On Tuesdays, we cover the latest research, but on Monday nights, we cover common questions with our new providers and pearls about the various techniques for the different procedures.

Last week we talked specifically about ways to help men recover after prostate surgery, penile rehabilitation, went through a protocol and I sent that out in an email. If you missed it and are interested, it should be in your email. If not, call us because somehow we’ve got on your spam list or something.

This is also an open forum for someone if you have questions and to answer questions that might get posted to the website.

So when I log in, if you look at the top, there is a little icon like you would have in a cartoon indicating a text message. The software looks all the way through the website, and if anyone posted a question anywhere on the website, it shows up there, and I can click it and bring it up on the webinar.

There were no questions again this week, so it looks like our group is actually growing and may actually be working. I thought tonight we would cover my best pearls for treating acne scars or scars in general and give you…

Well, actually, more specifically, I think let’s talk about acne scars because you can carry that over to keloid and surgical scars. But maybe we’ll do that next week because if I include all that, it could go on for several hours. I’m logged into the Vampire Facial® website because microneedling is a big part of what you do to help people with scars. You’ll also find this information on the Vampire Facelift® website because you can also use an HA filler.

I will diagram it for you and give you a three-step process, and then we’ll call it tonight. It will easily come in under 30 minutes.

If you’re already skilled at treating scars, this may not apply to you. Just for kicks, I haven’t tried this yet, but let’s see what comes up if we ask our AI about it.

How do you treat acne scars?

Let’s see if it gives a good answer. I will summarize it, but I want to know if it does a decent job of thinking. We’ll be back to treat acne scars for each target.

Oh, this AI is reading our websites, so it’s not going out on the internet. Now we’re up to 900 videos and millions of words over the past decade plus adding to this website, me and others who have been on here as guests, many different specialties from multiple countries. So hopefully it will be reliable. Let’s see what answer it gave us.

One notable approach is microneedling combined with platelet-rich plasma. This method involves microneedling stimulate collagen reduction. PRP can be injected to aid the healing further, additional use of TCA enhances. Moreover, subcision is another technique that involves breaking apart fibrous tissue. This could be paired with microneedling in PRP. It’s also topical treatments. Here we go. So they did it. They pulled it up and they gave…

Those are the journal clubs where we talked about it. In the past if you would’ve used this search bar right here, it would’ve just given you all of those different times we talked about it. I’m going to summarize the whole thing with three pictures, but isn’t that beautiful? There’s a nice summary and references from our own website. We’ll say, yeah, that was helpful, but we’re going to do something even better. Let me swap over and I’ll draw you a diagram, three little sketches and we will be done.

By the way, this can be so life-changing for a young person, male or female, to be… One or two scars is bad enough, but if you have multiple scars, this can be truly socially inhibiting. So when you treat someone for this, they love you for it. It changes their life. Let me change what you can look at. Hold on a moment. Here’s my technique for treating scars. This would be some acne scars, is what we’re talking about. This would be someone who has horrific acne scars all over their face.

Where do you even start?

I start by asking them which scars do they hate the most? Because they don’t like their face, but they have some that really bothered them. Maybe it’s on the nose or it’s between their eyes or something.

But I’ve never had someone say, “Ah, it doesn’t matter to me.”

They have some that they really hate the most. So you find those. The first thing you do is you subsize with PRP. AI did a decent job, but I think I can draw it better than it described it.

So if this is the scar like that, and here’s the flatness of the surrounding tissue, you don’t have to use a different needle, just come in with your little 30 gauge. It doesn’t have to be big or 27 at the most. And you’ve used your topical 30% lidocaine ointment, not a cream, but an ointment.

You come in underneath it, this is your needle and you inject your PRP, subsizing back and forth under there and injecting as you do. So you’re cutting the tethered tissue and you’re raising a wheel at the same time. So you’re subdermal. When you’re done, it looks like this.

It’s actually raised some because you’ve filled this with PRP.

So that was subsizing.

Then you take your needle and you inject, intradermal.

That’s a little tricky because if you’re not deep enough, it goes subdermal like you did up here. If you are too shallow you give them a bath or it sprays. So it helps to have glasses on when you do this. B

ut once you get the knack of it, you can get bevel of your needle actually into the skin. The skin has some thickness to it, and so you want to have your bevel right in the skin. You know you have it right because now when you inject your PRP, the skin blanches from the injection. So now you’ve done intradermal. You don’t do this if their face is covered with scars. You can’t do that with every scar, but you do it with the deeper ones and you do it with the ones they most dislike.

If it’s really deep, you can put a little filler. If it’s depressed like that, you can not only inject the PRP after you subsize it, but you put 0.1 or 0.2 of HA filler to raise it up and then dig all the rest. You put filler, then the PRP and now subsize and you have got a HA under there too.

It’s still like Juvederm® Ultra Plus is the best, but whatever your favorite flavor is. If I have a really large depressed scar, then I always use the HA. Large as in an example would be someone who had a umbilical piercing and now they took it out or it was torn out and there’s a defect that’s a half an inch and there’s no tissue there.

Another example is someone who has atrophy. I had someone who had pretty significant atrophy of the skin overlaying a bone, the ankle.

If it’s fatty tissue, if you have atrophy and a depressed area from a cortisone shot that did not make it into the muscle, which is pretty common trying to do intramuscular, had a cortisone shot into the buttocks and instead it’s put into the fatty tissue, you get atrophy that’s significant. It looks like someone can put their thumb into the hole. With that, you don’t even need HA filler. You just fill it up with PRP and the fatty tissue will fill it in. Back to the acne scars. That’s the first two steps. I don’t really need the HA unless it’s significantly depressed. Most of the time I would just do this for acne. The third step would be the microneedling.

And these do that everywhere. You do a Vampire Facial®. Now when you do the Vampire Facial®, the research shows that actually TCA, which is why you saw that AI answer mentioned it trichloroacetic acid, and I like the VI Derm people or the VI Institute, they have VI Derm and they have a VI Peel that is only 5% TCA. I would not do a 10% TCA.
I think you risk burning people. I never had it happen to me, but I saw two women horrifically scarred from a TCA pill that was a 10%, both done by very prominent plastic surgeons in Mobile who I highly respect. When I saw that, I quit doing the Obagi Blue Peel, which uses 10% TCA.

I stick to the 5% TCA, which has a little salicylic acid mixed with it and the VI Derm formulation, and you alternate. TCA combined with microneedling has actually been shown in one study to be more effective for acne scars than PRP combined with microneedling. But they hit it from two different mechanisms. Of course in the studies they don’t combine, they just compare.

On treatment one, I would do undermining, and you already have your PRP there because you’re undermining and you’re injecting PRP after you subsize, subdermally, intradermally, then you microneedle.

This is the first time, go ahead and put PRP topically during and after your microneedling. They go home with it, wash it off the next morning or that evening if they want before they go to bed. Then you put them on Retin-A, not the 0.25, the 0.1%, Retin-A. The VI Derm people have a formulation that has vitamin mixed with it, but just the plain Retin-A gel. I think works better instead of the cream, is more of a moisturizer.

But you could use the cream. That will actually cause a peel itself. If they’ll use a full gram of it every night before they go to bed, they’ll get a chemical peel from that. If they keep using it will help with restoring a healthy dermis and help augment what you’re doing.
Retinol is definitely not the same as Retin-A and does not work as well. Retinol is the same as if you took a vitamin A capsule out of a bottle of pills from Walmart and broke them open and smeared them on your face. I

t does something, but it is not as effective as Retin-A prescription strength, high strength Retin-A. Here’s the whole recipe. You subsize with PRP injecting, turn the depressed areas… just the big ones. You can’t do this the whole face. That would feel tormented and it would take half a day. Just do the ones they hate the most. Then you inject those same deeper ones intradermally but then you microneedle the whole face with PRP topically. So that’s your Vampire Facial® part.

I have one other secret trick I’ll tell you in a second. Bring them back four to six weeks later, do the whole process, but this time when you do it, use the TCA.

So you do the micro-needling and then you do a 5% TCA pill on top of that. You do that every four to six weeks until they’re happy. Probably I would sell it in packages of three for someone with severe acne scarring.

Now here’s the other trick that I haven’t talked about much. I teach it in my workshop, but I forget to talk about it often. Oh, and you put them on the Retin-A.

That’s the full treatment. It doesn’t work as well if it’s a male, but if it’s a female and they have any loss of volume at all, then just do the plain straight-up Vampire Facelift®. Especially if you have a woman past the age of 20, really, and especially if she’s lean. Because think about it, imagine a basketball to think of the physics of it with many depressed areas, if you put more air in the basketball and the basketball gets larger in diameter, then that alone would make the depressed areas more shallow.

So without doing anything to your acne scars at all, if you put an HA filler in their cheeks and restore volume to the cheeks, you will see less depression of the scarring before you even treat the scars. Again, that only would work if you had a female for whom you could put filler in their cheeks without making them look odd. Would not work in a male, of course, if you’re going to, unless you had a lot of volume loss already from age or just body habitus.

It’s a wonderful thing to do for really, the 25 and up year old female because you can usually add volume with an HA to a female and at a pretty generous portion without making her look odd. Of course, in the mouth and other areas, you have to be more meticulous and sparing, but in the cheeks you can be pretty generous. That expansion will improve the appearance of the scars really in the whole cheek and up to the eye area because it causes increased tension and stretch on the skin when you add volume to the cheeks.

That’s my last tip. As far as pigment changes, your Vampire Facial® will help that as well. It’s still, I think, a very, very useful thing to prescribe hydroquinone, and you can do that just regular prescription or if you have a skincare line, you can do it that way. That would be at night applied as well. I think with that, let me see if there are questions and if not, we will call it a night.

That’s my best protocol for treating acne scars. If you want more details, the research that I refer to and more will be seen on that. I’ll take you back for those who showed up late. So when I demonstrated logging into the website and putting in the question in the AI, it brings up a computer generated answer, but then it also brings up the resources, and when you click into it, there will be references to those different answers. I think with that, let’s see what questions there are, and if there are none, we will call it tonight.
Hold on a moment.

Let’s see. How many treatments, hey Irena, for acne scars and what’s the timeframe between?

Of course, it’s going to vary and you’re just going to go until they’re happy or until it quits improving.

But I would ask people to commit to three treatments, four to six weeks apart if they want your best work. If they happen to just love it after the first one, then okay, fine, give them part of their money back.

But you can be certain that you’ll see improvement every time you treat them. And you will see, the research shows it, and anecdotally from our group, we’ve had people who have had microneedling without having the Vampire Facial® part.

Most of these kits come with an HA of some type. Someone did microneedling and applied the HA, but they did not receive the PRP component of our Vampire Facial®. Then they show up with one of our providers and they improve dramatically. My wife, Alex, had a patient like this who had been multiple treatments with microneedling without much improvement, and then she did it the way I just described to you and the man had a life-changing result.

Let’s see if there are other questions. Okay, I think that’s it. I hope that’s helpful to you. I will be on standby.

Hopefully I’ll see some of you tomorrow in the journal club.

Good night.