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We see this pattern in patients who fit one or more of these profiles: History of severe cystic or nodular acne with multiple deep lesions in the same area Years of picking or squeezing pimples before seeking care Chronic sun exposure without consistent SPF use (very common in South Florida) Compromised skin barrier from over-treatment with harsh products Mature patients (over 40), where capillary repair capacity is naturally slower The practical takeaway: if your PIE has not visibly improved after 4 to 6 months of consistent home care, the natural-fade window is closing and professional vascular treatment becomes the realistic path forward