Dr. Sam Lam Plastic Surgery Forum

Do you ever place fat above the cheekbone? I've seen after pictures of fat transfer patients where the fat is placed up much higher to the eye and some times where the fat is placed lower in the cheek? Do you always place the fat in the cheek in the same spot in every patient or in different places depending on what they want?

Just to think of celebrities, you have someone like Cameron Diaz who has nice full cheeks but her fat seems a little lower and not quite so high up by the eye creating what I believe to be the ogee curve. And then you have someone like Jessica Biel who has her fat/cheekbones very high up on the face.

Is there a general rule about where the fat should be places or does it vary per patient and their facial structure?

great questions. no, i put fat differently in almost every single individual. the only constant is if there is a malar ligament depression, that line that runs from the inner eye to the outer lower cheek, i put fat in there consistently to soften that line. also, under the eye i follow the bony rim. everywhere else is microcontouring. for example, if someone has a fatter lower inner cheek (just above the smile line), i will aim very high in the anterior cheek to blend it away. if someone has a very deep hollow just below the outer cheek bone, i will put fat right below it to blend better there. i subdivide the lower "cheek" known as the buccal area into 3 parts (see the video lecture I gave in St. Louis to understand this better): nearer the mouth is the area where we lose bone around our teeth that i replace. i put it into the central area if there is hollowness there (the most common), I feather it out to the area below the cheek when that area is dropped in. i feather into the jawline and go further into the anterior chin for weak chins. I work around the chin when it is too prominent to make it appear smaller. I rebuild the outer jawline in thin faces that have been further worsened through loss of fat via traditional pull-back facelifts. There are millions of permutations of how I feather a face with fat. I look at it as airbrush work. There is no precise way to explain it but the book I wrote for surgeons is a basic cookbook that I go well well well beyond in imagination. It is very difficult to teach these exceptions but is easy when it is just "put a little fat in the anterior cheek." That is not what I do.
best,
sml

How exactly do you feather the face with fat? Does the cannula go into those areas and put fat there or is there another tool to feather?

I work around the chin when it is too prominent to make it appear smaller.

This doesn't make sense to me? How would fat make a prominent chin appear smaller?

1. feathering means applying small amounts of fat in areas of relatively small depressions relative to areas with relative prominences. remember that the cannula is fanned out from multiple single entry points made by needles. so i gently place small aliquots of fat where they are needed.
2. if the anterior lower chin is sticking out too far,then i feather (place) small amounts of fat above and around the sticking out chin, then it no longer looks sticking out. this is all about artistry and design to make a face more stunning without abruptly changing an identity.
think of a glass of water on a television screen, without a reference point of another glass of water, you have no idea about the size. if i put a larger glass of water next to the original smaller water, then the original water glass looks smaller. next to a smaller one, it will look larger. that is the art of what i call balance.
best,
sml