Dr. Sam Lam Plastic Surgery Forum

I am so happy to come across this special site! I have two areas of concern:
1) A mole (really tiny one, 1 mm in diameter, maybe) was removed from the side of my nose. It had bled once after exfoliation, and my derm thought it was slightly suspicious. The plastic surgeon I went to promised a line after the stitches were removed (I had the stitches for a week), but what I really have is a dent that looks like a huge pore. It really looks like the stitches were never there, as if the mole was just pulled out, and there is a hole in its place. Why did this happen and is it repairable?
2) I'm in my forties, very fit and skinny. I don't like the "skinny" part when it comes to my face. I've been thinking about fat injections for a couple of years, and finally (thanks to the "bad" mole) I started doing my homework: I visited three plastic surgeons, and I can summarize their opinions as follows -a. You don't have wrinkles, we use fat mostly to fill up wrinkles, -b. Fat is not predictable, we might overfill, and you'll end up removing fat later on, -c. You never know whether fat will stay or not (one of the MDs told me that he had a lady, who had her left side still filled with fat after 2 years, whereas the right side of her face was "flat") and you might end up with asymmentry, -d. You'll be severely bruised for 2 weeks minimum.
Basically, none of them sounded confident, and all of them wanted to put me on the path of facial fillers. They would work with me and do fat grafting, I'm sure, but if I don't sense confidence in my doctor, I become shaky myself. I left with more questions than answers: why fat can't be used for volume and contouring? I thought I discovered this concept (just kidding) until I came across Dr. Lam's site. Your before and after pics are amazing, and the information I'm getting on this site is very exciting. Do you have followers/students/think alikes in Philadelphia / NJ?
Looking forward to hearing from you,
Zoya

hi,
glad that you found this site because in short what these doctors are telling you is WRONG!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! In short, they have no idea what they are saying because they don't do fat or don't do it well. My fat holds well and improves over two years. I have never seen one side grow and not the other. You can find another fat transfer surgeon but you must find a surgeon in whom you like the results because it expresses artistry besides technical skill. i don't think you will find another surgeon whose results look anything like mine. the good thing is that you can fly in and fly out the next day in most cases since there is no cutting. this week alone i have had people fly in from europe twice and both coasts. it is not that difficult.

as far as your nose is concerned, this video will answer your question perhaps on why. it is a long answer about nasal anatomy and i suspect the answer is that it was not done the way that i would but who knows since i was not there:http://www.lamfacialplastics.com/gallery2/v/Video/Video+Logs+_VLogs_/rhinoplasty/architecture-nose-rhinoplasty.flv.html

Thank you, Dr. Lam!
I've never thought of traveling far for a cosmetic procedure, it's a new idea to me, but I'll definitely think about it. How far in advance do you book?
-How much fat do you need to graft for the face? I don't mean in terms of numbers. I'm size 2, and although I do have some fat, like everybody else, I don't have big deposits, suitable for liposuction.
-How would you address the nose scar, if at all? It's a small area, but it bothers me; I would love to have it corrected.
Dr. Lam, a couple of other things:
-What do you do for veins? I have one on my cheek bone I'd like to get rid of. I was told it's done with some kind of electric device/catheter (don't know the name).
-Although I'm in my forties, I've never done anything to my face (except for great skin care at home) until a couple of months ago - I was trying to treat several sun spots with IPL. After a couple of sessions, there were no results at all, not even slightest. The dermatologist said that my skin is not responding to IPL. Is this possible? My skin is pretty thin, actually (in case it matters), why wouldn't it respond? How else do you treat brown spots?
Thank you so-o much for your time! I appreciate your answers and your informative site.

l'll definitely think about it. How far in advance do you book?
-How much fat do you need to graft for the face? NOT A LOT. IT JUST NEEDS TO BE WELL DONE. I don't mean in terms of numbers. I'm size 2, and although I do have some fat, like everybody else, I don't have big deposits, suitable for liposuction. I'M NOT WORRIED.
-How would you address the nose scar, if at all? It's a small area, but it bothers me; I would love to have it corrected. THAT MAY BE A QUESTION OF LETTING THE PUNISHMENT FIT THE CRIME. TYPICALLY, A NOSE NEEDS TO BE OPENED UP ENTIRELY AND CLOSED WITH VISIBLE SCARRING FOR A YEAR. IT OFTENTIMES IS NOT WORTH IT. I WOULD HAVE TO SEE. IT MUST BE DONE RIGHT, PERIOD. THERE ARE NO SECOND OPTIONS FOR A NOSE. YOU MUST DISSECT IN THE RIGHT PLANES BUT AGAIN, WE HAVE TO FIT WHAT YOU HAVE TO WHAT MERITS TREATMENT.
Dr. Lam, a couple of other things:
-What do you do for veins? I have one on my cheek bone I'd like to get rid of. I was told it's done with some kind of electric device/catheter (don't know the name). NO, THOSE DEVICES DON'T PROVIDE LONG-TERM SUCCESS. TYPICALLY, A LASER IS BETTER. MY LASER IS BETTER FOR RED. IF IT IS BLUE IT IS HARDER. PLUS, I ALWAYS SAY SKIN IS A PROCESS, MEANING THAT WHATEVER TREATMENT YOU DO WILL HAVE IT COME BACK OVER TIME WHETHER THAT BE MONTHS OR YEARS.
-Although I'm in my forties, I've never done anything to my face (except for great skin care at home) until a couple of months ago - I was trying to treat several sun spots with IPL. After a couple of sessions, there were no results at all, not even slightest. The dermatologist said that my skin is not responding to IPL. Is this possible? My skin is pretty thin, actually (in case it matters), why wouldn't it respond? How else do you treat brown spots? NOT EVERYONE RESPONDS. BLEACHING WITH MEDICAL GRADE HYDROQUINONE IS A GREAT OPTION. ALSO IF YOU ARE IN THE SUN, NOTHING WILL WORK PERIOD. ALSO, YOU MIGHT WANT TO CHECK HORMONES. REMEMBER AGAIN, WHATEVER "WORKS" NEEDS TO BE MAINTAINED BECAUSE HORMONES AND SUN WILL STILL RAVAGE YOUR SKIN OVER TIME. REMEMBER, SKIN IS A "PROCESS". THAT IS CRITICAL.

-How far in advance do you book?
-I would like to know whether I can afford the trip, the fat graft, and maybe other procedures. Could you tell me how much fat graft costs? If you don't discuss prices in this forum, please tell me how I can get the information.
-Dr. Lam, what do you mean by "open the nose entirely"? Do you mean a new excision or some opening on the inside as well? "Opening entirely" sounds scary to me.
-My vein is green/blue, it was visible since I was a child, but now that skin is getting thinner, it is a lot more visible. It might be slightly higher than the cheek bone, touching my under the eye circle. It's probably an inch long (at least the part I can see). So, your lazer is for the red ones only?
-Thanks for interesting info on hydroquinone option. Is it a cream you prescribe or it's a peel?
Best regards!

-How far in advance do you book? TYPICALLY 3 TO 4 MONTHS.
-I would like to know whether I can afford the trip, the fat graft, and maybe other procedures. Could you tell me how much fat graft costs? If you don't discuss prices in this forum, please tell me how I can get the information. YES, EMAIL MARCY@LAMFACIALPLASTICS.COM.
-Dr. Lam, what do you mean by "open the nose entirely"? Do you mean a new excision or some opening on the inside as well? "Opening entirely" sounds scary to me. YES, IT SHOULD. IT MEANS CUTTING DOWN DEEPER THEN RAISING TISSUE TO MOVE THE NOSE IN AN APPROPRIATE PLANE. THIS IS SOMETHING THAT REQUIRES SOMETHING BIGGER FOR SOMETHING SMALLER. THAT IS WHY I EITHER SHAVE OFF THE AREA OR I MAKE A LARGER INCISION ACROSS THE NOSE. THOSE ARE REALLY THE ONLY TWO CHOICES WHEN YOU DO A NOSE EXCISION IN MOST CASES UNLESS THE LESION IS WAY HIGH ON THE NOSE LIKE ON THE HIGHER BRIDGE. STILL THE INCISION MUST GO DEEP ENOUGH THROUGH THE MUSCLE LAYER OR THE EDGES WILL BUCKLE IN. ALL OF THIS IS NEAR IMPOSSIBLE TO EXPLAIN ON A FORUM RESPONSE BUT IT IS A CRITICAL THING THAT REQUIRES KNOWLEDGE AND CONSULTATION WORK.
-My vein is green/blue, it was visible since I was a child, but now that skin is getting thinner, it is a lot more visible. It might be slightly higher than the cheek bone, touching my under the eye circle. It's probably an inch long (at least the part I can see). So, your lazer is for the red ones only?
IF IT IS THAT CLOSE TO THE EYE, I WOULD NOT RECOMMEND A LASER. I WOULD SIMPLY LEAVE IT. SOMETIMES SAFETY IS BETTER THAN THERAPY BUT AGAIN I CANNOT MAKE THAT RECOMMENDATION WITHOUT SEEING YOU.
-Thanks for interesting info on hydroquinone option. Is it a cream you prescribe or it's a peel? CREAM.
Best regards!
SAME TO YOU!

Thanks, I'll email Marcy some time soon.
Dr. Lam, when you do nose surgery (on the side of the nose, where most adults have lots of enlarged pores), how do you expect the area to heal? Do you expect the edges of the incision to be together or they're sometimes apart and heal gradually? My scar is two months old now, and when the surgeon was removing sutures, he told me that he didn't expect the skin to be together necessarily, that what I'm referring to as small hole / crack will "fill up" and heal eventually. The thing is that my family members did have stitches several times (regular injuries, stitches put in the emergency room), and my idea of a good scar is when the skin is together from the very start. A hole/ pore or whatever that is to "fill in" sounds like magic to me, but I'm not a medical person. I did watch your video, and you did explain peculiarities of the nose, but could you please comment on how "your" scars look after removal of the stitches? Thank you very-very much!

that area is an area that tends not to heal that well in general. however, i would trust your surgeon since i should not comment on someone else's work. 2 months is early to judge anything.
best,
sml

I'm glad that 2 months is early; although the scar/hole hasn't changed much for the past 4 weeks, your words give me some hope ( I wish I could have my mole back, but it's not an option). Meanwhile I took some healing meditation tapes from the library, and will be listening to them as I drive, trying to think positive thoughts about my nose. Thanks!

great! if you haven't seen my meditation videos, check these out.
http://www.lamfacialplastics.com/galler ... tion-Yoga/