LAM FACIAL PLASTICS

Would building collagen help fill in the indentations?

Is acne scarring fat loss or scar tissue?

Is CIT safe for people with rosacea?

Would building collagen help fill in the indentations?
HARD TO SAY. COULD HELP.

Is acne scarring fat loss or scar tissue?
SCAR TISSUE WITH LOSS OF SOME FAT TOO. DEPENDS ON THE TYPE.

Is CIT safe for people with rosacea?
DON'T KNOW. BELIEVE IT OR NOT, I DON'T KNOW EVERYTHING, ESPECIALLY WHEN IT COMES TO THE SKIN. I AM PRINCIPALLY A SURGEON NOT A DERMATOLOGIST.

Your honesty means a lot after what I have been through. My IPL doctor blamed me for my skin indentations, said I was doing something purposely to my skin and that I needed to stop.

Anyways, I am sorry to ask so many questions. I am just trying to keep hope in my situation. It is really the fear of not knowing to what extent this will progress. I look forward to meeting you.

don't apologize for asking. that is why i have this forum. i enjoy answering questions and helping people, but sometimes i can't answer the question. hopefully, your questions will not only help you but hundreds of others.
best,
sml

Is there a chance TCA CROSS could be a possible treatment for the shallow dents? I understand you have not seen them, but they look like very shallow acne scars.

no, it will probably make them worse. trust me. not in your situation.
best,
sml

Please explain stem cells in fat grafting.

I have read that stem cells in fat grafting may naturally fix the indentations in my face.

Thanks

not in your situation. stem cells may rejuvenate skin after a year or two but in your situation you have a greater risk of creating a visible growing lump because fat, which is a live graft with blood supply, will shape, grow and change over your life if you just stick it somewhere to fill an indentation that is possibly temporary. way, way, way, way too risky. you are taking a gamble for something that is not worth gambling.

let me try to explain it better. let's look at the positive of stem cell changes. they MIGHT make the skin look better through a stimulatory effect in that area. MIGHT is a big word. let's look at the negative of doing fat transfer asymmetrically into points of indentation:
1. you are very young so over your lifetime, the fat will change in unexpected ways, especially...
2. if you place it asymmetrically. fat is not bio-inert. it is not a piece of plastic. it will have blood supply and change with weight and metabolism. the docs out there that put fat into a defect to reconstruct are asking for trouble about 2 to 3 years down the road because they are just sticking fat asymmetrically. i remember talking with a doc down in bogota, colombia, who came up to me and said, "Now, I understand why I should not have put fat asymmetrically to fill a jawline defect because the girl looks like she has a tumor there." Most likely he also had no idea how much fat to put in there and stuffed a ball of fat, which would lead to the problem.
3. your indentation may be temporary as the area regrows collagen. so let's imagine the best case scenario which is that the collagen would regrow and heal in a year and the worst case scenario which is that the fat would then become too much over time in those select areas.

all that being said,
1. do not ask me to fat transplant you. i won't do it.
2. ask another doc to do it who has no experience with fat grafting and you will most likely be looking at a disaster within 1 year.
3. read my blog about forgetting your past. it should be the framework of your current thinking to help you escape your self-imposed hell. as viktor frankl said (read my blog from a few months ago), when he was in the concentration camp and when all freedoms are taken from you, you have but one left, the freedom of attitude. i want to help you sincerely. just don't ask enough docs for solutions, you might get what you asked for.
best,
sml

Well, I didnt actually mean inject the indentations with fat, I just read that in some cases fat grafting to fill volume in someones face can in some cases actually repair some of the indents. I'm sorry If I am wrong, I am simply going off of what I read.

"It has been discovered that liposuctioned fat is rich with stem cells. These are the undifferentiated cells that when placed in contact with the other organs will actually create or repair those organs. We have seen for years that fat (which contains stem cells) injected into the face has corrected problems with skin pigmentation, wrinkles, loss of facial volume secondary to decrease in bony size, and other aging effects."

I found one woman that was a patient of yours at one point, I pm'd you the link. If you read her post on down the page she mentions the fat transfer helped with her dents and scars.

Also, I read in a past post of yours where you said fat grafting actually helped with one of your patients acne scarring. I am just searching for answers, I'm not being demanding.

no, sorry if my tone was off. i am very protective of my patients and those seeking responses not to get a dangerous treatment for the wrong reasons by doctors who simply do not know better due to lack of understanding of fat transfer. yes, you are right. fat grafting CAN help the skin but there are no guarantees but you have to get fat in there, which adds volume. therefore, when you need volume with fat grafting then you can get a derivative benefit with fat grafting for possible stem cell changes. however, if you don't need volume and you do it for stem cells, you risk the volume issue for a questionable benefit. i always say questionable because i want to undersell that component for you.
best,
sml

Thanks. I understand your concern. I will just try to stay positive and hope for the best. If I lose volume I'll keep hope that you said "I never say never". I don't want to take any more chances with my face. I do respect your opinion as It is obvious you care for the outcome of your patients. It just scares me that if I do lose volume in my face, I may have to live with it for quite a while until you consider me of age for the fat transfer. I guess depending on the severity you may consider it.

yes, never say never. we'll see as we progress.
best,
sml

Ok Dr. Lam. Last question for a while hopefully.

I purchased an All Red LED therapy lamp for my rosacea. I have not started using it. Since I suffered from fat loss from IPL, is there a chance the same could happen with the LED lights? My thoughts is the IPL heated the sebaceous fat layer to cause the loss, and the LED does not even emit heat, so it could not do damage.

Thanks

the LED is pretty darn safe in my opinion since there is really no heat generated but of course, i withdraw myself from official advice.
best,
sml

When someone suffers from fat loss from IPL, what do you think causes it? The heat produced to the sebaceous fat layer?

I would like to try my Red LED lamp out. Just being cautious. Thanks