Dr. Sam Lam Plastic Surgery Forum

Hi Dr. Lam,

I have hollows under my eyes but the rest of my face is plump. what i have noticed is when i am in "good" light that hits the skin on my hollows directly and brightly, the skin there looks really good, but when there is no direct light there the skin looks craggy and all the blemishes show. Now conversely the skin on the rest of my face that is plumped up always looks consistent. Do you think its possible that this inconsitency in my hollows is due to a lack of light illuminating the area? And does this mean that fat grafting can help not only to improve shape but also the apparent appeareance of skin texture by exposing it to better light?

I hope i expressed that properly? Does that make sense and what are your thoughts
Thanks Dr. Lam

wow, wow, wow. simply brilliant. you stole my next video. i have been thinking of shooting this video for 3 to 4 days but simply did not have the time. your insight is profound. let me explain:

we live in a world with overhead lighting, almost always, whether we are indoors or outdoors. Therefore, the overhead light causes a shadow on the skin making it look bad. Also, the overhead light which is oblique to the face causes the transition zones of the face to be accentuated, namely between the brow and upper eyelid, temple to forehead, lower eyelid to cheek, cheek to upper lip, outer jawline to chin, outer cheek bone to anterior cheek depression, outer cheek to buccal, anterior cheek to buccal, etc. My goal when doing fat transfer is to reunite these elements that are shadowed and separate. This truly separates my fat transfer results from a "partial fat transfer" that just hits a little under the eyes or cheeks. We need to judge the entire face when we judge the face, not a microsection of it.

I can typically notice that someone's skin looks better at 20 feet away because there is this beaming light that bounces off the face, a radiance that is amazing when I am at the back of my office looking at one of my patients walk through the outer door of my office. If I have a few minutes this week, I will try to do a 9 or 10 minute video on this topic because it deserves it. Well beyond any "stem cell" changes to the actual skin, which I notice frequently after a year or so, the light that glows off a face following fat transfer is simply delectable. sorry for my psychotic enthusiasm. i am just so pleased that a non-physician gets this and perhaps gets it a lot better than my colleagues do. bravo or should i say brava! bravissimo/a! i am quite enthused at your insight.
best,
sml

This is a great point, and I hope you do make a video on this topic Dr. Lam. I don't think people realize how they are really seen. I mean, I even catch myself looking in my make-up mirror (not magnified btw) with this beautiful glowing light shining on my face and think, "you're crazy...there are no hollows or lines or anything." But then I turn the light on the mirror off and magically there they are...the hollows, lines, broken caps, etc...and I know I'm not crazy. One thing that does drive me crazy though are how retailers are capitalizing on this idea. Have you noticed lately that certain retail stores have changed their dressing room lighting from overhead (heaven forbid fluorescent) to wall mounted muted lighting adjacent to the mirror. It makes you look fabulous!!! Of course, you look better...the clothes look better. Cha-ching! Until, that is, you get home, try those clothes on and think to yourself what the *@!! was I thinking. Brilliant retailers!!! Anyhow, my point is...lighting is everything. I appreciate you using overhead lighting when evaluating your patients Dr. Lam and staying consistent with the lighting on your before and after pictures. It's critical. Good luck with your new video. I am in the process of saving up all of my pennies so you can make me glow again...in any lighting.

thank you. i am so touched by the warmth that people express in their comments and questions. i truly am, and i thank my patients and prospective patients for being so kind in this forum. i really love what i do, and your appreciative words spur me on to educate more and to think and refine my thinking. i have 2 great videos in my head that i have to find time to shoot this next week or so. don't know when. won't let you down!
best,
sml

Thanks for your enthusiastic response Dr. Lam! i'm glad that I "get it" and that i generated discussion from other readers. I just have one more question of understanding that I hope you can clarify:) I saw one of your earlier videos about fat grafting and the analogy of a balloon being blown up. I would like to know if this has any effect on the skin. I'm assuming fat grafting couldnt remove major wrinkles (or maybe i'm wrong?) but just like how a balloon is sort of shrivelled and a little crepey when its empty and then goes smooth and plump when its blown up, does fat grafting have a similiar sort of effect? For example again with my eyes, it looks to me like the lack of fat means there is no support base to uplift the skin, and it looks like if fat was placed below it would sort of provide a foundation or structure so that it didnt look so lax. Is there any merit in what i've just explained, or am i off the mark?

Thanks Dr. Lam, as always

you are on the mark. however, i always undersell the ability for a fat graft to balloon a skin to satisfaction of the skin. if anywhere it can work well in terms of an analogy that would be the upper eyelid. however, i do see some small degree of variable resorption of fat in that area. therefore, i usually recommend a very tiny upper eyelid procedure when the skin sits at the eyelid margin (at the eyelashes that is). if the eyelid skin is crepey at the edge (usually most women overemphasize what they think is crepey so i need to make that decision), then i also remove a tiny bit of skin. however, in most cases (8 or 10) just the fat will suffice.
best,
sml

Hi Dr. Lam

great vlog on this topic! it was fantastic to see you follow up so quickly on your mention of doing the video! I have one follow up question regarding hollowing and lighting. In addition to my skin looking better in good lighting, my hollows look far more pronounced in bad lighting and so conversely in good bright, warm, direct lighting the hollows look much softer and almost filled in. Does that sound logical? And so does that mean that if fat grafting is performed, the hollows would look filled in in bad lighting and over-filled in good lighting?

Thanks for your time as always Dr. Lam

no. think of it this way. did you have that problem at 28 years old? does a 28 year old individual have that problem? no. i don't put that much fat in. but the areas that have some convexity now have more so there is even more light on those areas so you look even brighter and softer. your face should literally glow. i see that with all my patients walking through the door 20 or 30 feet away. hope that makes sense.
best,
sml