Dr. Sam Lam Plastic Surgery Forum

Dr. Lam, let me start of by saying that you are absolutely brilliant. A true Da Vinci of your craft.

My story starts in my adult life, where I blossomed from a awkward adolesant into one that was undeservingly treated like royalty because of the way he looked. One who drew in the eyes of everyone he passed by on the street. One who could come home from a bar with 14 new female phone numbers in a single night. Even spent time modeling in an exotic country. I became used to that attention, and as pitiful as it may sound, I even relished in it and then one morning I awoke, sometime last year when I was 28, I woke up and poof. It was over. No more celebrity like attention. Nothing. Nada. Went back to being a regular Joe. My weight didn't change. I wasn't invloved in a disfiguring accident. Had I aged overnight? I began to examine myself very closely and quite honestly I didn't see a difference. Perhaps a couple of new fine lines but nothing you could notice standing within 3 feet of me. Perhaps it was because now I have found my true love and female companion in life. I questioned. I pondered.

But the closer I began to look, the more flaws I began to see. Not changes that occured, but likely that I always had but was noticing now because I looked so closely. Perhaps its not the changes of aging that I cannot accept, but the changing role that I now play on this planet. Shallow or not, I miss who I was. Still I wonder if it is actually the contours of my face that have changed, or if there is some youthful spark in your eyes that goes out when you reach a certain point of maturity that no ammount of plastic surgery will recapture.

Can you restore me to my former glory? Or am I chasing something that is fruitless?

wow, that sounds more philosophical than plastic surgical. given your younger age bracket, i am not certain what is "aging" (as we all age and we age depending on previous "lifestyle" like smoking and sun exposure and genetics) and what is psychological perception. this sounds much more involved than something that i can answer in this forum.
best,
sml

Got it.

I'll take it down a notch from the philisophical mumbo-jumbo and make this discussion a little more plastic surgery specific.
I am now a 29 year old male, half italian/half swedish, blue eyes, brown hair with a pale olive complexion in the winter, but I tan quite easily in the summer and burn sometimes as well. I would say that I am likely Fitz skin type 3. I am looking to address the static fine lines that seemed to spontaneously develop under my eyes in the past year. They are actually not in the crows feet area, but somewhere slightly below (this area has always crinkled when I smiled so I'm guessing the fine lines were caused by the repetition of this movement). I also have some expression lines on my forehead. Pores also seem a little larger.

Botox- Is it really going to help static lines? I've heard various opinions on this which all seem to differ.

TCA Peel- Is it really enough to wipe out fine lines? I heard that once the swelling subsides, so do the improvements.

Pixel- Is a fractional erbium really going to get me there? I heard of people going in for many treatments {not at your establishment just in general} without substantial improvement.

Plasma- I've heard you are a master of this device. I have also heard of many people suffering complications because they went to other doctors who were not. Apparantly this treatment is very difficult to administer. As confident as I would feel in your capable hands, there is no telling how anybodies skin is going to react to major resurfacing and textural changes are always a possibility. Is this device too hardcore for somebody who is only going through mild aging related changes and perhaps overkill for someone in my age bracket and of my skin type? (I know from reading your forum that your esthetician preforms the lighter treatment and I'm sure she's great, but I ain't letting an esthetician touch my face lolz)

Thanks!

Botox- this is the single most important thing you do. yes, botox has a harder time under the eye area but the injector must go under the eye and do it aggressively and smoothly. most doctors inject 2 to 3 injections. i inject 9 or more per side. this makes the result much smoother and i go right under the eye. there really is very minimal discomfort with my technique. you will go elsewhere, have a painful experience, and then say, "there is no way this doc can do 4 times the number of injections with no pain". but try me to believe me. botox in this very hard to treat area requires not only good technique but consistent application. watch my video logs on botox tutorial: botox like a shirt, botox like exercise, and botox scale. you will really understand why nothing will help the crease unless you knock out the source problem which is the movement causing the creasing.

TCA Peel- agreed. it is very hard to get sustainable results. that is why i stopped a few years ago in replacement using plasma. however, the tca peel for light skin damage is great. it just does not affect deep skin problems. around the eyes? not bad. but remember the shirt analogy, if you iron the shirt and wear your shirt again (move the shirt,i.e., move your skin), NOTHING works. you must stop the movement. i had a 26 year old who had premature sun damage. i got her through 1 year of botox. because she is so young, her collagen really healed well and now i told her she could take a hiatus from botox. again, you MUST WATCH THE 3 VIEOS I OUTLINED. it would take a book to write the answer here. if you don't watch these videos, you simply won't understand it.

Pixel- agreed. it is a good light treatment for skin like tca peel but for constant wear and tear areas like the movement zones, you first need botox. are you getting a theme here?

Plasma- the best thing for texture and tone but okay only for wrinkles. it does help the skin look much better but for what you are wanting it to do it won't work well. yes, even i had problems early on with 2 to 3 patients having delayed healing. however, i helped the company set guidelines for safe administration and i have not seen ANY issues in 2 years. here is the big problem: the company went chapter 7 two months ago so i am doing my last 2 to 3 patients and i have no more nozzles. i hope the company restructures. if it does, i will mention it here. however, really the use of plasma in the U.S. is at a standstill for now. the company's state does not reflect the quality of the laser but the fact that the entire laser industry is in peril given the current economic climate. surgeons are just not willing to invest $100,000 into a laser purchase right now.

hope that helps,
sml

Regarding Rhytec. I also heard of their financial woes. Some other US plastic surgeon claimed he was going to continue receiving nozzles from their european branch. Hopefully something can be worked out.

Anyway I'm interested to see what you can do with Botox. See you soon!

don't wory, i think i will grow old doing botox, or not, so to speak.
sml

I had to comment on this. Sometimes "pretty people" never develop their inner selves, the intelligent strength that comes from occasional struggles. They learn early on that their looks are their essence...and they go through life based on that one thread, never using their other aspects to gain substance. Then one day they wake up and it's gone, or fading. And they are lost.

There is a very small amount of time that we are in our "prime" and the other decades we will be growing old....so we need to make other aspects of ourselves vital because life shouldn't come to a screeching halt when your face no longer garners the attention you once had.

MORAL: Live everyday like you are humble...homely....and happy.

(I can say all this because I had to learn this lesson myself.)

Thankyou Esmerelda. I know, that you know, that i know how true that is. I really needed to read this today. X

interesting comments. thanks for all of your contributions to this forum!

Thanks for the comments guys. Very true.

Okay Dr. Lam I have sent you a pic, and I understand some of this may come off as nitpicking and that nobody should be looking for perfection when it comes to things plastic surgery related, but this is how I make a living and as I have been aging, it's becoming increasingly difficult to compete with guys 10 years younger than me at castings and perfection truly is required.

So besides the fine lines beside my eyes, which are difficult to capture in the picture. Here are my issues,

1. Texture of skin is appearing more rough these days (too much sun and partying). I would really like freshen up the appearance of it with some measure of resurfacing (Tried Retin A not helping) but also without taking a great deal of risks. Any suggestions?

2. We've already spoken about botox and I definately need you to do it beneath the eyes, between the eyes, and on the forehead, but will I also need resurfacing to help minimize those forehead lines?

3. My right NL fold. It has become increasingly asymetrical to the over the years. The only thing I have done plastic surgery related so far, is that I have tried to fill it in twice over the past three months, and as you can see in the pic, with NO success. It actually looks exactly the same even though I went to two different doctors and they tried two different techniques. One injected it superficially, and the other injected it deeper. Half a vial of Restylane each time from two different doctors. Never budged. Do you think this is something that can be fully corrected? Also, the bag under my left eye is starting to look increasing large when compared to my right eye. When looking back at my pictures from 5 years ago, the areas were perfectly symetrical, but now in every photograph, no matter what lighting, they are not.

5. The area under my chin is looking a little more slack.

6. I don't have a lot of fat on me so I doubt a fat graft would be possible, but do you think you could enhance my look with facial fillers even beyond the problems I have listed. I really want my bone structure to pop in photographs.

If you can answer any of these questions it would be greatly appreaciated.

Thanks,

J

1. Texture of skin is appearing more rough these days (too much sun and partying). I would really like freshen up the appearance of it with some measure of resurfacing (Tried Retin A not helping) but also without taking a great deal of risks. Any suggestions?
SUN WILL CREATE 13 YEARS OF ONGOING COLLAGEN DESTRUCTION. YOU WILL CONTINUE TO AGE FROM CUMULATIVE SUN DAMAGE. YOU CAN'T REPLACE A PEEL OR A LASER TO FIX THAT LEVEL OF COLLAGEN FRAGMENTATION. I CAN'T READ SKIN FROM A PHOTO BUT AT LEAST YOU DON'T LOOK TERRIBLE. I WOULD SAY FIRST AND FOREMOST CONTROL YOUR SUN EXPOSURE: THAT MEANS NO TANNING OR TANNING BEDS, SPF AND HATS. SPRAY TAN IF YOU WANT COLOR. O/W NOTHING ELSE WILL REALLY HELP. YOU NEED BOTOX TO START BUT I WOULD HAVE TO SEE YOU IN PERSON TO SEE HOW LEGITIMATE EVEN THAT COMMENT IS. YOU CAN DO PLASMA AT LOW ENERGIES OR HIGH ENERGIES BUT THERE WOULD BE RECOVERY TIME AND EVEN THEN IT MIGHT NOT BE ENOUGH SINCE YOU DON'T HAVE A LOT OF DAMAGE PER SE. JUST TRYING TO HAVE A HAPPY PATIENT.

2. We've already spoken about botox and I definately need you to do it beneath the eyes, between the eyes, and on the forehead, but will I also need resurfacing to help minimize those forehead lines?
IF YOU ARE TALKING JUST ABOUT LINES, ALL YOU REALLY NEED IS BOTOX AND PATIENCE. TYPICALLY GIVEN YOUR AGE, YOU SHOULD BE ABLE TO MANAGE MOST FINE LINES WITHIN A YEAR OF CONSISTENT USAGE.

3. My right NL fold. It has become increasingly asymetrical to the over the years. The only thing I have done plastic surgery related so far, is that I have tried to fill it in twice over the past three months, and as you can see in the pic, with NO success. It actually looks exactly the same even though I went to two different doctors and they tried two different techniques. One injected it superficially, and the other injected it deeper. Half a vial of Restylane each time from two different doctors. Never budged. Do you think this is something that can be fully corrected? Also, the bag under my left eye is starting to look increasing large when compared to my right eye. When looking back at my pictures from 5 years ago, the areas were perfectly symetrical, but now in every photograph, no matter what lighting, they are not.
SYMMETRY IS ALMOST IMPOSSIBLE TO FIX. PLEASE GO TO THE SEARCH BUTTON AND TYPE IN SYMMETRY,YOU WILL SEE MY THOUGHTS ON THAT. I CAN'T TELL YOU IF YOUR RESTYLANE WAS INJECTED RIGHT OR IF IT WAS JUST YOUR ANATOMY. LINES ARE ALWAYS HARD TO MANAGE TO ONE'S SATISFACTION. ALSO THE RESULTS ARE NOT AS LONG LIVED. I TEND TO USE PERLANE TO GET A BIGGER LIFT AND I NOW ENCOURAGE PATIENTS TO MENTALLY COMMIT TO TWO CONSECUTIVE ROUNDS ABOUT 1 TO 3 MONTHS APART TO KICK IT UP A NOTCH. EVEN THEN, NO PROMISES. I CAN WORK UNDER THE EYES WITH RESTYLANE WHICH IS SMOOTHER THAN PERLANE UNDER THE EYES. HOPE THAT ANSWERS THAT QUESTION WELL ENOUGH.

5. The area under my chin is looking a little more slack.
IT MIGHT BE SOMETHING ONLY YOU SEE. GIVEN YOUR AGE AND THINNESS, YOU PROBABLY COULD JUST DO SOME RADIOFREQUENCY LIKE ACCENT OR JUST SIMPLY STOP STARING AT YOUR NECK! SORRY, JUST TRYING TO SAVE YOU MONEY AND REFOCUS YOUR PERSPECTIVE.

6. I don't have a lot of fat on me so I doubt a fat graft would be possible, but do you think you could enhance my look with facial fillers even beyond the problems I have listed. I really want my bone structure to pop in photographs.
YES, GIVEN YOUR AGE AND WHAT I SEE IN THE PHOTOS, I THINK FILLERS COULD BE SUFFICIENT.

Thank you for the comprehensive, realistic and honest reply. I will consider everything you say