LAM FACIAL PLASTICS

Hi Dr. Lam,
I want to thank you for the commitment and passion so visible in your work. I'm an artist in my twenties, since I was 13 I've sketched, painted, and studied the face with an obsession. I'm asian and there's something that has always bothered me about my face. I feel like my face looks flat, not just because of my wider-set jaw or cheekbone but because the maxilla around the nose appears recessed and my brow bone seems flat. I guess I would make the comparison to the profile of a Bulldog versus a Husky. I don't feel like reshaping my nose or adding an implant to make the tip project further would give me the profile I am looking for (see: Pinocchio). I don't think my nose is particularly flat, it appears flat because the base is concave and the maxilla region around my mouth juts out accentuating the nasolabial fold. I feel as if alot of surgeons dismiss this region, I drew an illustration of what I meant below:

I exaggerated alot of features in the illustration above. I would hope that most of this midface region would be addressed via implants or fat fillers instead of breaking bones and repositioning them.

My question is, are the current advances in plastic surgery addressing this area? What are the available procedures and methods as of today? What are your thoughts on the topic? Pros and Cons to addressing facial balance in this way? How complicated or dangerous would this method be? I just wanted to pick your brain and see what you thought and maybe perhaps what the inner circle of plastic surgeons may be discussing regarding this region. Thank you =)

thank you for the question and comments. there are many ways to skin a cat, so to speak. however, there are also many things that i do not perform simply because i don't have enough volume to be good at something. that being said, i have featured other surgeons' work in my book, Cosmetic Surgery of the Asian Face (2nd Ed.).

For the forehead if the forehead appears too flat, forehead implants can be used such as silicone that must be custom made using a wax template and dental alginate. If the frontal bar (just above the brow) is too thick, you can burr down the bone until it is flatter.

For the midface, obviously you know you can perform a LeFort style osteotomy, meaning a midface bony advancement or recession. However, in Asians with a retrusive midface, you can implant the area just below the nose called the premaxilla with an implant. I do that with diced ear or nose cartilage all the time during an Asian rhinoplasty. However, there is slightly less lift effect than when using a silicone block implant. I stopped using silicone implants there because people hated how the implant felt during smiling. It can restrict smiling a lot.

As far as the upper retrusive chin is concerned, you can do a bony type advancement again by a qualified oro-maxillofacial surgeon. However, a solid implant in that area just below the lower lip is not safe since there are nerves right there. However, I perform fat transfer all the time there because in all races it tends to age us when fat and bone is lost over time in this area. That is safe but in someone very young such as yourself looking for isolated augmentation with fat grafting, I do not believe it is safe since the fat is a live graft and can change over your lifetime, especially if I am just augmenting a small area of your face like that. Also, keep in mind that if I am just augmenting an area with soft tissue and your true deficiency is bony then I can make the area look fat and not structured. If it is slight then fat works, if it is significant you need to consider bony advancement surgery,which yes is much more invasive.

As far as the term "mid-face lift", as you have termed your entry, this is almost always inappropriate in every case since there is no benefit for a young or old patient. We do not have gravitational forces on the entire face. If you go to my section vlog and watch rethinking gravity video, you will have a better understanding of what I am trying to say.
best,
sml