Subcision, Sculptra, PIH, PIE, Tretinoin- April 8th 2025

Hello everyone, I am Dr. Qazi, a skin restoration specialist based in Newport Beach, California. My primary focus is on treating acne, scars, pigmentation issues, and achieving facial balance. In this article, I will walk you through one of my favorite cases that beautifully illustrates the importance of volume replacement in scar treatment. I will also discuss topics like Subcision, Rosacea, PIH, PIE, Sculptra, Tretinoin and more.

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The Case: Rolling Scars and Volume Replacement

I want to share an incredible transformation with you today—one that showcases why volume replacement is crucial in treating rolling scars. This particular patient had significant volume loss, which we addressed using a combination of subcision, laser treatments, TCA cross, and Sculptra. The results were remarkable, demonstrating the necessity of addressing both scar tissue and volume deficiencies to achieve optimal outcomes.

Subcision and Laser Treatments

Subcision involves breaking up the scar tissue beneath the skin, allowing it to lift and heal more naturally. We complemented this procedure with ablative CO2 laser for the edges of the scars and TCA cross for boxcar scars. These techniques work synergistically to smooth out the skin texture.

Volume Replacement with Sculptra

Sculptra was instrumental in restoring lost volume. For patients experiencing substantial fat loss, such as the individual in this case, Sculptra provides a durable solution by stimulating collagen production. This approach ensures that the face regains its natural contours without appearing overly filled or unnatural.

Scheduling Appointments and Contact Information

If you're interested in scheduling an appointment, it's quite straightforward. Simply click here to self-schedule your consultation. Alternatively, feel free to call our office during business hours at 949-336-7293.

Understanding Scar Treatments and Their Importance

Treating scars effectively often requires a multi-faceted approach. Let’s delve deeper into some specific aspects related to scar treatments, particularly focusing on temple scars and volume replacement.

Temple Scars and Volume Loss

The temples are areas prone to rapid volume loss due to scarring from acne or other skin conditions. This volume depletion can significantly impact facial aesthetics. In many cases, Bellafill proves effective in addressing temple scars because it not only fills the scarred area but also restores lost volume quickly. Fat transfer could be another viable option if sufficient donor fat is available. However, treatments like Sculptra or Radiesse offer excellent alternatives for volume replacement when fat isn't an option.

Comprehensive Approach to Treating Acne Scars

Acne scars present unique challenges that necessitate tailored solutions. For instance, rolling scars often require subcision to release tethered bands of scar tissue. Following this, fillers such as hyaluronic acid or Bellafill can add necessary volume. Additionally, combining these procedures with laser treatments enhances overall skin texture and tone. It’s important to note that each patient’s needs differ; thus, a personalized treatment plan is essential.

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Advanced Techniques and Considerations in Scar Management

Advanced techniques in scar management continue to evolve, providing new avenues for effective treatment. Here, we explore some cutting-edge methods and their implications.

Subcision and Filler Synergy

Subcision remains a cornerstone in releasing deep-seated scar tissue. While some practitioners advocate for immediate filler placement post-subcision, I prefer assessing the initial results before deciding on additional volume enhancement. Overfilling can lead to unnatural appearances, especially in dynamic areas like the mid-cheek. Therefore, judicious use of fillers like Sculptra or Bellafill ensures long-lasting, natural-looking outcomes.

Managing Risks and Side Effects

As with any medical procedure, understanding potential risks is vital. Subcision can cause swelling, hematoma formation, and, rarely, infection. More concerning is the risk of sagging, particularly in the lower face when combined with aggressive volume augmentation. To mitigate these risks, meticulous technique and conservative approaches are paramount. Ensuring cleanliness and proper depth during injections further reduces complications, such as granulomas with Bellafill.

Questions Answered

• Question: What's the best treatment for scars on my temples?
  Dr. Qazi: Bellafill often works wonders for temple scars due to rapid volume loss in these areas. It effectively addresses both scarring and volume depletion.
• Question: How do you treat hypopigmentation?
  Dr. Qazi: UV light therapy can help improve hypopigmentation caused by lasers. Additionally, tacrolimus and protective measures for surrounding skin are beneficial.
• Question: Do you prefer the Taylor Liberator versus cannula and why?
  Dr. Qazi: Most of my work utilizes blunt cannulas. They effectively break up scar tissue without needing blades, except in localized spots requiring precision.
• Question: Why can we not figure out how to get rid of cellulite?
  Dr. Qazi: Cellulite shares similarities with scars; manual intervention via subcision breaks tethered bands. Fat transfer or fillers like Sculptra and Bellafill further enhance results.
• Question: I got hyperpigmentation after a laser. How should I fix it?
  Dr. Qazi: Sunblock is essential. Consider hydroquinone, Eucerin anti-pigment cream, Triluma, or Pico laser for post-inflammatory hyperpigmentation.
• Question: How to get rid of years of large areas of hyperpigmentation from eczema?
  Dr. Qazi: Start with creams like hydroquinone or Eucerin anti-pigment cream. Lasers may also be considered for persistent discoloration.
• Question: How to determine if atrophic scars on the nose need subcision?
  Dr. Qazi: Subcision isn’t typically necessary for nasal scars. Instead, small amounts of Bellafill placed strategically can yield excellent results.
• Question: Can you explain the difference between tretinoin and clindamycin and benzyl peroxide?
  Dr. Qazi: Benzoyl peroxide kills surface bacteria, while clindamycin is an active antibiotic. Retinoids like tretinoin regulate oil production and stimulate collagen.
• Question: Hey doc, how effective is 15% azelaic acid for uneven skin tone and discoloration?
  Dr. Qazi: Azelaic acid offers mild benefits. Over-the-counter 10% solutions might suffice, but stronger treatments may be needed for severe cases.
• Question: Is subcision less effective without filler? Also, how common is sagging?
  Dr. Qazi: Subcision aims to release scar tissue. Filler placement depends on specific needs, avoiding overfilling to maintain natural aesthetics.
• Question: What do you recommend for cystic acne?
  Dr. Qazi: Control bacterial components with oral antibiotics. Procedures like Accure laser normalize oil glands, and isotretinoin prevents future breakouts.
• Question: Hi Dr. Qazi, would you do patch testing with laser like a Pico?
  Dr. Qazi: Typically, no patch tests are required. Starting with low energy settings and gradually increasing intensity suffices.

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• Question: Are injections still the best for keloids out there?
  Dr. Qazi: Yes, steroid injections combined with 5FU remain effective. Proper technique minimizes risks associated with improper depth or dosage.
• Question: Hi doctor, my nose was red with pores on month two of Accutane and pores closed but still red. Derm said it's not rosacea.
  Dr. Qazi: Post-inflammatory erythema responds well to Excel V laser treatment targeting redness directly.
• Question: Hi Doc, why Sculptra over Bellafill?
  Dr. Qazi: Sculptra suits extensive volume loss better initially, though Bellafill remains a viable alternative depending on the situation.
• Question: Hi doctor, which laser is good for stubborn KP I've tried everything including urea and am lactin?
  Dr. Qazi: Excel V laser shows promise for resistant keratosis pilaris (KP). Vbeam is another option worth considering.
• Question: Would Pico laser help with PIE?
  Dr. Qazi: For red marks (PIE), Excel V is preferable, especially for darker skin tones. Pico lasers excel in treating dark marks (PIH).
• Question: What are the risks of subcision?
  Dr. Qazi: Swelling, hematoma formation, infection, and potential changes in facial structure are possible side effects managed carefully.
• Question: Can you fly home the day of subcision and laser?
  Dr. Qazi: Yes, flying immediately post-procedure is generally safe, provided comfort levels permit.
• Question: What do you think of PRP for men's hair loss?
  Dr. Qazi: PRP serves as an excellent adjunct therapy alongside topical/oral minoxidil and finasteride, enhancing circulation and prolonging growth phases.
• Question: What's the best laser for PIE and PIH?
  Dr. Qazi: Excel V targets red marks (PIE), whereas Pico lasers address dark marks (PIH) effectively.
• Question: How risky is Bellafill due to granulomas long term?
  Dr. Qazi: Granuloma incidence with Bellafill is extremely low (~0.02%). Technique matters significantly to avoid complications.
• Question: Can subcision be done on a temple safely?
  Dr. Qazi: Temple subcision using blunt cannulas poses minimal risk compared to unnecessary blade usage.
• Question: Best treatment for acne scars in the temple area?
  Dr. Qazi: Sculptra and Radiesse offer superb options for temple scar correction via volume replacement.

Final Thoughts

In conclusion, understanding the interplay between scar tissue disruption and volume replacement is pivotal in achieving successful outcomes in dermatological procedures. Each patient presents unique challenges, demanding tailored approaches to deliver satisfactory results. Whether dealing with acne scars, pigmentation issues, or other concerns, personalized care remains paramount.

Feel free to reach out with any additional questions or to schedule your consultation. Together, let’s embark on your journey toward radiant, confident skin!