Dr. Sam Lam Plastic Surgery Forum

Dear Dr. Lam,

I was just wondering about something. You often state that a majority of wrinkles are produced by the deflation effect; i.e. the grape to a rason. My question is that after fat grafting is perfored on somone who has been using botox mainly as a premptive tool against aging and is relativly young (late thirties) is there a good chance that because there face has been "reflated" that botox would no longer be needed around the eyes and cheek, at least until another "reflation" is needed in four to five years due to the continued effects of aging. Thanks for your time.

Good question: you really misunderstand my analogy of the grape, raisin, and the pea. Fat grafting does little to nothing for wrinkles. Yes, some stem cell effects can cause skin rejuvenation but don't count on it. That is what Botox, plasma, etc. are there for. Fat transfer simply won't do the trick reliably. Plus, there are areas that fat transfer are unsafe like the forehead or in the outer crow's feet so 1/3 of the face is not touched with fat transfer. Essentially, that is exactly where Botox works to finish the job. The raisinated deflation that we are talking about does not refer to skin wrinkles but the deflation of a balloon. You can also have a balloon analogy if that is easier to digest than a raisin since a raisin does have wrinkles and we are not looking at them with fat transfer.

In an ideal world for wrinkles and moreover skin texture/tone, I hit them with what I like to call my belt and suspenders move, i.e., 2 technologies for the skin problem. In the upper 1/3 of the face that would be Botox and plasma. For the lower 2/3 of the face that would be plasma and fat (yes, fat does not do that much for skin but it does provide a better contour of the face that makes the skin look better by creating more light to hit it through added convexity plus it does create better skin texture and tone over time in most cases). I hope that makes sense.
best,
sml