Dr. Sam Lam Plastic Surgery Forum

Hello Dr. Lam,

my questions :

1) if I'm correct, you perform lip reduction. Do you think it's possible to reduce not only the lip but the whole part that's between the mouth and nose. This part is quite thick I think (my upper teeth are located like 2 cm beneath that layer of skin and muscle)

2) I have also quite fat and round lower cheeks. Do you think it's possible to reduce them.

3) I'm not happy with the global shape of my face. Is it possible in your view to reduce the zygomatic bones? I'm half Asian and I'd like to have a less rounded face. Asians also have very high cheek bones and small orbits. Is it conceivable to make them bigger so as to make the eyes look bigger, too, in your opinion?

thank you in advance. (I know those are general questions but this forum is the only decent one I could find on the internet)

1) if I'm correct, you perform lip reduction. Do you think it's possible to reduce not only the lip but the whole part that's between the mouth and nose. This part is quite thick I think (my upper teeth are located like 2 cm beneath that layer of skin and muscle)
I REALLY DO NOT BELIEVE IN SHORTENING THE WHITE UPPER LIP IN MOST CASES. THERE ARE TWO REASONS. FIRST, THE SCAR UNDER THE NOSE OR WORSE AT THE BORDER OF THE WHITE AND RED LIP CAN BE NOTICEABLE. SECOND, THE RED LIP GETS TURNED UP WITH THE PULL WHICH REALLY CAN LOOK LIKE A DUCK. I SEE TOO MANY OF THESE DUCK LIKE LOOKS BECAUSE SOMEONE IS TRYING TO SHORTEN THE WHITE LIP TO GET SOME RED LIP SHOW. TRY JUST PULLING UP ON THE WHITE LIP AND TAKE A LOOK. I PERSONALLY DON'T LIKE IT. REMEMBER YOU CAN ASK 10 DOCS AND GET 10 ANSWERS. MY ANSWERS ARE BASED ON MY AESTHETIC WORLDVIEW, WHICH I DON'T COMPROMISE.

2) I have also quite fat and round lower cheeks. Do you think it's possible to reduce them.

I DON'T BELIEVE IN BUCCAL FAT REMOVAL AND FACIAL LIPOSUCTION. I THINK THE RESULTS CAN LOOK UNEVEN AND UNAESTHETIC. WHAT I DO DO IS BALANCE THE OUTER LOWER FACE WITH EITHER A SMALL CHIN IMPLANT OR SOME FAT TRANSFER TO THE CENTRAL LOWER FACE AND AT TIMES THE CENTRAL FACE (TAKE A LOOK AT SOME OF MY ASIAN FAT TRANSFERS) TO OFFSET THE WIDTH OF THE FACE AND CREATE THE ILLUSION OF A NARROWER FACE.

3) I'm not happy with the global shape of my face. Is it possible in your view to reduce the zygomatic bones? I'm half Asian and I'd like to have a less rounded face. Asians also have very high cheek bones and small orbits. Is it conceivable to make them bigger so as to make the eyes look bigger, too, in your opinion?

YES, IT IS POSSIBLE. HOWEVER, I DO NOT PERFORM ZYGOMATIC BONE REDUCTIONS. YOU NEED TO GO TO KOREA AND FIND A SPECIALIST WHO BASICALLY ONLY DOES THAT PROCEDURE OR THAT IT OCCUPIES ABOUT 80% OF HIS/HER PRACTICE. THIS PROCEDURE IS TOO RISKY IN UNSKILLED HANDS. ALTHOUGH I TRAINED TO DO IT IN KOREA, I HAVE NEVER INCORPORATED THAT INTO MY PRACTICE BECAUSE I DO NOT FEEL MY TRAINING WAS SUFFICIENT AND I WOULD NOT BE DOING THAT PROCEDURE WITH SUFFICIENT REGULARITY TO GIVE MY PATIENTS THE BEST THAT THEY DESERVE. THAT IS ALSO WHY I GAVE UP PTOSIS EYELID REPAIRS AND SEND THAT OUT NOW.

1) I absolutely share your opinion on that one but I wasn't actually talking about that issue. I meant, in profile view, this part between the nose and the mouth that i don t know what to call, is too thick. So I would like to reduce it not vertically as you understood but horizontally. In other words, take fat out via an internal incision on the red lip and make the whole thing sit closer to the teeth. (my objective would be, as you can guess, to have a less projected mouth).

2) is it technically possible to alter the cheek line? mine vied from the side is quite round like a baby's would be. could a surgeon make it less convex?

3) do you know if such a procedure is expensive? do you know trustworthy surgeons in Korea as you studied there? do you know if it's dangerous (is there critical nerves in that very area?)

1) I absolutely share your opinion on that one but I wasn't actually talking about that issue. I meant, in profile view, this part between the nose and the mouth that i don t know what to call, is too thick. So I would like to reduce it not vertically as you understood but horizontally. In other words, take fat out via an internal incision on the red lip and make the whole thing sit closer to the teeth. (my objective would be, as you can guess, to have a less projected mouth).
TWO THINGS: FIRST, I WOULD NOT DO THAT. IT WILL CREATE A RISK OF SCAR TISSUE THERE WITH UNEXPECTED SURPRISES. SECOND, OFTENTIMES, THE LOWER PORTION OF THE UPPER LIP IS TOO FULL DUE TO A BONY PROTRUSION LOW DOWN AND A DEFICIENCY IN THE PREMAXILLA (THE BONE RIGHT UNDER THE NOSE) CAUSING THE LIP TO SCOOP OUT AS IT GOES DOWN. THIS "SIMIAN" APPEARANCE (SORRY FOR THE NEGATIVE ANALOGY BUT THAT IS WHAT IT IS CALLED) IS PREVALENT IN ASIANS. THE ONLY THING SURGICALLY THAT I DO TO IMPROVE IT IS TO EITHER REDUCE THE RED LIP (AS NEEDED) AND/OR AUGMENT THE PREMAXILLARY DEFICIENCY. HOWEVER, A PREMAXILLARY IMPLANT ONLY DOES SO MUCH. THE REASON IS THAT I NO LONGER USE THE LARGE SILICONE MONOBLOCKS IN THIS AREA. I FOUND THAT THEY CAUSED DIFFICULTY SMILING AND JUST FELT UNNATURAL DURING ANIMATION OF THE FACE. I USE SMALL EAR OR SEPTAL CARTILAGE BUT THE GAINS OR MODEST SO I DON'T RECOMMEND THIS AS AN ISOLATED TREATMENT. USUALLY I DO THAT IN COMBINATION WITH RHINOPLASTY AT NO EXTRA CHARGE.

2) is it technically possible to alter the cheek line? mine vied from the side is quite round like a baby's would be. could a surgeon make it less convex?
I DON'T DO THAT. THE ONLY WAY THAT I KNOW OF DOING THAT IS BONY SURGERY WHICH IS DONE IN KOREA. I WOULD MOST LIKELY NOT GO TO A GUY IN THE U.S. WHO DOES A FEW A YEAR. YOU REALLY NEED TO DO THIS A LOT. I PERSONALLY DON'T RECOMMEND IT BECAUSE THE RISKS ARE HIGH AND THE RECOVERY EXTREME. IF YOUR TEETH ARE OUT OF POSITION TOO, YOU MAY WANT TO CHECK WITH AN ORTHOGNATHIC SURGEON WHO FIXES THE MAXILLA AND MANDIBLE TO CORRECT ALIGNMENT AND THE CHEEK AND CHIN FOLLOW. THIS KIND OF SURGEON IS HERE IN THE UNITED STATES AND YOU MUST INTERVIEW HIM/HER CAREFULLY BECAUSE THIS IS ALSO HIGHLY INVASIVE SURGERY (AND VERY EXPENSIVE) WITH A LONG RECOVERY. THE RISKS ARE HIGH BUT THAT MAY BE YOUR SOLUTION. WHEN IT COMES TO SUBTLE FACIAL BALANCING, I USE FAT TRANSFER TO OFFSET A WIDE CHEEK BUT WOULD ONLY DO THAT IF YOU HAVE SIGNS OF AGING. I DO PERFORM FAT BALANCING IN VERY SELECT YOUNGER PATIENTS.

3) do you know if such a procedure is expensive? do you know trustworthy surgeons in Korea as you studied there? do you know if it's dangerous (is there critical nerves in that very area?)

YES, ANY BONY SURGERY IS TYPICALLY VERY EXPENSIVE BUT MAY BE A LOT LESS IN KOREA ONLY BECAUSE PRICES ARE LOWER THERE. I CAN'T MAKE ANY FIRM RECOMMENDATIONS THERE. YOU WILL HAVE TO DO YOUR OWN HOMEWORK. I WILL REFRAIN FROM COMMENTARY ABOUT NERVES. YOU NEED TO TALK WITH A SURGEON SPECIALIZING IN THIS ISSUE. MY HUMBLE OPINION SOMETIMES IS OUR SOLUTION TO A PERCEIVED PROBLEM MAY BE MORE RADICAL THAN IT IS WORTH. IF YOU ARE VERY YOUNG, SOMETIMES, THE FACIAL SHAPE SLIMS AS YOU AGE, SOMETIMES NOT. JUST MY THOUGHTS.