LAM FACIAL PLASTICS

Hi
My name is megan. I had a z plasty performed by an unqualified doctor about 4 years ago. In dec of 2008 I had another surgical revision done to the scar. This doctor reopend the scar and closed it in hopes that this would make the lines thinner. That surgery really had no effect on the scar and it actually may have widend it more. I have just finished a series of 5 fraxel treatments with a very qualified docter in NYC and I am very happy with the results on the scar itself. The one thing that still bothers me is that there is some assymetry in my cheeks. There seems to be some puffines at the bottom of the Z and it is very slightly concaved underneath of the entire scar. I think that it may be possible that when the first z plasty was performed the "Apple" or fatty part of my cheek may have been moved to the lower part of my cheek, leaving it puffy looking and the upper part of my cheek looking slightly flat or indented. I would like to know what you think could possilby be done about this. It is not a major deformity but it is enough to make my cheek look like it is bruised. I have an appointment with you on the phone coming up but I am not sure that a pic will show you an accurate idea of what it really looks like. I would also like to know that if you do have to remove or smooth out the fatty area what type of procedure will that be and are you also very qualified in this area. I really do not want to have any more surgical procedures on my face. I would like to stick with the safer noninvasive procedures. Please, I would appreciate any adviced that you can give me. I am 23 yrs old and this is something i have been dealing with with quite some time.

it is hard to ascertain what may have caused asymmetry but if you have asymmetry and there is a dip of some kind or a puffiness then those areas most likely should be treated if they don't improve over the first 6 to 12 months following scar revision and/or fraxel:
1. if the areas is depressed, then injecting it with a filler is your best best like restylane, which is temporary or silicone, which is permanent.
2. if the area has a bulge or puffiness, unfortunately if it does not settle down, the best option is to cut the "dog ear" out. however, if you are worried about another scar (which is a reasonable concern), then we should not do it. i would have to see it in person to give you a reasonable advice. however, i know that does not sound feasible. probably seeing the photo and discussing here in the forum is a good start. that may save you the phone consult but of course i would be more than happy to do that with you.
best,
sml