Case 17- Shadowed fillers

Diagnosis: Rolling and atrophic scar, follicular scars
Treatment: Once again I use shadows to my advantage to remove acne scars. Overhead lighting cast a shadow that enables me to detect subtle undulations. I then spend 30 minutes injecting and building atrophic and depressed areas, always changing the angles of light to ensure scars are corrected. Most patients will require 2 sessions for an 80% improvement in atrophic and depressed scars. Dermal fillers last beyond 18 months.

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Case 16- Instant scar removal with fillers

Diagnosis: Rolling and atrophic scar, follicular scars
Treatment: This is my special method of scar revision. I like to work under down lighting to find scars hiding in the shadows. Placing fillers in gaps and edges helps remove acne scars. I finally fill the tiny depressions on the temple areas to achieve an almost perfect result. Dermal fillers last beyond 18 months.

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Case 15 - Atrophic and mixed scarring

Diagnosis: Atrophic and mix scarring
Treatment: In this case only dermal filler was used. 3 sessions to get this result. The advantage with dermal fillers is that there is little downtime, however the results are not usually permanent, and need to be repeated every 12-18 months.

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Case 14 - Atrophic scars, with out any ice pick, box car nor anchored scars

Diagnosis: This is the other side of case 13- predominantly atrophic scars, with out any ice pick, box car nor anchored scars.
Treatment: In this case only dermal filler was used. Two sessions to get it just about perfect with the surrounding skin. This illustrates that fillers can be used for certain scar types with little, if any downtime. The great thing about fillers is that results are instantaneous.

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Case 13 - Mixed scars

Diagnosis: This is another example of mixed scars, predominantly ATROPHIC together with ROLLING and tethered scars. This combination makes this a rather difficult combination of acne scars to treat, especially if little or no downtime is needed.
Treatment: In this case I used a combination of both surgical procedures (subscion), along with a dermal filler, 3 treatments over 3 weeks. Virtually back at work 10 minutes later. I would expect results to last 14-18 months, or even longer given the subscion.

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Case 12 - Rolling, atrophic and tethered scars

Diagnosis: This took 16 months to complete due to the fact this lad had severe scarring (rolling, atrophic and tethered scars), on the background of severe cystic acne.
Treatment: Acne had to be treated with Roaccutane, a wash out of 4 months was given before fractional and full face laser, followed by Juvaderm Volbella filler. Marked improvement in acne scars with the fillers-even more so than lasers, given atrophic acne scars.

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Case 11 - Mixed scars

Diagnosis: This is an example of mixed scars, predominantly ATROPHIC together with ROLLING and tethered scars. This combination makes this a rather difficult combination of acne scars to treat.
Treatment: Multiple treatments were needed over 4 months, though we got some success with fractional lasers and subscision, the biggest improvement were with dermal fillers – in this case Juvaderm Volbella. Though there is a substantial improvement I do believe another layer of Volbella can improve things even further. This should last between 9-12 months, maybe even longer.

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Case 10 - Atrophic, tethered, box-car and rolling scars

Diagnosis: Due to a medical condition, lasers could not be used in this patient. She had severe atrophic, tethered, box-car and rolling scars on the cheeks and temples.
Treatment: I had to use fillers in two separate sessions to achieve this result. Fillers were used in conjunction with subscision as local anaesthetic was in the filler. We achieved a great result that should last up to 12 months in this area. Her temples were also treated with Juvederm Dermal fillers with a similar result. The advantage of fillers to treat acne scars is that results are instantaneous, with no downtime to the patient. Risks and side effects are minimal, and results are predictable. The downside is that fillers need to be repeated every 6-18 months, depending on the area and type of filler used.

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Case 9 - Atrophic box car scarring and depressed scars

Diagnosis: This is an example of atrophic box car scarring and depressed scars, together with tethered and anchored scars on the temples - a very common place for acne scarring.
Treatment: Acne scarring in the temple area can be resistant to laser treatments- even using the latest in fractional CO2 and Fraxel lasers. The use of a dermal filler in this area can improve scarring markedly. Fillers in this area are very difficult to perform as there are numerous blood vessels in the temples, additionally the skin on the temples is very thin and fillers need to be placed superficially. Fillers for scarring in this area often last upwards of 8 months.

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Case 5 - Enlarged acne pores, minor acne scarring

Diagnosis: Enlarged acne pores, minor acne scarring
Treatment: This patient has enlarged pores, treatment was with full laser resurfacing. Recovery time was just over 8 days. Redness will settle over 2 months, however can be hastened with V Beam Laser. One treatment to deliver permanent reduction in pore size.

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Case 4 - Severe scars, Asian male

Diagnosis: Severe scars, Asian male. Acne scars mixed with skin pigmentation
Treatment: Laser resurfacing Erbium Micorpeel combined with Fractional Laser resurfacing. One treatment. 4 days to recover. The pictures depicts before, immediately after laser, and day 4 after Erbium laser. Ideally this patient will benefit from another laser treatment.

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Case 3 - Moderate to severe mixed scars

Diagnosis: Moderate to severe mixed scars, including hypertrophic scars, box and rolling scars. Extensive acne scarring on cheeks, temples and chin area of female patient.
Treatment: Laser resurfacing Erbium Micorpeel (Full resurfacing) combined with Fractional Laser resurfacing. Patient took 8 days off work to recover, however only one Full Resurfacing procedure was conducted, followed by 2 vascular laser treatments to reduce redness.

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Case 2 - Moderate severity box-car scars on type 2 skin

Diagnosis: Moderate severity box-car scars on type 2 skin
Treatment: Laser resurfacing Erbium Laser combined with Fractional erbium at the same time. One treatment. Subscision used on anchored scars on right cheek, all in the same procedure. Only one scar revision procedure performed.

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Case 1 - Moderate to severe box-car scars

Diagnosis: Moderate to severe box-car scars, present for 20 years
Treatment: Laser resurfacing Erbium Micorpeel (Full resurfacing) combined with Fractional Laser resurfacing. One treatment. 8 days to recover. Excellent improvement with only one treatment

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