Dr. Sam Lam Plastic Surgery Forum

Hello Dr Lam,
Thankyou for your generous teaching. I'd like to learn more about the injection site with 18 i nch cannula to midface and the blocks you use for the face. Do you have just one injection site and then target the periorbital/ malar/zygomatic areas and mould it towards the areas? If it's all in the hand out given at the lecture " Injectable fillers for volume contouring' at Hilton Head South Carolina 2007, would it be possible to purchase it? Thanks again.

interestingly, i constantly refine my techniques. the techniques you see there on that lecture are far outdated. i have now moved forward to micro puncture micro transition technique that i do with a stationery needle (instead of cannulas), no blocks, and i can hit small transition facial zones in less than 2 minutes. again no blocks. it is amazing. it is distortion free and you can see the results in a minute. now when i do the eyes that is the only time i use a cannula but i have now moved to 22 gauge (much much much smaller than the 18 gauge) so there is almost no discernible needle stick at the insertion point after the procedure and also what i call a "needle push" technique to capture the outer part of the eye known as the canthus. i have developed all of these techniques myself and you simply put will not find them anywhere. once you've experienced it, you will understand especially if you have tried fillers before.
best,
sml

Thankyou. I've been using Juvederm ultra mixed with adrenalin and lidocaine targetting midpoint infraorbitally and using a bolus dose - directing half to inner and half to outer canthus, then moulding it around the infraorbital rim as it's quite fluid. ( 1:1 dilution). I've heard of the splaying side effect from Juvederm but have not encountered it personally as yet - maybe I've been lucky? From this needle point insertion, I then inject ultraplus to anterior cheek and zygoma. It's virtually painfree but occassionally there is some bruising still, that's why I was interested in your usage of a cannula - I'll try the 22 inch one. What formulations do you tend to use Restylane/ Sub Q or Perlane for the cheeks? What's your experience been with Restylane vital? I'm off to a 10 day Buddhist silent retreat today so will look forward to your reply on my return.

i prefer perlane for cheeks and chin, and restylane for under eyes, brows, temples, noses. i use one area for the under eye with a cannula and a separate needle push for the outer canthus. now, i use a needle stick technique for everything else. i don't use as many cannulas for the rest of the face due to more precise targeting with a needle aiming superficially. it works even better in my hands. i can use less product with better results.
best,
sml