LAM FACIAL PLASTICS

I would be very happy to hear your opinion. I had been on accutane almost 3 years ago for cystic acne. While on the accutane I seemed to develop nodular like pimples. One in particular left a crater scar on my cheek it is a pretty good size almost like a chicken pox scar. I know its hard to assess without seeing me.
It really bothered me and therefore I'm not sure if I did not wait long enough but after 6 mos I did a few affirm laser treatments to help fill in the indentation at a spa with little to no results. I than saw a dermatology/laser doctor in boston at MGH and had a 4 fraxel treatments. The one with the shorter downtime. Again with not much improvement. I than asked if there was anything additional that could be done to help. He said more fraxel or restylane.The scar is crater like on the outside with lighter coloring. The edges are irregular and the middle is hyperpigmented and atrophic. He said we could try restylane. I tried the restylane and that seemed to help for about a week and than the scar looked worse. I think its like a donut effect. He had also excised the scar I think before he did the filler and now the scar seems bigger. The edges are more prominent. At this point it looks terrible. I have tried to visit different plastic surgeons and their opinion is to leave it or cover it with makeup. One recommended more fraxel, another collagen induction therapy and another silicone microdroplet technique.
I ended up having the restlyane dissolved it was placed FEB 3, 2010 but I think there may still be some in there. The edges are still irregular and raised like. I would like to go with the silicone microdroplet technique. The surgeon said I would not have to wait 6 mos to start and she would just go very slow. Is this safe in your opinion? Also after the silicone is there anything that can be done to improve the crater like edges? Would any type of pigmentation tattoo be safe? I am pretty desperate it looks awful. I am 23 and would like to live a normal life but feel this scar is so disfiguring. I live in the Boston area. I am not sure if there is someone up here you could recommend? I am thinking of doing the microdroplet technique to help with the shadowing but where the scar has irregular edges would this make it look worse? I am willing to travel to Texas if you feel there is something that you could do to help.
I have been told that scar revision could make it look worse. Thanks Nicole

sorry to hear what you are going through. here are my thoughts:
1. i cannot make a diagnosis without seeing you in person.
2. silicone if done by someone experienced in the right scar can help but again someone must be qualified and the scar must be evaluated for that end.
3. tattooing in my opinion is almost always dangerous. with any tanning or changes seasonally the scar can look worse. that is a general rule. it might not apply to you but that i what i have seen.
4. scar revision is typically not indicated for crater like scars but for linear scars. when it is crater like filling in is generally preferred. but again, i would have to see it.
5. if the area is hyperpigmented then bleaching products can help but again you must see a doctor to determine whether in your case that makes sense.
best wishes,
sml

Hi Dr. Lam,
Thank you for replying so soon. I do feel I will go with the silicone microdroplet technique than. Do you think I should wait longer for the restylane to completly dissolve though? The surgeon said she could do a little bit in the atrophic area and than come back in 4-6 weeks. Than I should probably wait a few months to see if more will dissolve and if I need more silicone than maybe in years with collagen lost etc. I may need additional silicone?
I think I will get rid of the idea of the tattooing than. Maybe the center will lighten in time or with hydroquinones.
Do you know plastic surgeons in the boston area experienced with the silicone? I did feel comfortable with her and she even had it in her nose which I couldnt tell. I think maybe I should ask her for photos etc. considering silicone is irreversible.
Thanks again

1. if you have had the area dissolved then it should be dissolved in my opinion but i don't know what they did to dissolve it. typically hylarunidase dissolves the restylane within 24 hours.
2. i cannot make any recommendations for other physicians. i am sorry about that.
best,
sml