LAM FACIAL PLASTICS

Dear Dr Lam, I email from Australia out of sheer desperation. I have Leukaemia and 2003 had stem cell transplant and bone marrow transplant in 2004. In January 2006 I had two lumps removed from my lower lip at local hospital by dermatologist. I had little lip left and in November 2007 as I had to have another small node removed from upper lip I went to cosmetic resconstrucitve surgeon who told me he would re do my lower lip to give me more lip. This he did.....but the lip was uneven and I struggled eating, drinking and pronouncing some words as the central part did not seem to pout when it should. The side dipped and I had to use a straw. The surgeon did not want to use collagen so did scar revision surgery in April of the whole lip.......this has devastated me. My leukaemia did return last year and the whole idea was to try and give me some self esteem and confidence back after having no hair for almost 2 years. It has done the opposite.......

There is scar tissue on one side of the mouth which pulls inwards, and in the central part of the lip the surgeon removed (he said small bit of muscle). This has resulted in the some of the central area being totally flat and with hardly any lip. I cannot keep food in my mouth and when I eat throw my head back whilst I try and move the food to the side part of the mouth. I use a straw and NEVER SMILE, and avoid talking. This is because where the muscle has been removed and a tight stitch at one side pulls the lip to one side, so when I do attempt to speak, smile etc it is very obvious and pulls tightly.

I have one young son and since April have avoided picking him up from school, no longer attend any school functions and husband goes instead and stay home 24 x 7, unless I MUST go to the hospital for my specialist visit and to check my bloods.

I am so desperate I have seen 2 surgeons who did not make me feel like they were interested at all in helping me. But the surgeon who did it has been doing it for over 25-30 years and is highly reputable but extremely arrogant and rude and I think the problem was he didn't listen to me. It was not explained what would occur if muscle was removed and stupid of me I didn't ask as I felt the surgeon knew what he was doing and to just leave it up to him.

I am not financially well off, but my husband says that no matter what I need to do we will get someone to at least try and help with the comfort as I JUST CAN'T LIVE THE REST OF MY LIFE HOWEVER LONG IT MAY BE ISOLATED.

I have photographs etc etc but I expect it is no good for you. It has been suggested by a nurse that Juvaderm might help but I am so petrified of not having someone do it that knows what they are totally doing...most importantly are not just doing it for the money and the wealthy, but have compassion for people who need the help to function properly.

Any advice would be welcome....if you know anyone within Australia who might be qualitifed and sincere in helping, please let me know.

I am sorry to hear of your plight. I am not entirely certain what the problem is per se. I tend to work with cosmetic lip deformities where there is too big a lip or too little a lip etc. However, in your case, you seem to be describing a functional lip problem that I am not certain of. Perhaps you could first send me a private message with your lip photos so that I can make an initial evaluation. Please send a full face, a close up with mouth closed, a close up with mouth open and a close up with mouth smiling. Let's start there.
best,
sml

Hi,
I just finished your long PM to me and obviously feel your pain. I am sorry that life has been unkind to you in many ways. However, I am glad to hear that at least you have a good support network (son and husband). There are few things that I want to say to you. First, let's begin with the "physical" problem then we will go to perhaps something more important, which is your perception of it.

I clearly see the problem. However, a realizable solution may not be that easy in anyone's hands. I just took care of a lady pro bono who had a lower lip scarring from a burn injury in which there was just a massive amount of scar tissue. I just saw her last week and she looks much better. In your situation it is not too much scar, it is that the area has been contracted inward and is a bit tethered. I don't know if any of the solutions would be worth it for you. The two that come to mind are a red lip advancement into the white lip but I can't tell you for a fact that would work in light of the scarring. When it is truly tethered, restylane would probably be hard to create much vertical show to the red lip that is red lip height. Two more options would be to cut out the contraction in a vertical wedge fashion but that would only further contract the lip horizontally. The third option which is a big one is to do a cross lip flap to take tissue from the upper lip and transpose it to the bottom lip. Since I do not do cancer operations anymore it is been a long time since I have done one. I don't know if that is the best solution either. The white scar on your upper lip does not make me feel comfortable to cut across there. Your blood supply may lead to flap loss which could be devastating.

I know that i have given you a lot of options but none of which is necessarily safe or ideal. I know you are from Australia so it would be difficult to come to see me here also given that this would probably require multiple smaller things to get the job done. It is always a wrong thing to do to give medical advice in this forum which, as you know, is not the intent. I really wish you could find someone who specializes in facial cancer reconstruction, whether that is a facial plastic surgeon or a plastic surgeon. I just probably should not try to outline too much of a course of action for you given the limitations of what this forum is all about.

I will say this much. There are certain things in life that we simply can't fix. There are certain things in life that we simply can't improve. My father was born with a debilitating bone disease that ultimately took his life at 76. I can't remember a day after the age of 40 for my dad that he was not in pain. He sometimes got down about it but he always showed me the courage and bravery that I think most of us would not have had to deal with it.

I wrote a blog last week called "the Freedom of attitude". Instead of rewriting the whole thing here, I would ask you to read it. Here is the link:

http://www.lamfacialplastics.com/lfp-blog/archives/314

In short, Victor Frankl who was a concentration camp survivor could tell when the prisoner would soon die because he gave up hope. He gave away his food for cigarettes. Frankl instead focused on his getting back to Austria to teach again one day. And guess what he did. What he said was that when all freedoms are taken away from you, you have only one freedom left, your freedom of attitude. It is only your choice of how you deal with this situation and no one else's. My mentor, Ed Williams, told me that "happiness comes from inside", meaning that no matter what anyone should do for your condition (and I don't make light of it), only you will ultimately find happiness from your own perceptions. No surgeon no matter how good he is will give you that freedom. Only you will. I have learned that the hard way with some patients who are chronically miserable. They won't admit it but they ultimately wallow in their own misery and seek to sustain that misery because that is part of their own identity now.

Only you have the freedom to turn a terrible stigma of your past into something that you can wear with pride and say, "I survived this." I am now a stronger person. Only you can look at your own imperfections and say, "Boy, I am a survivor and am taking this journey day by day. I am thankful to the Almighty that I am alive and I will never forget this scar on my face that is physical proof that I am a stronger person because of it." Or you can take the other road and seek correction. I am not saying not to have it corrected. However, seek what you can to do it but don't let it become an obsession. Don't let it consume you. Use it as a way to make yourself a better and stronger person. Perhaps, you can use your strengths to teach others. If you can get out there and speak to others who may be in your same plight, you might find the freedom from it. If you seek consultations until you drive yourself crazy, you will ultimately fall victim to your own desires. Remember the law of attraction. the more you seek out correction, the more your mind enters into a deep abyss.

Open your mind to the fact that you are alive and well. Read Lance Armstrong's book, "It's Not about the Bike" (just finished it). Read the late Randy Pausch's book "The Last Lecture" (just finished it). Put perspective on your situation. I wish you the best in whatever you choose. But remember it is not a surgeon's choice. It is entirely yours to make.
best wishes,
sml

Dear Dr Lam

Thank you so very much for your response...yes you hv given me lots to think about. I feel guilty that I have survived 2 transplants and still have my illness yet this is bothering me so much. I think it is because food comes out of my mouth and I have over last few years wanted to get myself as back to normal as I can. Problems with the lip is difficult to hide as you use it all the time, it is physcially a must.

I totally appreciate everything you have said, and in my heart I know. But it is extremely difficult to be this way and even if I only have a few years I so much want some quality. I see other cancer patients who are worse off than me, and it was me a few years ago who was in the same position and I dreamed for my hair to come back and the dark circles from chemo to go so I could look normal again, especially when i went with my son to school and with his friends. Some of them have only known me with no hair and sick, and now it is my lip.

I will try to overcome it, but will also try to find a specialised cancer surgeon. It is difficult however as internet details all plastic surgeons talk about cancer reconstruction surgery etc, the surgeon who did my two was of the highest reputation yet did not communicate with my husband and I fully. Did not explain the risk in having a second surgery and muscle removed....then perhaps I would have left it as it was as I managed far better before the scar revision both physically and mentally.

Anyway, I will let you know how things go....but if you ever through your circle of contacts find of a surgeon in Australia who might be able to compassionately give me some advice by a personal consultation, it would be most welcome.

You are the first surgeon whom has seemed human, and I totally appreciate it. You never know perhaps I will win lotto one day as if not for me, my husband and son truly deserve something good to happen to them after putting up with my melt downs.

Thank you so much.
Alison

i wish I could help you more. I am also saddened when someone is suffering. Keep your spirits up. A solution is around the corner whether it be physical or in some other way.
best,
sml