Let me see if I can clarify. Are we talking manual microneedling or say a dermapen like device or rf needling?
If it's rf needling this uses energy as such you need 3 months to heal from this just like laser. Many practitioners will do it every 4 weeks but I don't think this is smart nor is it conservative with the way collagen heals. They get quicker money that way and keep you in a constant state of swelling. Some do not have time to treat properly and thus rush. Just because the surface epidermis heals there is reconstruction under the skin over many months.
DIY needling weather at home dermarolling or a dermapen at a Dr's office yes you can do this monthly.
It also depends on how you heal. If it's poor or slow I would not go pushing treatments.
If you perform to too soon you could damage the new collagen, heal poorly, have ongoing long down time, not see what is working (healing) and evaluate next steps. Etc.
Just tell the Dr or Receptionist you will get back to them when you can reschedule the apt. Then make it 3 months after for rf needling.
@Cowboy72 Manual methods always win out over a device (subcision, tca cross, peels), that being said no device will fix anyone's problems with scarring, maybe 15-20% softening here, you need to be treated as a whole person not a Mixto treatment. This is what poor practitioners do they sell you a device and don't help you achieve your acne scar goals as it takes multi- things.
I would do multiple subcisions here 3-4 of them spaced out 3 months apart, you may need filler on some of your deeper rolling scars. RF needling is effective for some of your box cars (3-4 treatments). Mixto here in context would soften the scars but do nothing about the pits. You can add that on or any CO2 laser if you need another bump in improvement after rf needling, some don't even do laser at all and are happy with the sub and filler.
Finally you can do several tca peels once you raise up the texture.
Many treat over 3 years. Everything is optional. 3 months between all treatments to heal properly. Stop whenever your happy. There is not glass smooth skin solution but you will get some improvement. Filler and sub help a lot. It's all about how you heal.
@saySam Chicken pox scars are very hard to treat. Some do excisions for this or punch elevations. For this cannular subicison multiple sessions and Filler is very effective.
Tiny bleph of filler can be inject and push down under the scar but this is a dangerous area to inject and thin..Your best bets here are multi-sub. chinese cupping, and rf needling several sessions.
If you need more Laser can smooth out the sharp transition/ scar border - like Angled CO2 to the border.
All this is optional, I would look at the FAQ list or find a local subcision Dr to start and see how you heal. Wait 3 months between all treatments.
Thank you for sharing always love new data!!!
I read this several years ago, the Chinese did this way back. It has never gained popularity. Ultherapy has a terrible rating for treatments.
This sounds like more of a study sponsored by a device company ie. Ultherapy. I have never found MFU-V effective for acne scar treatment. It is bulk heating and dare I say less controllable than a laser. RF needling is more controllable in fact for this purpose. You are basically bulk healing a area and doing a filler.
We already use filler for scarring. Subcision and Filler are a much better combo (manual methods always win).
Radiesse or liquid bone is already used for scaring, but it unfavorable as it's not reversible when there are side effects like a HA Filler. Like "more" permanent fillers do not get this unless you do well with a HA filler first a few times and like the results.
@Tarantino98 I don't see you yet at a scarring phase, perhaps you mean the slight box cars on your temples and upper cheeks.
Your biggest issue is not scarring but PIE or wounding post acne. The redness. I see active acne that must be treated! Some helpful treatments for this are ematrix also called sublative rf OR picosure for your skin type helps as well, OR Vascular laser. You need to get to a Derm and stop the acne or you will have much worse scarring.
As your 17 you will heal with time, without many treatments, get the acne, PIE under control.
Some do Low Dose Accutane.
Once you get this stopped, you can do subcision on the temples and cheeks w/ Chinese cupping (see the FAQ- top post of the main sub). Do NOT do this now as you will spread infection and be casing new problems.
Because of Sebum, Get the oil and sebum under control. It can make large pores and ice picks appear larger. A Acid that unplugs the sebum can be helpful. Salicylic acid etc do this (washes and peels). Glycolic opens up the keratin plug. Ice picks happen by scarring on a hair follicle normally.
The only other thing I can think of is your inducing them to look larger and smaller by over treating, exfoliating so the epidermis is removed showing the scar. Some have a different condition where they have spontaneous scarring, blackheads, and pore issues.
It would be best to see a dermatologist to check out the issue. Hydro peels are also cheap and effective to clean things out.
Please post a picture of your scarring (scars make shadows) and I can confirm. Microneedlng even after a year or so will not do much on it's own. Peels added to it will make a difference as they work together. I also don't know how you heal, ... some it's poorly. Are you nightly using a retin-a/tretinorin/differin (Target OTC) as we need to induce cell turnover. Subcision is cheap even for the most budget minded and can be done even once or twice a year if you save up some money. This manual method does make a difference. Also with box cars tca cross by a Dr can sometimes help dramatically and be pretty cheap.
See the FAQ, Acid Peel Section, and paint on tca, and peels for more info.
Start with the above at home needling, peels, retin.... nightly and bump up treatments if you want more improvement. Dr's treatments have the power tools if you need them. Severe scarring needs severe treatments. Most severe scars need aggressive subcision. RF needling is not microneedling,... rf being more like a laser and a treatment for box cars.
Everything is affordable if we think in the long run over years. Some get discouraged with the long process but this is the trade off for at home DIY treatments, patience and knowing when you need a Dr's help if you have plateaued .
@Eric N That is the problem, you are not going to get results with your scar severity with normal needles. This is bad subcision skill. Find a Dr who does Nokor (needle type) or cannula subcision. Normal needle subcision will do nothing here. Find someone else.
We don't use filler to be permanent, if you want permanent - Bellafill PMMA you get that after the 4th treatment of subcision. Your subcisions have not been done properly here. Find another practitioner for this. Regarding the filler again if you only knew how many messages I get from people with complications from permanent fillers which manifest months to years later after injection, they must have them surgically removed. You have to like the results from a HA filler to even consider this. According to your pictures above I have seen no benefit from filler yet in your case. We use filler as a spacer not for aesthetics. We want your body to replace with new collagen in the subcision process. Your scarring is very severe and we need to break up the scarring as well as it looks fibrotic. Start by finding another subcision provider. You would see a difference if they were good. I would also see a lifting of the whole cheek with HA filler done afterwards.
- Last Week
Sorry this is silly whoever told you this "As a black skinned, I was told unfortunately there are not much to do with old scarring..." Whatever skin color can improve their skin.
You have rolling scars and some box cars.
Get some subcision done with filler (3-4 sessions). This will lift the pits and work on the tethers.
RF needling (3-4 sessions) is safe on your skin type if the needle is insulated (ie, infini), have them stamp the scar areas. Laser can be done but not at a higher setting in your skin type because of pigment, hence rf needling being a good choice.
Picosure is a great laser for your skin type to make new collagen and work on that PIE (redness discoloration), or vascular laser can be done.
That is the worst thing I see the discoloration in your pictures that needs work.
Goto someone who has treated your skin type, ... if they have not they are clueless. Ask them about how many patients they have seen like you monthly.
We have a list of practitioners in the FAQ - top post of the scar treatments sub, first post, ... find the France ones or find one you like better by you who does "subcision" - ask them about this. Treat as you have time and money, no rush, please make 3 months between all treatments.
Use a retin-a, tretinorin, of differin cream nightly with konjac and licorice ingredients in a whitening cream to prevent hyperpigmentation and make cell turnover, stop when treating.
@Eric N I am sorry it caused you redness. Subcision must be done multiple times at least 3 months apart to work. You need filler after the subcision, see the atrophy in the cheek. A red are can be normal in a sensitive person, discuss this with the Dr they may be able to use a vascular laser on the area. Without filler and without aggressive cannular subcsion (less marks on the skin as it reaches a wider area) you won't see improvement form subcision.... also if the practitioner is bad at doing it. Yes subcision would be done in your case you have a huge amount of fat loss on the left cheek. I am not just talking about treating on higher planes individual scars but putting volume there - raise the skin even if you do not raise the individual pits.
Your box cars are very atrophic, ... I suggested the rf needling and laser treatments above for them as well.
It's a long journey lots of work to do still.
You don't need to goto AUS, sure treat locally in Indonesia.
@Frid Thank You for providing those pics, that helps.
Fat loss in the cheeks. Rolling scars mainly and a few box cars.
Keeping in mind your in Mexico and said you have trouble finding a practioner. Can you call some of the dermatologists in Mexico city and see if they do subcision or at the dermatology school (where they teach it there) see if they do subcision. I would imagine the plastic surgeon's and dermatologists foreigners goto in Mexico might be able to do it but you would have to call around and see if they do cannular subcision. Check also whatever is popular in Mexico to post videos and look for the Spanish word for Subcision and mexico or the city.
I see subcision helping you most you need 3-4 sessions. IF you cannot afford the cost of filler which you need you can do Chinese cupping (order online) after your subcisions.
At home I want you to do microneedling monthly and alternate with TCA chemical peels. If you have a nearby medical spa goto there if you feel more comfortable having them do it.
If anywhere around you has rf needling have them do a few sessions or you can do laser if you cannot find it.
I know all this seems overwhelming and expensive but space it out when you have the time and money. Some treat over many years. Everything is optional.
I want you to use a retin-a or tretinorin or differin cream nightly, they have to sell those over the counter in mexico as people go across the border for those things. Also use a lightening cream with this that has ingredients like konjac or licorice, etc... This will make cell turnover and prevent hyperpigmentation.
The main thing you really need is several subcision and several mls of filler in your cheeks which will make them look much better.
If you can't find anyone you could always do a quick visit to Dr Rullan in San Diego.
If you find anyone in Mexico who does subcision let me know so I can help others in Mexico.
@Frid I would be glad to help you. I need pictures to give you a plan. Please take them with angled lighting making shadows, a flashlight is fine. The shadows help most. We can come up with a plan to do in Mexico even if you don't have a good Dr nearby.
To attach, choose, insert, draft, submit the pics.
Forums Scar treatments 12 replies@HugeSoil I do not know who this person is so perhaps you have some insight I don't From the pics linked I see some major problems.
He lives a hard lifestyle drugs, alcohol, bad food, poor health conditions. Acne scars are related to immunity, bacteria, and the body dealing with inflammation. The dude still has acne and does not have it under control, it's absolutely pointless to treat at this time.They won't even let you smoke a bunch of pot and have a surgery because of potential complications and healing issues. Ask a Dr about healing, surgery, treatment and cigarette smoke and they will tell you ;-) The treatments he has received are not appropriate for his scars. Some of them are worthless and used for aesthetics, he is definitely not going to a specialist, ie. ""dry ice facials". His major issue is PIE and active acne. If his skin did not have red inflammation you would see improvement, he needs vascular laser.
There is histology for all acne scar treatments, this is required with medical device or implants (filler), certainly anything that is the "gold" standard. Tons of Split-Face Double-blind Studies out there. Western beauty standards of improvement are not the same as the rest of the world. This is not representative of all cases of treatment. Drs are not magicians nor do they have some ability to fix something that is broken and not responsive, ... why do some people have auto-immune diseases, their symptoms can be treated but not the root of their ongoing problem.
Many in aesthetics do not feel scars are worth treating as the money is in general aesthetics, easy treatments with high profit. Acne scar work is a surgery, there is variability of this outcome like any other surgery.
We would never have had acne scars if your bodies immunity would fight of bacteria and inflammation without making scarring. Different degrees of improvement and healing. This is much more complex than someone just getting treatment. We are treating based on the way you wish to look, not the way you will look, when those goals do not meet, we have a problem.
What are the person's lifestyle choices, diet, health issues, patterns of mental health, treatment goals, after care routines, skill of the practitioner.
I do agree lots of fakes and frauds out there who give unrealistic expectations. I detest people who play off people's hopes. But there are some good guys out there who just treat acne scars. I try to educate people so they spend the minimum amount to get improvement and if that does not occur they stop treatments.
We should refocus, there is a acne vaccine that has been approved. Stop the acne to stop the cause. Hell might as well get HIV, Cancer under control, and every other serious disease. They treat the symptom not the problem. Aesthetics and plastic surgery is about superficial looks, it is not in the realm of life threatening medicine to the medical profession. 10 years ago,... in the past you would not even get 50% improvement, the treatments could also harm you, we are evolving, new techniques, new devices, and new methods will continue to give more improvement.
I am the one who said 50% improvement - "maybe", ... most Drs will tell you 100%. I have helped far to many people to promise something that is so variable. Some people simply do not heal well and have major health issues that no scar treatment can fix. Then you have the guys who see 3 doctors at once, do all sorts of treatments, don't heal properly and cause more damage than good because they cannot wait for the long process of improvement. Half of the cases I help still have active acne, explain to me how that promotes healing of scarring it's another variable to deal with.
I would like a blind, split-face study of patient expectations vs true outcome. That is the part that is suffering in health care (When is good enough good enough, and how do others judge the improvement that was done vs the patient). There should be regulated standards on the way before and after pictures are taken, and blatant false advertising dealt with.
People want the fountain of youth to be discovered, without disease, aging, inflammation, or environmental stressors. Perfect with no scars. There is hope for improvement and betterment if one keeps a realistic mindset. Just like Hollywood has good/bad plastic surgery cases with some of the best doctors, care, and newest techniques being used on them in the world.
For some cases treatment is not effective, but nothing will be until their immunity, disease, allergies, and sensitives are addressed. Age /fat / bone loss is also a issue, a acne scar suffer pre-maturely ages and thus needs treatment.
Otherwise this is a scar less healing mega-thread about theories on regenerating new skin, watch the burn scar treatment market if this is what our hoping for.
Wrap up - go in expecting some improvement, not glass smooth perfection.
@Obi wan What are your thoughts on this??
@Kmarqui Big improvement. But as you said it's a long journey. Your on the right track.
Was filler used with your subcsion or are you holding off? If it were me I would do one vial of sculptra over dilute throghout your cheek areas pre- rf microneedling (Rullan can do this or any injector). I would do the 4 subcisions. If you need volume you can do that the last sub treatment or Bellafill which is permanent.
Phenol Cross keep that up with Rullan on the icepicks and smaller box cars.
Rullan isn't the best for energy devices but rocks on everything else. So I would find rf needling as you mentioned and do 3-4 treatments in between your subcisions. The sculptra would stimulated by the rf needling.
I would get co2 done angled 3-7% density at the highest power to the box car borders, many Drs do not know how to do this, so if you have to stamp motion instead do that. Dr Goldman (laser derm mainly) is in San Diego or you can do a med spa. I added some new practitioners in the FAQ if you want to research them.
Do your phenol peel at the end not now. I see scars that still need to be lifted and volume that needs to occur.
A missing piece towards the end is V-beam for your PIE (redness).
Keep it up as you have time any money, many treat over 3 years, no rush, do dr treatments every 3 months and your microneedling at home in between. Use a retin-a/tretinorin/differin (OTC Target) nightly for cell turnover.
Your in good hands with Rullans manual work, that is a huge improvement! Keep going ;-)
Dr Jason Emer will never be on the preferred practitioner list. During the past year I have had to help "several" acne scar patients that fell for the Hollywood Razzle and Dazzle Glamorizing treatments and social media usage of his office. Emer uses a Hollywood film production team with aggressive marketing. It seems many fall for social media sales over someone who may not advertise and has the patients best interest. I think transparency and the visual nature of aesthetics treatment fits well with social media but also can cause the patient to not know what they are getting into, ... research!
Have you seen Emer's canned responses to questions on RealSelf - Always the same thing, leading to seeing him.
He often does irresponsible treatments based off of $$,$$$ (5 energy devices done at one time is not ethical - nor does any one heal like this).
Not only are the patients faces ruined and must be fixed but they spend exorbitant prices for this work that is pushed and over sold to them. He has told members here that they must treat with him for the rest of their life as their scars will never be fixed without him, can you imagine...One guy spent $36,000 for 2 treatment sessions, in the end he had to have his face fixed by a plastic surgeon for severe damage.
I applaud Lim for trying to help dermatological community (make a difference, I stand with him in this goal). Emer was being helped learn a new skill (not that you can learn something in a few hrs). Training is part of that goal. Lim has earned his praise by hard work to help the scar community evolve. He is unselfish with his help (See Real Self Questions he answer). He would say see another acne scar specialist,... he is not the only one who can treat you. I have never heard Emer say this. If anyone is reading this and new to acne.org, checkout the scar treatments sub forum, first post FAQ, there is a whole list of practitioners and information about scarring there.
I do not want to glamorize Emer (Ethics / Patient Information - Buyer Beware). It is my opinion, it' not in a patients best interest to see Emer. Of course you are responsible for you who see and your own decisions. Many other choices of practitioners for people to see on the list.
Acne scar work is not only a medical procedure, there is psychological component (the patient must be considered as a whole).
@Eric N Hi there this is severe scarring. Mainly Box cars, Icepicks, and rolling scars.
Chemical peel alone will do nothing for your acne type, you need many subcisions, I can tell they were not aggressive enough, and dermapen would be worthless in your scar type because of severity by itself as a main treatment. Sorry you spent so much money but the treatments were not done properly, perhaps your dermatologist was not aware of how to treat.
TCA Cross and TCA paint on (multi - layer of TCA put into the bed of the scar and the walls are not touched). This raises the floor of the smaller boxcars and icepicks. You will need several of these. Be aware they can widen with treatment but you will resurface the skin towards the end.
I would do multiple subcisions (4 of them). Lots of tethering going on there.
RF Needling is needed 3-4 sessions. Lots of fibrosis on your cheeks, this may not be enough.
CO2 angled to the border walls of the box cars. Few Drs do this besides Lim but see if you can find someone, otherwise do Erbium profractional or low density co2 (Several sessions).
Picosure laser is great for your skin type for the hyperpigmentation (redness) and collagen production.
Several TCA Peels or Fully ablative Erbium resurfacing by someone familiar with your ethnic skin type, otherwise this can have side effects. This step of treatment is used for texture, once you lift the scars as much as possible.
I don't know your location but perhaps travel to Dr Lim as you have a harder case to treat.
Please use a retin-a/tretinorin/differin cream every night and a konjac arbtuin cream for hyperpigmentation with it nightly. Stop when you have your Treatments.
You may do at home dermastamping or microneedling as well between Dr treatments once per month. All Dr treatments should be 3 months apart. Everything is optional. Treat as you have time and money, many take 3 years to treat as the body is slow to heal. Yes it's expensive but is affordable if spread out and done by a Dr who knows what they are doing.
@Olqa9229 Atrederm ... mix it 50:50 with moisturizer for the flakiness, or you can skip every 1 or 2 nights if the flaking is to bad.
You can try a tca peel with him and dermabrasion if you wish, ... lots of down time. If he is not a good Dr he can make things worse so research his experience. Ask him questions about this.
You need v-beam or picosure regardless this is vascular laser for the redness after treatments are done.
I always would do subcision first, perhaps you could do this with someone local or emil,... Then worry about peels and dermabrasion or laser resurfacing. Have you tried calling Polish Dermatologists and dermatology schools or plastic surgeons and looking for subcision. I can't speak Polish but perhaps you can search for the word on Google or a video with that in a title.
If you have the down time and are comfortable perhaps the TCA peel is fine. Many Drs do fully ablative erbium peels for your type of scarring but perhaps he is as skilled at his peeling method.
Regarding fuss and money, Your scars seems to be monomorphic so peel like treatments or laser resurfacing will help. You can always go this route first if you wish fo your scar type, ...there are no deeper pits it looks like.
@Byebyescars I would do the filler a week or so after when the swelling goes down. He has been doing cannular subcision cool. The one exception to the above is he can inject 1 vial of sculptra throughout the cheek with over dilute saline (not for volume but a spacer).
No Sculptra can happen directly after subcision if you choose that, ... Filler can happen at a later time .. either your last subcision or another appointment for volume. A permanent filler like Bellafill can be considered after a HA filler is used if you like the fill from HA... Permanent is Permanent - Bellafill so be sure you like filled look;-)
retina/ differin/tretinorin are the same thing. Differin is OTC at Target. Pick one. The other are ingredients konjac and arbutin or konjac and hydroquinone many products on Amazon. Yes both together nightly, stop before treatment. You can rotate if they cause you any irritation mix with moisturizer or go a few days between.
Yes the temples test mean you need volume ;-)
@Sibel Look at any white paper on acne scars. Treatments take 3 to 6 months to heal, Laser can take 6 months to a year. You had PDO threads as well (filler can last longer than that period). Dr's push sooner treatment as they get money quicker, some stack multiple treatments which can add risk, they do not think people need time to heal which I think is smart don't you to evaluate what worked and what did not with your treatment. There is a simple solution, you tell them you will contact them back for follow up and you make the time period, or you tell them 3 months is better for your schedule. You don't have to do whatever a Dr tells you. some go year or years between treatments. This is your body healing. We cannot rush treatment that is a mistake. Skin is more sensitive and collagen is slow to build. This is your plan, not his. As you get older it even is a slower process to heal (taking longer than when your young).
I agree with this at home aka DIY, or even basic stuff like microneedling that you can do once a month between Dr treatments at home or by a technician. Light - Mild peels you can do once a month. Dr treatments like Sucbision, tca cross, deeper peels, especially any energy device take "AT LEAST" 3 months to show full results, sometimes looking worse before better. Hence why I say at home microneedle and do your peels once a month between treatments and any Dr treatment 3 months apart.
The one exception is if the practitioner say is doing the face in quadrants, ... say he did the cheeks, and missed a area or the forehead, of course he can treat that ASAP, it was never treated. For those traveling internationally, they agree to take the risk of multi treatments and the possibility of a issue and treat all at once, know the sensitiveness of your skin, pushing things will not make the body heal quicker.
There has been hundreds of recent members who saw Chu? Just search and you can see reviews and experience. Dr's like him do not need to advertise/market as so many goto him for "manual" scar work like Rullan. It's pretty self evident his experience as so many in London/UK/EU goto him. He is a professor who teaches other Drs how to do dermatology. He has a set menu of treatments and does the same thing. If you want other things after you find a laser Dr. His prices are also quite cheap.
Fractora is terrible, ... please find another dermatologist, this is baby rf needling. Go with Infini or the other brands if you want to work on those boxcars and icepicks.
You need TCA Cross first, and some subcision first, 3-4 sessions to raise the icepicks and boxcars before considering any energy devices. Do not do this backwards. Energy devices are last followed by peels or resurfacing with a laser (fully ablative peels).
Further improvement can be had on those boxcars with pro factional erbium for your skin type Or 3-7% density co2 laser at the fullest power angles only to the box car walls (scar border).
You only microneedle at home between treatments once a month (rf microneedling is like a laser). Drs based treatments you get every 3 months, this is how the body heals regardless of Drs pushing sooner treatments for $$$$. Many treat over 3 years, everything is optional.
TCA or Glycolic peels are also helpful to alternate at home monthly. Please use a tretinorin/differin/retin-a cream nightly and a konjac and arbutin cream for cell turnover and hyperpigmentation.
@f93d Just wanted to let you know I linked your post in the FAQ as you actually have a big improvement. You will never have glass smooth skin but you have a huge improvement from your base pictures. As you know this is a slooooooooow process of healing, many treat over 3 years.
Have Rullan do more Sucbisions and filler. You can do Bellafill if you like the temporary look of the HA filler with subcisions, but permanent is permanent so be sure. If you like the volume of a HA temp fillers which does make permanent collagen, ... you like Volume and thus Bellafill may work for you if you so choose, some like temporary fillers ongoing.
RF needling will make a change, ... again in your case I would do a vial as you have done of over dilute scultra before your rf needling, ... yes you will swell but it stimulates collagen. If after 3 treatment you do not see improvement get profractional erbium done or angled co2 to the box cars at 3-7% density and the highest power only to the walls of the box cars, ... Rullan can do phenol cross and dermabarion of these first if you would like a manual method.
>> Have Rullan do Phenol Cross and dermabrasion of the boxcars, discuss peels for further texture work.
You have a big change, ... but I get a feeling you had different expectations. Keep up the treatments.
@fuckacne2828 I don't compare scarring typically, ... that does not help you fix your issue. Please post some pictures if you wish to get a plan for treatment. Choose, insert, draft, submit - we did not get what you attaches as it's your first post.
It will take me 24 hrs to respond because of volume of helping others, thanks for your patience.