LAM FACIAL PLASTICS

I'm a 21 year old male who suffered from acne when I was much younger. I can't recall the last time I've had any acne but I've been left with one rolling scar which has devastated me. I can't go outside as much anymore and I wear sunglasses everywhere I go. I'm a current college student and life has been rough. I'm currently seeing a psychiatrist. I've reached the conclusion that I simply can't live and function like a normal person unless I can get treated. The scar is in a very noticeable place on my face. It is on my cheeks but closer to my nose area compared to many who suffer from outer cheek scarring. I've seen some of your patients testimonials and I've been left in amazement. I don't have severe scarring like many of those that you have treated. I have only one scar, which has now broken into two smaller but deep scars due to the treatment with TCA Cross.

With that being said if my scars at not severe can I still be treated with silicone injections, and would I still be required to pay for the entire syringe? I.e. around $700 per session for 1-2 scars?
Would you even be willing to treat a patient like me with few scars?

I've hoped and prayed for many years now that I may find a solution and I feel a permanent fix is the only real solution. I truly hope from the bottom of my heart that I can find help within your office Dr. Lam.

hi,
first, i am sorry to hear of your situation. second, i think seeing a psychiatrist as you are doing is so very important right now. it is not a good idea for a plastic surgeon to work with someone who has serious, unresolved psychological issues until you are nearing an end to your treatment. it sounds as if you have perhaps body dysmorphic disorder (but i am not a psychologist), which is defined in short as having a physical attribute that is so crippling to you that it affects your social/professional life but that typically would not be noticed by someone else. someone that has BDD needs to be managed first before a physical treatment should be offered. third, the "amazing results" are more likely in someone with severe problems. the smaller the problem, the harder to fix the problem because it becomes increasingly narrow in the margin for improvement. fourth, silicone fills deeper holes in the skin and is very difficult to use for shallow etch marks. i would have to see it. the price of silicone is pretty standard. you are paying for a treatment not a quantity unlike restylane. i would have to see you to individualize that further but price is something that is not discussed in this forum. i wish you the best. i don't think i should be treating you right now. however, in the future, the door is open. i wish you the best.
best,
sml

I agree with you doctor. Seeing a psychiatrist is very important and I will continue to do so. I kind of over exaggerated in my previous post and I apologize for that. Those words came more so from my frustration and not my heart. As with any individual, and I think we can both agree on this scarring can make an impact on your social life. I apologize for asking about price here.


Well I have a few more questions if you don't mind.

1) How do you define scars by their depths shallow, medium, deep? Is there any way I can find out for myself how deep my scar is?

2) If my scar is not deep enough, there is no way silicone can help me at all? Would any filler help me in that case?

3) Is it possible to send a picture and get an opinion back from you or maybe a nurse to see if treatment is possible. When I'm cleared by another doctor to come see you and get treatment I hope I can get treatment, lol. With that being said I'm not from the Texas area. I'm actually from IL. If I were to come in and find out I can't be treated because my scar is too shallow.. well I just want to avoid any kind of situation like that.

4) Is it the width of the scar or how deep the scar is that plays a bigger factor in whether silicone can be used? I understand it's much harder to treat a scar that is smaller or not as wide than it is to treat bigger scars but I assume it can still be done as long as the scar is deep enough, correct or no?

5) I kind of want to say that I don't think I expect 100% improvement. You can't go in expecting that, being unrealistic won't do anything positive. I am a realist. I accept reality and I have a acne scar and it may never be completely gone but I think I'd be happy with small improvement versus no improvement at all. That is also another reason that I want a permanent filler like silicone. I don't want to treat this for the rest of my life with temporary fillers. It's costly and inconvenient.

Lastly I just want to say thank you for taking your time to answer these questions. I really do appreciate that. I know your a doctor who cares about his patients and that's great to see.

1) How do you define scars by their depths shallow, medium, deep? Is there any way I can find out for myself how deep my scar is?
THIS IS HARD WITHOUT AN IN PERSON CONSULTATION. PHOTOS RARELY GIVE ME AN ACCURATE IDEA SINCE LIGHTING HAS SO MUCH TO DO WITH IT.

2) If my scar is not deep enough, there is no way silicone can help me at all? Would any filler help me in that case?
THAT IS RIGHT. IF THE SCAR IS TOO SHALLOW, SILICONE WON'T HELP. SOMETIMES RESTYLANE CAN BE INJECTED CLOSER TO THE DERMIS BUT IF IT IS VERY SHALLOW THEN IT MIGHT NOT LAST AS LONG (A FEW MONTHS POSSIBLY) SINCE IT IS INJECTED IN A SMALLER QUANTITY.

3) Is it possible to send a picture and get an opinion back from you or maybe a nurse to see if treatment is possible. When I'm cleared by another doctor to come see you and get treatment I hope I can get treatment, lol. With that being said I'm not from the Texas area. I'm actually from IL. If I were to come in and find out I can't be treated because my scar is too shallow.. well I just want to avoid any kind of situation like that.
AGAIN, PHOTOS DO NOT COME CLOSE TO UNDERSTANDING YOUR SITUATION BUT YOU CAN SEND ME A PHOTO IN A PM.
4) Is it the width of the scar or how deep the scar is that plays a bigger factor in whether silicone can be used? I understand it's much harder to treat a scar that is smaller or not as wide than it is to treat bigger scars but I assume it can still be done as long as the scar is deep enough, correct or no?
DEPTH IS THE KEY. IF IT IS A DERMAL ISSUE THEN SILICONE CANNOT ADEQUATELY FILL IT. HOWEVER, IF IT IS EXTREMELY NARROW THEN TOO THAT IS A DERMAL ISSUE INTERESTINGLY ENOUGH. SILICONE IS IDEAL FOR LARGE, WIDE ROLLING SCARS.

5) I kind of want to say that I don't think I expect 100% improvement. You can't go in expecting that, being unrealistic won't do anything positive. I am a realist. I accept reality and I have a acne scar and it may never be completely gone but I think I'd be happy with small improvement versus no improvement at all. That is also another reason that I want a permanent filler like silicone. I don't want to treat this for the rest of my life with temporary fillers. It's costly and inconvenient.
I UNDERSTAND.