Dr. Sam Lam Plastic Surgery Forum

Hi DR! I was watching your videos on youtube. So excellent. Loved the explanation of the "aging of the nose by using the concepts of "hard versus soft" architecture of the nose. The video left me with a doubt, though. For someone relatively young whose nose starts becoming more noticeable out of the effects of the loss of the "soft architecture" of the face, where would fillers or fat have to go? you mention that fat can be used only to a point (as in effective) in a post that someone made about a cavity in the paranasal area. What products can be used and where? you mention the cheeks, in the video. But would the injection of fillers alongside the nose and in the paranasal area help? if so, what type of filler? restylane would work? or should fillers that are injected deeper (under the muscle? work better? What would disguise the problem, in a standard case (if there is such a thing, I mean, what you've seen more commonly) the best? putting filler (if it can be done) around the nostrils? alongside the nose and nostrils? only at the sides of the nostrils? what fillers would be safe and what not? all this assuming that fat transfer would not have a very "target" effect there and that the person would not go for rhinoplasty? Is restylane thick enough to help? or does sculptra, juvederm, artefill (where available) be used instead? it seems like such a difficult area to work with... Hugs and so happy again about the wonderful trip you made

hi,
i think you may be overthinking the video. i am just talking general facial soft tissue loss as compared with the nose. the canine fossa does lose both fat and bone. however, that one area in my hands is hard to make a difference with fat transfer, as we have discussed. depth is not that critical there. i tend to inject it more deeply with fat and less deeply with products. i use restylane, perlane, and artefill for fillers. there is no ideal filler per se. restylane is softer when you smile, but perlane tends to soften a bit over time but lasts longer. artefill is permanent for someone wanting a permanent option but is willing to pay more on the front end. i inject fat more deeply there because i think i get better lift, and i inject product less deep so i can get a better effect. i hope that helps.
best,
sml

My dear Doctor, not only you teach me something, always, but you also make me smile When you said that I had maybe over analyzed the video you made laugh... It is a big flaw of mine that I tend to over analyze everything

It was super clear and I understood the explanation of why you "use" different depths for fat and fillers. My one remaining question is the following: even though it is injected more superficially than fat, I assume that among the fillers, Artefill still has to go under the dermis, right?

Hugs a ton!

sorry, typed up a whole answer then it disappeared. in short, i almost never go intradermal. it is too tight to try to raise volume or deep folds with two exceptions. for tiny smoker's lines or small dermal etches associated with acne scarring, i will go intradermal. no problem with the overanalyzing. that is what this forum is for. lol.
best,
sml