LAM FACIAL PLASTICS

http://www.realself.com/question/scar-r ... itis-weeks (pictures)
I thank you for your previous input in my posting (link above) and inquiring about having things done to my scar from you.

In a couple of more days it will be 3 months post-op since I had my scar revision. Things have gotten better (it was possible I had herpes simplex [took medication for] not contact dermatitis [topical steroid applications]) but I don't have the options for my current condition (5-FU injection/KTP laser/Dermabrasion with wire brush) either from previous surgeon and in my general area.

I have a raised area left from a big blister-like welt at the top of the incision that possibly needs 5-Fu injections and/or dermabrasion but then I also have quite the opposite, a majority of the incision line that's indented with a few indented holes (from fine suture pulling/digging/breaking of the skin from swelling/rash[delicate skin]) which maybe needs dermabrasion as well? and then the redness.

I like to point out I had dermabrasion, TCA, and kenalog (1 drop) for a hypertrophic scar 1.5 years prior to this scar revision.

Open to suggestions and costs to correct my issue?

i would not irritate the scar (with dermabrasion) but just try to calm it down (KTP and 5FU and silicone sheets) until all redness and irritation subsides. then i would dermabrade it to soften the edges. i cannot post prices here but to give you a ball park, KTP and 5FU would be several hundred dollars and the dermabrasion would be over a thousand.

I looked into IPL and was told its not advisable for light tan/olive skin. Is that the same for KTP?

Also about dermabrasion, is there an advantage to using the wire brush instead of the other tips? For a locate area such as mine, can I do without the local anesthesia? I feel that the local anesthesia causes prolong irritation/swelling to my skin. Definitely don't want to be put under general anesthesia just for that.

I have used silicone sheets but it seems irritating to my skin as its not breathable to the skin.

1. for your skin type the KTP should be fine. it is ok up until a Fitzpatrick IV (google that).
2. wire brush gets better results but it is more difficult to handle so most surgeons do not use it.
3. in your location i can do a dental block (which is painless if i do it) and/or topical anesthetic. no anesthetic is insane and inappropriate.
4. try silicone gel. maybe less of an issue than the sheets.
best,
sml

In your experience, how many treatments of KTP and how far apart (on average) does it take for redness to subside? Also, does one of your dermabrasion treatment usually resolve an indented incision line along with uneven texture (raised bumps/indented suture holes/tracks)?

1. KTP can take 1 to 5 sessions depending on what i see.
2. Dermabrasion typically one time can help with a slightly slightly indented line but may completely fail when you have suture bumps and a lot of other issues. i typically only dermabrade something that has already achieved a very good surgical result and not begin to dermabrade anything shy of that ideal.

Okay, the only raise area is from a reminisce of a blister (could be temporary) the rest is a slight indented of the incision line and track suture marks. Thanks!

I'm not having much luck finding a local treatment for KTP laser. Would BBL laser work just as well on light tan skin?

Update: I heard BBL is stronger than IPL and after reading this I'm afraid of both.
Hi Dr. I...Like many of us on your site...how I wish you were in my state! I am a light (olive)hispanic and had an IPL done for spots and I am mortified!!! The first 7 days the areas treated were brown/purple and now on my 12th day the scabs have fallen off and the area is pink and very scaly/white blistery type skin. The pink has started to darken again to a light brown. The doctor (who I did research prior to the procedure) says its healing and I need to give it time!!! My question to you is will my skin return to normal from your experience ? I had great skin with some sun spots I has hoping to lighten and I am so afraid that I damaged my skin permenantly.

hi,
i do not know if BBL or IPL would do much. typically it is in a certain wavelength. the two best are KTP and Pulsed Dye laser, if you cannot find a KTP laser. IPL may help as well and it is worth a try. I would narrow the beam to around 500 to 600 nm range which would try to equal KTP or PDL. however, again i have no clinical experience with IPL or BBL for scars.
best,
sml

Okay, I'll be sure to stay keen on those range but how many passes should be done?

If I were to find a place that does Pulsed Dye laser, would that include the same range..passes?

Since I'm having irregularities would this scar revision should I just opt for (total fx) fractional CO2 laser instead?

dr. lam wrote:hi,
i do not know if BBL or IPL would do much. typically it is in a certain wavelength. the two best are KTP and Pulsed Dye laser, if you cannot find a KTP laser. IPL may help as well and it is worth a try. I would narrow the beam to around 500 to 600 nm range which would try to equal KTP or PDL. however, again i have no clinical experience with IPL or BBL for scars.
best,
sml

1. since i only use KTP i cannot advise on settings for other lasers.
2. if the scar is hypertrophic i would not do fractionated laser. hard to say because your scar is not typical. it has elements of hypertrophy but also elements of just suture related changes to the skin. i wish i could give you better thoughts on this but your scar is not an easy one.

Its not so much hypertrophic. The areas of died down some from blister/etc possibly from Herpes Simplex (not sure). I still have redness/irritation and slight feel of burning sensation. I went to a derm multiple times because of this and not much of an answer. I get tiny bumps that hurts and takes a while to go away adding to persistent irritation/redness.

It's slightly atrophic than anything (of the incision line and a bit of suture marks). The rough texture left from a big blister and the rest is what I want to smooth out and calm down. I'm at a lost.

I visit family/friends often in Dallas, TX. I would like to be seen by you but can't stand to be seen in airports, etc. with this skin condition.

if you would like for me to take a look at some point, i would be happy to. i do not have an easy solution for you.
best,
sml

Do you do skin eversion closure in scar revision for depressed scars? I think thats were my PS failed to correct my scar. That's what I want and to take precaution as well (anti-herpes drug and antibiotics) in my next scar revision.