1 post in this topic

ACNE SCAR Q&A / FAQ; LIBRARY of POPULAR THREADS
<If You Have Updates / Hints/ Tips for This Thread, or Questions, Please PM Me>

:smileys_n_people_105:Special Thanks for Contributors : Robertitoo, DeLovely, PCT14, QuanHenry, Hope01, Dan Owner of Acne.org  :smileys_n_people_105:

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 

 
:activity_30:Scar Treatment Success:activity_30:
> 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
2016-07-17_035116.jpg
What-causes-acne-stages-of-acne.jpg

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)
    2016-07-17_035157.jpg
    Please note non-white skin can hyper pigment with energy devices

    source: https://books.google.com/books?id=47HGBAAAQBAJ&pg=PA394


     
    ___________________________________________________________

     

    Q: Can you describe the different types of scarring? scar types:
    main-qimg-ff98eff2b8f652553a87ee43382e9d

    acne_scars.jpg

    2016-07-17_040633.jpg

    source: https://books.google.com/books?id=47HGBAAAQBAJ&pg=PA394
     

    2018-12-19_065731.jpg
    type of acne scars.png

    • Icepick: Looks like an ice pick has been pressed into the skin. It is generally small in diameter, but can be shallow or deep.

          acne%2Bscars%2Bdavin-lim%2Bbefore.jpgP1020404.JPG

     

    • 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.

          skin%2Bneedling%2Bbefore.jpglaser%2Btreatments%2Bacne%2Bscar%2BbeforDeep-scars-2.jpg

     

    • Rolling: Looks like a smooth indentation in the skin. These scars can be deep or shallow, but are generally shallower.

            rolling-scars.jpg richardson%2Bbefore%2Bl.jpg

    • 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).

    fig25.jpggr1.jpeg

     

    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.

    00002314_standalone.jpg00001176_standalone.jpg

    • 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).
     
    keloids_hypertrophic_scars.jpgback.jpg


    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) 

    2016-07-20_174154.jpg



    ____________________________________________________________
    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, Painting Scars with Lugol's Iodine, Or Castor Oil 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. Two other well known ways to treat scars at home before doing the more exstensive treatments are to paint your scar with Lugol's iodine (note it will discolor the skin - but the body absorbs the iodine over time), you paint a few coats of iodine once it dries and do this a few times a week, depending on how your skin reacts. Note it acts like a peel, the skin will probably dry out, and skin will flake and fall off. Another option is to take castor oil and paint it on the scar this uses the bodies healing ability to deal with wounds (you can do this a few times a week).

     

    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). A very cost effective solution is to find a doctor that does Cannula (type of needle) Subcision (see below recommendations) and do the rest of the treatments at home. Subcision is not costly and can be done every 3 months or even years in between for acne scar pits (this is a good first treatment).

    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 / severe 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. A better treatment now are hydropeels (Drs/ Spa's / Skin Specialists). This clears clogged and dead skin, infuses the skin with beneficial ingredients and AHA BHA acids. Part of the issue with unhealthy looking skin a good Hydro Peel Extraction and improvement can help. They are relatively cheap as well often $100 on special.


    Q: What treatments offer the biggest change?
    A: Subcision (Cannula type of needle) 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, ask how many they do a month - good doctors do many. 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 or Improve My Health Following Invasive scar Procedures or Having Acne Problems?

    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. Data shows the things that effect sensitivity the most in patients are milk / dairy, sugar, and highly processed cars. Organic Produce can be beneficial if you can afford it or grow it yourself. The raw diet and vegan lifestyles do help some overcome allergies and medical conditions. Your scars and acne could be related to a fungal infection (known as fungal acne or Folliculitus) or skin and food allergies. Worth getting testing for this.  


    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. 

    Also people go on sites like RealSelf to Complain about treatments (they do not go there to talk about positive experiences). Marketing teams can often be involved with positive reviews. It is in your best interest to personally contact those who leave a review or members on here to ask questions (don't just read the reviews). Get 2-3 Consultations even if you pay $150 you will be able to find the best doctor for yourself (you will spend thousands on treatment). If you cannot find someone to do subcision (see our below suggestions) or find a school that teaches dermatology, they often do this procedure. One can get filler done locally by a expert injector or find a overly common laser Dr for other parts of their treatment.


     

    2016-07-20_174154.jpg

     

    2016-07-15_143621.jpg

    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 HOME

    Q: 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=uGtFVO7hEHM
     

     

     

    https://www.youtube.com/watch?v=Re_NdcVGI_A
     

     

    https://www.youtube.com/watch?v=Bsd0YbvZdaI

    ___________________________________________________________
        DIET NEEDED FOR HEALING

    Q: 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 (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.
    •  Picosure is a great treatment (non - ablative). IF you have Ethnic Skin (Asian, Indian, Mediterranean, Black/African,etc...), it works well because you have more collagen in your skin. Works perfect for your skin type. This promotes new collagen, is a alternative to vascular laser for lighter skin types, and gets rid of the PIE.
     
    2016-11-04_114815.jpg

    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.

    hyperpigmentation sun exposure
    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.

    do not pick

    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 .
    •  Picosure is a great treatment (non - ablative). IF you have Ethnic Skin (Asian, Indian, Mediterranean, Black/African,etc...), it works well because you have more collagen in your skin. Works perfect for your skin type. This promotes new collagen, is a alternative to vascular laser for lighter skin types, and gets rid of the PIE.

    Image result for PIH skin 16 oz. AHA+ (Glycolic Acid - 10%)

    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.11

    hyperpigmentation sun exposure
    Hyperpigmentation 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.

     

    do not pick

    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

    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.

     

    Retinoids

    tretinoin, dapalene and tazarotene

    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.

     

    Niacinamide, also known as Nicotinamide.

    niacinamide

    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.

     

    Azelaic acid

    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.

    Gentle Chemical Exfoliation

    gentle chemical exfoliation for hyperpigmentation

    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.


    ___________________________________________________________

       WHAT IS: HYPOPIGMENTATION 
         - white spots (loss of pigment)


    Q: What Is Hypopigmentation? 
    A: Hypopigmentation is: Vitiligo, pigment loss due to burns, scars, skin discoloration.

    littekens2.jpg

     

     

     

    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.  

    img_00966.jpgImage resultImage resultImage result
     

    •  

      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 only a 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).


    punch excision singapore.JPG

    ___________________________________________________________
    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

    sl3.jpg

    Q: What is subcision? Will it improve my scars? Should I use filler?

    A: Subcision is a method whereby a doctor uses a "Cannula" blunt 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 (you must wait a week(+) for the swelling to go fully down 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 (typically a month after). 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. Many do several subcisions when the filler needs a top up again. 

    Subicision is the act of making a pocket, and filler, saline (cheap - water - does not last) or prp growth factors 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 cannula subcsion which can create swelling and bruising. If they put to much filler under swelling it can create a bump (which can be fixed). Some injectors need the skin to not have swelling when injecting and this makes the best results.

    You will know where your scars are located post subcision. They will more than likely be bruised or have a diffrent texture. You will have a deficiency in your skin volume (remember the swelling goes down) and need filler in that spot. Find someone who is meticulous.

    Eventually after a few times of cannula subcision, they "can" do more filler at your local expert injectors office. Filler is needed naturally as we age and loose volume.

    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 saline (water), or prp-growth factors. 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 or do filler on your last subcision treatment. 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. Micro 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 (this can be fixed with subcision after to fix it). 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

    IF you have extremely fibrotic thick scars that bend needles , they may not use a Nokor (scalpel needle - instead using a normal needle, or a blunt cannula, or possibly a different technique. Do what you have available nearby your location (many Drs 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 saline (sterile water) after subcision . Otherwise you can just cup at home, the Dr will be clueless about this.

    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/

    2016-07-17_040357.jpg

    source: https://books.google.com/books?id=47HGBAAAQBAJ&pg=PA394

    2016-11-15_035956.jpg



     

     

    https://youtu.be/ansKjWAw_G0
     

    wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==

     

     


    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, also infectious biofilms. Very Few Drs do this for a reason, complications.

    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/

    2016-11-15_040726.jpg



    __________________________________________________
    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/

    full ablative laser.JPG

    Fraxel.png
    infini rf.jpg

    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.

    Screen Shot 2016-09-23 at 16.25.29


    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.
     

    Grids Vs. Deep Laser Peel
    Another common misconception is laser delivery. Most doctors are using grids or fractional laser now (areas of untreated skin are between where the laser treats - see above picture). They do this to avoid complications and increase healing time. Unless you have extremely thick scars and nothing can get through them (then you get Ultra Pulse to break through the tough scar tissue  this has side effects). I would instead get RF microneedling which gives better results to a scar patient. I would use Fully Ablative Erbium Resurfacing (no grids (see picture above about lasers) at the end for texture. Please note there are side effects and a deep peel is often better by a experienced Dr.
     

    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 Are Good Laser Treatments for Ethnic Skin (Black/ African, Asian, Indian, Mediterranean, Latin) ?
    A:  Picosure is great, it induces collagen growth. Non Ablative so it does not harm the skin or discolor for ethnic patients. Takes away redness. Rejuvenates ethnic scars. Works on various skin types for Ethnic skin especially if you have more collagen (several treatments are needed). Also 3-7% density with the highest power on a CO2 laser for large pores, boxcars, and scars is helpful and safe in ethnic patients.  Infini RF with protected micro-needles for Ethnic Skin (various other brands have this) is a great treatment  for box cars, and rolling scars, or skin defects and pores. ** Always use nightly retin a/ tretinorin / Differin and a bleaching cream like hydroquinone, or something with Albutin and Konjac for 3 weeks prior to any treatment with a 1 week break before the treatment. This prevents discoloration in Ethnic Skin Types.

    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 - Sculptra if you have deep pits and fat loss).

    __________________________________________________
    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. 

     

    how-does-microneedling-work.jpg


    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/
     

    maxresdefault.jpg


    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. Please click on the above link for a full mega-post on acid peels and their usage. 


      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). 
      • Before and After Pictures Often Mean Nothing (Paid Marketing, 1% of the best cases, we all heal differently), word of mouth by real patients is much more beneficial 
      • 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).
      • Goto 2-3 Specialists (get their opinion), even if you have to pay for consultation (some do this by Skype and on the Phone or App). You will be spending thousands on the Dr better to be comfortable and like what they will do.
      • Subcision is often the hardest treatment to find. Dermatology teaching colleges often offer this, ... otherwise call around and ask "do you do subcision with a cannula (Needle Type)?  How many do you do a month?. You can use our Recommended Drs below. Some travel across country only for this step of treatment, they fill locally (to them) with a expert injector (after swelling goes down).
      • You can often see Expert Injectors (Drs and Nurses) locally to yourself, and it's easy to find Energy Drs (laser). Most treatments can be done closer to home.
      • Do not fall for reviews (Yelp, RealSelf), they are often done by marketing teams, contact patients directly and ask questions, read reviews on Acne.org Scar Sub ... people have nothing to sell you by sharing here.
      • RESEARCH - make a informed decision.
      • See if the Dr has Youtube videos on Acne Scars or has done academic papers, this is a sign he specializes in it.
      • Cheaper is not always better. You must way how experience factors into your experience. If you don't have a ton of money do the at home stuff above (See section) and get cannula subcision done first, it's a cheap procedure that can be done when you have time and money to treat.
      • We are not a referral service, ... these are well known Drs who perform these services, your experience may vary with them or you may find someone better nearby. The more well known they are the more costly they are, often sponsored by Pharmaceutical, and Medical Device companies to push a procedure. The biggest Drs have marketing teams, ... that is why everyone knows about them. A example is Fraxel might give them a free Laser to push this on social media and in talks they give.

      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 (Expert Injector), Skin Boosters, Lasers, Subcision

      http://drnaomi.com.au/

      Professor and Department Head Tony Chu 
      Chiswick, London
      Specialty: Dermatologist Expert - Teaches Other Derms, Economical, PRP, 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, 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: Subcision, Fillers, Sedated Acid Peels for ALL SKIN TYPES (teaches Drs how to do peels for resurfacing)
      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 - Main Focus is Laser Wrote books on the subject, 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 Trains Drs on anything about Lasers

      http://www.skinlasers.com/

      Dr. Evan Ransom
      San Francisco, California
      Specialty: Facial Plastic Surgeon, Infini RF, Lasers, Aesthetics, Dermabrasion, Subcision

      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 aggressive 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 w/ Taylor Liberator Tool (See Video Below)

      https://www.youtube.com/watch?v=sqoy5D6ilss

      Dr. Shivananjappa
      Boston, Massachusetts 
      Specialty: PRP, Subcision, Rf Microneedling, HA & Bellafill Fillers, Laser Resurfacing
      https://shanthalamd.com/

      Dr. Nelson Lee Novick
      *** Highly Recommended Acne Scar NYC Favorite Dr.

      NYC, New York & Israel - Prices 1/2 Off, perfect for Europeans / Middle Eastern Region
      Specialty:  Expensive Famous Dr, Aggressive Subcision, Filler Master Injector, Can do Peels like Laser Resurfacing, 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 and body 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: Subcision
      http://www.myskincaredoctor.com/

      Dr. John Burns
      Dallas, Texas
      Specialty: Aggressive Subcision
      http://drjohnburns.com/

      Dr. Sam Lam
      Plano, Texas
      Specialty: Fat Grafting, Plastic Surgery, 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. Benjamin Barankin

      Toronto, Canada 
      Specialty: Energy Devices, Subcision (?), TCA Cross, infini

      Dr. Sheldon Pollack

      Toronto, Canada 
      Specialty: Energy Devices, Subcision (?), TCA Cross, infini

      Dr. Payman Kosari

      Toronto, Canada 
      Specialty: Plastic Surgeon, Fully Ablative Erbium Resurfacing, Subcision, Energy Devices, TCA Cross, infini

      Dr. Jeffrey Orringer
      Ann Arbor, Michigan
      Specialty: Subcision, TCA Cross

      Dr. Murad Alam
      Chicago, Illinois
      Specialty: Subcision

      Dr. Steven Mandrea
      Chicago, Illinois
      Specialty: Subcision with sculptra

       

      _________________________________________________

      14. ANATOMY (FAT / MUSCLE) PICTURES

      g3751_skin-normal-acne-model-acne-skin-s

       

      2017-02-10_123553.JPG

      Derm01_Fig2_Cosmetic%20Clinic_FIg%202_Mi

      face_lifting.jpg


       

      Facial-aging.jpg

      Characteristics-of-aging.png


       

      wrinkle.jpg

      Botox-frown-lines-treatment.jpg

      Botox-forehead-wrinkles-treatment.jpg

      2016-011.jpg

      2017-02-10_123153.JPG

       

      dontcrybaby, PCT14, Remicade and 22 others reacted to this

      ** Please "Like" my response above; Capturedwdn.JPG  As a volunteer encouragement helps! |::wiggle:

      I provide personalized-private-messaging to coach and answer your acne scar and aesthetics questions. PM me to ask more.

      [Thank You For Your Kind Understanding - I reply to individual PM's addressing your concerns as soon as I can, helping many people a day, please be patient.]
      __________________________________________________________________________________________________________________________________________

       :smileys_n_people_116: CLICKABLE LINK: OFFICIAL ACNE SCAR SOLUTIONS; Q&A / FAQ :smileys_n_people_108:
      TABLE OF CONTENTS:
      1. SUCCESSFUL TREATMENT THREADS                                                                 7. HYPERTROPHIC / KELOID (RAISED SCARS)
      2. WHAT IS ACNE & PREVENTING SCARS                                                              8. SUBCISION
      3. DIFFERENT TYPES OF SCARRING                                                                      
      9. FILLER FOR SCARS
      4. TREATING SCARS AT HOME                                                                              10. LASER
      5. SKIN: RED (PIE) BROWN (PIH), WHITE MARKS,                                               11. MICRONEEDLING
           TEXTURE, LARGE PORES,  DRYNESS, & COVERING UP SCARS                    12. TCA CROSS FOR ICEPICK SCARS & ACID PEELS                       
      6. PUNCH GRAFTING & EXCISION                                                                        13.
      LIST OF ACNE SCAR TREATMENT DOCTORS

      Share this post


      Link to post
      Share on other sites
      Guest
      This topic is now closed to further replies.