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Dazarooni

Had consultation with Dermatologist today

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Well, it's probably been the longest day of my life today. I had an appointment with a Dermatologist today for which i have been waiting with anticipation for 2 months. He is based near Belfast in Northern Ireland and although i am from Northern Ireland myself, i have been in Dundee (Scotland) this past 5 years as i finished finished university not so long ago and prefer to stay here and get a job. There is a serious lack of Dermatologists in the UK who are trained with the wide range of procedures for properly treating scarring, so much so that there were none in Scotland! I have been travelling since 7am this morning and have just got back in my flat and it is now 1120pm. I am knackered and am asking myself if it was worth all the hassle.

I was expecting the derm to suggest subcision/punch grafts/punch elevation to begin with and then some kind of resurfacing 4-6 months afterwards. When i went into his office he immediately told me that my scarring was mainly boxcar type with little or no icepicks and that i needed some sort of "sanding" (in his words) to level it all out. He then began to go on about How Laser resurfacing was the "gold standard" (once again using his exact words) in treating full areas for acne scarring. I asked him about punch grafts and subcision... he said that punch grafts carry the risk of making scars worse and that my scarring was not deep enough for that and he said that he didn't think much of subcision because when then underlying tissue is cut away from the scar, it eventually goes back to what it was like again after some time. He talked quite negatively about subcision, punch floats and punch elevation in general. I was very surprised. I told him that i had done my research and it is generally considered that these surgical interventions were much better but he disagreed. He said that if he were to do laser resurfacings on 20 people, he would be sure that he could get decent results with most of them. He then proceeded to show me some pictures of a few of his past patients and that he said when he does his resurfacings, he aims for around a 30% improvement and if the patient wants better results, he then would do some surgical cutting with the scars and then another laser "touch up". He said that if i had that done, i would probably get around a 50% improvement.

He then suggested that i "LEAVE IT FOR NOW". At that moment i froze and thought what the hell? he began to explain about the Fraxel laser and that it has only been introduced in europe recently and he didn't want to go ahead and plan anything with me if he thought fraxel would be more beneficial than laser. He said he didn't know much about the Fraxel laser but had heard some rave reviews about it, but then went on to say that when he normally hears so much positive things about a new treatment.. it's usually just a marketing ploy. He said that i should come back and see him in FEBRUARY as he and other dermatologists throughout the UK/EUROPE or wherever are having a meeting in Paris in January and the Fraxel laser is top of the agenda, and only then will he know for sure if he is gonna go ahead and get it for his clinic. So that was it basically... i was very disappointed and i told him that i was gutted that i couldn't get something done much sooner and told him how much the scarring was bothering me and i was having difficulty socialising with people and spent most of my time in my flat. He began to talk about arranging with my doc to have me see a psychologist because "I WAS LETTING SOMETHING AFFECT ME MUCH MORE THAN IT SHOULD BE AFFECTING ME". At this stage i could have swung for him. He had no sympathy at all. Anyway, i really don't know what to make of it all and i am not impressed one bit and i am very disappointed with the outcome. He gave me a quick run down of the costs of laser resurfacing for cheeks only as thats all i need and it was £1932 for both cheeks! at this moment i thought i was having a nightmare. Punch floats/elevations were £300 or so, but he if he was to do any he would have to do it weeks apart as i had scars that were too close together and he said for the "touch up" with the laser that he referred to earlier the cost would be half of the £1932. So for supposed 50% improvement i would have to pay over £3000 (which is approximately $5000 US). Oh and.. he charged me £90 for the so called "consultation".

As soon as i left his office i was very disheartened and on the bus back into Belfast i thought about Dr Chu and i heard that if i get referral to him from my GP i will get my treatment free on the NHS? does anyone in the UK know if this is still the case? I've heard a lot about Dr Chu, and nothing has been bad. It would be a 5-6 hour train journey for me but i'd definitely do it, and i'm pretty sure he'd tell me something much different than Dr. Handley did.

So to end it all.. i have to wait until February to see what Dr. Handley is going to do. That's just going to be another consultation, another £90 and it won't be for months after until i get treated probably. I really can't be bothered with all this nonsense. I'm considering Dr Chu....

Anyway, sorry for the novel but i'd just like to hear your thoughts and what your dermatologists thoughts were of the various procedures mentioned above?

Do i get a "longest post" award? :D

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I asked why the hell lasers are so expensive for patients. He said that they're expensive to buy and to run blah blah, whatever

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He wanted you to see a psychologist?? :shock: What an idiot doctor!! Imagine if he came onto this board, ohh the trouble he'd be in!

Sounds like the doctor is buying into all that Fraxel laser hype. He's had no experience with it but he's already raving about it. How annoying. :|

Anyway, though there are many dissappointing CO2 laser stories, I have heard of one CO2 laser success story. This one guy had CO2 laser done on his badly scarred forehead for about $2000 and achieved great results. But that's the forehead.. and maybe the doctor actually knew what she was doing. Experience counts!

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I had laser resurfacing (erbium yag ,a newer form than co2 apparently) done on my cheeks and chin 4 weeks ago, on the nhs. I live in the North East of England. I have very good dermatologist who i been seeing on the nhs for about 6 years on and off roaccutane, although i did wait 2 years for this treatment. I can't see any improvement yet and actually think I look worse although others dont agree. I have been told that it takes 3-9 months to see the best effects so heres hoping . If I see a 30% improvement I would have it done again if offered. The pain is not too bad. Iam disapointed at the moment but trying to keep positive. I am having a course of different laser done on my red nose (connected through acne) in December by the same doctor called pulsed dye laser and are hoping for good results from that.

If you can get laser I'd say give a try. I've heard good and bad but felt i had to give it a go.

Good look and I hope you get a more understanding doctor.

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He wanted you to see a psychologist?? :shock: What an idiot doctor!! Imagine if he came onto this board, ohh the trouble he'd be in!

Sounds like the doctor is buying into all that Fraxel laser hype. He's had no experience with it but he's already raving about it. How annoying. :|

Anyway, though there are many dissappointing CO2 laser stories, I have heard of one CO2 laser success story. This one guy had CO2 laser done on his badly scarred forehead for about $2000 and achieved great results. But that's the forehead.. and maybe the doctor actually knew what she was doing. Experience counts!

I can't remember even one satisfied patient.I've read articles about how great CO2 lasers are but I haven't read about anyone thats had much if any improvement.If a doctor was dead set on lasers for treating acne scars,I think I would find a different doctor.

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Thanks orpey, i hope you get the results you're looking for :) I was contemplating seeing a dermatologist through the NHS but i think the waiting list is a year or more and i really don't want to wait that long

My derm kept going about how beneficial a "sanding procedure" would be for me such was the nature of my scarring and he felt it would be the best treatment for my scarring. What surprised me most was how negatively he spoke of subcision, punch elevation/grafts.

jeffh and guerillabrown- I am considering Dr Chu who is a renowned acne scarring specialist down in London at the Hammersmith Hospital. As far as i'm aware, if you get a referral from your GP (doctor) to him you can get the treatment free on the NHS. I don't know if that is still the case. I am sure he would pretty

much say the opposite of what Dr Handley said.

London is around a 6 hour train journey away, but it would work out as much less travelling an waiting around than my experience yesterday at Belfast.

I think i'll try and find some contact details for Dr Chu then see about getting a letter of referral from my doctor.

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My derm kept going about how beneficial a "sanding procedure" would be for me such was the nature of my scarring and he felt it would be the best treatment for my scarring. What surprised me most was how negatively he spoke of subcision, punch elevation/grafts.

A year and a half ago I had one punch float done, without dermabrasion, about 4mm round and don't like the outcome. It could have been fixed by regular TCA, now I have this ugly round thing on my face. The dent where the cut was made is ugly. Earlier this year I wanted to have it excised so I went to another plastic surgeon(this was in Japan) to see if he could do it. He wouldn't and said that excision would make the scar look much worse, that the excision will make a crease, and that in the past patients who've had it done regretted it very much. He had 25 years of experience and seemed like a very credible, honest person. He didn't charge me for the consultation, didn't try to sell me lasers, just told me what was best, and that the only thing he would do for acne scars is fillers.

What he said about excisions does make a lot of sense. If excision works well then why haven't I seen even one picture of excision posted on this board? People are that hestitant to post up their excision pics? :|

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It seems to be worthwhile to have a second opinion. If you're unhappy with what the dermatologist tells you then it would probably be best to see a different dermatologist. Pity about the damn consultation fees though :rolleyes:

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I haven't seen much on here about excision either sadcat. There are one or 2 areas on my face where i would like to have fillers too. That dermatologist that i had a consultation with offers many kinds of fillers from temporary to permanent. His permanent one is artecoll (artefill) and i don't know what other permanent ones he has if he has any others. I am seriously considering that second opinion by taking a long train journey to see Dr Chu in London. I can get a referral from my doctor to see him so the treatment wil cost nothing and i won't have to pay for the consultation.. so if this is definitely the case then i am going to see him.

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I haven't seen much on here about excision either sadcat. There are one or 2 areas on my face where i would like to have fillers too. That dermatologist that i had a consultation with offers many kinds of fillers from temporary to permanent. His permanent one is artecoll (artefill) and i don't know what other permanent ones he has if he has any others. I am seriously considering that second opinion by taking a long train journey to see Dr Chu in London. I can get a referral from my doctor to see him so the treatment wil cost nothing and i won't have to pay for the consultation.. so if this is definitely the case then i am going to see him.

I had a dermabrasion in the early 1980's that was paid in full by the insurance.I had superfical acne scars and one plastic surgeon turned me down.He said the risk/reward wasn't worth it.I did find a surgeon and he thought he got all the scars.I saw no(ZERO) objective improvement.When I think of all the potential problems and the down time, I would think twice about lasers or dermabrasion.I would also like to say, that I perfer dermabrasion over lasers.I have read about some patients that were somewhat happy with their dermabrasion but can't recall anyone happy with the lasers.Why am I telling this story again????At least consider your options from someone thats been there and done that.

Jeffh

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I really don't know what to make of what the derm told me. Lasers are so expensive and the cases of negative results on here are quite alarming. He thinks it would be best for my mainly boxcar scarring on both cheeks. I think i'm going to book an appointment with my doctor next week and ask him to refer me to Dr Chu. I believe i could get treatment on the NHS through him and i'd be interested to see what he recommends for me.

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