Dr. Sam Lam Plastic Surgery Forum

Hello Dr. Lam, I have heard many great things about you! I have a question concerning my fairly new cheek implants. When I was 18, I had some put in. At age 42 (now) I finally had them removed because they were much too prominent in my thin face. I wasn't thrilled with the look of my flat cheeks (despite having a cheeklift) so I had a small set put in a few months ago.

I like the look of them, but I'm worried about this "clicking" in my right cheek. When I scrunch my right eye up or push the implant up from below, it seems to shift slightly and make a "click". Could this be an indication that the pocket is too big, thus causing the implant to shift? Is there a possibility that, in time, this will correct itself? My doctor said they are the same on both sides and that he used a stitch to help anchor them in place. However, if the pocket is too big, that will still cause shifting, is that corrrect? It's been a few months, so I am afraid that I may need another operation to correct the pocket

Also, months ago, I had some swelling beneath my right cheekbone (after my implants were removed the first time). The doc gave me two rounds of kenalog and I was left with a fairly large "ditch". I had reservations about kenalog to begin with but the doc said not to worry. I am now being treated monthly with silikon 1000 to restore the lost volume. My question is, what if my atrophy corrects itself in a year and I have this silikon in place as well? Will I then have TOO much volume? I just couldn't wait that long with a ditch in my face, which is why I'm having the silikon. Thanks for your insight, Dr. Lam!

Dr. Lam, I forgot to mention that I am not a candidate for fat transfer, unfortunately (I'm too thin). I have been thinking about having silikon injected in my lower cheeks, just a little. I was very anti-permanent fillers not long ago, but I like how it's looking below my cheek implant (plus I have a little in my lips). What are your thoughts on permanent fillers in the face (for volume)? I know that some docs don't think it's a good idea because as the face ages and tissues shift, the filler will stay where it is placed and look strange.

By the way, what do you think of Madonna's new look? She suddenly has huge cheeks!

hi,
1. as far as the clicking noise, i would like to assist you in that and really feel uncomfortable dictating or advising your after care. it is inappropriate for me to comment on another surgeon's work.
2. as far as the dermal atrophy is concerned, this is why i almost never inject steroids because of this risk. i have seen it reverse over a year so personally if i encounter this situation i prefer restylane so that it is temporary and can be dissolved if it corrects itself. after a year, i use silikon. i truly think the silikon is so soft that you probably won't have a problem either way but i am very conservative.
3. i don't believe in placing silicone over a wide area of the face for volume. it is probably okay. i just make it a point to use silicone only for very small areas like acne scars, lips, lines, etc. that is only my opinion. of course, microdroplet technique and small amounts are critical. if not, you will have terrible problems down the road like migration especially with big volume fills.
4. i think permanent fillers are okay if you understand 3 things: conservatism, proper technique, and possible need for slight touchups with changes in facial shape.
5. i have not seen madonna recently. if they are just big cheeks then i am not a fan. i like areas to be blended in. see my blog on heather locklear.
6. as far as fat transfer, i would have to see your donor areas. i have done fat transfer on the bone thinnest of people. then i use your cheek implant to my advantage because i can cover it with fat and blend around it properly in most cases, especially if they are small. i would have to see you to make that decision. i would resolve the clicking issue first. btw, i am about to do a fat transfer on a VERY thin lady in about 30 minutes.
best,
sml
6.

Thank you, Dr. Lam! I suspect that my implant is shifting slightly...hopefully the scar tissue will form around it to anchor it in place. I wish I lived in Texas so you could do some fat grafting on my face! Hopefully, in the future, I will make a special trip there. I never really believed it when several doctors I talked to told me that I didn't have enough fat to harvest. I mean, come on, there has to be SOMETHING! I'm not quite a cadaver, lol.

no problem QueenBee. when the time is right for you, i'm ready. on certain weeks, 80% of my surgical patients are fly in. i will be posting an incredible hospitality section in a month or so that will greatly facilitate your visit.
best,
sml