LAM FACIAL PLASTICS

Hi Dr. Lam, I am 21 years old and I have been using facial fillers for about 2 years now and have become extremely frustrated with the results and in particular the duration of the results. My face is very thin, and my cheeks (area under the eye) are completely flattened. I wanted my cheeks to stand out so I used restylene a couple of times at first, then used Redexis Ultra because of its longer lasting effects (18-24 months). I got my redexis ultras in January of this year, and so they still have 1 to 1.5 years left. Unfortunately it seems like the fillers only look good the first couple of days when there's swelling and the cheeks looks completely filled in. After a couple days, the swelling dies down, and the effect is pretty minimal, leading me to believe this isn't the solution. Not to mention I spent over 5000 dollars for something that won't last more than 2 years.

Now i'm thinking about autologous fat transfer, and was wondering if you could give me some advice/information about it. I want to get fat transferred in my cheeks, and have it make a more permanent effect that won't completely die down after 2-3 days. There are also some permanent fillers I have read about but I get nothing but negative feedback, including permanent facial deformities etc...

What is your suggestion for someone who wants permanent, filled out, cheeks, but at the same doesn't want to go under the knife.

in my opinion there is no easy answer for a 21 year old per se. here are the pros and cons of permanent fillers that i use:
1. silicone injections: would not do this in your case. i tend to do this for small areas like acne scars, etc. i do not think it is a good idea for large facial areas in a very young individual. not a smart idea.
2. fat transfer: great for nicer shaped cheeks that are more feminine and attractive and great for anti-aging. limitation is that fat is truly a live graft not a bioinert substance like silicone injections or a solid implant so that there can be a couple of big drawbacks for someone young like you. first, if you gain weight as you get older, your cheeks can look too big. if you have children, your cheeks can also look bigger. i treat fat transfer very safely. i tend to prefer to do fat transfer in someone at least in their 30s. however, a nice safety situation is that i typically put very little fat transfer in a young person for the aforementioned safety reasons but still am not excited to do your treatment given how young you are. sorry.
3. solid cheek implants- good for poor bone structure individuals who meet the following criteria: a) pretty young person (which you fit) because the thicker fat padding will cover the implant and you will look fine until your mid 30s when the implant gets exposed and you start to actually look older because your bone exposure is now visually accelerated and also you have more hollowness around it making transitions more prominent. if you are young and very thin then a cheek implant will not help matters.

in short, there is no perfect answer for you but i would welcome the chance to see your face to make that decision. i always say "safety before quality" meaning always go with safety even if the quality and cost are less than ideal.
best,
sml

Thx for your input Dr. Lam.

I was a highly competitive athlete in my early teen years and went through some vigorous training. As a consequence I lost most of the fat in my face, or as it is termed "lipoatrophy". Thus the reason for my flat appearance.

Something that I've been curious about is the new permanent fillers such as Artecol and Bio-alcamid. I've read quite a few testimonials around the world, and it seems there isn't too many post-injected complications. I think it all depends on where you inject it and how much. Injecting a permanent Filler near the mouth area could have more consequences because it is a moveable area. The cheeks are an area of less movement, and maybe would react well with some permanent fillers?

artecoll is no longer made in the U.S. since the company went bankrupt as artefill (artes medical actually). if you live outside of the U.S. you may be able to still get it. in general, i would not like to comment on either product, especially the latter which is not FDA approved in the U.S. IMHO, i do not like to use permanent fillers into the face for someone that young. sorry not to give you definitive answers. i just feel safety overrides cosmetic desires and those are my opinions, but they are just opinions.
best,
sml