1. Yesterday
  2. You have surface box cars, rolling scars, and icepicks. I do not see major fat loss.

    Your not seeing major changes with the derminator because you have a more severe case than the derminator alone can treat. Do ther derminator between treatments with the DR.

    Are you using retin a / tretinorin/ differin nightly?

    You do need 3 sessions of cannular subcision throughout the scarred areas and threads of filler can be used. Sculptra us effective for mass filling like this.

    I would also in your case do 3-4 treatments of rf microneedling in between the subcisions.

    You need tca pain on method (tca is painted 3 layers in the larger box cars, at a lower %), tca cross for the smaller icepicks, many sessions. 

    I would lastly do a erbium resurfacing (you may need more than one), or a deep peel for the texture.

    I can't really recommend a closer Dr to Downtown LA. You can try them out. Perhaps you could do subcision and tca cross with Rullan and then find someone closer (or do your tca and subcision in one session (because of the drive). RF microneedling you can get done at a nearby spa, and there are lots of expert injectors nearby to you. It's the subcision that is hard to find, and perhaps tca cross. Many of the Hollywood derms are not that  good, perhaps try the dermatology school at UCSF and see if they do it, but they are pricey. 


    Call around (derms) about the TCA cross.

    TCA paint on would be used for your larger box cars. The deep scars need subcision and filler. 

    IF money is a issue do this over time when you have down time and money. 

     
  3. Subcision with Emil Henningsen

    Forums Scar treatments 29 replies

    Just because someone "can" do something does not mean it's the most healthy way to  get it done. Risk...
    If multi-treatment stacks for you great. I have to take care of multiple patients who have "ops" moments and wish they could go back and not have done so many things at once. I don't care what Dr's name you give me, ... all of them when they treatment stack have had patients who have had issues. It's a gamble your taking.

    Many acne scar suffers have auto-immune like symptoms, sensitivity, poor healing, thinned out skin, slow healing time, ethnic skin, or treatment / health complications. Again the one who does treatment stacking the most is Dr Emer in Hollywood, and "many" patients have to goto other Drs begging to be fixed by permanent damage done. How will you know what has worked and what didn't. Look at the reports of people saying they will not do a certain part of their treatment plan anymore (you will not have this option).

    It's a age old trick, you do as many treatments as possible and it creates massive swelling making things look better. How the body heals 6-months to a year later is what really maters.  We were not made to have 5 - treatments at once, ... this is not natural or normal. Mixing filler types, using different energy devices at once and stacking side effects. Some treatments are contradictory to each other as well and can lead to damage by doing them all at once. Would you rather get your hair cut maliciously or quickly, or have a surgeon who rushes through multiple things at once or specializes in just one. Dr's are already rushed to begin with, mistakes do happen. 

    It's all a gamble, and it's your face / your choice. I get it, it's cheap and you want to get it all done at once (that is not how acne scar treatments work - you cannot hurry your body's slow ability to heal). Even Dr Lim says it's best to take it slow if you can and let the body heal naturally. Many cases that Dr Lim does (before/after pictures) he treats over many sessions/time,  even though the list of treatments make you think someone ordered a one-time buffet. We also have had some reports by a few patients who said their skin was ruined by dong too many things at once and wished they would have done test patches of energy devices or trials of the treatments in just one zone. 

    Be well with your choice, I wish you the best.

    See Dr Lim Go through Multiple -Treatments over time with this patient (started with this patient in 2015 - laser treatment were done in 2017).
     

     

  4. The science behind acne scarringAcneScars2.jpg

    The intensity and duration of the inflammatory reaction in acne causes dermal damage and alteration of the sebaceous gland structure leading to atrophic scar formation, but not all patients are affected equally.
    Jul 16, 2018
     
    The inflammatory response in papules of patients with acne prone to scarring can last more than three weeks and is characterized by a marked infiltration of B cells, a study published in the British Journal of Dermatology has found,  whereas the immune response in papules of patients with acne not prone to scarring resolves much more rapidly.

    The researchers suggested that the intensity and duration of this inflammatory reaction causes dermal damage and alteration of the sebaceous gland structure leading to atrophic scar
    formation.

    While the pathogenesis of atrophic acne scarring is not completely understood, severity and duration of inflammation is considered likely to play a role.

    One previous study analyzed the immune response in acne scarring by comparing acne lesions in scar-prone and non-scar-prone patients,  and found that in the first seven days the inflammatory reaction around the pilosebaceous follicle was stronger and lasted longer in patients with scarring.

    THE STUDY
    For this current study, researchers wanted to look at the immune response over a longer period. They analyzed the pathophysiologic mechanisms occurring in scar prone and non-scar prone acne patients in lesions of three weeks by performing large scale gene expression profiling to identify molecular and cellular pathways that may account for the predisposition to scar formation. Then then used immunohistochemistry techniques to confirm their results.

    Nineteen patients with moderate inflammatory acne as defined by the ECLA score, were enrolled in the study with 10 prone to scarring and nine were not. Biopsies of non-lesional skin and of inflammatory lesions less than 48 hours old were taken from their backs, and further lesions less than 48 hours old were identified for follow up 21 days later. Biopsies of these “evolved lesions” were taken at 21 days.

    Biopsies were also from ten healthy volunteers to provide a comparison of healthy skin, and skin samples were obtained from five healthy people undergoing plastic surgery for gene expression profiling of human sebaceous glands and epidermis.

    Gene expression and immunohistochemistry analyses showed a very similar immune response in 48 hours-old papules in scar prone and non-scar prone patients with acne, characterized by elevated numbers of T cells, neutrophils and macrophages.

    However, when the three-week old papules were examined, it was clear that the immune response persisted only in scar prone patients, and an infiltrate of B cells was evident.

    Down-modulation of sebaceous gland markers related to lipid metabolism was observed in 48 hours-old papules in non-scar prone patients, but this had normalized after three weeks. In contrast, there was a drastic reduction of these markers in scar prone patients which persisted at three weeks, suggesting “an irreversible destruction of sebaceous gland structures after inflammatory remodelling in scar-prone acne patients”, the researchers said.

    “We demonstrated that the inflammatory response is still present in 21-days lesions in acne patients prone to scarring compared to those who do not develop scars, suggesting a difference in the acne lesion life-cycle between the two populations,” Dr Johannes Josef Voegel said.

    “Inflammatory lesions persist after three weeks only in patient with scars, with an exacerbation of number and modulation of genes involved in the immune response. This was in line with higher influx of T cells and macrophages observed by immunohistochemistry.”

    A lack of neutrophils in the three-week papules of scar prone patients showed the persistence of an adaptive immune response, he added, suggesting “either a non-elimination of the trigger factor and/or an absence of inflammation resolution signals or inappropriate immune response.” However, the infiltrate of mature B cells and strong expression of several immunoglobulin genes was unexpected, he said.

    B CELLS
    B cells have diverse functions in the adaptive immune system and have been observed in chronic inflammatory skin conditions such as atopic dermatitis. They may contribute to the skin-specific immune response by producing local antibodies and exhibiting either pro-inflammatory or anti-inflammatory activities, Dr Voegel said. “The influx of mature B cells occurs late in acne lesion cycle and only in long-lasting lesions of patients with scarring. It is currently unclear whether the flux of B cells in older acne lesions contributes to sustaining the immune response or to dampening the inflammation via anti-inflammatory mechanisms.”

    There is growing evidence suggesting that B cells might be as important as T cells in the pathogenesis of several inflammatory skin diseases, including autoimmune blistering disorders, psoriasis and atopic dermatitis.

    “In late-stage acne lesions, B cells might fulfil both antibody-dependent and independent roles in the maintenance of skin immunity and inflammation. Additionally, B cells by producing cytokines regulate collagen synthesis by fibroblasts and thus could contribute to the scarring process,” he suggested.

    GENE EXPRESSION PROFILE
    The difference in the gene expression profile of 48 hour and 21-day lesions in scar prone patients indicated profound remodelling of the skin, the researchers suggested. In particular, the dramatic down-modulation of a lipid-associated gene set, which is preferentially expressed in human sebaceous glands, supports the disappearance of sebaceous glands in atrophic acne scars.

    They speculated that dermal thinning is caused by a loss of pilosebaceous units and insufficient replacement of dermal matrix. Disappearance of sebaceous glands has also been noted in viral infection of the epidermis by herpes zoster (varicella) which has a potential to scar.

    “By extension, in the acne population prone to scarring, the destruction of sebaceous glands by an exacerbated inflammatory response can result in atrophic scar formation. The destruction of the entire pilo-sebaceous unit causes a loss of dermal continuity, which is later filled with granulation tissue. At the end of the healing process the granulation tissue shrinks, resulting in atrophic scar formation,” they proposed.

     

    References: 

    Carlavan I, Bertino B, Rivier M,  Martel P, Bourdes V, Motte M, Déret S, Reiniche P, Menigot C, Khammari A, Dreno B, Fogel P, Voegel JJ. Atrophic scar formation in acne patients involves long‐acting immune responses with plasma cells and alteration of sebaceous glands. British Journal of Dermatology 2018 doi: 10.1111/bjd.16680

      Holland DB, Jeremy AHT, Roberts SG, et al. Clinical and Laboratory Investigations Inflammation in acne scarring:  A comparison of the responses in lesions from patients prone and not prone to scar. Br J Dermatol 2004; 150:72–81.

     
  5. Hard to say what this is, ... may still have infection in it. Please goto a dermatologist and have it treated. Redness is normal after wounding. IT's called PIE. He may inject it, extract it, or use a steroid.

    You can try castor oil and or comfrey on it to begin with. Also retin a /tretinorin / differin is effective. These areas can take up to a year to heal. If not responsive you need vascular laser to address pigmentation. 

  6. Acne scar plan new post

    Forums Scar treatments 10 replies

    @GallantNight This Dr does not sound like a acne scar specialist. Just someone who owns a laser and pushes treatments that make money. Please consult, even if you have to pay with 3 Drs. Pick the one who seems best to address your questions and concerns (questions to ask are in the faq). Not the razzle dazzle or machine marketing. You are in control of your treatment, you can goto one dr for subcision and filler and another for laser. You don't have to stay with one. Just because they can do it does not mean they are a expert at acne scar treatments. This is what standard Drs do, throw co2 laser at it. Work on raising the pits before worrying about laser or texture. The body is slower to heal, and does not like mega treatments. When we compound treatments, the swelling hides what the Dr has done, you cannot see what works and does not through the healing process. 
  7. Subcision with Emil Henningsen

    Forums Scar treatments 29 replies

    @All_Posters Learn to say no, ^ this is way to many treatments in one session. This is Dr Emer level of multi-treatments. A lot can go wrong. Sure this makes him more money to stack treatments, induces swelling to hide mistakes / complicate healing, and makes you have less appointments travel time to him. But at what cost... Why are we stacking energy based treatments with subcision (manual methods). The body does not heal like this. IF you must combine treatments due to time issues do your filler / subcision and tca cross. Plexr and laser should be done at a later time. I would not let a Dr get away with this.  This is when you get fat loss and complications, .... but what caused it, we would never know with 5+ treatments at once. I would never do laser first unless the scars were slight and textural, ... otherwise one does not resurface a road when the pot holes have not been filled. 

  8. Last Week
  9. As you have a complex case(ie. sensitive skin) I don't recommend any more acids . These don't look like icepicks to me, they are more scarred pores, .... the peel was not deep enough and opened up the pores making them look wider.

    You need to be seen by a acne scar specialist, so I would not recommend trying things at home. Good treatments are Fraxel dual for large pores, or erbium resurfacing (I cannot tell how deep they are in the pic - but they look shallow), but a doctor would know in person. Please let them know your sensitive, and about your breakouts. It might be hormonal and they will recommend you take spiro.  You can have the Dr do a test spot if there is a concern about side effects - as a test. 

  10. Subcision with Emil Henningsen

    Forums Scar treatments 29 replies

    Yes you can workout, don't put your face against anything, don't use any harsh soaps at the gym. Be careful of wiping your face (bring a clean towel). 

    It's been several days and you should be fine.

  11. Acne scar plan new post

    Forums Scar treatments 10 replies

    10 hours ago, GallantNight said:

    If I get sculptra after a subcision and infinRF combination (I've read it gets absorbed after 48 hours) would the scars retether with no spacer left? 

    No it will not. Whoever published that is not very knowledgeable. It's used in HIV patients for fat loss in the face to give you a idea what it can do in extreme cases. Where your right is the saline goes away and collagen is further stimulated over month in the upper tissue layers. The PLLA will act as a spacer for subcision, if injected correctly. 
  12. Acne Scarring

    Forums Hyperpigmentation - red/dark marks 11 replies

    Rosacea is not related to PIE or PIH, it is it's own dermatological condition. Please consult with the Dr. Steriods give temporary relief. 

  13. Acne scar plan new post

    Forums Scar treatments 10 replies

    Scuptra is quite popular for those with your case type and age. IT provides collagen stimulation. It can be expensive and is not a spot filler - volumizer, but a mass filler for the whole area. HA is also fine, consult with the Dr what is available locally. I don't believe your issue is only re-tethering. I think it's textural, wide spread scars, and hard to treat since they are surface oriented. Filler will not give you glass smooth skin, ... You must treat over time to get improvements with multiple things. 

    IF you do sculptra a set of 3 injections is done. You can space them out if you wish.  You can do 3-4 cannular subcisions even if you only do filler on the 3 or 4th.

    Yes you can rf microneedle with filler, it stimulates it. 

    Both, your doing this nightly konjac/albutin / tretinorin as it also helps with the scarring some. You stop during treatment a week before till you heal. 

    Yes you can do erbium resurfacing as stated above, it's finding the right Dr for your skin type that has experience. You will have more down time due to ethnicity and hyperpigmentation. They may need to do more than one if conservative. Do NOT start with this, many drs will try that as you have not done the necessary work prior to resurfacing, think of a road with potholes before repaving. 

    We are incredibly slow to heal, treatments are typically spaced out 3 months apart. 

     

  14. @love4biology728 That means either (a) she over injected or (b) you had a reaction to the filler that was encapsulated and must be dissolved either way as you know. This is why people are conservative and often top up if more filler is needed.

    She must flood the area with  Hyaluronidase, it may take one session but sometimes a few. Yes it can dissolve natural collagen as well but this comes back with time. She can under inject Hyaluronidase is you still want to keep some of the filler.

    Another option is it dough-nutted around the scars, and in this case subcision can be done to break up the filler encapsulation or use Hyaluronidase.

    Most people if they don't have it under injected and are not allergic to the filler or have health issues, would get a conservative amount of filler again after it's dissolved. 

    She can always try to break up the area with a needle first before another appointment for Hyaluronidase
  15. Acne scar plan new post

    Forums Scar treatments 10 replies

    You have textural boxcars and mainly surface rolling scars, I do not see deep fat loss. These are harder to treat as they are textural in nature.

    Dermabrasion is for texture and is not done first (this is more like the erbium resurfacing and it takes multiple treatments, many don't do this anymore because it's painful and can be messed up (Side effects).

    Microneedling you can do at home as a treatment with small amounts of improvement (between treatments).

    One always needs more than one subcision. In your case I would do cannular subcision throughout the cheeks.

    If you wish you can use threads of prp, ha filler, or sculptra. The sculptra stimulates collagen with the other treatments. Filler in your case will give smaller results as it works best on pits but it can add overall volume which you could use in the cheeks to make the cars look better. I would do 3 sessions when the filler runs out do it again.

    I would do RF microneedling only on the scarred areas, you can do this between the subcisions 3 months apart, or whenever you have time and money.

    I don't see TCA cross helping you here.

    I would then do erbium resurfacing, you may need more than one or a deep peel. Always work on texture last. 

    Because you have ethnic skin you must do tretinorin, retin-a, or differin nightly when not treating, and a cream with konjac and albutin to prevent discoloration in ethnic skin types. 

  16. Dr. Novick - bad result

    Forums Scar treatments 7 replies

    @Nina22 I kinda feel Novick was overly conservative. I think you could do better with your local Dr doing the filler. Some people do cannula filler weekly or monthly with no scars (Hollywood) so no it should not cause scarring unless you heal poorly to standard injections. This is the beauty of cannula reduced swelling and down time. But yes you can also use a standard needled to fill. They fill in diffrent ways as you know. One does threads and the other does a bleph, though you can do threads as well (standard). You can also reach many areas with one entry point with cannula.

    Possibly it reattached or perhaps it was not aggressive enough with enough filler to get the fill you wanted from your past Dr. If you liked the way he did it go back to him.   Then work on the rf microneedling and resurfacing.

    What I see is mainly patients think one syringe of filler is a lot and it's really not, about 1/4th of a teaspoon, cost is always a factor for filler. 
  17. Subcision with Emil Henningsen

    Forums Scar treatments 29 replies

    @Katski84 Firstly this is not non-ablative laser, ... there would be no redness. See the difference in texture, grids, etc... This is ablative erbium laser.

    While I think Emil is a ok Dr. I do not agree with starting out with laser. I typically propose to do resurfacing weather through a peel or erbium last. Cannula and filler first. Perhaps he felt you had slight textural scars and he could correct them with laser for texture firstly. 

    Do not be concerned about the redness. In a week or two you can put makeup. Some are such slow healers there are months of redness. It all depends on how you heal. It's normal when you have laser or a peel to be red and the skin to exfoliate with time. 

    Keep it moist with strataderm, biaphine, or the simple vaseline. Apply daily. Do vinegar soaks where you dilute and pat the skin,in stead of a wash - this kills bacteria, no exfoliation for 2 weeks. 

    Everyone has swelling, redness, healing, flaking skin after laser and peels. 
     
  18. Scar Treatment with Plasmage

    Forums Scar treatments 7 replies

    IT's completely normal. Use castor oil or a comfrey balm. You have never skin growing. IT will take months to calm down in ethnic skin types. This is normal. Wear some makeup.

  19. Dr. Novick - bad result

    Forums Scar treatments 7 replies

    I simply see Nina as I told you in private messages you sent me. Not enough filler was used. You can do this by any expert injector close to you. When you do not use enough filler this is a common complaint. Novick is expensive and you pay for the name. I feel you could do better locally to yourself.

    Secondly I see fat definenecy under the eye area left cheek, filler is the fix for this.

    You need rf microneedling as sirius said, and resurfacing by a deep peel or erbium after. This works on all layers of your issue. When you have time and money treat. 

  20. Acne Scarring

    Forums Hyperpigmentation - red/dark marks 11 replies

    1 hour ago, RedMandolin said:

    Also wanted to know if the scars will improve going forward or only the redness will improve. I have heard that MRF takes around 8 months to show up results and CO2 takes around 6 months. 


     

    This is right the body takes time to heal. You need to be applying tretinorin, retin a, or differin nightly now as well topically on the skin. CO2 can take a year actually, MRF is up to 6 months peak, 3 months min.

    You have hyperpigmentation - I cannot tell if it's PIE or PIH, see the FAQ for how to tell. This is normal in your skin type especially after these procedures. Please see the FAQ, skin section, and PIE - wounding, PIH - pigmentation. 

    Laser is the most effective for this. In your skin type picosure works well, but there are other vascular laser options.

    Redness is not scarring. For many redness can take up to a year to go away, this is not scarring. It's wounding. This is why we recommended comfrey and castor oil above as a first line of defense, also try the retin - a / tretinorin as I said. Guys can wear a concealer / tinted sunscreen like dermablend too while they heal to cover redness.

    I see a bunch of pits, ... cannular subcision should have been done. This was not done prior to treatments and is still needed.
     

  21. @Aalyg6 Can you take a picture for me where your scar's make shadows. Using a flashlight. This is easier to give advice on as your skin looks in very good condition in the picture. 
     
    It seems you have slight textural scars. A few TCA peels would help soften this. We have a guide in the FAQ under TCA Peels and a mega-link. 
     
    You might need cannular subcision throughout the cheek but I cannot tell from the picture provided currently.
     
    BA


    FYI...I do not know any Drs in Minnesota as it's very hard to find scar specialists nationwide, if not worldwide. Perhaps call around using the tips I mentioned above or someone else can chime in.

     

    https://www.acne.org/messageboard/topic/361029-acne-scar-qa-faq-library-of-popular-threads/

  22. @RedMandolin

    It could, but it will take time. Sometimes up to a year. If you had any sort of fat loss this also makes things show up. But it's normal after all those energy treatments to have PIE or wounding, by their very design. 

    You have ethnic skin. Typically they prep the skin with retin-a/tretinorin/differin and a konjac and albutin cream nightly or hydroquinone. This prevents discoloration in these skin types. 

    You can try things like Comfrey which @Sirius Lee Likes and uses himself for healing and castor oil for healing.

    Otherwise for your skin type you can do picosure or a vascular laser for the PIE.

    Learn more in the faq under skin and PIE section.

    BA
     

    https://www.acne.org/messageboard/topic/361029-acne-scar-qa-faq-library-of-popular-threads/

  23. Last Month
  24. @Aalyg6 Hi there I don't know anyone in Minnesota. The list of Drs is located in the FAQ. You can always call a college where they teach dermatology and see if they do subcision, or call around the derm offices. 

    We never recommend bellafill first as it's permanent and can lead to permanent problems, especially very close to the mouth. I would try a HA filler first and see how you like it (found naturally also in the body).

    I can give you a better recommendation if you post a closeup picture of your scarring, scars make shadows (flashlight).

    https://www.acne.org/messageboard/topic/361029-acne-scar-qa-faq-library-of-popular-threads/

    BA
  25. @RedMandolin

    Hey there,

    What I am seeing happen is a few things, treatments occurred in the wrong order. Improper treatments for scar type and instead generalized energy devices, and finally side effects of energy device treatments. I also wonder if the MRF they did the treatment wrong and hit the fat or were too superficial. If the operator was poor this could happen. 

    If it were me I would get a few consultations for next steps and not go back to that Dr. Pick the one who makes most logical sense to you (questions to ask are in the FAQ).


    Find someone who does canular subcision. This should have been done first before the MRF. They can use filler, and or prp to do it. For filler you can try something like sculptra which is a collagen stimular or ha filler throughout the cheeks. It will take 3-4 treatments spaced out when the filler runs out. The MRF stimulates the collagen after filler or prp is done. What's happened is you had a bit of fat loss or the pits became wider after the energy treatments, because the pits were not raised as much as possible first or you healed poorly.

    I feel on some of your spots you need tca cross and paint on tca to raise some of those icepicks and boxcars.

    Get a derminator and miconeedle at home between sessions. Use retin A/tretinorin/differin nightly.

    I would avoid energy devices until you do more manual scar work.

    You can then resurface at the end the slight texture with erbium or a deep peel, this will help a lot if they go deep enough to get under the pitting, but the scars must be raised first sub/filler. 


     


     
  26. @getschwifty
    Oh in that case...sounds bad about your treatment, see Dr Rullan - SD. 

    @ALL_Posters
    Regarding Nokor vs Cannula... They are surgical tools. As time progresses so does the usage and evolution of using new and existing tools. The dentist uses different surgical tools, heart surgeons do surgery's different ways. some people have severe scarring and need Nokor. A cannula will not cut through thick fibrosis, ... even if you cannot physically see it above the skin. That is the issue here, people thinking their scarring is severe when most are not who post on this board (80% are just textural scarring - this is why it gets recommended more now, because it fit's the posters individual issue). The type of tool is picked by the needs of the patient. It thus makes since that light acne scar patients as I said a few times above would do cannula subcision. Pick the experience of the Dr and not the tool. Remember Lim still does Nokor for severe cases, and cannula sub for those with lighter scarring. Nokor can be done very safely if your Dr knows anatomy and has experience, but why use a jack hammer if only a broom is needed for the job. For some people the only choice they have is Nokor and that is completely fine, both work great in the right patients, who heal well. 

    It's hard enough to find subcision as a dying art many Dr won't do as it's not a big money maker like laser.
  27. @49ersFan Dr Taylor is extremely expensive $$$$ and he stacks treatments, similar to Dr Emer Hollywood. As such (I am sure you saw the video I linked) the down time will be long and you have to be fully sedated. Depends how sensitive you are and how your body heals. The pluses is he invented his own subcision method/ tool, much stronger than Nokor for severe scarring and your paying more money to have a mega surgery / procedure to get it over with, which works better for some people who have the $$$$. Treatments of course are always better when someone spaces them out and let's the body heal naturally (Slow). When you stack that many things there can be side effects but he is a experienced plastic / derm. I would do 3 consultations even if it costs some money before deciding who you go with. Why because this is your face, time, and money, and you have to make the decision who is the best (not who sells you the best selling treatments - see the questions to ask drs in the faq).
Improving Your Scars. ^ Adam Levine is great inspiration of beautiful skin ^