Dr. Sam Lam Plastic Surgery Forum

Thanks for all your answers Dr Lam...

When people get fat transfer does it ever make nasolabial lines really prominent? Like I notice when I curve my lips up in a sort of smile I get fuller cheeks and then I notice these lines, I guess they are nasolabial lines. So first will the fat transfer take on the look of pushing my cheeks up when I do this smile and second will it give me those nasolabial lines?

Great question. Let's clarify my philosophy, results, and techniques. If fat is placed simply into the cheek, the fold can actually deepen or at least the shadow become more prominent. A major goal in FT is to create not only convexity in the right places along with covering exposed bone but also uniformity, i.e., a diminution of transition zones in the face. Accordingly, not treating the NLF with fat in my opinion can be a bit counter to one of the basic tenets of FT, which is to reduce transition zones. Therefore, I place fat into the NLF in almost every single individual getting fat, especially if fat is placed into the cheek (which is almost always the case).

A few more points of refinement that have been partially addressed but not entirely in this forum:
1. I have repeatedly mentioned that fat is too soft a material to knock out the NLF with consistent results. I have seen nice positive changes here but just do not want to offer that as a bald guarantee. it is simply an area of less predictability when it comes to knocking out a line.
2. as mentioned above, putting fat in the line is still very important but not for the reason of eliminating a fold (as mentioned in #1) but instead to soften the transition from the augmented cheek to the unaugmented upper lip. i use the fat to maintain or further soften the cheek to upper lip transition. i hope that is clear. if not, i would be happy to respond again to further clarify matters.
3. i subdivide the NLF into the canine fossa and NLF proper. i find the most important area to fill is the canine fossa which is situated right at the top of the NLF near the side of the nose because this is oftentimes the deepest part of the NLF and also represents a sign of aging as we lose bone right over this area. gentle augmentation of the canine region will create a much more balanced look without again necessarily eliminating the NLF all together.

suffice it to say, i should be able to maintain if not slightly improve the NLF region but could obviously theoretically make that area deeper but unlikely so. hope that is clear.
best,
sml

Hmmm...this was kind of hard for me to follow. What if a patient doesn't have naso labial lines yet...will it cause them? Maybe that's a better question for me as I am so flat in the cheek I have no lines and I don't want fat, in a an effort to give me more fullness, to create those naso labial lines.

Sorry for the confusion. In short, fat transfer or fillers should not create nasolabial folds. However, just filling the cheek with fillers can make you think they are a bit deeper in occasional cases but not frequently. With fat, it is rarely rarely the case (as i never say never) because I put fat into the line to buttress the area. With fillers if the lines get deeper which they really shouldn't, i can always add a syringe into them to correct them. I am always conservative when I write these responses because I do not want to be absolute in any responses.
best,
sml