LAM FACIAL PLASTICS

Hi Dr Lam,

I am very interested in your opinion on this subject as you are one of the very few [i]plastic surgeons [/i]injecting silicone. If I have silicone injected into a scar, would I still be a canidate for surgical scar revision? I am worried the silicone may donought around the scar resulting in adhesions in the surrounding tissue therefore making undermining difficult.

Also regarding surgical scar revision of acne scars in general. Could a 1.5cm x 2cm rolling type depressed acne scar be surgically removed? I have heard in some cases the scar depresses again. Could this be avoided with adequate undermining? Or any other method?

1. in answer to question 1, i think it is not harder to manage with silicone. the reason for my answer is that i do a TON of silicone lip corrections from doctors (or most likely lay injectors) who went a little overboard with injections and in that case i actually find it tremendously EASIER to reduce the lips because of the firm nature of the silicone when i do so. does that apply to acne scarring? don't know to be honest. can't recall needing to do that.
2. in answer to question 2, no. my opinion is cutting out scarring is risky. i just did an 8th revision on a scar (i.e., i was the 8th surgeon and hopefully last) that was created by a surgeon trying to remove acne scarring by doing so. this poor gentleman flew 10,000 miles for me to fix this error.
best,
sml

Not to beat a dead horse, but why is it risky?

because it can create now a linear scar that is now worse than what you started with in the best case scenarios. in the worse case scenarios you can get a depression, scar widening, hyperpigementation, redness, hypopigmenation, hypertrophic elevation, etc.