Dr. Sam Lam Plastic Surgery Forum

no, typically you must fill lines and volume differently. when i focus on volume, i use it augment an area. when i fill a fold, i focus on getting the product into the line. however, if it is a wrinkle not a fold, it is hard to get product into a fine wrinkle. even if you can, it won't last long because you can only put very little product into it. the worst combination is the obsession that 85% of women have with fine lines around the mouth. why is this so bad? first, most people cannot even see it so to fill it to one's satisfaction is impossible because most often times it is only visible to the woman at 5x magnification. second, these lines are so tiny that only very little product can be placed to lift them. third, the injection is in an area of high mobility which means the product result is very short lived. fourth, no one else will appreciate the improvement because no one saw it to begin with even if you think they can. they really can't in 85% of cases. so there are a lot of factors when dealing with fillers that involve psychology of perception, how the product was placed, quantity, and location on the face.

fillers won't really change with body weight. obviously if you lose a ton of weight, the fillers might not look right. but that is why i use restylane so that i can reverse it easily.

no, laughing lines are a botox issue. if you wait too long to start botox and they start going down your face, the botox will fail to capture them. that is why i say to start botox early. you cannot fill up dynamic wrinkles because you will have a lump when you don't smile. botox is to manage dynamic wrinkles. even if your lines go down a large part of your face, botox still will help but just not that great. it will prevent them from getting worse. if you say that you still see a fine line on the face when you don't smile, that is really hard to manage with fillers still because the filler will be squeezed out very fast with dynamic motion, i.e., it won't last long. how do you fix these lines then? not easy. plasma skin resurfacing (rhytec) and other skin peels can at least help a little (not a lot). there is no magic cure. EVERYONE, START BOTOX EARLY AND BE CONSISTENT. if the lines are only when you smile and they are near your eyes, ongoing botox will get rid of them IF THE BOTOX IS DONE WELL. i can't emphasize that to you enough. it is the quality of delivery not just using botox. hope that helps.
best,
sml

Q1)What can this be done when our jowl is obvious and our face shape is getting squarer?
1. if the jowl is slight, then fat grafting or fillers is sufficient. i assume you watched the video on the upside down U? it is in the video log section and entitled something about jawline and buccal area. that will help you to reframe your thinking and move away from just seeing a jowl. the upper recess of the chin and area right in front of the jowl are the areas that age most individuals. that being said, it will also help you have less of a square by augmenting that area.
2. however, if you are older or have a significant jowl then a facelift combined with fat transfer would be required. i would have to see your situation to decide. in short, almost everyone needs fat grafting to the chin and some need both fat transfer and a facelift.
3. radiofrequency tightening (with Accent XL) can help but it is not as assured as the two above.

Q2)Can a younger patient in her 40s opt for laser treatment like IPL etc, to tighten the chin and jowl area(to help remove the ugly line from our nose all the way down to our lower chin), so as we can maintain the inverted diamond shape found in younger faces?
1. IPL does not tighten much. it is intended instead for managing color. see above for tightening with Accent.
2. any lines are not managed with lasers, fat or facelift. they require a filler of some kind like restylane or for certain lines like puppet lines i do use permanent fillers like silicone.
hope those answers help.
best,
sml

I'm trying to find the video that address to the upside down U that concern my jowl problem...could you send the link to me?
http://www.lamfacialplastics.com/plasti ... eo_id,460/

Q1)So,for a younger patient that do not need a facelift from mouth down for now,if i understand you correctly you'd recommend doing a filler to get rid of the 'puppet' line even when we don't smile?
to get rid of the puppet line you need to fill it with either silicone or another filler. fat does not work well there.

Q2)May i know where exactly will you inject the filler as you'd mentioned that by injecting fillers on the line itself will be weared off as there are lots of motion involved when we smile.so was just wondering where do you do it so has to reap the best result and not wasting any fillers.
for fillers i tend to focus on the tear trough, anterior cheek, buccal zone as needed, prejowl and anterior chin.

Q3)When you inject fillers under the eyes area, to get rid of tiredness and dark circles to look refresh and younger...how much cc does a patient usually require per eye hollow area(excluding tear trough)?
if young and only tear trough, then 0.5 cc per side. for older who want most of the rim filled, then about 1 cc per side.

no, quite the opposite. the more you fill into your cheek and chin, the more that the line can be shadowed. you need fillers in your lines directly to counterbalance the cheek fill.
best,
sml

how do you tell if your clothes match? how do you tell a painting is beautiful or ugly? both have subjective elements but also underscore the importance of looking at a surgeon's work and liking it. sorry to be elliptical in this response but taste and artistry along with technical skill is how i would judge a cheek size. also, along those lines, remember that the cheek size must fit the rest of your face or be used to balance a nose or chin. also, what is a cheek? i subdivide a cheek into the anterior high cheek, central anterior cheek, anterior low cheek, lateral cheek, far lateral cheek, subzygomatic portion of the lateral cheek/lateral backfill buccal area, central buccal, medial buccal hollow. most docs see a cheek as a cheek. i see it as an integral component to the face and for proper facial rejuvenation and to make the eyes look better. i saw a lady the other week who was interested in nose work but her cheeks, chin, and lips were overfilled with fat grafting from another surgeon in dallas that literally frightened me and my staff. she was seeing me for her nose and wanted her lips even bigger. i realized instantly there was a profound disconnect. if you do not have the same taste as i do, then i can't have you as a patient. i appreciate your question but it is truly a complicated one. it is important to like an artist's work just as much as your liking a painting before you buy it.
best,
sml