LAM FACIAL PLASTICS

Hi Dr Lam,

Well my story goes as follow. Over 15 years ago I fell asleep with a alcohol cloth on my forehead due to a bad headache. When i woke up i had burned my forehead with the alcohol, I had a horrible red burn. I was very nervous and scared being this was on my face, forehead, and noticeable. I tried applying several creams, then decided to go to a plastic surgeon(was my first time) and i guess naive about what to look for in a doctor. Well he opened my forehead, applied dissolvable stitches which opened the first night, i went back to him within several days, my forehead went from bad to horrific sight i had an opened scar deep, ugly terrible.. I went to him he then did a microdermabrasion on an opened scar. Again was young, naive, scared, and wanted my scar gone, little did i know he butchered me...3 years later i went to another surgeon who was hesitant about taking me as a patient, due to the sloppy work of another. He decided to work on me. He opened me up redid my scar this time alternating the outer stitches (said my skin was thick olive complexion and doesnt heal right). he applied some dissolvable stitches as well, but focus on the outer stitches i went back in three days removed those and put more on different places. finally the scar looked so much better, i put silicone patches the first three weeks, then after awhile he performed dermabrasion which made the scare almost invisible was pink and flat(was so happy for the first time ever). then as months went by the scar starting changing, my scar developed rough edges, sunk a little and became noticeable again(dont understand)..well 13 years later i have lived with it and very unhappy must say i know its a shallow of me, im not but i have become obsessed with it. I then again had the courage to go to another surgeon who decided that scar revision would work, four months ago i did it, he removed the outer stitches within three days, had many dissolvable stitches, my scar became longer( he said it had to be when you open a scar). well four months later again rough edges, indent sunken in(horrible)...my scar didn't heal properly. it opened up. the doctor said it looks like im the type of person that doesn't do well with dissolvable stitches , they were still coming through three months later he said it wasn't normal... they should have dissolved and closed properly... now he wants to do another scar revision to correct his mistake.... Doctor Lam i am desperate,, and so disillusioned, and worried here, please tell me if another scar revision will work, or will the same thing happen, how can it be different, what should i do , what is the best procedure for me, help im starting to loose confidence in surgeons...I now have more rough edges and indented scar which is healing still but dint think will look better only fade. im sorry i write such a lengthy letter i just wanted you to understand my journey here... what do you think i should do?????? thank you Sara

sara,
i'm really sorry to hear of your situation. i truly am. obviously, i am not a God but just a human being that cares about people and cares about results. i would be happy to review your situation when you are ready. the best would be a formal phone consultation if you would like. you can set that up with constanze@lamfacialplastics.com. until then, here are some thoughts:
1. it is normal for some dissolvable sutures to be exposed. i tell patients that i sometimes need to trim them back. but they are important to minimize stretch back.
2. also to minimize stretchback i prepare the area with botox around the wound edges so that there is minimum stretchback.
3. i am very careful when i do the surgery but also would like to emphasize postop care as being just as important. you already know about silicone and taping, which are important with great hydration during the first 7 days.
4. then postop we might need KTP laser and 5-FU to minimize scar formation.
those are the big topics here. also, i just did a scar revision for a gentleman from michigan last week who probably can comment about this but he has truly healed in more ways than just his face. read my daily blogs to look for ways to heal the heart, the mind, and the soul. i'll take care of your face.
best,
sml

Dr Lam,

thank you for your quick response,and your information. I would like to possibly make a phone appt with you. I am in nyc, thought we had the best surgeons, but honestly after reading your email, not only did i feel emotionally better, but it sounds you have different methods then many here....I am willing to travel to better this scar that has haunted me for too long, and i know i shouldn't think this way sounds shallow of me, since I have my health...But it has bothered me for too long,and after so long to do this again and nothing same thing is very saddening...So i would like to speak to you, i guess doing another scar revision as he suggested will not make much difference if done in the same manner im assuming...Again thank you so much and I look forward t speaking with you soon...Sara

sara,
i would love to heal you in body and spirit. that is why i have been put on this earth. i hope and pray that i can give you resolution, but i hope i can help heal your spirit as much as your face. you can email constanze@lamfacialplastics.com. please have peace in your soul. we will find resolution. if you truly do not mind, please read my blogs over the next few weeks until we talk.
best,
sml

appt.

what does appt. mean?

Hi Dr Lam,
Since our last email, The Dr. that performed the scar revision 4 months ago, has called me to set up an appt. However due to all my past bad experiences I dont trust, and am very hesitant again, but this scar haunts me everyday...As you know from my previous emails, my scar has a tendency to widen and indent..When i went in for an office consultation with this DR, I explained my past bad experiences from over ten years ago. He said the stitches then are different now...So he went ahead and did it, and we are here today with the same problem 4 months later, it widened and its indented pretty badly. there is however a very tiny small part that stayed together and looks acceptable.

Now he's receptionist call me to set up an appt. for another scar revision. I have been wanting to talk to him, so he can comfort me and ease my insecurities, but its been almost impossible.. I need to hear something different. He claims this time from other visits two months ago that he too is not happy with the scar, he said to give it time to heal, sometimes scars get worse before they get better, also stated that i don't do well with dissolvable stitches, but I told him that 4 months ago and next time he will not put too many since they take to long to dissolve because of my skin type, and they push themselves threw the scar causing the widening... Im afraid with less dissolvable stitches it will still open since my skin is thick, and its the forehead a very stressed area,i'm afraid i will start again with red horrible scar, i'm just afraid...Dr can you please give me your advice on this, might this work? can this be possible that with less stitches the scar will stay in tact, should I go ahead and do this... or should I just not waste my energy and go somewhere else...
Also Dr lam if its possible i would like to speak with you over the phone, i know we are in different states but somehow, when i read your emails you comfort me and reassure me that there is a possibility that i might regain my confidence again....one day. And if it takes traveling there, well so be it... thank you sara

we can do a phone consultation. you can schedule that with marcy@lamfacialplastics.com or call 888-866-3388. i am booked pretty far in advance (several months ahead even for phone consults) so schedule that time soon. i hope i can help, but to be honest i believe in a lot of deep sutures even if they push through. i believe that they will push through and that is better than a scar widening. just my opinion on things.
best,
sml

Good morning Dr Lam,

I'm not sure what you meant by your email. That it will push through, and its better than a widened scar. I'm confused here,can you explain a little more. My question again is will this method of using less dissolvable stitches work better in the scar revision, or in the end will the scar still widened slightly, and basically the same thing again....I just want to know if I should endure this again to be disappointed, or just wait to see you..I guess now my scar is loosing the red, but still has the indentation, and uneven edges, due to my complication with dissolvable stitches, so if he uses less, I'm afraid the same thing will happen.....Thank You again Sara......

okay, here are the things that I would do and perhaps do differently:
1. I pre Botox the area the day before to limit dermal stretch back on the incision (and I don't just mean 2 or 3 drops but analyzing the entire forehead and any other muscles so that everything has no tension.) That helps tremendously.
2. I would still use a lot of deep sutures even if they eventually come sticking out because it will limit scar widening.
3. I would do a 2 layer skin closure (after the dissolvable suture layer) to help evert or turn the wound edge outward so that the wound would then lie flat over time. i do that because if you make the wound edge flat, it can then indent over time. obviously, i can't promise you any of this.
4. i would work with 5-FU and laser to manage scar thickening afterward but that would make your recovery more of an issue because you don't live here.
bottom line is that i can't make any promises that i am some kind of super God but i think gentle care and good technique AND good followup are key to trying to get a better chance at success.

Dr Lam,

Thank you so much, that actually makes sense. I have done my own research on this, read so many articles. And i can actually visualize what your saying...wow....okay I guess next step for me would be to set up and appointment.., to see you. I will email or call your assistant.........Oh by the way you might find this funny, the other day I met with a friend, who's friend has a practice, he's a surgeon nice guy, but not aggressive with marketing and he knows it..He came out and him and I were talking, he eventually took off about certain procedures, how things are done, and funny he said i quote: there is this Dr. I read his medical blogs and he sounds like a great surgeon, he has this method with one syringe can create fullness on both cheeks".... plus he continued by saying besides I met him briefly.. He also said i wouldn't mind traveling to him to learn some of his secrets, but hes out of town....pretty cool I thought... then it clicked I asked by any chance is his name Dr. lam..... confirmed... thought you might enjoy this story small world after all......Thank You for your time... Hope to meet you soon. Sara

Funny story. I look forward to meeting you.