Dr. Sam Lam Plastic Surgery Forum

Hello Dr. Lam. I have not scheduled an appointment with you yet and am very interested in doing so. I do have a few questions that I would like for you to answer if it isn't a problem. I started taking accutane a few years ago and have been on it off and on for the past two years. When i started taking it these hypertrophic scars appeared on my face out of nowhere, and I wasn't injured in those spots and have never really had acne in those spots either. They are little bumps on my left cheek. Unfortunately, whenever I would start on a new dose more would appear and some of them would get worse. When I wasn't on it I didn't have that problem. Anyways, I am assuming that what I do have is hypertrophic scarring, but I know you haven't seen my face yet, but do you know if what I have could possibly go away over time or would I need surgery? and if so what kind of surgery do you normally do on hypertrophic scars? The other thing is that I have rolling scars on the left side of my chin, it's almost as if someone had cut my face with a knife and it left this long scar along my face. I also have a few on the right side, but not as bad. Anyways, I heard people's stories with silicone injections and wondered how successful this particular treatment is. I have heard it was successful but those individuals had just gotten the injections done. Also I was curious about the cost as well. Thank You.

as you know, i have not seen you so i don't know 100%. here are my thoughts in general:
1. hypertrophic scarring is best managed with laser therapy like KTP/PDL and 5-FU injections to bring them down. with keloids (which is rare on the face and does not sound as if that is what you have), they require much more aggressive therapy with laser, 5-FU, and I add steroid. Plus silicone sheeting, etc. Anyway, that is not what you have.
2. acne scarring- traditionally, acne scars are the opposite of hypertrophic scars as they are actually atrophic or depressed. that is why when surgeons sand all the normal skin down to the abnormal skin, it does not make sense to me. I now divide these scars into large rolling areas and smaller pits. Most of the larger areas plus some of the pits can be managed with silicone injections, which are permanent. They are $700 per treatment but you have to space out treatments a month or so a apart. Typically, mild cases require 1 to 2 treatments. In general, most need 2 to 4 treatments. For the jagged knife like problem, sometimes filling and sanding can help but you probably need it cut out. I would have to see it. At the end to finesse the skin edges, I can do plasma to clean it up but you are only gaining another 20% or so improvement. that costs a lot more like $3500 plus sedation costs and it will make you look bad for a week.
Anyway all of this is conjecture until I see you.
best,
sml

thank you for replying to my message dr. lams. I was just curious, how successful are those procedures that you use for hypertrophic scars, those are my main problem right now. I can deal with the rolling ones, but not with these hypertrophic ones. Also on the right side of my face my skin is very uneven from acne over the years. I would say it is shallow scarring, would you do the same procedure for shallow scarring as well? And as for my knife like scars, they are close together but are separated. Again, it would be better for me to just send you photos and I will definitely call your office this week to start the process. Thank You for your timely responses to my questions.

Oh, and what is the cost for the laser therapy for hypertrophic scars?

typically 350 per round. hopefully you won't need more than 2 to 3 rounds but i can't make that promise.