LAM FACIAL PLASTICS

Hi Dr. Lam

My doctor has published quite a bit on fat grafting including a book dedicated to the subject. In these works, he has put forward some interesting stem cell related claims and/or theories about its effects on patients based on his results from thousands of procedures. You are the only other surgeon I am aware of who has extensive experience with facial fat grafting along with a lot of good before and after photo examples. Thus, I hope you can share your professional opinion on the validity of couple of these claims/theories and expand on them a bit based on your own longer term results. I also added a couple more questions at the end.

1. Claims
a. Fat cell transplants often yield visible improvements in the quality and tone of surrounding skin which are ongoing from roughly 6 months to 3 years. After the 3 year peak point, aging catches-up and the skin quality gradually worsens.

b. Fat cell transplants do not necessarily continue to live as fat cells in the host site. They may transform into bone cells or muscle cells depending on where they are placed. For example, placement of fat immediately above the malar cheek bone could actually create new malar bone tissue and yield a cosmetic result similar to that of a hard cheek-bone implant.

3. Also, assuming transplanted fat cells survive and continue on as fat cells, do they behave metabolically like the surrounding fat at the host site or at the donor site. For example, if a patient tended to gain weight first in the abdomen area, then the love handles, then the thighs, and finally in the face pre-op, and fat is transplanted from his abdomen to his face, will that new fat in his face post op behave like the other abdominal fat cells or the original facial fat cells when he gains or looses weight again? If it behaves like donor area fat, wouldn’t that cause cosmetic distortions in patients who undergo dramatic weight fluctuations?

4. Finally, is your book “Complementary Fat Graftingâ€￾ useful for patients or is it addressed just to other surgeons?

Thank you

Hi, I will respond in all caps below to each question:

1. Claims
a. Fat cell transplants often yield visible improvements in the quality and tone of surrounding skin which are ongoing from roughly 6 months to 3 years. After the 3 year peak point, aging catches-up and the skin quality gradually worsens.

I WOULD AGREE WITH THIS ASSESSMENT, AS I HAVE WITNESSED IMPROVEMENTS IN SKIN TEXTURE AND TONE, BROWN SPOTS GETTING BETTER, WRINKLES IMPROVING, AND ACNE SCARRING DIMINISHING. HOWEVER, TWO THINGS: ONE, I NEVER MAKE THIS CLAIM TO INDIVIDUALS BECAUSE IT IS DANGEROUS TO SELL FAT AS A SKIN TREATMENT, ALTHOUGH I HAVE WITNESSED IT IN MOST CASES. SECOND, WE REALLY DON'T KNOW WHAT IS GOING ON. STEM CELL OR OTHERWISE, I DO SEE IMPROVEMENTS. I THINK THE OTHER REASON WE TEND TO OVERLOOK IS THAT THE FACE SIMPLY HAS MORE LIGHT CAPTURE. THAT IS, SINCE WE LIVE IN A WORLD WITH OVERHEAD LIGHTS, THE LIGHT FROM ABOVE THAT HITS A CONVEX BROW, CHEEK, AND CHIN MAKES THE FACE LOOK BRIGHTER AND THEREFORE THE SKIN BETTER. WHEN THE FACE IS RELATIVELY CONCAVE WITH MULTIPLE POINTS OF TRANSITIONS, THE FACE SIMPLY LOOKS WORSE.

b. Fat cell transplants do not necessarily continue to live as fat cells in the host site. They may transform into bone cells or muscle cells depending on where they are placed. For example, placement of fat immediately above the malar cheek bone could actually create new malar bone tissue and yield a cosmetic result similar to that of a hard cheek-bone implant.

I DON'T DISAGREE OR AGREE. I HAVE NO CLINICAL OR BASIC SCIENCE KNOWLEDGE TO SUPPORT OR REFUTE THAT CLAIM. IN ORDER FOR ME TO BELIEVE THIS CLAIM, I WOULD HAVE TO SEE SOME BASIC SCIENCE RESEARCH TO JUSTIFY IT.

3. Also, assuming transplanted fat cells survive and continue on as fat cells, do they behave metabolically like the surrounding fat at the host site or at the donor site. For example, if a patient tended to gain weight first in the abdomen area, then the love handles, then the thighs, and finally in the face pre-op, and fat is transplanted from his abdomen to his face, will that new fat in his face post op behave like the other abdominal fat cells or the original facial fat cells when he gains or looses weight again? If it behaves like donor area fat, wouldn’t that cause cosmetic distortions in patients who undergo dramatic weight fluctuations?

UNFORTUNATELY, YES. THAT IS WHY I PICK MY PATIENTS VERY CAREFULLY BASED ON A STABLE WEIGHT PATTERN. ALL OF MY PREOPERATIVE CONSENTS AND INSTRUCTIONS LIST THE ADVERSE EFFECTS OF EXCESSIVE WEIGHT GAIN AND LOSS FOLLOWING FAT GRAFTING. I GENERALLY SAY WITHIN 20 POUNDS YOU SHOULD BE OKAY BUT THAT MEANS NO PROPORTIONATE GAIN IN MUSCLE DURING WORKING OUT TO OFFSET THAT NUMBER. PLUS, THAT NUMBER IS MORE CONJECTURE THAN BASED ON HARD EMPIRIC DATA. THEREFORE, I WOULD ALWAYS BE CAREFUL WHEN TALKING TO A PATIENT ABOUT FAT GRAFTING REGARDING POSTOPERATIVE WEIGHT GAIN AND LOSS.

4. Finally, is your book “Complementary Fat Graftingâ€￾ useful for patients or is it addressed just to other surgeons?
IT REALLY IS INTENDED FOR SURGEONS NOT LAY PEOPLE, PLUS AT 240 BUCKS I THINK IT IS NOT WORTH BUYING FOR THE LAY PUBLIC. BTW, I JUST FOUND OUT THIS MORNING IT HAS BEEN SIGNED ON FOR A PORTUGUESE TRANSLATION!
Best,
SML