LAM FACIAL PLASTICS

So, I am asking if it is prudent to fill with Silkon now and wait longer for the redness to go away since is is very slowly making progress?
I am also concerned with future surgery that I might have using dissolvable stitches (Vicryl) since I had a bad reaction. I am thinking of doing a necklift/mini lift and am afraid of this complication. Can you recommend anything to help me? Catopril cream, silicone gel sheets, your Botox injection prior to surgery?

unfortunately, i cannot have other people's names on this web site. also, i cannot officially recommend anyone else. as far as the small arm area, i feel comfortable that silicone would work fine there since i have done it before for a defect like yours. to do your whole face or large areas of your face with silicone in my opinion is not a good idea as it is unsafe at high doses and you would have to do multiple multiple rounds to get any chance at a real result. i really doubt you had a bad reaction to vicryl suture. you most likely either had an infection or the sutures just extruded but obviously i would use a different suture like polydiaxanone (PDS/PDO) instead for a deep closure. before a facelift, i cannot recommend any Botox or anything else. i really do not think you need that.

Hi, I have been reading more on your site about the 5-FU injections.
You mentioned for my scar that has residual redness now at two years and was already injected with steroid twice (mistake), PDL laser might reduce the redness, but not entirely.
Is it really way too late to use the 5-FU? I guess from my reading the time to have done that was initially when it was raised, red, and itchy....darn!
Is there any way to reduce the shinyness to it which might have been caused either by the laser/fraxel or the Kenalog? I would get a tattoo and be done with it but not sure I want a butterfly on my bicep at 57 years old Thank you again! J
Wish there were more surgeons like you who are so expert in scar prevention and treatment.
I don't see many citations of using the 5-FU for the treatment of scars in my area in CT.

Hi, you said that you would not recommend Silikon for filler on the face at all except in the lips?
Are you saying you would not use it at all for nasolabial folds, marionette lines or for glabella creases?
Also, you are probably correct when you said that the Vicryl probably just extruded out of the wound on my arm causing a host of problems and scarring..... and recommend POS or PDO sutures. Is the length of time that the suture takes to dissolve have any bearing on the whether it might exturde or the thickness of the suture used? I would like to minimize the opportunity for this to happen again. How thick of PDS do you use on the inside of the Mini-lift to close and what do you use on the outside where the stitches are removed? 7 days for removal? Thank you!

1. absolutely not for silicone outside of the lips. in the glabella, beyond no because it can cause blindness there. with micro droplets and vascularity i only use restylane and rarely do i do it always pulling back. with the micro droplets there you would have to be crazy to do it. the nasolabial grooves with silicone i hate. it can look lumpy. it is a bad area to use silicone. if you want permanent artefill works much better in these lower folds.
2. i use a Quill barbed 4-0 PDO. since it is barbed it has a much lower chance of extruding since there is not a single knot in it.

I am not sure what you meant about silicone and vascularity?
I have residual redness on my arm, but perhaps a slight vascularity, but feel the silicone will help with the divot and irregularity. I think over time the redness would probably fade on its own, but very slowly.

As for your mention of Artefill, have you had any negative reactions, or nodularity, bumps, etc?
Surprising what you say about silicone in the nasolabial folds, and other areas as I have seen photos in under eye areas, all many areas of the face...I guess it is prudent not to do that as you mentioned. I suppose you prefter fat grafting to add volume in the under eye area and cheeks?
How successful long term is this technique and there is alot of reabsorption. I have seen strip fat grafting under the eye, rather than the micro-droplet technque. Are you familiar with that?
Thank you again

I am not sure what you meant about silicone and vascularity? SORRY, WAS TYPING FAST. VASCULARITY MEANS THE BLOOD SUPPLY. THE RISK OF INJECTING LITTLE DROPLETS OF SILICONE IN THE GLABELLA REGION IS THAT THE SILICONE CAN GET INTO THE BLOOD STREAM AND CAUSE ISSUES WITH TISSUE LOSS, DEATH, AND EVEN RARE CASES BLINDNESS. THAT IS WHY I DON'T DO IT THERE.
I have residual redness on my arm, but perhaps a slight vascularity, but feel the silicone will help with the divot and irregularity. I think over time the redness would probably fade on its own, but very slowly. OK, AGREED.

As for your mention of Artefill, have you had any negative reactions, or nodularity, bumps, etc? NEVER. GRANULOMA IS A RISK JUST LIKE WITH ANY INJECTABLE PRODUCT BUT THE 5 YEAR RESULTS IN 10,000 CASES ONLY TURNED UP 1 OR 2 CASES, WHICH WERE EASILY TREATED. I HAVE PROBABLY DONE A THOUSAND SYRINGES AND NOT HAD EVEN A SINGLE ADVERSE EVENT IN TERMS OF BAD CONTOUR, ETC.
Surprising what you say about silicone in the nasolabial folds, and other areas as I have seen photos in under eye areas, all many areas of the face...I guess it is prudent not to do that as you mentioned. WELL, THAT IS MY OPINION AND I USE SILICONE. I suppose you prefter fat grafting to add volume in the under eye area and cheeks? FAT, RESTYLANE, OR ARTEFILL IS WHAT I USE.
How successful long term is this technique and there is alot of reabsorption. VERY SUCCESSFUL IF YOU ARE ONE OF THE FEW SURGEONS WHO DO FAT WELL. REMEMBER THERE ARE TWO COMPONENTS TOWARD FAT GRAFTING THAT YOU NEED TO REMEMBER: TECHNICAL SKILL (LONGEVITY AND SMOOTHNESS) AND ARTISTRY (NOT OVERDONE AND BALANCED TOTAL FACE REJUVENATION). I have seen strip fat grafting under the eye, rather than the micro-droplet technque. Are you familiar with that? YES, I HATE IT FOR A FEW REASONS. FIRST, A STRIP OF FAT MUST HAVE MORE BLOOD SUPPLY TO MAKE IT SURVIVE AND SECOND THERE IS A RISK OF SURVIVAL. THINK OF IT THIS WAY: WHEN YOU PLACE LITTLE MICRODROPLETS OF FAT WITHOUT A NEEDLE BUT WITH A CANNULA THE FAT LAYERS EVENLY INTO THE SURROUNDING TISSUE AND THEREBY GETS ENOUGH BLOOD SUPPLY SURROUNDING EACH MICROPARTICLE THAT IT SURVIVES AND IS SMOOTH. A STRIP CAN LOOK LUMPY AND MUST HAVE GREATER PROBLEMS WITH BLOOD SUPPLY INHERENTLY.
Thank you again WELCOME!