LAM FACIAL PLASTICS

Hello Dr. Lam,

I am a 28 year old caucasian male who lives near Los Angeles, CA and was in a car accident in mid July 2008. As a result of the unfortunate accident, I am considering facial scar revision for an: (i) irregular shaped scar on my upper forehead area, and (ii) a straight line scar which lies a little lower on my forehead.

I have seen two practitioners (I will call them Dr. X, and Dr. Y) here in the southern CA area but neither of them inspired confidence.

When I asked Dr. X (who didn't look much older than me) if I could see pictures of his scar revision results he conceded that he had only done five in his life and had no pictures to show me. His opinion was that I needed a "geometric broken line" revision for the irregular shaped scar and a "fusiform" revision for the straight lined one. I asked him for a reference.

Dr. Y was affiliated with a local university hospital, had written some publications, and had years of experience. When I asked him for his opinion, he simply said that he would do "local tissue advancement" in 6-12 months and did not comment on closure type. He injected some form of steroid into yet another scar I have on my hand to flatten the scar. Despite his credentials, I was not impressed when upon our first and only meeting he fumbled around and dropped the syringe he used to do the steroid injection on the floor. In my mind he became "Dr. Butterfingers" and I worried what might happen if I trusted him with my face!!

Yet after reviewing your materials, I can see that you are an experienced and knowledgeable practitioner and I am very interested in having you do the scar revision. But I do have a few questions for you.

1) Would it be practical for me to fly from California to Texas to come see you for scar revision? (i.e. number of flights, how long would i stay, etc.)
2) If needed, how long do you wait to do follow up dermabrasion?
3) what is the difference between the two methods advocated by Dr. X and Dr. Y and what should I do to get the best result one could reasonably hope for?
4) What should I be doing now to care for the scars?
5) Will massage help/hurt at all?
6) Will silicon cream help/hurt at all?
7) Will a silicon patch help/hurt at all?
Will the product bio-oil help/hurt at all?
Thanks Dr. Lam, I hope I can see you soon.

Very Truly Yours,
bts

1) Would it be practical for me to fly from California to Texas to come see you for scar revision? (i.e. number of flights, how long would i stay, etc.)
Obviously, scars are unpredictable to a certain extent. The ultimate goal would be 2 visits. One to do the scar revision and then 6 weeks to 3 months later to do the dermabrasion. However, redness and thickening can mandate laser and 5-FU (I don't use steroids) for management of a thicker scar. That could be done in LA but the M.D. would probably charge you whereas I simply would not for anything after your initial surgery.
2) If needed, how long do you wait to do follow up dermabrasion?
see above.
3) what is the difference between the two methods advocated by Dr. X and Dr. Y and what should I do to get the best result one could reasonably hope for?
I would need to see you to see what they are talking about but what you describe sounds to me as if a GLBR is the way to go. would need to see a photo and you to make sure.
4) What should I be doing now to care for the scars?
Stay away from sunlight and make sure they do not thicken or stay red. that would require the strategies mentioned above.
5) Will massage help/hurt at all?
won't help could theoretically hurt if you get crazy. no reason to massage them.
6) Will silicon cream help/hurt at all?
will do nothing except for keloids. you do not sound like you have that.
7) Will a silicon patch help/hurt at all?
ditto.
Will the product bio-oil help/hurt at all?
voodoo part 2. no need.

Hello Dr. Lam,

Thank you for your response to the many questions in my last post. I really appreciate you taking your time to answer my questions.

I have uploaded two photos showing the accident scars referred to in my last post which I am looking to have revised. The photos show the scars at approximately 4 weeks from the accident and than 8 weeks. It has now been about 6 months since the accident.

Based on the photos, I was wondering:

1) What course of treatment would you recommend?
2) What can I realistically expect in terms of a result?
3) Is six months after the accident enough time to wait before considering treatment?
4) Would you revise your estimate of the number of plane flights necessary (from 2, see above) after seeing the photos?

Thank you Dr. Lam, I hope I can see you soon!
bts

first, you are welcome. second, why don't you send me a photo today? that is important to see. if i saw just your 8 week photo i would say most likely you would not even need a scar revision because most likely it would fade. based on the 8 week i would say just go though 2 to 3 rounds of KTP type laser to manage the redness and you might need a dermabrasion to manage the scar at 6 months to a year but would probably wait 1 year. if i saw a current photo, it would help tremendously.

Dr Lam,

Here are three current (April 2, 2009) photos showing the two forehead scars I am primarily concerned with. It has now been around 9 months since the accident and I am now very serious about formally contacting your office to schedule a revision.

Truth be told, I have experienced some depression over these scars and will be anxious to receive your input on these current photos.

Truly Yours,
bts

hmm, look as if you head pretty well but there is some raised portion and a bit of whiteness. i think a little 5-FU to bring the scar down followed by dermabrasion may be a good way to start. i can't tell 100% by the photos but it does not look as if you need a formal scar revision. i think dermabrasion will bring the scar down to the point that it will look better, but i would consider 5-FU possible laser treatment 3 weeks before to soften the scar. hope that helps.
best,
sml

dr lam, is this feasible for you to treat given that I am in CA?

i have scars on other areas of my body, and it seems i have a tendency to heal with a "white" scar. what is the best treatment to get rid of the white scars on my forehead?

also, what is your opinion on "permanent makeup"?

finally, do you have any recommended treatment for a receding hairline that is a "widow's peak?"

thanks in advance for your response--

dr lam, is this feasible for you to treat given that I am in CA?
YES AND NO. OBVIOUSLY, I DO NOT HAVE THE LUXURY OF INJECTING SMALL 5-FU OVER MULTIPLE VISITS TO SEE THE EFFECT. IF YOU FLY OUT FOR SMALL THINGS ON THE FRONT END OR NEED SMALL TOUCH UPS, COSTS BECOME VERY HIGH.

i have scars on other areas of my body, and it seems i have a tendency to heal with a "white" scar. what is the best treatment to get rid of the white scars on my forehead?
REALLY, FIRST CONTROLLING THE THICKNESS WITH 5-FU, THEN POSSIBLY BLENDING IT WITH DERMABRASION. BUT THE ONLY TRUE WAY TO "GET RID OF IT" OR HAVE A BETTER CHANCE S TO EXCISE IT AND CLOSE IT WITH PRE-BOTOX BUT IT STILL COULD COME BACK. IF YOU ARE SUFFERING DEPRESSION YOU SHOULD TRULY READ MY BLOGS ABOUT PUTTING OUR LIFE INTO PERSPECTIVE ESPECIALLY STARTING WITH TUESDAY'S BLOG. I CANNOT HELP DEPRESSION BUT YOU TRULY CAN.

also, what is your opinion on "permanent makeup"?
DON'T DO IT. IF YOU TATTOO THE AREA SLIGHTLY OF A CERTAIN COLOR AND YOU HAVE ANY TANNING OR ANY OTHER SKIN COLOR CHANGES IT WILL LOOK WORSE THAN IT DOES NOW. DON'T DO IT.

finally, do you have any recommended treatment for a receding hairline that is a "widow's peak?"
IF YOU ARE UNDER 30, THEN NO TRANSPLANT BUT PROPECIA/ROGAINE. GO TO HAIRTX.COM AND READ ABOUT MEDICAL MANAGEMENT. THE LONGER YOU WAIT, THE HARDER TO FIX.
best,
sml