LAM FACIAL PLASTICS

Dr Lam, I read recently a theory that resty can actual help to build collagen. I was wondering what your thoughts on this are?. I had resty injected into some acne scars (completely leveling them out) about 18months ago and it seems that the result i had then hasnt changed at all, which i am extremely pleased about. I was wondering if this may be due to collagen being built taking place of the resty. Or whether i am just extremely lucky to have kept such a solid result?

Thankyou for your time , Nick

That is a great question. Here are my thoughts: First, I think that the claim that Restylane can build collagen is overstated. Yes, I am familiar with the study you are citing. As a point of understanding this fact, I wrote an award-winning research paper about 6 years ago that looked at the collagen changes with both non-ablative pulsed-dye laser and ablative carbon-dioxide laser using a pig model (the pig was not harmed), which is the closest model we have to the human. I found that the degree of collagen remodeling in BOTH the non-ablative laser (no skin burning) and the ablative laser (burned off all the skin) were very close quantitatively and qualitatively using a blinded, randomized analysis, which blew my mind. We also compared that against untreated controls. We also found that the collagen increased depending on the fluence (laser strength). Now all of that sounds remarkable, right? The non-ablative laser we studied has been found to be completely useless and is off the cosmetic market. You can buy the N-lite probably for $5 on eBay as a coat rack. So be wary of believing in well-designed, well-controlled studies on collagen.

Okay, now when it comes to your situation, you most likely have 1 of 3 things going on. First, the needle stick and not the Restylane may be causing some "collagen growth". There was a study showing that repeated needle sticks in an area could help improve acne scarring even without any injectable agent. The theory is that the scar tissue is building up and creating a better result in that area. I also tend to use a larger bore needle with multiple sticks perpendicular to the skin when doing silicone for acne scarring. That is why I believe I am getting also better results in that area than Restylane (smaller needle, very few injections) that continue to improve over year when I do silicone. Second possibility is that the product placed is splinting the tissue open that can stimulate collagen in a different way proposed by the study. It is almost subcising or undercutting the scar and holding it in a stented position for a long time. Another study in which just saline (salt water) was injected into the scar showed improvement due to the stenting or subcising effect, but the salt water required repeated injections to break down the adhesion. With Restylane you are getting prolonged stenting or undercutting. Finally, you may simply be holding the Restylane for two reasons. You may just hold Restylane well. Second, Restylane in the lips and smile lines lasts a very short time because it is in a highly mobile area. However, Restylane in acne scarring is in a highly NON-mobile zone, so it much better retained. If your result is due to the needling or stenting, you may have a permanent outcome. If it is due to the Restylane result, it may be gone in another 6 months to a year and a half.
best,
sml

Dr Lam,
Thank you for your informative answer. The resty that i had injected was injected into scars on both temples but only the right temple has held the resty for this period of time. I believe the resty that was placed in the left temple was placed poorly as it seemed to be gone within a few weeks. So at this point i am hoping that i have permanent improvement. I was also wondering if you think that by careful placement of a second round of resty in my left temple i could achieve this 'splinting' that your have described? or do you think that it would have been by sheer luck that this has occurred in the first place ( if in fact this is the case) . Do you think subcision before the resty could be beneficial also?. Thank you for your time

Nick

I don't have that much experience with Restylane for acne scars since I principally use silicone to do the work. Your questions are valid and I would give it a try. That's the best that I can say, honestly.
best,
sml