Dr. Sam Lam Plastic Surgery Forum

Hello Dr. Lam
I'm glad that you have this very helpful web sight. I have a couple questions that I'd like to ask you, I apologize a head of time for the lengthy questions as I'm sure that you have other people's questions to answer. I will do my best to keep them as short as I can.

A little about myself: I'm a half Asian and Caucasian female in her mid 30s. I have a mixture of facial features, not all of them are in harmony with each other in my opinion, in other words, my facial features could use a little softening. I look mad all the time for some reason, I think its beause of my small lips, flat face, and large eyes. The only cosmetic enhancements that I have ever had is a little juvaderm in my lips about 9 months ago. (loved it by the way!) I know you are a conservative surgeon and prefer a balanced look to someones face in stead of what its popular at the moment. (example: large upper lips)

Questions:

A.) I have a long/oval shape face. My chin is a bit large and unbalances the harmony of my face. I would like to shorten my chin. Do you perform chin height reduction genioplasty/ostectomy? I think I read somewhere in one of these post that you don't but just thought Id ask.) My bite is fine, just my chin is a little on the large side.

B.) I have a flat face with large eyes. I know you mentioned that you don't like cheek implants but prefer fat transfer to the face. My question to you is, is that still the case if someones face is really flat? I seen this guys video on youtube who had double jaw surgery. He had an under bite and a flat face. He also got cheek implants and now looks amazing! You can view his results here http://youtu.be/A6DIb3Mv6Dg It totally changed his apperace. His face went from flat and long looking to oval/heartshaped looking. I think he may be white and Asian as well. Here is his before video http://youtu.be/PndhhNYqOYU Anyways, if fat transfer to the cheek area is performed, is it just a "fat transfer/injection" or a "fat graft"? I have read that a fat graft will last longer than fat transfer/injections. (My weight is stable, I could lose a couple pounds though) Going back to the flatness of my face, would a premaxillary cartilage graft do well in addition with cheek augmentation? Also, does it last a life time? Could a cartlage graft be use to augment my retracted columella as well? This person got cheek implants and from looking at his straight forward, his face looks really great. http://youtu.be/cDlMjiwFn8M Can fat transfer/graft augment my cheeks this much?

c.) Since my face is flat, I think it makes my eyes appear a little bulgy and round. I'd like them to appear less round. Large amounts of scleral show run on my dads side of the family, it gets bad or saggy with age. Would fat transfer under my eyes fix this or would I need a Canthoplasty or orbital rim implants? (I like the examples of lower eyelid shapes here http://www.veriteclinic.jp/academic/08_11_29_korea.html)


d.) lastly, Lips....as I mentioned earlier, I have had juvaderm injected into my lips about 9 months ago. Besides making my lips appear a little larger, It also helped balance/soften my features. I didn't look so tired/haggard/harsh/mean looking. It just made me look more feminine and softer. I really liked the results but would like to know if fat transfer would last longer? What about fat grafts? Also, I know that you dont like to perform lip lifts on anyone unless they are older and do not have lips to begin with but my question to you is, is there another way to reduce the area of skin between the upper lip and nose? This area of large space really bothers me and I'd like to reduce it. (Almost to the point of putting up with a small lip lift scar) I look very masculine with this large space. If I was going to get my retracted columella augmented with a graft, would it be possible to make a tiny U shaped incision under it to make a partial lip lift? Not the basic bullhorn incision but a little U under the columella. I know there will be a scar, but wouldn't that look better than a bullhorn scar? I really, really want to get this area reduced.

Besides the chin reduction, I hope that cartilage grafts, fat grafting, or fat transfer will help alleviate most these issues instead of more invasive solutions. (Crossing fingers) I also think a small refinement to the tip of my nose would look nice as it is a little bulbous. One more thing (I promise I'm done after this) I know that you mentioned that having a large upper lip is unnatural looking in most women but I have noticed that many Asian women have large upper lips including my mother. I do have my fathers small upper lip but after the juvaderm, I feel my lips look more balanced. I think Jessica Alba type lips would look great with my facial features. Please tell me what your thoughts are, I am anxious to know!

Thanks so much for your important time. It is greatly appreciated!

ANSWERS TYPED IN ALL CAPS BELOW:
A.) I have a long/oval shape face. My chin is a bit large and unbalances the harmony of my face. I would like to shorten my chin. Do you perform chin height reduction genioplasty/ostectomy? NO, THAT WOULD BE AN ORO-MAXILLO-FACIAL SURGEON. I think I read somewhere in one of these post that you don't but just thought Id ask.) My bite is fine, just my chin is a little on the large side.

B.) I have a flat face with large eyes. I know you mentioned that you don't like cheek implants but prefer fat transfer to the face. My question to you is, is that still the case if someones face is really flat? I seen this guys video on youtube who had double jaw surgery. He had an under bite and a flat face. He also got cheek implants and now looks amazing! You can view his results here http://youtu.be/A6DIb3Mv6Dg It totally changed his apperace. His face went from flat and long looking to oval/heartshaped looking. I think he may be white and Asian as well. Here is his before video http://youtu.be/PndhhNYqOYU Anyways, if fat transfer to the cheek area is performed, is it just a "fat transfer/injection" or a "fat graft"? I have read that a fat graft will last longer than fat transfer/injections. (My weight is stable, I could lose a couple pounds though) Going back to the flatness of my face, would a premaxillary cartilage graft do well in addition with cheek augmentation? Also, does it last a life time? Could a cartlage graft be use to augment my retracted columella as well? This person got cheek implants and from looking at his straight forward, his face looks really great. http://youtu.be/cDlMjiwFn8M Can fat transfer/graft augment my cheeks this much? I THINK CHEEK IMPLANTS CAN LOOK OK IN SOMEONE YOUNGER BUT THEY DON'T AGE WELL AS THE SOFT TISSUE ENVELOPE BEGINS TO EXPOSE THEM. I SEE THIS ALL THE TIME. THIS IS ESPECIALLY TRUE FOR WOMEN WHO WOULD BENEFIT FROM FAT GRAFTING TO GENTLY CONTOUR THEIR FACE WITH THE KNOWN CAVEAT OF STABLE WEIGHT. I THINK THAT PREMAXILLARY GRAFTS THAT ARE MADE OF SILICONE AFFECT THE SMILE TOO MUCH. I STOPPED USING THEM. I USE CARTILAGE GRAFTS TO HELP WITH THE PREMAXILLA AND THE RETRUDED COLUMELLA. ALTHOUGH THEY ARE LESS POWERFUL THAN SILICONE. THEY LOOK AND FEEL MUCH MORE NATURAL. I INJECT FAT WHICH CAN BE KNOWN AS A FAT GRAFT, FAT TRANSFER, ETC. THESE ARE ALL INTERCHANGEABLE TERMS. IF YOU ARE MEANING DO I CUT A LUMP OF FAT OUT AND STICK IT IN, THE ANSWER IS A DEFINITE NO NO NO. THAT IS BAD.

c.) Since my face is flat, I think it makes my eyes appear a little bulgy and round. I'd like them to appear less round. Large amounts of scleral show run on my dads side of the family, it gets bad or saggy with age. Would fat transfer under my eyes fix this or would I need a Canthoplasty or orbital rim implants? (I like the examples of lower eyelid shapes here http://www.veriteclinic.jp/academic/08_11_29_korea.html) AGAIN, I HATE SOLID IMPLANTS AND CANTHAL SURGERY. I THINK THE RISK IS TOO HIGH. SOMETIMES LESS IS MORE. I AM A STRONG PROPONENT OF GENTLE, NON-INVASIVE FAT TRANSFER TO SOFTEN AGING AND FEATURES.


d.) lastly, Lips....as I mentioned earlier, I have had juvaderm injected into my lips about 9 months ago. Besides making my lips appear a little larger, It also helped balance/soften my features. I didn't look so tired/haggard/harsh/mean looking. It just made me look more feminine and softer. I really liked the results but would like to know if fat transfer would last longer? What about fat grafts? Also, I know that you dont like to perform lip lifts on anyone unless they are older and do not have lips to begin with but my question to you is, is there another way to reduce the area of skin between the upper lip and nose? This area of large space really bothers me and I'd like to reduce it. (Almost to the point of putting up with a small lip lift scar) I look very masculine with this large space. If I was going to get my retracted columella augmented with a graft, would it be possible to make a tiny U shaped incision under it to make a partial lip lift? Not the basic bullhorn incision but a little U under the columella. I know there will be a scar, but wouldn't that look better than a bullhorn scar? I really, really want to get this area reduced. ONCE AGAIN, LESS IS MORE. WHEN WE TRY TO FIX THINGS THAT ONLY LEAD TO PROBLEMS, WE GET PROBLEMS. EVEN IF YOU ARE DYING TO FIX THAT DISTANCE BETWEN YOUR UPPER LIP AND YOUR NOSE, DOING SO WILL MAKE YOUR LIP LOOK RIDICULOUS AND ALSO LESS IMPORTANTLY RISK A SCAR (THAT IS TYPICALLY NOT A BIG DEAL). I HATE THE LOOK OF LIP LIFTS PERIOD. I DON'T DO FAT GRAFTS IN LIPS BECAUSE THEIR ABSORPTION RATE IS HIGH, THE RESULTS THAT LAST ARE NOT SMOOTH IN MANY CASES, AND THE RECOVERY IS TREMENDOUSLY LONG FOR LITTLE GAIN. I THINK BEING ASIAN YOU HAVE TO BE CAREFUL NOT TO LOOK AT WHITE ACTRESSES, TOO MUCH OF A LIP CAN MAKE YOU HAVE EXAGGERATED ETHNIC APPEARANCE.
thanks for the questions! hope that helps.
sml

"...I THINK THAT PREMAXILLARY GRAFTS THAT ARE MADE OF SILICONE AFFECT THE SMILE TOO MUCH. I STOPPED USING THEM. I USE CARTILAGE GRAFTS TO HELP WITH THE PREMAXILLA AND THE RETRUDED COLUMELLA. ALTHOUGH THEY ARE LESS POWERFUL THAN SILICONE. THEY LOOK AND FEEL MUCH MORE NATURAL."

Quick question... about what is the price range for a premaxillary graft? I called your office several weeks ago and spoke with someone but they couldn't give me a price. I'd like to know an idea of how much this will cost if I decide to have this done. Any info is appreciated. Thank you.

the reason you did not get a price is that i do not perform premax augs in isolation. they are part of a rhinoplasty. i sometimes use columellar struts placed low in combination with premax plumping grafts to bring out the premax so in short it would be a rhinoplasty to get that result. since plumping grafts are more subtle, i do not perform them in isolation; and you know my feeling about silicone implants there.

Thank you for your reply's to my questions. I am really considering cartilage grafts to help with my flat premaxilla area, retruded columella, and orbital rim flatness. I was wondering if your office offers computer imaging photos of what the outcome might look like. If so, I am in a different state from your office and I was wondering if I could email you a photo of myself and see what the results could possibly look like. Thank you for your time.

yes, i do offer computer imaging but i do not send to anyone in order to avoid creating false expectations. i only do that in short for someone in my office. the best thing is you could send me a photo at drlam@lamfacialplastics.com and i could comment on the likelihood for improvement in the areas you are asking for.
best,
s.