Dr. Sam Lam Plastic Surgery Forum

all great questions. as you know, i tend to be more conservative than my colleagues who are more prone to fat graft anyone at any age with any amount of fat. but i truly think about long-term aspects of fat grafting for my patients because it is a permanent graft. like anything in life there are blacks, whites, and grays. you are in the gray zone. someone 22 years old without kids yet would be a black/white no. someone 45 years old after kids would be a black/white yes. here are the pros/cons you must weigh:
1. if you are planning to have more kids the risks that you would incur are threefold: a) weight gain during pregnancy that may look distorted if it is significant, b) you can actually lose more volume in the face after having more kids (don't know if you saw that with your first one). for some reasons kids age you and i am not just talking about wearing you out. interestingly, to me this is a pro and a con: you have some safety because you lose some more fat but you have some lack thereof because you may "lose" some of what you have paid for. c) your metabolism may change and become slower, see point 2. now.
2. the real key with fat grafting is that you do not gain excessive weight afterward. because you are young the one concern i have is that when you hit 40 and get lazier with your diet you gain weight. with fat grafting you cannot afford to do that because the fat will show up in your face if you gain 20 to 30 pounds. now if your entire family is thin and you have not fluctuated much in your weight over your adult life then i feel more comfortable. if your mother ballooned up in her 40s and you have fluctuated in your weight a lot that would be two strikes against you and make you less of a candidate.
3. now even though fat is pemanent you are very young meaning you will age further and at such a young age you might need another fat graft in 10 years with further aging. i tend not to need that in someone who is 40 plus years of age as often as someone very young when the volume is more conservative.
4. fillers may not be as expensive as you think given your age but still there is a maintenance but then again fat transfer has a "maintenance" either with fillers or with fat grafting since you will continue to age.

i hope those thoughts are clear to you, as safety always comes first. there is not a simple answer to this question. i have to take it on a case by case basis, but i hope that helps a bit. let me know your thoughts.
best,
sml

hi,
1. glad you understand what i am saying.
2. i do not think based on the photo that your buccal area would need very much. although i am a big buccal fan for filling i go by a total aesthetic benefit and i do not think you need much or anything there but i am basing it on a single photo rather than seeing you in person. that being said, i think volume done right for you would make you look significantly better. i think the flatness of your central and upper face (brow, lower eyelid, anterior cheek) are principally where i see the aging and yes fat would look very good for you with the aforementioned considerations.
3. will you lose more fat after a second child? probably the same as the first one. hard for me to know but that unfortunately is very common situation.
4. thanks for the compliments regarding my work. i take a lot of pride in creating a very balanced result. even though you would look better with a fat transfer than a filler i would suggest for you one of two options:
a. wait until you have had another child before considering fat grafting and maybe when you are closer to 35 ish.
b. or do fillers for the meantime to get you to that point. in general i do not like to do fillers before fat transfer but given the recommended delay in time to do fat grafting i don't think it would "mess things up" so to speak. i truly believe that i would do a much better (and painless) work for your fillers than most docs out there because what i do with fillers is simulate a fat transfer (like a mini-fat graft). if it is at all possible for you to come in for me to help you you can fly back out the same day. my guess is that it would cost you probably 1000 to 2000 depending on your budget and it should last most of it for a year with good benefit for a couple years to 3 years after that in my experience. i personally think it would be worth it.
best,
sml

no too sure what you are talking about here.

i would use restylane. i don't use sculptra. there is a ton of reasons why not. do a search in this forum for why. i am going to write a blog on it soon so i don't have to keep answering the same question. i think you should find the answer somewhere in one of these forum threads.

best,
sml

i have developed techniques with microcannulas now that actually simulate my fat graft very well. i think you will be tremendously pleased.