Dr. Sam Lam Plastic Surgery Forum

Hello, Dr. Lam,
I had 3 sessions of Pulsed Dye Laser Treatment for my Rosacea on my cheeks and some broken capillaries around my nose. The last session was 2 months ago. After that I had severe swelling for a week, and when the swelling started to subside I started noticing changes in the way my face and skin looked: I developed two skin depressions under both my eyes, my cheeks "deflated", it seems like all of the fat is gone from that area, my skin is hanging like a rag on my face now, and I look at least 10 years older than I did before the procedure. All that change happened in a matter of a couple of months. I am convinced that PDL accelerated the aging process in my skin (due to the laser induced oxidative stress, maybe?)... I am 30.
My question is: Is there a treatment that can restore the damaged subcutanious tissue, something like Stem Cell Therapy? I understand that when you transplant the fat into the cheeks some of the stem cells are present in that fat. Is there a treatment that uses the same technique but using the stem cells only; and would it have the same effect with time, since the stem cells can become any tissue in the body? And do you perform this kind of procedure?

Thank you.

First, I am very sorry to hear of what you have gone through. That is terrible. I don't honestly know enough about stem cells to say that they work effectively or do anything. I really don't have confidence in it but i don't know enough to state with certainty. A fat transfer could help you but there are a very caveats:
1. if you are only a few months out i would probably wait at least a year to see how things progress.
2. fat transfer is great but it is a weight dependent treatment in other words if your weight swings or will swing when you get older or with kids, we may want to wait on it. although i have done fat transfers on twentysomethings, i generally prefer to wait until at least mid-30s to consider it. i would have to see your situation to help decide on a safe and effective method.
i don't have strong recommendations but you might want to wait to see how things progress. hopefully things recover for you without intervention. i know there are internet support groups for this and maybe there is help out there that i am unaware of. i have successfully fat transferred into areas of fat loss where laser was performed and have had long term hold of the fat. however, given the above limitations, let's take this slowly. in the meantime, don't panic. if you have time, read my blogs on spirituality, peace, and a positive outlook on life. maybe that will help in the meantime:
http://lfp-blog.com/
best wishes,
dr. sam lam

Thank you for your reply, Dr. Lam,
I agree with you that it's probably best to wait before making any further steps. I am not sure though if the things are going to get better from now on or there is going to be more damage showing- that's the scariest part. Supposedly, the full cycle of collagen synthesis takes about three to four months. If that's true I've got two more months to wait and see how it turnes out. I really want to be hopeful, but the reality in the mirror just doesn't give me any chance. I would like to send you my before and after pics, once I get them from my doc. Based on your experience, is there a difference in the appearance of the face with a fat loss and a face with collagen loss? And would you be able to tell the difference by looking at the pictures? I am still hoping that the fat is still there, and the collagen taking a long time to form. There is an opinion that the reason why fat dies is because all the blood vessels are removed from the treated areas, but isn't our body constantly branching off the new blood vessels?

Thank you.

hi,
i do lasers as well but have not seen this issue with my lasers. therefore, i do not know the exact course of how things proceed. i wish i could give you appropriate reassurance but i cannot legitimately say how things will proceed. however, i can say that our mind does play a major role of how things can occur in our body. i am reading michael samuel m.d.'s book, healing with the mind's eye (great book) with visualization exercises. i would highly recommend it. i think you will be fine if you believe it. watch these videos as a start:
http://lamfacialplastics.com/gallery2/v ... tion-Yoga/
and also read my blog every day:
http://lfp-blog.com/
best,
dr. samuel lam

Thank you for your recommendations, Dr. Lam. I hope with all my heart that I recover without any interventions.
I ordered the book you recommended and received it right on my birthday, it's amazing.
Thanks again.

all the best from my heart to yours.

Hi Dr. Lam- I was looking at your answers to another person that had fat loss from pulsed dye laser. I had one done around my cheek and chin area and right away I had an indention on the chin area and fat loss on sides of chin near the area were you would have marionette lines.. It has been 9 months. People around me say they dont see a problem but I do see it and it looks like the shape of my chin is different also. I am thin, small framed about 108 pds and 5 5. I have always been naturally thin so my weigh does not change. My question is you said to her to wait to see if it will go away on its own so I wanted to know can it get better and does fat come back to an area that has been "melted" for a lack of a better word? If it can get better on its own then I would wait or will it just get worse with time. Also would gaining a few pounds help(though that is hard to do for me) or is it like an area that is liposuctioned were it does not usually come back to that area. please let me know on this I have not seen this answered on any of your blogs . thanks for your time

i honestly cannot give you a perfect answer but i can give you an answer that is as good as i can:
1. generally if fat is lost, then it is lost. collagen may come back and repair the area but it may not 100%
2. gaining weight will not help. your analogy of a liposuctioned area is very appropriate in many ways.
3. fat transfer to the area may not be a good idea if it is in an isolated area. the fat transferred from the belly or thighs acts differently.
4. i would use restylane or something as a first line and maybe in a static area like the chin it might hold for a long time. you could also do micro silicone treatments if it is minor. i only use silicone to fix minor dents.
hope that helps.
best,
sml

Hi Dr. Lam- thanks for answering me back. I was just noticing that you wrote to the other person that hopefully things will recover without intervention. Can things recover without intervention in these situations? And also I am sure that even though there looks like less fat in my chin area laser should not remove all the fat there right? There should be some left and can the fat left there get bigger with some weight gain or any other way besides fillers ? I know you said it cant because of the reference to liposuction but if there is some fat cells left cant they grow? I know when I would lose a few pounds I would see a difference in pictures in that area even before this happened. Also the texture of my skin in that area is different. I got more pigmentation and it does not seem smooth maybe I would say lightly orange peel type though I dont have that anywhere else and there are some small scars in the area from it. Is there anything you do to help the texture or is that how it will be from now on. Can facial peels , microdermabrasion or things like that help skin that was damaged or do you recommend doing nothing. Have you done any procedures to help this? Sorry to bother you but I feel you seem to be the expert on facial damage from laser.thanks for your time.

hi,
my answers are below in all caps:
Hi Dr. Lam- thanks for answering me back. I was just noticing that you wrote to the other person that hopefully things will recover without intervention. Can things recover without intervention in these situations? UNFORTUNATELY, I DON'T KNOW WELL ENOUGH TO SAY EITHER WAY. IF THERE IS SOME COLLAGEN DAMAGE, THAT HOPEFULLY WOULD REPAIR. IF FAT IS ACTUALLY GONE, THAT IS HARD FOR IT TO COME BACK. I THINK IT DEPENDS ON THE SEVERITY OF THE DAMAGE. THE PROBLEM IS THAT WE DON'T REALLY UNDERSTAND WHAT IS GOING ON WELL ENOUGH TO COMMENT. And also I am sure that even though there looks like less fat in my chin area laser should not remove all the fat there right? NO, YOU STILL SHOULD HAVE FAT THERE. There should be some left and can the fat left there get bigger with some weight gain or any other way besides fillers ? WEIGHT GAIN IS GOING TO BE HARD BECAUSE WHEN PEOPLE GET HEAVIER THE FRONT CHIN TENDS NOT TO GET THAT MUCH BIGGER. AREAS LIKE THE HIPS AND BELLY DO AND THE LOWER OUTER FACE. THAT IS WHY IF I TRANSPLANT FAT FROM THE BELLY TO THE FACE, IT HOLDS QUITE WELL BUT CAN ALSO FLUCTUATE WITH EXTREMES OF WEIGHT. I know you said it cant because of the reference to liposuction but if there is some fat cells left cant they grow? YES, IF THERE IS FAT THERE IT CAN GROW WITH WEIGHT BUT SEE THE RESPONSE JUST ABOVE. I know when I would lose a few pounds I would see a difference in pictures in that area even before this happened. Also the texture of my skin in that area is different. I got more pigmentation and it does not seem smooth maybe I would say lightly orange peel type though I dont have that anywhere else and there are some small scars in the area from it. Is there anything you do to help the texture or is that how it will be from now on. OBVIOUSLY, LASERS, ETC. CAN HELP BUT I WOULD HAVE TO SEE YOU. PERHAPS SPEAK WITH A DERAMTOLOGIST OR TRY GOOD SKIN CARE PRODUCTS AS A START. DON'T KNOW A PERFECT ANSWER HERE. Can facial peels , microdermabrasion or things like that help skin that was damaged or do you recommend doing nothing. Have you done any procedures to help this? I DON'T KNOW WHAT YOU ARE TALKING ABOUT EXACTLY SO I HAVE NOT TREATED THE EXACT CONDITION YOU ARE TALKING ABOUT. Sorry to bother you but I feel you seem to be the expert on facial damage from laser.thanks for your time. MY PLEASURE. HOPE MY LIMITED ANSWERS HELP SOMEWHAT.
best,
sml

Hi Dr. Lam- Thank you so much for writing me back. You are a wonderful doctor to spend your off time writing people back with all these questions. I understand it is very hard to write much without seeing me maybe I could send a picture though I know pictures don't really show things very well. Would you advise anything that would help collagen repair and can it take a long time for it to repair. I have used differin for years but when I put on the chin/marionette line area now it seems to give me a weird pulling sensation I think because of the skin being damaged. I went to a facialist with a great reputation and she wanted to do some peels and maybe something called a silkpeel which is like microdermabrasion but not as irritating and invasive. I use good skin care products and saw a dermatologist who wanted me to use obagi for pigment which ended up irritating my skin and caused breakouts and redness(i think an allergy to hydroquinone). She said then to just leave everything alone . So really my question is what is the best help for collagen regeneration without the use of lasers which I would never want to use again and maybe to help texture changes like light scarring and irritation. I think a lot of people on this forum seem to want to know how to help that. Thanks again and if its ok I would like to send private picture. thanks again.

hi,
i don't think photos really would help me decide what you are discussing. to be honest, you have reached a limit of my knowledge. i know there are forums out there dedicated to this problem. maybe someone with more knowledge could help you. btw, i am always honored to answer questions. i don't always have the answers, but i will tell you that upfront. best wishes on finding the solution for your situation. sorry that you are going through so much.
best,
sml

Dr.Lam,
I understand that success of a fat grafting procedure depends much on the size of the fat droplets that are grafted and the location where they are grafted. I have watched some of your videos about your fat transfer technique. You mentioned that your grafted fat droplets are a size of 1/5 of a rice grain; but where exactly are they placed: under the muscle, in the muscle or just above it?
I hear a lot of people complain about “bumps and lumps” under the skin, especially in the under eye area, after the FG. Does that mean that their fat was placed too superficially; or it can happen, regardless of the location of the grafted fat?
Thank you.

bumps and lumps are due to placing fat too close to the skin "above the muscle", too large a droplet and not in the right area. that really only applies below the eyelid. the other areas of the face do not matter as much in terms of depth. i get very safe results because i stay below the muscle around the eyes entirely and place small drops everywhere.
best,
sml