Dr. Sam Lam Plastic Surgery Forum

Dr. Lam,

I had liposuction only to the cheeks a year ago and the results turned out horribly because the cheekbones are protruding out and the cheek itself looks like its collapsed. I thought that by having liposuction, it would smooth out the cheeks (mine used to have a "pouchy look" with most of the volume hanging at the bottom close to the nasolabial fold) because I've recently went through a 40lb weight loss, but I guess what I had was loose skin not fat. Liposuctioning the area didn't smooth out the cheeks at at!! I've read your information and saw your videos on YouTube am very much interested in having this done with you.

I was wondering if I can just find out the following information:

1) whats the typical fee for fat grafting to cheeks? (I understand this will vary , but a rough estimate, or even a baseline would help)

2) lately, whats the typical waitlist usually like after the first consultation? If I were to do a telephone consult now (I live quite a bit of distance away), would it be possible to have the surgery in Feb or March?

Thank You and all the Best!

Hi Cat2007,
I'm so sorry to hear of your previous experience. In a way, your testimony is helping me convince others why I don't perform full-blown facial liposuction. I recently saw a nice lady who had a deformity by going to another PS in Dallas who performed facial liposuction that I now have to correct. I also have to correct her neck liposuction.

In answer to your question, honestly I rarely perform just cheek lipografting for many reasons. For rejuvenation, it is a poor substitute for a balanced an uniform rejuvenation. Filling fat into the cheeks alone can worsen the hollow above and below the area. What you are paying me for is my technical skills, judgment, and artistry. In summary, unless this procedure is simply performed to correct a deformity, I only perform full facial fat transfer which costs $8800, including all related fees (except maybe 30 to 50 dollars for some medications and of course travel and accommodations). In other words, that fee would include the procedure, anesthesia, and facility.

I don't know my schedule but I should be able to fit you into February or March so long as I get a consultation done as soon as possible with you. Although I discourage phone consultations compared with an in-person meeting, I understand your situation, as 20 to 30% of my patients fly in for my services. You can call my office 888-866-3388 Monday to Friday 9-5 CDT to schedule a consult and/or procedure.

Look forward to take care of you,
SML

Hi Dr. Lam,

Thank you for the response and the PM. If you think you can do something for me after the virtual consultation, I would love to have this done with you.

Finding a plastic surgeon is an arduous task because it is remarkable how many different responses I heard from different surgeons. There were all sorts of variations in regards to how many ccs they would add and how what % of that fat graft would stay. Theres also the SpaceLift technique thats received a lot of coverage here in California which involves administration directly into the muscle as opposed to placing the fat subcutaneously, but touch-ups are needed. I used to think that as long as you were board certified in the US, your approach/strategy were standardized along with other surgeons but after talking to several I learned this was FAR from the truth. One surgeon has a survival of 50% whereas another one has 20%. Even injection sites, cc's added all varied. I guess the only way to tell if someone is good is based on their results and yours are just absolutely outstanding. I've seen that photo you've referred me to along with others and its remarkable that even though they may be twice my age, they still have more beautiful cheeks than I do because of the liposuction.

A full, fat face has negative connotations because you see images of slim, slender models with chiseled features everywhere. However, there is still a huge difference between looking chiseled versus haggard because of the volume and how the fat is distributed. I have no anterior cheeks, but I can attest I don't look any slimmer than when I was at this exact same weight pre-op. Hah! I learned this the hard way.

Thanks again doctor!

Hi Cat,
Thank you for the compliment. I think beyond board certification and excellent credentials, there are 5 things that make a good plastic surgeon: technical skill (precise and gentle technique), artistry (this is a big dividing point, having an eye for beauty. that is something that i think i cannot overstate), empathy (understanding what a patient is feeling or going through and how to help that individual to be happy with a result), integrity (doing only what the surgeon believes is right and standing behind his results), and creativity/education (I lump this together in meaning that the surgeon is constantly striving to improve his results and to offer the latest and best techniques that are proven. that is why i go to 14 meetings a year, most of which i lecture at).

That being said, I remember your age is in the 20s. There are two things from a preoperative informed consent that I need to discuss with you:
1. MOST women do not like their face in their early to mid 20s because they think it is too round. Listen to my lectures on the subject: Watch the St. Louis or Hong Kong lecture under my Video Lectures under the Dr. Lam tab. Most women start to like their face in their early 30s when they start to be more chiseled but not hollow yet. In Asian faces, we can look rounder even for many more years (see my face!!!).
2. Understand that fat grafting is permanent and is a live graft. If you gain a lot of weight, you can see the face may look too big and even distorted. Also, you probably have not had children yet, meaning that your face could get bigger during pregnancy. I cannot say with certainty whether that will happen but it could.

I am not trying to frighten you but just to be honest with you. If you do not come in person to meet me for consultation (I assume you are out of town?), photographs can be distorting because you do not use a standardized lens. However, I can still make the read in most cases. You can call my office to schedule a consultation 888-866-3388.

Okay, as far as the "spacelift", I HATE marketing terms because they are essentially meaningless. Fortunately, you told me what they are doing which is muscle injections. The proper term for this is FAMI (Fat Autologous Muscle Injection). However, we had the guy who invented it perform the procedure live and watched the results and his technique did not take as well as mine. This was performed in my co-author's clinic. Obviously, many techniques work and many techniques do not. Before and after results and testimonials are critical to help making your decision on a surgeon. In short, however, I do not believe that the FAMI approach offers as excellent an outcome as injecting into the subcutaneous/fascial/supraperiosteal planes and following natural tissue planes.
best,
sml

I did watch the bit on women preferring their faces between ages 28-32. I wish I had watched your videos or read that a year ago before I had this surgery because then I dont think I would be in this situation. Right now, I wouldn't say I look a different age or even a different weight because the entire face wasn't affected fortunately. My face shape has changed a lot though, before I had a 3-D look at 45 degrees (like the after picture for the Asian female patient) whereas now with the missing anterior cheeks its more flat and 2-D. I now understand why a lot of women have cheek implants, I never understood the appeal of them until now.

When I'm puffy such as during menstruation, really flustered, weight gain, what happens is the entire face expands in volume except for that region which remains practically flat. When I'm not puffy what happens is the cheekbones protrude out and you can see the hollow below the cheekbones. Even my own mother (who isn't overweight) doesn't have this look at her age and her cheekbones are well covered. This is somewhat disturbing for me and I just have to look away when I see those cheekbones sticking out. The texture of the skin has changed a lot as well. Before the skin was more firm, more structual integrity. Now, the skin feels like playdo between my fingers and I can scrunch up my nose and smile a lot higher than before. The day after the surgery I felt my cheeks and I was shocked to be able to feel my cheekbones so easily. It felt like they were covered barely by a thin film of skin.


I'll send you the photos for the consultation by email and I'm sure they'll be more informative than what I tell you. I really don't know what to do or whats really going on here but maybe you can help me? I guess all I'm trying to do is cover those bones and indents, and smooth everything out. I'm not trying to have perfect cheeks like Michelle Pfeiffer or those supermodels you see in the magazines, but I just want look closer to what I did before and I understand perfection is not attainable. As a live graft, if I were to gain a lot of weight my hope is that the volume will expand along with the rest of the face like it did before. Currently, this area doesn't seem to expand at all along with the rest of the face which wasn't touched and it looks like the lower face is taking up most of the face giving it a more masculine look.

I look forward to our consultation.

Hi Dr Lam

I’m wondering if you had a chance to look at the postop photos I’ve submitted by email and if they’re sufficient to get an idea of whats happened. To be realistic, the damage from that liposuction has been done and I know theres no way to return to what I had before. I’m just hoping to make the bony protrusions/indents LESS prominent (completely covered is probably out of the question at this point without that huge risk). My guess is that 1/2, 3/4, or 1 of a tablespoon/cheek would be enough (again, this is only an assumption from a layman). I understand that the fat restored may not graft symmetrically, may not even change in volume symmetrically along with weight gain/loss, etc. If I need more, I can always do the rest in the future as I approach my 40s and see what happens.

I’m just a tad thinner (5-7lbs) and less bloated in many of the postop pics I’ve sent you, but are they informative enough (that is, in place of a live consultation)?

Unfortunately, I did not receive your email.

HI Dr. Lam,

Thank you graciously for the consultation! You’re very knowledgeable and the consultation itself was very informative. I apologize because know these are very difficult questions, but the reason I’m asking is me not knowing what the surgeon was going to do was which was removing the entire cheek and touching areas which we had not previously discussed was what got me in this situation in the first place. Any information or insight will do and if there are aspects which you can’t answer that is perfectly fine.

1) One area of concern that I’ve been having, and I know this is a difficult question to answer but a rough range will suffice, is how many total cc do you think I may require and would be injected into each cheek to treat just the affected area? The fat sources I have in mind are the stomach and inner thighs, but depending on how much you need I may need to gain just a couple of pounds because I’m only 15% body fat right now. I know you discourage weight changes within 20lbs, but I’m only talking about 5lbs here which does seem to make a difference in my waistline and how much you can grab when you pull my stomach. I know younger patients retain the fat much better but roughly on average, what % range do you anticipate will dissipate? Theres that consent form I will sign that forbids major weight changes, but I hope to have just enough fat placed that’s in harmony with what you see now, so that if I were to gain weight (e.g. natural weight gain due to pregnancy, aging) the grafted region will grow along in sync with the rest of the face unlike that photo of me in my attempt to gain weight, which only enlarged the buccal fat pad and everything else disproportionately and created this deformed appearance.

2) I’ve also read excerpts from your book and I see that in a lot of the figures, they’re beautiful tailored for your aging patients. In my case, this is a result from liposuction and I was wondering if your strategy will differ a lot than if you address an aging patient?

3) I was also wondering if your technique is similar to Sydney Coleman, the originator of fat grafting? Your results turn out remarkable and well blended, but hes been getting a lot of bad publicity and there was even a website entitled “Bad Fat Graftingâ€￾ which I looked at last year and there were these photos of women with horrific lumps all over their faces. I know that technique also injects fat threats into the fatty tissue, but why is it that if the technique is essentially the same there are so many inconsistencies in the final outcome amongst different surgeons?

hi,
it was nice speaking with you too. here are your answers:
1. i really discourage trying to gain weight just for a result. i don't want you then to lose the 5 pounds which you can then lose on your face. i only need a few cc's of fat so don't worry about gaining weight. however, if you are as thin as you are saying, please send me a photograph of your abdomen and thighs with a bikini on. i need a frontal view.
2. yes, the technique will be essentially the same as for "old" people.
3. i really should not speak on behalf of dr. coleman. i know that my volumes are tremendously lower than his. it is an entirely different aesthetic. each surgeon applies his own artistry and judgment. i don't like very full faces. i just like to create softer, youthful faces. i err on a more conservative profile. also, i like a total balanced face. that is why i am encouraging you to let me do a little more but i can stay within your guidelines. i truly think when you put buckets of fat into the face you get uneven resorption. i put so little fat in the face but i put it in an even manner so that is why my results look better and hold without lumpiness. in short, i do use a coleman-esque technique. however, two cars may have four wheels and an engine but they can be totally different based on the manufacturer.
best,
sml

Hi Dr. Lam,

How are you doing? I'm looking forward to seeing you in person. I've watched your youtube videos and finally get to meet you in person very soon.

I've forwarded the bikini shots to Constanze for the potential fat harvesting sites in the updated powerpoint slides (I've also included more preop and just a couple of postop pics if you may need them). At this point, I'm very very certain I only want the liposuctioned regions touched. The reason I say this is not that I don't agree that the final outcome will look better, but the problem is those other areas don't bother me too much....well at least not yet, it probably will be a different story by the time I'm 30 because I am aging quickly because of my stressful circumstances. There will be more hollowing in time, and I hope to address the age issues all at once at that time (probably even in 5 years when I'm 30).

The psychological consequences from that liposuction procedure affected every aspect of my life including social, academic, career. I've lost all my friends from this, and I could not open up and tell anyone except my mother what I've done because its downright embarassing and something I don't really understand why I even did in the first place. Unlike most people, my fat is extremely dynamic in response to slight adjustments in weight gain, and during estrogen dominated states such as during menstruation as well as pregnancy I'm sure if I were to go through it. I don't know if its genetics, the fact I had childhood obesity therefore I may just have a greater number of fat cells which are determined by the time one hits puberty, etc. I just hope to play it safe and just touch the liposuctioned area only because I don't think I can go through that experience again, even though I'm doing it by someone who clearly knows what he's doing. If anyone can do it, I know you can, but I also understand even surgeons have their limitations. Is it possible to stick only to the midface/liposuctioned area?

Oh, before I forget, I was wondering if can see the borders where the region was touched? For 6 months after the liposuction procedure, you could mark out the borders because it looked like someone scooped out skin from a flat surface. Fortunately over time its blended in better (as will be the case with fat grafting I'm sure). It might be a little hard to tell, but would you require surgical notes from my last procedure?

No worries. We´ll stick to only the liposuctioned areas. I understand your concerns and your desires. I´ll mark out the areas when you come here. Also, I really don´t need your op notes. Just seeing you will help establish the right course of action. I really look forward to helping you put this chapter of your life behind you.
best,
sml

Ah, thank you Dr. Lam! I spoke to Constanze earlier this week and she told me I was coming in for a full facial fat graft, then I got a little worried because I'm not entirely sure thats what I want to do. As for the cheeks, oh DEFINITELY. Thank you and all the best to you!

don't worry, it is always booked as an FFFT even if it is a partial job.
best,
sml