There is a post with extra Drs on past one of scar treatments - proactioner's to add to the FAQ. Sadly I do not know anyone in Japan. There should be tons of derms and plastic. Since you can speak the language, ... look for a video of someone doing "subcision" on a acne scar patient. Manual methods are always best first before laser. You can also call some well rated plastic surgeons and ask if they do subcision for acne scars.
No, laser does not fix scars, ... Dr's sell machines and treatments. I gave a plan above for help. Everything is customized for your scars. Many ways to get to the same point. Resurfx would be the CO2 portion only above. Manual methods are always best first aka subcision and tca cross.
You do not have blue pigmentation, that is a artery and some veins around the eye. You need some subcision and there and maybe with a experienced Dr some filler.
3-4 sessions of cannular subcision.
TCA Cross to your icpicks and smaller box cars (Several sessions are needed).
RF Microneedling or 3-7% desnity CO2 laser and the highest power in a angle to the borders of the walls of the box car scars.
A few tca peels or fully abaltive erbium laser for the texture at the end.
I see discoloartion reds/browns, I would get a few sessions of picosure laser.
Please use nightly tretinorin/differin/retin-a and a konjac arbutin cream for call turnover and pigmentation.
Treat as you have time and money, everything is optional, 3 months between treatments, many treat over 3 years.
You mainly have icpicks and box cars, ... I see some fat loss with a rolling scar upper cheek.
You need several sessions of tca cross to the icepicks.
Subcision and filler to the upper cheeks with the fat loss (3 treatments).
CO2 laser 3-7% have them just treat the box cars on a angle to the borders around the scars. You could also do rf microneedling.
Finally you could do a few tca peels for texture.
You treat over 3 years as you have time and money, space treatments 3 months apart, everything is optional.
I think you need a combo of Volume throughout the cheeks through something like Sculptra or Voluma for volume, PRP can work on skin that needs some healing. Dr Lim often recommends 1927nm fraxel and 3-7%density co2 laser with the highest power. If you don't use volume (I see volume loss showing more texture), and some laser ... how will you replace this texture.
I am not a big fan of Ponzer, Weiner is much better, but I am sure you can goto him. Just because they speak on forum boards does not mean they are good. Some loose the zest to treat besides $$$$$ and energy device machine endorsements $$$$$$.
Halo is just erbium, mixed with fraxel. Infini shrinks pores through heating the sebaceous gland (Sebum - oils, pores, etc...).
Infini is a energy device as such is like a laser, Derminator is a microneedle.
Infini is fine in experienced hands, ... Weiner trains many Drs on this machine.
Fat gave you volume hence fillers that stimulate collagen/ volume Sculptra or Voluma.
You can always do Infini (3 treatments spaced 3 months apart - Drs do not agree with me on this, ... laser takes 6 months to heal from and see results - they want quicker $$$). Then do Halo if needed.
No Dr will give you detail over email, they are not paid for their time and patients price shop.
@Vidrar This is covered in the FAQ under fillers and subcision. Yes one can fill and subcise at any time. Wait till the filler needs a top up and then subcise, ... you wait a week or two for swelling to go down and then can get filler. It depends how long the filler lasts in your face, ... gym guys it hardly lasts, ...can be between 6 months to a year and a half. We are not using it for volume again, but as a spacer post subcision. You subcise again when you need it, and fill when you need it, ... some wait for the last subcision to fill, some do it all the sessions.
@MotivatedCode Dr Emer, 5X treatments at once and paying 36,000$ for treatments is not normal for sucess. We have a full list of the "top" acne scar providers in the FAQ - First post of the scar treatments sub.
@grandor I cannot legally or ethically tell you where to get it except ebay or amazon - research on Google, and buyer beware (research what higher % acid does). You can do multi-layer tca cross with 30%, ... the amount of applications you will have to build and see. Spot test on just one icepick and see how you heal and allow proper healing time. Never treat two nearby scars at one time as they can connect.
@nickie115 While I am thankful for your post and your very encouraged to give your opinion. I do not agree.
You are 3 days out of a procedure that can take weeks or months to heal from, you need multiple procedures. We have seen hundreds of cases of TCA Cross helping here, read the old posts.
Can I ask why have you not followed up with the treating Dr about your concerns, you are under his care and submitted to him being qualified to perform this?
TCA cross does not have high risks by any experienced Dr. If your saying high risks for people who try things at home DIY,.... sure doe does doing any treatment using things improperly or without research and proper preparation. We only give advice to do 30% peels and cross here. That will not have high risks. IF you choose to get 100% acid, ... that is on you. Look at all the posters on Amazon reviews who ruined their face with high % and freak out. They thought you could just throw the acid on ;-)
I do agree with you on one point, if your skin is next to perfect and you have some minor blemish, ... why are you trying harsh treatments that are made for those with acne scars, ... who often do not get enough results as they suffer with severe disfigurement. We have a acid peel guide, ... it's the top post of scar treatments sub, FAQ, goto the acid peel section, and the the mega-link, I clearly give you safe instructions how not to hurt yourself. ALL treatments have down time, there is healing and redness.
Nothing will make your skin glass smooth over night (this is hard work physically and emotionally to deal with scars), it's how you heal ( if that is poor, or you have sensitivity, PLEASE DO NOT TREAT WITH ANYTHING - you will be displeased). One after TCA cross can heal for 3 weeks to 3 months. The scars will get wider and the floor become more shallow. They will be red and might need some concealer. We are not looking for anything "to fill in" we are raising the scar floor, ... the walls need to be resurfaced (peels/laser) when it's more shallow. It sounds to me like you were not fully educated on tca cross's use and it was not appropriate for your case which was not severe to have any treatment frankly. The comments on the procedure being bad can be from DIY at home people doing stupid mistakes with 100% acid on their face, dr's who do not know the various applications of tca cross (techniques), poor patient education on how this treatment becomes wider before we resurface, several are needed, and one had lasting redness.
I think a lot of people think they can use acid, ... let me repeat that ... "Acids" and they will magically erase any issue. That's not how it works. I sense some paranoia, concern posting here and other issues going on - "walk-in towards the doctors office i was so afraid." Know they self, ... there is no magical, no down time procedure to fix people with obsession on tiny issues (non-moderate to severe scarring) that do not effect them - we get the aesthetics crowd who want to improve the Instagram selfie or minor imperfections they obsess on. Thank you for you concern not to do TCA Cross. It helps many with icepicks, scarred pores. Your other chooses are excision which can look terrible, and laser which only works for some.
I urge everyone who reads posts like this to (1) Research application and the procedure, (2) Follow your gut, ... here you were not even pleased doing the procedure to begin with, (3) Have them do a test spot on a few spots, before jumping into full face, ... see how you do. (4) If it's not that bad, just don't do anything, ... not worth it.
Test Spot! Any treatment will have down time, and depend on your healing. Start low and build up. One has to resurface after cross, it's not a one treatment one step process. Often taking months of treatment.
This post will be added to the acid mega-post in a few days.
@HugeSoil While treatment under a Dr such as Dr Lim one might do TCA Cross he has liability and responsibility for your treatment and care. Doing otherwise at home or a unexpereinced Dr "could" be ill advised. It's another complexity to thin healing skin from Accutane. We all heal differently. That being said if the practitioner is ok with treating you and experienced sure go get some tca cross. You are on low dose at 20mg so you can start and stop at any time. Stop 1-2 weeks before and allow a week or 1-2 after treatment. Everyone is different with the effects of tane and how they heal. some have destroyed skin while on tane and sensitivities that need to heal prior to other treatments.
@mekos I need some pics where your scars make shadows, using a flashlight or directional light. I cannot gauge the depth. Looks like mainly surface textural issues. One is always surprised of the extent of scarring with shadows.
If you do have them then yes filler and cannular subicsion throughout the cheeks will help will help. RF mironeedling OR 3-7% density co2 laser with the highest power (3-4 sessions spaced between subcisions). Wait 3 months between treatments. You can do a few acid peels or for texture or erbium resurfacing at the end.
Use tretinorin/differin/retin-a nightly at home with a konjac and arbutin cream for cell turn over.
- Last Week
Goto Dr Weiner and have him speak with Dr Lim. They are friends and often see each other.
Weiner's plan could work as well, he is the ambassador and trainer for Infini. Note your issue will not be fixed in 1 session. It will take several over time.
Lim's plan works with low density laser 3-7% and the highest power. 1927nm is Fraxel and good for large or scarred pores.
You looked good with the fat transfer as volume hides all these issues that scars and aging can show.
It all depends on how you heal. Allow 3 months after each treatment to evaluate what works, it's progressive.
I would not peel over a area that is healing and or PIH - hyperpigmentation. Have you tried nightly retin-a/tretinorin and a konjac and arbutin cream for cell turnover?
Perhaps it's best to see a professional at this point. There is Darlinghurst Dermatology and Dr Adrian Lim at U-Republic. Dr Lim is great as you know but in Braibane so a plane ride away.
I would do subcision for your scars with filler (3-4 treatments spaced out).
Also Rf needling or CO2 3-7% low density with the highest power (3 treatments).
It looks like rolling scars and some box cars.
I would space everything 3 months apart, treat as you have time and money. I beleive subcision/rfneedling/co2 and acne scars are covered under your medicare, Lim can bill that way.
Scar work is not a instant thing, treat as you have time and money, many treat over 3 years, space all your treatments 3 months apart, it's a marathon not a race, everything is optional. I would look for subcision and filler most from any provider.
Since you don't want to travel, ... it's best to see what your Plastic Surgeon recommends for your scars and what laser brands he has.
I do think erbium would work on the texture of some of your scars. Perhaps it's best if you don't do the TCA then as there is the possibility to make things worse DIY, and recovery time.
Dr Rullan could help you in San Deigo, fly in treat, and fly home.
Softer fillers often do not last as long, some of the new Juvederm products you could get possibly 12 months (depending on how you assimilate the filler - it's individual). Vollbela is pretty good but there are other new products that could work as well by Juvederm (depends what your plastic is comfortable using).
RF needling is pretty common, check the nearby med spa's maybe they have it look for Infini, Intracel, Intensif, Vivance, etc...
Angled - CO2 ...Basically is a method Lim developed but there are a few other practitioner's using it for Box cars / chicken pox scars. No it's fractional and fractions of the scar wall are treated so that the skin regenerates itself and the wall is broken down (so yes your smoothing out the transition of the skin). This also can be done with a erbium laser.
We are limited by your travel distance and plastic surgeon (What he performs). Perhaps it's better to see what he recommends and offers and I can best respond.
The right injection of filler, some mini sub, and some laser could do wonders.
You could also post this on RealSelf.com Under Acne Scars and see if Lim responds, if no one else responds in a few days.
@Obi wan Recommendations?
@lems you should be ok. Please occlude with vaseline, aquaphor, biaphine, or a la roche laser product. A wet wound is a happy wound. Do this for 2 weeks. Do not pick the scab or put it under the shower (splash instead). Clean with vinegar pats 50/50 water to white vinegar and pat don't scrub. No exfoliants chemical cosmetics or scrubbing.
You can put concealer on it once it's healed a bit more. The red will linger for a few weeks.
I agree this was a bit much 100% for a test spot on the nose with that much spread. Perhaps see another Dr for another opinion.
Your paying for the Dr's experience. It is a different fee to see your general practitioner and a specialist. You can buy a day worker or a plumber who will fix your issues with certification, skill, and experience. You get what you pay for. Cheap is not better here unless you want someone to make mistakes. Nurse's are experienced injectors who do this all day and board certified Drs.
Fillers really are not expensive (unless you find a provider that is above market). Several people pay for haircuts (ie. $10 haircut vs $100+ salon difference), clothes, vacations, special coffee's, toys, etc... yearly. Add that together and you get filler. We age and loose fat, thus it's something some want to upkeep. Again we are not using it for aesthetics reasons but as a spacer with subcision. Anything extra is because you like the look of volume. There is care credit, credit cards, tax deductible health savings. Many can save up for once a year of filler. If you cannot afford filler do subcision + Chinese cupping (Amazon), people have variable results.
@Aldi Yes you can get big improvement. Filler and subcision is most important!
The other is for further improvement and texture work.
Your main issue is volume and tethering.
Again: "Everything should be 3 months (between treatments) - the body is slow to heal - Dr's push treatment to soon, many take 3 years to treat. Besides the at home stuff which is done monthly. Treat as you have time and money, everything is optional."
Forums Scar treatments 5 replies@Novai95 We have a list of Dr's in the FAQ - frist post in the acne scar solutions. Dr Weiner is a short plane ride to Florida, or there are some other Drs. Novick is in NYC but expensive (NYC prices).
QuoteWhat treatment you think would work best for me?
Thank you for having patience, due to Dr Lim's endorsement of me I am having heavy traffic, ... helping everyone. I try to respond in 24-hrs.
Ok you have severe scarring. Fat loss. Mainly rolling scars. Filler and subcision will help you most. I see a lot of room for improvement with your scars. I would never excise them as you have a fat loss problem, ... so you don't need bigger cuts on your face, you need volume.
You need 4 sessions of agressive subcision. I would have a 2 vials of Sculptra injected throughout the cheek and temples. On your last subcision you can have HA filler done for volume to the atrophy / deep pits. We are going to subcise again when we need a top up to the filler and do the other treatments between.
I would do 3 sessions of rf microneedling spaced between the subcisions to your face, this will stimulate the sculptra to fourm more collagen. Lookup HIV fat loss sculptra in google images and you will see that it can help.
You may (optional) also need co2 3-7% density to the border of some of your scars to soften them.
I would finally do many tca peels or a fully ablative erbium resurfacing.
At home between treatments. I want you to dermastamp the scars or get a dermiantor. Also use tretinorin/differin/retin-a nightly.
Everything should be 3 months (between treatments) - the body is slow to heal - Dr's push treatment to soon, many take 3 years to treat. Besides the at home stuff which is done monthly. Treat as you have time and money, everything is optional.
@jwebs91 Thank you for posting the pics. I don't see anything with the flashlight regarding the scar, ... see the FAQ - top post of scar solutions for how to take a flashlight pic (pic as example). Thank you for trying. I just see the light. I even looked at the square on the left of your forehead.
Is it depressed. Approx how big is the scar, are there large pores.
"there is one boxcar like scar which is about one sheet of paper deep and bothers me the most."
If it's a sheet deep that is not that deep. Do a few acid peels to soften the area and dermastamp it especially the borders. Do one treatment a month.
Use retin-a/differin/tretinorin at night.
Box cars can be lasered as well to the borders of the scar.
Forums Scar treatments 3 replies@botanied I don't think the intent of your post was fully addressed. If not, and Obi gave good advice... please post some pics of close up's of your scars using a flashlight or directional lighting. Then we can customize where to goto next with a plan. Attachment is choose file, insert, draft, submit - some have issues.
@Ps07ha What's done is done. White means the proteins of the tissue were effected (death of the cells to be turned over, based on application w/ areas of frosting). Sounds like un-even application, ... this is where peels take skill, to high % of TCA was used without a test spot and building up, no acetone was used on the whole area to clear oil and debris thus the un-even, and no feathering of the peel (some areas got a harsher treatment than others). This is where peels can be more complex than laser as they are very technique variable.
Ok what can we do. Occlude with a vaseline, acquaphor, triple antibiotic cream, biaphine, strataderm, or la roche after laser cream, or use manuka honey, you will have a few weeks of healing. Do daily twice a day vinegar pats where white vinegar with water (diluted is patted on the skin) - use this to kill bacteria and help the turnover of cells, never rub, do not use any other products on your skin AHA-BHA, no exfoliants or harsh chemicals. Aloe Vera can be healing. Time is a healer. Only spot treat zits as needed, sunscreen.
This is all in the peel guide, please goto the FAQ - first post of acne scar solutions, then the tca section, then the mega link to peels, and read about the freak outs and application hints of people who had issues with peels.