Dr. Sam Lam Plastic Surgery Forum

Sorry had to delete the link. Not allowed to promote or denigrate another doc on here. I have probably done a thousand syringes of hydoxyapatite in the past but have not used it for at least 4 years now because I have noted in the past that over time the product makes the cheeks progressively firmer like cement. It just keeps building up residue. Even some of my staffs' cheeks are very firm over time. I prefer fat, restylane/juvederm, and artefill.

i personally think that could be fine. however, i do have some concerns.
1. for young faces under the age of 30 that have sufficient soft tissue envelope but just lack structure then this technique could be valid. however, you do lack the ability to remove it unlike an implant.
2. for anyone over the age of 30, the result can be less than desirable. the reason is that the soft tissue envelope (fat, muscle, collagen) starts to dissipate over that age year by year and the bony augmentation you had when you were younger starts to actually make you look older. the reason for this is that the exposure of bone on the face is a hallmark of aging and the more bone you see, the older you look. this is why cheek implants that are done in one's teenage or twenties start to look bad by one's thirties and almost definitely by 40s.
hope that makes sense.
best,
sml

you do not need to augment bone and fat loss in someone 40. yes, it is true you can lose a little bit of bone but it is so insignificant that the fat alone can cover both. that is not the case if you use an implant which causes too much bone exposed. the people that lose bone would be much older with really bad dentition (dental care). in short, fat grafting is totally sufficient and the right way to go in someone with experienced hands to do it.

it depends on how flat. if you truly have very flat bones, you probably cannot use fat to augment the whole thing otherwise you could have a fat looking cheek. i would have to see you. i do not however perform HA paste or cheek implants.