Scars after picking or acne the skin on the face, neck and chest

Good morning Doctor. I was born in 1979 and i started developing dermatillomania since 1996, it has not stop totally yet but i am so much better and most of the time i keep thing under control. The year that i stopped with it was recently in 2014. So i always had combination to oily skin , pimples and some breakout in mu face, but not cystic acne. But my dermatillomania has left scars in my face, neck , chest.Most of them are white (because of the years i thinks) , they are not deep, they are almost flat (Also i remember that the wound scratch that i made to myself were like 3 mm of diameter and 1 mm deep i think). And i have some red and some brown, I decided to make a laser treatment, so here i my country i went to 2 different laser centrs. In the first one they advised me the fractional laser co2 for about 4 sessions. In the second one they advised me the fractional laser for my face and the fractional laser co2 for my chest and part of my neck. In the second one they told me that they find that the fractional laser (without co2) is ideal for my skin because my skin is not thick and is a little sensitive and something about my capillaries, and that i have open pores as it not goes so deep than the fractional laser co2. My question is this. I am afraid to decide for the fractional laser for my face and in the future it wont be as effective as the fractional laser co2. Because the session of both have the same cost. My fototype skin is between a 3 and a 4 , like 3.5. I am already eating very healthy (as i always tried because of my skin type) but now more taking care of the vitamins and all of that. Can you help me please? I know that you have to see and touch my skin to give a certain opinion but, i would appreciate your orientation, which one should i use, how should my skin be to decide for one of these? (and how should i prepare it, it is little dry right now) Thank you very much. Please ask me as soon as you can, I am going to make the treatment the 7 of June. Thank you very much again.

My heart goes out to you on this.  And it sounds like you’ve done an amazing job with a difficult health issue.  Kudos!  I love that you’re eating healthily.

We sometimes tell our patients at the clinic that everyone picks something, so it’s really more a matter of degree.  Some people pick just a little……and some people pick a lot more than the average.  This is more like your case.  Many psychologists consider picking to the point of scarring as a form of obsessive compulsive disorder (OCD), because it IS very hard to stop. You have a lot of company. And…..please consider seeing a psychologist if you need support or help.

So on the scars, what are your options.

First, and most important (you’ve already done this):

  • Stop picking.  It’s very difficult to make progress with the scars while still picking.  Makes sense doesn’t it.
  • Get help if you need it.  Many need to see a psychologist to get to the root of the anxiety that drives this.  Many of these issues stem from childhood or trauma.
  • See a doctor to make sure your skin isn’t infected. Often we transfer bacteria from our hands to our face.
  • See a doctor to get help with any acne or other skin diseases that may be contributing.

Second phase, treating the scars:

  • Fractional lasers ARE the best for the scarring.  Most of these are either fractional erbium (is that what you mean by fractional laser?) or fractional CO2.  It sounds like your doctors are thoughtful and good, so go with the one you feel most confident in.
  • The fractional erbium (like the Fraxel) is generally better for more superficial scars and scars with pigment problems.  The fractional CO2 laser is generally better for scars that are deeper and where some skin tightening or wrinkle relief would be beneficial.
  • Fractional CO2 on the neck and chest is riskier… than on the face because it can CAUSE more scarring, if the doctor goes too deep or is too aggressive.   Make sure your doctor is very experienced.
  • These lasers won’t always even up color and you may need a different laser to do that.

Good luck to you!   And I hope this helps.

Dr. Brandith Irwin
Founder, SkinTour
Director, Madison Skin & Laser Center
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Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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