LAM FACIAL PLASTICS

Hey Dr. Lam! I had a brief telephone consultation with you yesterday afternoon. I was stuck in traffic during our conversation and did not have access to my question list, hence the reason I am here (and thankful for this board:). I am scheduled for an appointment this upcoming Tuesday, April 21. I will just list my additional questions:

What is the recommended length of time an individual must wait before they can be exposed to the sun after the silicone injections?

How long before using a tanning bed?

Can an individual receive IPL treatments after silicone? --again, time length?

If I am not satisfied with the end silicone results, can I get other fillers on top of the silicone? (again, how long after last procedure?)

And my final question is very specific related to the pictures I had emailed you for my consultation. My most bothersome scar appears on my right jawline. It is by far (very very very far) the absolute worst scar I have and occurred due to cortisone atrophy. I have an upcoming wedding that I am the maid of honor in on May 16th. (my 1st silicone appt with you is on April 21) Although you stated I may only need 1-2 treatments, I also understand that results may not be apparent for several months (90 days, as you stated yesterday) after the last procedure. So, in terms of the single, most severe scar on my jawline I am considering something that may produce significant results a bit quicker. Are there other temporary fillers that may have a quicker effect that we may use for this single scar? I also understand that I will then have to wait to use the mircrodroplet silicone in this location until the filler dissolves. I know in the past, they have dissolved within a matter of a couple months for me. I am aware that the most practical solution would be to have this scar injected with silicone along with the others on April 21st, however, due to the major event I have less than 1 month later, I am more worried about the appearance of this scar on May 16th than I am the most practical/cost effective solution. Please let me know what you think about this matter.


Thank you for your time...and I apologize for not having my entire question list available at our consultation yesterday.

What is the recommended length of time an individual must wait before they can be exposed to the sun after the silicone injections?
SINCE YOU ARE FAIR SKINNED, YOU WILL PROBABLY NOT HYPERPIGMENT/TURN DARK. PROBABLY A WEEK OR SO. OBVIOUSLY, YOU CAN HAVE A LITTLE SUN EVEN IMMEDIATELY AFTER.
How long before using a tanning bed?
UGHGGHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH!
DO YOU KNOW THAT EVERY TIME YOU GO UNDER THE TANNING BED, THAT YOU DESTROY 13 YEARS OF COLLAGEN. YOU WILL LOOK 50 BY THE TIME YOU HIT 35. DO'N'T BELIEVE ME. JUST WAIT. IT IS TERRIBLE NOT TO MENTION SKIN CANCER THAT CAN KILL AND/OR DISFIGURE YOU. I HESITATE TO EVEN ANSWER THIS QUESTION. YOU CAN GO BACK IN A WEEK BUT PLEASE DON'T LET ME KNOW YOU ARE KILLING YOURSELF SLOWLY.
Can an individual receive IPL treatments after silicone? --again, time length?
YES. PROBABLY A 3 TO 4 WEEKS.
If I am not satisfied with the end silicone results, can I get other fillers on top of the silicone? (again, how long after last procedure?)
YES. AT LEAST A MONTH BUT WOULD PROBABLY WAIT 3 MONTHS TO SEE THE COLLAGEN RESULTS.
And my final question is very specific related to the pictures I had emailed you for my consultation. My most bothersome scar appears on my right jawline. It is by far (very very very far) the absolute worst scar I have and occurred due to cortisone atrophy. I have an upcoming wedding that I am the maid of honor in on May 16th. (my 1st silicone appt with you is on April 21) Although you stated I may only need 1-2 treatments, I also understand that results may not be apparent for several months (90 days, as you stated yesterday) after the last procedure. So, in terms of the single, most severe scar on my jawline I am considering something that may produce significant results a bit quicker. Are there other temporary fillers that may have a quicker effect that we may use for this single scar? I also understand that I will then have to wait to use the mircrodroplet silicone in this location until the filler dissolves. I know in the past, they have dissolved within a matter of a couple months for me. I am aware that the most practical solution would be to have this scar injected with silicone along with the others on April 21st, however, due to the major event I have less than 1 month later, I am more worried about the appearance of this scar on May 16th than I am the most practical/cost effective solution. Please let me know what you think about this matter.
YOU WILL PROBABLY SEE SOME NICE CHANGES WITH 1 ROUND OF SILICONE FROM WHAT I SEE. O/W I WOULD DO SOME PERLANE AND THEN FOLLOW IT WITH SILICONE EITHER WHEN IT IS GONE OR HAVE IT DISSOLVED OUT A WEEK BEFORE SILICONE USING VITRASE. LET ME SEE YOU TO DECIDE.

How long before using a tanning bed?
UGHGGHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH!
DO YOU KNOW THAT EVERY TIME YOU GO UNDER THE TANNING BED, THAT YOU DESTROY 13 YEARS OF COLLAGEN. YOU WILL LOOK 50 BY THE TIME YOU HIT 35. DO'N'T BELIEVE ME. JUST WAIT. IT IS TERRIBLE NOT TO MENTION SKIN CANCER THAT CAN KILL AND/OR DISFIGURE YOU. I HESITATE TO EVEN ANSWER THIS QUESTION. YOU CAN GO BACK IN A WEEK BUT PLEASE DON'T LET ME KNOW YOU ARE KILLING YOURSELF SLOWLY.

ok, this response was kind of funny but not really because I know you are serious. 13 years?? uh-oh...during my teenage years, I tanned quite frequently...so I am guessing I've lost thousands of years worth of collagen. Quite scary, but those are the kinds of things you never think about as a teen! As for now...not that it makes it any better, but I only tan indoors on very rare special occasions (such as the upcoming wedding). However, I need to show this response to my best friend--who owns a salon and tans literally on a daily basis-year round!

Thank you for addressing my questions so quickly (and thoroughly)--on a Friday evening, not to mention! I really appreciate it. I have heard many great things about your work and am anxiously anticipating my appointment on Tuesday!

Thanks again...See you Tues!

thanks. sorry, i'm both funny and serious. you got the tone right. your friend will hate me, but i speak the truth. whatever your friend says to the contrary (which he/she will), please listen to me and stay safe. my mission in life is to help people and acne scars are only part of the whole story. use fake bake. stay safe!

Hi Dr Lam

You have addressed previously that generally you prefere to either have restylane or perlane absorbed or dissolved before injecting silicone. I'm wondering why.

I currently have restalyne and perlane in my right cheek. It was injected in an attempt to fill a large very depressed rolling broadbased acne scar. Unfortunatly the filler only doughnuted around the scar and did not fill it in at all. It was injected 5 months ago, however I can still feel quite a large lump.

Being that the depression is still 100% visible - would it be ok to start injecting silicone? If I lived closer to you I would have no problem coming in first to have it dissolved then return for the silicone, but because I have to fly I was hoping to avoid having to dissolve it first. I would wait to have it absorb but I have a lot left over! I had a seriers of 4 injections spaced 2 weeks apart. I'm thinking it will take a lot longer to dissolve because it is one big giant lump, and even though my last injection was 5 months ago it has not dissolved at all! At this rate it may take a couple of years. (I kept going back for more injections thinking it would start to improve - silly me!).

Do you like to have restylane gone for the simple reason of the area not being visible from the effect of the filler - or is there another reason?

yes, you should find someone local to dissolve and wait at least 7 days before i contemplate silicone, preferably even 2 weeks. the reasons are as follows:
1. i don't like to inject permanent fillers over a moving target. God knows what is permanent, temporary, scar, etc. Not safe.
2. if i am injecting silicone into a mound of temporary product, my fear (so far only theoretical) is that the silicone can coalesce as the restylane disappears. most likely this is unnecessary concern but since i am working with a permanent filler, i don't mess around and you should not either.
best,
sml

Thank you, OK here is my next question/concern, there always is one right?

I have had tremendous tissue loss in this cheek. I'm afraid dissolving the resty may deplete some volume along with the resty. The reason I'm concerned is I have noticed even the tiniest pimple in this area has resulted in a scar. I have not broken out in a year but since the tissue loss I got one tiny tiny tiny little pimple about a inch from the depressed area and it resulted in a scar!! My theory is that because of the overall lack of volume in this area anything will further scar me. The quality of the skin in this area is just not good.

I know a lot of the skins composition is water - and I'm afraid dissolving the resty could deplete me of additional fluid and possibly tissue loss. Am I correct to wonder that dissolving resty in a person with "normal" tissue may be a lot safer than someone in my situation?

Or am I over thinking this?

you are overthinking it. dissolve the restylane to be safe.

you are overthinking it. dissolve the restylane to be safe.

Thanks Dr Lam. Unfortunately 4 weeks ago I had .01ml of silicone injected by a DR who did not think the resty would be a problem. However now I disagree with him and will not proceed with more silicone until the resty is dissolved or absorbed. How long should I wait post silicone to have the resty dissolved? How picky should I be trying to find someone to dissolve the restylane. I'm not sure how far the restylane extends, is it an issue injecting a dissolving agent into an area with no resylane?

I really really really want to come to see you!! I have two smalll children which makes travel difficult. I am in the process of convincing the husband. The good news is he LOVES Texas so hopefully Iwill see you sooner than later!
No more silicone until I can make my way to you. You have an amazing reputation. I'm glad you caught wind of your PT posting his amazing before and afters on the web.

Would you ever consider holding a clinic in the New York area???

you should wait at least a week or two before doing silicone after restylane injection because the dissolver can affect the surrounding collagen temporarily. i think almost anyone can dissolve the restylane. that does not require technical skill. just make sure you do a skin test first.
best,
sml