Dr. Sam Lam Plastic Surgery Forum

Hi Dr. Lam~
Can you please tell me if these scars would respond well to silicone?
Thank you for your time!!

just based on the photos, they look more amenable to CROSS. i think silicone won't help.
best,
sml

Do you think Cross TCA is the best option? If so how many treatments and what kind of improvement would you expect to see? What are your thoughts on fraxel re:pair?
Thank you!

probably 3 rounds of CROSS would give you 50 some % improvement. i have no experience with fraxel repair. i can say that i was working on a book project with a prominent fractionated guy who has worked with multiple machines. i was looking to buy one specifically for acne scarring. he told me don't bother. does that mean it does not work? of course, not. i just don't have clinical experience with it and decided against it based on those comments. here is the problem also, i see a lot of "failed" acne scarring treatments in my office with a great percentage of them having tried the fraxel repair for acne scarring. in fact, i just got off the phone with a phone consultation with a gentleman from australia who had that experience. but i have a very skewed population because i am seeing failed attempts. there may be an overwhelming majority who have succeeded that never come to me. hope that makes sense.

Again thank you so much for your time and for responding so quickly. How long do results last from the Cross and how far apart do treatments need to be? I am assuming it is important to go to someone with experience with this to get the best results? I am out of state but willing to fly if you think you would be able to help me!! I have been researching for about a year now on options, I was considering fraxel re:pair and the more research I did the more I didn't want to do it! 50% improvement would be great, how long is the recovery time, as in how long would I need off work, if any?

yes, i am very experienced in doing this. the only negative with CROSS is twofold:
1. you must wait several months after at least 2 rounds to see some nice changes since it is compelling the collagen to grow. i would probably wait 6 weeks to 2 months between sessions.
2. recovery- if the area turns red it could be a few weeks (coverable with makeup after a week) or turn pigmented for a few months. we may even need to bleach it with hydroquinone if that happens. hopefully none of those temporary issues arise but giving you the worst case scenario.
best,
sml

Once results are seen, how long would the results last from Cross treatments?

the result is permanent. (obviously i cannot account for any further changes with aging etc.) but for all intents and purposes it is a permanent result.

HI Dr. Lam,

I posted the previous message last summer, I still have not taken the steps to get any treatments done, but I still want to and still plan to! I read on another post of yours that with the Cross method, the scars should be pin sized, if not, only slightly bigger. I provided a picture earlier in which you said Cross would be the best method, however several of my scars are larger than pin sized....I only have a few that are not. What are your thoughts on this?

Thank you!

A few larger than a pin are fine. Typically no greater than say 3-4 mm. And if they are that big I do not like to do a lot like that, just a few. Like everything I have to personally review your case.

Reviewing your photos again, you may actually get some result from silicone in the larger areas.

Ok great, thank you.
One more question, I have read that silicone can migrate, is this common?

obviously, technically, i can say that anything is possible. but the short answer is no. i have never seen it and have worked with docs who have reviewed over 40 years of their work for acne scars with zero evidence of migration. the reason silicone has been touted to migrate is due to one of two reasons. first, the big one: bad technique. if you inject it, you must put little droplets in there and wait at least a month before re-injecting it. that way each micro droplet is held in place. second: use only medical grade silicone. i use only Silikon 1000 from Alcon Labs.
best,
sml

Are there any procedures that should not be done over the cross or the silicone injections? Say in the future I want a chemical peel, microdermabrasion, laser resurfacing...etc...

Thanks!!

i personally think it is fine so long as you give it several months before considering those other modalities.
best,
sml