Dr. Sam Lam Plastic Surgery Forum

Dr. Lam,

Studies have shown that aging is due to the loss of collagen and volume in our faces resulting everything coming down. Adding volume lifts things back up. What role does gravity pulling play then? Also, adding collagen can add volume, but I thought a loss of gravity played a role as well?

Would getting botox prevent a lot of future aging as far as wrinkles come and are botox ingrediants natural occuring substance found in a body?

there are a host of factors that create the composite of aging. basically, you have to divide them to understand the issue.
1. volume loss- implants and fat grafting restore volume. i truly believe that volume loss in the majority people are better served being fixed with fat grafting. for reasons why watch my video log on cheeks: the good, the bad, and the ugly. filling a depressed area does not lift it but fills it. we truly have thought everything is gravity by pulling up on our face and saying, "Wow I look better." No, you don't! You have to rethink what you see. Only a consultation with me will help you understand that.
2. gravity- absolutely gravity becomes an issue. at this point, i truly believe that the real area where gravity presents itself is in the neck. therefore, i still believe in facelifts but they are way over done in people too young for no reason.
3. wrinkles and skin damage- a combination of botox, sun avoidance, skin care products, and various types of resurfacing (plasma, fraxel, etc.) are ways to manage these issues.

if you divide the problems of your face into the subcomponents, you will see how each procedure fixes a certain part of aging, not the whole thing. botox does not fix sagging, and fat grafting does not lift tissues (even though you might think they would need lifting, they often don't).

Thank you for your answer. I watched a lecture on a PS doing a nonsurgical cheek lift and he explained that the fat pad in cheeks in this particular person had in my own terms fallen down and he was trying to put it back into place by adding perlane to the cheeks and lifting it up again. Do you really put the falling fat pad into place with fat or a filler restoring volume, or is that fat pad falling a result of gravity and not even a filler can lift the fat pad up. I am so confused because I hear so many different stories about the aging process and los of volume.

the fat pad truly does not fall down it falls inward, i.e., it loses volume. i disagree with cheek lifts. i think cheeks need filling not lifting. even though some docs use the term "lift', i think it is wrong.

you really should be confused because each doc has a different opinion. if you ask 10 people what they think about a certain topic, you will get 10 opinions. when you ask a question on my site, you get mine. of course, i believe that my philosophy is the right one.

That helped enhance my knowledge tremendously, thanks very much.

Since I am emailing you, I would like to ask another question if you don'tmind. In older men and women approximately 63+ years old, I notice bags under the eyes of loose skin it seems. Some are way worse then others. I notice some bags hang down lower almost to the upper cheek area of sagging skin under the eye. What causes this and do you treat any elderly people of this age group very often in your office for this problem and if so, what do you recommend if anything can be done about it. I either assume it is part of the inevitable of aging gracefully or a genetic component because some are more prominent then in others.

let's stage it:
1. a little hollowness: fat grafting
2. a little hollowness and a small to moderate "bag": fat grafting
3. a little hollowness and significant bag: fat grafting plus no-incision fat removal.
4. any of the above plus some fine wrinkles and texture issues: the above surgical treatments plus plasma skin resurfacing with preventative botox.
5. a very significant bag, significant skin redundancy, etc.: all of the above plus a skin pinch.
6. if the bag is continuous with an upper cheek bag, that is a whole different animal. that requires a direct removal. there is really no substitute for that.

and, yes, i treat all age groups but less frequently with these larger bags. if you want to see one of the biggest "cheek bag" removals that literally look like testicles, go under the first tab under "procedures" and slide down to "malar mound reduction".
best,
sml