LAM FACIAL PLASTICS

Dear Dr. Lam

Trust you are doing well, I’m half the world away but i'm still planning to come to the states and see you if necessary, hoping you can help me in my complex case. First let me explain to you what happened and caused the scar on my face.

Back in Jan 2004 I visited a local doctor in Bahrain, because of my oily skin, black/white heads and miner old acne scars, he advised me on a scar revision procedure on some areas on my face. They really weren’t that bad and can hardly be noticed even when someone is next to me. Anyways the surgery worked fine on two areas on the right side of my face but for some reason the third area took a deeper small circular shape, the wound did not open but instead the skin around the scar seemed to stretch.

Later in August 2005 I went to the same Doctor and did the same procedure and the skin on the Scar widened and stretched again 3 weeks after removing the stitches out. Results were worst the scar stretched more and I felt really bad and depressed.

Later in September 2007, I went and did the same procedure with the same Doctor, but the skin also widened 4 week later and the results were still bad. At least the normal skin color came back this time 5 months later

I went to well known plastic surgeon in London in June 2008, he advised me that even if I had the same scar revision procedure again, most probably the skin would stretch again a few weeks later, this is the case for some individual's skin types and reasons are unknown neither to dermatologist nor cosmetic sergeants, but he will still try to do his best, so I had my fourth and final Scar revision procedure. I must say that the scar looked like a little scratch when he first removed the stitches out, the results were impressive. Yet the scar stretched and got darker 5 weeks later when I came back to Bahrain. Could the hot humid weather be a reason?

Could you possibly have a theory and help me, Is it a hormonal cologne reproduction problem, and is there something I can do about it? Or is it because of smoking, or that I might accidently sleep on the scar, maybe dermabrasion or laser is the right solution. Is there hope Doctor Lam I heard you are one of the best in the world.

I understand your busy schedule but I really need your help as a Doctor. Give me some of your time and you can change my life. It's so annoying that I dont even feel comfortable letting my wife be on my right side. Should I come see you, or will you advice me on a procedure I can do in Bahrain or London

I have reviewed your photo in your PM and your question. Obviously, two things: 1) I can't dispense medical advice in your situation, 2) there are no easy solutions. Here are some thoughts to perhaps improve it if you have this done again, which unfortunately I really think you will need to do since surgery appears to me your best option:
1. stop smoking a month before and at least a month after. smoking over your lifetime can also draamatically affect wound healing even if you quit around the time of the procedure. as much as you can stop the better for your chances for healing.
2. are you picking at the area? sometimes subconscious behavior might be at play either during the day or at night when you are a sleep and don't know it. If you are, any further cutting will not work and lead to more scar tissue. If you have any question about this, you might seek psychological evaluation or wear mitts at night for the first 6 weeks. the area looks traumatized but it could just be scar widening.
3. did the surgeon close the incision in 2 layers? i would say that even though some sutures may spit, it helps limit the real problem which are experiencing which is wound breakdown and widening. i would really encourage a 2 layer closure. and in your situation, a lot of deep sutures.
4. preoperative botox performed 2 weeks before. even though it might affect your speech for a month or 2 (unlikely), it will limit wound spreading. your doc should place it on either side of the wound.
5. taping the incision WITH mastisol (sticky stuff) and taping it for months until we are certain it won't spread.
6. you will then probably need dermabrasion to make the edges look good if all heals well after your revision plus 5-FU injections to manage any scar thickening.
i don't know if i will have more success than your docs. this SHOULD be a relatively straightforward procedure that most docs can handle. i don't know why you are not healing that well to be honest. if you don't heal well in general, maybe you should see a medical internist.
best,
sml

Dear Dr. Lam

Appreciate your time for getting back at me, i'll make sure that i follow all you instructions on my next surgery. Would you advice me to have it by the March 2009 since my last surgery was on June 2008.

What can I do regarding my oily skin, black heads, and white heads.

the timeline sounds reasonable. as far as skin concerns go, you really should ask a dermatologist that question. good luck with your next scar revision!
best,
sml

Hi Dr. Lam

It me feras with the complex scar issue again seeking your advice again. I have done my scar revision again in lebanon this time i showed your recomandations here and the dr. here did the surgery here and he recut the scar at a more neeter shape and restiched it on four layers of the skin whith perminate stiches the will only desolve by them selves in approximetly six months from now. he did not prefom any botex injections 2 week earlier cuz I can only be here for a week. There is no Mastisol in lebanon so he put some sort of plasters on the surgery that he will change for me after every other 2 days. then when I go back to mahrain i will do it myself for the next month or so. Is there a substitue for mastisol that i may find here. and how should I exactly use it.

Thank you for your time again, please do me this favour

don't worry about the mastisol. just keep it taped.
best,
sml