Dr. Sam Lam Plastic Surgery Forum

Hi Dr Lam,

I've been reading a lot of your posts about how woman lose fat in their face in their 30s and that this is a good time to get a f/t. Well I am in my late 20s and have always had a very flat, gaunt face and it's concave in my submalar area. My lack of fat is not due to the aging process, rather genetics.

So for someone in my case would you do anything differently?

Thanks

that is a wonderful question and gives me a chance to answer it. many women are gaunt in youth and stay that way throughout their life becoming even gaunter as they get older. i have done FT's in women in their 20s, 30s, etc. However, the younger the age you are, the more careful I have to be with the FT. I believe I have answered something to that effect in a previous forum post. But since FT is such a popular topic (rightfully so) you might have a hard time finding the post.

My concern about doing younger women is twofold. First, if you get pregnant, during the pregnancy time your face might look too full or even slightly distorted. Have I ever seen that? No, but it is theoretically possible. Second, and much more importantly, your metabolism will slow down and you might gain weight meaning your face might look too full.

You might have read that I likened FT to HT (Hair transplant) and that similarity also extends to long-term safety with HTs. (Actually this is going to be a new thought that I have never published but only thought...) When someone comes into the office to do an HT at 27 (which I just did on a patient), I have to look at long term safety for him: will he have enough donor hair to transplant enough to maintain the natural result. For FT, the opposite is true: will the person gain weight making my FT result look too enlarged. Remember I am not trying to make you look fat but more attractive. Big difference.

Also like HT, family genetics is a huge part but only serves as part of the guess work. Let's say I see an individual who is 27 years old not rapidly losing hair that has both parents having most of their hair and his grandparents on both sides having a lot of their hair. I would feel more comfortable at least using that imprecise information in my judgement to perform HT earlier for him than I would prefer (which is someone at least 30 if not much older). However, if his dad was completely bald with only a horseshoe ring of hair left at the age of 40 then that would be a bad sign for me. Similarly, in your case, if both of your parents were gaunt and most of your relatives were gaunt, then you would be a much safer candidate than say if you told me, "Mom was a stick figure until 35 and then she now weighs over 250 pounds." Do you see what I am saying? Long-term safety is always priority one for me and it should be for you too.

That being said, at least I know how to get a great result for you without taking excessive risk. I can use a little fat blended well to create a nice result without filling too much. Many surgeons take undue risk with FT in someone younger by stuffing your face and then regretting it down the road. I don't do that. Can fillers be a good alternative? Two ways to look at that: Yes and No. Yes, because they provide a safe alternative to FT for someone that I am not sure what is going on with their weight. No, in the sense that it is not as soft as fat and way too expensive to allow me to "paint the canvas" to the point where I think the result will look as good as I would like. Plus, if you are younger, that means many many times of injectables. My feeling now about injectables (different from a previous post) is that after 5 or 6 rounds of injectables you can build up a little scar tissue making my FT (still viable) but possibly with more recovery because I have to penetrate some of the scar. And because you are younger that means you will need a lot of fillers. So depending on what your long-term goals are, FT sometimes can be a better option given the safety factors elaborated above and with the right surgeon's technique and sensitivity to long-term safety. hope that helps to explain what goes through my mind when i see a person for a consultation.

one more thing, if you are gaunt and your entire family is pretty gaunt then the fat I put in you will have great longevity in one respect because you will really need it in the future (because you will become more gaunt). Also, just as a reminder more than anything else, you will probably need another round in 10 years or so because the way you will age will be to become even more gaunt in the face (if that is what happens with your family), even despite a slowdown in metabolism and some weight gain.

great answer, learned alot reading that. Just want to point out:

dr. lam wrote:However, if his dad was completely bald with only a horseshoe ring of hair left at the age of 40 then that would be a bad sign for me.

Horseshoe hair is a bad sign for anyone! Until getting the HT, better to shave it off! (maybe the ladies can give their opinion on this - is horseshoe hair sexy? )

i can already tell you the ladies' opinion: shave it off. this is why today when i address a man in his 20s who is rapidly losing hair, i do not automatically sell him an HT. he probably will look better shaved. however if he is in his 20s with early loss that is not rapid with good family genes and excellent donor hair (like i just did last week) we then have a higher chance of getting things done safely for the long haul. there was some kind of study in which women found men either with a full head of hair or completely shaved almost equally attractive whereas the thinning hair and especially the horseshoe was deemed unattractive. interestingly, when i deal with older men who are not in the culture of shaving it off and i still have enough donor hair in the back to do the job, i will at least "frame the head" and get some semblance of anterior coverage even though i can't fill the whole head or frame down the face appropriately. it is about understanding age, culture, and everything in between.

one more thing, if you are gaunt and your entire family is pretty gaunt then the fat I put in you will have great longevity in one respect because you will really need it in the future (because you will become more gaunt).

Well my dad is gaunt and I got his facial structure. My mom has a fuller face and always did. I'll be 30 in less than a year so does that make it slightly "safer"? My weight fluctuates between 10-20 pounds and I am currently on the thinner side...so does that mean less fat should go in since I could potentially be 20 pounds heavier?

Also I have never had children and hope to at some point. I do have concerns about this but I can't plan my life around this since I am currently single and don't know for sure what the future holds.

Also, another question about the harvested fat. My fat would come from my thighs which I wrote in another post have cellulite on them. My thighs are also the toughest area for me to lose weight and first place I gain weight. So since I am getting fat from this area does that mean it will behave the same way in my face as it does in my thighs meaning it will "gain" there very easily?

Also, if a patient just wants a very conservative look and doesn't really want anyone to notice...just a little to take away the gauntness how do you do that? Do you just put less fat in?

Thanks again.

Well my dad is gaunt and I got his facial structure. My mom has a fuller face and always did. I'll be 30 in less than a year so does that make it slightly "safer"? My weight fluctuates between 10-20 pounds and I am currently on the thinner side...so does that mean less fat should go in since I could potentially be 20 pounds heavier?

IF YOU ARE TRULY GAUNT AND YOU FLUCTUATE 20 POUNDS THEN I WOULD CONSIDER DOING YOU STILL IN THE MIDPOINT OF THAT WEIGHT. MOST INDIVIDUALS THAT ARE SLIGHTLY HEAVIER AND MAY POTENTIALLY GET HEAVIER, I DO AT THE HIGHER WEIGHT SINCE I DO NOT WANT THEM TO GET HEAVIER AND LOOK TOO HEAVY. IF THEY LOSE WEIGHT AND LOSE SOME OF MY RESULT TEMPORARILY I RATHER SEE THAT THAN A FACE THAT LOOKS SIMPLY TOO HEAVY. ALSO, I WOULD LOVE TO SEE A PHOTO OF YOUR MOM AT 29 AND HER CURRENT AGE WHEN YOU COME IN. LET ME BE THE JUDGE. ALSO, I WOULD LIKE TO SEE WHO YOU RESEMBLE MORE GENETICALLY BY SEEING WHO YOU LOOK LIKE MORE. THESE ARE INACCURATE ASSESSMENTS BUT I LIKE ALL THE DATA THAT I CAN GET WHEN DEALING WITH SOMEONE VERY YOUNG.

Also I have never had children and hope to at some point. I do have concerns about this but I can't plan my life around this since I am currently single and don't know for sure what the future holds.

UNDERSTOOD. JUST BEING THOROUGH IN MY RESPONSES. I HAVE DONE MANY WOMEN WHO ARE NOT MARRIED AND HAVE NOT HAD KIDS BUT PLAN TO DO SO.

Also, another question about the harvested fat. My fat would come from my thighs which I wrote in another post have cellulite on them. My thighs are also the toughest area for me to lose weight and first place I gain weight. So since I am getting fat from this area does that mean it will behave the same way in my face as it does in my thighs meaning it will "gain" there very easily?

GREAT QUESTION. THAT IS POSSIBLE. THAT IS IN FACT WHY I USE THAT FAT BECAUSE IT HAS MUCH BETTER HOLDING POWER. IF I DO A CONSULT WITH YOU WE CAN LOOK AT SOME POTENTIAL SITES OTHER THAN THE CELLULITE AREA BUT MOST LIKELY IT WOULD BE THE PREFERRED AREA SINCE IT HAS THE BEST LONGEVITY.

Also, if a patient just wants a very conservative look and doesn't really want anyone to notice...just a little to take away the gauntness how do you do that? Do you just put less fat in?

YES, ABSOLUTELY. I WOULD NEED TO SEE YOU TO HELP GUIDE WHAT YOU SEE. OFTENTIMES WHERE YOU THINK YOU NEED THE FAT IS NOT PERHAPS WHERE YOU WOULD BENEFIT FROM IT MOST. I LIKE TO FEATHER THE AREAS AND NOT JUST PUT IT IN ONE AREA. HOWEVER, AGAIN WE CAN DISCUSS THAT WHEN I EVALUATE YOUR FACE.