Dr. Sam Lam Plastic Surgery Forum

Hi Dr Lam,
Thanks for having such an informative website.

This time last year I lost a lot of weight due to a stressful event- I have since put it back on but I have noticed it never went back fully in my face. My main concern is that when I smile I can see lots of creases just above the naso fold (not sure of the technical term). Is fat transfer a good option for me? (I am 33 and not liking this wrinkling skin! )
I am interested in fat transfer but I would like it to address the smile lines, I am not too interested in it changing the shape of my face. I am also concerned about the puffy look.
Any suggestions for smile lines?
Many thanks,

Smiles

hi,
sorry we were transferring data over to a new server this weekend. i actually answered this question twice but apparently it was never published so here goes a third time.

fat transfer to the folds in my opinion does not work. it fails because the fat is very soft and does not lift the fold up well. second, the fat around the highly mobile mouth does not have the same longevity as the upper and middle face so placing in the fold just does not work in 85% of people. with that failure rate, no one would attempt it. now if it works you also have risk. being a younger person i always worry that fat selectively placed into a small area will not age as well because it is body fat that changes with metabolism. that is why i always use it to blend more safely over a wide area than place it just in one or two areas.

as far as a puffy face is concerned, fat transfer done well does not lead to puffy faces. it leads to a balanced, rejuvenated look. that is why an artistic surgeon places small amounts in the right places to make the face overall look more youthful and balanced.

i prefer for the smile lines instead temporary or permanent products, e.g., perlane/restylane and artefill, respectively. i tend to prefer permanent fillers in most people because i think it is the most economical long-term solution since i believe temporary products in the folds do not last long. however, i am always focused on long-term safety. the younger you are the less aggressive i am with permanent fillers. if you are under 30, i will most likely not do a permanent. under 35 years of age, i am more conservative with a permanent filler.

if you are talking about fine lines that show up when you smile, you cannot fill those. you need a combination of 50 things to have long-term success: sun avoidance, good diet, less stress, hydration, good skin care products, light laser treatments like IPL, adequate sleep, facials, etc. not one thing will do and there are no miracle cures for it. hope that helps and i hope this is published this time.
best,
sml

Dear Dr Lam,

Thank you for your prompt response.

At the moment my smile lines are dynamic so I will definitely investigate fillers and see how I go with that. However, I am a little fearful of permanent fillers as I’ve heard they cause nodules. If I start temporary fillers now will this interfere/prevent me from having a fat transfer done in a few years time?

Anyway, I have always had a good skin care regime of sunscreen and an aha and this year, I added Tazorac to the mix- so hopefully this will help.

Many thanks for your response- I found it very useful.

Many thanks,
Smiles

if you are just using fillers for the fine lines and movement it should not interfere with possible FT in the future.