Dr. Sam Lam Plastic Surgery Forum

1. Complications w/ hyper or hypo pigmentation after TCA treatment in %?
2. Percent of improvement for most patients? 50-70%?
3. I have heard usually 2 or 3 treatments is sometime needed for moderate to severe acne scarring is this true.
4. These treatments are usually 3 to 4 months apart?
5. Does it work good on icepick scars?
6. Would you suggest silicone or TCA or a combination of both for Rolling scars?
7. Cost of a full face TCA treatment at your office?
8. Can you work in the sunlight w/ sunscreen before 4 weeks is up after the TCA procedure?
9. When can you return to work after a TCA treatment?
Sorry for all the questions at once but could possibly answer a bunch of other peoples in one post. Thanks for you time.

1. Complications w/ hyper or hypo pigmentation after TCA treatment in %?
hyper very common if you are asian but this is temporary but could last months. hypo very rare. can't remember a case of it.

2. Percent of improvement for most patients? 50-70%?
impossible to say because of perception. take a look at all my videos on expectations and blogs. i talk specifically about acne scarring. your 50% is my 75%. your 20% is my 10%. these numbers don't fly. in general, consider more modest gains because no matter how good i get you will still be disappointed.

3. I have heard usually 2 or 3 treatments is sometime needed for moderate to severe acne scarring is this true.
hard to say. i have gone 4 to 5 for moderate to severe.

4. These treatments are usually 3 to 4 months apart?
usually 3 to 4 weeks for the first few rounds then i wait 3 to 4 months to see how the stacked doses are doing.

5. Does it work good on icepick scars?
in general, yes. that is what i use it for.

6. Would you suggest silicone or TCA or a combination of both for Rolling scars?
rolling scars = silicone ice pick, tiny holes = tca. i rarely combine but would combine if you had both conditions.

7. Cost of a full face TCA treatment at your office?
you can email constanze@lamfacialplastics.com. i have been asked no more prices in this forum, which i am respecting.

8. Can you work in the sunlight w/ sunscreen before 4 weeks is up after the TCA procedure?
generally, no. sunlight even with sunscreen for the first few weeks after each treatment can increase the risk of hyperpig.

9. When can you return to work after a TCA treatment?
if you don't have a lot of areas, you can go back in a few days. most people don't take much time off work but you will have color issues that won't match even for a few months. you must know that. watch my video.

Sorry for all the questions at once but could possibly answer a bunch of other peoples in one post. Thanks for you time.
sure. do an archive search. i answer these similar questions all the time. thanks for the posting.
best,
sml

Wow, I'm really impressed that you answered so fast, didn't expect an answer for a couple of days.
I'm really disappointed to hear that I can't work in the sunlight after TCA. I can't really take 4 weeks off either. Don't know when I could do TCA if at all. I work shift work and don't really spend long periods in the sun when I work days, maybe 5 to 10 mins at a time. Could this work? I am also from Hispanic Decent, Have an olive type skin, would this be a problem with TCA and would this increase my risk for Hyper pigmentation % of potential complication please? You said above Rolling scars = silicone icepick can you please clarify what you mean and also what do you call a small enough icepick for TCA? I am really confused on what silicone is used for. I've heard that if you can stretch a scar and it disappears, silicone would work, these are most likely rolling scars, is this correct. I have both very mild rolling and pretty moderate to severe icepicks, What would you say the effectiveness of silicone on icepicks is compared to TCA. Thanks.

i have done a lot of hispanics. you should be fine. as far as being in the sun, just take the risk of hyperpigmentation. it is a temporary phenomenon. i can't promise you the difference between 5 to 10 minutes in the sun versus 30 minutes per se. the stretching thing does not make total sense to me. basically, if they are about a mm or less and deeper than shallower, that's an icepick. if the areas are wider saucer shaped that's a rolling type that requires silicone. i hope that is clear.
best,
sml

I've seen where you had people pm you pictures, if it is o.k. I will pm some to you tomorrow. I will take them in harsh lighting as well as good lighting. I seen Dr. Y about 5 yrs. ago and had Dermabrasion done. He told me I had mostly icepick scars. I was not impressed with Dermabrasion but is it o.k. to have either TCA or Silicone done now since I had Dermabrasion? You really must not ever take a min. off of work thank you for the quick responses. I have read most articles on TCA on this site. I will be scheduling an appointment soon, I've seen where you said it takes about 3 mths. to get one is this still so? I have researched you for a good while now. I am just now trying to figure what I need, when I can get it done, and how much I need to save. Oh and is it true you have seen less than 1 percent of a foreign body reaction w/ silicone? Thanks again.

hi,
1. you can send me a PM.
2. i am not surprised dermabrasion did not help.
3. it is safe to work over dermabrasion areas. have done it all the time.
4. have never seen any fb response with silicone.
5. i am still booked out 2 to 3 months now.
best,
sml

I've seen your videos and would like to know what are the negatives of silicone. What are the risks? I seen where you say it's been around since 1960. Has any shifted w/ age? I know its perm. you can't remove it when its in. Would a punch in the face a year after or repeated hits like to a kick boxer move them? On your website, I've looked at the before and after pics, is listed anywhere what procedures these people have done?

silicone should not shift even with trauma. it is held in position with microdroplets because it is built slowly over time. the risk is a bad injector creating problems. i am very safe with the product. most of the photos show silicone.
best,
sml

Would it be possible to do silicone this year and follow it with TCA Cross next year? Does TCA penetrate to the silicone level? Has anyone done this? If so what were the results? Thanks.

yes, there should be no problems. i have done it many times.

Hi Doctor!

I have read and asked many times about TCA Cross and to not create a new post about it, I am adding my question to this already existing one.
Disclaimer: I know here you can only give general advice, you can't speak for others nor about someone whose face you haven't seen yourself nor are treating yourself. I am just asking because I know of your experience with TCA Cross.

It is obvious that TCA works for specific types of scars, but how much it will "work" depends on too many factors and is not easy to measure.

The thing is, I have a few indented point-like scars on my nose of less than 1 mm (but not as deep as some icepicks scars I've seen in other people, a bit more shallow). Small and depressed. From what I read, the size would be "ok" for TCA? There are 2 slightly larger than 1 mm.

A dermatologist that I have high respect for, and who has the same approach than you do over most matters (guess why I picked him ) told me, when discussing options for those nose scars, that TCA Cross is a possibility. But he spoke of not having guarantees of how much improvement it would imply. That it is hard to tell and difficult to measure, and that, if done correctly. And he has done TCA but in worse cases of overall icepick scarring, along with other procedures, so it is hard for him to have an idea of how a milder case like mine, that is not associated with other treatments, would respond like. (At least he is honest). He would not treat the scars slightly larger than 1 mm but only in the very middle, IF treated. And he wouldn't use anythin above 50% TCA.

I know you can't say yes or no for me, nor pretend to, I only want to know if in your practice, you've seen patients with mild cases, like mine sounds (you can't know, I know, just from what it sounds) that saw some modest improvement with TCA Cross, or, if, the contrary, it implies too many risks for modest results.

A priori, based on your general experience, without seeing me or knowing anything, so just based on your general opinion, do you think I should take the plunge or that it's nonsense and that I should forget about it?

TCA Cross always has a risk because you are using very intense acid that can make things worse if spilled or applied with too much frequency. my advice would be as follows:
1. go to someone skilled in the technique.
2. if it is shallow, wait 3 months between treatments to avoid either overcorrection or creating too much of a burn injury to the area. just be conservative.
3. if they are a few isolated areas that tends to respond well. when it is a cluster of pores, then it is relatively not a great idea to do CROSS.
hope that helps.
best,
sml

Awww, thanks for answering so soon!!!!


Great advice:
1. go to someone skilled in the technique.

That would be ok. This is the one only derm "here" I would trust with acid. No other one. Only him.
He was the only doc who suggested things so far who always made sense and were in harmony with the things you said, even used the same doses of botox you spoke of for some parts of the face. It was his being trustworthy and full of common sense that reminded me of you who made me go for him (since I can't for for you bwwwwah, but one day I will :)!)

On a sidenote, not that it is really related, but let me know when you publish your book because I might buy one for him. He has your same approach to procedures and ... almost everything, so I bet your experience would be hyper valuable to him.

2. if it is shallow, wait 3 months between treatments to avoid either overcorrection or creating too much of a burn injury to the area. just be conservative.

Great to hear because he said he would try it only once, wait many months until it healed and built collagen to see how well or not it had worked.

3. if they are a few isolated areas that tends to respond well. when it is a cluster of pores, then it is relatively not a great idea to do CROSS.

I understand.
One question: my scars are very clearly delimited (not pores, scars, although pore-looking from afar), not too distant from each other on one side, yet not "connected". I mean, it's like very definite "depressed points" that are close but not connected nor can be confused. If I used a toothpick to show you (without acid), I could find the center of each one without touching other ones. Does that still fall into the "cluster of pores (pore-like but not pores, in this case)" category?

Hugs a ton.
Gonna go read your blog. Need my everyday dose of Dr Lam's food for soul .

perfect. all sounds good. my book will probably not be out until late 2009 or early 2010. let me know how else i can help.
best,
sml

[quote="dr. lam"]perfect. all sounds good. my book will probably not be out until late 2009 or early 2010. let me know how else i can help.
best,
sml[/quote]

He will love that book. I am so certain.
He does not know you personally and does not have the large experience you have, but I have noticed him having the same approach about "having an artistic eye" for facial reconstruction or "adjustements" versus caring only about symmetry. He also thinks like you when it comes to smiling and the way the lip should look, the issue of volume loss as the main sign of ageing versus "you just need a lift" approach, that he does not like, even the units of botox to use under the eye... well, it was because he thought like you in so many matters that I trusted him. And only because he is so short in time to be online, he can not come visit himself. I know for sure that your book would reflect his own thinking plus add knowledge to his practice. So far, I have been sharing opinions from you with him, during casual conversations when he sees me for botox checkups (he always asks to not let botox wear off totally because of the long term effect of botox being a lot better) and he has always nodded in agreement with what you said. A book from you would be the ultimate gift to him.