LAM FACIAL PLASTICS

dr. lam wrote:i have a fractionated laser and i don't think it does a lot for acne scars. i was going to get an active fx and was working on a book project a couple of years ago with a senior user of the product and warned me not to get it for acne scars because he said simply it was not effective. i personally do not have a good laser recommendation, as i find that in general it does not work well. however, you can give it a try but not with me. i personally would do the CROSS but it is not perfect, as very few things are for acne scars. thank you for the kind words.
best,
sml

Hi Dr Lam,

I feel conflicted about fractional laser, as I am currently using the DEEP FX (just had first treatment) for rolling acne scars, which is really sinking me financially at almost $5,000. Just reading your thoughts about this after spending almost $2500 already has me worried to keep going; however, I have been conversing with other people who have tried it on acne.org and who strongly emphasize more than one treatment is needed for results. I planned on having a total of 3 combined with subcisions first. I would be very surprised and disappointed if I went all the way through with this with minimal/no noticeable improvement. Have you tried multiple rounds of the DEEP FX with still disappointing results on rolling acne scars? I thought I did alot of research into this before I proceeded, and the fact that had me convined to try it was the penetration depth of the laser, which standard dermbrasion and CO2 cannot do. Is this still a moot issue with depressed/rolling acne scars? Also, can combining subcisions with the DEEP FX theoretically improve my chances of obtaning improvement?



I tried over 7 rounds of silicone microdroplet (medical grade Alcon Labs) with a plastic surgeon in Boulder in 2006/2007. I did not see a noticeable reduction in the 'shadowing' and depth which is what really is the most upsetting for me with the acne scarring. I suppose it is a highly injector-dependent procedure and maybe my injector was too conservative? I easily dropped a couple grand there having had so many rounds of it

Also, what do you think about RECELL from Avita Medical? A doctor has been using this in combination with Fraxel REPAIR and another poster on acne.org had 75% improvment with a combo of subcision+fraxel repair+recell. It is not FDA-approved yet in the US.
http://www.avitamedical.com/?id=5&ob=1

hi,
1. i have never used Deep FX. this is only going by talking with a person who has tremendous experience with it but it does not mean that it does not work. i do not like speaking about something i have never done. i do know that i see tons of people who have gone through that without success and have come to me and i have helped them with silicone. but then again i am sometimes a doctor of last resorts for people so it is normal to see a lot of failures from all different routes.
2. you probably know my opinion about lasers for acne scarring. in general, the problem is the philosophical approach. even if the laser goes deeper than dermabrasion and co2, that means nothing to me. i do not think leveling out tissues is the issue i think raising the atrophic holes is the way to go. dermabrasion and co2 are methods to take down normal skin until they get closer to abnormal skin. silicone and CROSS are methods to raise holes to normal skin levels. the opposite of traditional approaches.
3. yes, silicone is tremendously injector dependent. the two techniques that i use CROSS and silicone are the most technique dependent. i can even get silicone into very difficult to raise dermal etches unless they are just too superficial then i really have to use CROSS. although i am good at what i do, i am just a human being. sometimes despite all good efforts, i may not be able to fix a problem to one's satisfaction. acne scars are really the toughest thing i work on because i know that i can only improve and not perfect the results.
i really cannot advise you one way or another. if i can help you in the future, i look forward to doing so.
best,
sml

dr. lam wrote:hi,
1. i have never used Deep FX. this is only going by talking with a person who has tremendous experience with it but it does not mean that it does not work. i do not like speaking about something i have never done. i do know that i see tons of people who have gone through that without success and have come to me and i have helped them with silicone. but then again i am sometimes a doctor of last resorts for people so it is normal to see a lot of failures from all different routes.
2. you probably know my opinion about lasers for acne scarring. in general, the problem is the philosophical approach. even if the laser goes deeper than dermabrasion and co2, that means nothing to me. i do not think leveling out tissues is the issue i think raising the atrophic holes is the way to go. dermabrasion and co2 are methods to take down normal skin until they get closer to abnormal skin. silicone and CROSS are methods to raise holes to normal skin levels. the opposite of traditional approaches.
3. yes, silicone is tremendously injector dependent. the two techniques that i use CROSS and silicone are the most technique dependent. i can even get silicone into very difficult to raise dermal etches unless they are just too superficial then i really have to use CROSS. although i am good at what i do, i am just a human being. sometimes despite all good efforts, i may not be able to fix a problem to one's satisfaction. acne scars are really the toughest thing i work on because i know that i can only improve and not perfect the results.
i really cannot advise you one way or another. if i can help you in the future, i look forward to doing so.
best,
sml

Thanks, well I am going by one guy's opinion (who has tried it on his rolling scars) on its efficacy. Did these people who complained about it not producing the desired results have more than one round of it to your knowldedge? I keep hearing it is not a one and done thing, and it is quite common for many people to spend a few grand after one session and then give up. I guess it is hard for me to research enough cases of people who have had 3+ high intensity sessions wfor rolling scars because it is so expensive it is not popular to have this many treatments.

yes, i take a pretty good history for each acne scar patient i see which dictate in a note and almost every patient i can recall have undergone multiple rounds not a single treatment.

dr. lam wrote:yes, i take a pretty good history for each acne scar patient i see which dictate in a note and almost every patient i can recall have undergone multiple rounds not a single treatment.

Bummer...that is disappointing, especially considering you have already had tons of people complaining about no results for a relatively new technology. But I appreciate your quick responses. It's nice to have a doctor with a personal touch.

One more thing, I always try combined approaches and was wondering if subcision followed by PRP (platelet-Rich Plasma) makes any theoretical sense to you. I know there are some MD's who think it does not make any sense at all as a treatment for depressed acne scars. I was contemplating embarking on a clinical trial for this treatment. Maybe this would hold more promise for rolling scars??

really don't like to speak out of ignorance. i don't know enough about PRP to comment. it could help.

Hi Dr Lam-

Are burn scars easier to treat with a laser then acne scars? Reason I ask is the Bern Triplets were supposedly remarkably improved with the DEEP FX laser. Their story seems to be the big marketing campaign for the lasers. It seems like there should be a way to improve acne scars if burn scars can improve. What do you think? Even at highest settings and highest coverage? I know you don't use the laser for acne scars, but I thought I would get your two cents about burn scars, which are probably more raised/hypertrophic and maybe easier to treat.

Thank again!

first, i do not treat burn scars. there are plastic surgeons who specialize in that. second, burn scars as you indicated are the exact opposite of acne scars. they are hypertrophic versus atrophic in most cases (although some can be atrophic too). in general using fractionated technology for burn scars does not make too much sense to me (although certainly i am speaking out of ignorance here) since fractionated lasers could theoretically raise up more a hypertrophic scars. i would consider PD, KTP, or IPLs to manage these types of scars.
best,
sml

Thank you again for your response, Dr. Lam. It is obvious you love what you do to be answering all of our questions for free on this board. My field of study has me most likely relocating to Texas. If I end up in your state, I will probably end up in your waiting room for my next acne scar treatment!

sounds great, and yes i love what i do!