LAM FACIAL PLASTICS

Dear Dr.Lam, i have posted on numerous websites, and seen numerous derms about my face. Some said i have no scars... while others said i have scars.

Are these acne scars, or is this some other sort of skin condition (sebacious hyperplasia comes to mind)? If its scarring or something else, what can i do to treat the condition? I should also let you know that i have seborrheic dermatitis, which is in the form of scaly skin.

Here are the photos:

http://i56.tinypic.com/2hsajh2.jpg

http://i52.tinypic.com/15gur2s.jpg

http://i52.tinypic.com/1hv5zk.jpg

http://i51.tinypic.com/2wmg8lc.jpg

http://i51.tinypic.com/29opogi.jpg

http://i51.tinypic.com/bfh005.jpg

thanks doctor

one more thing doctor, regarding acne. Obviously the best way to prevent scarring is preventing acne, but i have several quick questions.

Does rubbing over pustules cause them to scar? Rubbing as in the same way you would rub a cleanser on your face, but with a little bit more force? Sometimes i get severe dead skin on my acne (due to seborrheic dermatitis), and the dead skin stays there indefinitely unless i manually exofliate it. If i use a washcloth over the pustules to exofliate the dead skin, will this make the pustules scar? When i do this, the pustules don't burst, but the ones that are really dried up usually peel off (but i think that means they were essentially ready to go).

thanks

hmmmm, your condition is not straight forward. even if i saw you in person i don't know if i would have an answer. derms are the best source of an answer for your condition, because even though i am well versed with acne scarring i am not with esoteric difficult to diagnose skin conditions.
best,
sml

thanks for the response.

In YOUR OPINION, what does it appear to you that i have? Is it a form of scarring? what exactly do you think it is?

tests wrote:one more thing doctor, regarding acne. Obviously the best way to prevent scarring is preventing acne, but i have several quick questions.

Does rubbing over pustules cause them to scar? Rubbing as in the same way you would rub a cleanser on your face, but with a little bit more force? Sometimes i get severe dead skin on my acne (due to seborrheic dermatitis), and the dead skin stays there indefinitely unless i manually exofliate it. If i use a washcloth over the pustules to exofliate the dead skin, will this make the pustules scar? When i do this, the pustules don't burst, but the ones that are really dried up usually peel off (but i think that means they were essentially ready to go).

thanks

Also dr.lam, can you answer this post as well? thanks

again, that is something you probably should ask a dermatologist. i don't have a good answer but intuitively i would say you are probably safe.
best,
sml

Thanks for the response. Safe as in rubbing over pustules will probably not scar them?

And regards to my pictures, does this look like any type of scarring, at all? I have seen several derms already, and out of the 4 saw, 2 said i had shallow scarring, 2 said i had no scars. They did not mention that weird texture on my skin at all. I will be making another appointment to get another opinion.

One more time doctor, just in your opinion, what does it look like i have on my face? I won't take your opinion "to heart," i just want to know what you think.

thanks doc!

i hate to say this but i have no idea. it is either just your skin texture or light scarring/sebaceous glands but i am not a derm so my opinion is pretty meaningless. sorry.
best,
sml

Thanks for the response doctor. I really appreciate your honesty.
I will most definitely get another opinion, but if it is either just my skin texture or sebaceous glands, are these possible to treat?

all the best

in my hands, no. i think there is greater risk in making the texture worse BUT i have not treated this condition so my answer is only a guess rather than a truly educated, experiential answer so take that with a gigantic scoop of salt.
sml

thats is quite disheartening doctor.

don't listen to what i have to say on this one, as i mentioned. what you have is something i don't manage. best of luck in finding the right, qualified person for you.

Dr.Lam, one more question i would like to ask you:

In your opinion, is it possible/ideal to excise scarred pores if they are near each other?

I would not mind a shallow linear scar vs a series of scarred pores.

Or is TCA a better option? How much percent of improvement can be TYPICALLY seen from tca crossing a scarred pore (i.e., how much percent improvement do your patients notice)?

thank you!

In your opinion, is it possible/ideal to excise scarred pores if they are near each other?
no, almost never worth the risk. the results typically are horrendous.
I would not mind a shallow linear scar vs a series of scarred pores.
no, you probably would. it does not look good.
Or is TCA a better option? How much percent of improvement can be TYPICALLY seen from tca crossing a scarred pore (i.e., how much percent improvement do your patients notice)?
i never quote percentages because your concept of % improvement can always be different from mine but if you are a good candidate when i see you i can say that it should work well (but not perfectly) to improve your situation.

thanks for the response doctor.

When i get the time, i will book an appointment with you.

cheers