LAM FACIAL PLASTICS

Hi Dr, firstly thank you so much for taking the time to answer these questions! I'm a first time asker from South Africa, and I have some questions on the fat transfer procedure.

I am 22 years old and have quite deep tear troughs and the skin in that area is incredibly thin, resulting in a bluish tint near the corner of my eyes and a strangely textured skin around the area in the orbital rim where the skin is stretching over the bone of the socket. Here are my questions:

a) My research on the Internet shows great inconsistencies around fat transfer to the tear trough area. Some doctors swear by it and/or treat it as a speciality (yourself for example) whereas others who I have been in contact with declare it risky with the potential for lumps and uneveness. So where does the truth lie? Assuming that the doctor is highly skilled and specialises in fat transfer, how much of a risk is there, and if lumps do form what is the procedure to fix them? Does having thin skin increase that risk?

b) If someone (such as myself) has thin skin, can the colouring of the fat show through? Since i can see the bluish tint caused by my blood vessels, it seems intuitive that the colouring of the fat would show through too?

c) I've seen three highly respected surgeons about my tear troughs, all three recommended fat transfer, but I have no idea who i should go about choosing. The one i didn't take a shine to, but the other two i did, although for different reasons. The one was very charismatic, confident and made me feel totally at ease and secure, whereas the other was somewhat more softly spoken but appeared to be more knowledgable and conservative which made me feel safer about the outcome of my face. What criteria do you think are important to consider when choosing a surgeon, assuming you have never seen their previous work to compare against?

and finally...

d) Regarding the strangely textured skin that is stretched over my orbital bone socket, when i pull the skin back with my finger it tightens and the texture improves greatly. Will the fat transfer help achieve a similiar result, almost like pumping air into a balloon would smooth out all the creases?

Thanks for enduring my long-winded questions, and thank you in advance for your answers!

Gavin

hi, in answer to your questions, i have posted them in all caps below following each respective query:

a) My research on the Internet shows great inconsistencies around fat transfer to the tear trough area. Some doctors swear by it and/or treat it as a speciality (yourself for example) whereas others who I have been in contact with declare it risky with the potential for lumps and uneveness. So where does the truth lie? Assuming that the doctor is highly skilled and specialises in fat transfer, how much of a risk is there, and if lumps do form what is the procedure to fix them? Does having thin skin increase that risk?
I HAVE PERSONALLY PERFORMED HUNDREDS OF FAT TRANSFERS AND CAN HONESTLY SAY I HAVE NEVER HAD A LUMP FROM THE LOWER EYELID REGION THAT I HAD TO REMOVE. NOW, WE ARE ALL HUMAN AND IT CAN STILL HAPPEN. I WOULD SAY THAT TECHNIQUE AND EXPERIENCE ARE OVERWHELMINGLY IMPORTANT WHEN IT COMES TO FAT GRAFTING THE EYE AREA. THAT IS WHY I WROTE A BOOK ON IT TO HELP NOVICE SURGEONS STAY OUT OF TROUBLE. I DON'T BELIEVE IT IS MY WAY OR THE HIGHWAY IN GENERAL BUT WHEN IT COMES TO FAT IN THE LOWER EYELID, I AM PRETTY GOSHDARN DOGMATIC ABOUT SAFETY. I WOULD DEFINITELY ASK TO SEE A LOT OF BEFORE AND AFTERS AND ASK THE SURGEON HOW EXPERIENCED HE IS IN THIS PROCEDURE. I DO ONE ALMOST EVERY SINGLE DAY. IF YOU HAVE A LUMP, UNFORTUNATELY THE ONLY REAL OPTION IS TO CUT IT OUT. THAT IS NOT IDEAL BUT SUCTIONING AND TRYING TO INJECT IT USUALLY WILL FAIL. ONLY IF THE AREA IS EXTREMELY FIBROTIC AND THICK WILL INJECTIONS HELP BUT USUALLY A LUMP NEEDS TO BE CUT OUT. YES, THIN SKIN IS A RISK FACTOR. IN FACT, I AM 2/3 AS CONSERVATIVE WHEN WORKING WITH THIN SKIN, I.E., I PUT IN 2/3 THE AMOUNT PER EYELID. I WOULD RATHER COME BACK AND TOUCH IT UP THEN HAVE A PROBLEM. ALSO, SINCE YOU ARE YOUNG AT 22 REMEMBER THAT IF YOU GAIN WEIGHT FROM HAVING A BABY YOU MAY HAVE SOME SWELLING UNDER THE EYE DURING WEIGHT GAIN BECAUSE THIS FAT IS THE "GOOD FAT" THAT TENDS TO SWELL. WEIGHT GAIN IS REALLY IMPORTANT ISSUE WHEN YOU LOOK AT YOUR TOTAL LIFESPAN, AS WE ALL GAIN WEIGHT SO BE PROPERLY COUNSELED ON THAT FACT. FAT IS PERMANENT AND A LIVE GRAFT. IT MUST BE TREATED AS SUCH. IN ADDITION, OFTENTIMES, THE ARTISTRY WHEN DOING FAT IS SO IMPORTANT THAT LIES BEYOND THE TECHNICAL SKILLS. SIMPLY FILLING A LOWER EYELID IS OFTENTIMES INSUFFICIENT TO MAKE SOMEONE LOOK GOOD. HOWEVER, YOU ARE YOUNG SO THAT MAY BE ALL THAT YOU NEED.
b) If someone (such as myself) has thin skin, can the colouring of the fat show through? Since i can see the bluish tint caused by my blood vessels, it seems intuitive that the colouring of the fat would show through too?
THAT IS A GOOD POINT BUT I REALLY AM NOT WORRIED ABOUT THAT IN GENERAL. THE REASON IS I PUT FAT ON TOP OF THE BONE, I.E., WAY BELOW THE SKIN, FAT, VESSELS, AND MUSCLE. THAT HELPS PROTECT THE FAT FROM SHOWING THROUGH. PLUS I USE A VERY CONSERVATIVE AMOUNT OF FAT PER SIDE.
c) I've seen three highly respected surgeons about my tear troughs, all three recommended fat transfer, but I have no idea who i should go about choosing. The one i didn't take a shine to, but the other two i did, although for different reasons. The one was very charismatic, confident and made me feel totally at ease and secure, whereas the other was somewhat more softly spoken but appeared to be more knowledgable and conservative which made me feel safer about the outcome of my face. What criteria do you think are important to consider when choosing a surgeon, assuming you have never seen their previous work to compare against?
FIRST, YOU NEED TO SEE THEIR WORK. ANYONE CAN TALK A GOOD GAME. YOU NEED TO SEE PROOF OF THEIR WORK AS A TESTAMENT TO THE QUALITY OF THEIR LOWER EYELID WORK. I WOULD EVEN ASK TO SPEAK WITH PATIENTS. THAT IS WHY I HAVE OVER 100 VIDEO TESTIMONIALS OF SATISFIED PATIENTS. FAT GRAFTING IS ESSENTIALLY IRREVERSIBLE AND YOU NEED TO HAVE SOMEONE VERY EXPERIENCED DOING THIS WORK NOT SOMEONE WHO MAY TRY IT 2 TO 3 TIMES A YEAR. JUST TAKE YOUR TIME BEFORE SELECTING YOUR SURGEON.
and finally...

d) Regarding the strangely textured skin that is stretched over my orbital bone socket, when i pull the skin back with my finger it tightens and the texture improves greatly. Will the fat transfer help achieve a similiar result, almost like pumping air into a balloon would smooth out all the creases?
NO, THIS IS A STRETCH, NO PUN INTENDED. BE CAREFUL IN EXERCISING THE TWO FINGER RULE WHICH IS STRETCHING A SKIN BACK TO SIMULATE A SURGICAL OUTCOME. IT IS BAD BUT EVERYONE DOES IT. SOMETIMES FAT WILL HELP BY VIRTUE OF THE STEM CELL CHANGES THAT CAN OCCUR. I EMPHASIZE CAN. I NEVER SELL A SKIN TREATMENT WITH FAT GRAFTING. ALSO, WITH THE REPEATED MUSCLE MOVEMENTS, YOU WILL CONTINUE TO HAVE THIS AREA WORSEN. YOU REALLY NEED BOTOX TO HELP SOFTEN, REVERSE, AND PREVENT THEM FROM WORSENING. THERE IS NO REAL PERMANENT FIX AT THIS TIME. OTHER SKIN CARE TREATMENTS ARE JUST SUPPORTIVE TO BOTOX. THAT IS MY FEELING AND OPINION.
BEST WISHES,
SML