LAM FACIAL PLASTICS

Hello Dr Lam

I had upper and lower lip reduction done three months ago. I wrote to you to ask for your expert opinion as to lumps I had in the lips after about six weeks. I am trying to be extremely patient to allow it to completely heal. The problem I am having is that thre months later I still have several lumps in different areas ranging from the size of a grain to pea sized some feel deep amd some more superficial. My plastic surgean is treating it with kenalog injections I have had the injections twice in two months but it is not helping. They I have "granulomas". I am African American if that makes a difference. I am concerned because the lumps they used to be soft and have gotten hard. You suggestesd 5FU injections the last time you responded to my post. I mentioned this to my surgeon and he does not use it. He has suggested if they dont go away to cut skin and remove them. I am opposed to this several reaseons:

I had a very painful and miserable healing process after the initial surgery.

I am afraid that after cutting to move them there may be a possibility that is happens again.

I am extremely concerned abouth this. I live in NYC but I am more than willing to fly in to Dallas if you think you can help me.

Have you come across this in your practice?

How caustic is 5FU to the skin? Are there any major side effects?

What is your opinion on Kenalog for this?

I also metioned before that there is assymetry of the top lip and it is quite obvious still even after the swelling has subsided.

Can I send you pictures? Where should I send them? and possibly arrange for a consultation.

Thanks for you help

Hi,
I'm sorry to hear of your plight. It is obviously extremely difficult for me to comment on another surgeon's work, as it would simply be unfair. However, honestly, I have not encountered the lumps you are talking about so I don't know if it is simply scar tissue, granulomas??? (that would be very unusual), uneven closure, a wound that opened up??? I really cannot say. You can send me a photograph by uploading to photobucket and sending me a private message with the link. Then I will respond in this public forum to what I see, but again this is a very very very inaccurate determination. Of course, the most accurate way is for you to fly down here to let me take a look. If I can do something, I will do it for you. If not, I will have you go back to NYC.

My opinion is that I prefer 5-FU for scars but most physicians don't know about it. Unfortunately, if it is a thick scar, I have to oftentimes repeatedly inject the area over a few months to settle it. Kenalog is fine but I don't love it only because there is a greater risk of atrophy to the injected tissues. In most cases, this won't happen. I just prefer 5-FU. I really wish I could help you more but this long distance is hard to surmount unless I see you.
best,
sml

The photos are very helpful. Here are a couple of thoughts based on the photos:
1. I think the uneven-ness particularly of the upper lip is due to an uneven cutting and/or healing.
2. The upper lip is still quite large and "ethnic". I think it could be further reduced.
3. I think the bottom lip could be too but I really think just working on your upper will suffice.

Oftentimes, surgeons who do not perform a lot of lip reductions only cut the inside part of the lip. This does almost nothing to reduce the size of the lip. You have to cut out dry lip. If not, you will not see a disernible result. The only problem with this technique is that you will see a visible incision line for at least a week and possibly even beyond that if you don't wear lipstick.

My suggestion is for you to think about reducing the upper lip again, which I think I can accomplish for you. But I would have to see you in person to decide. I can proceed with the procedure the same day if I decide I can do it.
best,
sml

Dr Lam

Approximately how many of these reductions have you done in your practice? What extent of unevenness would you say is possible with your technique?

i do one about one every other week. i have yet to encounter anyone with uneven lips (except for those who came in with them from another physician typically from bad silicone.) i can only get them partially corrected.