas that it has caused PIE (we agreed it was strange it's mostly concentrated on one cheek - same settings but other cheek's redness has mostly faded). She zapped the problematic areas today using low settings of Fotona vascular laser and I have a follow up in 3 weeks to see if I need another round.  

She told me to keep it light. Didn't get clearance for retinol and was horrified when I brought it up, lol. She wants me to keep using my cicaplast balm, arnica gel and SPF. Fingers crossed it fades in a week or so!  

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On 8/2/2022 at 9:32 PM, needhelp1234567 said:

Just an update on this, I asked my doc and she said that she didn't use fractionated laser on me. She used a combination of ablative and non ablative in 'conservative' settings.

Derm also said the discoloration isn't due to hyperpigmentation from subcision. It's due to the energy device not being tolerated in some areas that it has caused PIE (we agreed it was strange it's mostly concentrated on one cheek - same settings but other cheek's redness has mostly faded). She zapped the problematic areas today using low settings of Fotona vascular laser and I have a follow up in 3 weeks to see if I need another round.  

She told me to keep it light. Didn't get clearance for retinol and was horrified when I brought it up, lol. She wants me to keep using my cicaplast balm, arnica gel and SPF. Fingers crossed it fades in a week or so!  

heyy :) how is your recovery? i wanted to message earlier but forgot pw,

c
heck out this link below, i am trying this method after subcision for more collagen production

it's boiled down to 3 main products:
Coloplast hydrogel dressing
Fibracol Plus Wound Dressing 2" X 2
3m tegaderm film dressing

 

Edited by Insearch
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4 minutes ago, Insearch said:

heyy :) how is your recovery? check out this link

i am going to try this method after subcision for more collagen production

 

Hi, my healing is slow. Unfortunately not much progress as of right now.

I'm using Good Molecules transexamic acid + niaminicide, LeRoche Posay Cicalfate balm and spf (during the day only). I'm also using silicone scar tape/patches I got from Amazon.

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4 hours ago, needhelp1234567 said:

Hi, my healing is slow. Unfortunately not much progress as of right now.

I'm using Good Molecules transexamic acid + niaminicide, LeRoche Posay Cicalfate balm and spf (during the day only). I'm also using silicone scar tape/patches I got from Amazon.

Unfortunate to hear but its why im not a big fan of laser.. subcision is fine though. Wish you luck! im doing subcsion 

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6 hours ago, Insearch said:

Unfortunate to hear but its why im not a big fan of laser.. subcision is fine though. Wish you luck! im doing subcsion 

Good luck with your procedure, I am just waiting for all to heal so I can move on to the next step. I've had success with subcision in the past but I didn't see the improvement until after half a year.

I don't want to deter anyone from doing laser - it could help someone who might respond better to it. Unfortunately, I am prone to pigmentation due to being mixed Asian. 

Thanks for the link. I've ordered the Cocoplast dressing gel and will apply it under the silicone tape, just to see if it speeds up the healing. 

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On 8/5/2022 at 3:30 PM, needhelp1234567 said:

Good luck with your procedure, I am just waiting for all to heal so I can move on to the next step. I've had success with subcision in the past but I didn't see the improvement until after half a year.

I don't want to deter anyone from doing laser - it could help someone who might respond better to it. Unfortunately, I am prone to pigmentation due to being mixed Asian. 

Thanks for the link. I've ordered the Cocoplast dressing gel and will apply it under the silicone tape, just to see if it speeds up the healing. 

thank you! :), its a DIY project and so far, no real dramatic improvements :( but i shall see.. i have experience with subcision from a derm and have documented it on here in the past with an old acc but those scars came back or should say didnt improve much but it did soften them. your scars dont seem too deep... what happened with your experience with tca? its documented to help your type of scarring, i believe. i did the dressing gel a few times with the tegaderm, its a cooling gel but too early for me to say anything. anyway, nice name .. i seem to scar very easily :/

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4 hours ago, Insearch said:

thank you! :), its a DIY project and so far, no real dramatic improvements :( but i shall see.. i have experience with subcision from a derm and have documented it on here in the past with an old acc but those scars came back or should say didnt improve much but it did soften them. your scars dont seem too deep... what happened with your experience with tca? its documented to help your type of scarring, i believe. i did the dressing gel a few times with the tegaderm, its a cooling gel but too early for me to say anything. anyway, nice name .. i seem to scar very easily :/

TCA did not reap any benefit for me. I had a test area done and it widened the circumference of the scars almost immediately. Could see the widening by 2nd week. No scabbing whatsoever. Had it done by Behnam who is supposedly experienced in TCA. Might help most, but I don't think I'm a candidate for it.

I think in general, I don't react well to acids. Current derm who did laser + subcision refused to do any chemical peels on me. I had a test phenol paint + subcision done by Hazany in 2020 but the scar turned purple for 6 mos. most likely due to phenol.  The scar did lift a bit after a year after. so yes, I have should been more careful and had my subicision done by a derm surgeon instead of just a regular board certified one but I was afraid of the purpling of the skin. Hindsight is 20/20.

My scars right now look worse and more deep and highlighted by the discoloration,  but everyone is telling me 3 wks is too soon and to wait around 2 months or more to judge.  However, I'm rather discouraged right now as all I see is the worsening.

I bought the Coloplast gel and it's soothing and non-irritating but it's not really doing much to calm redness. I've been told in other forums that Neogeneis recovery serum is worth a try for any type of skin injury, along with Psoria-gold for laser damage.  I'm currrently using psoria gold in the AM under cicabalm. I ordered trial sizes for Neogenesis but they won't arrive until next week. 

 

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