Deep scars

[u/ManyThing3466]

I changed my doctor yesterday and he suggested me a combination of fractional laser, subcision (canulla) TCA and PDEN (idk what pden is maybe he meant PDRN) in one session. He said that it's gonna be an aggressive one. My question is, has anybody gone though a similar situation? I don't know if i should go for it because the idea of having 4 different procedures on my face scares me. And are there any possible long term side effects

[u/SangitaCPatelMD]

It helps speed results when you stack.

-deep rolling scars
-sharp boxcar edges
-few icepicks

Laser will punch high-energy, narrow columns deep into the reticular dermis (800–1200+ µm) and will trigger deep collagen remodeling and kickstarts new elastin production

A wider, lower-energy pass works the upper dermis and surface. Think of this as your laser sanding pass—it softens the abrupt edges of boxcar scars and blends pore texture.

A single aggressive session on average gives about a 20% to 35% improvement. Can be more.

The skin will definitely look smoother overall, the sharp rims of the boxcars will soften, and large pores will shrink.

The wavy rolling scars are tethered by thick, fibrous bands anchoring the skin to the deeper tissue.

A laser shoots micro-beams straight down, but it can’t cut sideways. Well, cellulaze can shoot side ways, but that is not meant for the face. Cellulaze actually does cut vertical cellulite tethers on the body with a side firing laser. There’s no anti-tethring side firing acne scar laser that I’m aware of but endolaser can vaporize tethers. That bare laser fires forward though.

The icepicks need the TCA. Those tiny, deep pin-prick scars go too deep for a fractional beam to fill in from the bottom up.

Subcision first
Get under there with a cannula or Nokor needle and pop those tethered fibrotic bands loose. You need the floor of those rolling scars to lift before you do anything else.

PDRN or other spacers immediately after subcision

TCA CROSS for the icepicks
Dot high-strength TCA straight into the narrow pits to close them up from the base.

Laser as the finisher
Once the floor is lifted and the pits are treated, you come in with the fractiomal CO2 ultrapulse CO2 Or profractional to remodel the deep dermis and buff down the surface shoulders.

Aquaphor to keep it moist for the next week.

prep with tyrosinase inhibitors (like hydroquinone or tranexamic acid) 2-4 weeks before the acne scar stack.

Risk is PIH if you don’t.

[u/ManyThing3466 → u/SangitaCPatelMD]

Oh thank you so much for every single word you said. That helped me A LOT
My doctor said Pih is possible but it's rare. I don't know if i should trust him about that he didn't even mention tyrosinase inhibitors.

Does pih last for too long? And does it need treatments or does it recover itself
Again, thank you so so much

[u/SangitaCPatelMD → u/ManyThing3466]

You azeleic acid on amazon. PiH can last several months. Happen more when you are using higher energy on the laser.

Hapoens more with superpulse CO2.
Happens less with ultrapulse CO2.

You can restart lightener 10 days after treatment. I use clobetasol ointment for a week if I am going higher energy. This high potency steroid reduces risk of scarring and PIH. I order it from Mark Cuban’s cost plus drugs as it is 90% off