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Posts posted by billyboy

  1. No more Profractional or fraxel. Blood and scabbing, even on a small patch creates downtime that I would not go through again.

    It is possible I might do a couple more subcisions or TCA. The subcision is simple, no real down time and I seem to get good results now. He missed 2 scars last time. Less sure on TCA because it is not clear to me that I will get a good result from last round. If so, yet I perceive room for more improvement, I will probably do TCA also, but only if I decide to try subcision 1 more time.

  2. I've been absent for some time, but am excited enough to report back, with the hope it helps others. I had lots of acne scarring, none on forehead and none deep.

    Biggest mistake was going to New Orleans to Dr Y to have punch floats - twice, as both rounds were disasters, turning small scars into larger depressions. Avoid floats! Next big mistake was Dr. ? formerly at UCSF and now at UC Irvine who is an engaging Brit and a paid researcher for Fraxel, but a horrid surgeon, with a big name. He performed 3 excisions that turned out horribly. Avoid excisions, especially by a derm or a poor surgeon!

    Fraxel restore was a significant improvement in skin by turning rough skin into smooth skin, with evening of tone anc color. But, it had limited effect on true scars. I'd rate the 8 or 9 sessions as expensive, yet worthwhile, despite the small impact on scars.

    A couple years ago I found Dr. Dhawan in Fremont CA who initially tried dermal grafts and a couple subcissions. The dermal grafts helped quite a bit with 3 deep surgical scars left by the UC Doc. But, they requried several rounds to fill in. However, evetnaully I ended up with a cyst forming around each of these grafts, causing inflamation, infections and overall nastiness. Apparently, I'm promne to cyst formation and this is a risk if a single epidermal cell is in the piece of dermis inserted under the scar. That said, despite the repeated effort and problems, I'd rate this procedure fairly high if you have a large depression to fill.

    I was underwhelmed by Dhawan's early attempts at subcision as well as 3 or 4 TCA cross attempts. So, I told him that I did not want to try subcision alone (ie, without a graft) or further TCA cross on ice pciks or scarrred pores. In fact, one TCA cross went way outside the scar by mistake creating a larger pit on my nose, which annoyed me. He convinced me to try heavy subcision on that scar on my visit last November. It worked incredily well leaving it 95% flat, so my view of subcision changed dramatically. So, in my most recent vist we tried a couple more subcisions. I'm prety happy at what I see with 3 of them so far, a fourth looks like it won't do anything, and a fifth was done in the wrong place. He also overcame my objection to Cross on my scarred pores because it said it so easy, no mess (like Profractional), and he has had good results with others. It's too early to tell, but I'm hopeful.

    I've tried Profractional a couple times in a couple small patches of scarring with mild improvement. He used much higher settings this time on one patch with a bunch of shallow, superficial scarring. He said Sciton increased the Protocols and that Dr. Dhawan had been too timid in past. It is a very bloody, ugly procedure that will keep you indoors for a few days

    I'm basically done, having had early setbacks, but enough improvement over the last few years that I'm happy with where I am. I think Dhawan's early attemts at subcision were not aggressive enough because the recent results have been so much better. I think he is the best of the scar Docs I have seen. He is quick, reasonably priced, and has expereicne with all techniques. My only criticisms are that he goes too fast sometimes and perhaps he starts out too unaggressive until he sees how you respond. Some of the scars that bother me are on side of face and sometimes he can't find them and he works on a different area, where to me there is no discernible scar. And, he was sloppy on one TCA. That said, I am finally seeing great results! I'd recommend him and also advise you to stick out underwhelming results like I had in my early visits.

    Hope this helps

  3. Cuts skin down into cyst and then squeezes the cottage cheese material out. Once this incision is done, I have found that they either don't return or I am able to make a subsequent squeeze and they don't return. But it is very frustrating to have them return and sometimes be infected. As I understand it, if there is a single epithelial cell left in the dermis, then the cyst can reformn, so I have wondered whether the graft is partly removed in this process.

    Ok result, but far form perfect and with complications in my case. If I lived near an SMD exert, I would go that route, given my very mixed results.

  4. Dermal grafts is often used to describe skin grafting as well as various types of dermal grafts. Your use of dermal graft is associated with replacing patches of skin including epidermis, dermis and subdermal layers. The precise definition used by Docs for dermal grafts is to implant harvested dermis into the dermal layer for augmentation. It's semantics, but when someone on this board refers to dermal grafts, they are referring to the type I describe.

    I thought the grafts resulted in over correction, producing large round lumps, but the Doc determined they were cysts and lanced them. Sometimes the problem would start 2 years after implantation! Odd. And, he said only 10% of grafts get cysts, but I'm probably 85%. Some return, but they are now gone, hopefully for good, I have two large scars from incisions, that have been filled several times each with dermal grafts. This has worked better than any other technique I've tried. It is essentially just a filler using your own dermis. I've had restylane which worked much more precisely with no complications, but is temporary and expensive.

    Like I said, if there was a SMD expert in my vicinity, I would definitely go that route, based on my experience with gfats

  5. I've had rounds of dermal grafts. As noted, it involves harvested skin from behind ear, removing the epidermis and then implanting a small chunk under depressed scar through a small slit, which is then covered by a steristrip. There is no injection or sutures for this type of graft. And, no, this is not the type of grafting used in burn victims. It is similar to Silicone micros droplet, except the latter is probably more accurate in the right hands. While it does help to fill depressed scars, a cyst has eventually formed in virtually every site for me. This is a known risk factor if even a single epdidermal cell is implanted into dermis, and I seem especially prone to it. If you find a Dr who does SMD, I would go that route. Hope thsi helps.

  6. I think Datura went to the same Doc I did for dermal grafts. My experience has been mixed. That said, I am pretty convinced that dermal grafts or SMD are the way to go for deeper, wider depressions. It does not work for ice picks nor for wide but shallow scars.

    If I lived in Texas rather than CA, I would have elected to go for SMD with Dr. Lam. It seems to me that the injection of micro droplets is likely to be far more precise than the insertion of harvested dermis through a slit in the skin under the depressed scar. For one, I often find that it is not inserted all the way under the scar, but only at the top. Or, it can lead to overcorrection. I agree this Doc is experienced and skilled and results are permanent and safe, but keep in mind the technique is not very precise. That's why based solely on my experience with dermal grafts, I expect that SMD would produce more precise results. Dermal grafts is way better than Fraxel Restore.

  7. Below is excerpt from email from Doc where I had Fraxel treatments some time back. I read on his website that he had the Fraxel Repair, so I enquired about Repair vs. Fraxel Restore. Restore helped me, but not as much as I wanted, but 6 of the 8 were performed by the first generation machine. Hope this is helpful. given the below and the fact that your scarring is mild, I would definitely not take a risk with Repair, but Restore is very safe, based on my personal experience.

    "We've stopped using the repair since we've had some scarring with it and results of a single treatment have not been very impressive. Multiple treatments probably are better, but they are prohibitively expensive. For single treatments we use our Sciton Profile, more effective & less risk. We've never seen scarring with this laser. I can't tell you how a single treatment with the Sciton compares to a series of treatments with the Restore, but the Restore is slower and safer."

  8. Good luck on your CROSS treatment! I just had my first TCA CROSS on monday with Dr. Lam. So I am hoping for great results :)

    Just curious, what is your post treatment care like? I just wanted to compare the instructions I got from Lam with yours.

    I did not get good instructions (mine were done on March 1), but I avoided washing area for several days. Let me know what your instructions are. I'm a little concerned; 4 were on my nose and one on cheek. They all look worse now, which I understand happens and then they fill in. But I'm worried, given my past failures, that my nose won't turn out well since I seem to have some bad luck when it comes to scar correction. My biggest fear is that my Doc and I had a miscommincation. He did a very small nose scar that did not bother me. Worse, the acid must have fell off the applicator because he treated an area 2 to 3 times larger than scar. The other 4 had the TCA confimed to inside scar. It formed a big scab, which came off, but there is another scab underneath. Right now, it looks like a much bigger pit will form. I know it will get better with time, but I know he made a mistake on that one.

    How do yours look so far? Good luck

  9. In the hope that some of you won't repeat my many mistakes, here is what worked and did not work.


    Punch floats by Dr Y in New Orleans. Several years ago, he was the "positive rage" on these boards. I traveled to NO and had him do many punch floats given my desire for no further travel (i.e, get it all done at once, even if scar was tiny). Floats produced larger, deeper scars or no change, so I went back, thinking that the steri srips did not hold the floats in place. I had the same bad experience the second time as did many others who visited him during this period after Katrina. Either he lost his touch, or the previous posters had completely different results than the post Katrina posters.

    3 Excisions by Dr Zachary at UCSF now at UC Irvine, who is a consultant to most of the laser makers. He was a charming Brit, but a terrible surgeon, whom I would not trust after my horrible experience with him. I'm not surprised that he is consultant and spokesperson for the laser companies because he is well spoken and will do anything for money. Furthermore, I am guessing he has learned that he is a poor surgeon and should leave that for others.

    These experiences have made me cynical of "name" Docs.


    Subcision did not work for me. Not sure why not. Perhaps the doc was not aggressive enough. Also, my scarring is mostly from lost tissue and shallow. I have no sense that the scar Is "tethered" or bound down, so perhaps these scars don't respond to subcision. Also, I am now 58, which could make a difference. At least it caused no regression like the first 2 failures.

    Fraxel refine and restore (8 total as per below) helped with even tone, shallow scarring, but no effect on deeper scars. Overall improvement of say 20%, which isn't very good after 8 sessions and many $s, but most were the first generation machine. I notice that I flush much more easily in respone to heat (sauna and steam), but it does not bother me much. Also, I think my skin color is very slgihtly lighter where the fraxel went. Hardly noticable though.

    Dermal grafts of dermis from behind the ear under scars have been quite successful in correcting the 3 failed excisions, where the scar separated and there was significant tissue loss. This procdure seems analogous to SMD, except it is probably safer, as it is your own skin. On the other hand, I suspect it is much harder to be precise in the scar correction with grafts than with SMD. The good is that, with multiple visits, it has rasised the scars to essentially even with the surrouding skin. But, it is a a little lumpy and far from perfect. I considered going to Dr. Lam, but after my horrible experience with Dr. Y, decided to stay in the Bay Area and away from name Docs. Not trying SMD may have have been a mistake, but dermal grafts have worked pretty well. My Doc has also tried grafts under a few larger ptis, besides the 3 failed excision corrections, but with limited success. Importantly, every scar was improved, with none worse than before.


    I have many very small ice pick scars, left over from Dr. Y using hsi smllest puch tool. We tried 2 spots tests with pro fractional. I was underwhelmed. That said, I may try spot treatments, as my final step after TCA cross.

    Cross seems counterintuitive but my DOC started doing it with some success on other patients and suggested I try it. Anyway, I had 5 scars crossed 7 days ago, so I won't know results for some time. If this seems to work, then I will do another round and may finish off with spot profractionals, not whole face.

    MY BIGGEST MISTAKE, IN HINDSIGHT, was trying to correct small scars surgically. Leave these alone as you may make them worse, except for possibly a fractional laser at the end. Also, if I had it to do over again, I would have dermal grafts or SMD on a very few bad scars, TCA on small ice picks, and then finish with several fractional laser treatments. In other words, fill the valleys and then minimally tighten/sand down to a more even finish with a couple laser treatments. but again, the verdict is still out on TCA cross for me, but it seems safe, albeit counterintuitive.

    Hope this helps.

  10. I can't conceive how it is drainable. It is a firm small round lump. Being a little unhappy and busy, I have decided not to go this route any further. If I do anything, it will be travel to a Silicone Mciro Doc. Perhaps he can inject around it to make it more level. There is definitely lost tissue in this excision area, so it may be best to try to raise the area around with several small injections. Otherwise, I think it will need to be shaved off. It does not bother me that much. Just trying to point out that, having had the procedure, I can see why fewer Docs are doing it.

    Yes, in my case, it was simply transplanting small pieces of drmis under the depressed scar so that it raises up.

  11. I had a few dermal grafts. My view, without having tried Silicone Mricro Droplete, is that the latter is a more precise procedure, likely to lead to better results.

    I had dermal grafts for 3 excisions that turned out poorly. The Dr. said the rest of my scars were too small for a graft. Remember, the graft is a small peice of dermis from behind the ear that is planted under the scar by creating a small pocket, with the hope that collagen will grow around it and help even the depression caused by lost dermis. In one case, I got a small improvement, approximately equal to the small scar created from the pocket slit. In another case, after a couple rounds, there was definite improvement (80%). However, in the third case, either because the peice of dermis was too large, inserted too close to the skin surface, or my body simply created way too much collagen, it has left an unsightly lump.

    Having seen how this works, it seems that it is hard to predict results. I would think the SMD method can insert more droplets in multiple spots with no slit to create a pocket. It is inherently more precise from that perspective of usng multiple small droplets ather than a single larger piece of dermis. I will not try further dermal grafts, but may try to SMD. That said, silicone is a foreign material, which is a disadvantage.

    Hope this helps

  12. I had 2 small spot treatments about 1/2 square at most. One spot was treated at 200 last July and repeated again in mid Nov at 400. This area had 4 scarred pores/icepciks that got worse after failed punch flots by Dr. Y.

    The otehr spot had only the 1 treatment at 400 in Nov and had 2 small scars. At this point, I am underwhelmed by results, but I need to give it more time. I also think that 200 was too low of a setting. Honestly, have not formed a solid opinion yet, but I know it is not super positive. Easy procedure, but I think it is somewhat ineffective.

    Anyone else.

  13. Some posters, Naitch especially, have been way out of line toward DrewBoy.

    I have tried many things, with less than expected results. The only technique that I have any interest in pursuing at this point in SMD, mostly because I trust the information that has been provided by multiple, objective sources, both in this and outside this thread. Unfortunately, I am here in SF Bay Area. Going to LA is no problem, but SF would be best. I don't have time right now to fly to Dallas or NY etc.

    Anyone have success with a CA SMD doc? Names?

    PS: A couple years ago I posted pictures here. It is way harder than people realize to get a perfect match of up close, detailed pictures to highlight scarring (harder than I expected anyway). After realizing this, I have come to rely more on objective evaluations than on photos. Objective does not mean Fraxel literature and photos, which, while beneficial to me, was way overhyped as to efficacy.

  14. Measured my patch it is 1/2 by 1/2 inch. Yes, this will be redder, longer than expected. Timig is bad workwise, but Dr. assured me that I would look normal in 3 days. Did you peel? Did you swell and have scars appear largerat first? After 4 weeks, was theri much improvement?

    Thanks for you help.

    I have 2 small boxcar/rolling scars on my nose (that were given to me by a chiropractor using a laser for rosacea). I have done 2 profractional treatments so far (I'm not sure of the parameters, but I would estimate 200 and 300-400 microns for each session). I will let everyone know the outcome in a few weeks. In terms of downtime, they tell you you'll be red for 3 days which is a big lie. You'll be red for 7-10 days, pinkish for another 7 days, and then gradual fading to normal color will take place over 7-14 more days. In my opinion, the total downtime in terms of return to baseline color is 4 weeks. I am 2 weeks after my last session, and still noticeably off color.

    I wouldn't worry about the test patch, it will only look better, but it will take 4 weeks to have absolutely no redness. Hope this helps you and anyone wondering about true downtime from this procedure.

  15. Friday, I went in for 4 subcisions and 3 dermal grafts. I asked about 4 "ice picks". Dr. said they were psuedo ice picks because they were so small - really just scarred pores. Too small for excision and too small for grafts or subscision. Previsouly, I had tried puch elevatsion, with a 1 mm pucnh which made them worse, and subcsison that did nothing for them. Anyway, he suggested a test patch using profractional at 250 microns.

    Right now, it looks way worse. Patch is maybe 1 inch sqaure, red and raised,swollen. To me, the swelling makes scars look wider. I see the white dots.

    Anyway, I am concerned that I will regret this test patch. He thought the redness would disapppear in a few days. But I am dubious.

    Dr. siad he would not do a full face on me because I only have a few patches of scars. I have been happy with the subscisions for the most part, but I am concered about whether this test is going to look ok in the near term. Any ideas based on your own experience?

  16. Drewboy: Thanks for the offer. I will keep it in mind, but if I go I would try to fly in and out. It would be nice to meet though.

    Pakifairy: thanks for link. I am not sure what to make of it. I several reactions: Good comparisons, some patients have pretty severe scarring, the last male seemed to have the most improvement. He had some sharp ice picks and box scars which turned into rolling scars. In fact, I wonder if he might have had a couple excisions also. I could be way wrong, but the photos show less improvement than I expected, but seemed to help sharp scars more than I thought possible. I thought it was supposed to be best for shallow rolling scars.

  17. I'm almost 57, which may have adversely affect my results.

    That said, I tend to agree with others that fraxel does not visibly improve significant scars. It helped to even out tone, pigment and superficial scars. For deeper scars, it appears that fillers are the answer, not fraxel. While not a waste of time and money, fraxel did not come close to meeting my expectations. My improvement was no where near 50%. It is over hyped in my opinion.

    Unfortunately, I can't find a NorCal doc that does silcone micro, which seems to get the best reviews.

    Hope this helps.