LAM FACIAL PLASTICS

Hi Dr. Lam-

I have had one treatment of silicone microdroplet with a new doctor who is more experienced than my previous doctor and I've already had tremendous imrpovement in the depth of the scarring. What used to be DEEP rolling scars that I could insert my entire index finger into can now barely be felt with the tip of my fingers. What I wanted to know is since silicone microdroplet can turn deep scars into superficial scars, do you believe supposedly 'tried and true' old methods for superficial acne scarring, such as dermabrasion with a wire brush that has coarse burrs, or immersing specially-prepared silica carbide sandpaper in a solution of 10 to 30% Trichloracetic acid followed by abrasion of the skin with the wet sandpaper, would yield even further cosmetic improvement (after several more treatments)? Reason I ask is it feels logical to me that this would work after the silicone because the reason they do not work beforehand is that the scarring is too deep for abrasive procedures to reach. The silicone would elevate the skin inside each depression close enough to the level of the normal skin surface for resurfacing to produce a result during reepithelialization. Also, I keep hearing the right type of combo treatments optimize results. I know you are pretty good at explaining these things, so please let me know your thoughts about this. Have you ever tried this combo on your patients to reach any conclusions about its efficacy? Why is it that these procedures were 'invented' for certain types of acne scars but prooduce no results?
Do you also know alot about using TCA-soaked silica carbide sandpaper on the skin for softening rolling scars? I've never heard of this before and researched it somewhere online. I think it is probably the oldest, but most experience-sensitive, procedure to treat defects in the skin. I know this seems extreme, but my acne scars were very deep to begin with.

Also, another question, how do the results on forehead acne scars compare to the results on 'softer' skin acne scars (on the cheeks)? I have deep lines on my forehead from where the rolling acne scars 'joined' together on my frown lines. Can silicone work for this, or is it not as good in 'harder' skin areas that are next to bone?

1. i do not believe dermabrasion has a significant role anymore in acne scarring even in superficial ones. i simply can't get the dermabrader to get the results i would like but your theory is good in the sense that typically i start with silicone then i use TCA CROSS to finish the job on areas of remaining etching.
2. soaking TCA on a dermabrader sounds crazy. the dermabrader will cut through skin. the tca impregnated dermabrader will then bleed through cut skin leading to a completely uncontrolled thermal injury that will create unpredictable and insane scarring. tca should be done on intact skin.
3. i think forehead scars are not that much harder to treat. but if you are talking about a confluent line then that may be dermabradable (an exception since dermabrader works better on lines like on linear scars) or CROSS or start with botox to see if the line is a product of movement superimposed over scarring.
best,
sml

Yes, my forehead definitely has movement superimposed over scarring. This is exactly my case as my scarring occurred where I would have natural folds from raising my eyebrows. I couldn't think of a way to describe it. I tried wire brush dermabrasion with a very experienced doctor who has been around for many many years and is well known for his technique. He has had great results with his patients. I had an area on my forehead treated that had these 'superimposed lines' that did have some depth improvement, as in they felt shallower to the touch, but not much cosmetically, and this was only one round. I also tried silicone microdroplet with another doctor who was overall too conservative. I defintiely will give botox a try when I make it your place soon.

TCA sandpaper is what I read they used to treat acne scarring many decades ago. Another doctor was referring to this procedure as an option in a peer-reviewed article. Im really not sure how they pull it off though because I would find it hard to believe the sandpaper can be made to have even grit to give an even resurfacing.

So, basically for superficial scarring there isn't much more that can be done beyond silicone it sounds like. I'm definitiely happier with my skin so far, but I always wonder about the combination approach so many advocate for the best results with depressed scars. My skin still has that roughed up, beat up look in digitial camera photos, esp. because of my forehead.

Hopefully my vague references to doctors here are discrete enough

yes, vague enough to my satisfaction. yes, do botox for your forehead for a few rounds, and if you get any resurfacing botox it 2 weeks prior. that will let the healing improve. for medium to deeper areas i would do silicone by an experienced person; for shallower areas, i would do TCA again by someone qualified.
best,
sml