This section of the forum is dedicated to discussions on managing, treating, and correcting acne scarring. (Of note, Dr. Lam is focused principally on acne scarring rather than on managing the ongoing condition of acne, which a dermatologist would be better equipped to address.)
Dr Lam, I"m 46 years old and have rolling type acne scars on my chin and cheek area. I also have a silicone nodule that I have had for 20 years. It's located on the side of my chin below the corner of my mouth. I have cortizone injections to keep it smaller, but it never goes away. I would like it excised, is something that you would do? I'm also looking for a facelift/fatgrafting to help with my acne scars. As I age my chin area is becoming very uneven from the scarring. I believe the silicone nodule is a result of overcorrection. A derm excised a smaller nodule after attempting to get rid of it with 5-flu injections. He said after examining the excised area that it was all silicone. I'm not sure if I would risk more silicone from a skilled doctor. I really need you help, you seem very caring and knowledgeable. I have no problem traveling there from california. thank you very much.
in answer to your queries, first, silicone is very hard to actually remove unless it is very near the skin. trying to bring silicone nodules down with 5-FU and/or steroid can also be fruitless in many cases. the best way to address it is to try to remove it and if not, just to cut down the tissue to the point that the area looks flat. if there is only a small bump in the outer skin, which this sounds more than that, you can just shave the outer skin down to flatten it without having to remove the silicone. bottom line, silicone is hard to fix and hard to remove. of course, i can put more silicone into the acne scars but that may be hard for you considering your silicone that you had before was not ideal. also, all of this takes more than a one shot deal which makes coming from another state more difficult for you.
when you have rolling acne scars, silicone really is ideal more than any other treatment that i have tried. besides building your trust in my silicone treatments, it also takes usually 2 to 4 times before getting you there. and when i mean getting you there, it still is not ideal, just better.
okay, now for some depressing news about fat grafting and facelifting. neither technique is well suited to manage acne scarring. although i have seen fat grafting improve the texture of that area, it is a hit or miss proposition. i have one before and after close up of acne scars improved with fat grafting. i would truly suggest that you believe that it will NOT help at all. the only way fat grafting even has a chance at improving acne scarring is to help improve the skin texture/tone over a period of a year and NOT by filling the defects. just as i believe that fat grafting is useless practically speaking in filling deep lines, i believe that fat grafting is practically useless for filling rolling depressions. that being said, if you are 46 years old and showing signs of just overall atrophy and shadowing, then fat grafting can help rejuvenate your face effectively. also, if the fat grafting does improve the skin texture/tone over a year's time, consider it a bonus. do not bank on that. finally, fat grafting in most cases makes the skin look better sooner than later through a different mechanism, by creating more light on the face, the face appears less shadowed and the skin can look better. if you have some sun damage on your skin, then rhytec plasma skin resurfacing can also help with both the aging and indirectly help the acne scarring but again i want to be extremely careful in overselling this feature. consider that it won't do a lot for that condition. as far as the facelift is concerned, even though it seems so easy to help these scars when you pull your skin back with your hand, a face lift will NOT help in any shape or form the acne scars. a face lift will only help a sagging jawline and neck.
hope this answer helps a bit. you can ask me a followup if you need clarification.
Samuel M. Lam, M.D., F.A.C.S.
Diplomate, American Board of Facial Plastic & Reconstructive Surgery
Diplomate, American Board of Otolaryngology Head & Neck Surgery
Diplomate, American Board of Hair Restoration Surgery
Dr Lam, thank you for response. I have a few more questions for you. Regarding fat grafting and acne scars, some of my scars have just appeared in like the last couple of years due to fat loss and elasticity loss. It seems if I augment the whole chin area my scars would fill in some too. Does fat grafting not work that way? In regards to the silicone in the side of my chin, would it be possibe to make the incision under my chin so that the scar wouldn't be as noticable? If you think it would help to see a picture I can make a phone consultation with you. Thank you for you assistance, it's difficult to find plastic surgeons that want to deal with the silicone.
1. If the "acne scarring" is more shadowing caused by bone and soft tissue resorption, the fat will help. If anything some of the shadowing is improved by just placing fat. However, to fill in an actual tethered scar, fat will not do it.
2. As far as removing silicone, I will most likely fail in removing it. I just want to take down the area to be flush with the skin to the best of my ability. If it is over the jawline, then a vertical incision heals much better: please review my relaxed skin tension lines on the mole removal faqs section of my website. If it is FULLY UNDER the chin, then a horizontal incision will heal better. I would have to see it.
3. I think a photo would help me assess the situation. Please send it to me privately at firstname.lastname@example.org.