Dr. Sam Lam Plastic Surgery Forum

I have (what I consider) deep nasolabial lines. I have tried using restylane twice (about 9 months apart)to correct them. Each time with a different Doctor. Both times after about 2 -4 weeks on the area right next to my nostrils I developed granulomas. The second time I was injected the granuloma that developed on the right side went up to under my right eye. First the right side of my face was swollen. Then a hard line up to my eye. I was given steroid injections at the injection site and pills to take. It eventually went away. I was told by the second Dr. that did the injections that what happened to me was so rare she hadn't heard of it or seen it happen before. She was convinced that I am allergic to the protein that binds it. I have 2 questions. Has anyone had this happen to them or heard of it happening to someone in the past? and I have been looking for another injectable with out the protein and from what I have read Radiesse is made of other components. Has anyone heard of similiar allergic reactions to radiesse?

I would consider fat injections but don't know much about how successful fat injections are.

Please help

first, fat is very successful in my hands. most docs will talk you out of it because they have no idea what they are doing with fat transfer. even if they tell you, "I tried it and it does not work." That is correct. It does not work in their hands.

as far as restylane is concerned, since 2002 or so, the antigens have been cleaned up reducing the incidence of an allergic reaction from 0.9 to 0.3%. so there is still a risk of allergy. usually, it is just a redness, itchiness, and hardness. to me what you are describing sounds like an infection and lymphatic occlusion, but i might be wrong. honestly, the best thing is fat transfer because it is permanent and with better results but also costs much more and requires anesthesia and a recovery time. the good thing with restylane is that if you get an allergy, i can dissolve out the product and eliminate the allergy within hours. you can't do that with radiesse.

i cannot cite the allergic profile of radiesse but it is very low as well. it is a great product but has a few major drawbacks. it is good for cheek and jawline fills but terrible for lips and under eye fills. too risky. plus, if i want to do fat, it sort of screws up my fat transfer for a year and a half or more since you can't dissolve out the product. the other problem is if you have an allergic reaction with radiesse, there is no treatment for it since the product cannot be reversed. however, as stated, the incidence to allergy is extremely low. like restylane, you are not responding to the product since both products are naturally found in your body but the carrier substance for each product.
best,
sml

Thank you for your quick response!

I wish it was only an infection because I loved the results (that's why I went back and tried it again with another Dr.). It didn't happen until approx. 2 weeks after the injections. Both times starting on the right side and then a couple of weeks later on the left. The right side was worse both times and the 2nd time I had the injections I had more injected... most likely the reason for the larger reaction. I actually went to a gen. practitioner for an xray (at the request of the Dr. that injected it the 2nd time) to make sure it hadn't calcified (which it hadn't). The Dr. didn't dissolve the product and the steroids made the swelling go down although the hard line remained for several months (not so much visual but you could definitely feel it when you touched it).

I don't know what a lymphatic occlusion is. I tried googling the term and what I got was way over my head. lol!

I really would like to find an injectible that works as i'm only 42 and not ready to start cutting up my face just yet. An esthitician friend of mine suggested cheek implants as an alternative. I have cheekbones though and I don't know how that will help.

Anyway, I like your approach. It's nice to get some honest answers once in a while.

Could you give me a ballpark amount of fat grafting for the lines? Also what do you charge for Botox? I live in the North Dallas area so I will call your office on Monday and set up a consultation. Perhaps I can get my file from the last Dr. and bring it with me.

Thanks again!

hi,
1. first do NOT do cheek implants. that is a crime against humanity, an atrocity, an affront to good taste and beauty. if you really want to know what i think, watch my video in my vlog section entitled, "cheeks: the good, the bad, and the ugly."
2. you are not going to like this but i am booked until mid to late july just for a consultation. i am sorry. this is even a slow time for me but i am simply booked out. please do not go elsewhere and get some weird surgery. i would love the chance to show you another way of doing things that is far more natural without cutting and PLEASE NO IMPLANTS.
3. fat grafting is not for lines. it fails completely there. i really cannot explain my philosophy via a forum response. bring some old photos for our consultation (probably 28 or 32 years old) and let's talk. i know you think lines are the issue and they are not. let me hold on a further explanation until i see you in person. too hard to explain in a forum response.
4. fat grafting is 9k. i know that i charge more than my colleagues but i deliver a far better result. you will get what you pay for. just give me a chance to do a consultation with you.
5. botox is 310 for one area, 215 for a second, 215 for a third, e.g., between the eyes, sides of the eyes, forehead. once you have had my botox you won't want to go anywhere else.
thank God you are from dallas. that will make it much easier so that I can do a face to face with you. just promise me you won't get a cut or even an injectable until we meet. that is how convinced i am of what i do and how i do it. i am so sorry that i am booked so far out. however, just put yourself on the waiting list. it actually opens up occasionally. like today, i had 2 patients not show up so i was able to put in someone that was supposed to be coming in on july 9th.
best,
sml