LAM FACIAL PLASTICS

Hi Dr. Lam,

At the start of February this year i had a treatment with the ng yag laser for facial redness and broken capillaries . I have had IPL with this practitioner in the past and all was OK. However after the ng yag laser i developed some blisters, one on the top of my nose was particulary big and painful and when the blister drained it scabbed and after about ten days the scab came off and i have an atrophic vertical scar on my nose. The scar is in the middle of my nose about two thirds down, about 6mm long and 2 mm wide. It resembles an acne type scar but is long and narrow. I am due to visit the practioner next week as he wants to try some dermarolling on the scar. If this is not succesful do you think a scar like this could be excised and stitched precisely to form a better scar. Thankyou for any information.

hi,
sorry to have heard of that situation. the best thing to do is to ask your physician first. however, i can say in general that most nasal scars heal tremendously badly if excised and closed. the nose is a very unusual animal. the bottom part of the nose cannot be closed directly because the skin is too tight. the upper and mid portions are still tight and can be closed depending on the size of the defect and also AFTER undermining the skin all the way across the nose in the right plane which is way below the skin just above bone. unfortunately, most docs who try to open and close a nasal skin defect make it worse because they do not know the anatomy. it is NOT the same as the rest of the face. my suggestion is dermarolling etc. are safer in general (cannot speak about your situation since this forum is about general comments not specific ones) whereas scar revision on noses is a very very specific topic that mandates a skilled surgeon. if the scar is not bad enough, i myself do not even take the case many times because i risk making the scar worse. i would have to see it in person to decide. right now, it sounds like your doctor should be handling it for the next few months. i could see it after a year if conservative measures and patience fail. hope all goes well.
best,
sml

Thankyou for your reply.
I will try the dermalrolling and see how this goes. If this does not improve things, do you think after waiting twelve months from the injury that a tempory filler may help?

I am disappointed to hear that noses are difficult when excising a scar. The amount of skin excised would only need to be very narrow, probably 2mm which i was hoping would not create any skin tension.

Thankyou for the information.

fillers can help but you would have to be seen by a doctor and have that judgment given to you by him since i am not seeing your scar. 2mm is not wide but ultimately again if a scar revision is done it must meet 3 criteria: 1) you are a good candidate (that is it hopefully would not worsen things) 2) you have expectations of how long the recovery is in terms of making it better (typically a year) with possible need for dermabrasion, 3) it is done the right way (in the right plane and with the right undermining.)
best,
sml

Thankyou for your reply, I will see how things progress with the dermarolling and then decide what to do.

Hi Dr. Lam,

I just wanted to add that i have had a hypertrophic scar in the past but this was only because excessive tension was placed on the wound. Would you automatically think that i was not a good candidate because of this factor. I understand that nose scars usually leave quite an inconspicious scar if closed carefully. Also if the skin was undermined over the bone would this mean that the nose would have swelling and maybe internal scarring issues.
Thankyou again.

no hypertrophic scar does not preclude another incision if it was related to technique. internal scarring does not matter unless you were planning to have a rhinoplasty, which makes things harder then.
best,
sml

Thankyou for your reply. No i have never had a rhinoplasty , although my nose could be improved. If i did have a rhinoplasty and the nose was reduced in size slightly would this make excising the scar easier because there would be more skin available.
Thankyou.

unfortunately, no because the scar contraction would reduce the skin envelope down. it would actually probably make a scar revision worse (probably not seriously) because the blood supply is now slightly compromised.
best,
sml

Thankyou Dr.Lam, i will see how things progress over the months.