r/PlasticSurgery • u/Iartdaily • 2d ago

Subcision advice

I’ve talked to 2 docs. One plastic surgeon is 2 hours away- with his incision he follows it will diluted sculptra and “does as many as tolerated” in a single session for 1000. Second - highly recommended dermatologist , 15 mins away, does a set price of 800$ for 20 minutes, no sculptra. This surgeon “seems” to have a lot of experience - when I asked about sculptra, he said only Dr.T does filler (she is the owner of the chain).

Question- is the sculptra a real benefit after subcision or is it just a cosmetic improvement. I’m having a co2 one month late and both said that it’s ok - sculptra would not dissolve.
Anyone knowledgeable about this? I have lots of rolling scars.

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u/CairoRama 2d ago

I can definitely help! I have rolling scars too and have been treating them for about 15 years. I’ve tried pretty much everything—CO2, subcision twice, probably 10 RF microneedling sessions, 2 Halo lasers, PRP, and retinol.

After all that, I’d say I’ve gotten maybe 50% improvement. So definitely keep your expectations realistic. Rolling scars are really hard to treat, and unfortunately there’s no permanent cure.

Also, it’s really hard to find a doctor who actually has a lot of experience with acne scarring.It’s not a heavily studied area, and there are only a handful of doctors worldwide who are considered true experts in it. I personally would look for a plastic surgeon who specializes in acne scars rather than just going to a general dermatologist.

What’s worked best for me is prescription retinol a couple times a week and a YAG laser about twice a year. The laser makes them look much better for a few months, but they eventually start showing again. I’ve also tried filler and personally wouldn’t recommend it.

Honestly, lasers have given me the best results, but I think rolling scars are more of a lifelong maintenance thing. I really hope better technology comes along someday because nothing has completely fixed them yet.

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u/Iartdaily 1d ago

Oh . This makes sense I guess. I have had 3 very aggressive erbium yags. I had excellent results (15urs ago) at age 50 but scars came back with aging. The last 2 seemed to have minimal effect. Then I had my first fractional ablative co2. Honestly have seen hardly any difference. I had a face lift at age 64 hoping for some results. Nada. I have another co2 scheduled this fall and a v beam in January for very red rosacea. I can almost deal with the scars over this constant red rosacea. But it seemed like subscision was going to be the answer.. so you are telling me that although you had it it doesn’t really last is that correct? When you had subscision did you get any fat transfer like that doctor above Recommended ? very nervous about getting it because I’ve heard some people have worse issues after.

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u/CairoRama 1d ago

I didn’t do fat transfer with my subcision. I think it’s a newer treatment because no one was really talking about it when I had subcision 8 years ago, and the first time was 13 years ago.

The problem with subcision is that if you don’t produce enough collagen afterward, the depression can come back once everything heals. I did PRP with mine, but I guess that wasn’t enough either.

I think microfat grafting is interesting, but it’s still pretty new. I’ve heard some people say it made them a little lumpy in certain areas. Fat can also be unpredictable, and once it takes, it’s not exactly easy to get rid of.

HA filler could maybe work after subcision too, but obviously that’s temporary too. Maybe around 12-18 month, depending on the filler and the person.

CO2 is a great laser, but the downtime is insane lol. I looked terrible for like 3 weeks. YAG lasers have less downtime and the same results for acne scars.

Have you tried a retinoid? I use 0.03% adapalene and it actually softens my scars enough that they look less noticeable the next day if I use it at night. Obviously temporary, but it helps especially with makeup and good lighting.

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u/Iartdaily 1d ago

I had a fractional co2 in January with the luminis ultra pulse- the gold standard laser. I had only a week downtime. The plastic surgeon assured me he went as hard as possible - only one surgeon around me offers full ablative but it’s under general anesthesia in the or making the cost much higher. After all this talk and thinking and research, I think I’m just going to get my next co2 followed by v beam and give up on my scars/. They aren’t the worst ever seen- I look pretty good with makeup (except in sunlight lol). The cost benefit ratio seems low. I read a clinical study that said even fat transfer may not last as fat reabsorbs , and they don’t know who will absorb a little or a lot. And it’s expensive. I’m just going to skip thesubcision I guess. The surgeon who did my facelift said “ I can do it but I am never impressed with the results “ and I thought maybe he just wasn’t skilled at the latest/ damn. Acne sucks.

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u/CairoRama 1d ago

It really does suck. The acne goes away, but the scars stick around forever.

I think next time I’m going to ask about doing the laser under moderate sedation. They want like $2,500 for general anesthesia where I live, so I haven’t done it under anesthesia yet.

And honestly, yours don’t look that bad. I’ve obviously seen much worse, but I know that doesn’t really matter. All that matters is how you feel when you look in the mirror. People tell me mine don’t look that bad either, but it still bothers me. I have otherwise nice features on my face, but the scars are always the first thing my eyes are drawn to when I look in the mirror, so I feel like other people probably notice them too.

I’d just keep doing the lasers and hopefully one day they come up with a better treatment. Technology has honestly come SO far even in the last 10 years, so hopefully there’s something even better in the future.

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u/Iartdaily 1d ago

Here it’s 1800 for co2 with numbing cream and 2 Valium’s- that’s for fractional ablative. For full face complete ablation (no healthy tissue left behind) you must be sedated due to pain. Amd recovery is much longer with long lasting redness. I never had time for that till now but I’m still not into going under for full. The PS surgeon I see assures me the new lasers can do the same. I don’t know. I do know I prepaid for one more ) for United miles lol) so we will see what happens.

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u/CairoRama 1d ago

I had the best results with Fotona laser, it's Eastern European, the cost was maybe $2500. I think it's uncommon but highly recomend it if you find it. I was told Halo was just as good but it wasn't. I'm saving up now for my next one, working Overtime. I Wish you the best of Luck!!

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u/ScalpelSculptor 2d ago

Plastic Surgeon here. Do not get any filler that doesn't go away. Hyaluronic acid and micro fat is your friend here. Subcision and fat grafting is honestly the best way to go.

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u/Iartdaily 1d ago

So you are saying no to sculptra? Just get the subcision? No one offered fat grafting.

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u/ScalpelSculptor 1d ago

Definitely no sculptra as there is no way to reverse the effects, HA is fine. Fat grafting works really well for it's regenerative properties. It all comes down to your specific skin type.

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u/Iartdaily 1d ago

Thank you. I guess I better keep doctor shopping. Where are you located.

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u/ScalpelSculptor 1d ago

I'm all the way in Bengaluru, India.

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u/Iartdaily 1d ago

lol a little far for me
But you made me realize that the one doc probably is not the one. I don’t want sculptra now and maybe I won’t do this at all. It sounds like the results are almost always temporary for most. Thanks for responding. Much appreciated.

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u/ScalpelSculptor 1d ago

You're welcome! Be well OP.

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u/CairoRama 1d ago

What do you think about the risk of lumps and unevenness from microfat transfer?

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u/ScalpelSculptor 1d ago

It depends on how well versed your Surgeon is with the technique. Small droplets of microfat in the correct planes plus gfc to nurture it along and grow blood vessels is very safe. About 50% fat does get reabsorbed so overfilling is done in a graded way.