LAM FACIAL PLASTICS

Hello Dr. Lam,

I am a 25 year old male, Asian mother, Caucasian father. I had lip reduction in Asia two years ago and also open rhinoplasty. Now, although you can't really see it, there are hard spots everywhere that there was an incision: my lips feel hard along the incision line and when I stretch them (by smiling or with my fingers) the line is visible and quite hard. Is that normal, and is there a way to make the scar tissue softer? I was embarrassed when my dentist who had me open my mouth big noticed there was something about my lips...
Same thing about my nose, the columella incision feels hard when I touch it. Again, is it normal and is there a way to improve it?

I decided at the time against having alar base reduction because I was very afraid of scarring. I'd like your opinion: is it a problem (more than a columella scar for instance), and would it become hard as well afterwards? By the way what's your price for alar base reduction and your method?

Thank you!

PS: the columella scar is also a bit darker somehow so depending on the light it is rather conspicuous. The lip scars are on the other hand redder than the rest of the lips...

1. if your lip is hard, 5FU injections done a few times should resolve or greatly improve your situation.
2. as far as alar base reduction, i use a Sheen flap so that it does not have that pinched look. however, the key is that you can't take too much or it will make the center of the nose look too bulbous. i would have to see it to decide. pricing i can't post here but you can check with my office about that.
best,
s.

Hello,
I'll send you a picture.

Regarding the columella incision, you should know since rhinoplasty is one of your specialties, is it ordinary for it to be somewhat hard even after 2 years? When I pinch my nose tip with my thumb on the columella, I can feel hardness as if it were a cyst or something. Can scar tissue be treated to become as soft as regular tissue?
And same question as to lip tissue, do you think it could become as stretchable, elastic, as the rest of the mucous tissue?

And another question: can anything be done to make blepharoplasty incision lines (white scar) vanish?

All the best!

RESPONSE IN ALL CAPS:

Regarding the columella incision, you should know since rhinoplasty is one of your specialties, is it ordinary for it to be somewhat hard even after 2 years? POSSIBLY. IT COULD BE A GRAFT LIKE A COLUMELLAR STRUT THAT IS MAKING IT HARD. When I pinch my nose tip with my thumb on the columella, I can feel hardness as if it were a cyst or something. Can scar tissue be treated to become as soft as regular tissue? ONLY IF THE HARDNESS IS SCAR TISSUE AND NOT A GRAFT.
And same question as to lip tissue, do you think it could become as stretchable, elastic, as the rest of the mucous tissue? YES, SHOULD BE OVER TIME.

And another question: can anything be done to make blepharoplasty incision lines (white scar) vanish? NO.

is it ordinary for it to be somewhat hard even after 2 years? POSSIBLY. IT COULD BE A GRAFT LIKE A COLUMELLAR STRUT THAT IS MAKING IT HARD.
Can scar tissue be treated to become as soft as regular tissue? ONLY IF THE HARDNESS IS SCAR TISSUE AND NOT A GRAFT.
I didn't have any graft done, it is scar tissue. How can it be improved? Excision?

And same question as to lip tissue, do you think it could become as stretchable, elastic, as the rest of the mucous tissue? YES, SHOULD BE OVER TIME.
How do I get 5FU injections? Is it expensive? Can I administrate them myself or do I have to see a specialist?

And another question: can anything be done to make blepharoplasty incision lines (white scar) vanish? NO
Is that a categoric No? Isn't there a way to make the white line more inconspicuous? What is funny is only one side scarred that badly...

That's all great news then, because being reminded I had surgery every time I bite my lip or blow my nose really gets me down. Thank you for your answers!

is it ordinary for it to be somewhat hard even after 2 years? POSSIBLY. IT COULD BE A GRAFT LIKE A COLUMELLAR STRUT THAT IS MAKING IT HARD.
Can scar tissue be treated to become as soft as regular tissue? ONLY IF THE HARDNESS IS SCAR TISSUE AND NOT A GRAFT.
I didn't have any graft done, it is scar tissue. How can it be improved? Excision?
OK, THEN 5FU WOULD BE THE ANSWER.

And same question as to lip tissue, do you think it could become as stretchable, elastic, as the rest of the mucous tissue? YES, SHOULD BE OVER TIME.
How do I get 5FU injections? EITHER ME OR FIND SOMEONE WHO CAN DO IT. Is it expensive? NOT TOO MUCH. IN THE LOW HUNDREDS. CANNOT POST PRICING ON HERE. Can I administrate them myself or do I have to see a specialist? NO, AN MD MUST DO IT.

And another question: can anything be done to make blepharoplasty incision lines (white scar) vanish? NO
Is that a categoric No? Isn't there a way to make the white line more inconspicuous? What is funny is only one side scarred that badly... YES, CATEGORICAL FOR THE MOST PART. IF YOU REVISE IT ON ONE SIDE YOU HAVE TO REMOVE SKIN ON THAT SIDE AND IT CAN LEAD TO AN ASYMMETRIC RESULT. NOT WORTH IT.

That's all great news then, because being reminded I had surgery every time I bite my lip or blow my nose really gets me down. Thank you for your answers!
surgic

Hello again,

I've got a couple more questions:
is it usual in your practice to get white scarring lines after full incision blepharoplasty in patients of mixed background (eastern Asian and Caucasian)? If not, I might consider a revision with full incision, excision of scar tissue, and so on.

similarly, do you usually get (even barely) visible scars after open rhinoplasty (on the columella) and alar base reduction? As I wrote before, I still have a darker area (depends on the lighting) on the right side of the columella, can anything be done?

is it usual in your practice to get white scarring lines after full incision blepharoplasty in patients of mixed background (eastern Asian and Caucasian)? If not, I might consider a revision with full incision, excision of scar tissue, and so on. NO, I DONT. BUT THE REASON IS THAT I DONT TAKE A LOT OF SKIN OUT FOR ASIAN OR CAUCASIAN BLEPHS. I REALLY BELIEVE THAT IS UNNECESSARY. I BELIEVE THAT IN ASIAN LIDS, A 3 MM EXCISION IS SUFFICIENT IN MOST CASES UNLESS YOU ARE DEALING WITH AN AGING ASIAN EYELID (YOU CAN WATCH MY LECTURE ON THAT IN THE LECTURE VIDEO SECTION) IN WHICH CASE I BELIEVE THAT STILL A CONSERVATIVE EXCISION PLUS ADDING FAT OR FILLERS IS THE WAY TO GO. THE WHITE SCAR TYPICALLY OCCURS BECAUSE A LOT OF SKIN WAS REMOVED AND/OR SO MUCH WAS REMOVED THAT THE THIN EYELID SKIN IS NOW PAIRED WITH THE THICKER BROW SKIN, CAUSING A WHITE LINE. IN MOST CASES IT IS A BAD IDEA TO SEEK REVISION IN WHICH THE SCAR IS REMOVED. THE PROBLEM WITH THIS IN BOTH ASIAN (BUT PARTICULARLY FOR ASIANS) IS THAT THE CREASE WILL BE TOO HIGH AND POSSIBLY THE EYELID MAY NOT CLOSE AT NIGHT WHEN YOU SLEEP. I WOULD TRULY TELL YOU LEAVE IT ALONE BUT YOU CAN MAKE THAT JUDGMENT. I WILL NOT PERSONALLY REVISE IT FOR THE SAFETY REASONS OUTLINED ABOVE.

similarly, do you usually get (even barely) visible scars after open rhinoplasty (on the columella) and alar base reduction? As I wrote before, I still have a darker area (depends on the lighting) on the right side of the columella, can anything be done? YES, TO THE FIRST; AND NO TO THE SECOND. MY COLUMELLAR SCARS TYPICALLY ARE VERY VERY HARD TO DETECT UNLESS YOU ARE LOOKING VERY CLOSELY BECAUSE OF THE CARE WITH WITH I CLOSE THEM. OBVIOUSLY, SOMETIMES THEY ARE SLIGHTLY MORE VISIBLE THAN OTHERS DEPENDING ON HOW THINGS HEAL. AS FAR AS AN ALAR BASE REDUCTION, THE PROBLEM IS THAT IT CAN LEAD TO SCARRING EVEN IN MY BEST CASES. I PREPARE ALL MY ALAR BASE PATIENTS WITH THE PROSPECT THAT THERE WILL BE A VERY FINE LINE VISIBLE FROM A PROFILE VIEW. ALAR BASES JUST DON'T HEAL QUITE AS WELL, AND I AM CRAZY ANAL WITH MY CLOSURES. I AM NOT SAYING I GET SOME UGLY HYPERTROPHIC SCARRING BUT I AM SAYING THAT IF YOU LOOK CLOSELY YOU CAN SEE SOME FINE LINE THERE IN SOME CASES. CAN ANYTHING BE DONE? IN MY OPINON NO FOR THE MOST PART FOR THE COLUMELLA. BUT A REVISION CASE OF THE INCISION COULD BE ATTEMPTED IF IT IS TRULY BAD. JUST CAN'T PROMISE THE OUTCOME. FOR THE ALAR BASE, THE THING IS THAT IT COULD BE DONE WITH DERMABRASION ONLY IF YOUR SKIN IS LIGHT ENOUGH LIKE A FAIR SKINNED ASIAN COMPARED WITH SAY A HISPANIC OR FILIPINO IN WHICH CASE COLOR MISMATCH IS A POTENTIAL PROBLEM.

dr. lam wrote:THE WHITE SCAR TYPICALLY OCCURS BECAUSE A LOT OF SKIN WAS REMOVED AND/OR SO MUCH WAS REMOVED THAT THE THIN EYELID SKIN IS NOW PAIRED WITH THE THICKER BROW SKIN, CAUSING A WHITE LINE. IN MOST CASES IT IS A BAD IDEA TO SEEK REVISION IN WHICH THE SCAR IS REMOVED. THE PROBLEM WITH THIS IN BOTH ASIAN (BUT PARTICULARLY FOR ASIANS) IS THAT THE CREASE WILL BE TOO HIGH AND POSSIBLY THE EYELID MAY NOT CLOSE AT NIGHT WHEN YOU SLEEP. I WOULD TRULY TELL YOU LEAVE IT ALONE BUT YOU CAN MAKE THAT JUDGMENT. I WILL NOT PERSONALLY REVISE IT FOR THE SAFETY REASONS OUTLINED ABOVE.

I don't think, in my case, that too much was removed, the crease is rather low and you would have to take out a great deal more for my eyelids not to close properly. Only one side has a really visible white line, which I can't explain. Maybe I should show you a picture, but I haven't been able to take any in which you can see what I mean.

Could dermabrasion make alar base scars as unnoticeable as a regular columellar scar?

1. if you have a white line on one side only, you probably still need to have surgery on both sides since removing skin on one side only would raise the crease on one side and make you look lopsided. i personally would most likely not feel comfortable with this since whatever caused the scar in the first place may cause it again.
2. you may consider tattooing the incision line but obviously the risk is messing it up more. and also i don't know if you can do that on thin skin of the eyelid. just a thought. have never seen it done there but wondering if it would work.
3. dermabrasion can make alar base scars better but typically not quite as good as a good columellar scar.
s.