LAM FACIAL PLASTICS

Hi Dr Lam,

I had fat grafting in the under eye area and in the upper eyelids two years ago in Europe, because I hollowed dramatically after to much fat was taken after a bad lower blepharoplasty. I have prominent eyes with negative vector. Unfortunately almost all fat has gone away, except for hardened fat bumps and a ridge both in upper and lower eyelid area, which are very noticable. I've since then visited 5 different Plastic surgeons and they all seemed to be clueless. One suggested to put in some more fat, another one suggested to cut it out, but the outcome would be unpredictable and could give some more visible scarring. What is according to you the best option. Its now a raised bump, near the tear through. Is F5U an option? I'm desperately seeking for the best long term solution since I'm only 40 years old. I can send you some pictures, and am willing to fly over ! Thanks in advance Kind regards, Luc

I'm really sorry to hear of your situation. Short of seeing you in person, here are some guidelines I have listed in my first book on fat transfer:
1. lump- this is a soft ball of fat placed too big and too much into a discrete area. the best way to handle that is through an excision along a discreet incision like the tear trough or upper eyelid crease.
2. bulge- a firm, long, fibrotic cigar roll due to placing fat in the wrong plane and too much of it in that area. that should be best treated by using a combination of super dilute steroids/5-FU or maybe starting with 5-FU.
hope that helps as a start. i have managed both conditions but fortunately not from one of my patients. you can obviously have your surgeons buy my book, learn how to do it, or you can come to see me to take care of it. Hopefully they can manage it, which is more realistic. My book is Complementary Fat Grafting. Btw, I get like 3 dollars per book so my incentive is not to make a buck on my book. It is to make 3. Just kidding.
best,
sml

Thanks Dr Lam, a follow up question. By removing the hard parts, I will lose further volume. Will the cutting make more scartissue? Since I probably need another round of fat will this scartissue be a problem for further complications? Or do I need to stick to fillers?

Kind regards

If you have a lump, then you should remove it. if you have a rigid bulge, you should soften and flatten it before any further fillers. you really in most cases can't cover those problems. those problems should not cause volume loss since the doc should remove only the bump and not the principal volume.

you should have be safe to have fat in the future by someone who is good at it, and i would love to do it for you. scar tissue should not be built up but you will have a linear scar in the area that you remove the lump if that is your problem rather than a bulge. there is no real way around it. microliposuction for a discrete bulge is very unsuccessful but theoretically possible.
best,
sml