LAM FACIAL PLASTICS

Hi Dr. Lam,

first of all, thank you very much for offering a platform where people can have

professional advice and a listening ear!

I've posted this text on the forum and to your personal mail address

(samlammd@yahoo.com) as well. I have only included pictures in the email.

my situation is this:
I'm 32 years old now, and when I was 7 or 8 years old, I had split my upper lip

through and through up to my nose. It was an accident when playing. The local docter

stitched it. It soon turned out to be an annoying and bothersome scar up till now:

it is not only visible, but most annoying, it is also very much felt during smiling

and talking. You loose (some) harmony in your smile and speech. Smiling is not as

what it used to be before. Everytime I smile, I feel the scar very strong, annoying.

I also developed some asymmetric facial skinfolds.

Almost one year ago, I underwent a scar correction, by a PC. I did this because the

initial scar had too much tissue somehow, and also it was more than 2 mm wide on the

moustache area outside. Because scar tissue grows no hair, it was pronounced. The PC

said that the doctor who initially stitched the scar did not stitch it in layers

(skin, tissue). He than cut a piece out of the inside of my lip, and he also cut out

the superficial scar on the skin outside and stitched it back.

Although that scar revision had some positive results:
the scar became less wide on the moustache area so that the hairless scarstrip is

less apparent,

the operation also has some more negative results:
* it feels more awkward than before, during talking and smiling
* there is a hard ridge on the inside of my lip which is very much felt and which is

probably the cause that a lump is seen on my red lip tissue from the outside. The

ridge is about 1.5 inch long. That ridge was in the beginning VERY VERY hard and

thick. The ridge developed out of a cut which was firmly stitched at the end of the

operation. I have had message on that hard ridge for 6 weeks, which lessened it a

bit.

Here are my questions:

1) Can you help me out with the hard ridge (with 5-FU?); if you can, will the lump

stay? or will it shrink? Will the 5-FU injection (if possible) also result in a

visual improvement (dissapearing of lump)?

2) I have also have a discontinuous vermilion border which my PC said he should

align, but he forgot. Are there risks for aligning the vermilion border? For

example: new scarring, or extra awkward feeling? Can you do the alignment

3) Do you think planting extra moustache hairs in the scar tissue (in the moustache

area of course) can make the scar even less visible?

4) Do you know existing techniques which can give me a more harmonious feeling when

smiling, for example by partially reconnecting muscle tissue between lacerated lip

parts (growth hormones, stem cells, whatever)

5) Do you think the awkward feeling during speech and smiling will lessen if the

hard ridge gets soft again?

6) If you can do anything or have any advice to improve my situation (anything) somehow, please let me know

Thank you very much,

J.

yes, i answered your question in a private email. here i have copied my response:
hi,
my feeling is that he did a good job and i would not necessarily try to do another scar revision which could increase variability and thereby risk during healing. i would leave the discontinuity, the bump, and the hair loss as probably things would be hard to improve them with further surgery including a hair transplant. however, the awkward feeling and the ridge could be helped with 5-FU and some silicone could help the small divot but could not guarantee it.
best,
sml

Hi dr. Lam,

thank you for the quick respond.

a bit pitty that the bump cannot be removed because only a little bit tissue away would improve aestethics a lot in my opinion. But of course better nothing than worse.

What do you mean with small divot? (english is not my mother tongue)

what do you cannot guarantee? the silicone that could help the small divot, the 5-FU which could help the hard ridge? or both?

Thank you,
J.

a bit pitty that the bump cannot be removed because only a little bit tissue away would improve aestethics a lot in my opinion. But of course better nothing than worse.
I ALWAYS SAY THAT I MAY NOT IMPROVE THINGS SO IT IS NOT WORTH TRYING TO MAKE SMALL CHANGES WHEN I MAY NOT IMPROVE IT OR COULD SLIGHTLY WORSEN IT.

What do you mean with small divot? (english is not my mother tongue)
THE DIP NEXT TO THE BUMP. IF THERE IS A BUMP, THERE WILL BE A DIP (OR DIVOT) NEXT TO IT.

what do you cannot guarantee? the silicone that could help the small divot, the 5-FU which could help the hard ridge? or both? I CANNOT GUARANTEE ANYTHING SINCE PLASTIC SURGERY IS ALWAYS AN ART AND A SCIENCE AND CARRIES RISKS. BUT SILICONE AND 5-FU BOTH HAVE A GOOD SUCCESS RATE WITH A VERY LOW RISK OF A PROBLEM. I THINK THEY BOTH COULD HELP YOU.
best,
sml