LAM FACIAL PLASTICS

Dear dr Lam,

I would would like to ask you a few questions concerning my treatment with a permanent filler (ISP/PMS; Implantible Silicone Polymer and Purified Medical-grade Silicone) for my acne scarring five months ago.

The treatment was without much positive result. Most of the dimples are still there and and they are now accompanied by little lumps surrounding them, overcompensation.
I mean, on spots where there wern't any lumps before.
Also when I laugh I feel tension on some some treated areas. My idea is that the filler is brought in to closely under the skins surface.
My attending doctor says there is not much he can do about it. (This clinic said to be one of the best in my country)
If I would have known the end result would be like this I would have never done it.

I would like to know if there is a possible way to treat my case. For both the dimples (tissue loss) as well as the lumps (overcompensation).
I would like to send you some photos.

Best regards,
Julian

I'm truly sorry to hear of your situation. Yes, you can send me photos, preferably with links in a PM. If not, send it to drlam@lamfacialplastics.com. However, acne scarring is really hard to interpret in a photo. Preferably, I would see it in person. Here are my thoughts:
1. if you have little bumps, most likely the silicone was injected too superficially instead of subctuaneously (below the skin). or, you have developed some kind of abnormal scarring. if it is the latter, a little 5-FU can help the situation. i would start with that anyway. the reason is that silicone generates a little bit of collagen encapsulation that can raise the surrounding area a bit. if that fails, then i would consider that the silicone has been placed in an improper plane. the best way to manage it (which is not ideal) is to dermabrade the bumps down but leave the dimples/pits. as you probably know, i do not believe in aggressive dermabrasion for acne scarring because taking down tissue all the way to the abnormal pit is not a great idea. basically the purpose of dermabrasion is to sand down the higher skin surface leaving the silicone in place. this should be a viable method but i can't promise you. i have not had to do that before but talking with a senior silicone injector in the past, that is what he suggested, not dermabrasion per se but just cutting down the skin with a knife. i don't believe that would be ideal if you have multiple areas.
2. believe it or not, i still believe that silicone injections would be ideal for the remaining dimples if they are of a kind that would be amenable to silicone. obviously, they should be injected by an experienced injector. if you are gun shy, i completely understand. i just would not sand down your skin all the way to the abnormal pits.

all of this is conjecture obviously since i have not seen your photos. even after seeing them as i mentioned, i can't make any promises because acne scarring is simply terrible to photograph well.
best,
sml

looking at the photos, it appears that you still suffer principally from depressions. it is hard for me to see the lumps, so to speak. from what i see, i basically see more of an issue with the depressions meaning that further silicone (done well) would be my approach. however, if there are definitely lumps, they should be addressed first in the manner i outlined.
best,
sml