Dr. Sam Lam Plastic Surgery Forum

Hi Dr. Lam,

A plastic surgeon with a similiar Q and A forum on the Internet has consistently renounced fat grafting/injections on his website. I asked him the following question:

Hi Dr this site appears to be full of horror stories around fat injections to the lower eyelids. Do they really have such a high failure rate or do we only hear about the poor outcomes on this site? Are there ever any successes with the procedure?

his answer is as follows:

Answer: I think the results are, at best, short lived and I feel that the probelms that can arise compared to the success stories make it not a viable option, certainly when off the shelf fillers are easier and have less risk and last about as long.


Can you explain why you (im assuming) disagree with him, and what reasons could put plastic surgeons off, that do not seem to deter you

thank you!

Great questions.
Yes, fat grafting in inexperienced hands can have devastating consequences to say the least. Fortunately, with hundreds of patients, I can honestly say I have NEVER had a lump under the eye that I needed to remove. In inexperienced hands, fat also will not last. My fat not only lasts but gets better over time. Fillers do not provide anything like what I can do with fat grafting and fillers do not last. I love fillers to bridge someone over to fat grafting.

Now, why would this PS respond as he did? One of two reasons:
1. He has tried fat grafting and could not get it to work based on bad technique. Either he had some disasters or he could not get it to stick. One of the big problems that I see is the PS putting fat into lips and lines. That is the MOST common area to fill and it simply does not work there. For those two areas, fillers are MUCH better. Even though I put some fat in the smile lines, I expect not much of a difference. The lips are an area that I categorically do not put fat in for two reasons. Too much swelling and very little longevity.
2. The other reason that the PS may be opposed to fat is that he has never done it and has seen real problems come through his door. That is unfortunately the situation in many doctors' hands. That is why a lot of PS make the judgment a priori not to do fat at all because they see too many dissatisfied patients and problems.

If you want to know why my fat lasts, please read another entry in which I wrote a 20 paragraph response. There is a difference between my fat grafting and someone else's. Why else would I do my own mother 6 months ago who looks better today than 3 months ago if I thought the fat would not last and that she would have a lump under her eyes? The answer is that I wouldn't but fat is very safe and effective IN MY HANDS.
best,
sml