Dr. Sam Lam Plastic Surgery Forum

Q1)When you doing the cheeks, do you just inject fillers on the anterior cheeks and the outer cheeks as well? What's the difference if you just do the anterior cheek only?
YES, I DO THAT AT TIMES WHEN I AM TRYING ARCHITECTURALLY TO NARROW THE FACE. FOR EXAMPLE, SOMEONE HAS A RELATIVELY WIDE FACE, I WOULD DO THAT ON THAT INDIVIDUAL, I.E., NOT PUT FAT IN THE OUTER CHEEK. ALSO MANY KOREANS, SOME VIETNAMESE, AND FEW CHINESE HAVE A WIDE FLARED CHEEK BONE (OUTER CHEEK) THAT I DON'T PUT FAT IN OR PUT VERY LITTLE FAT IN TO CREATE A SLIMMING EFFECT TO THAT AREA. THAT IS PART OF MY DESIGN WORK. ALSO, I HAVE PEOPLE THAT HAVE UGLY CHEEK IMPLANTS AND DON'T WANT THEM REMOVED SO I FILL THE ANTERIOR CHEEK ONLY TO OFFSET THE UGLINESS. I RATHER FILL THE OUTER CHEEK AND CREATE A NICE CONVEX HIGHLIGHT BUT IN THE EXCEPTIONS ABOVE, I DON'T.

Q2)As for the eye area to look less tired and more rested,can we just do the outer eye area but not the tear trough area?what is the effect if only outer eye area is being filled only:D
HMM, THAT IS AN ODD REQUEST. USUALLY AS WE HOLLOW THE WORST IS IN THE TEAR TROUGH AND SOMETIMES THE OUTER EYE IS NOT HOLLOW AT ALL SO I DON'T FILL IT VERY MUCH IN CERTAIN CIRCUMSTANCES. SOMETIMES THE HOLLOWNESS IS WAY OUTSIDE NEAR THE OUTER EYELID AREA CALLED THE "LATERAL CANTHUS". I FREQUENTLY FILL THAT AREA TO ACHIEVE BALANCE IN THE LOWER EYELID. OF COURSE, THERE ARE ALWAYS EXCEPTIONS SO I WOULD HAVE TO SEE YOUR EYELID AND FACE TO TELL YOU THE ANSWER TO YOUR PARTICULAR SITUATION. IN GENERAL, YOUR REQUEST IS ODD BUT I WOULD NEED TO MAKE SURE THAT I WOULD HELP YOU RATHER THAN HURT YOU IN DOING YOUR REQUEST.
best,
sml

the lumpy result is 100% technique. that is why i go deep with cannulas for both fillers and fat. i really see consistently smooth results. that being said, yes in many cases, you can look a lot better even if i don't hit the lower rim BUT I NEED TO SEE YOU to make that decision. in most cases, i would still recommend my doing it. simply put, i am much better. sorry for the arrogance, but i know your fears. i have seen too many bad results under the eye (but not from me.)

if you are going to add fillers on top of fillers, you should be fine. no need to dissolve unless the previous work is bad. then i would not refill the same day o/w you will dissolve my fillers at the same time plus, i need to see how much is filler and how much is you. ideally for those who live in dallas, i wait 5 to 7 days so that any small swelling will not be present. for out of town individuals, i usually would inject it the following day if i had to dissolve the previous work. remember if your previous work is fine, then i can add to it without dissolving.

i don't think a deeper injection would lead to less bruising. i think the # of passes can lead to more bruising. the depth can affect how smooth the result is. sometimes deep injections can last longer sometimes actually less long. longevity is more dependent on the product (perlane instead of restylane) and areas with less movement (cheeks versus smile lines). i go deeper depending on the area i am hitting. very deep - lower eyelids (for smoothness), medium depth - cheeks and chin, right near the skin when i am trying to lift a ligament (malar septum prejowl) or crease (fold or scar).
best,
sml

everyone one is different. because sometimes you really need 20 to 30 cc of fat, the filler result can actually look better immediately after injection since the swelling can make up for the difference between fat and a limited filler. however, in many cases people only notice the swelling and are concerned. i would say minus bruising the swelling with volume-based fillers may have a 2 to 3 day "recovery" that really typically is not that bad.
best,
sml

thank you! you too!!!

it depends on how old you are, how i place it and where i place it. i know how to get a result in a cheek with half a syringe each that most doctors cannot get even with 1 syringe a side. can't give all my secrets out here!