Acne Scarring Correction

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This is a podcast on acne scarring and acne scarring is one of those things that is a very deep passion of mine because I believe that people that have that really should be treated to make them look better and make them feel more socially integrated if possible. The traditional way of treating acne scar is to go and sand down the tissues, either using laser or dermabrasion. And believe it or not, the 80% of my patients that come in for treatment have failed these treatments. So I don’t believe it works. And the reason is you’re trying to lower the normal skin to the abnormal skin, which is near impossible, especially when there’s a deep depression. So the way that I look at acne scar now, if you’ve got someone with really deep depressions and they’re completely volumetrically collapsed, then you need to add deep filler to bring it back up, whether it be fat grafting or Restylane or some other product.

But for the majority of people out there where they don’t have that deep, deep volume loss but they have little pits all over, then there’s a better way to do it, which is instead of lowering the normal skin down to the abnormal skin through lasering, I elevate the abnormal skin to the surrounding normal skin. And the way that I do that is through micro silicone injections. Now, silicone has a bad rap because people are using adulterated product or they’re doing it in areas that are unsafe. A typical area that is unsafe is lip enhancement. I do not use silicone in the lips. I have done in the past and I’ve had a few issues with it, but I will tell you that almost every week I’m doing a surgical correction for silicone in the lips. But having done silicone now for about 20 years, I have not had any longterm major issues with silicone.

Because I use silicone 1000 highly purified, I draw it up sterilely a third party and I clean and prep the patient very carefully. The reason I use silicone over Restylane, for example, or other products is that the way to think about it. The skin has three layers. There’s the epidermis, the outer layer, the coating. You know, if you do like a laser at burns, that area off the dermis, which is what constitutes for the most part, the collagen. And when you feel the skin, there’s a thickness to it. That is the dermal layer. And then below it is fat. So Restylane, for example, is injected into the fat layer. If you eject it into the dermis layer, it’s going to show up as blob of clear fluid. That will also be known as a Tyndall effect. So it’s not good. So you, so the way that I inject silicone and micro silicone is I injected into the dermis.

So the dermis is very thin. It’s like a millimeter to maybe a little over a millimeter thick. So it’s incredibly thin. And I’m injecting this permanent filler into that dermis. And you think, well that’s gotta be risky cause you can make it blob up blip up. And actually yes, if you don’t know what you’re doing, you can absolutely create problems. I have seen in my own patients have gone elsewhere after my injections and tried to inject it somewhere else. The doctor can inject it appropriately in the dermis, but I’ve done hundreds of thousands of injections. The way that I do it is I slowly inject it. So it’s one of those things that you don’t do silicone one time and then you get a good result. It takes about three or four times once a month. So it’s very difficult for my patients who fly in and I slowly expand the dermis to minimize or really avoid lumpiness is that you need to put a little bit at a time, wait a month and let it to grow.

And the hardest thing is treating patients from out of town because it’s not one of those things. It’s one and done. It takes many rounds to get there. But it is, I treat more acne, scar failures and I treat patients that are virginal. In other words, they have come in for the first time, they usually have failed everything else and then I’m the last person their last hope and I usually can correct it for them. So I always tell my patients that that swelling that occurs over the first few days is absolute. A falsehood is not a result and not to get too excited about that. And the second thing is that it takes at least three rounds before you see a difference. Some people takes five, some people takes two, some people takes one. But on average, three to four to start seeing a difference. 

And I emphasize it starting to see the difference.

You don’t see the immediate benefit. I mean you don’t see the full benefit. You see the beginning of a benefit and I have now, because I had one lady that sort of pushed me to go beyond 10, 12 rounds. I’m like, wow, I’m now really seeing over the last few years when I start to go more than 10 or 12 rounds, the skin I used to get BB plus results, I’m now getting a minus a results. Of course there’s always can be a lighting situation that’s not good. And of course there may be a situation where you don’t, think it’s awesome. But that is my go to treatment for acne scars with great success. There’s some exceptions. As I mentioned earlier, if there’s a very deep pitted scar that goes all the way down, you’re losing volume while the silicon’s enough to elevate that you’re going to need fat grafting or wrestling to bring up the subcutaneous, the tissues and the fat to be restored.

Silicone is not safe to do that in large quantities. It’s going to migrate will have problems that you don’t want to do that. Also, if people have a very acute boxcar scar, which means that the scar has like a right angle component to it, that type of scar is very hard for the silicone to fully correct. I’ve still been able to correct it, but not entirely. So those patients where that hard edge, is there not a soft rolling edge, in those cases I need support. So for those little things left, I usually use radio frequency microneedle done over a series of five rounds every month. I find that to be quite helpful. Other therapies, other lasers out there, I don’t think they’re very helpful at all. And then if there’s that little edge left and there at least no more than a Fitzpatrick, four meaning no more than a Hispanic, middle Eastern, I can’t treat light-skin Indians or African Americans cause that’s too dark. 

But then I will do a fractionated laser over the edge just to help clean up the edge so that can finish the result. And I only need that in about 5% of my acne scar patients. The majority do quite well with just the micro silicone with or without some RF microneedle. I know that’s a lot to digest with acne scar, but I want it to sort of explain safety benefit is sort of a strategy, philosophy and results. You can look at my before and afters in my website. You can start to understand my philosophy and hopefully this appeals to you. It makes sense. But the biggest thing, it is an expense. It’s an expensive commitment and especially it’s a time delay. You have to wait a while to see those results. Oh, one more thing is that when I find that a patient gets toward 80, 90% of an outcome, I usually tell them at that point they could back off and do it less frequently, like every 90 days so that they can start to see some, let the collagen build itself up over 90 days. 

Because oftentimes there is that extra benefit after 90 days.

You’re not going to be overfilled, but it just adds that extra little push to keep the cost a little bit more less burdensome for them. But the reason I also encourage patients to get through at least the first three to five rounds and they’re starting to see some really good results before they back off, is people get frustrated if they’re not seeing a result quickly. They want to quit and they figured another thing that didn’t work for them. So I really want you to get to the point where you’re 80% happy, for example, whatever defines that happiness for you before we decide, you know what, let’s back off and slowly finish this off, if that makes sense. The one final warning is, as I think I briefly alluded to, is there’s always gonna be a time or circumstance where you go and you just have a bad lighting situation. 

We go, Oh my God, I gotta have another treatment. There’s, it’s not ever perfect. It’s just a good, good improvement. But there’s always going to be a lighting situation or something where you feel as if this was not as bad. In fact, I love what my patient today told me that she’s tried everything and she’s gotten, she said no more than 20% benefit in the past. She’s done, I think four rounds or fifth round today, and big difference as she said, you know what’s great is now people make eye contact with me. They never, they don’t look at my acne scars anymore, and that’s a really very life changing thing if possible. So hopefully you come to see me for this particular problem. Hopefully this was a good explanation for you and you got some of your questions answered. Love to see you in consultation and treat you if need be.

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