LAM FACIAL PLASTICS

Hello Dr: Lam Sam

I had a scar revision in a wound that I have on my face,the Dr that treats me at that time told me that mine was a Hypertrophic scar,and he did the surgery and 4 section of radiation (10) months after the original trauma,and this is what I have now... My question is Dr Lam , ¿can I have another scar revision? please help me Dr: Lam because I have seen your work and I really think that you have the right answer on this

By the way, In both cases,they use a dissolvable skin sutures,and in both cases,the original and the scar revition,the sutures start to pop up like if my body was rejecting them (i was able to see them outside of my wound).

I have no history in my family with this condition and i had some other serious wounds on my body and they are fine.

Best regards

hi,
i would love to help. my only fear is your track record of problems in the past. assuming you had a good surgeon, sometimes tissues do stretch back. i would be afraid of making things worse for you, especially since i assume you do not live in dallas and i would have difficulty providing you adequate after care. you should find someone locally to help unless you live in dallas.
sorry,
sml

Oh god,thanks Dr Lam for you quick answer
My problem,you think it could be my after care of the surgery?
I know you don't want to make it worse for me,of course not but i have other issues
Its ok to have those kind of sutures again?
So because of your answer its seems like ¿i cant try de surgery again?
Is this a keloid or hypertrophic scar?
There is not expert like you here Dr Lam,im just 23...i really don´t want to live with this,it was a car accident that almost was fatal.

Sorry for continuing bothering you besides of your contundent answer.
But you have no tip or something that can help me?

i cannot give you direct medical advice on here. but in general, it does not look like a keloid or hypertrophic scar. it looks like a stretched out atrophic scar. you should really find a good surgeon more locally who can do revision procedure of excision and closure and can make sure that you do not need further follow up interventions. i am just afraid that you come here, have the scar removed, and then it stretches back again and you feel like you wasted your money with me. i do not want to take that risk. i am selective with my patients because i want patients who are happy with my work, and your distance makes it very hard for me to feel comfortable with that. i truly am sorry. there are a ton of qualified surgeons. you just have to find one.
best,
sml

I understand very well Dr: Lam,there is not advise that you can make if I find a good surgeon over here?
A atrophy can itch like a keloid or hypertrophic scar?¿can have some elevated areas too?¿can create contractures?...because i have it.
Im glad that persons like you with dedication and that just want to make happy your patiens still exist,Im really thankfull.

typically atrophic scars do not itch. you might have a combination of a hypertrophic scar and an atrophic scar together. any scar can have contractures. yours looks like the opposite, like it is stretched out more than contracted.
best,
sml

Dr Lam, sorry for bothering you again but I was reading your other answers carefully and in one of the cases your advised to the other pacient this ----multi-layered closure, non-dissolvable skin sutures, following relaxed skin tension lines are the key---- so can I tell this advise to a good surgeon that you recomendes to look for? thanks, and sorry but im really desperate to get rid of this.

you can mention that to a doctor but with tension on a wound, things may still not work for you. just trying to be realistic about your situation. sorry.
best,
sml

Oh god,well so being realistic its almost imposible to me to get rid of it?

Best regards.

you might benefit from a rotation flap where a larger incision is made to rotate tissue into the defect or a tissue expander in the cheek to get enough tissue to limit stretch back. you might want to consider another scar revision but if things fail you will most likely need some kind of rotation or expansion of your tissues to make it work. i do rotation flaps but not expansions. i would still hesitate to treat you given the risk of making things worse because you do not live in this area. you need to find someone qualified closer to you because of possible after care that will be involved.
best,
sml