Subcision is the process of elevating the tissue under the skin and scarred areas, to allow the depressed scars to elevate to the more normal unscarred skin. This is the first step in making the scars look better. The depression in acne scars can cast a shadow in this area, the darkness clues people on the status that the particular area is not like the rest (ie it looks like a scar).  After the scar is more elevated then you can proceed to polish the skin level to get it to look more like normal skin. The polishing step is when we decide to do laser resurfacing and dermasanding. Dermasanding is the process of dermabrasion with medical grade sterilized sandpaper.  This is a more accurate way of doing dermabrasion in Dr. Young’s opinion. It also avoids spreading infection to the people around.

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Our team at Aesthetic Facial Plastic Surgery!

Acne is a process that can affect all layers of the skin. The process originates from the hair follicle. The hair follicle depending on the point of the growth cycle that it is in will have a certain length that it goes in the skin. At times, the hair follicle will be very deep and sometimes less deep. The point is that when acne erupts, the process can extend deep into the skin and affect all the layers even the area deep to the skin. When scars form from Acne, they also affect all the layers of the skin. So the scarring is really pervasive. That makes treating acne difficult as well. When it comes to excisions, acne scarred skin is less pliable and it doesn’t stretch as much. This makes for a more difficult time with healing. Better results are harder to achieve. So you want to heal your skin. We believe that you have to prep the skin before you actually do other things like excisions, subcisions, punch grafting, flap reconstructions, and deep chemical peeling.  We have a 3-4 step process that we like to do for people. It entails 1. tissue grafting, 2. more invasive work such as excisions, subcisions, deep chemical peeling, punch grafting, flap reconstructions, 3. More refinement, 4. co2 laser resurfacing and dermasanding. Our goals are to heal the skin first, treat the skin with more invasive procedures to get the scarred skin to the same level, repeating the second step until the goals are reached, then refining our results with a polishing technique that entails co2 laser resurfacing and dermasanding.

You can go through our webpages with this in mind to better understand what we are aiming to do.

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Our team at Aesthetic Facial Plastic Surgery!

Dr. Young,

Patient: I wanted to thank you again for your personable consultation the other day.  It’s never easy talking to a stranger about one’s insecurities, but you certainly made it comfortable enough that I am considering your recommendations.  Just a few questions I first need to ask.

Dr. Young: It was my pleasure.

Patient: Why did you choose the subcision with the chemical peel over other procedures? .

Dr. Young: I think that laser resurfacing may not fully cause those ice picks scars to come up to the level of the rest of your skin.  They (laser resurfacing / dermabrasion / Dermasanding) are better when the surfaces are more closely aligned. and leveled.  The chemical peel will get the ice picks to come up and the subcision will make them rise by stimulating from below.  Alternatively you can add fat grafting with the subcision for more of an effect. I would do the subcision / fat grafting first and then 1-2 weeks later do the chemical peels so that your skin is not too traumatized.

Patient: What are the alternatives?  And do they offer similar or less satisfactory results?

Dr. Young: You can cut around the ice picks and then raise them. This could help. They are more work though. You can add filler underneath them. You can excise a group of ice pick scars that are oriented in a pattern. You can do Dermabrasion but again resurfacing would be the last step. You can laser just the ice pick scars to get them to rise up (not as effective in my experience)

Patient: What are the side effects of these procedures?

Dr. Young: The side effects are mostly swelling, bruising.  Sometimes if you are too aggressive the scars could get wider but flatter. That is why I stage the subcision and chemical peels sometimes if the scars are deep and prominent and numerous.

Patient: How long is the procedure, and is it performed at the same clinic?  Do you schedule surgery on Fridays?

Dr. Young: The procedure will take about 1-2 hours. We can do Friday’s. We do the procedures here. We are AAAHC certified  here is a link http://www.drphilipyoung.com/aaahcplasticsurgery.php to our plastic surgery AAAHC certification page

You can see more of our Acne Scar Revision Before and Afters here.

Thanks for Reading Dr. Young

The patient mentioned this: “I actually have an epidermoid cyst and dermatologists told me that there is no way to get rid of them without a scar. she said you can leave them alone and hopefullly one day they can go away.. is this the best advice with no scar ?”

I answered:”They could get worst and get infected.  If you don’t mind the cosmetic impact then you can wait and see what happens. I don’t usually see them go away and if they do it takes a long time”

Epidermoid cysts occur when there is some event that causes the hair follicle or pilosebaceous unit to become clogged and then the lining of the hair follicle starts to grow and form a cyst or pocket that goes into your tissues.  I am unaware of removing them without a scar. Usually the best way is to excise the lesion to get rid of them.  There are ways to make the incision look better.

Thanks for reading, Dr Young

Dr Young specializes in Plastic Surgery and is located in Bellevue near Seattle, Washington

Excision is an important technique in Acne Scar Treatment. There are some scars (many of them actually) that will benefit most from excisional methods The outcomes are variable depending on your genes, the degree of your scar, location, healing, procedure preparation (how you prepare for the procedure), etc.  One person / client may have more of an issue with healing because of reactions that they may have to the suture used. I have had many patients whose bodies are just not as compatible with some of the absorbable sutures that we use to close incisions. Their bodies react to the sutures and the healing can be very difficult. In this situation, I use more permanent less reactive sutures to close the incision. The skill, consideration, and experience of the surgeon / doctor can have a major impact (among many other variables). I think that people with acne tend to have healing issues more so than the general population because their skin’s vascularity is compromised and hence the tissue and closure of the skin heal in a less than desirable manner. The way to combat this situation is to do fat grafting, in my opinion. Fat grafting as a procedure that starts off the whole process can really help the situation. It does this by freeing up the scars, increasing the vascularity to the skin, stretching out the skin so that the scars are not as deep, etc. Also there are stem cells in the fat that may contribute to healing the skin as well. The healthier skin after fat injections can have a significant impact in healing when future procedures are done. Frankly, there are some scars that will only respond most favorably when excision is the major method that is used.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington