LAM FACIAL PLASTICS

I now charge the same for Perlane as Restylane although I actually have to pay more for it. I place it deeply so the chance of lumpiness is quite small. As I said, if it happens I can dissolve the product within 24 hours.

I'm not worried about it. I know I'll be in excellent hands.

I appreciate your willingness and patience to answer my questions. I can imagine it probably gets irritating after awhile. I'm just trying to be smart about this whole process by being inquisitive and doing my "homework" beforehand.

I look forward to seeing you sometime in April.

Take care and I'll see you then!

no problem. the questions you have probably other people have to. so when i answer them, i am probably answering several people who also wanted to ask but were afraid to or did not want to take the time. see you in april.
best,
sml

Christi,

I just wanted to comment on your statements. I am 29 and just had two vials of juvederm injected for a total of 1,100. I actually need more. I also have very hollow undereyes like you describe. I think that hollow undereyes is a genetic trait and as it gets more prominent in the early twenties, it can cause the smile lines to be more prominent as well. I have seen a pattern of people with our similiar problem. It is very easy to become obsessed with dermal fillers once you get them because as they all absord in our bodies, we want more. This not only can cause us to get into dept but can be a serious problem with our vanity and what we think is so important when really it isn't. Just a word of advice also. I hate smile lines too, that is why I had them filled, but everyone has them. 5 year old children have them even, it is something everyone has from the time they are born and yes, they are visable on everyone. However, some are more noticeable and prominent on some people then on others. Just be careful with this form of vanity you my have, because it can cause problems in your future. Amy

I agree: smile lines are pretty much useless to fill in 90% of cases (see my video on smile lines). Only when there is a deeper "parentheses" or "clown" look is it worth filling in my opinion. I don't have a knee jerk reaction to fill them. I have just filled a 28 and 29 year old in the past couple of days for hollow eyes and volume balancing so I think with disposable income that doing so is fine. However, I agree if you are on a tight budget, just be careful. Feed yourself before you feed your face. Like any behavior, there can be an addiction: buying clothing, eating, etc. Things in moderation and within budgetary constraints are important.
best,
sml

Hello, Dr. Lam. How are you? Doing well, I hope.

My appointment with you is a little less than a week away. I am very much looking forward to it and am counting down the days! I'll be in to get my "smile lines" and hollow under eyes treated.

I'd like to take a moment to pose a handful of additional questions beforehand, if that's alright. Also, please forgive the redundancy of some of them:

1. Are people at risk of suffering any potentially permanent and/or negative side-effects associated with Restylane injections around the eyes (particularly the lower eyelid region)?

2. Specifically speaking - are you aware of any cases where Restylane filler, pertaining to the lower lid, once fully absorbed by the body, has left the patient's under eye skin permanently saggy and stretched out with newly formed bags or loss of elasticity?

Honestly, that's something I'm a bit concerned about. As much as I would love the hollowness beneath my eyes filled out and corrected, I would hate the thought of ultimately trading in one problem for another.

3. Even if permanent and/or negative side-effects haven't necessarily been observed in your own patients, do you have a basic knowledge of any other possibly permanent and/or negative effects relating to patients in general (who've had their under eyes treated with Restylane)?

4. Or, once the Restylane is absorbed by the body, does the under eye skin literally revert back to its previous state before having been injected, essentially appearing as though nothing had ever even been done?

5. I understand that the under eye filler gradually fades over a series of months, but approximately how long do the initial Restylane results last at 100% fullness before the volume begins to wane? One month? Two months? Possibly longer?

6. How do you simultaneously refrain from overfilling <and> underfilling to achieve a preciseness with your injection technique beneath the eyes? Is there an exact method used by all, or is it solely left to the discretion and the trained eye of the individual surgeon?

7. Will Restylane injections help diminish dark circles and discoloration beneath the eyes, if not get rid of the problem entirely?

In a nutshell -- as I'm sure you've already gathered by now -- I must admit I'm a little apprehensive about the possibilities of permanent/negative side-effects being left behind once the filler wears off. Then again, I admit I don't know enough about this procedure, or this product, to know whether or not I'm concerned for nothing and just being overly cautious.

By the way..... you're probably the only surgeon I trust to answer the aforementioned litany of questions honestly. As I've stated previously, most surgeons, sad to say, are too wrapped up in tossing sales pitches at their patients, only telling them what they want to hear, constantly trying to downplay or ignore the possibility of serious/long-term side-effects. I believe that you, on the other hand, are one of the few doctors who gives it to your patients straight. Thank you for your honesty.

I appreciate your time and assistance.

Christi

hi christie,
thank you for your kind remarks. here are my answers below in all caps:

1. Are people at risk of suffering any potentially permanent and/or negative side-effects associated with Restylane injections around the eyes (particularly the lower eyelid region)?

NO, NOT THAT I HAVE SEEN.

2. Specifically speaking - are you aware of any cases where Restylane filler, pertaining to the lower lid, once fully absorbed by the body, has left the patient's under eye skin permanently saggy and stretched out with newly formed bags or loss of elasticity?

NO, I HAVE NOT SEEN THAT.

Honestly, that's something I'm a bit concerned about. As much as I would love the hollowness beneath my eyes filled out and corrected, I would hate the thought of ultimately trading in one problem for another.

3. Even if permanent and/or negative side-effects haven't necessarily been observed in your own patients, do you have a basic knowledge of any other possibly permanent and/or negative effects relating to patients in general (who've had their under eyes treated with Restylane)?

NOT THAT I AM AWARE OF.

4. Or, once the Restylane is absorbed by the body, does the under eye skin literally revert back to its previous state before having been injected, essentially appearing as though nothing had ever even been done?

YES, AS FAR AS I HAVE SEEN.

5. I understand that the under eye filler gradually fades over a series of months, but approximately how long do the initial Restylane results last at 100% fullness before the volume begins to wane? One month? Two months? Possibly longer?

I WOULD SAY 3 TO 4 MONTHS THEN IT FADES A BIT BUT HOLDS IN MANY CASES ABOUT A YEAR OR SO. CHEEKS HOLD MUCH BETTER WITH PERLANE BUT I DON'T THINK WE ARE DOING THAT.

6. How do you simultaneously refrain from overfilling <and> underfilling to achieve a preciseness with your injection technique beneath the eyes? Is there an exact method used by all, or is it solely left to the discretion and the trained eye of the individual surgeon?

TRAINED EYE IS THE BEST THING. I HAVE TREMENDOUS EXPERIENCE UNDER THE EYES DOING SEVERAL A DAY SO I KNOW WHAT I AM DOING.

7. Will Restylane injections help diminish dark circles and discoloration beneath the eyes, if not get rid of the problem entirely?

NO, MOST LIKELY NOT. THAT IS A SKIN AND MUSCLE ISSUE.

Look forward to seeing you,
SML

is it possible to get silicone microdroplet while on accutane (i am not on accutane but am just curious)?

also is it possible to temporarily treat the appearance of icepick scarring with restalyne, if so how much of a result can one really see?

Christi,

I just wanted to share my experiences with you. I am in my late twenties and I remember feeling very worried before I went in to get my smile lines done. I asked a lot of questions and feared a lot. Once you get one thing done, you get more relaxed for the next and then the next. I spent about 3200 app. on 6 syringes. I got 2 syringes of juvederm in my nasolabials, 2 syringles of perlane in my cheeks on the sides (buccal zone) 1 syringe of juvederm in my upper anterior region cheek (area below tear trough in the front cheek), r1 syringe of estylane under my eyes (tear trough) and boy, I look like I did in high school again. Just getting my nasolabial folds and tear troughs done didn't complete the job for me. It took a lot of more and expensive for me. I hope you are happy with your results and next time, don't worry, everything will be fine.

thanks serena. as far as "facial questions" responses: i don't think it is a problem to put silicone in with accutane but personally i would wait until you are done. i don't have to wait a year just maybe a month or so. restylane is not great for classic icepicks in my opinion.

Dr. Lam and Christi,

I have read your conversations, and I am very curious to know how the procedure went. and the outcome result. Did the smile lines and tear trough get treated and with how many syringes?

Reading the posts, it sounds like Christi really wanted her Nasolabial folds treated. At 24, I am curious how deep they could be, I guess genetics and sun exposure play a part to that.

If I may answer on christi's behalf. after careful evaluation, her smile lines were really only apparent during smiling so i felt that it would have been less than stellar in terms of a result. she also wanted her tear troughs filled. aesthetically from what i saw she had a little bit of dark coloration but really not enough to get a great result there. i really only say that in about 1 in 100 people. so what i saw is that what made her not look as fresh and feminine (although she is beautiful) was her anterior cheek and buccal transitions so i did both areas with one syringe of Perlane because she is younger and didn't need much. if she wants more, i can do another one at a price break. i hope she is happy.
best,
sml

Dr. Lam,

That was the result I kept thinking she needed all along. I kept thinking, why at 24 would she want smile lines taken care of. I think she will be happy because the cheek area really is important. Not every surgeon has the artistic eye you do, so I just want to say that you are amazing in what you do for people and how you offer your honesty and input in a situation. I wish all would do that. Thanks for sharing that, I really was curious.

no problem. thank you thank you thank you for the kind words. every nice word means the world to me. thanks!
sml

Dr. Lam,


Dr. Lam, first I would like to say that you are an amazing person. You truly know what is best for people and you make the best decisions for people as well. Everyone respects that about you. I really enjoyed this conversation, it was fun to read and get knowledge at the same time. Good decision Dr. Lam. You are the expert and the cheek area is number 1, I GET THAT TOTALLY. I have to say that at 24 or even up to 28 and a half, I never even noticed smile lines nor knew they existed on myself. tear trough area, never crossed my mind. When I got to be 29, I first developed my smile lines that were prominent and were seen without animation. that was the first time in my life that I noticed them. But smiles lines should only be treated on old ladies after 65 in my opinion in combination with the cheeks and tear trough. If you don't mind me also sharing my opinion as well because I think it is fun to talk this stuff over. I agree that fat transfer is the only way to go. What causes smile lines, well, that would be a a diminishing lack of volume in our cheeks and the result of ac volume and cheek decrease resulting in cheeks coming down rather then lifted up near the upper region like we see in younger children. Treating laugh lines and tear troughs in isolation without treating the cheeks doesn't make sense. It is like seeing a dropped cheek with some filling in the laugh line, that is not natural looking at all. What would create a natural look would be to treat the cheeks including the anterior, buccal zones and laugh lines. with tear trough if needed in that area. that way the area is lifted and looks natural. This result with fillers is hard to do because it is going to get expensive. With fat transfer the fat is there and more contouring and balance can take place without running out of a syringe and then wondering now what.

Dr. Lam, I must say that you are amazing. You made the best decision for that girl. Did you do 2 syringes of perlane total (one for each side of the cheek) for her?