LAM FACIAL PLASTICS

Hi Dr. Lam,
I'm being really diligent about cleaning the areas 3 times each day with peroxide and then putting the Bacitracin on each area right away so it is always moist. Still, yesterday, the incision area on my left side seemed to very small have a white scab-like area in the middle (kind of on top of the stitches). It kind of worried me a bit because I have been reading that scabs are bad. It wasn't dry though, it was soft. So, is it really a scab if it's not dry? I realize you don't know without seeing it but I just wanted some re-assurance about what it SHOULD look like. I washed my face with soap and water in the shower a bit later and cleaned it again with peroxide, then applied the Bacitracin. The white area was not as noticeable after that now so maybe I washed it off. I even looked on Google image to see if I could find pictures of what stitches should look like during the healing process but didn't really find anything.

Can you let me know if it should basically be pink/white/ at this stage and if any skin should be forming on top of the stitches. Sorry, to ask yet another question, but I want to be sure this is healing the best way possible. I know you said scabs are bad and also not to ever remove a scab so I'm a little confused. Thanks in advance.

(If anyone else wants to chime in with what THEIR stitches looked like 3 days after, I'd love to hear about it. I had a mole excision on my face done on Monday)

Tracy

first of all, don't worry. whatever the white thing is it is not a scab. a scab is a dark colored thing like a scab should look like. second of all, back off to 2 times a day with the peroxide. you can continue to be aggressive with the bacitracin.
best,
sml

Ok. Thank you!

you're very welcome!

Hello Dr. Lam,
I'm posting my question here rather than starting a new thread. So, I had 2 moles excised by you almost a month ago. Here is an update for you.

The one closer to my eye on my left side is still looking "scabby" - that's really the only way I know how to describe it. Well, it's not a scab because it's not a dark color and it's also not hard. It's more like white skin. I'm assuming the stitches that are poking thru are causing this problem. How soon can I expect the stitches to start dissolving?

I know you warned against letting the wounds dry out so I've been really thorough about keeping everything moisturized. The skin is very bumpy and uneven and I can see skin that just doesn't seem to be healing or laying down. Does that make sense? I was wondering if by keeping it too moist, I'm preventing the dead skin from falling away or closing?

I wash it daily with a gentle soap and I always apply lotion in the morning (a non-oily lubriderm), then I usually wear make up when I go somewhere. Then at night I clean my face with a mild soap and apply Aquaphor before bed. I am just totally confused about why it looks so scaley. Shouldn't I be past that point by now? I'll send you a picture in a PM. Could you let me know your thoughts? I have my follow appointment in about a month.

The other incision (in the nasolabial fold) looks good. It is still red (they both are but I know the laser will help that) and there is some height difference at the end of the incision so the scar looks pretty pronounced when I wear make up, but I know you said the dermabrasion will address that.

Thanks!

HERE ARE MY RESPONSES IN ALL CAPS:
The one closer to my eye on my left side is still looking "scabby" - that's really the only way I know how to describe it. Well, it's not a scab because it's not a dark color and it's also not hard. It's more like white skin. I'm assuming the stitches that are poking thru are causing this problem. How soon can I expect the stitches to start dissolving?
AS MENTIONED IN A PM, THESE SUTURES CAN TAKE MONTHS TO DISSOLVE. IN A WAY, THAT IS A GOOD THING BECAUSE THEY ARE MINIMIZING TENSION ON THE WOUND EDGES. HOWEVER, I CAN TRIM THEM BACK WHEN YOU ARE HERE. DON'T WORRY IF THEY ARE POKING OUT OR EVEN IF THEY ARE CAUSING A LITTLE WHITE AREA AS YOU MENTIONED. ULTIMATELY, IT WON'T MAKE A DIFFERENCE. I'M SORRY. THIS IS PART OF THE REASON THAT IT IS SO VERY DIFFICULT TO HANDLE A MOLE REMOVAL FROM OUT OF CITY. AS I MENTIONED IN MY OPENING EMAIL, IT MIGHT TAKE 5 TO 6 VISITS TO HANDLE THE SMALL THINGS TO MAKE IT RIGHT. JUST COME ON YOUR SCHEDULED VISIT AND YOU SHOULD BE FINE.

I know you warned against letting the wounds dry out so I've been really thorough about keeping everything moisturized. The skin is very bumpy and uneven and I can see skin that just doesn't seem to be healing or laying down. Does that make sense? I was wondering if by keeping it too moist, I'm preventing the dead skin from falling away or closing?

STOP MOISTURIZING. GENERALLY, IT IS FOR THE FIRST WEEK ONLY. YOU MAY BE GETTING MILIA OR EPIDERMAL INCLUSIONS WHICH CAN HAPPEN WHEN SOMETHING IS KEPT TOO MOIST FOR TOO LONG. IN ANY CASE, IT SHOULD HEAL FINE.

I wash it daily with a gentle soap and I always apply lotion in the morning (a non-oily lubriderm), then I usually wear make up when I go somewhere. Then at night I clean my face with a mild soap and apply Aquaphor before bed. I am just totally confused about why it looks so scaley. Shouldn't I be past that point by now? I'll send you a picture in a PM. Could you let me know your thoughts? I have my follow appointment in about a month.
I THINK A PICTURE IS HARD TO READ BUT I WILL TAKE A LOOK. WHATEVER IS GOING ON, JUST LEAVE IT BE. I WILL SEE IT WHEN YOU COME IN. BUT LET ME SEE A PHOTO.

The other incision (in the nasolabial fold) looks good. It is still red (they both are but I know the laser will help that) and there is some height difference at the end of the incision so the scar looks pretty pronounced when I wear make up, but I know you said the dermabrasion will address that.
YES, LASER FIRST, THEN DERMABRASION. THIS WILL TAKE A FEW ROUNDS TO GET YOU THERE. THIS FORUM RESPONSE IS VERY HELPFUL FOR PEOPLE TO SEE WHY I HAVE NEVER DONE A MOLE REMOVAL FOR SOMEONE FROM OUT OF TOWN. I MADE AN EXCEPTION FOR YOU BECAUSE YOU LIVE RELATIVELY CLOSE BY (NOT THAT CLOSE). THIS IS VERY CLEAR HOW MUCH GOOD SURGERY IS SIMPLY NOT ENOUGH. GOOD AFTER CARE AFTER MOLE REMOVAL (BY ME) IS CRITICAL ULTIMATELY FOR THE RESULT YOU WANT. DON'T WORRY. IT WILL TURN OUT FINE, BUT YOU WILL HAVE TO SEE ME AT LEAST TWICE BEFORE WE GET THERE.

Hello Dr. Lam,
Thanks for your reply. I really appreciate it. I am fine with it taking several visits - that is no problem. You did tell me that up front. It's relatively easy for me to get to you and I'm happy to make the trip. I do think it's good for others to see that this kind of procedure is not a "one time" fix but more of a process. I know it will all turn out fine. Thanks for answering all my questions. :-) I will follow your instructions to stop moisturizing.

Thanks again!

perfect! see you soon.

Hello Dr. Lam,
I sent you a picture in a PM. Things seem to be healing well, but still a little slow on the one on my left. It seems dry and scaly one day and then kind of oozing the next. The one in the nasolabial area is pretty much completely healed. Thanks.

i have replied. looks much better.