LAM FACIAL PLASTICS

Hello Dr Lam
I'm an Australian resident who recently stumbled across your forum and hope you can give me some advice.
Two weeks ago, I had had a skin check carried out at a skin cancer clinic and asked the doctor what could be done about a small sebaceous hyperplasia on the tip of my nose. I wanted it removed purely for cosmetic reasons (there was no risk of it being basal cell carcinoma) and the doctor suggested it could be shaved off. Of course, I trusted in the doctor and expected that the outcome of its removal would be an improved cosmetic outcome. After 10 days, the scab fell off and to my surprise I found a cavity/crater-like wound that measures about 4mm in diameter. It's difficult to gauge the depth but it can be felt with the finger tip.
The wound no longer has a scab. I realise it is still early days (15 days to be precise), but I really have no clear idea of the healing process. Am I right to assume that over the coming months that the wound should/will begin to lift from below as collogen is generated and thereby reduce the cavity? Should the wound also reduce in diameter in the coming months? Should I start to see an improvement in a month or two months? I really hope there is some improvement within 2 months for personal reasons (I'm meant to meet a female for the first time face to face in January)! Perhaps that sounds shallow, but this wound is in such a prominent place and it's affecting my confidence
Any advice you can give me would be much appreciated! Thanks

hard to say but hopefully over time it will improve. if it does not after a year you could put a permanent filler like silicone injections. before then i would be careful with a permanent filler. i would probably use restylane which could be reversible.
best,
sml

Hello Dr Lam
Thanks for the reply. Silicone fillers are apparently illegal in Australia ... and I'm not too keen on having needles in my nose every 9-12 months to have temporary fillers. What other techniques might be used?
In the past week, the wound has felt like it's getting slightly narrower. It will be 3 weeks since the procedure in 2 days from now. I can't say I can see any noticeable difference in the wound depth but it does seem narrower to touch -- is this typical wound healing that it will become narrower and then lift from the bottom, hopfully making the cavity smaller?

U sure it is illegal? It may just be off label like in the US. Artefill is another permanent product that I use. Either case dont do anything permanent in your first year. And yes, things can fill in and shrink over time.
S.

Thanks again for taking the time to reply.

my pleasure.

Sorry to bother you again.
I keep getting conflicting answers to the question "will this fill in more with time", and it's not helping my anxiety!!
I've had some say it won't improve and others say it will generally improve and the decrease in depth.
It's only about 3 weeks since the procedure -- is it too soon to know the final cosmetic result? Generally speaking, how many weeks from now should I start noticing it getting smaller and less depth?
Thanks

generally speaking wound contraction starts several weeks and continues for several months up to a year after an injury.
s.

Thanks again for a quick reply, much appreciated.

my pleasure.

Me again I have read that wound contraction lasts only for several weeks ... perhaps I'm confused about the wound healing process, but does that mean this crater won't get any smaller in diameter from now on? Or, does the "filling out" continue to occur during the maturation stage of the wound?

incorrect. wounds continue to contract and fill in for months.

Hello again ... it's been a month since the last time I posted and the scar is a little shallower which I suppose is a good thing but this is like torture waiting to see if this thing will leave an acceptable scar and not leave me with an ugly depressed scar!!
I've spoken to a few plastic surgeons in Australia and none will use a permanent filler like silicon, if after a year I need revision.
Have you performed many filler revisions for depressed scars on the nose tip (and before and after photos - I couldn't see any in your galleries)?
What are the risks and worst scenarios of a permanent filler - for instance, could it leave a bump? Why is silicone "off label"? Could the silicone "move" and end up creating a bump in another part of the nose?
Thanks again for the advice.

1. yes, i have done many but the results in the tip are never great, just good.
2. i believe that in my hands that silicone is safe in the tip if done with a micro droplet technique and done by a very experienced injector.
3. is there a risk of complication? of course, there is for anything i do but pretty unlikely. as far as i can recall, i have only had one in the nasolabial groove and i stopped doing it there. i had to shave it down to flatten it and the patient is happy now. in contrast, i have probably done 5,000 injections with mild, moderate or very satisfied patients. there is always variability in satisfaction. as i said, the nasal tip is difficult to achieve great results.
4. silicone is off label for a ton of reasons. first, the company Alcon has no desire to market it as a cosmetic procedure so it has only sought FDA clearance for retinal detachments. if a company does not feel there is a market to spend millions of dollars to get cosmetic clearance then it won't. does that make it illegal? of course not. think of restylane. it is only FDA cleared for the smile lines. i use it over the entire face. botox is only FDA cleared for the area between the eyes (armpits and for neurological dysfunctions). i use it on the sides of the eyes, the forehead, the chin, the neck, the jawline and many other areas. i used radiesse when it was only cleared as a soft tissue marker and as a vocal cord enhancement for years when it was off label. however, if you explore the net you will see a ton of problems due to bad technique and bad product. i personally fix a bad silicone lip job about once a month.
hope those are some answers you are looking for.
best,
s.

Thanks again for the reply.
Do you have any before and after photos of work you have done on nasal tips? It would be calming, perhaps, to see the results.
The scar I have is about 3mm in diameter and was about 2mm deep (it looks and feels shallower now but it's difficult to judge its depth - probably 1mm-1.5mm deep). It has been 6 weeks since the scab fell off the wound and 7.5 weeks since the procedure was performed. I realize there is no definitive answer to this question but generally speaking how long does it take for a depressed scar on the nasal tip to fill-in? If it has become shallower in the last 6 weeks by 0.5mm, will it continue at that rate or does the process slow down?

Also, if after 12 months I'm not happy with the results, how much would a silicone procedure cost if I was to come there? Does it require only one treatment and, if the procedure is a failure, can the silicone be removed?

Thanks