LAM FACIAL PLASTICS

Dr Lam,

I have rather shallow rolling scars on my temples. I have tried resty injections before and got a 100% correction on one side which i still have over 14 months later. Im not sure whether this will be permanent although i am hoping so. My question is how much of a more accurate result can you get from silicone injections and also what level should it be injected as i have heard conflicting reports, with some doctors saying it must be strictly subcutaneous whilst other say deep-mid dermis is ok in minute amounts?. Also do you think subcision would be beneficial before having the silicone injections just to release any tissue that may be bound down?

Thank you for your time , Nick

Restylane tends to hold very well for acne scarring and static areas like that. Some people however burn through their Restylane in a matter of months for acne scarring. I just talked to a woman in consultation an hour ago about how she could not hold her Restylane for acne scarring. That is why I prefer silicone.

As far as depth of injection, I think deep dermis is safe in the right hands. However, there is a risk if you are not absolutely precise. That being said, I see no real benefit and only risk to inject into the deep dermis. Therefore, I inject exclusively into the subcutaneous plane. What is more important than the injection plane (which is very important) is the experience level and skill of the injector.

My silicone treatments are very good. In my opinion better than Restylane. However, I can't argue against a "100%" result since you can't be better than that. Plus, I typically never get "100%" but more like 70 to 80% on a good day.

My feeling is that subcision is ineffectual in about 90% plus of cases. I do use subcision but find it almost never useful, especially in the thin temporal area where there is not much deeper scarring and risk of a lot of bruising.

Hope that helps.
Best,
SML