LAM FACIAL PLASTICS

Dear Dr. Lam,
I have a scar that is indented right on the end of my nose. I have had the previous old scar cut out hoping that it would heal shut and not leave the same indentation in the tip of my nose...but it healed the same as before...leaving an indented white scar. It cannot be covered with makeup....as it just stands out more due to the slight ridge around the indented scar. If is was flat, then I could just cover it with makeup. I am wondering if there is anything I can have done to remove the scar or make it less prominent. I have tried to do some researching and don't know if some type of laser treatment, acne scar treatment, silicone injections, a cosmetic procedure on my nose, or any other type of procedure would help either remove the scar or even the ridge around the edges of the scar. Your advice would be very much appreciated...as I have been concerned about this for 9 years and don't know how to fix it. Am having trouble with my attachment, so not sure if it will show right.
Thank you for your help.
Sandy2011

hi,
do not see an attachment. you can send it to me at samlammd@yahoo.com if you like. in short, if it is very small and not too deep, then silicone can help. if it is deeper or larger, then you have to do a much larger procedure than just cutting it out and closing it. the reason is that the tip of the nose simply will not close without dimpling. you have to undermine the tissues below the level of the muscle and do a rotational flap from the higher part of the nose downward. that will leave more scars across the nose that with good technique should heal well and that would only be worth it if the defect were bad enough to justify the larger incisions. there is unfortunately no compromise for a smaller treatment other than silicone when it comes to the nasal tip. attached is an example of a cancer defect closed with a flap:
http://www.lamfacialplastics.com/galler ... 0.jpg.html
best,
sml

Thank you, Dr. Lam. I will get a picture and send it to you. The scar is only about 1/3 the size of the end of a pencil eraser and gosh.....after seeing those other pictures....I shouldn't feel bad. I had ask a plastic surgeon to just remove a little red spot (the size of a pin head) with a laser (just zap it) during a surgery procedure I was having....and to my surprise....I woke up with a hole cut out of the end of my nose and a scab. When I confronted him over the next several months....he said I was just being too sensitive and he would do nothing about it. I wouldn't have minded except it is right on the tip of my nose and indented with a ridge around the edge and cannot be covered by makeup.
I appreciate your help and advise on this situation....will get the picture to you.
Thank you, again.

i totally understand. when it is on the middle of your face, i can see why it bother you plus it was not something you expected to have show up. when it is a cancer, then one is willing to accept more but that is not the case in your situation. i will await what photos but remember they cannot replace my seeing you in person per se.
best,
sml

Dr. Lam,
I have sent photos via your email.
Thank you for being so prompt and answering my questions. I will wait for your response to the pictures.
Sandy2011

sandy,
ok, i have reviewed your photos. first, i do not think you are over-reacting, as i see the deficit you are talking about. second, i think a flap reconstruction would be overkill and would risk having more scarring for a longer period of time (if not permanently) and would not be worth it, at least not as a primary maneuver. i would consider a filler like restylane, silicone, or artefill to do the job. probably you would want a permanent filler but it would have to be done by a skilled physician. if not, try out restylane which is temporary but long lasting and reversible if you don't like it. could last a year or more to make sure that it works well for you. unfortunately, the white dot at the tip of the nose cannot be fixed. textural changes cannot really be helped either but if need be dermabrasion to sand down and blend the edges down the road could be an option.

finally, on a larger note, besides working to get the best that you can get out of it, i would truly try to let this episode go otherwise you risk continuing to obsess about it and go down a dark, deep tunnel. watch the following video to understand what i am talking about:

http://www.lamfacialplastics.com/galler ... s.flv.html

please watch this video too if you don't mind:

http://www.lamfacialplastics.com/galler ... Video.html


i believe that physical healing must be married to psychological healing for the best chance at recovery.
best,
sml

Dr. Lam,
Thank you for your reply. I will check with a doctor here that might be able to do what you suggested. I would be interested in checking with your office about having the work done there, also.....as I would want the best results in whatever is done. I would be happy with just being able to cover the scar with makeup so will pursue getting it to that point.
I am not able to view the videos for some reason.....maybe I could if you would send them to my email address.
You are very kind to take your time to help so many people.
Best regards,
Sandy2011

sounds good. ok, will send them to your email.

Hello Dr Lam. I have a similar scenario where I had a cut out procedure done to close a crater on my nose but now looks worse than before. It's now about a 1/4 wide pitted scar on the right side of my nose. I was wondering if a filler injection would get rid of my scar and if this is something you can help me with? I can send you some pics if u don't mind peeking at it?

photos are hard to see things but you can do that. fillers are less effective in the tip of the nose. sometimes time will improve the hole. you should consider probably starting with fillers if things do not improve because the alternative is a pretty big cut across the nose and a flap to improve things which may not be worth the tradeoff of large incisions across the nose.
best,
s.

At first it was looking better when the stitcheswere removed. Then one day,about a few weeks after the procedure) when I was rubbing the scar gel on I felt what seemed like a little pop underneath my skin. over a course of about a year it's slowly opened up and sank in. Y
It even opened where some of the stitches were. It's looks like a open gash on my nose. Its been the way it is now for about 5 yrs. I've noticed no improvements since then.

if it is just a hole then you might want to try fillers first. if it is in fact a gash or linear scar, then a scar revision may entail a much longer incision in which tissues are rotated in to the area to fix both the scar and the divot. this may or may not be worth it to you because you will definitely have much longer incisions across the nose. it would be a judgment of letting the punishment fit the crime.
best,
s.

Hello Dr. Sam Lam,
I have a scar on my nose,which I got due to chicken pox.I am very much worried about it.I have lost my confidence.I can send you my pictures,if you don't mind looking at them.Please help me on this.

post a close up image on this forum. however, probably the best way to manage it would be a combination of techniques: micro silicone injection, possibly TCA CROSS, and possibly even some mild dermabrasion.
best,
s.