Hi everyone, Iām Dr. Qazi, a skin restoration specialist based in Newport Beach, California. My passion lies in helping patients with acne scars, pigmentation issues, and collagen stimulation. Every day, I work to restore confidence by addressing some of the most challenging skin concernsārolling scars, fat destruction, and more. Today, I want to walk you through one of my recent cases, share insights into treatments like subcision, TCA cross, laser resurfacing, and volume replacement, and answer some burning questions from my community.
This particular case is fascinating because it highlights how combining multiple techniques can yield transformative results. The patient had significant fat loss and rolling scars, which required a multi-step approach. Let me break down what we did step-by-step so you can understand why each treatment mattersāand how they work together for optimal outcomes.
The Case Study: A Multi-Step Approach to Scar Treatment
When this patient first came in, his mid-cheek area was visibly destroyed by deep rolling scars caused by years of untreated cystic acne. These scars arenāt just surface-level imperfections; they often involve underlying scar tissue and fat loss, making them incredibly difficult to treat without a comprehensive strategy.
Hereās what we did:
- Subcision: First, I performed subcision, a manual procedure where I use a specialized tool to break up the fibrous bands pulling the skin downward. This allows the skin to rise back up naturally over time.
- TCA Cross: Next, I applied trichloroacetic acid (TCA) directly at the base of the scars. This chemical peel helps remodel the scar tissue while promoting healing and collagen production.
- Laser Resurfacing: To smooth out the edges of the scars and improve overall texture, I used lasers tailored specifically for the patient's Fitzpatrick 5 skin type. Precision is key hereāwe avoid high heat to prevent complications like hyperpigmentation or hypopigmentation.
- Volume Replacement with Bio-Stimulatory Fillers: Finally, I introduced bio-stimulatory fillers like Sculptra to address the severe fat loss in the mid-cheek area. Unlike traditional hyaluronic acid fillers, these products stimulate your bodyās natural collagen production, providing gradual and long-lasting volumization.
After two sessions, the transformation was already noticeable. Over the next few months, as collagen continues to build, the improvements will become even more dramatic. Weāll likely revisit TCA cross, additional laser treatments, and possibly more bio-stimulatory filler injections to fine-tune the results.
Why Volume Matters in Scar Revision
One thing I emphasize repeatedly is that volume plays a critical role in scar revision, especially when dealing with fat loss. Many practitioners focus solely on resurfacing, but if you skip volume replacement, youāre missing half the equation. In cases like this, where thereās extensive tissue damage, bio-stimulatory fillers are game-changers. They help re-expand the collapsed areas, creating a smoother canvas for other treatments to shine.
For darker skin tones, precision is non-negotiable. High-energy devices or aggressive peels can lead to complications like post-inflammatory hyperpigmentation (PIH). Thatās why I lean toward low-heat, controlled treatments like erbium lasers and carefully formulated acids like TCA. Itās all about respecting the skinās unique characteristics while pushing boundaries safely.
The Role of Subcision: Breaking Down the Trauma
Subcision is one of the most misunderstood procedures in dermatology, yet itās one of the most effective for certain types of scars. Many patients come to me terrified of the process, fearing pain or further damage. However, once they experience it firsthand, they often describe it as catharticāeven therapeutic.
During subcision, I manually break up the fibrous bands beneath the skin that tether scars downward. Patients often feel a sense of release, as though weāre breaking free years of emotional and physical trauma tied to their scars. For those with ice pick or boxcar scars, this technique creates an immediate improvement in texture and appearance. While not every scar requires subcision, it remains a cornerstone of my practice for treating rolling scars and severe tissue damage.
Skincare Simplified: Why Less Is More
In todayās world, skincare has become overly complicated, with countless serums, acids, and āmiracleā ingredients flooding the market. One question I frequently receive is about peptides. While peptides sound impressive, theyāre often marketed vaguely without clear evidence of efficacy. Skincare should remain simple and focused on proven ingredients like retinoids, antioxidants, and moisturizers.
For patients dealing with acne or scarring, simplicity is especially crucial. Over-exfoliating or using harsh scrubs can exacerbate inflammation and worsen breakouts. Instead, I recommend gentle cleansers, low-dose retinoids, and hydrating moisturizers. Remember, no amount of expensive skincare can replace professional treatments like bio-stimulatory fillers, laser resurfacing, or TCA cross. Skincare complements these proceduresāit doesnāt replace them.
Questions Answered: Insights from My Practice
Letās dive into some questions I received during the live session. If youāve ever wondered about peptides, sunscreen for hypopigmentation, or whether PRP works for closed comedones, youāre in the right place!
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Question: How do I feel about peptides?
Dr. Qazi: Peptides are often marketed as miracle ingredients, but honestly, I find the term vague and misleading. Without knowing exactly which peptides are being discussed and their intended purpose, itās hard to endorse them wholeheartedly. While certain peptides might offer benefits, skincare should remain simple and focused on proven ingredients like retinoids, antioxidants, and moisturizers. -
Question: Is the volume permanent with Sculptra, or is it like a filler that you need to redo?
Dr. Qazi: Great question! Sculptra isnāt permanentāitās a bio-stimulatory product designed to kickstart your bodyās collagen production. Results typically last around two years, depending on individual factors like age and lifestyle. For longer-lasting options, Bellafill may be considered, though nothing truly stops the aging process entirely. -
Question: At what age does cystic acne become definitively scarring, and when should someone initiate Accutane?
Dr. Qazi: Cystic acne can leave permanent scars at any age, so early intervention is crucial. Whether itās Accutane or alternative therapies like the Accure laser, getting inflammation under control prevents further damage. Donāt waitāseek professional guidance as soon as possible. -
Question: Hey Dr. Qazi, can you explain what the micro laser peel is?
Dr. Qazi: Absolutely! A micro laser peel uses low-energy erbium lasers to remove thin layers of damaged skin. Itās an excellent option for exfoliation, improving texture, and brightening the complexion. With minimal downtime (just a couple of days), itās perfect for those looking to refresh their skin regularly. -
Question: Does PRP help with closed comedones?
Dr. Qazi: Unfortunately, no. Platelet-rich plasma (PRP) primarily boosts blood flow and aids in wound healing, but it doesnāt target oil productionāthe root cause of closed comedones. For stubborn comedones, prescription-strength retinoids or low-dose Accutane might be necessary. -
Question: Is there a sunscreen specifically designed for people with hypopigmentation?
Dr. Qazi: While there isnāt a single āmagicā sunscreen for hypopigmentation, products containing titanium dioxide or iron oxide are highly effective. Mesoestetic offers a tinted sunscreen rich in iron oxides, offering both UV protection and cosmetic coverage. -
Question: Should I go on Accutane before coming to you for help with scarring?
Dr. Qazi: Yes, absolutely. Getting active acne under control is essential before pursuing scar treatments. Whether itās Accutane, topical medications, or advanced technologies like the Accure laser, prioritize stabilizing your skin health first. -
Question: How can I get rid of closed comedones? Iāve been using Differin for a few weeks but am impatient.
Dr. Qazi: Patience is key! Closed comedones take time to resolve. Differin (adapalene) is a good start, but if progress stalls, consult a dermatologist for stronger retinoids or systemic treatments like low-dose Accutane. -
Question: Whatās your opinion on peels versus lasers for PIH?
Dr. Qazi: Both have their place! Superficial PIH responds well to peels and topical creams, while deeper pigmentation requires precise lasers like the PicoSure 755nm or Nd:YAG 1064nm. Always tailor the approach to the depth and severity of the discoloration. -
Question: When we do a consultation with you, do you prefer in-person or online, and do we get the total cost upfront?
Dr. Qazi: I offer virtual consultations via Zoom since most of my patients travel from out of state. During these calls, I provide detailed treatment plans and transparent pricing. Face-to-face interaction ensures clarity and trust. -
Question: Do you work with dark skin?
Dr. Qazi: Absolutely! Most of my patients have darker skin tones, including Fitzpatrick types IV-VI. Understanding melanin-rich skin is vitalāI always opt for low-heat, low-energy devices to minimize risks like PIH. -
Question: How do I treat acne on the jawline and neck?
Dr. Qazi: Friction from shaving tools, nighttime irritation, and excessive oil production contribute to jawline and neck acne. Silicone tapes, gentle cleansers, tretinoin, and antimicrobials like dapsone can make a big difference. -
Question: Which filler would you use on indented glabella frown lines?
Dr. Qazi: Frown lines require caution due to dynamic movement. Instead of traditional fillers, consider subcision followed by Botox to relax the muscles and soften the appearance. -
Question: Is there anything to help with keratosis pilaris (KP)?
Dr. Qazi: Start with urea-based creamsātheyāre affordable, effective, and widely available. Brands like Eucerin offer great options. Urea softens rough patches and reduces KPās bumpy texture.
Final Thoughts: Empowering Patients Through Education
Skin restoration is not just about the proceduresāitās about empowering patients with knowledge. By understanding the science behind treatments like bio-stimulatory fillers, TCA cross, and laser resurfacing, you can make informed decisions about your care. Remember, every journey is unique, and patience is paramount. Together, we can create beautiful, lasting transformations.
If youād like to schedule a consultation or learn more about my approach, visit doctorqazi.com . Until next time, take care of your skināitās worth it!
