LAM FACIAL PLASTICS

okay, sounds good. my book costs typically about $200-300 just to let you know and not shock you.
best,
sml

Oh, I think it is a very reasonable price!
I work in medical libraries and am used to see the value of medical texts, I think the value of yours is very sensible, and not expensive at all if one considers the knowledge and innovative approaches on the matter that you have (so many books are like "re-hearsals" of things not original!).

ok, cool!

Ohmy... I can tell I need vacations... I forgot to ask you something simple and specific on the matter (I really need some days off, I am forgetting obvious stuff *LOL*).
I had mentioned the doc would not try anything above 50% in terms of TCA, but I wonder if for CROSS that still is too "low" for collagen buildup.
Sorry I went back to the topic! Trust me, I am annoyed at myself for forgetting stuff so often!

I was looking at your vlogs and before and after pics...

WHOA! Amazing!!!
What did you do in that guy? I assume both silicone and TCA Cross?
The visible but small roundish depressed scars there that were not linear-like or "jagged" (the smallest yet visible round depressed ones) of the "before" were treated with silicone or TCA Cross?

no, that was just TCA CROSS. no silicone.

Impressive!!!!!!!!!!!!!!!!!!!!

Gee, couldn't you be born somewhere a bit more toward the south of the continent ??

I must definitely have an appointment with you one day, you will be worth every penny, trip and all. Your work is impressive, whatever I look at! (botox, fat grafting, work on scars...).

Whoa....

Do you realize how many lives you must have changed thank to your skills?
I am not talking of vain people obsessed over the littlest details and having crazy expectations... I am talking of real people with real concerns or at least situations that made them self-conscious for years and that thank to your skills now can walk heads up!

If I were that man, wow, I wouldn't have enough of a lifetime to thank you, really.

Impressive.

Hats off to you. Especially considering the *love* with which you do all that. I bet that just your caring attitude (obvious in the v-logs and testimonials on video) improves the healing and the recovery of any of your patients, making results better.

Wow.
God bless you, really.

wow, thanks m/a!!!

Hi there! The curious me again!
I don't know myself how I always come up with some new doubt. I guess I am too curious and always keep on wondering stuff about "stuff", my poor doctor!

I wanted to know... after a TCA Cross, normally the area is not touched for about one month, right?
Well, is that just to see how much collagen builds up over that time? As in not overcorrecting by treating the area again sooner?

Or...

Is it because "crossing" an area already treated when the scab has fallen off but that a month has not passed by can "harm" the new collagen?

Is the time between treatments chosen so that one knows what the results are, or because otherwise you can use more scars by putting tca on the same spot that has not had the time to regenerate?

Hugs

no problem with the questions. that is why i'm here. i actually get worried when i get too few of them! also, you definitely get a free pass given how nice you are in commenting on the blogs! basically, after a single treatment, you typically won't see much change. it is just a safety factor because over doing it will not build collagen but break it down. also, in your case, you don't want to overdo anything with too much acid because it is reportedly so shallow so over time the 3 month wait i commented on was to gauge results, which is indirectly safety too.
best,
sml

Thanks!!!!!

Hi Doctor!
I can imagine you rolling your eyes and wondering "what on earth can she have as a question now?" LOL. I myself don't know sometimes why or how I keep on wondering and wondering about subjects *blushing*

It is clear from your experience and posts that TCA Cross works for the icepick type of scars, small ones of that type. That was clear. What I now wonder is ... what are the reasons behind Cross not working for small depressed scars that are linear? Is it because in such type of scar there is no way of "crossing" the line in an uniform way and therefore obtaining an uniform collagen buildup all along the line? When a person treats a line, could the person end with an irregular scar? as in a bit raised in some areas, and not so in others? making it, then, look worse?

The final question/issue (I really hope it is my last one ) is: why does TCA have to be used at such high concentrations? I can imagine that concentrations up to 30% won't create a dramatic result or else such a concentration could not be used for TCA peels for the entire face.
But why is it necessary to use 100% TCA? I know some people use 50%, but the literature on the matter and what doctors seem to use most of the time for Cross is TCA at 100%. Doesn't TCA kick-start collagen buildup at lower strenghts? I remember the original paper mentioned studies with 65% TCA concentrations (not as effective as 100% but still effective)... how much lower than that could the TCA Cross get and still get results? At what percentage is the TCA strong enough to have a real effect... without going to it being at 65% or 100%? In your hands, 100% TCA is safe, but I bet in the hands of other doctors and practiotioners, it is not. I guess that in most doctors' hands, lower TCA percentages would make both the doctors and patients feel safer (again, not in your case!). So why aren't lower percentages of this acid used more often? Even if the results were less dramatic or took more sessions, wouldn't doctors and patients feel safer and wouldn't the negative side effects be less serious and happen less often?

Hugs

hi,
no problems with the questions:
1. the linear defect is too narrow to make sure that it is evenly raised. a circle is easier to raise because you do not need to have such precise raising of the area as a line would. dermabrasion is what i use to manage a line in most cases like after a mole removal.
2. yes, you are right about the 65% versus 100% TCA study. i simply do not have experience using anything but 100% TCA based on the results of that study. accordingly, i do not want to speak from ignorance regarding the 65% TCA since i have never used that or any other concentration in a CROSS technique.
best,
sml

Thanks! :)