Dr. Sam Lam Plastic Surgery Forum

Dr. Lam,
Do you perform this technique or are you familiar with it. Here is the link to you tube
http://www.youtube.com/watch?v=iLlEkYI_7I8
Thanks

I watched the entire video. Interestingly, this is merely a glorified term for autologous fat transfer, which is what I do practically every single day. The collagen comes along with the fat as it is part of it. The central fat zone is retained while the upper supranatant (oil/lysed fat cells) and infranatant (blood/lidocaine) are cleared. Hello! that is what I do every day.

Okay, here are my thoughts: autologous fat is TERRIBLE for all the applications they are using it for. Why? Here goes:
1. The aging face is principally a volume issue and fat is intended to restore lost volume, which they didn't even bother to do. Did you notice that? I just lectured on how we have moved away from wrinkles to volume with fat transfer in Vegas about 3 weeks ago.
2. Wrinkles are not a good treatment for 2 reasons. First, it is very hard to get safe and accurate results in such fine lines on the forehead, etc. Did you see how precise you have to be to avoid a problem? Even the slightest over or undercorrection can lead to problems there. I don't need a heart attack putting fat in those wrinkles. Here is the real kicker though: fat is a live graft. It is not bioinert like silicone. If you gain or lose weight it can change in volume even grow slightly at a year. That is very dangerous. Can you picture ridges running across the forehead or that is bulges there? That would be an unfixable disaster. The only way I use fat transfer is to blend and balance a wide zone and blend it in with surrounding areas. I don't just stick it in discrete areas. That is unsafe.
3. Here is the other thing: one month postops????? How can you legitimately show 1 month postops? That is all swelling. My fat grafting swelling lasts about 2 to 3 months when I am talking about a little swelling there. (Look at my fat grafting evolution photos under the before and after gallery marked "new). Also, the fat has not even taken yet. It takes 6 months to 2 years out for it to take. So show me 2 year plus followups before I believe that this procedure is safe. Also, remember the Japanese typically don't gain a single pound as they age so autologous fat could be safe in these lines theoretically (in my opinion still very unsafe) but in the U.S. we gain and lose a few pounds which could translate into forehead bumps with the live fat graft.
4. If you want to read about what I think will happen to long-term fat in the forehead, just do an archive search for fat transfer in the forehead.
Okay those are my thoughts and they come from years of doing fat transfer and speaking to the world's experts even training for a couple of months on fat transfer in Japan by respected Japanese surgeons and publishing papers on fat transfer and a book (Cosmetic Surgery of the Asian Face, 2nd Ed.) with them.
best,
sml

After my long answer, I did not explain what I do for the two types of wrinkles: the action wrinkles of the upper face (forehead and crow's feet) and smile lines or nasolabial groove:
1. for upper face wrinkles, i use Botox. Filling a forehead line simply does not provide long-term correction. Botox knocks out the source problem which is motion. Motion that is derived either from natural expression or in most cases overzealous bad habits. That is why people can have tremendously deep frown lines and no forehead lines or vice versa. Botox knocks out the bad habit over time so that you forget literally how to be so over-animated. People say, "oh, i like to move my forehead". Trust me if you are moving enough to cause deep set wrinkles, you are moving it way too much and it is terribly ugly. I sit in a consultation and I look at someone and all they are doing is frowning at me for 2/3 of the time and they don't even know it. Is that attractive? No. Or they are lifting their forehead so high that they look like a clown because they think they look less tired. Not attractive. The only area that Botox works on a favorable wrinkle if you will is the crow's feet because smiling is a good thing. However, consistent Botox use provides incredible long-term benefits. Look at my before and after gallery for Botox and go down halfway to the "long-term results" (try to find another website with those kinds of photos. you won't). these photos were taken with the patient coming back to me for more Botox. in other words, the Botox had almost completely or completely faded out (i indicated next to each photo how long that individual had been doing Botox with me.) and they still had no wrinkles. the reason for this is that the collagen had time to heal without the disruption of constant movement. It would take a long time for that person to regain those wrinkles again. Let's use 2 more analogies to make this clearer. First, the skin is like a shirt. If you wear the same shirt for 5 years straight, that shirt would be pretty wrinkled. Now, let's say you iron the shirt, fill in all the cracks, and you still wear it, is it still going to wrinkle over time? Of course! That is why Botox is necessary. It is like hanging a shirt on a hanger. Over time, the wrinkles start to fade and entirely disappear in the case of the skin since a shirt does not have regenerative capacity. the skin does and it heals the wrinkles almost entirely (if you don't wait too long to start). also, i look at Botox like exercise. The more that you do Botox the better the muscles become conditioned and the longer and smoother your effect. Botox is truly a REGIMEN. People look at Botox entirely wrong: that it is a short term fix (yes it does that) but it provides long term reversal of aging. Plus, it is so important to let the skin heal. There is no skin care product or filler that can get to the root of the problem and solve it, which is excessive motion. You need to understand the pathology to improve the problem. further, i use Botox entirely differently than most of my colleagues in 2 ways: first my injection technique is psychotically painless. TRY ME. second the method i use creates truly a skin texture improvement beyond wrinkle changes. watch my video log on Microbotox to understand this idea better.
2. Wow, that was a long answer. The smile line first of all is entirely overrated. Watch my Video Log "How About Those Smile Lines?" If you meet my selective criteria for correction (or simply want to waste your money), I will perform the smile line correction. If you want a permanent correction, silicone microdroplets will work well. I also tried that Surgiwire technique and boy that thing is terrible. Fortunately, I did not have any disasters just dissatisfied patients (which i covered by putting free silicone treatments to permanently correct the line over even what they paid for the Surgiwire). My colleagues experienced disasters. Also, don't do solid implants in the lines. that is a disaster. watch my video log on why i don't put solid implants into lips because i also mention why i don't do it around the mouth either. okay, enough said.
best,
sml