LAM FACIAL PLASTICS

Hi Dr Lam, I have a raised mole on the bottom left of my chin. I'm considering getting it removed as I find it quite annoying looking. But I am keloid prone. I read somewhere that there is a high occurrence that keloid will form on the chin area. Is this somehow true? What kind of surgery do you suggest for my mole removal to minimize keloid occurence? Thank you for your reply.

hi,
1. if it sits right at the border of the jawline veering toward the neck, then yes there is a slightly higher chance of scarring. it rarely would keloid though. it might be hypertrophic or thicker.
2. the way to minimize it would be first and foremost to have it excised vertically (slightly tilted inward toward the lip) to precisely match a relaxed skin tension line. the biggest mistake that i have seen is someone that is inexperienced trying to cut it horizontally to "hide" the scar along the jawline. this is a true junior mistake that can lead to bad scarring. if your surgeon proposes that kind of line, run!
3. a 3-layered closure being really careful to take any tension off the wound by doing a deep subdermal closure is important. i like that 3rd layer even though many think it is unnecessary. i do that to help with not allowing the wound to dip in. i use a horizontal mattress technique.
4. preventative laser and possible 5-FU injections at a month and every 2 to 3 months as necessary. the laser really can minimize the propensity toward scar formation.
5. silicone gel like kelo-cote or scar guard starting 10 days afterward is very important for 9 to 12 weeks.
6. thick emollients like Bacitracin or vaseline during the first week until sutures are removed.
7. go to a qualified plastic surgeon. the joke always is that the definition of plastic surgery is just "surgery done right", i.e., meticulous care was taken to dissect along relaxed skin tension lines and closure was done precisely and in layers.
best,
sml

Dear Dr Lam

thank you this was actually really helpfull....

to currykakari... would be nice to know if you did remove it?

all the best

Sarah

cool.

I removed it 5 days ago by excision method. The doctor kept saying that no medicine to apply or taken was needed. I just removed my stitches and Im so worried that a keloid will appear. He just simply ignored me. Actually I just wrote a new post to Dr Lam for help. If I'm staying in US, I would definitely look for Dr Lam. Please help Dr Lam!

hi,
i think you will be fine. i really cannot give direct medical advice to someone who is freshly postop from another procedure. you must speak with your doctor. however, as a general rule i do start people on silicone gel (you can get various brands like Kelo-cote or scar guard) about 3 days after sutures are out. i do that for 9 to 12 weeks. also, if the scar starts to get thicker i typically laser it with my KTP or equivalent IPL that can help modulate the scar. also if it thickens i use 5FU injection to manage it. i don't just inject 5FU unless there is actually early scarring. hope that helps.
s.