Dr. Sam Lam Plastic Surgery Forum

by **summertan** » Fri Nov 30, 2007 8:00 pm

Dr. Lam is it true that nasolabial lines are caused by the malar fat pad sliding downwards due to gravity? Is it proven it really slides downwards or it's just a hypothesis like the going down of the upper eyelids which you say actually don't go down but only deflate due to fat loss.

If the malar pad is really sinking, does it slide with respect to the facial muscles or it is the muscles that get loose and the pad follows them? I am asking because there are claims from facial exercise programs that toning the muscles will raise the pad back to the previous position. If the pad is not attached to the muscles in a rigid way, I don't see how that would happen.

by **dr. lam** » Sat Dec 01, 2007 8:37 pm

You can ask ten surgeons and you will get ten answers. I truly believe that the fat pad does not slide down but really deflates. Now a very heavy malar fat pad may both hypertrophy (get bigger) and possibly slide down in the setting of hollowing in the upper cheek that would make that lower portion seem much worse. The malar fat pad in my opinion would not be significantly improved with muscle exercises. Why do I think this? Because a full surgical midface lift that releases all of the musculature and suspends the malar fat pad still FAILS IN MOST CASES BECAUSE IT IS A VOLUME ISSUE. So if a full surgery fails how can a few muscle exercises help? How do I know about midface lifts? I wrote the book on it. My first book, Comprehensive Facial Rejuvenation, was all about midface lifts. I have since abandoned this essentially useless procedure that is much more highly invasive than fat grafting. At least that is my opinion.
Best,
SML

by **summertan** » Sat Dec 01, 2007 11:49 pm

Thank you for answering. The facial muscle exercise programs claim they create volume by muscle hypertrophy but the proof they can generate enough hypertrophy to fill in significant volume deficiency is really shaky - mostly based on smiling pics LOL.

If the malar pad doesn't fall down, how do the nasolabial lines actually form? I can't imagine the process. Could it be sinking/deflating of the skin triangle formed by the mouth and the nose with respect to the cheeks? What is your working theory about it?

by **dr. lam** » Sun Dec 02, 2007 1:58 pm

First of all, oftentimes folds do not deepen. When they do, I think it is a combination of deflating the midface where the line gets deeper as the midface falls inward. I also think there is a gain of weight in the lower cheek that can make it hang so that it looks like a deeper line. Also, I think there can be some sag in the midface leading to the line so yes, some gravity can play a factor. In summary, even though you may have some gravity fall in the midface, the principal mechanism that occurs is hollowing in most individuals. I think when the midface truly begins to sag if at all, the neck does as well. At this point, my face and neck lift does capture the midface to lift it up but I don't think the midface really requires much lifting.

Dr. Sam Lam Plastic Surgery Forum

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nasolabial lines and sagging of the malar fat pad

nasolabial lines and sagging of the malar fat pad

midface lift?

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