LAM FACIAL PLASTICS

Hi, Dr. Lam

I have been researching you and your work for many months now, in fact, I began my TCA CROSS journey after hearing your discussion on the acne scarring video presentation. I'm a huge fan- I hope that you may find time in your busy schedule to answer this post, as I think I could trust your opinion most out of the doctors I've researched online. I have an unsual area on my cheek where I've had two quasi-traumatic incidents leave me with the most oddly shaped depression in my right cheek that I'm unsure how I should look into treating. About a year ago, an inflamed acne lesion formed there, which I had fiddled with, leaving me with the beginning of the depression, but nothing anyone but myself could notice. However, about 4 weeks ago, a similar lesion became inflamed in the same area, which my dermatologist incised, leaving me with a secondary intention wound that is healing up now. After this visit with the dermatologist, my depression became MUCH deeper and MUCH more noticeable. Not only is this rather small incision taking more than 4 weeks to close, but the area looks like the recent trauma (cortisone, inflammation, blood flow?) has changed its appearance. Any idea how I should go about treating this? (I realize I MUST wait at least six months before trying anything, to give the recent incision time to heal and mature) I've attached a picture, the best lighting and quality I can get, unfortunately. I hope it offers a good idea what I'm working with. Thank you so much!

hi,
you are right. that early out is a bit premature to read what is going on. based on the photos i probably would try silicone injections first since i find that to be more predictable for a larger hole as what i am seeing. you may still need a little bit of CROSS at the very end. again, i would need to see it in person to decide. thanks for your kind trust in me.
best,
sml

Thank you for responding so quickly, Dr. Lam! Based on your work with silicone injection (and the testimonials about you doing it all over acne.org), it sounds like that may be my best option in the end. My only other question is that I'd read a testimonial from one of your patients who said that "if stretching the scar results in flattened appearance, silicone injections will work great for you." The odd thing about my scar is that it is not tethered whatsoever, or if my understanding of tethering is wrong, I only mean that my surface skin is not being pulled down to make the depression. The depression is there due to lack of collagen or fat cells to push the skin up; there is a lack of underlying material to push up my natural-looking surface skin. I've heard this could be due to the cortisone injections, so you're right, I should wait a few months and see if it improves, but I just wanted to hear any further thoughts you may have. Again, thank you so much for your quick response, and God Bless.

I do not think the tethering issue is a big deal in my hands. What people are mentioning is the need for so-called subcision to release the underlying scar. I really do not find that being necessary especially not with my micro droplet silicone technique. Sorry for the delay in responding, just finishing 5 hours of moderating and lecturing in Vegas. Just got off the podium.
Best,
SML

Your response is much appreciated no matter when you get around to it, Dr! Everything sounds great, answered, and to my liking-- and my last-last question is something you may or may not be able to help me with, but like I'd said- I'd had this incision done on my cheek exactly 4 weeks ago, your stereotypical "minor incision" used to open a small facial abscess, although this is my first go-around with one. My dermatologist had said "it would heal in a week" being that it is on the face, which typically heals the fastest, and based on the fact that it was superficial. Four weeks later, I haven't even seen the wound edges close (healing via secondary intention), and for something she'd said would heal in a week, it's taking more than four. I realize I should probably be asking her about this, but she's not easy to get in touch with, and I'm out of town for school. Based on your experience with skin and its ability to heal, is this "normal" per say? I know you can't offer medical advice, so I don't expect much, but I thought I'd ask- no harm, no foul. Thanks a lot, it's truly something to speak with a doctor who goes out of his way to help people out

hi,
in short, when i cut out a facial lesion and have a scar in the middle of the face, i tell people give me a year before it will look really good. if it is widened, then it may not heal as well. that being said, if it were not an abscess but a non-infected incision i tend to close it in 3 layers and also use a jagged geometric closure all to make it look better. i think yours will hopefully fade nicely over time. glad to help!
best,
sml

Hi Dr. Lam!
Well, good news- the incision finally closed thanks to steri-strips. It took a full 7 weeks for the incision to completely close, which I find incredibly hard to believe. However, now, there is an area about the scar I have a question about. The line itself where the skin edges have met couldn't be more perfect, but I noticed that the left side is 'tethering' into the incision line? My dermatologist managed to cut a sliver of skin more off the left side than the right side of the incision (probably why they suggest to do it by plastic surgeons), and that lack of skin is leaving whatever skin is left being pulled greatly inward towards the scar, which makes the scar look wider because of the redness and tension. Is this something that will still fade into a thin line in 6 months to a year, or would a something like this require possible revising in the future to fix? Thanks so much, get back to me when you can
(Normally I would not worry about something like this if it were not on my face, although I'm sure you understand that)

it is hard for me to say without seeing it. but even if i saw it, you are still early in the healing phase. i withold judgment for a year but obviously if it is staying red or becoming thicker, that is when i intervene earlier with KTP laser and/or 5FU injections as needed.
best,
sml