Can C02 laser be done a week or two after subcision?

Question

I plan to have subcision done by a different doctor than my laser treatment, that's why I can't do it on the same day. Would like to know if the results will be less effective if the subcision is done several days or weeks before the laser vs. having both done on the same day? Also, how important is subcision in combination with laser for correcting rolling scars? Will laser do anything on its own or is subcision necessary to see good results? How long is the skin bruised/swollen from subcision?

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HIDEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be been improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional laser such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone.

Subcision works well alone and in combination with other laser and RF platforms, including fillers and air subcision. TCA Cross can be combined with subcision. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian

Subcision works well alone and in combination with other laser and RF platforms, including fillers and air subcision. TCA Cross can be combined with subcision. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian

Jason Emer, MD · Answer

This should be fine, but I recommend following up with your Doctor about their recommended timeline. Yes, a combination approach will give the most improvement to rolling scars. These types of scars need a combination of lasers, microneedling/prp, Cosmelan, subcision and fillers. It will take a series of treatments and may need some treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Steven M. Daines, MD, FACS · Answer

Subcision alone is not a powerful treatment for acne scarring which is why it is usually combined with other modalities such as filler, laser, dermabrasion or peels. I would choose the same doctor to perform both modalities (subcision and laser) as the physician who performs the subcision will have very little "skin in the game" (excuse the pun) while you will likely hold the physician who performs the laser accountable for the final clinical result.

Arbella Sarkis, MD · Answer

Yes, generally, lasers are also required for best results. Each are doing their own work with different targets.
These types of procedures are commonly performed at the same time. Therefore, week or two later shouldn't negatively impact your subcision. 
However, the cost will likely be more when performed separately than at once. There will also be some duplication of down time. 
In terms of cost, I prefer and believe it is beneficial to use PRP with each procedure. It takes roughly as much PRP for a single combined treatment than a single treatment. Prep time is another factor that will add cost. Such an approach doubles things up. 
Time is money. Both in terms of physicians time and your extended amount of recovery time.
The extra PRP will certainly be beneficial. However, being so close together I doubt you'll get your moneys worth of benefit.
Lasers on their own with PRP can work, but highly dependent on many factors. Absent photos or evaluation it is impossible to make a determination or hazard a guess.
Bruising is again another multi factorial issue that is impossible to estimate with the scant information available.       
Wish I could help more.
Warmly,
Arbella Sarkis, MD

Davin Lim, MBBS, FACD - Account Suspended · Answer

For tethered and rolling scars, subcision is the stand out procedure, most often I combine this with CO2 high energy, but low density - namely DEEP CO2 if downtime is not an issue. All the questions and more answered in the web reference below- it really depends on your scar type and tissue response. 
Acne scar revision is a sub-specialised field. For the best results, one should target the acne scar type with ideal treatments and not just one device. The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 
  
For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, PRP and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal scars. 
  
The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best, 
  
Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

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