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Hi yall, Im looking for advice on how to go about treating these hyperpigmented boxcar scars. Ive been recommended a bunch of treatment plans from doctors, ranging from RFMN, TCA CROSS, fractional Erbium:YAG laser (Im Asian), to Picosecond lasers. Im so confused!
First off, how deep or shallow would you say these boxcar scars are? Would a couple of laser resurfacing sessions be enough? Secondly, do we think these scars are tethered, and do I need subcision?
To be honest, the brown spots are whats most bothersome to me. Im not sure if they are hyperpigmentation or shadows cast by the scars. What do we think?
Would appreciate any advice! Thanks!
These look shallow-ish to me but also not "easy" to treat by any means.
I would imagine that ablative fractional laser with PRP might be helpful, but probably not just "a couple" of sessions. You might need quite a few.
Whether or not subcision would be helpful, I'm not sure about that since they are shallow, but you can ask a doc.
I'd say one of the most important things for you to do is to go with a doctor who has similar before and afters for you to look at. Make sure you go with someone who has treated similar scarring. I think it's a little unique what you have going on.
They look very shallow to me, especially when the light hits in the first picture. The redness might make them look deeper than the actual texture, because redness makes it look semi-transparent. I don't think I'd recommend subcision, the areas are tiny and shallow. I'm testing fractional laser and that's probably something to research. I would try a test spot or two. I always suggest that. Even after 1 spot of my own, I still can't tell lol.
PRP microneedling might work. Some swear by it. I got a consult a week ago where the woman wanted to do that with me "possibly with erbium". I shied away from PRP microneedling recommendation in my case because I feel like that sort of random trauma could undo prior success in my case. But you have much healthier younger skin around the spots so PRP microneedling might be really good for you perhaps. Especially given the number of spots.
As for redness, it's possible vbeam could help. I had 4 vbeams, but it was hit or miss. I noticed some coloration downsides like more pale overall but vbeam targets redness/vessels so that's kind of to be expected. Maybe zapping each spot with vbeam specifically rather than the whole face would be worth it for you.
Summary: Investigate in order Fractional c02, vbeam/other redness non-ablative laser, PRP microneedling. Possibly investigate light peels or medium peels? I don't know much about those but dealing with shallow issues this might be worthy of investigation.