Dr. Sam Lam Plastic Surgery Forum

Hi Dr Lam, I found your forum extremely informative and helpful! Hope you can help me on my problem. I am going to remove a mole located just below my lower lip, on the left (the mole doesn't touch the lip). However, I am prone to keloids and already have a bad keloid scar on my left arm from an injection when I was young. I am still treating this scar. My doctor refuses to remove the mole for me for fear that it would turn into a keloid scar. I have sought a second opinion and found another dermatologist who assured me that the area where my mole is located will not turn into a keloid scar if removed.

May I have your advice on this please, and if removed, what are the aftercare that I need? Hope to have your reply soon as my surgery is on this coming Friday. Thank you so much for your advice!!

first a few things:
1. it is almost impossible to get a keloid (honestly impossible as far i am concerned) on the face by the very nature of the type of facial skin that we have which has abundant oil glands (unless you had accutane within 18 months then you can scar with a hypertrophic scar but not keloid). and the lip area heals even better than the rest of the face, which then heals better than the body. the body heals terribly. that is why i don't think any mole removed from the body ever looks good.
2. your doctor most likely (but i cannot tell because you need him to make that judgment) should follow a relaxed skin tension line which is going vertically up and downward not side to side. take a look at this link:
http://www.lamfacialplastics.com/resour ... oval-faqs/
o/w you can scar.
3. i tend to do 2 layered closures to minimize stretch back. believe it or not, despite the lack of risk of keloid, bad surgical technique can still lead to other types of bad scars (but not keloids) like a hypertrophic scar (thicker scar), wider scar, or depressed scar (i actually do a 3 layer closure to minimize the latter risk but that falls beyond what i can guide another surgeon to do.)
hope that helps.
best,
dr. sam lam

Hi Dr Lam,

Thanks for your fast reply! I am very much reassured after hearing your advice. I will check with my doctor further on the procedure you mentioned. Thank you so much!

my pleasure. best wishes on your procedure.
dr. sam lam

Hello Dr.Lam. In April of this year my 18 year old daughter was having laser hair removal procedure on her upper lip,the technician fail to remove the anesthetic cream she had on and she got burned on her philtrum and chin ,now she formed keloid/ hypertrofic scar on the philtrum and despise the cortisone injections,v-beam laser and silicon sheets we don't see much improvement and its been almost 6 month,she is caucasian with no history of keloid formation in the family.I would appreciate your input very much.

i would have to see this to see what i could do to help. i prefer 5FU injections in hypertrophic scars with KTP laser. it tends to work well but not in everyone. if you don't live in dallas, that would be harder for me to do. if you do, then i should be able to help.
best,
sml