Dr. Sam Lam Plastic Surgery Forum

hello dr. lam!
i wanted some explanations about the risks of ilp reduction.
first: if i have silicon injection, during the surgery there is a high risk of bacteria infection, which can result in abcesses, how do you low the this risk?
2. in lip reduction, how do you sure that you are not cutting muscle or nerves? and if there is silicon in the muscle layer, do you live it there?
3.what are the different techniques for lip reduction?
4. if there is assymetry in the lip after the reduction, do you charge the patient for the correction of it?

i am asking all of those questions, becuase i want to come to you for this procedure, but i didn't found info about these issues over your site.

thank you,
vered

first: if i have silicon injection, during the surgery there is a high risk of bacteria infection, which can result in abcesses, how do you low the this risk?
GREAT QUESTION. SILICONE UNLIKE ALMOST ANY OTHER PRODUCT IS VERY RESISTANT TO BACTERIA. THE SOLID SILICONE PIECES USED FOR NOSES AND CHIN IMPLANTS HAVE A RARE BUT POSSIBLE CHANCE FOR INFECTION BUT THAT IS NOT THE CASE FOR SILICONE INJECTIONS. IT IS NOT IMPOSSIBLE THEORETICALLY BUT VERY RARE. OBVIOUSLY, I WOULD NOT INJECT SILICONE INTO A LIP THAT I AM CONCURRENTLY REDUCING BUT THAT GOES WITHOUT SAYING. BTW, I ALSO PREPARE THE LIP STERILELY WITH ALCOHOL AND REMOVE ALL LIPSTICK ETC. BEFORE PERFORMING THE INJECTION.
2. in lip reduction, how do you sure that you are not cutting muscle or nerves? and if there is silicon in the muscle layer, do you live it there?
I DO SOMETIMES CUT THROUGH SOME MUSCLE RARELY ANY NERVES THAT WOULD LEAVE ANY PERMANENT NUMBNESS. SURPRISINGLY, THE LIPS ARE THE MOST SENSITIVE AREAS AS FAR AS NERVES ARE CONCERNED MEANING THAT THEY ARE VERY REDUNDANT IN THEIR BLOOD SUPPLY SO CUTTING THROUGH A NERVE LEAVING TO PERMANENT NUMBNESS IS ALMOST IMPOSSIBLE (BUT I NEVER WANT TO SAY NEVER). THAT IS WHY A LIP BLOCK IS SO IMPORTANT SO THAT YOU DO NOT FEEL ANY DISCOMFORT DURING THE PROCEDURE. AFTER THE PROCEDURE IT IS SORE THE FIRST NIGHT BUT NOT PAINFUL. BY THE NEXT DAY, MOST DISCOMFORT HAS SUBSIDED BUT STILL COULD LINGER IN A CERTAIN SMALL PERCENTAGE OF PATIENTS. THE SILICONE THAT IS ALREADY THERE IS NOT TECHNICALLY REMOVED BECAUSE IT BECOMES ACTUALLY PART OF THE TISSUE. I JUST REMOVE SILICONE AND NATURAL LIP TISSUE TOGETHER UNTIL THE APPROPRIATE DEGREE OF REDUCTION IS ACHIEVED.
3.what are the different techniques for lip reduction?
I PRINCIPALLY USE ONE TYPE OF LIP REDUCTION WHERE I REMOVE EXACTLY WHAT I NEED TO REMOVE. HOWEVER, I TAILOR THE DEGREE OF REMOVAL AND THE SHAPE OF REMOVAL BASED ON WHAT I AM TRYING TO ACHIEVE. OTHER DOCTORS USE OTHER REDUCTION TECHNIQUES BUT I HAVE FOUND THAT MY TECHNIQUE LEADS TO THE BEST RESULTS, LEAST DISCOMFORT, AND FASTEST RECOVERY, ALL DONE IN THE OFFICE WITH DISSOLVABLE SUTURES SO THAT PATIENTS WHO FLY IN (WHICH IS ABOUT 90%) CAN TYPICALLY FLY BACK OUT THE SAME DAY AS THE CONSULT/PROCEDURE.
4. if there is assymetry in the lip after the reduction, do you charge the patient for the correction of it?
NO, I DON'T. TYPICALLY ASYMMETRY IS NOT THE PROBLEM BUT IN ABOUT 10% OF INDIVIDUALS I REQUIRE A SLIGHT FURTHER REDUCTION TO GET THE RESULT AS GOOD AS POSSIBLE. IN THESE PATIENTS, I DO NOT CHARGE. OF COURSE, THE SAME APPLIES TO ASYMMETRY. REMEMBER THAT I ALWAYS SAY THAT "THE TWO SIDES ARE NOT THE SAME AND CAN NEVER BE MADE THE SAME." THAT MEANS I SHOULD NOT CREATE ANY ASYMMETRY BUT IT IS VERY HARD TO PERFECTLY FIX EXISTING ASYMMETRY TO THE CLOSE SCRUTINY THAT MOST PATIENTS DEMAND WHEN THEY STARE AT THEIR OWN LIP FROM 3 INCHES IN A MAGNIFYING MIRROR THAT NO ONE ELSE CAN PERCEIVE TO BE A PROBLEM.
BEST,
SML

thanks! i will send you an email.
about the risk of infection, i would prefer to take antibiotics before the surgery, just in case.

vered

i think that is unnecessary but ok.

hi dr. lam!
i called your office today, they said you are busy until november.. anyway, since i am serious about coming to you i have a practical question. you said that you treat bumps with 5FU, so if i have a bump on my lip, would you inject this material and immedatly could do the lip reduction or i have to wait? and if i have to wait, how much time?
since i was treated with steroides for the bumps, could you specify the the function of 5FU, what exacly it does to the granulomas? and how much time it takes to see the result from the moment of the injection?

thanks, vered

honestly, 5FU will almost certainly not work. that is for thick scar tissue. you most likely just have a bump from not great injection. if it is in a lip that i am not working on, we can try it. if it is in a lip that we are working on then we need to wait 3 to 4 weeks to see how things are going. 5-fu is most likely not going to work.