LAM FACIAL PLASTICS

Hi Dr. Lam,

First off, I want to say what a true pleasure it was to meet you in person! I know you see lots of patients, so I will remind you--I am the girl from Chicago and saw you about 3 weeks ago for botox for "jaw reduction". Just want to say that I am seeing fabulous results and I am absolutely THRILLED with how it looks!!

Anyway, I am writing you about skin-tightening procedures, but want to remind you of our conversation so you may answer my question "more in general, for all your readers, and then more specific for me". If you recall, when I was in, I talked to you about fat-grafting or perlane and you told me that I should wait at least a year before doing anything as I was already "full" from my sculptra. BUT, there's one thing that we didn't get into, and that is that I have some areas around the lower jaw and eye area that probably weren't treated by sculptra and I think could benefit from skin tightening laser. So my question for you is do these lasers work, and if so, which ones?? I have read up on Thermage (lots of bad press), Refirm, Titan, and Lux IR, so curious on your thoughts of these and whether or not they work and if there is another one I missed that you would recommend?

Once again, it was really great to meet you and definitley worth a trip from Chicago!
.

Hi,
OF COURSE I REMEMBER YOU! I am glad the Botox is working well. If it is only 3 weeks, you have seen nothing yet. It will really start to take shape in 3 more weeks.

Great question about the skin tightening. I think right now there is a trend toward two major skin tightening modalities: infrared and radiofrequency. Of course, every laser is sold as a skin tightener. Here are my thoughts:

1. I used infrared for a year or so and just sold off my unit. I think the Titan and all that do absolutely close to nothing. You may get a short end result but that goes away in about a month or so. Unfortunately, the hype did not live up to the reality.
2. As far as radiofrequency goes, I just got the Alma Accent XL. I have had pretty good success for body treatments as well as tightening jowls. I think we have to be very careful with high intensity treatments like this in the face. Thermage, for example, has actually been pretty good in the body but not that great in the face with typically two outcomes. At low intensity, there can be no difference. At high intensity, there can be risk of fat loss and uneven results. I think that radiofrequency has yet to be firmly estabilshed but is on its way to being effective but again much more so for the body than for the face. I would be very careful with facial treatments.
3. I think anytime you hear "skin tightening" and "collagen growth" you have to be skeptical and careful. As an example, I wrote a paper about 5 years ago that won the prestigious John Orlando Roe Award for best clinical paper by the American Academy of Facial Plastic & Reconstructive Surgery. In this paper, we showed that the light pulsed dye laser had as much collagen thickness as carbon dioxide laser in a blinded, randomized trial in pig skin (as you may or may not know, pig skin is closed to human skin. also, the pig was not harmed and was adopted by a petting farm by the way for all of you animal rights people). Now that is amazing in that a light photofacial laser had as much collagen change as a heavy duty burn the skin off co2 laser. what is also interesting is that the N-Lite is completely off the market because it does squat. There is another study in which restylane builds collagen. That is dangerous again because I truly think all of these studies have to be met with a great degree of skepticism since "basic science" does not meet "clinical outcomes".
Hope that helps,
SML

If radiofrequency can really melt fat, can't that be used to reduce 'pot bellies' ?

Radiofrequency really is good for very little fat reduction. It is better for overall skin treatments than reducing pot bellies although my mom reportedly tells me her belly is a lot smaller after two sessions of Accent XL. I am next!

For people with a little bit more fat in the belly and who do not want traditional liposuction, I offer a combined service upstairs in my anti-aging center using liposelection and smart lipo. Liposelection is a technique that relies on ultrasound waves to destroy the fat cells. Although it is an office procedure, it still requires insertion of a probe (ultrasound wand) to target the fat cells. Essentially, the ultrasound probe vibrates at 40,000 Hz, which is the frequency specifically targeted to knock out fat cells while sparing other structures. The fat is then removed as a liquid. Smart lipo which involves placement of a small laser wand can then tighten the skin further and effect further fat reduction. This is really again for someone with a small extra belly, not for someone obese.

For someone who is obese, they may require 2 to 3 other treatment methods. First, behavioral modification, nutritional counseling, and hormone balancing may help considerably (all of which can of course help the milder cases of being overweight as well)-- all of which we offer in our building. Second, a lap band procedure in which a tiny band is placed around the upper stomach can reduce the urge to eat can be performed as an outpatient procedure and can be easily adjusted in the office or removed as necessary. We also offer this service upstairs in our building. Finally, traditional liposuction or an abdominoplasty (tummy tuck) may be necessary. For this, you need consultation with a body plastic surgeon.

So in summary:
1. cellulite, small excess fat: radiofrequency (RF)
2. small to moderate excess fat: liposelection/smart lipo +/-RF
3. moderate to excess fat: lap bad and/or liposuction/tummy tuck +/-RF

Do you have experience with mesotherapy with fat melting ingredients? It's not FDA approved but is offered at many places in the states.

yes, i have tried lipodissolve and mesotherapy. it does work but the results are modest. i don't do as much anymore, but i think it is good for modest gains.

Dr. Lam what would be the best treatment for small fat under the chin - it makes my jaw line look diffuse, not sharp, and creates the impression of sagging. I want to restore the sharply deliniated jaw line. I don't have a huge fat double chin, just the angle between neck and chin is not really an angle but a smooth curved transition (maybe the chin is not projecting enough too) and when I tilt my head forward to read, I can really see the fat bulging out as a separate double chin.

What is the usual price for that procedure?

If you are under 40, then you could have liposuction or something lighter like smart lipo/VASER, which are laser assisted and ultrasound assisted lipo for a good result in thinner necks. People that are lipo'd above 40 risk showing up the muscle bands more after the procedure. If you are over or under 40, you could have Accent XL skin tightening combined with mesotherapy to dissolve and tighten the skin. The result would be a bit less but still good if you have limited fat.

Sometimes, what you have is subplatysmal fat (below the muscle) and/or prominent digastric muscles. It is hard to know what the problem is before getting in there. I no longer perform subplatysmal work as I have noticed in a few cases divoting in that area after going just below the muscle.

In summary, I would try some light treatments including light lipo or nonsurgically the Accent XL/mesotherapy (which requires about 6 treatments) but if that fails I would not pursue it with any further aggressive surgery.

[quote="dr. lam"]yes, i have tried lipodissolve and mesotherapy. it does work but the results are modest. i don't do as much anymore, but i think it is good for modest gains.[/quote]

i believe that Lipodissolve is now banned in the UK,as it does,nt live up to the hype.....i did consider it myself for my little 'Buddha belly'

correct about its results. i use it in combination with Accent XL for mild skin and fat issues. Anything more you need smart lipo, vaser, or full liposuction to address. but don't take your fat out until i can use if for your face!

[quote="dr. lam"]correct about its results. i use it in combination with Accent XL for mild skin and fat issues. Anything more you need smart lipo, vaser, or full liposuction to address. but don't take your fat out until i can use if for your face![/quote]

oh eerrr no,i wont.!

good girl!