Dr. Sam Lam Plastic Surgery Forum

Hi Dr. Lam,

Firstly, I must express how impressed I am to your thoughtfulness and thoroughness of addressing the needs of your patients in so many ways. I've learned so much by browsing through forums, commentary and videos of you and your previous patients. For that, thank you.

Secondly, I'm hoping you're able to address some concerns I have about a lip scar that has left me devastated. To make a long story short, about 8 months ago I was bitten by a dog which left me physically and emotionally scarred. The scar extends from just below my nose on the left side through to the pink part of my lip. The scar was closed by a plastic surgeon on the day of the injury.

Once a socially outgoing person, my self-esteem has dwindled. I am a 25 year old female whose job requires me to constantly speak and be in public. The physical effects of the scar seem complicated and include asymmetry of lip contours and length, thickened/swollen appearance of lip on left side, visible scar on the upper lip and a whitish scar on the pink part (though not clearly visible in pictures), bumpiness on the pink part of the lip and discomfort/numbness, especially in the pink part of the lip.

I will be getting Fraxel: restore on my upper lip to address the uneven texture/shadows the scar on the upper lip creates and a 2nd steroid (kenalog) injection in the pink part of the lip later this month (I had one about a month ago). I suppose my questions are: do these seem like appropriate ways to achieve something close to my original lip contours given that it is 8 mos. old? Could something else be injected?

I've been told to wait at least a year for any surgical revisions, but do you think surgery is a possible option to correct some or all of the asymmetries? Is it possible for any of the discomfort to go away on its own or with surgery?

In general, what I think I'm asking is what types of procedures could I possibly be a candidate for in order to achieve a more balanced lip and when should those procedures happen?

Thank you so much for your time & response. It's much appreciated! (I am including 2 pictures)

i am sorry to hear that you had that incident and the effects that the incident has left on you. to be honest, when i look at the photos i only see the bump inside your mouth. don't know what the fraxel will do. there is some risk with it given your skin color but speak with your doc about it. in my opinion probably will not do much. on the lip itself, i prefer 5-FU which is non-steroid based but that is what i do. most docs don't know about it. we all have our biases. personally, when i look at your photos, i don't see a lot of things going on that should make you feel socially embarrassed but they are just photos. i hope emotionally you heal. life is too short to live in our past. as you know, i write a daily blog on healing. i myself am in a process of self healing.
best wishes,
sml

Thank you, Doctor, for your quick response.

My dermatologist did mention the risks of Fraxel to me, due to my skin color. While hard to see in pictures, the scar often creates a shadow that really bothers me in natural lighting. I guess I'm willing to try almost anything at this point.

While I don't think I look different enough to have a social stigma placed upon me by others, compared to how balanced and pleased I was with the shape of my lips before, this definitely bothers me. To me, they appear swollen and uneven on one side. The discomfort and strange feeling I have whenever I talk is also a constant reminder of the scar. I'm hoping it's not complete nerve damage, but rather just the feeling of the scar tissue pulling on my normal skin.

What might the chances of that lessening be if the scar goes down with injections or an excision?
:/

Thank you for mentioning the 5-FU. This is something I will look into; it does seem safer. And thank you for mentioning the emotional healing I think I have to do too. I've long forgiven the dog about the injury, I just have yet to forgive the dog owners for putting me in this situation. I will be looking into your blog as well.

1. if you cannot see the scar easily, excision always carries with it the risk that the result will be significantly worse than what you have now. just remember that. i always say, "let the punishment fit the crime."
2. forgiveness is the start of all healing. until you forgive the owners and forgive yourself, you will not make progress on this situation. the heart must heal before the mind. that is my honest feeling about it. read the power of now, excuses begone, and the four agreements, three books that have changed my thinking.
best,
sml