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  1. I have a hypertrophic scar on my forehead. Its very dark in pigment. I have already had a few cortisone shots to flatten it. I have done a few peels but none are working to remove the dark color and I barely see any improvement. Retin a and hydroquinone are not helping it to lighten. I went to a few derms and they suggested either Fraxel Dual or Intracel RF microneedling to help improve the scar at this point. The scar has lichened, meaning it has a leathery appearance. Its not smooth. Should I follow thru with Intracel or Fraxel Dual for hyperpigmentation and hypertrophic scar? For reference, I am brown skin.
  2. My Story of failure

    Forums Scar treatments 49 replies

    Hey Guys, I found this forum today and I am relieved in a way I can speak to like minded people because my general friends/family do not understand what I go through on a day to day basis. In my teen years I suffered severe acne. Parents took me to a dermatologist, took accutane for the time needed. Yes it was a temporary fix. But what came afterwards was what has affected me for years and still to this day it kills me to see everyone around me with nice skin and I have been unlucky. Being a 20 year old with fat loss in cheeks is a very rare occurence. Some dermatologists said it was the accutane, others said its my "genes". Not ONE family member of mine has what I have. At 22 years of age I moved states to get better medical advice and start a pathway to treating my scars/fat loss/large pores. After going to apparently the best dermatologist in the area, I started undergoing a treatment plan which consisted of a few co2 laser sessions. With high hopes I did everything right, after 8 weeks there was very little improvement and no collagen reproduction whatsoever. Tried a second co2 after 12 weeks, same result. Very little improvement. As a matter of fact I believe I may have lost more fat. After a few weeks I got hyperpigmentation. Did a series of peels with same thing again, little improvement. Did another cycle of accutane, little improvement and horrible experience. Last year I decided to go to a different dermatologist. They tried to fill my face up with fillers and botox for the forehead and cheeks. Botox worked for a while. A month to be exact. Only 1ml each side was put into my cheeks. Little improvement but they definitely underestimated how much I needed to fill my face up. Now at 27 I have gone to another dermatologist yet again. I have started a new treatment of co2 laser but they have done a subcision treatment and a tca peel in certain areas. I am being hopeful with this new treatment but with my past experiences its playing with my mind. The day after co2 my face looked so full. if only that was a permanent look I am after other possible treatments that have been proven to work if this fails. I have spent easily over $15000 in just treatments alone only to see the same face in the mirror everyday without improvement. Some of the users here complain about a couple of scars here and there. I would kill to have what other complain about on here. I have attached pictures of my scars, this is 1 week post co2 (today)
  3. The papers seem to be solid, I really don't know what to think of this? All the dermatologist seem to practice old school method, expect for the ones select ones in the US and UK. It now seems that acne scars can be prevented or treated early with safe outcomes on patients on Accutane. It make sense to prevent scars, rather than treat them in the first place? I wonder how many dermatologist and plastics actually read and follow the latest research ? I think its a controversial video as most dermatologist will cover their back, rather than look after the interest of their patients, but I guess time will tell as these papers are only a few week to months old. Some of the jargon is beyond my limited understanding, and BA will have a objective view point on these papers and the video. Its seems to really change the way we should be managing severe acne and prevent scars. I think this will be highly controversial. (MOD edit:) Source: http://www.lasersandlifts.com.au/wp-content/uploads/2017/09/Acne-scar-guidelines-2017-Part-2.pdf
  4. Hi, I just got off 10 months of accutane and my skin has improved dramatically. But like a lot of people on here, I was left with pretty bad scaring. I plan on getting fraxel next summer with a reputable doctor and I have a few questions about this. 1) What type of scars are these (box, rolling, etc)? 2) How would you classify them in terms of severity? 3) About how many fraxel treatments would it take a good doctor to get my skin to an acceptable point? (I know "acceptable point" is a bit subjective, but in your opinion). Thanks for the help.
  5. Never Give Up

    Forums Scar treatments 5 replies

    Well well well, here I am. Back again. Back in the early 00s this community gave me so much support. I thought I would come back and give an update. Back then I was known as "Guardedly Optimistic" now i'm "Guardedly Optimistic 2017" This is the thing, it's a journey. My skin is still very damaged; mostly visible under harsh over head lighting. But...and get this...I ended up pursuing my dream of being an actor and filmmaker! Yes, acne and scars and insecurities and all that crap was not going to hold me back. I don't want it to hold you back either. Here are some recent pics under overhead lighting. This is the harshest of pics I could take. It's painful for me even to look at now but you know what? That's ok. I will keep trying to improve it but not let it hold me back. After the accutane helped to take away the cysts, the scars started showing in time. I think i've spent the following, estimated: Doctor 1: Deep Fx Laser (4K) Doctor 2: Consult $100 Doctor 3: Consult $100 Doctor 4: Fraxel ($800) Subscision with Restylene Filler ($600) Fraxel ($800) Excision ($400) Subscision with Restylene Filler ($600) Doctor 5: Consult $350 Total: $7750 Never giving up = priceless You can see the scars are still there but they are definitely more shallow than when I started revision. Strangely, I think the micro needling (which was the least painful or expensive) was the most effective. I think i'm going to start doing that again at home because I was happy with the results I was getting. Now, and I don't know if i'm right, but micro needling soon after injury prevents the building up of scar tissue I think. Now back in the early 00s before YouTube or anything of the sort, we wouldn't have known that but now we do.
  6. I'm 24 and have dealt with acne scarring ever since I had really bad acne in high school and went through accutane (late 2007). I got fraxel laser treatments twice - I think the first treatment was around 2011 and they did about 3 treatments, and then I just finished the second round (went 4 times) in 2016. I am still having scars which I can easily see in indirect light. I think the second round in 2016 helped out a little bit to make my face smoother and round out the edges on my scars, but these scars are still very visible in my mind. I'm not going through any psychological issues where I dont want to be in public, its just I kind of want these all to go away and move on with my life. I'm still doing fine socially as well as with girls, but I feel like they can still definitely notice them. As you can see I can make the indirect light to show these scars, but in other lighting it doesnt look like I have any scars at all! I really just want to know what types of scars I have and what you guys think I should do about it. I'm open to anything, and id be willing to spend up to 5K if need be for any procedures. Do people think I shouldn't use lasers again? As to the scars - I think left cheek is worse because of the two scars at the top of my check which are the deepest scars that I have. I feel like the right cheek doesnt have as deep of scars. Also, on the bottom left side of my chin I have this very deep crater which is unlike any other scar on my face. It sorta just gapes deep into my skin. I think you can see it best in my very last picture. **let me know if you need me to post any more pics with better lighting to make a better read on what I have/should do, this was my first time taking pictures like this Pictures (I took two of each cheek): Right cheek: Left cheek:
  7. Hypo Pigmentation from Fraxel

    Forums Scar treatments 3 replies

    Hey guys - I am new to this community and hopefully will find some help here. After battling with acne for a few years, I finally got it cleared and went it for fraxel to clear a few scars. Worst mistake ever. Infact the day I was going for my fraxel my niece even commented my skin was glowing. Anyways, the fraxel has now left white spots on several places on my skin and I have to idea how to treat it. Its devastating because now I have no acne but a horrible new problem. I would take back that acne anytime because I knew what to do , right now I am so depressed and desperate. If abybody has any suggestions, please please help. Thanks, Mia
  8. Results after 1 session of Fraxel

    Forums Scar treatments 16 replies

    Hey guys, I wanted to share what I consider to be really positive results after just a single session of Fraxel (I've purchased a total of three). I hope it helps anyone who might be considering this treatment. I have a mix of scar types, as you'll see in the before photo; I'm really pleased with the improvement so far and hope for more in subsequent sessions. I had the first treatment two days ago. I'd appreciate any feedback or advice you guys may have. P (before and after)
  9. I need some help. I know the scarring is not terrible, but a few months ago I had no scarring and smooth skin. I went through, and still have some adult acne. However they never scarred until i used benzoyl peroxide. Big mistake. Anyways, I did one treatment of dermapen three months ago, but i think the esthetician did not do it correctly as her pen would stop mid treatment and get stuck!!! This probably made the scars worse. I feel like the texture of my chin is terrible. Please see the pictures below. Scarri
  10. Holes from fraxel

    Forums Scar treatments 1 reply

    Hi, I'm after 3 treatments fraxel and rf. 3 months after. I have big holes and my skin broken on its very forehead. Please help !!! who help me :(:(:( Please
  11. I had a few Fraxel and PRP treatments to repair my acne scarring and ended up with really bad skin quality that looks worse than an orange peel. (To be precise 3 Fraxel treatments and two PRP treatments -- all of them one month apart) I have wrinkles and inflammation all over my face and it has made even looking into the mirror really difficult. I have no clue how to fix this and now all I do is keep looking for solutions online or dermatologists or at beauty clinics. Dermatologists and beauty clinics keep dumping more treatment packages. The spa where I got the treatments refuses to even acknowledge my condition (How can someone be so cruel) Based on what I have read about skin that looks like mine, I might have burned the skin barrier and destroyed the facial fat (But this is just my assumption because my skin matches the appearance of lost barrier and fat lost texture) I have read a lot of articles mentioning what these harsh treatments can do to your skin. Wish I had read those before doing something so drastic. I read an article on how emu oil and honey helped a lady who had similar skin texture but she got that orange peel like texture from using too much Vitamin A on her face. I keep reading on forums that thermal damage is irreversible and skin can never recover from it. It pains me emotionally so much every time I read something like that. Now I seem to be stuck in a dark zone with little hope for light, a way to fix my skin. I wouldn't wish this on my worst enemy but does anyone have any experience with this kind of situation or know any treatments that can help my situation. I would really appreciate some help on this.
  12. Skin condition

    Forums Scar treatments 4 replies

    Hello everyone, that's my first thread on this forum. Found it somewhere in the Internet cause I was looking for help and here's my story. As I started puberty, I got acne. It wasn't as bad as in some cases but it left me with scars - especially on the temples. Anyway - when I was 18 I've started taking isotretinoin for about a year and I got rid of acne. About a year after my isotretinoin therapy had ended I underwent a sieries of fraxel laser treatment (for the scars) - the last one was 2 weekes ago so the skin doesn't look healthy yet (redness and the peeling). I'm describing this so that you knew my situtation. I'd like you to assess condition of my skin. Especially the center of the forehead - don't you think there's something weird going on - I've got a problem with those dark little dots, what are they, are they scars? How can I get rid of them? Sorry if I made any mistakes writing this - English is not my first language .
  13. Microneedling vs Fraxel for my Scars

    Forums Scar treatments 1 reply

    I had cystic acne on my chin in high school, I went to an asthetician who extracted the big pimples with a needle, yes BIG mistake, but I didn't know any better. Finally my acne had cleared up but I have been left with ice pick scars that I have tried to get rid of over the years (I am 28 years old now) and I have tried Maderma scar cream but that doesn't do anything for old scars. I have tried a session on microneedling two months ago (found a Groupon that had great reviews for this asthetician who does the treaments in New York where i live). She told me that it will take 8 sessions to see improvement but told me they will never completely go away, which I know, but I just need improvement. She also told me I had to get a facial to clean my skin prior to th first treatment, so I did, I paid $120 for that plus the microneedling session, well after one microneedling session of course you cannot see any improvement but I did notice my skin otherwise being smoother and less tired. I went to my derma doctor for another issue and he told me that microneeding is a waste of time for my scars and that I should do non-ablative fraxel in his office(I paid $65 for the consult on this that will go towards the first session of the fraxel plus I have to get a facial to clean my skin prior to the session ($100, not much money but still I am tired of paying for this service when I don't need it as I do not have active acne and my skin is fine otherwise). I did consider Fraxel before doing microneedling but am so scared of any bad side effects. He told me that the nonabalative fraxel will only help 40% which is fine, I want to improve my skin, I know it will never be perfect. He also told me to consider excision of each scar and then fraxel after, which I am certainly not considering. Can someone tell me what is best for my skin? I have posted my scars on my blog, link here. Any help will be appreciated asI really am lost and would like to stop paying money for something that will not give me results. Thank you! http://thedrasticallyblog.blogspot.com/2016/12/acne-scars.html
  14. Hi Everyone, Long time lurker, and I finally bit the bullet to create an account and post. I need some advice for my pitted scars on my left cheek with active acne. For some reason my cystic acne loves my left cheek and crops up every 4 months or so for the past 2 years. I've had cystic acne all my life, and after different treatments it slowed down for the most part. Just my left cheek is active. My wedding is next July and I'm trying to lessen the severity of the pit appearances. My dermatologist recommended me RF - Radial Frequency? Microneedling or Faxel treatement. They recommend Microneedling for me. It costs $3,600 USD for 3 treatments. This seems very high priced based on what I've seen, however I really trust and like my dermatologist and she's never been one to push me to do things I didn't like. Based on the comments I've seen , RF microneedling hasn't really worked for a lot of people, in fact ive seen it damage people ? What about Fraxel? Should I just go ahead with Inifini or fraxel - even if it helps a little? I feel stuck with little options. Are there any other recommendations that are not aggressive like skin punching/surgery (both NOT recommended by dermatologist due to skin type) or subsicion or even dermarolling? I don't want to do any DIY stuff since I scar very easily - I'm prone to have keloids and raised scars. (If it's basic name brand creams - I'm all for it. Just nothing like aggressive such as 80% TCA peels at home) I'm also tempted to consult with other dermatologist, but it is time consuming and costly for several consultations. I just want advice on what has worked for people who have had not-too-aggressive treatments. Anything that has helped slightly improved appearance(10-20% improvement) would be good with me, I'm feeling desperate. Provided below is my skin background alongisde the duration or year completed: Skin background: -Cystic Acne (all my life, I am 25 yo) -3 Keloids scars from cystic acne on shoulders and shoulder blade (10 years old) -raised white back acne scars ( 10 years old) Treatments: -regular monthly "light" chemical TCA peels on face and back , 10 - 30% depending on face or back ( 2015 - 2016 current dr) -Steroid injections for keloids and cystic acne (2015-2016 current dr) -Laser treatment, Genesis - Did not work ( 2014, at skin spa) -Obagi Kit - Effective for forehead cystic acne , got rid of 80% of acne (2010, done at different skin spa) -Birth Control, got rid of 5-10% of acne - stopped working after 6 months (2010 PC physician) -Tetracycline, worked for 6 months (2008/2009 PC physician) Provided below is a pic of my lower half of my face, apologies as i have makeup on, but you can still see my pitted scars.
  15. Fraxel Repair? Restore? Pixel? Pearl?

    Forums Scar treatments 2 replies

    What is the difference between fraxel repair laser, restore, pixel and pearl? I want to repair some individual atrophic scars. What kind of down time is there?
  16. ACNE SCAR Q&A / FAQ; LIBRARY of POPULAR THREADS <If You Have Updates / Hints/ Tips for This Thread, or Questions, Please PM Me> Special Thanks for Contributors : Robertitoo, DeLovely, PCT14, QuanHenry, Hope01, Dan Owner of Acne.org Disclaimer: The information below is provided as a courtesy to address general questions. As we are not medical professionals, we cannot be held responsible for the accuracy of this information. By reading this information, you agree not to hold us liable for any damages that may result in your use of this information. This information should not replace information that your Doctor, Dermatologist, or Plastic Surgeon provides you. Please keep in mind that this is for general information only and results will vary for each individual and their bodies ability to heal. TABLE OF CONTENTS: 1. SUCCESSFUL TREATMENT THREADS 2. WHAT IS ACNE & PREVENTING SCARS 3. DIFFERENT TYPES OF SCARRING 4. TREATING SCARS AT HOME 5. SKIN: TEXTURE, DRYNESS, RED, BROWN, WHITE MARKS, & COVERING UP SCARS 6. PUNCH GRAFTING & EXCISION 7. HYPERTROPIC / KELOID (RAISED SCARS) 8. SUBCISION 9. FILLER FOR SCARS 10. LASER 11. MICRONEEDLING 12. TCA CROSS FOR ICEPICK SCARS & ACID PEELS 13. LIST OF ACNE SCAR TREATMENT DOCTORS 14. ANATOMY PICTURES ____________________________________________________ 1. SUCCESSFUL TREATMENT THREADS Scar Treatment Success > Proof (Pictures - included) Acne Scar Treatments, Medical Case Studies, Acne Scar Successful Treatments https://www.acne.org/messageboard/topic/374081-proof-pictures-included-acne-scar-treatments-medical-case-studies-acne-scar-successful-treatments/ > PCT14 Suction and Subcision Success with Suction http://www.acne.org/messageboard/topic/361755-my-subcision-saline-suction-treatment/ > MR. Matt Subcision Success http://www.acne.org/messageboard/topic/232731-man-in-the-mirror-pre-and-post-subcision-photos/ > Boxcar scars improved significantly through subcison http://www.acne.org/messageboard/topic/323172-my-total-fx-diary-procedure-scheduled-for-120412-updates-to-follow/ > 91baby Surface Acne (Textural), Subcision, Filler throughout cheek (not individual scars), and TCA Peels https://www.acne.org/messageboard/topic/364086-justhadsubcision-documentingwphotos > DC Girl TCA improvement http://www.acne.org/messageboard/topic/337794-scar-success/ > Success Recell UVB Lamp + Melgain (Decapeptide - Basic Fibroblast Growth Factor) Fixing Vitiligo, Lightened Scar Hypopigmentation, Loss of Pigment Skin Discoloration http://www.acne.org/messageboard/topic/352685-recell-for-hypopigmentation-burn/ > Laser Didn't Fix It alone, Infini RF and Filler and Subcision Did http://www.acne.org/messageboard/topic/322562-my-infini-treatment-for-my-acne-scarring/#entry3301228 > Scared pores/ice picks improvement of as well as a few boxcar scars http://www.acne.org/messageboard/topic/316133-just-had-ablative-fraxelrepair-and-ultrapulse-co2-with-photos/ ____________________________________________________ EMOTIONAL / PSYCHOLOGICAL EFFECTS OF ACNE / SCARS (YOU'RE NOT ALONE) Many acne scar sufferers live a life of pain from their outward appearance. This often manifests itself with low self esteem or hiding away in the house from anyone seeing them. It can affect one's life in many ways that are not healthy, both physically, mentally, and spiritually. When the acne scar sufferer finds treatment, they often are overly critical of themselves and think everyone else sees them the same way; this is a sub form of BDD - Body Dysmorphic Disorder called Acne Dysmorphic Disorder. This can lead to a obsession for perfect skin and finding small faults in them and others. A roller coaster of unrealistic expectations of treatment outcomes and something to save them becomes not realistic. Part of healing from Acne Scars is realizing you will get a small percentage of improvement at a time with each treatment that can take many years in some cases. Glass perfect smooth skin is a goal but often not a reality of severe scarring. Therapy can help get that remaining percentage to live happy and healthy lives. Colleges offer low cost therapy to everyone and now there is a smart phone app even if you cannot leave the house where you can get therapy called Talkspace which has helped many. Acne.org also has a psychological challenges sub forum linked below. > Emotional/Psychological Effects of Acne Scarring (Individual stories) http://www.acne.org/messageboard/topic/360711-emotionalpsychological-effects-of-scarring/ > Emotional/Psychological Effects of General Acne - Sub Fourm for Acne.org http://www.acne.org/messageboard/forum/10-emotional-and-psychological-effects-of-acne/ ____________________________________________________ 2. WHAT IS ACNE & PREVENTING SCARS Q: How Does Acne Occur? A: Sebum overproduction, hyperkeratotic obstruction of sebaceous follicles, and microbial colonization that promote perifollicular inflammation. When the content of a comedone, the mixture of keratin, cell debris, sebum and bacteria, is exposed to tissue due to the breakdown of the follicular wall, inflammatory cells aggregate and counteract these foreign bodies. That is why painful papules, pustules, nodules and cystic acne form. Inflammation in acne is typically a destructive process, reaching deep into the subcutaneous tissue where the follicular structures are situated. It is more destructive for the deeper structures than the superficial. The more manipulation through squeezing, pushing, and pricking, and picking the greater the chance follicles will rupture, and the more severely the acne will inflame. The longer the inflammation persists, the more tissue that will be destroyed and scar. Scarring tends to be genetically linked to an individual's unique inflammation response. Those people with a "secondary inflammatory response" to trauma tend to scar, while those with a "single inflammatory response" to trauma tend not to scar. This explains why some people will scar easily and others maintain a smooth complexion even through moderately severe battles with acne. Prevention is always better than cure. Q: How can I prevent my acne from scarring? A: The best way to prevent scarring is to prevent the acne that causes it. See http://www.acne.org/regimen.html Sulfur cream, or Benzoyl peroxide on pimples, and Retin A cream nightly have helped many. ** The newest treatment(s) are called Laser Carbon Peels which clean out the pores and Photodynamic therapy (PDT) which uses a medication which is absorbed by the bacteria and oil glands in the skin, and a light source (blue led) to activate the medication closing the pore after several treatments. Intense pulsed light that is used for photofacials can also be used to do a PDL type treatment by activating these medications. A vaccine for Acne has been developed but has yet to be released after trials. For extremely severe, widespread acne, you may choose to see a dermatologist to inquire about Accutane medication which does have side effects. Many dermatologists contend that scars are really more from picking than from the acne itself. Occasional popping can often be performed quickly and safely. It is the picking afterward that often leads to the worst scarring. Scarring tissue theoretically has no regenerative capacity, and will not grow unless it is hypertrophic or a keloid. Meaning you can improve the cosmetic "look" of the scarred skin but the underlying skin structure is scared tissue. If you have pimples specifically underneath the nose region or in the chin / goatee region, or they could be just near your ears and on the cheeks. These pimples or cysts maybe keep appearing in the same spot(s). This could be due to Staphylococcus Aureus bacteria, do not pop these, ask your dermatologist to swab and send to the lab to culture, antibiotics will be needed. Pimples tend to be all over the face, staph can be more cystic or in a contained region. Q: What happens to my scars as I age? A: In ageing skin, progressive tissue laxity worsens the problem of unevenness around scar tissue. Aged skin loses its elasticity and descends under gravity, the scarred tissue and the normal ageing skin behave differently. This difference makes the skin appear more uneven. More Fat loss naturally makes the scars appear much worse, this is why we use fat and hyaluronic acid fillers for ageing augmentation. Aging is accelerated by acne, scarring treatments are needed much sooner than those who age naturally. Q: What is my Fitzpatrick Scale of Skin Darkness & Type (This Determines Treatment) Please note non-white skin can hyper pigment with energy devices source: https://books.google.com/books?id=47HGBAAAQBAJ&pg=PA394 ___________________________________________________________ 3. DIFFERENT TYPES OF SCARRING Q: Can you describe the different types of scarring? scar types: source: https://books.google.com/books?id=47HGBAAAQBAJ&pg=PA394 Icepick: Looks like an ice pick has been pressed into the skin. It is generally small in diameter, but can be shallow or deep. Boxcar: Looks somewhat like a chicken pox scar with more rounded edges. It can be small or large in diameter and is fairly deep, though not usually as deep as icepick scars. Rolling: Looks like a smooth indentation in the skin. These scars can be deep or shallow, but are generally shallower. Macules: Pigmented scars, These are most common on the back, chest and arms. They are small areas of hairless scar tissue that will initially be red but will usually fade to pale ivory within 1-2 years. They can be raised (hypertrophic) or indented (atrophic). There are two basic types of Raised scar types: Hypertrophic scars - are scars that are raised above the skin surface but remain within the boundaries of the original injury. Scarring and can be treated with silicone sheets , liquid silicone, or cortisone injections (provided by dermatologist). Color can be treated with the V-Beam / QuadroStar Pro Yellow Laser. The treatment options include laser ablation, electro - dessication, or surgical excision. Other options for the treatment of elevated scars include injection of bleomycin, cryotherapy, topical application of imiquimod, flurandrenolide, tacrolimus, and silicon gel. Intralesional injection of botulinum toxin has been shown to reduce scar formation. Pressure, flavonoids, TGF, mannose-phosphate, and IFN25 were also listed as helpful. Keloid scars - which are raised scars that extend BEYOND the boundaries of the original sore, blemish or injury. It is scar tissue gone wild. It can continue to grow. Some people are genetically prone to keloid scarring. (Treatments are the same as Hypertrophic Scars above, with steroid injection & cryosurgery being the number one treatment for the raised texture). Q: How can lighting effect the appearance of acne scarring? A: Lighting can have a tremendous effect on the appearance of acne scarring. Some women use silicone primers to fill the scar / pore before makeup or blurring creams, serums, and primers you can get from a makeup store. Your scars will look worse with fluorescent lighting and when not moisturized and plump. Night light and harsh lighting can look worse for many, this is why they put HD makeup (which is thick) on at night. Guys can grow facial hair to cover it, put lots of sunscreen, or avoid sports where they get red and it shows the scars. Pure higher weight serum has bigger molecules,... hyaluronic acid makes your skin moist, low weight HA inflames and plumps the skin hiding the scarring. Use a gel moisturizer over a cream, less break out potential though often the thicker moisturizers plump the cells. Indirect lighting - shows the true scars (scars make shadows, turn out the lights and use a flashlight) . ___________________________________________________________ 4. TREATING SCARS AT HOME Q: Is it okay for me to treat my scars while I am on Accutane? A: No, it is suggested that you wait at least 6 months to a year to treat your scars after taking Accutane. Some individuals have reported that they seem to scar more easily while taking Accutane. If you have completed a course of Accutane and only use it occasionally or in low dose form your probably ok to do acne scar treatments (you can stop 2 weeks before major treatment). New data says you may do subcision and filler while on Accutane with a trained professional. Please note healing will be extended as the skin is thin and in bad shape while this happens (it is best to wait at the very least till after you finish Accutane). Q: What is the Lemon & Vinegar Method? A: This is a method that may improve the appearance of shallow, rolling scars. Drink either Robinson, Lemon Barley Water or plain water with half a teaspoon of lemon juice to a full glass of water throughout the day. It is best to use fresh lemons if possible. Use any diluted vinegar (organic apple cider if possible, malt or white are also acceptable) in warm water to splash onto the face day and night. You may have to experiment to find the right combination of water to vinegar. Try diluting it 1 part vinegar to 4 parts water to start with. First wash your face with your normal cleanser, and then apply the vinegar (dab the solution on with cotton balls and leave on) before other topicals / moisturizers (apply topicals 20 minutes later). You should see an improvement within a week or two. Q: What can I do NOW (at HOME) to improve my scars without going to the doctor? A: Retin A topical from ebay or sold Over the Counter at Target Differin (In other countries called tretinorin at the pharmacy) turns over skin quicker. Microneedle the scars we recommend you buy the Derminator (see link below) and use at 1.5mm once per month. When that heals alternate with a Acid Peel (like TCA - Can be bought at "Makeup Artist Choice"). TCA Cross is the best treatment for icepicks, see below for more info on these treatments. Makeup will help guys and girls spot treat their scars and even out color (all the stars and people on TV wear it) Dermablend at Macy's and Nordstrom was made for surgical scars and tattoos (Unisex). http://www.acne.org/messageboard/topic/359068-the-derminator-thread/ http://www.acne.org/messageboard/topic/366754-discussion-all-things-acid-peels-for-scars-tca-full-face-peel-tca-cross-phenol-glycolic-salicylic-methods-and-techniques/ A: As mentioned, most people with moderate scarring do not find that topical solutions have a significant effect on their scarring. However, they can help lessen scars if used in the healing stage. Topicals typically do nothing for scarring. They are a preventative, but Retin A Gel and Vitamin C Serum can help the skin heal and create new collagen. Many combine these with their other treatments like microneedling. Q: Will Microdermabrasion reduce the appearance of scarring? A: It is generally thought that Microdermabrasion cannot penetrate the skin deeply enough to affect the appearance of moderate to deep scarring. It is a great method of exfoliation at home using a microfiber cloth or spin brush. Be careful of bacteria. This will only help the lightest cases of scarring. Q: What treatments offer the biggest change? A: Subcision can help smooth out the skin for those with tethered scars. Filler with subcision to avoid tethering down again if you have atrophy (missing fat under scars), be sure to see a specialist who has done acne scars before, you can always ask for pics. If they don't do subcision to create a pocket under the scar the tethering will not lift with filler. For ice picks, TCA Cross to make the ice pick raise and widen. Microneedling for all types of scars makes the skin heal and renew itself, it's a slow process (also breaks up scar tissue), RF needling offers better results but is more costly. TCA peels renew the skin and cause it to refresh what's under the controlled chemical peel (similar to laser without the cost). -- See below detailed subcision section. Q: Is there anything I can do to optimize my healing responses following invasive scar procedures? A: Yes. Through a healthy diet (no sugar, carbs, highly processed foods, lots of fruit, veggies, and greens, lean fat meats, low salt). Supplementation: collagen, vitamin c, vitamin K, Bromelain, pure HA serum. Topicals: Vaseline - keep it moist until scabs fall off, don't pick it, vinegar soaks with diluted vinegar water, Arnica Montana for the bruising and red, sunscreen all the time, hydroquinone for bleaching and hyperpigmentation issues. Do not take blood thinning products (i.e. Ibuprofen / Motrin...take Tylenol instead, vitamin E). Spices that thin the blood: cayenne pepper, onion, ginger, paprika, peppermint, thyme, cinnamon, dill, oregano, turmeric, garlic, chocolate, fish oil. ginkgo biloba, ginseng, magnesium, taurine energy drinks. You may take these once your body has healed from the initial surgery (a few days , to a week). Using makeup can cause infection if the skin is not healed fully. Drinking and smoking hinder healing. Make sure to get plenty of rest during recovery, & drink lots of water. Q: How do I get multiple doctors opinions for treatment "FREE"? A: Post a few pictures of your scars using indirect lighting (scars make shadows) like below on http://www.realself.com . Some doctors will give you their opinion. Be aware sometimes their treatment recommendation is a canned response (the "laser" they own or are sponsored by). Post treatment recommendations for a second opinion on the forum here. Start with Non- Energy treatments first. source: https://books.google.com/books?id=47HGBAAAQBAJ&pg=PA394 ___________________________________________________________ 5. SKIN: PIH, PIE, Erythema (red), Hyperpigmentation (brown or other colors), Hypopigmentation (white), TEXTURE, DRYNESS, & COVERING UP SCARS DEALING WITH SPOTS OF ALL COLORS AT HOMEQ: Where do I start?A: Hyperpigmentation takes a long time to heal. You can try to simply wait it out...but it never hurts to try and heal your spots naturally:-Aloe vera gel + honey and vitamin K (gets rid of bruises and red) keeps the spots moist creating quicker healing.OR You can use Emu oil or triple antibiotic cream to keep your wounds moist (Note: this breaks out some people so please spot test). In the morning you use cool water to cleanse your face. Use diluted white vinegar and pat (not rub) the face to sterilize it. Moisture with a pure 100% Hyaluronic Acid Serum, this avoids skin irritation.-Fresh lemon has helped some people fade their spots and also topical green tea. -Topical Vitamin C serum can help some fade their reds and browns and in others it has irritated their skin. Always wear sunscreen. In the morning you use cool water to cleanse your face. Use diluted white vinegar and pat (not rub) the face to sterilize it. Moisture with a pure 100% Hyaluronic Acid Serum, this avoids skin irritation. These spots can take months to heal being irritated wounds, the remnants of acne or other skin issues. If this doesn't work stronger treatments are below>> https://www.youtube.com/watch?v=Re_NdcVGI_A https://www.youtube.com/watch?v=Bsd0YbvZdaI ___________________________________________________________ DIET NEEDED FOR HEALINGQ: What can I do diet-wise to deal with my spots (red, brown, white)?A: Eliminate: sugar, dairy, gluten, start eating fermented foods and bone broths, take your probiotics, and antioxidants such as green tea, vitamin C, and niacinamide. Smoking stops healing as does too little rest. You need animal foods in your diet, especially healthy fats, so don't be afraid to eat fatty meats! If you are a vegetarian eat nuts, hummus, coconut & olive oils, Many with these spot flare-ups mixed with red hyperpigmentation have candida (yeast) and gut health issues. This might need addressing. After antibiotics, this common yeast can cause issues in the body.___________________________________________________________ WHAT IS: POST INFLAMMATORY ERYTHEMA (PIE) - red spots that turn white after being pressed on Q: What Is Post Inflammatory Erythema (PIE)? A: Post Inflammatory Erythema (PIE) describes pink to red discoloration after an inflammatory acne lesion. Patients with lighter skin types (I-III) the post-inflammatory dyspigmentation is often not hyperpigmentation, but instead discrete erythematous macules (PIE). Acne may not be the only cause of post inflammatory erythema, as any resolving cutaneous inflammatory process may have residual erythema. Treatments (ranked most effective to least): V-beam, or IPL, or Excel V, or 1064nm, or QuadroStar Pro Yellow Laser (vascular laser can help these areas quickly by making the body dissolve the trapped red blood / surface veins), steroid creams from the derm, Retin-A Cream, Bactroban cream, Silicone Sheets and topicals (known as scar gels), 2.5% hydrocortisone twice per day (only for a weeks time - it thins the skin), triple antibiotic. Some find light (%) peels helpful like Salicylic Acid or Glycolic (Acne.org has an excellent one in the store)... Your skin must not be raw, overly thin, or any allergy to aspirin (Sali) . Please do not use Scrubs, Harsh Soaps or Exfoliants that prolong the wounding. Emu Oil, Honey, Aloe Vera, and Green Tea are soothing / healing. Visine aka red reducing eye drops temporarily reduces the red and concealer (makeup), while you heal. How to care for Erythema First, get your skin completely clear from active acne. This way you are preventing any future Erythema. Once you are clear, you can try a Erythema treatment above to reduce the marks you might have. Topical treatments are the first choice for treating Erythema. The treatments most commonly prescribed by dermatologists are Steroids.Erythema is common among people of Caucasian descent. Erythema can also occur in darker skin, albeit less frequently. UV light – the light from the rays of the sun – can make Erythema worse and cause it to remain longer. However, it is not clear whether UV light worsens acne itself, as research studies have reported that UV radiation can both increase6 and decrease7 acne. Regardless, for all skin types, it is important to take appropriate steps to protect your skin from excessive sun in order to avoid worsening of Erythema and allow any Erythema you currently have to heal as fast as possible. How to prevent Erythema Picking at acne lesions is the worst culprit when it comes to creating Erythema. Absolutely do not pick at acne lesions. Properly pop a pimple only when it is ready to be popped, and then leave the lesion alone. Also, while it may seem intuitive to scrub marks away, harsh scrubbing will only prolong their duration and should be avoided. Be sure to wash gently. Next, as mentioned, keeping Erythema skin out of the sun when possible is a huge help in allowing these marks to fade as quickly as possible. Wearing a sunscreen is important as well.1,5,9 The best way to prevent hyperpigmentation is to treat the acne itself, thus preventing future acne lesions and any Erythema that they might leave behind.10 Acne is treated the same regardless of skin color and responds extremely well to proper topical treatment with benzoyl peroxide. When acne is severe, widespread, and deeply scarring, Accutane (isotretinoin) is also an option. ___________________________________________________________ WHAT IS: POST INFLAMMATORY HYPERPIGMENTATION (PIH) - brown spots or red that stay after being pressed on Q: What Is Post Inflammatory Hyperpigmentation (PIH)? A: Post Inflammatory Hyperpigmentation (PIH) is related to brown spots, and permanent red spots. The discolorations are caused by an excess production of melanin. Vitamin C, Glycolic, Hydroquinone (skin bleaching cream) are all great tools for inhibiting melanin which will fade the discoloration. PIH is more common in darker skin types (Fitzpatrick IV-VI), although it is not limited to any skin type. Treatments ( ranked most effective to least): V-beam, or IPL/ photofacials, or Excel V, or 1064nm, or QuadroStar Pro Yellow Laser (vascular laser can help these areas quickly by making the body dissolve the trapped red blood / surface veins), Alpha Hydroxy Acid peels: glycolic * good also for smaller pores, TCA, Mandelic (Acne.org has an excellent one in the store), Skin bleaching creams (aka hydroquinone or Kojic cid w/ Arbutin), Retin-A Cream for cell turnover, Vita-K cream for Blotchy Skin . How to care for hyperpigmentation First, get your skin completely clear from active acne. This way you are preventing any future hyperpigmentation. Once you are clear, you can try a hyperpigmentation treatment from above to reduce the marks you might have. Topical treatments are the first choice for treating hyperpigmentation. The treatments most commonly prescribed by dermatologists are hydroquinone (HQ) and retinoids.11Hyperpigmentation is common among people of African, Asian, and Latino descent, as well as other forms of non-Caucasian skin.1-5 Hyperpigmentation can also occur in Caucasian skin, albeit less frequently. UV light – the light from the rays of the sun – can make hyperpigmentation worse and cause it to remain longer. However, it is not clear whether UV light worsens acne itself, as research studies have reported that UV radiation can both increase6 and decrease7 acne. Regardless, for all skin types, it is important to take appropriate steps to protect your skin from excessive sun in order to avoid worsening of hyperpigmentation and allow any hyperpigmentation you currently have to heal as fast as possible. How to prevent hyperpigmentation Picking at acne lesions is the worst culprit when it comes to creating hyperpigmentation. Absolutely do not pick at acne lesions. Properly pop a pimple only when it is ready to be popped, and then leave the lesion alone. Also, while it may seem intuitive to scrub marks away, harsh scrubbing will only prolong their duration and should be avoided. Be sure to wash gently. Next, as mentioned, keeping hyperpigmented skin out of the sun when possible is a huge help in allowing these marks to fade as quickly as possible. Wearing a sunscreen is important as well.1,5,9 The best way to prevent hyperpigmentation is to treat the acne itself, thus preventing future acne lesions and any hyperpigmentation that they might leave behind.10 Acne is treated the same regardless of skin color and responds extremely well to proper topical treatment with benzoyl peroxide. When acne is severe, widespread, and deeply scarring, Accutane (isotretinoin) is also an option. Hydroquinone: (Bleach Eze®) Hydroquinone is the first choice of treatment for hyperpigmentation.12 It is normally used at a concentration of 4%. In higher concentrations it can cause "spotted halos," which appear as lighter colored ring around marks. Hydroquinone treatment results in a marked improvement or complete clearing of PIH in 63% of the patients.4 The efficacy of hydroquinone may be increased by the addition of a retinoid and a low potency corticosteroid, such as hydrocortisone.13 Side effects of hydroquinone include burning, redness, and itching in 30% of the patients.12 The addition of ascorbic acid (Vitamin C) to a topical hydroquinone treatment may help minimize side effects.2-3 Hyperpigmentation starts to subside after 4 weeks of hydroquinone treatment, but maximum results usually require 8 to 12 weeks of treatment. Be certain to work closely with your physician or dermatologist if you decide to use hydroquinone to ensure proper dosage and reduction of side effects. Read Reviews No Reviews Retinoids Tretinoin (Retin-A®), Adapalene (Differin®), or Tazarotene (Tazorac®). Retinoids are vitamin A analogues that are typically used together with hydroquinone. Retinoids are topical treatments that can help fade marks and treat acne at the same time. According to the Journal of the American Academy of Dermatology, “Of particular significance to skin of color patients is the ability of retinoids to treat both acne and PIH. By increasing epidermal turnover, these agents facilitate melanin dispersion and removal.”8 A study published in The New England Journal of Medicine on people with skin that was darkened by hyperpigmentation showed that daily retinoid treatment resulted in “much lighter” skin in 53% of participants and in “somewhat lighter” skin in an additional 33% of patients.14 If retinoids are used alone and not in combination with hydroquinone, dermatologists often prescribe a topical corticosteroid in order to reduce the irritation and potential worsening of PIH that retinoids can cause when they are used alone. An expert opinion in Skin Therapy Letters sums it up: “The use of retinoids as monotherapy is not recommended as an irritant reaction may cause inflammation that induces paradoxical hyperpigmentation; a similar concern exists over the use of HQ as monotherapy at very high concentrations (i.e., 8-20%).”12 Retinoids typically take 8 to 12 weeks to produce maximum results. The frequency and concentration of retinoid therapy depends on the severity of hyperpigmentation and should be determined by a dermatologist. Tretinoin Read Reviews 3.54/5 - 1396 reviews Adapalene Read Reviews 3.3/5 - 1305 reviews Tazarotene Read Reviews 3.51/5 - 615 reviews Niacinamide, also known as Nicotinamide. Niacinamide is a B vitamin that can be administered topically, and is currently being investigated as a potential therapy for hyperpigmentation. A study published in the journal Cutis in 2015 showed that a topical cream containing 4% niacinamide in combination with the other pigment-lightening and anti-inflammatory compounds arbutin, bisabolol, and retinaldehyde reduced hyperpigmentation due to melasma by 34% over a period of two months. Melasma is a common skin problem where brown marks appear on the face due to pregnancy or sun exposure.15 To date, there exists no published research that has investigated whether niacinamide is also effective in treating PIH, but studies are currently in progress. Read Reviews 4.5/5 - 3 reviews Azelaic acid Azelaic acid is another topical acne prescription that is sometimes used for PIH that works by slowing down the production of melanin. It is a gel that doctors normally prescribe in 20% concentration for PIH, applied twice a day. Azelaic acid is safe and effective for the treatment of both acne and PIH conditions in darker skin types. Common side effects include mild redness, scaling, and burning.16 Due to the mechanism of action of azelaic acid, results are not seen for the first few months of azelaic acid treatment, but results are eventually seen after six months. Read Reviews 3.89/5 - 218 reviews Gentle Chemical Exfoliation Over-the-counter glycolic acid products are available in strengths up to 10% and can provide gentler chemical “peeling,” which is better described as gentle chemical exfoliation. At lower percentages in over-the-counter products, glycolic acid does not cause the skin to visibly peel off in sheets like professionally administered chemical peels do, and instead provides exfoliation of only the surface cells of the skin. This is a slower and safer way to achieve the skin turnover required to reduce hyperpigmentation and can be used on a more frequent basis when compared to chemical peels. Most people find that they can tolerate over-the-counter 10% glycolic acid products every two or three nights, or every night when mixed ½ and ½ with moisturizer. Acne.org AHA+ Read Reviews 4.41/5 - 332 reviews Alpha Hydrox Enhanced Lotion Read Reviews 4.11/5 - 58 reviews ___________________________________________________________ WHAT IS: HYPOPIGMENTATION - white spots (loss of pigment) Q: What Is Hypopigmentation? A: Hypopigmentation is: Vitiligo, pigment loss due to burns, scars, skin discoloration. Treatments: XTRAC Excimer Laser at 308nm or Light Box phototherapy treatments UV-B lamp, Melgain (Decapeptide - Basic Fibroblast Growth Factor), and microneedling at home. Clinics use costly Recell which only has a small percentage of working on scars. A new spot treatment is LATISSE (bimatoprost ophthalmic solution) to darken the hypopigmentation and and cause "some" pigment to slowly return. Checkout the link below for how a member fixed his hypopigmentation. If nothing works there is medical tattooing http://basmahameed.com/paramedical/surgical-scars.php Read More here: http://www.acne.org/messageboard/topic/352685-recell-for-hypopigmentation-burn/?page=5 https://www.youtube.com/watch?v=lW7VAUMclIk ___________________________________________________________ TEXTURE, EXTREME DRYNESS, & COVERING UP SPOTS, Large / Scarred Pores Q: How do I improve my large pores, and orange peel texture? -- Please See the Filler and Subcision Section below for a detailed description for scars. A: At Home - Retin-A - Increases Skin turnover production. - BHA (Glycolic acid peels) like you find from Acne.org store above. - Paula's Choice 10% niamincide booster. Niamincide has been proven to thicken skin and shrink pores. - There is a cream called Benefit Cosmetics "Pore"fessional that blurs these spots, used as a primer under makeup or by itself. - TCA Cross using 50%, you need a very tiny way to either get into the pore and not hit the walls doing a little at a time until they heal. Some have used a broom bristle, shaved down toothpick, and tiny needle to fit inside pores or ice picks. - Filler injected throughout the cheeks not specifically for the scars (broad filling to plump the skin). - Skin Boosters help some also called Meso. This benefit does not last long before a top up is needed. This hydrates and plumps the skin a bit but will not work for all but the most shallow/ small scarring. For a larger area you can spot treat with TCA full peels (spot treatment on your scars 35% and under, start at 15% and move up, do a test spot to see how your skin reacts before going crazy). Always degrease with acetone or rubbing alcohol and a pre-peel jesner / glycolic peel before. You can do a few at a time, so you can cover with makeup. Doctors treatments: -PDT (Photo Dynamic Therapy) using led blue light and medication to shrink pores -Infini shrinks pores -Laser Genesis, Clear and Brilliant, Fraxel 1927 (only, not 1550), Shrinks pores and small acne scars -Sublative (ematrix) is good for surface texture takes many treatments, results are subtle like laser genesis -Microneedle .05mm followed by botox to the pores superficially shrinks them. - The Most costly is a deep sedated Phenol peel, this should be your last solution if all else fails, ... the doctor must go deep enough to get under the scars. Q: Can Guys Do Anything to Cover Their spots and Help with Self Esteem?A: Guys you can be as manly as you want and wear makeup (the ladies have had this tool for some time). Hear me out. Movie stars, news anchors, models, musicians, Youtubers, and even politicians wear makeup. Buy a concealer for just your acne scars and spots (spot treat them). You want it to match exactly your skin color and not be shiny ("matte"). My favorite is sold at Sephora (they color match you) Makeup Forever Camouflage Concealer, this looks extremely natural on the spots. Dermablend is sold at Macy's and Nordstrom. This is used for medical scars and to cover tattoos (they match your color) and it's very thickly pigmented. Ben Nye Cover All Wheel and Bill Nye Concealer Wheel sold on Amazon and Ebay (it has various shades), this is used in the theater. Q: What can I do for extreme dryness, bumpy or bad texture, small wrinkles, or marks? -- Please See the Filler and Subcision Section below for a detailed description for scars. A: Moisture with a pure 100% Hyaluronic Acid Serum, this avoids skin irritation or ... Skin boosters or Meso Treatments (very popular in Europe and Asia) like Restylane Vital, Juvederm Hydrate or other HA products are not crosslinked like what is used in filler and much more superficial (just under the epidermis). Filler provides lift; but boosters are different making a bunch of small injections to provide intense hydration, minor skin correction, and small textural improvements.http://www.acne.org/messageboard/topic/357406-skin-boosters-restylane-vital-hyaluronic-acid/ ___________________________________________________________ 6. PUNCH: GRAFTING, ELEVATION, & EXCISION Q: What is Punch Excision & Dermal Grafting? A: Punch Excision is a procedure whereby a doctor will use a tool to punch out the scar and then sew the remaining skin together. Dermal grafting is a procedure whereby a doctor removes skin from a different part of your body (usually from behind the ear) and places it into the scar. Ice picks are often treated this way. Dermal Grafting has lost favor with dermatologists because the fat is surgical with variable results and we have fillers now. Acne Scar suffers heal poorly, so there is a high outcome of poor results using this method. There is exceptions see the below and pick someone highly experienced. ** If you have very few smaller surface scars or a few scared pores this may be a good option, ... one must resurface after you have the excisions (laser or peels for the texture). Please note this makes a thin line (depending on the scar size instead of a scar so it does not work well for large scars or deep defects. It can work well on a few large pores or body scars if you have a few of them (because filler does not work here), one must do laser and steroid drip in this case (body only) as well. Punch Excision: The scar is removed with a punch biopsy tool and the site is sutured. Punch Elevation: The punched-out scar is elevated to the level of the surrounding skin and secondarily heals like a graft. Punch Grafting: The scar is first excised and discarded as with circular punch excision; in its place, a full-thickness skin graft is positioned, taken from an inconspicuous site, such as the postauricular scalp or behind ear. The grafts were placed slightly elevated above surrounding skin, with ablation or resurfacing performed later to correct any residual surface abnormalities. Important Notes: There is a good chance of a small scar after punch excision so you are trading one type of scar for another (indentation vs a small light linear scar). ___________________________________________________________ 7. HYPERTROPIC / KELOID RAISED SCARS Q: My scars are raised (hypertropic), not indented (atrophic). How can it be treated? A: This is called hypertropic (aka keloid) scarring and can be treated with silicone sheets (OTC - Walmart, Walgreen's, CVS, Boots), liquid silicone, or cortisone injections (provided by dermatologist). Color can be treated with the V-Beam / QuadroStar Pro Yellow Laserlaser. The treatment options include laser ablation, electrodessication, or surgical excision. Other options for the treatment of elevated scars include injection of bleomycin, cryotherapy, topical application of imiquimod, flurandrenolide, tacrolimus, and silicon gel. Intralesional injection of botulinum toxin has been shown to reduce scar formation. Pressure, flavonoids, TGF, mannose-phosphate, and IFN25 were also listed as helpful. Keloid scars, different from hypertropic, are scars with tendencies to invade the peripheral tissue, expanding in size, and growing persistently. Keloid scars should not be treated by way of surface destruction. ___________________________________________________________ 8. SUBCISION Q: What is subcision? Will it improve my scars? Should I use filler? A: Subcision is a method whereby a doctor uses a "Nokor" needle to break up the scar tissue underneath the surface of the skin. It is said to be best for rolling scars that are bound down. If your bound-down scar tissue looks smoother when the skin on the sides of the scar is pulled tighter apart you're a good candidate. Some people's scarring has improved by this method, others have had minimal or no improvement, and others have had their scarring deepen (though this seems to be more rare). Please see your dermatologist for further information on this procedure. We recommend doing filler after subcision for consistent and instant outcomes (only if you have a pencil eraser or more in scar depth - otherwise do suction and saline)... You do not need to get filler at the time of subcision, you can also get it done before it re tethers to your skin. I don't mean the swelling goes down from subcision (This is not tethered). When it is tethered again, you cannot stretch it and make it go away (the scar). Subcision simply means to make a pocket. Various people heal at different intervals. I have myself done tons of subcision, and then gotten filler a week or two after when the filler goes down with no dough nutting ( I also work in aesthetics) and have observed this with others. You know best how your body heals. Subicision is the act of making a pocket, and filler or prp can be used as a spacer. Prp does not last as long as filler but can make you heal better as it stimulates the body to heal. You can do both if you wish, or just the filler. They can fill you with filler it donuts and they also subcise the donuts. What maters most is they are a expert injector who has filled scars before and you state clearly you do not want a doughnut. HA can be dissolved also. They must be exceptionally good when doing a NOKOR subcsion which creates a bunch of swelling and the wound is full of blood. If they put to much under swelling it can create a bump (which can be fixed). Some injectors need the skin to not have swelling when injecting. You will know where your scars are located post subcision. They will more than likely be bruised if a nokor is done. You will have a deficiency in your skin volume (remember the swelling is down) and need filler in that spot. Find someone who is meticulous. Eventually after a few times of nokor subcision, they can do filler at your expert injectors office nearby with just the needle (not as effective but a ongoing solution if one is needed as we age or heal differently). A master injector is meticulous, knows on your face where you need volume, know anatomy (nurses know this), has a plan how to fill you, ... you trust. Know the products and works with your budget. They have experience injecting others with acne scars and are informational. This does not mean they are acne scar specialist but they know facial anatomy and can fix deficiency effectively. They feel the skin and not just inject. Most doctors. They charge a initial office fee and treatment cost. Then the cost goes down as you pay for a package or do ongoing treatments. Filler of course makes the cost of the subcision go up from just prp subcision. Sub with filler costs more than sub with prp. Some doctors give cheaper pricing after the initial consultation. PRP does not last as long as cross linked filler which can last 5 months up to 1.5 years depending on your body and material. You can again do both if you wish or just subcision with the filler elsewhere. There are longer lasting fillers like Bellafill/ Artefill but I would never do them until doing HA fillers (naturally found in the body & can be dissolved)a few times first. Fat is another option, but it's very expensive and takes 3 sedated operations to maintain the volume (does not work well to fill small spots unlike HA filler). PRP is a spacer, saline is a spacer (sterile water), botox is a spacer, etc. Blood is a spacer with cupping. The question is the only one who lasts the longest with volume is filler because it's cross linked. You can just do PRP and see how you do (everyone is different). UPDATE: Filler and Subcision is now the standard for acne scar revision for rolling and box scar scars that are sunken (fat deficient). Fillers typically used are Perlane also known as LYFT, Ultra, Belotero, and permanent solutions you should only try if satisfied from filler are Aretefill / Bellafill, Fat. Note, if your doctor does not subcise the scar to make pockets for the filler and release the scarring, it will doughnut around the bound-down area and do nothing. Fat Grafting or Fat Transfer is used for those with large acne scars where it would take several syringes to fill one scar. Drs perform Subcision in several ways, they may not use a Nokor needle (instead using a normal needle, or a blunt cannula, or possibly a different technique. Do what you have availble nearby your location (many don't know about suction or saline injections - see below). Q: What is Vacuuming / Cupping / Suctioning After Subcision (Prevents Re-Tethering)? This is the cheapest option if you cannot afford Fillers, ask the doctor to inject after subcision . The role of suctioning is to prevent re-tethering, induce repeated hemorrhage, delay healing. IF your scars are less than a pencil eraser in depth (filler could create bumps) then you would do Saline injections (basically purified water - much cheaper) at the time of your subcision, followed by 3-4 weeks of Chinese Cupping (Amazon/eBay) when the injections go down 3 days to a week after. You should begin suctioning 24 - to 48 hrs after your procedure if you don't have saline (this depends on your healing capability, some are still to tender to do it at this time period, and it's ok to wait). Depending on how you heal you will want the wounds to be closed enough that you don't break them open when Suctioning. You rest the suction for several seconds over the scars to create blood flow to the area. Hematoma under the skin. this is the goal a under skin Hematoma to "fill" the tissues with your own skin. Rings from cupping go away and probably mean the suction was to much for that spot. " You will continue this 8 times a day for 4 seconds, you can also do it 3 times a day (3 sets a time of 15 seconds, or however long you can stand it). Overlap to cover the area. " If you get any raised bumps, stop everything immediately, massage the area, and use ice, or a antihistamine like Benadryl, no harsh soaps or scrubs, you can continue when the skin is not raised again. Do less suction (with less force) to avoid over stimulating the area in this case only. If your susceptible to Keloids (raised scars- very rare) then have the Dr do dilute steroid injections.Do not take blood thinners, pain meds, and avoid other drugs that could induce this, check with a Dr pre-subcision. This will enhance the results of your subcision. You will get possible bruising after subcision because of the hemorrhage creating filler under the scar and in the pocket wear make-up over this. If the area becomes hard and permanently as a raised bump after treatment, your body is susceptible to Keloid scars (extremely rare). > Success PCT14 Suction and Subcision Protocol http://www.acne.org/messageboard/topic/361755-my-subcision-saline-suction-treatment/ source: https://books.google.com/books?id=47HGBAAAQBAJ&pg=PA394 https://youtu.be/ansKjWAw_G0 https://youtu.be/SrtA44lPO_c ___________________________________________________________ 9. FILLER FOR SCARS In Depth Thread on Subject: http://www.acne.org/messageboard/topic/360849-discussion-acne-scar-fillers-injections-brands-augmentation-new-techniques-fat-atrophy/ Q: What are injectable fillers and how can they reduce the appearance of scarring? A: There are many types of injectables used for augmentation. It has been shown that once they are injected into the skin, they can raise the surface of the scar. Unfortunately, most of the injectables widely available are not considered permanent. In addition, some are not available in all countries. Always try non-permanent fillers before you go the permanent route. Here is a list of some of them to get you started in your research: Juvederm Ultra or Perlane / LYFT HA Filler: <12 Month (If you're lucky) Filler / Cheaper / Lots of Lift: http://restylanelyft.com/ Juvederm Volluma - Lasts 1.5 years (less for some, more for others), for very fat deficient cheeks and temples Juvederm Volbella: Softer filler, can be used near the surface in the upper Dermis with subcision, great for under eye area. Beletero: HA filler, softer dermal filler, shorter lasting period great for thinned-skinned areas, no water hydration from surrounding tissue http://www.belotero.com/ Restalyne: Shorter lasting period: HA, cheapest Emervel Teosyal Various HA fillers from your country Semi-Permanent / Permanent Sculptra (Semi- Permanent) this stimulates collagen production in those with major fat loss. First used on those with HIV who had fat loss of the face. It works great in combination with rf needling which stimulates it. It is injected throughout the area of concern one a month for 3 months. IT has a slow effects which takes 6 months to see in full, and lasts 2-5 years before a top up is needed. Fat (harvested from your own body - only some survives, may be lumpy and need a few surgeries, some is longer lasting). This is used for scars that are large (over 10mm) and would take several syringes of filler costing more than the fat grafting surgery itself which is a few thousand dollars - See your doctor for further info. Not Recommended but some users have success with these (our skin ages and changes, fat is lost, so long-term use outcomes are unknown - yet they are permanent). We heal poorly as acne scar sufferers or we would not have scars so it's a gamble... ArteFill / Bellafill, FDA approved - Microspere beads that are permanent, can migrate or cause grandulomas or fibrosis around the material. This is the number-one recommended permanent filler for acne scars right now. Silicone Microinjections, Not FDA approved - off label usage (Must be an experienced doctor who has done thousands of these), can migrate or cause grandulomas or fibrosis around the material. Here is a thread on various types of fillers: http://www.acne.org/messageboard/topic/360849-discussion-acne-scar-fillers-injections-brands-augmentation-new-techniques-fat-atrophy/ ___________________________________________________________ 10. LASER In Depth Thread on Subject: http://www.acne.org/messageboard/topic/357373-discussion-all-things-laser-new-laser-technologies-treatments-updated-laser-link-o-rama/ Q: When is laser best used? A: The last step when there are no others options, you have exhausted and done all the pre-resurfacing work to improve your scars (making them monomorphic or on the same level as possible), you know the risks and side effects (discussed below), and you have someone who specializes in the laser's use specifically for acne scars. There are many bad Drs who own lasers with pre-set settings. Infini RF has gained more acceptance for acne scars (used in fractional manner than laser for a earlier collagen producing treatment). Latter on fully ablative erbium laser resurfacing - no grids to get under the scars - mainly for texture after you have done all other treatments to improve volume issues and raise the scars to the surface. A deep peel (see the peel section below for a how to and more info) can be performed that does the same thing with less side effects (than laser and easier to find Drs). These are performed by a experienced Plastic Surgeon or Dermatologist. Peels are for slight surface texture, not pits, holes or divots. One can do a test spot or only treat the scarred areas to make sure the good skin is not effected. One thing to note with full laser is that it is important to ‘chase the scar’. For permanent pore reduction, laser needs to go below the widest opening of pore otherwise it can open up the scar (looks larger). Q: My doctor says to get laser, will this fix my scarring quickly {NO IT WONT!}? A: Run, the doctor wants you to pay for his or her $110,000 new toy. They tell everyone it can slice and dice and do miracles light-based treatments of acne scars, patients are often encouraged to receive a greater number of treatments to get more satisfactory results but are seldom told that the clinical results are good for only 2 years (see the harmful side effects below an Dermabrasion which is permanent). If you have uniform scarring that is relatively shallow (Ie. Orangepeel or Monomophic scarring), you can do Fully Ablative Erbium resurfacing (not fractional at the end of other treatments not the beginning), but I recommend TCA and Phenol Deep peels over this as they are more controllable, easier to find, and have less side effects. A deep phenol peel by a doctor is much more effective than a laser procedure if the doctor gets under your scarring once other work has been done to raise them as much as possible. Laser does not work on pits and is made for surface texture (filler and subcision does). Start with non-energy devices: your diet, hygiene, topicals such as Retin A, Accutane, Food allergy or allergy test from beauty products, acid peels, tca cross for those ice picks, microneedle, subcision to lift the tethered scars w/ filler to keep things plump. As acne scar sufferers we heal poorly, or we would not have the scars to begin with. Next step is move onto the big guys - energy devices that have high side effects (fat loss, healing worse) and only possible rewards. V-Beam / QuadroStar Pro Yellow Laser is safe for discoloration and most lasers are for surface texture only (acid peel also do this), it will not make fat appear or magical new skin. Laser smooths and softens texture and makes scars wider (the rough sharp edges). Q: What are the side effects of laser? A: I go into this in-depth in the below post... Burns, additional scars, hypopigmentation, hyperpigmentation, thinning of the skin, long-term redness, scar worsening, bacterial infections, breakouts, fat loss, blistering, scabbing, crusting, months of down time, demarcation lines, bruising, sun sensitivity, pain, swelling, itching, milia, lumps, bumps, large pores / orange peel, and acne. The most common treatment outcome I have heard by hundreds is they wished they would not have started with laser and tried other things first. Fat loss is a real possibility with energy devices. Many doctors use the laser on preset settings and have no idea how to use it for those with acne scarring, thus making them butchers. IF you do choose to do laser goto someone with lots of experience treating your scarring type (specialist - few the in world, not a common general derm). Aftercare is sometimes more important than the procedure. Many offices do not take care of their patients after leaving them with poor results. Walk out or never call again if a Dr says laser will solve all your problems, you are helping to pay for their very expensive and cool looking machine. http://www.acne.org/messageboard/topic/357373-discussion-all-things-laser-new-laser-technologies-treatments-updated-laser-link-o-rama/ Q: I did all the non - energy device recommendations first with no changes in my scars. What lasers should I take a look at now (remember it is a gamble of outcomes...as acne scarred individuals, we do not heal properly)? https://www.youtube.com/watch?v=sQUM3Xxzm3Q Q: What is the difference between ablative and non-ablative lasers? Definition of ablate from dictionary.com: "To remove by erosion, melting, evaporation, or vaporization." Ablative lasers are much more invasive than non-ablative lasers. Ablative lasers are not recommended for use on darker skin colors. Of course, with higher energy and removal of skin (in fractional cores) better outcomes are often had than non-ablative means. Also higher side effects, and in fact may make it worse. Seek an experienced professional of acne scarring. Always try non energy device solutions first. Laser is a gamble. Examples of ablative lasers: - CO2 - Erbium: Yag Non-ablative lasers do not remove layers of skin, but instead penetrate through the skin in an attempt to stimulate collagen growth from underneath the surface of the skin. They also are not very effective. Q: Will ablative lasers (CO2 or Erbium) reduce the appearance of my scarring? A: It is possible that it will reduce the appearance of your scarring but it can come with a hefty price tag, a significant amount of downtime and a risk of new scarring (see below). Q: What are the side effects of Ablative, Non-Ablative Laser Procedures / IPL / RF? A: Risks from ablative procedures include: Swelling, scabbing, and oozing Bleeding, flaking, and redness Significant irritation that requires a longer time to heal Long-term skin discoloration and more scarring Fat Loss, Filler Loss Poor Healing by Acne Scar Sufferers (who already heal poorly) Does nothing, a waste of money with long down time and healing For ablative resurfacing with a laser, the quality of the postoperative techniques is as important as the skill of the physician during the procedure. After ablative laser treatment, the skin oozes, crusts, and needs to be cleaned and dressed for about two weeks before you look even vaguely normal. Because the top layer of skin has been stripped away, the raw, exposed skin needs to be cleaned and treated very carefully. Patients need to make sure they follow post-op care instructions precisely, because inconsistency or incomplete care can cause infection, delay healing, and increase irritation. Non-ablative resurfacing has none of the side effects associated with ablative resurfacing. However, non-ablative resurfacing doesn't produce the same dramatic or impressive results. The advantage for non-ablative resurfacing is its minimal downtime and they work on ethnic skin without hyperpigmentation. Women can reapply makeup before leaving the doctor's office and return to work the same day. Non-ablative lasers can cause: Swelling and potential bruising (this fade within days) Enhanced redness or a sunburn-like reaction (this is temporary) Temporary darkening of treated spots (these lighten as they heal) No improvement, a waste of money Q: What should I get instead of laser if my scars are bad? A: RF Microneedling, subcision, and several medium TCA peels. This is done over 2 years. If you have uniform scarring that is relatively shallow (Ie. Orangepeel or Monomophic scarring), you can do Fully Ablative Erbium resurfacing (not fractional at the end of other treatments not the beginning), but I recommend TCA and Phenol Deep peels over this as they are more controllable, easier to find, and have less side effects. A deep phenol peel by a doctor is much more effective than a laser procedure if the doctor gets under your scarring once other work has been done to raise them as much as possible. Laser does not work on pits and is made for surface texture (filler and subcision does). ___________________________________________________________ 11. MICRONEEDLING, RF MICRONEEDLING, & Derminator In Depth Thread on Subject: http://www.acne.org/messageboard/topic/359068-the-derminator-thread/ Q: What are other names for Microneedling? A: Dermaroller, Dermastamp, Microneedle, Microneedling, Needling, Single Needling, RF needling (See below question). Q: What is Microneedling? A: This is a technique whereby an aesthetician, doctor, or tattoo artist uses either a hand tool or a tattoo machine to needle the skin without using pigment. This is said to "break up" the scar tissue thereby smoothing the appearance of the skin. This is also known as a cheap man's laser, the skin heals the tiny cores that are made. NOTE: It is possible to needle yourself, but there are risks associated with this. Also, results are generally not as pleasing. It is best to see a specialist whenever possible. For more information, read this thread: http://www.acne.org/messageboard/topic/359068-the-derminator-thread/ To buy an automated machine to do this at home: http://shop.owndoc.com/product-list.php?Derminator-pg1-cid61.html Q: What is the "Dermaroller"? Can it improve scarring? A: The Dermaroller is an instrument that has tiny needles embedded in it that is rolled across the surface of the skin. It is mainly used for better absorption of topical treatments and does not appear to actually break up scar tissue. Q: What is BETTER than microneedling? A: RF Microneedling is much more effective and a better treatment than at home microneedling, and it is better than laser treatments. The reason is it's much more controllable. Energy is delivered into the dermis for regeneration, using "insulated" needles which protect the top epidermis even in darker skin types unlike laser which is much more destructive. Make sure the doctor pinches your skin to feel for thickness and does not put the energy to high especially for your first treatment to see how you do. Collagen production and remodeling happens in 6 months after your treatment, you typically need 3 treatments spaced around your subcisions (see above section). The minimum amount needed between treatments is 3 months. Most doctors will push sooner treatments but this is not conductive to the bodies slow healing capabilities. Better to observe how you do. Also unlike laser the spread is much less and more controllable meaning less damage will occur if the nurse, med spa, doctor operator has done thousands of treatments. This is important to find. Some brands are Infini, Vivance, Intracel, Intensif, Secret,etc ... As long as the needles are insulated. This is the best effective treatment as a alternative to microneedling (more effective with energy) and safer than laser. Some people still dermastamp (manual form of needling better than microneedling as there are no microtears to the skin), Derminator (automatic - does not hurt, adjustable needle length) are at home options to upkeep the skin but are very slow in action - the next step of effectiveness which is more $$$$ is RF needling. Retin A / Tretinorin / Differin Cream sold OTC at Target should be used at night when not healing from microneedling. Peels work well in conjunction with needling (they must be done at separate times allowing the body the proper months of healing time). ___________________________________________________________ 12. TCA CROSS FOR ICEPICK SCARS & ACID PEELS ** MUST READ (Link) -Everything About Acid Peels! How Do Do Them, What They Do, TCA Cross, Spot TCA Peels, Salicylic, Glycolic, Etc...): http://www.acne.org/messageboard/topic/366754-discussion-all-things-acid-peels-for-scars-tca-full-face-peel-tca-cross-phenol-glycolic-salicylic-methods-and-techniques/ Q: What is the difference between TCA CROSS and a TCA peel? TCA CROSS is a method whereby a doctor or skilled practitioner uses a high percentage of TCA Acid (100%) and spot treats each scar. This procedure is especially beneficial for ice pick scarring. TCA CROSS is something that should be done by a skilled practitioner because the risk of damage to your skin can be great. TCA peels (Spot Peeling) are of a much lower percentage (15-35%) than TCA CROSS. TCA peels are done by dermatologists and aestheticians and affect hyperpigmentation and more shallow scarring. Buy TCA, Excellent Customer Service (Not Chinese Made Industrial Chemicals!): http://www.makeupartistschoice.com/ What is TCA Cross for Icepicks, Please Read The Below Link for All Things Acid Peels: https://www.youtube.com/watch?v=7qRj0pLXPIQ ___________________________________________________________ 13. LIST OF ACNE SCAR TREATMENT DOCTORS ** Please note we are not responsible for your treatment and care. Please be informed before you contact the physician for acne scar improvement. Further doctors can be found that are board certified on the Real Self website. Some Great Places for Reviews are http://www.yelp.com and http://www.realself.com Look For in a Dr See a specialist, Derm or Plastics, (sometimes going to a Med Spa can be ok for peels or certain treatments, not for laser/surgery/ sub). Have a look at their before and after pictures. If the specialist doesn't use angle lighting, beware. If he or she does not touch your skin to feel for fibrosis, they don't know what they are doing. If they don't ask you to animate to see if your scars are tethered they have no clue. If they don't stretch your skin to see the amount of atrophy, beware Revision starts with a through examination - touch is critical, if they miss fibrosis, they have no clue. Like every sub specialist, who ever you see should take heaps of photos People on the Scar Forum have nothing to gain by speaking about their experience, this is more reliable than review sites. Does the doctor listen to you, are the over selling something, do they answer all your many questions "why." Do they care - what is the bedside manner, ask to see their aftercare instructions for proposed procedures (this says a lot). Recommended Dr's Dr. Davin Lim *** Highly Recommended, Famous Specialty Acne Scars Dr, YouTube Channel : Lasers and Lifts Brisbane, Australia Specialty: **Lasers for Acne Scars, Subcision, TCA Cross, Filler, PRP, Vbeam / Picosure, multiple treatments at the same time. http://www.lasersandlifts.com.au Dr. Adrian Lim Sydney, Australia Dr. Davin Lim's Mentor While in Med School and Famous Derm Specialty: Fillers, Microneedle, Subcision, TCA Cross, Vbeam, Lasers http://urepublic.com.au/our-expertise/ Dr. Naomi Sydney, Australia Specialty: All Things Filler Core Interest (Expert Injector), Skin Boosters, Lasers http://drnaomi.com.au/ Professor and Department Head Tony Chu Chiswick, London Specialty: Dermatologist Expert, Subcision, TCA Cross, Microneedle http://www.westlondondermatology.co.uk Dr. Emil Henningsen Denmark / Nyborg, Sweden Specialty: Subcision, TCA Cross, Microneedle, Lasers http://www.emilhenningsen.dk/behandling_ar/ Prof C.L. Goh Singapore, Malaysia Specialty: Lasers for Asian Skin http://www.nsc.com.sg/Patient-Guide/Our-Doctors/Pages/Dermatologists.aspx Renewme Various, Korea Specialty: Acne Scars, Nokor Subcision, Lasers, Plastic Surgery, Micro Fat Grafting http://rnmeskin.net/ Dr. Rullan *** Highly Recommended as a Top Scar Dr For the West Coast by Many Forum Members Chula Vista, California Specialty: Nokor Subcision, Fillers, Sedated Peels for ALL SKIN TYPES - Even Dark Skin, TCA Cross, Vbeam, Lasers http://www.drrullan.com/ Dr. Kim Hollywood, California Dream Clinic - Plastic Surgeon in LA Also Has Clinic in Korea Specialty: Fat Grafting, Korean Face Lifts, Subcision http://www.drkennethkim.com/meet-dr-kim/dream-medical-group/ Professor and Department Head UC Irvine Dr. Chris Zachary Irvine, California Dr. Davin Lim's Mentor While in Med School Specialty: All Things Dermatology, TCA Cross, Subcision http://www.drzachary.net/ Dr. Sandra Lee AKA Dr. Pimple Popper YouTube Channel Upland, California Specialty: General Derm, Popping Pimples and Cysts, Acne Scars, TCA Cross, Microneedle, Subcision http://www.skinps.com/ Dr. Suzanne Kilmer Sacramento, California Specialty: Lecturer and Trainer on anything about Lasers http://www.skinlasers.com/ Dr. Evan Ransom San Francisco, California Specialty: Facial Plastic Surgeon, Infini RF, Lasers, Aesthetics, Dermabrasion http://www.sanfranciscofacialplasticsurgery.com Dr. Seven Swengel Los Gatos, California Specialty: TCA Cross, Infini RF, Subcision, Fillers, General Derm http://www.RefinedMD.com Dr. E Victor Ross San Diego, California http://www.scripps.org Dr. Joe Niamtu YouTube Channel: Joe Niamtu Midlothian, Virginia Specialty: plastic surgeon and trainer laser expert, fillers, subcision, chemical peels, excision, dermabrasion, and scar revision Now does Taylor Liberator Subcision from DR. Taylor below in Salt Lake, Full Face Agressive Sub done by a plastic surgeon. http://www.lovethatface.com/ https://www.youtube.com/watch?v=sqoy5D6ilss Dr. Mark Taylor Salt Lake City, Utah Specialty: Inventor of Full Face Subcision Taylor Liberator Tool (See Video Below) https://www.youtube.com/watch?v=sqoy5D6ilss Dr. Nelson Lee Novick *** Highly Recommended Acne Scar NYC Favorite Dr. NYC, New York & Israel - Prices 1/2 Off, perfect for Europeans Specialty: Aggressive Subcision, Filler Master Injector, Peels, TCA Cross, General Derm http://www.doctornovick.com Dr. Yang NYC, New York Specialty: TCA Cross, Infini RF, Subcision, Fillers, General Derm http://www.GeorgeYangMD.com Dr. Ron Shelton NYC, New York Specialty: TCA Cross, Infini RF, Subcision, Fillers, General Derm http://www.thenyac.com Dr. Roy Gerononus in NYC, New York Specialty: TCA Cross, Subcision, Microneedle, Fillers, General Derm http://www.laserskinsurgery.com/Dermatologists/Roy-G-Geronemus-MD Dr. Berry Dibernardo Montclair, New Jersey Specialty: TCA Cross, Subcision, Microneedle, Fillers, General Derm http://www.newjerseyplasticsurgery.com Dr. Weiner Youtube Channel: Dr Weiner Panama City, Florida Specialty: Expert Injector/ Plastic Surgeon /Famous trainer, pioneer Infini RF spokesman, Fillers, Laser, Aesthetics http://www.theclinique.net Dr. Jill Waibel Laser Burn and Traumatic Scar Specialist Miami, Florida Specialty: Jill specializes in major burn scars with lasers and steroids laser drip, grafting, surgeries, General Derm http://www.miamidermlaser.com/jill-waibel/ Dr. Richard Sadove *** Highly Recommended Acne Scar Fat Grafting Facial Plastic Surgeon Gainesville, FL Specialty: Fat Grafting For Acne Scars, Subcision, Excision http://acnescarflorida.com/about-dr-sadove/ o2Clinic Antwerp, Belgium Specialty: Micro Fat Grafting / Injections, Lasers, Plastic Surgery http://www.o2clinic.be/en/ Dr. Philip Bekhor Box Hill, Melbourne, Australia Specialty: Lasers, TCA Cross, Subcision, Microneedle, Fillers, General Derm http://www.drphilipbekhor.com.au/ Richard Ort Lone Tree, Colorado Specialty: Nokor Subcision http://www.myskincaredoctor.com/ Dr. John Burns Dallas, Texas Specialty: Aggressive Nokor Subcision http://drjohnburns.com/ Dr. Sam Lam Plano, Texas Specialty: Fat Grafting, Plastic Surgery, TCA Cross, Subcision, Microneedle, Fillers, General Derm http://www.lamfacialplastics.com/ Dr. Michael Gold Nashville, Tennessee Specialty: TCA Cross, Subcision, Microneedle, Fillers, Lasers, General Derm http://www.goldskincare.com Dr. Tina B. West Chevy Chase, Maryland Specialty: TCA Cross, Subcision, Microneedle, Fillers, Lasers, General Derm http://www.westskinlaser.com Dr. Noelle S. Sherber Washington, District of Columbia Specialty: TCA Cross, Subcision, Microneedle, Fillers, Lasers, General Derm http://sherberandrad.com/ Dr. Moon Choi Vancouver, Canada Specialty: Subcision, TCA Cross, infini Dr. Jeffrey Orringer Ann Arbor, Michigan Specialty: Subcision, TCA Cross Dr. Payman Kosari Charlotte, North Carolina Specialty: Subcision, infini Dr. Murad Alam Chicago, Illinois Specialty: Subcision Dr. Steven Mandrea Chicago, Illinois Specialty: Subcision with sculptra ___________________________________________________________ 14. ANATOMY (FAT / MUSCLE) PICTURES
  17. Hi everyone, I am a 21 year old Asian-Indian origin female struggling from moderate-severe acne scars. I first battled moderate acne for years before going on a low dosage of accutane (10 mg) for four months after which my breakouts stopped. I haven't had a new pimple in months now (yeeeeaas, thankfully) but I have horrid horrid acne scars all over my cheeks. These are almost impossible to conceal with makeup so I had decided to visit a dermatologist who could help me get rid of these using different techniques. I went through 4 rounds of subcision+ co2 laser over the span of 2 years and I recently (last month) had a fraxel treatment done at a new dermatologist's place. Needless to say after spending all this money, time and effort I have had barely 10-15% improvement in the scars. This is incredibly upsetting and I was wondering if people here who have had scars and have successfully minimised them to a large extent could provide some insight here. I have attached two pictures here. This was the harshest light I could find and my scars do look pretty pretty bad here. appreciate the input!
  18. Scarring

    Forums Hyperpigmentation - red/dark marks 1 reply

    I'm 22 and have acne scarring. If you would please help me and suggest what treatments I would need. I also have a scar on both my mouth lines. Is there anyway I can make it normal again?
  19. This is going to be a long post. A little background info, I have had acne since I was 10 years old, and I am turning 20 this year, finally with clear skin. I call the past 10 years the "decade of hell". I think we all encounter some kind of moment where we go, damn, I've had enough of this crap. And thus began my last ditch efforts to salvage my skin, which I am happy to say has finally become beautiful. Having lurked on this forum for years, I feel like its time for me to give back. 1. Diagnosis First I narrowed down and diagnosed what conditions I had. Cystic acne on forehead, painful boils on my butt and pityrosporum folliculitis on my back (recurrent, would flare up from time to time). Now this was tricky, because I had both bacterial AND fungal infection. Am I supposed to care for my face and butt and aggravate the situation on my back, or the other way round? Damn this body of mine. 2. Prevention Having determined all the skin conditions to be treated, the most important thing now was to PREVENT FURTHER SCARRING AND PIGMENTATION. I cannot stress how important this is, because deep scarring is so much more difficult to cure, and being fair skinned, my hyperpigmentation takes a hell lot of time to clear. I'm talking about dark spots that remain even after a year. For my bacterial infections (acne on butt and face), I immediately went on doxycyline. Cheap, effective, doesn't cure the root problem but it did the job for now. The doctor would only prescribe me 3 months of doxycyline, 2x100mg pills per day. What I did was take a 100mg pill a day with breakfast, which lasted me for 6 months and worked fine. For my fungal infection on my back, I began orally taking oil of oregano by Swanson. The dosage is 150mg per softgel, and you are recommended to take 1-4 pills per day. Now this varies by manufacturing brand, so follow guidelines accordingly. I started off with taking 2 a day in the afternoon and evening (not clashing with my doxycyline). In addition, I would also apply topical oil of oregano to my back (either buy the liquid in bottle kind or cut open a softgel). Be sure to do it sparingly, and dilute it with an oil/cream of your preference if its not diluted beforehand because the strong stuff can burn your skin. Last of all, I used Head and shoulders shampoo to wash my back as it had 1% zinc pyrithione. All this is gonna make your back dry as hell, but do not moisturize because the fungus thrives in wet environments. Along with all these, I was applying 5% benzoyl peroxide on my forehead and 2.5% on the rest of my face as a precaution. I use the brand Benzac, but probably any kind of BP will do. All of these worked to curb the acne from ever rising to the surface for the time being. 3. Dealing with scars/pigmentation Now the acne was gone, but there were A LOT of scars and pigmentation, which looked especially terrible because I'm a fair skinned Asian. This is the part where it all gets expensive. For my face, I caved and did a full ablative Fraxel on it, which removes pigmentation, scars, and returns pores to original size. This is very costly in most countries, but I was in Seoul, South Korea for a month, and I managed to find a clinic that offered Fraxel for 280 usd. Fraxel was significantly painful and I had red peeling monster skin for about 7 days, but the end result was flawless. For my back, I did a 35% TCA peel for about 130 usd. Once again, skin blisters, angry red skin, the whole works. This was truly painful as hell after the numbing cream they used wore off. However, I had clear skin after it all peeled off and the one week mark. For my butt, I had been using arbutin and hydroquinone creams, but the results were too slow for my liking. I did a ng yag laser for brown spots at about 130 usd. I believe that alexandrite lasers could do the job as well. One session was all it took for the brown spots to dry up and flake off, but if I had not been using creams beforehand I might have required more sessions. 4. To cure the root cause Now this was the hardest thing of all, because I suspect my acne has hormonal causes (it got drastically better when I was on hormonal birth control for 6 months). However, I am not willing to be on hormonal bc full time (I use a copper iud), so that made things difficult. In addition, as a female who is open to having kids in the future, what the hell am I going to do when I get off bc? Suffer the same skin conditions once more? So I did it. I WENT ON ACCUTANE. Now there are smart ways to do this, and stupid ways. One stupid way is to go on low dosage accutane (about 10mg-40mg) and then complain that the results don't last. I am horrified at the number of derms and docs that actually allow this. Of course it doesn't work, accutane is not meant to be used this way. One good way to calculate dosage is by body weight: 1.0mg x ___ kg = your dosage I weigh about 45 kg, and this was my dosage for 6 months Month 1: 40 mg (To adjust to the dryness etc.) Month 2, 3, 4: 60 mg Month 5: 80 mg Month 6: 120 mg to knock the acne senseless forever Depending on whether your weigh more or less, your dosage will vary. Monitor yourself, don't push the limits of your body and take care of yourself. Note the side effects you suffer from accutane and DO NOT STOP taking it halfway just because your skin has cleared and you think you're set. You are not using accutane as an antibiotic to keep acne at bay, you want to knock out this pesky acne once and for all. Be smart about this, take a fatty meal with accutane so your body can absorb it better. For dry skin, any rich moisturizer will do, for painful cracked peeling lips, go to the pharmacy/get a prescription for certain brands of lip ointments that not only moisturize but promote healing of lips. (there are several, they cost about 10 bucks a tub, ask your doc/derm about it) Most people do not experience the feelings of depression that may come as a side effect, but if you do get a family member/friend to monitor you. Remind yourself that this lasts 6 months, but the results will be for a lifetime. Now I know some of you are firmly against accutane and prefer changing your diet/using whatever topical creams and solutions. I'm happy it works for you, but you have to understand that for a lot of people acne is not necessarily caused by diet, and topical treatments only keep the acne at bay, not cure the root cause. Do you really want a lifelong battle to keep the acne from erupting to the surface? 5. Aftercare All the problem skin areas on my body are finally clear after approximately one and a half years since I started this entire war against acne/pityrosporum folliculitis. For maintenance, I use very simple and gentle products on my face, just a face wash, toner and moisturizer. Sometimes I apply some 2.5 % bp on my nose, to keep it from getting too oily. For my back, I bought a znp bar to wash my body with, and I am starting with a new treatment-ELECTROLYSIS. Yes, without the hair follicles, there is no way for the fungus to survive. Ha! This is because although I no longer have even a single red spot on my back, 10 years of suffering have made me paranoid as hell and I will never go back to that ultimate emotional and physical low I was at before. Summary: Acne: Doxycycline, Accutane, 2.5% and 5% BP Pityrosporum folliculitis: Head and shoulders, oil of oregano (oral and topical), znp bar, electrolysis Scars and pigmentation: Fraxel, Ng YAG, 35% TCA chemical peel, arbutin cream, 4% hydroquinone cream Long story short, a battle with skin conditions can be long and tedious, but in the end when you look in the mirror and have clear beautiful skin after a decade of hideousness, it will all be worth it. Honestly, now I have friends who only knew me after I solved my skin problems, and they complain over a single small pimple and tell me "Omg you're so lucky, your skin is so good and you don't understand how stressed out I am over my pimple". This makes me think about just how much effort, money and time I put into researching and healing my skin, and just how far I have come. I hope this post can help some of you readers out there, if only in the slightest way. I love you guys and may we all achieve clear, beautiful skin. Work hard! Lots of love, Pursuitofperfection
  20. I no longer have acne (accutane) but I have horrible redness on my cheeks which has existed for at least 10 years. I had VBeam done recently which caused purpula and heavy bruising, but it still hasn't got rid of the redness. I just want an even skin tone. Is fraxel worth a shot? Co2? I don't know what to do anymore.
  21. Overview on acne scar treatments

    Forums Scar treatments 1 reply

    Holy cow.. that must have taken a long time to do, but I think this guy has covered a lot in that time slot. Great video - a must see as he tell it like it is.
  22. July 2016 Davin Lim on Energy Devices and Scar Treatment Interesting Infini (goes 3.5mm, laser only 1.5mm) is his favorite when he is the Fraxel Spokesman, he gets the machines for free and is paid to talk at conferences. Fraxel he said "is the most overrated treatments out there", good for minor scars but not many things. CO2RE is more powerful than the Fraxel device, even Re:pair. His number one recommendation seems to be Subcision & Filler depressed scars, & TCA Cross Icepics. As I have been saying in the FAQ for out Sub Forum... lasers are for surface texture and filler, subcision, microneedling, tca cross / spot tca peels, are great for scars before you go the laser route. Start with non energy treatments first and move to energy devices if you are ready ;-P He said to only do a derminator not a dermaroller they are not effective microneedles and often tear Syneron Candela Core / Co2re laser (good for acne scars "laser of choice acne scars" as it is customizable up to 80mj setting and can do hybrid mode like Total FX or shallow settings like Re:Store ETC All-in-one) Fraxel re:pair (tightens, refreshes skin, acne scars) Cynosure Picosure focus laser (great for large pores, no down time, ethnic skin, hyperpigmentation) Lutronic Infini Radio Frequency Microneedling (tightens & plumps, fractionated skin refreshing, goes deeper than laser, low down time) Ematrix (active acne pustules ablates top surface of skin) Scition erbium laser (great for ethnic skin or stacking with CO2 laser) Video Overview / Fractional laser resurfacing- dermatologist Review of All New Laser Technologies and Radio Frequency and Pluses of Each: Syneron Candela Core / Co2re laser with deep acne scars: Results of Laser Acne Scar Procedures: Subscision is Still the Best Cheap Non Laser Treatment for Rolling Acne Scars: Tethered / Anchored / Puckered: TCA Cross for icepicks Procedure:
  23. Hello everybody, Just wanted to share my current experiences with fractional laser, treating rolling scars left by moderate/cystic acne. So far I've done 4 Fraxel Re:store procedures on an affected area on a right cheek (added the "before" picture). The procedures were a bit painful, but as I have high pain tolerance, it was no big deal for me. The downtime was short and I was actually going to work the very same day I got my fraxel done, since the slight throbbing/burning sensation didn't bother me much. Each time my skin would start peeling on day 3-4 and the redness would be gone in 3-4 weeks. I've done these 4 procedures with 4-5 weeks in between them. Improvement has been slight so far, around 20-30% which is quite little for the amount of money I've spent, but these lasers are supposed to show the final result in 3-6 months, so I can't say that Fraxel Re:store was a waste. In about a month I'm gonna get an ablative laser procedure for the affected half of my face, since I have only had acne on my right side. Thought that I should get this things done before the sunny season kicks in. A bit nervous and pretty sure that the healing won't be easy-peasy like it was on fraxel, but the results might be worth it. Too bad I had some acne since my last fraxel, so I can't put a picture of my current state, cause it's all red and can be misguiding. But I am going to put an "after" picture in autumn 2015, so please subscribe to this topic if you want to see the outcome. Any tips or questions are welcomed.
  24. Its been about one year since i started my treatment! Lots to update everyone about. My skin is doing great, but not perfect! I do have some hyperpigmintation from the acne left over, but I don't really break out anymore Clear skin!..? Skin Picking After my 30 day picking challenge, I had no urge to pick anymore! Success! Lol but it doesnt mean i don't pick at all anymore. If i have a massive blackhead sticking out of my face, i will pick it. The only difference now is that I don't FIND unnecessary things on my face to pick at. The sight of blackheads don’t bother me anymore. I just pick what needs to be picked. Which is like one or two things every month. Acne Meds. I kept going with my acne meds till mid July. Then I kinda weaned myself off of the antibiotics. I continued the duac for another two months. Then I stopped all together. It cleared majority of my old acne, but once in a while I would get massive cysts. I figured out what the cause was: sleep and lotion. Sleep and Lotion The tiny pimples on my face were the products of an irregular sleep pattern. Once I started sleeping on a fairly normal schedule, the tiny ones popped up no mo! Now, the cyst…. I’ve used Iope face lotion for many years and never did I think it seeded my cystic pimples. Until one day, I ran out and had to live off of etude sample lotions for a month. I had no new cysts! Even on my period! Then I bought a new bottle of Iope, and BaBAM! Two cysts on my chin. I was like, “no way!” so I tried out this experiment again. Stopped using Iope, then started again after a month. The next day I got a cyst in between my brow right away. Yeah.. all these years, my trusted Iope lotion was poisoning me T_T Such betrayal! So I just gave it to my mom cuz she loves the lotion and bought a cheap moisturizing lotion from Etude for $8. This was about 5 months ago and since then I haven’t had a cystic pimple even on my period J The horrible thing…. Is that I think all that pimple medication slowed down or stunted my collagen growth, so I am now left with lots of indented scars! No ice picks, but boxcars and rolling…. T_T And my skin tone is uneven. For the past 3 months, I’ve tried dermarolling with 1.5 needles. I do have to say that I see 10% improvement. Gave that up though. Lasers My skin, although its gots them indented scars, sometimes, it don’t look so bad….. When I catch my reflection here and there, my skin seems permissible… but then other times, it looks like Ive got caves on my face -_-;; I was very shocked last week when I saw my reflection on the elevator door….. OMG wtf is wrong with my face I thought. So I decided it’s time to get some lasering done. I went to three different dermatologists and found the one I like. The first clinic I went to, they said I’d need subcision and fraxel…… five times. LOL no fuckin way was it that bad. They just want my money. Anyways, the clinic I ended up choosing was having a package event. (Oh btw, I live in Korea now so all this shit is hella cheap compared to the US). It was 1 fraxel laser, 2 eTwo lasers, 3 shots of this thing called a Baby Needle(?) which is suppose to help collagen growth, and 3 facials(?). Total cost was $1000. I’m getting my first eTwo lasering done next Friday…. Soooooo the span of this whole process will be about 2 months? Hahaha I’m excited and once this is done, I will update again. I am also taking progress pictures
  25. Hi everyone, I got my first Fraxel Restore laser treatment for my acne scars on January 11th. Unfortunately, it did nothing for my acne scars. I have been debating on whether to go on Accutane or not, because I do have active acne all over my back, chest, and a couple of pimples here and there on my face. it isn't really the acne that bothers me... it's the acne scars. But the way I see it, I have no idea what to do right now. Should I continue with fraxel laser treatments? should I try a different laser? Fraxel repair maybe? Also, if I were to go on Accutane, am I even allowed to? I heard you can't get laser 6 months before or after Accutane. Is that true? What should I do? Please help....