Dr. Sam Lam Plastic Surgery Forum

You injected Restylane and Perlane in several areas of my face, such as hollow under eyes, cheeks & jowls but unfortunately it didn't last as long as I hoped (and as you explained could happen) but am still happy with results I did get. I do have very pronouned marrionette lines that bother me extremely as they make me look mad & old. Is there anything that you can use that is perhaps permanent (such as silicone)? That would make me extremely happy... thanks for everything, you're an awesome doc.

hi,
typically, if you have lost a little of the product, i can touch it up with a single syringe or possibly two. sometimes, the first week of swelling looks particularly good because it is closer to a fat transfer result. as you know it is hard to make 4 to 5 syringes look like 40 but i try my best. i would love to take a photo of you to show you that i bet a lot of product is still there, more than you think. this is a photo of a woman who flies in from out of country for my botox and fillers and said to me that she thought all of her fillers were gone at 4 months (take a look at the after photo taken at 4 months and tell me what you think):
[attachment=0]Picture 3.png[/attachment]

here is a photo of a lady on the left AFTER another surgeon's facelift and on the right AFTER my fat grafting for the face and silicone for the marionette lines (I think i did 3 rounds). she is shown 1 year after both treatments.
[attachment=1]Picture 2.png[/attachment]

read my blog on tuesday of last week to understand better what i am talking about. so in summary, yes, i can manage marionette lines with silicone microdroplets for a permanent correction minus the effects of further aging.
look forward to seeing you again.
best,
sml

wow. those are some really nice results, especially the restylane/perlane 1st pic- it completely enhanced her cheeks and lifted her whole face, even softening her eyes. Nice. Most clients do seem to think the products run out much faster than they expect until they are reminded in photos.

always take before photos in a consistently dedicated and lit room to show patients. always try to see patients because usually what they are complaining of is inaccurate and needs to be educated. my latest example is i had a lady last week who said, "You made my cheeks too big." I thought, "Hmmm, what is she talking about? She looks drop dead amazing." So she says, "When I smile see how my cheeks get big right here (pointing to the lower cheek)?" I said, "Oh, those get slightly bigger with aging I put the product above it to make that area look smaller when you smile." Fortunately, I had both a static and a smiling before photo (smiling shot for botox) and I showed her how her lower cheek looked so much bigger before my treatment. the reason for this problem is that every patient focuses on the remaining 20% of the problem and thinks that the area is a new problem instead of seeing the 80% correction because 1. they forgot what they looked like a week ago, 2. they now look in front of the mirror 50 times a day after a paid procedure. just a friendly advice to someone starting out. remember, the only photo you regret is the one you did not take.

here is one more advice: retake photos even for restylane after a year and especially after 2 years. i was in the office yesterday (saturday) loading some photos because i did not have time on friday. what was amazing was just looking at several individuals who have been my patients over a few years. one lady has lost significant volume over 3 years and is almost unrecognizable. now, if i did her fat transfer or fillers using her photo from 3 years ago the after result would be a lot less impressive. i had another young lady in her late 30s who came in for fillers. she has been being filled every now and a then for the past 2 years. i decided it was time to take another baseline shot before injection. just comparing her photo 2 years later even after having filled her over that time, she looked more gaunt. thank God I took the shot because when she comes back in a week to compare photos I need to compare them against her photo from a week ago not 2 years ago (whether I choose the before or after photo then, she still looks fuller than the recent photo I took).

this is why one someone says, "How long does fat transfer last?" I always say, "It's permanent if done right but you age." Because I can get someone 10 years to 20 years back and really reset the clock, it will take a long time to start showing your age again. However, in so many photos (there is not a week that goes by) in patients in whom I have taken photos over 2 to 3 years during which time I have not done a major procedure, they have significantly aged in many to most cases. Sorry guys. It really is the truth. That is also why I prefer to permanently correct someone so that I am not just staving off a year or 2 of aging but truly setting the clock back so that I can give you time for further aging. Wow, this has gotten long. I am always thinking and observing and love to share my thoughts here. If you guys don't believe me about the large degree of aging over a short window, ask Constanze all the times I have showed her this fact because I want my staff to be educated too. I can't wait to show her Friday's photos too.