LAM FACIAL PLASTICS

Hi Dr. Lam,

A few months prior to my 27th birthday, a bad esthetician convinced me I needed an IPL treatment after seeing me for a facial. At the time, I had an oily T-zone, slightly enlarged pores on parts of my face, and was prone to breakouts in my T-zone. I never broke out on the sides of my face or forehead, and I had a healthy glow to my complexion. I felt that her treatment was very haphazard - it took place at the end of her day (last appointment of the day), she never tested my skin, never asked me any questions about my skin type or sensitivity, and just went to town on my face. She even burned part of my eyebrow off while doing it, and was talking to someone else during the whole thing. While she was doing it, I almost thought to ask her not to treat the sides of my face, which had always been absolutely porcelain, but I stupidly didn't say anything. About 1 month following my treatment, I started to break out much worse than I had ever broken out in my entire life. I developed enormous, persistent cystic acne all over my face, even places where I'd never had it before the IPL treatment, like the sides of my face where my skin has always been perfect. This persisted for a year, and was very, very embarrassing for me. I hid in my house, never saw anyone but my roommates, and completely and totally halted my social life. I would not go to family events because I didn't want people to see me. I was breaking out around my eyes, on my cheeks, on my forehead, EVERYWHERE. Not an inch of my skin was spared. I spent hundreds and hundreds of dollars on supplements, creams, lotions, doctors, facials, and other things that I thought could remedy my skin. I considered that it was maybe a newly developed health problem, but the many doctors I went to all said that my tests were fine. I feel like I lost what could have been one of the best years of my life, my 27th, because I was hiding inside and depressed about my appearance.

Now, my skin has cleared up dramatically but the psychological effects of it all are still with me. I feel dramatically less confident, less able to be the same outgoing, friendly person I had been before all of this happened. I hide my face in certain light, I don't like to wear my hair pulled back, and I often still decline to attend social events. I feel really petty that something like my appearance has made me so depressed, but it is true. I still have fading red marks from the breakouts, and as my active acne has cleared (I still have some acne that comes and goes on the sides of my face), I have found that I now have some small pitted and icepick scars on my cheeks. I can usually cover these with makeup if I have to. However, I've also noticed that my skin since the treatment has become different in other ways. Overall, the elasticity is MUCH MUCH MUCH diminished. I'm not sure if this is just the passage of time, but it seems so dramatic that I feel it must have something to do with the IPL or the breakouts. Also, my skin tone is totally blotchy, my face looks much much much thinner than it used to, I have bags under my eyes where I didn't before, and just in general look "sick, worn-out, and pale" as my grandmother put it when she started to notice the changes. Friends of mine also comment that I look very "pale" and "tired" all the time. One friend said that "something" has "taken years off your life", guessing that it was stress or "health issues". This is true no matter how much sleep, exercise, vitamins, or water I get. I have dimples and lines around my face when I smile that were not present before the treatment, and they make me look older than I should, so I try to control my smile. Overall, my facial skin feels very lax, thinned out, and pale. The only time my skin feels even close to how it used to is when I first wake up and it is puffy from sleep. I actually feel decent about myself when I first wake up, but I know that it will all fade after a few hours of being awake. This leads me to believe that perhaps my circulation (which is weak to begin with - I have low blood pressure and my acupuncturist says I have very poor circulation) to my face has diminished, and that perhaps some of my blood vessels were damaged or destroyed through the treatment, which might account for the dull, dry, pale, thinned-out look of my face. I used to glow. Now I'm pale and worn-out looking all the time. I just turned 28, and I don't know if this is just part of the normal aging process. I have a feeling that it's not because my face just looks and acts different in little ways that are only noticable to people in my life who have known me since before the treatment. Other people might think I just look like a stressed out, tired, prematurely aged 28 year old.... I am convinced it has something to do with the IPL.

Any advice or feedback about potential treatments will be greatly appreciated. Thanks so much.

Obviously, I was not there to see what your aesthetician did. However, I would say many times when we are stressed about life and our past, we show it in our face whether we have had damage or not. Our friends read our depressed attitude and make comments that are unfavorable, further compounding our situation.

I would encourage you first to read my blogs every day. I would like you to do a search in my blog for "Viktor Frankl" and "attitude". Frankl, a concentration camp survivor, said that when all our freedoms are taken from us (that is we cannot change our face OR our past), we have one freedom that remains, which is our freedom of attitude. I truly believe that is powerful. If you type in my blog "Life in Perspective" and look for the blog on "the past", you will see how to look at something that will only haunt you if you allow it to.

I am not a dermatologist. I cannot speak affirmatively toward IPL damage but I can speak definitively on your mind, your soul, and your heart. When you forgive someone else, you will begin the healing process. As I helped another blog/forum contributor who asked me, "How do I begin to forgive this person who did such and such to me?" I said simply, "You must forgive yourself first for having picked that person." Also, in my blog, type in "forgiveness" and read my blogs on that.

I hope you don't think I am not taking you seriously. I am. However, there is one thing for certain, I sense anger and resentment in your voice meaning that whatever I do to help you I cannot help you until you heal yourself first.
best,
sml

Hi Dr. Lam,

Thanks for your response. I guess my post does seem a bit resentful or angry, though I must say that at this point I don't really harbor anger toward the woman who treated me. When I think about it, I'm sure she was just out to make a buck, but more than anything I am upset with myself for making the choice to mess with my face at all. I also regret that I didn't do enough research before undergoing the treatment. I was just trying to tell you exactly what happened, which brings up a lot of sadness and pain at remembering the year during which I was hiding out due to my severe acne. I didn't want people to see me so different from how I used to look. It is true that I still feel self-conscious about my skin due to the scarring and changes to my appearance, but I think that it's normal for people who have experienced acne/scarring/changes in their basic appearance... It definitely has psychological ramifications! And while I take my own insecurities and human experiences seriously, I am someone who works with refugees and survivors of torture and am lucky enough to have reminders every day of how privileged I am not to have survived some of the more vicious circumstances that humans endure.

At this point, I am hoping to take care of the pits and scars left over from the acne breakouts and get on with it. I saw a well-known dermatologist where I live in the New York metro area, and he did comment that the elasticity of my skin is not great for my age (he said it's more like that of a 35 year old, and commented that it's unusual for Asian skin to be so lax at my age) and suggested another laser, which I declined for obvious reasons (i.e. being freaked out by lasers in general). He also suggested TCA CROSS method for my scars, and quoted me $700 for each session, with about 4 sessions needed. The reason I wrote on your page is because you seem to be conservative with your treatments, and more than anything, you seem more honest than most practitioners I've encountered. I was hoping you could tell me more about scar treatment and was also just wondering what you think of my hypothesis about a potential loss of circulation in the face as a cause for discoloration and skin laxity, or whether loss of circulation is just part of the natural aging process.

Your feedback will be greatly appreciated, and thank you again for your words of advice! I'm going to check out the other blogs now. I"m new on this thing and am finding it to be quite a useful resource already. Thanks

i hate guessing and that is what i would be doing if i stated i knew whether your blood vessels could or may not be damaged. i simply refuse to create conjecture on my part. wishing you the best in your recovery, and i hope i can be helpful in that process.
best,
sml

btw, read tomorrow morning's blog. you might find it applicable to your situation.
good night,
sml

Thanks for your reply. I wasn't asking whether you think that my skin in particular lost blood supply, but rather whether -- from your experience -- you think that blood supply has something to do with discoloration and overall skin health/laxity in general. I have tried doing some of my own research but I figured asking you would be a good idea since you have a lot of experience with facial skin and its behavior, though you are not a dermatologist. It was just a thought of mine, borne of experience and intellectual curiosity about this whole process. I respect that you don't want to answer that question, but I wanted to clarify that I wasn't asking about my own skin or the IPL. I was initially writing to ask about scar revision and for feedback about my thoughts on this issue, and I am still interested in scar revision at some point in the future if you think it's within your capacity.

I am going to read your blog now, then it's off to pack for a month of work travel outside of the U.S.! Thank you again for your sincere and helpful notes/blogs and for this interactive website...

hi,
honestly, i don't the answer to your question even rephrased. sorry i misread it. have safe travels! to all my faithful forum posters, please refrain from any more questions this weekend. my entire website/forum/blog are being migrated over to a new platform.
thanks for your patience,
sam lam

Hi Dr. Lam,

Greetings from Europe! Quick question: do you mind if I send you some before and after pics of myself so you might be able to take a look and perhaps offer feedback about the ways in which you might be able to help with treatments (or not)?

I am sure you are very busy, but I have a few days of downtime right now and was prompted by something/someone to continue the process of seeking feedback about potential treatment.

Thanks very much!

ok. send them as a PM.

Albertine,

My heart goes out to you. I could have written every word you did...especially about the morning swelling (I used to hate it before IPL, now I need it!). You are not alone. There are lots of us who have similar experiences and you're not crazy nor is what your noticing solely attributed to stress. We have a forum if you want to have someone to talk to: http://iplandlaserdama.talkthis.com/. I wish you the best!

i hope i can help in the future.
best,
sml

Dr. Lam,

Thanks. I would be on a plane tomorrow to see you if I didn't know you thought the temples and sides of head were too risky.

Those areas were very damaged in my case, contributing to the complete hollowing of the eye sockets (which decompressed and the eyeballs dropped back - one worse than the other) and even affecting how my hair lays against my head. It feels like someone put their hands on the sides of my head and squished me! It hurts to brush my hair, lay against a pillow or give a hug cheek to cheek because there's no padding over the bones and veins to cushion pressure. I remember the horror only a week or so after my laser treatment when I went to tuck my hair behind my ear and as my finger passed from the arch of my brow to my hear there was suddenly nothing under my finger where it should have been - just a large canyon!

That along with nearly non-existent fat in every inch of my face (including nose, chin, forehead, cheeks, jowles/jaw, neck, lips/area around lips, and even earlobes) make me a pretty tough case. :*(

did you get the sides of your head lasered too? fat can correct only so much. usually the person looks much better but it cannot accomplish perfection.
best,
sml

They lasered the temples but nothing under the hairline. I've found that the fat loss spread to a lot of areas that were adjacent to treated areas.

hmmm, sorry to hear that. obviously fat transfer has its limitations but in general can work very well at least to help the major areas of the face to make it look better.
best,
sml