LAM FACIAL PLASTICS

HI dr,
10 years a go i had undergone warts electrical removal on my lips, it left 2 scars . one on the right side of lower lip(5 mm width and length), and the other on the left on the upper lip( much smaller ). I had consulted with a plastic surgeon 7 years a go, he said that scar revision is the solution and he talked about something called z closure which as i know leads to lengthen the scar. i was afraid of getting througth that (for the possibility of getting worse scar from stitches), but after seeing your work on photoes ,i feel that i trust you and would like to know your opinion. what is the best to improve my case?

sorry for weak language ,and i will be so glad to see your answer doctor

hi,
yes z-plasty lengthens scars. it is not always the right decision. do you think you could send a photo here as a closeup so that we can educate the public?
best,
sml

Thank u for ur replay doctor ,i appreciate that. Unfotunately,I do not have my camera these days ,but i will post a photo once i get it back.
I would like to know doctor what other techniques could best be done for scar revision on lips except z- plasty and the lengthening ?. what the new scar after the procedure will look like? ,and will the stretched skin along the new scar sides be like my natural lip colour?

i am so sorry for too much questions doctor but i do so because i trust you, the photo will be here soon

that is a great question. unfortunately, i don't have a lot of options on the red lip because geometric broken lines and z-plasties in many cases don't make sense. usually a straight line closure without tension. i know that sort of violates the principles of scar revision but i would have to see the scar to decide the best avenue.
best,
sml

thanks for the photos. obviously, a photo is not like an inperson consultation. however, i just see a wider, white, raised area that in my opinion should just be carefully cut out and closed. it should heal well but obviously no guarantees. i think that a z-plasty is an absolute mistake for 2 reasons:
1. it will lengthen the scar and make the lip drag down.
2. z-plasties are intended to also realign a scar. your scar falls along the relaxed skin tension line of a lip so there is no reason to do a z-plasty.
best,
sml

hi doctor
why did you say no guarantee is there any possibility to get worse??
what is your advise for me depending on your experience

sorry 4 questions

1. basically i always so no guarantee, and yes there is always a possibility that it could get worse.
2. i would say only based on photos (not on in person exam, which is of course more accurate) that it would most likely improve with excision and closure.
best,
sml

hi dr,
when i was searching in google,i found an answer for someone asking(why can’t I have lip surgery if I have lip scarring), and the answer was:

Surgery can’t be done on scar tissue due to the fact that tissue regrowth on a scar isn’t stable enough for sutures (lack of collagen) so, to keep the sutures in place, it would be necessary to go deeper or use tissue surrounding the scar. This would cause the scar on your lip to be larger, or more noticeable, than the existing one and the skin might grow in as a slightly different color.

is that true doctor?? would you please explain the red lines for me, do the writer mean the new stretched skin by(might grow in as a slightly different color)?

best regards

i think the comments that you posted are reasonable only because i cannot remove too much of your normal tissue or it might distort the surrounding lip itself given what i see. i think that your situation is not clearly obvious for improvement. you would be taking a slight risk (i don't think large) of worsening but a greater risk that i don't improve the situation much.
best,
sml