LAM FACIAL PLASTICS

Dr. Lam,
When I was in my teen years(I am now 33) I had fairly severe acne and in my opinion was not taken to the dermatologist nearly regularly enough. I now have small atrophic scars on both cheeks and a combination of atrophic and Hypertrophic scarring on both sides of my chin. My main question is this: I had a cyst on my chin in high school that the doctor said "wasnt healing on its own" so he gave me an injection of some sort into the cyst(steroids perhaps?). Over time it became just a small hypertrophic scar. As time progressed and my acne cleared I finally began to build some self confidence that I had been faking for years. A point where I was comfortable with myself finally, etc. Well then comes the kicker- about a year and a half ago a vertical hypertrophic scar running directly down to the aformentioned one just appeared, I mean, I looked into the mirror one day and there it was. I also now have a horizontal hypertrophic scar running directly out of the vertical one. I apologize for the length I just want the complete story out there. I went through a time where I was extremely critical of myself and started in on everything including my complexion and I touched and rubbed and did everything you are not supposed to do. Could this have caused these scars, could they have been preexisting and small and I just exacerbated them, are they some sort of weird keloid scenario- these are the questions that float around in my head. I realise you cannot diagnose without initial consultation so my queston is: can these things be removed, diminished etc. and how. Sorry again for the rant, its just after all the initial acne suffering and reaching a point of contentment for years, this is just too much. Thanks again.

unfortunately, despite a good history that you provided, i have really no idea how to answer your question. if you just rubbed it, most likely it did not cause this situation. if it is hypertrophic, injecting 5-FU may help manage it to start.
best,
sml

Thanks for the quick response, perhaps I can send some pics. yours, Joshua Nickerson

Is it possible to cut out this scar tissue, the most disturbing section is probably 1/4 inch wide and 3/4 inch in length? I have seen a fairly reputable dermatologist in Charleston SC (I am in Columbia) and she suggested fraxel laser for everything atrophic spots and hypertrophic ones. I have read that laser can be effective in leveling hypertrophic scarring, but I believe I read somewhere on your site that you believe lasers to be mostly useless with hypertrophic. I realize you do not want to discredit anyone else's diagnosis, but in your opinion can lasers help raised scars or no? Thanks again and sorry to pester, this stuff is just really getting to me and I have let it hinder me in so many ways. You seem to be extremely knowledgable and caring, so I moved in your direction. -Josh

thanks for the kind words. here are my thoughts:
1. lasers that try to burn down hypertrophic scars tend to worsen them in my opinion. however, lasers like my KTP or a pulsed dye can modulate the scars and bring them down so that they are not so thick. these kinds of lasers work well and i use them.
2. to cut out a thicker scar is not a good idea in the majority of cases because doing so can change a thick scar into a linear cut scar, which can be far worse looking.
best,
sml

Some pics. Please excuse the stubble I dont shave close anymore it wigs me out. The first pic you can see the linear scar on my chin(used to be just circular) and the second shows that I have small linear scars on both sides of my chin as well as atrophic scars on cheeks. Any advice would be helpful and I will stop posting after this, thank you for your valuable time.

This uploader is bizzare, only shows left of frame as I have noticed with others posts. I will try another route.

from the frontal view, i can see the scar on the left side of the chin. that would either benefit from some silicone or filler if you want to be conservative or more formally a geometric broken line repair. the other areas in the chin are hard to see in the photo. i would probably only do some small treatments like 5FU and KTP laser (may take a few rounds) to improve them if they are hypertrophic (but cannot see too well in the photo).
best,
sml

In the frontal picture you refer to the scar on the "left side of chin". I hope you mean left side of frame in picture(my actual right chin area) for that is my primary concern. It is the long white line clearly shown in the other shot(mirror), it is firm and raised. Both sides could use work I know, but my right is of major concern. Sorry for the whole stage left or right confusion.

sorry, i meant the left side anatomically. now i can see the white line you are talking about. there is a good chance that i can improve it but there is a small chance that it could worsen like with any scar revision. the only way to fix a white line is to cut it out and do a geometric broken line repair. also, with the beard in there, you will not shave that area for 2 weeks then you need an electric razor for 2 more. just to be clear on that.

Crystal. Thanks for the response.....kinda sucks you were referring to a spot I thought was fairly ok with as needing broken line repair...but hey its just scars right? Now that you see what I am primarily concerned with I thought you would go with a bit more hardcore approach. Im done with this shit.......thanks for your time.

Sorry for the negativity, just frustrated in general. May just fly to dallas and see what can be done. sincerely-josh

honestly, and i am being honest, i do not think they look that bad. i think you can possibly retire this whole affair and try to move on with your life.
best,
sml