Dr. Sam Lam Plastic Surgery Forum

Hi doctor,

I would like to private message you my pictures to see your suggestion for buccal fat removal. How do I do this?

i will be honest, i don't do that.

Thank you for being honest!
May I ask why though? I've been to a few surgeons, and I cannot seem to get a majority opinion. Everyone has their own thoughts on my face. The first two doctors suggested I get buccal fat transferred to upper cheek without me eve asking about that. I was asking about my nose. Then since They got me thinking about it, I went to two other surgeons to get an opinion and they both said that while it is true I have excess buccal fat in lower face, and not enough in the upper, that they too do not perform this procedure and are against it and suggested to simply get filler in my cheeks(upper cheeks). This is why I am asking because I'm just really confused.

I am 27, no children, and my mom and grandmother both had big cheeks at younger ages and now, at 52 and 72 respectively, they have jowling effect. looks like the buccal fat is sagging in other words. Do you think this I a good indicator of what I will look like at that age?

hi,
a few things:
1. i think there is a very limited indication for buccal fat removal, so limited that it is not worth my energy to acquire the skills to do a procedure well and consistently well. there are others that do that frequently.
2. a case in point is my own sister: she had full cheeks in her 20s then by her mid-30s after a child she is now having buccal hollowness. that is why i do not do it because only someone in their 20s would need it in most cases and if you wait a decade most people then have a need for more fat there.
3. no, i do not think your mother and grandmother will directly influence your aging. although genes are very important, environment like sun, diet, etc. are also important. finally, loss of tissue, i.e., hollowing, does not mean you will "sag more". sagging in the jawline is just a gravitational issue that has little bearing on how plump you are.
best,
sml

Ok

In your experience, has anyone with the issue I'm describing come in to your office and how did you treat it? My issue is my cheeks. I have nasolabial folds and I hate them. As a child I had huge cheeks and in high school even though I'm thin. Now my face looks thinner but the midface is still in excess and larger than the upper cheeks, which have sunken slightly, but because of my buccal fat, they look like they've sunken further than actuality. My cheeks are small and my chin is recessed a bit. What in your opinion is the best approach to fixing this problem?

If I pull my skin back, by my ears, I like how I look but I'm 27 and a mid face lift is just too early? How else do I achieve this look?

i would have to see you but in general at 20 something your face is in flux. i would use temporary lost lasting fillers to sculpt your face like restylane. the concept of balance is that if one area is hollower then i can add to that area to make the other area appear relatively smaller. for example, if your buccal area is full, then filling the chin and upper cheek can make the buccal area appear smaller. sometimes safety trumps fancy big surgery. mid face lifts are useless and horrible. i haven't done them in years now. the mid face does not fall based on long-term 40 year photographic evaluation of individuals.
best,
sml

Thank you for the thoughtful answer doctor Lam. I guess I'm just scared that my face will turn into the chipmunk cheeks I used to have. I really don't want to look big all over. I like how my face is now, just wish I could make it mire sculpted n get rid of nasolabial folds.

no worries. i do not make those pillow faces that hollywood loves so much. i am much more restrained with good taste.