I got freshly made scars over my temple in Apr and I am still receiving accutane. Is it boxcars scar, and would subcision be help to this kind of scar as they located at my temple.
Answer: Subcision can help bring up the indented scar. Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started. Best, Dr. Karamanoukian Realself100 Surgeon
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Answer: Subcision can help bring up the indented scar. Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started. Best, Dr. Karamanoukian Realself100 Surgeon
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May 27, 2020
Answer: Boxcars on Temple? Englewood Cliffs New Jersey Your scars appeared to be recent box cars. The fresher the scar, the better the results. Subcision using Nokor needles and cannula are my first choice. We combine this with PRP. Once the scars are lifted, a low density ablative fractionated laser may be added. Jeff Rapaport MD FAAD Realself Verified All-star
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May 27, 2020
Answer: Boxcars on Temple? Englewood Cliffs New Jersey Your scars appeared to be recent box cars. The fresher the scar, the better the results. Subcision using Nokor needles and cannula are my first choice. We combine this with PRP. Once the scars are lifted, a low density ablative fractionated laser may be added. Jeff Rapaport MD FAAD Realself Verified All-star
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May 27, 2020
Answer: Boxcar scars on temple The scars look red and would likely improve with treatment using a vascular laser such as pulsed dye laser. Subcision could be considered but extra caution is required in the temple where veins, arteries and nerves are more superficial. Typically I would wait with subcision until after Accutane is finished. You should discuss with your local acne scar specialist. Regards,Dr. Ort
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May 27, 2020
Answer: Boxcar scars on temple The scars look red and would likely improve with treatment using a vascular laser such as pulsed dye laser. Subcision could be considered but extra caution is required in the temple where veins, arteries and nerves are more superficial. Typically I would wait with subcision until after Accutane is finished. You should discuss with your local acne scar specialist. Regards,Dr. Ort
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June 7, 2020
Answer: Pulse dye laser- vascular laser, fractional therapy - TCA Many ways to approach this pattern of scarring. Ideally red can reduced with lasers. Fractional laser can help, careful TCA in strategic area can also shrink down the scar. In this pattern, subcision is probably lower down my list. The ideal treatment for acne scars will depend on the morphology of individual scars. For example, rolling scars are best treated with subcision, atrophic scars with fillers, pick-ice pick scars with TCA or Phenol CROSS/ Paint, box-scar scars with fractional laser/ modified TCA/ phenol chemical peels, hypertrophic scars with steroid injections/modulated fractional delivery. Energy devices such as lasers, microneedling RF and bipolar radiofrequency are other methods to treat ‘general’ scar types. For example devices can improve rolling-tethered scars as well as ‘deep - superficial scars’ such as broad ice-pick scars and broad box-car scars. Devices should be viewed as a method of scar revision, and rarely as a sole modality. Exceptions do apply- for example in patients with predominantly shallow/broad box-car scars and or superficial pits. Another factor that will determine the ideal combination of treatment is the skin type of patients. Skin typing used to determine the ‘skin colour’ of patients. Darker skin patients will require modifications to treatment parameters. This includes a lower percentage of chemical peels, conservative protocols for lasers and energy devices and in some cases pre and post treatment of skin to reduce but not eliminate the chances of PIH- post inflammatory hyperpigmentation- skin darkening. The very first step in scar revision is to accurately determine the subset of scars you have. This is best done with a real time examination. Factors such as animation (rather than static photographs) are frequently used to determine the amount of ‘deep scarring’ /anchored scars or tethering. Palpation or touch is also extremely important to determine the presence of dermal and subdermal fibrosis. Scars that have altered ‘texture’ either hard or soft (atrophy) are more challenging to treat compared to scars with ‘normal’ texture. In some cases the use of angled lighting can be employed to accurately map scar types. My answers given in the context of this question is a general plan given the limited information. For an accurate guide, one has to take into consideration factors such as animation, touch, feel, real time examination and most importantly subjective measures, namely patient expectations. A real time consult with a procedural dermatologist or plastic surgeon is required for the best accuracy- diagnosis. All the best, Dr Davin S. Lim, Dermatologist. Brisbane. Australia.
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June 7, 2020
Answer: Pulse dye laser- vascular laser, fractional therapy - TCA Many ways to approach this pattern of scarring. Ideally red can reduced with lasers. Fractional laser can help, careful TCA in strategic area can also shrink down the scar. In this pattern, subcision is probably lower down my list. The ideal treatment for acne scars will depend on the morphology of individual scars. For example, rolling scars are best treated with subcision, atrophic scars with fillers, pick-ice pick scars with TCA or Phenol CROSS/ Paint, box-scar scars with fractional laser/ modified TCA/ phenol chemical peels, hypertrophic scars with steroid injections/modulated fractional delivery. Energy devices such as lasers, microneedling RF and bipolar radiofrequency are other methods to treat ‘general’ scar types. For example devices can improve rolling-tethered scars as well as ‘deep - superficial scars’ such as broad ice-pick scars and broad box-car scars. Devices should be viewed as a method of scar revision, and rarely as a sole modality. Exceptions do apply- for example in patients with predominantly shallow/broad box-car scars and or superficial pits. Another factor that will determine the ideal combination of treatment is the skin type of patients. Skin typing used to determine the ‘skin colour’ of patients. Darker skin patients will require modifications to treatment parameters. This includes a lower percentage of chemical peels, conservative protocols for lasers and energy devices and in some cases pre and post treatment of skin to reduce but not eliminate the chances of PIH- post inflammatory hyperpigmentation- skin darkening. The very first step in scar revision is to accurately determine the subset of scars you have. This is best done with a real time examination. Factors such as animation (rather than static photographs) are frequently used to determine the amount of ‘deep scarring’ /anchored scars or tethering. Palpation or touch is also extremely important to determine the presence of dermal and subdermal fibrosis. Scars that have altered ‘texture’ either hard or soft (atrophy) are more challenging to treat compared to scars with ‘normal’ texture. In some cases the use of angled lighting can be employed to accurately map scar types. My answers given in the context of this question is a general plan given the limited information. For an accurate guide, one has to take into consideration factors such as animation, touch, feel, real time examination and most importantly subjective measures, namely patient expectations. A real time consult with a procedural dermatologist or plastic surgeon is required for the best accuracy- diagnosis. All the best, Dr Davin S. Lim, Dermatologist. Brisbane. Australia.
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