LAM FACIAL PLASTICS

Hi Dr. Lam,

i'm not sure if this is specifically a plastic surgery issue but it is a cosmetic one and i saw that you do perform laser resurfacing so i hope this issue is close enough to warrant taking up your time:)

About a year ago i was prescribed a cortisone cream containing 0.1% methylprednisolone aceponate and had to use it on my orbital rims for 3 weeks (i only ended up using it for 17 days) for inflammation arising from a procedure that went bad. The cream definitely had some effect on my skin because more veins became visible and it had a shiny lax look to it. THe dermatologist who prescribed it denied that any sort of effect atrophic or otherwise had occured. I saw my gp and another dermatologist who both agreed there was no atrophy or similiar effect on the skin, but the second dermatologist prescribed retin-a anyway after i requested to give it a try in order to correct the damage i felt had been done. so its been a year now and while i think alot of the shiny look and laxness has actually improved, some veins and broken cappilaries are still present.

Getting onto the point of this post, a few months ago i started noticing larger clusters of what looked like tiny tiny white bumps all over the affected area. I have been travelling up until now so i couldnt have it checked out, but i suspected they were milia from my internet research. When i returned from travelling I went to a new dermatologist requesting to have the "milia" removed, but when he examined my skin he remarked that there appeared to be cortisone damage and that the white dots were not in fact milia but were my sebaceous glands showing through the thin skin.

The dermatologist said he would not hold out much hope for my skin rethickening, and said maybe the best thing to do about the sebaceous glands was to cauterise them, with the one caveat being that it might make my skin redder. So we did a little test patch two days ago and so far so good but i have to wait a month to see what it does to my skin. So i'd like to know in your opinion if you think cauterising the sebaceuous glands is a good move? and also what your opinion is on reversing skin atrophy, other doctors i have written to on the internet have remarked that atrophy is generally never permanent, but then how long should the recovery time be?

Thanks for indulging me with this long post, i appreciate your time Dr.Lam!
regards

i really have no idea because i don't know you whether you have atrophy or not. however, i will say that cautery in most cases is a good way to manage little sebaceous glands. however, as we get older, we continue to get these over time since i always say "skin is a process". in other words, whatever i do to treat your skin, you will probably need another treatment in the future. that is to say whatever process has engendered these things, it will do it again in the future. months? years? don't know. depends on how your skin behaves. this is something a dermatologist should take care of for you. the only thing i am opposed to in principle is liquid nitrogen as i think it causes uncontrolled thermal injury and can lead to white spots on people's faces.
best,
sml