Dr. Sam Lam Plastic Surgery Forum

Hi Dr Lam,

I was diagnosed with a skin condition called eczema about 15 years ago and the dermatologist perscribed me a cortisone that was too strong to use on my face. Through the years, the usage of the cortisone caused my skin to be damaged and thinned as well. I have fine lines around my forehead, bridge of nose, around my eyelids and outer side of my eyes from the cortisone. Is there anything that you do in your facility that can regenerate the collagen on my skin? My skin is very sensitive and I was thinking that chemical peels or dermabrasion would be to harsh for it. Is this something I should ask my dermatologist before going to you?

Thanks

This may sound like an easy answer but botox is the best thing you can do if you have fine lines. most likely the main reason for the fine lines is a bit of aging through repeated movement. i just shot 3 video logs on botox but i am waiting to load them onto this site since i messed up my video log section last week. they are currently on youtube and i would highly recommend that you watch them. here are the links:

youtube.com/watch?v=tDFtVbdE1FQ
youtube.com/watch?v=Bva9ICAMtLQ
youtube.com/watch?v=ofSRCiDuDLQ
(you are going to have to type in the www portion since i have a spam filter here.)

in these videos i talk about letting the fragile collagen heal so that the lines start to go away. there is no real substitute for botox but other things like skin care products can help but only in a much much smaller way. the collagen is strengthened through botox since it can actually heal instead of becoming microfragmented over long-term through repeated movements. if you watch these videos, you will see how i focus on long-term gains NOT short-term ones because everyone says, "Oh, I don't want something that is for the short term or that i have to keep doing." That is not how I see botox. even a few rounds of botox will let your skin start to heal. first watch the videos then let me know if i can clarify.
best,
sml

A month ago I was mugged, and sustained a bad cut under my bottom lip, due to a traumatic tear. Apparantly, I bit through my lip. I had to get three stitches as a result. I have been doing everything possible to avoid scarring, including taking vitamin c tablets (1000 mg with rose hip) massaging with vitamin E, Mederma both cream and gel, scarzone, and even went one treatment with a v-beam laser. However, none of the topical applications seem to make a diference in newly formed indent. Im aware that this is due from a loss in collagen to that area. I went to a plastic surgeon to see if subcision would be appropriate, but since the accident was so recent, and the lip tissue is still hard, the Dr discouraged me from having surgery, at least for another 3-4 months. i have really good skin besides this, so in my mind it stands out. I have been reading a lot on fraxel treatments, but mainly the people that undergo the treatment are doing it to improve acne scars. Taking into consideration that multiple treatments will be needed, I am wondering what kind of results I can expect? If fraxel is my best option? Are derma-rollers a good choice? what other options might I have, besides fillers, to help minimize this atrophic looking scar. the picture i am including is the current state of the scar. however, don't let the size fool you, in certain lighting, the fine indented line stands out like a sore thumb.

first, i agree with your PS. way too early to touch it. it should heal fine over time. if not, you would need either dermabrasion or scar revision or both. i would wait at least 6 months if not more. that is still early. most oftentimes you will not need anything. v-beam is fine for redness but not necessary. if it becomes thickened and raised, then injectable 5-fu is helpful. if you read my scar and wound faqs you will see that mederma does not help at all and vitamin e has been shown in some studies to worsen a wound. i don't think you have. just leave it alone to heal. fraxel is a terrible mistake right now. you may worsen your scar considerably, redden it, make it angrier and ultimately lead to more scarring. leave it alone. your impatience will only make it worse. you are probably suffering from looking at the scar as an emblem and reminder of your previous mugging. you may need a psychologist to help you through not seeing the scar as a vestige of your past. i'm obviously just guessing here since i don't know you.

Thank you Dr. Lam, i appreciate the quick response! I do agree that Mederma is completely overrated, as I probably would be at the same point I am now even if i hadn't been rubbing mederma in it 3-4 times daily. Though I'm fully aware I must wait a substantial amount of time ( 6 months +) before i should do anything like scar revision surgery, I am curious to know how a plastic surgeon such as yourself would handle my case. Hypothetically if the wound were to stay relative to how it looks now, i.e. not raised, but still showing a fine line indent:

What would be your approach. I have heard of z-plasty and W-plasty, where the idea is to create a new scar outside of the old one, but instead of using a straight line, using all sorts of shapely cuts, to make it less noticeable to the eye.

Will any of these procedures initially make the scar bigger? ( since you're cutting AROUND the original one)

Could you relocate the scar by covering it up with a small graft and leaving the new scar, lets say below the chin?

Also, if i had initially gone to a plastic surgeon at the time of the traumatic incident, instead of a normal DR ( dr at our university health center) do you think the scar would have been smaller?

What would be your approach. I have heard of z-plasty and W-plasty, where the idea is to create a new scar outside of the old one, but instead of using a straight line, using all sorts of shapely cuts, to make it less noticeable to the eye.
YES, IRREGULARLIZING THE WOUND EDGES IS IN GENERAL A BETTER OPTION DOWN THE ROAD TO MAKE THE SCAR LESS VISIBLE. IN GENERAL, A Z-PLASTY TENDS TO LENGTHEN A WOUND. IF YOURS DOES NOT CONTRACT IN I WOULD NOT DO THAT. A W-PLASTY IS IN GENERAL AN INFERIOR WOUND CLOSING TECHNIQUE COMPARED WITH THE GEOMETRIC BROKEN LINE. SEE MY SCAR REVISION FAQS TO UNDERSTAND THE DIFFERENCE. I WOULD PROBABLY DO A STRAIGHTLINE CLOSURE NEAR THE RED LIP TO MINIMIZE DISTORTION OF THE RED LIP AND A GBLR NEAR THE OUTER PORTION. I WOULD HAVE TO SEE IT IN PERSON TO MAKE THE FINAL DETERMINATION DOWN THE ROAD.

Will any of these procedures initially make the scar bigger? ( since you're cutting AROUND the original one)
IT WILL CERTAINLY MAKE IT MORE VISIBLE. BIGGER, YES AND NO. YOUR SCAR LOOKS A BIT WIDENED ALREADY. THAT PART WOULD BE REMOVED SO IT WOULD MAKE IT SMALLER IN THAT REGARD. HOWEVER, IF I CREATE A ZIG-ZAG GBLR, THEN THE TOTAL WIDTH OF THE GBLR, TYPICALLY 3 TO 4 MM TOTAL INTERLOCKED DISTANCE WILL EXCEED THE CURRENT WIDENED SCAR AS FAR AS IS CAN SEE BY THE IMAGE BY PERHAPS 2 TO 3 MM.

Could you relocate the scar by covering it up with a small graft and leaving the new scar, lets say below the chin?
I WOULD NOT USE ANY GRAFTS THERE. THEY WILL LOOK LIKE A STICK OF GUM PUT ON YOUR FACE AND WOULD NOT WORK. ALSO, I HAVE NO IDEA WHAT YOU ARE TALKING ABOUT RELOCATING A SCAR BELOW YOUR CHIN. YOUR SCAR THERE ON YOUR FACE WILL BE THERE PERIOD.
Also, if i had initially gone to a plastic surgeon at the time of the traumatic incident, instead of a normal DR ( dr at our university health center) do you think the scar would have been smaller?
THE RUNNING JOKE IS THAT "DO YOU KNOW WHAT PLASTIC SURGERY IS?" "ALL IT IS IS SURGERY DONE RIGHT." OF COURSE, THAT IS WHAT I WOULD LOVE TO BELIEVE. BUT THE HONEST ANSWER IS MOST LIKELY NOT. DON'T PLAY THE WHAT IF GAMES. LEAVE THE PAST BEHIND YOU AND FOCUS ON THE FUTURE.
best,
sml

HAHA, yeah... now that i think about it, relocating the scar was just wishful thinking on my end. I will take your advise and just move on with my life. I keep telling myself there are people out there with it much worse than I do. Surgeries and lasers aside, are there any recommendations you have for me in terms of making sure the healing process goes smoothly. After reading your prior post i stopped using the Vitamin E and mederma, but still i have to wonder if there is some type of topical that can help minimize the redness at least. I keep hearing about lemon juice being applied, since its a natural dye and the citric acid helps exfoliate dead skin. Is this ultimately adverse to the healing process? (i realize you have a lot of other Q's to answer so this will be my last one )
Again, thanks for the advise. In times like these, sometimes all a person needs is a little reassurance. Sure the parents and therapists are always there to tell you things will get better, but sometimes the mind cant help but be skeptical that they are sugar coating things. Which is why your unbiased remarks are greatly appreciated. Again Dr. thank you!

thanks for the kind remarks. i have no idea when it comes to different home remedies so i can't speak about them intelligently. however, if the goal is to exfoliate, then the answer is an absolute no. do not try to aggravate the area. leave it alone. sometimes the more we finagle the area, the worse it becomes. let it heal. only if it starts to get very thick and raised, should it be injected with 5-FU and laser treated with KTP/PDL NOT co2/erbium. that would be worth managing earlier than later. i would say other than that, in general i would leave scars alone in the early phases.