Dr. Sam Lam Plastic Surgery Forum

Dr. Lam,

you said you sculpt men's faces differently from women's. What is the difference?

I had a half syringe of Radiesse per cheek downwards from the mallar septum line. I wanted it more around the line to smooth it out and on the cheek bone to create more angularity and perhaps if there was something left, in the lower/buccal cheeks to fill in hollows.

The way it is injected now it doesn't erase the mallar septum line (diagonally on cheek from eye corner) but flattens my face.

Also, could you recommend a book on male face proportions that will help me clarify exactly what look I want and can be achieved in my case with fillers before I go for permanent filler options.

Hi summertan,
1. Once Radiesse is injected, it makes it difficult for me to do fat for another 8 months to a year from the time of injection. I like to have most of the material gone before I like to inject fat for two reasons. I think a bulk of the material present can interfere with smooth fat injection. Second, I want the temporary product to be more or less gone before I put something permanent in there.
2. As far as attacking the malar septum, I now approach the malar septum with Radiesse/Restylane, etc. the same way that I do fat grafting, i.e., from a perpendicular orientation using a cannula so that I can better break up the fibers and make sure that I deposit the material through it and on either side of it so that I can get a better fill. If you inject it with a needle or go parallel to it, you can deposit the material more easily only on one side of the septum making it actually deeper rather than less deep. That at least is my philosophy and approach. I don't think that happened for you. Most likely you just didn't have enough product placed or it was placed all over the anterior cheek rather than focused on the septum. When I target the anterior cheek, I target the malar septum both for fat grafting and for injected fillers. Surprisingly, a targeted linear fill creates a better volume fill in my opinion. Boy, this is one of the most technical discussions I have had with a layperson. This is what I usually teach when I teach fat grafting and injectables. I have never had anyone ask me about the malar septum. Even my colleagues don't know what that structure is. Bravo!
3. There are really no good books out there for male facial sculpting, as a lot of the ideas that I am presenting are original. I think if you came to my office and were looking a bit gaunt and tired, I would still hit the malar septum because it is the most important area to make someone look less tired. With a single cc of Radiesse, I don't think it will feminize the face but I think it will have a good impact (if done well) on making your face look more rested. However, with fat grafting, I have more flexibility and creativity since my "paint" to paint your canvas is free. In that case, depending on what we discuss with your old photographs present, i.e., how young you want to look, we can talk about what you want done. Some men like to look a little more mature because they think they look more masculine. Some men like to look more youthful and I mean like in their 20s. That really depends on what your objective is. I would say the majority of men coming to me bring in photos when they were in their 30s but obviously if you are already young and having some facial fat loss, you may bring a photo of yourself in your 20s. As far as designing a male face, my aesthetic is to keep the anterior cheek relatively flat and to push the outer cheek bone (over the zygomatic arch, since we are being technical here) to create a stronger outer cheek bone. I think that is a feature that is present in many male models. The buccal transition can be filled depending on what you are looking for and what I think would look good for you. The anterior chin can be strengthened with fat but I am always careful as too much fat can actually also feminize the face. In general, the amount of fat that I put in for a guy is less than a female. How much less? Hard to say, that is where the aesthetic part comes in given age of the patient, size of the face, facial shape, what the patient desires, etc.
Hope that helps,
SML

Thanks for the reply Dr. Lam.

I am a PhD student in physics and I strive to understand every process because once you understand something, you have the power to apply it properly and even modify it if necessary. Unfortunately, I realized that here in Chicago, the injectors have no artistic view at all, they just inject exactly like the advertisement brochure tells them disregarding the specific facial topology and desires of the patient. It's my burden to construct the image I want to achieve simply because I don't trust them.

You are confirming my thoughts. I wanted the malar septum line smoothed out cause I totally agree with your ideology that non-smooth transitions/separations between facial zones contribute to the aged look. Now I come to think also that my chin must be made look more 'rectangular' and the buccal hollow filled in. Then probably the zigomatic arch augmented a little cause otherwise the face will be too flat and not interesting. It is really nice that you do plan the topology of the outcome with your patients, too bad I can't find someone like you in Chicago.

I appreciate your kind remarks. 10 to 20% of my patients come from out of town. I do at least one patient from out of town every week. Fat grafting in particular is very easy since you can fly back out the next day without any aftercare. When your Radiesse fades, let me know.
best,
sml

I had one consult with dermatologist that does fat grafting. He said I didn't have enough fat for full face fat grafting - he prefers to use the abdomen as donor site. I do a lot of exercises at the gym to keep my body slim cause otherwise the fat makes it kind of saggy. Of course I can always eat ice cream to put on some pounds but after the procedure I will start hitting the gym again cause I don't like myself even slightly saggy and all the extra fat will melt, doesn't matter it was transfered to the face.

That's why, unfortunately I have to do fillers, unless there is another donor site on my body that could be used. Currently I am 6'2 158.

For really lean men, I can use the lower back but that is if you have any there. If you are that gaunt, then fat is probably not an option for you. In that case, Radiesse is my favorite filler if you are not burning through it owing to your metabolism.

You said you augment the 'zigomatic arch' in males because many models have that. Isn't the zigomatic arch too far to the sides almost in front of ear, did you mean the zigomatic bone?

Yes, technically more lateral zygoma than arch. Thanks for the clarification. You are correct.
SML