LAM FACIAL PLASTICS

Disclaimer: I fell into the review of this new book out of sheer luck and have no link to the doctor nor his work or practice... I just found interesting how he spoke of observations our dear Dr Lam has made long ago and talked to us about for... ever.
This is from a book published by a Dr called Palmer (honestly don't know anything else about him).

"People that exhibit aging of the entire face and who undergo rejuvenation of the eye/eyebrow area do not regain full facial youth and beauty. While restoring the eye/eyebrow area to aesthetic ideal does have the effect of removing the tired look from the face, it will not enhance the entire face. People look better, but not all over".

Isn't that exactly what the Dr was talking to us about and explained really well when speaking in the blog of the way our eyes are shaped when young versus old and of blepharoplasty's shortcomings for achieving rejuvenation of the eye area.

"If we take the same individual and manipulate the cheek area to its ideal aesthetic size and shape, it is remarkable how much more attractive, youthful and beautiful this makes the entire face appear".
.......
"Other facial features, while important, have far less aesthetic impact. "

This reminds me of how Dr Lam has pointed out that we often, patients, focus on "details" such as smile lines or other signs of ageing that do not really have an impact in how people perceive us, versus what he said about his thinking that people's idea of how young or not we look tends to originate from what they see "in a blink", what they focus on when first seeing us: cheeks and eyes!

In a way, as I was reading that, I was feeling like screaming: hey, Dr Lam already said that! *LOL*

HI,
HERE ARE MY RESPONSES IN ALL CAPS:
Disclaimer: I fell into the review of this new book out of sheer luck and have no link to the doctor nor his work or practice... I just found interesting how he spoke of observations our dear Dr Lam has made long ago and talked to us about for... ever.
This is from a book published by a Dr called Palmer (honestly don't know anything else about him).

"People that exhibit aging of the entire face and who undergo rejuvenation of the eye/eyebrow area do not regain full facial youth and beauty. While restoring the eye/eyebrow area to aesthetic ideal does have the effect of removing the tired look from the face, it will not enhance the entire face. People look better, but not all over".
YES, SORT OF. THE POINT IS TRADITIONAL EYELID SURGERY IS ABSOLUTELY TERRIBLE. FAT TRANSFER TO THE EYES IS BRILLIANT.

Isn't that exactly what the Dr was talking to us about and explained really well when speaking in the blog of the way our eyes are shaped when young versus old and of blepharoplasty's shortcomings for achieving rejuvenation of the eye area.

"If we take the same individual and manipulate the cheek area to its ideal aesthetic size and shape, it is remarkable how much more attractive, youthful and beautiful this makes the entire face appear".
YES, IF IT IS DONE WITH FAT. IF IT IS DONE WITH A CHEEK IMPLANT, IT LOOKS TERRIBLE.
.......
"Other facial features, while important, have far less aesthetic impact. "
AGREED IN MANY CASES. HOWEVER, IN SOMEONE GAUNT THE LOWER CHEEK OR BUCCAL AREA CAN TAKE PRECEDENCE. WHEN I DO FAT, THE GOOD NEWS IS YOU DO NOT HAVE TO DECIDE. I CAN MAKE THE WHOLE FACE LOOK YOUNG AND THAT IS BY CREATING OVERALL BALANCE. JUST MAKING BIG CHEEKS IS NOT ATTRACTIVE. A LITTLE EVERYWHERE IS IMPORTANT. THAT IS TRULY THE COMPOSITE EFFECT I AM TALKING ABOUT WHEN I SAY BLINK.

This reminds me of how Dr Lam has pointed out that we often, patients, focus on "details" such as smile lines or other signs of ageing that do not really have an impact in how people perceive us, versus what he said about his thinking that people's idea of how young or not we look tends to originate from what they see "in a blink", what they focus on when first seeing us: cheeks and eyes!
YES.

In a way, as I was reading that, I was feeling like screaming: hey, Dr Lam already said that! *LOL*

Thank you for the answer and the clarifications !

my pleasure. thanks again for the diligent contributions to this forum.

having worked with a damn good occuloplastic surgeon i would agree about the fat transfer vs cutting debacle.

I'm doing training in Sculptra next month and would love to see what kind of effect that has. It just seems to take forever for results to kick in, but that certainly seems to have a 'whole face' rejuvenation effect, at least from what I can tell (and have been told).

IMHO stay away from sculptra in the temples, around the eyes, lips, mouth, and nose. you can use it in the cheek (malar/buccal) and possible chin but not in the immediate mouth area. i don't use the product anymore for 8 reasons: 1. too expensive, 2. takes too long to see a result (people want immediate gratification), 3. it hurts during injection despite a good block, 4. you need to repeat too many times to get what you want, 5. not good in the areas mentioned, 6. it screws up my fat transfers, 7. risk of nodules in the areas mentioned. 8. need for 3 days of massage. i have talked about this in my videos.

i was attending a lecture (and also giving a few) at cedars-sinai in LA and really had it knocked home for me on why nodules can occur around the mouth. i had one that took me over a year to manage and i can still slightly feel it in the patient at 2 years. sculptra is a "bioactivator", requiring your own collagen to build the product. in areas of intense movement like around the mouth and possibly eyes (although the reason to stay clear of the eyes is that the area is too thin to accommodate the product safely and consistently) you can get lumps no matter how good you are as an injector.

sculptra is one of the easiest products to inject since you just stick it in there and let the product grow, but i remember the defining moment when i realized i would stop training as an injector. i was in austin and i asked a physician, just put 0.1 cc per pass here in the subcutaneous plane. he put 0.5 and started in the dermis. my God, I thought how can you screw up sculptra. but apparently you can. if you have already been injecting other products, sculptra is brain dead easy. i just don't like it for all of the above reasons so i have stopped using it.
best,
sml

thanks for your opinion with sculptra and the advice too. I think the US and UK market are v different. I know in the States people get botox after the age of 30 like getting a haircut :p Here people are still really concerned, conservative etc. The idea that their own body's 'natural collagen is replenishing in the long run' actually appeals to them. I haven't done the training yet but just generally suggesting the price margin and timeline to clients getting botx/fillers, I'm surprised by the number of interest. But I suppose the credit crunch will soon have a noticeable effect

I will check out ur vids btw - the massage and nodules is what the Sanofi Aventis people warned me mostly about when we had a brief. So your tips on avoiding around those areas is certainly golden and probably has saved me from lawsuits (given that I even bother doing the training now!)

cheers

i have done a 100 more vials of botox consistently every year each year. why is that? partly due to an increasingly busier career. but in large part because i spend the time to educate a person about the benefits of long-term botox use. most docs just shove it in and shove you out. no matter how conservative your patient base is, they will respond to appropriate education always.

yeah, i mean i only do this part time, and so i spend AGES with each client (probably over an hour).

I'm actually thinking to start up a UK based blog educating people on non-invasive cosmetic stuff. it still remains a prettty fast growing industry

btw, have u tried macrolane? Saw some results at the FACE conference in the UK and results look very very impressive...

whatever macrolane is, it is not approved in the U.S. yet. i have been thrilled with restylane and perlane so far.
best,sml

oppsie, forgot you only do facial work - macrolane is a very new thicker filler from q-med that they are using here for breast and buttocks enhancements. there's not enough research data but the before/afters were really impressive from the ones i've seen. it's almost as expensive as a boob job though - I think £3k and only lasts a year. I doubt it'll catch on in the US though, since the cup size only usually goes up by 1! i still am astounded everytime i fly back and forth from us by the difference in mentality.

i thought they should call that breastylane.

breastylane. buttstylane. that would be a great range.

i get 5% on these ideas if you use them!

[quote="dr. lam"] sculptra is a "bioactivator", requiring your own collagen to build the product. in areas of intense movement like around the mouth and possibly eyes (although the reason to stay clear of the eyes is that the area is too thin to accommodate the product safely and consistently) you can get lumps no matter how good you are as an injector.
[/quote]

Doctor, just curious: I understand the link between more "movemented" areas and the possibility of the collagen build-up leading to granulomas in those areas.
But is that something that you think would happen relavitely soon after the injection (in a relatively short span of time after the sculptra kicked the collagen build-up)... Or do you think that is something that could happen any time in the life of the patient who once got sculptra?

Said, a person had sculptra 5 years ago : could the person still form granulomas if those did not appear when the collagen was first "build up" after the injection? Or is this risk of granuloma "stay" always there?

Does our collagen keep on building up over years and years after some fillers are put in?
(With fat transfers it does, right?)