Dr. Sam Lam Plastic Surgery Forum

TCA, laser, or fillers or all?
Thank you

that's a hard one. i do not think fillers will work. TCA or laser would be better. i have better results with CROSS TCA. if you do weak TCA, it does nothing. hope that helps as a start.
best,
sml

Thank you for you reply. My cousin recommended me to you. She thinks you are great.
What type of laser would you recommend? I was thinking about the active fx laser but so confused.

i have a fractionated laser and i don't think it does a lot for acne scars. i was going to get an active fx and was working on a book project a couple of years ago with a senior user of the product and warned me not to get it for acne scars because he said simply it was not effective. i personally do not have a good laser recommendation, as i find that in general it does not work well. however, you can give it a try but not with me. i personally would do the CROSS but it is not perfect, as very few things are for acne scars. thank you for the kind words.
best,
sml

Thank you so much for your help. You seem to be very genuine. I really appreciate that as alot of others will sell you on anything for a buck. My dermatologist said she could get rid of every scar guaranteed with the active fx laser.
I think I will still do the active fx for other issues like hyperpigmentation/wrinkles under my eyes and do the cross for the scars.
Is there alot of risk with cross? My family and friends ask me why I would do anything as they think my scarring is "hardly noticable and mild" I disagree and think they are just being nice. I just would not want to make things worse and then regret my decision.

in a way if you are going to pay for the laser for hyperpigmentation and wrinkles, you might as well give it a shot on the scars. if it works, fantastic then!
best,
sml

I just saw you before/afters. Impressive. I want to see you for treatment. I see you use the plasma laser. Would you consider this a good treatment for under eye wrinkles/ permanent tanned face(on a very caucasion white person)?
How many treatments of tca cross do you think I would have to do to get results?
As an embarrasing as this question may be I would like to ask you what you think the severity of my scarring is as I know this is going to cost some money and risks are always involoved in any treatments and I just dont want to make any haste decisions. I know tca cross doesnt cost too much but traveling will cost me. Thanks again!!!

wrinkles are best treated with botox. because wrinkles are caused by movement and the stopping of movement is the key. watch my botox videos to better understand why:
http://www.lamfacialplastics.com/galler ... Tutorials/
plasma is good for significant outer sun damage. i really don't think it will do too much for you. focus on the cross treatment and botox in my opinion. i see all types of scars so in the range that i have treated i would say not severe but remember that whenever it is your face it is always severe.
best,
sml

Thank you. I agree that I have moderate scarring. It makes me feel like Im not crazy to hear someone else agrees with me.
I think I will make an appointment with you as you seem like a honest Dr. It will be sometime this fall.
Does botox work on wrinkles directly under the eyes? I was under the impression it only worked on crows feet which I dont have yet!

botox won't exactly work there but by managing the sides of the eyes, indirectly it seems to work well to reduce the area below the eyes. i also use a product called elastoderm by obagi for all of my botox patients to enhance the tough to treat lower eyelid area. look forward to take care of you.

Thanks so much for answering my questions and also thank you for your honesty. I have read through this forum on cross to get a better idea of what to expect. I know you probably need to see me in person but what might you think about how many treatments I would need to see some improvement and how often would I need to have it done?
This photo was taken from lighting coming from behind me to showcase my scarring. I think that in most lights they look like hypopigmented spots so I am not sure how deep they are. Secondly what about the wider scars? I assume tca cross would not be used for those? If not, can anything be done for those?

hi,
1. i would guess 2 to 3 rounds spaced 2 to 3 months apart or slightly longer.
2. wider scars i assume you mean the chin area? if you are talking about a general depression, then silicone micro treatments.
hope that is clear.
best,
sml

Are you referring to the two depressions next to the acne spot on my chin?
Those and also horizontialy from my mouth on my cheek area. I guess saucered shape scars

Im sorry just one more question. There is also a scar right next to my eye caused from a dart thrown at me when I was a child. When I stretch the skin there the scars disappears. Would a filler work and if so is it safe to do the filler so close to the eye?

stretching the skin does not make any difference to my thinking. it is not too close to the eye to be filled. however, i do not think it will fill well. if you want that improved, you should have a formal scar revision requiring an incision.
best,
sml