LAM FACIAL PLASTICS

Hi Dr Lam,

I've noticed that my face looks very bloated in the morning after having Juvederm injected to the cheeks/nasiolabial folds and restylane under the eyes about 2 weeks ago. My face puffs up enough for the skin to feel kind of tight when I first awake (similar to having way too much salt for dinner during pre-menstural week). The puffiness gradually subsides over the morning. By lunch time it's pretty much back to normal.

Is this because these types of fillers attract water so well? Could the puffy effect potentially stretch the skin?

Since you are a master of fillers, have you come across this type of issue before & is there any way to prevent it?


Many thanks

hi,
the hydrophilic component does not typically extend that far out in time, but you could have a problem if your lymphatics are obstructed. sometimes the lymphatics get obstructed and over time clear. it is hard for me to give you a diagnosis over the Internet and also inappropriate. of course, whoever injected you should be in contact with you to help you out. i wish i could be more of service.
best,
sml

No problem at all Dr Lam, thank you for your post - I wish I lived in the US so I could get my fillers done with you. Hopefully one day!

All the best

no problem. you may allow your fillers to soften over time and consider something more permanent and global like a fat transfer when you are ready. look forward to take care of you in the future!
best,
sml

Thanks again Dr Lam

Yes, I will definitely look at having fat transfer in future.

I have the fillers purely for volume balancing of the face (not for the lips). It doesn't make sense to spend $3000 a year on dermal fillers! I've done that for over 2 years now. It gets injected to my cheeks, under eye area, brow and temple, plus a fraction into the smile lines. The bruising & swelling accounts for 2 weeks of downtime each year. I once arranged to have a top up of fillers whilst on vacation in LA, just so I was bruised and swollen away from work!

I'm trying to be patient though, since I've only just turned 30. I'm all for it the minute I'm old enough

Best wishes

I forgot to ask an important question......sorry!

When someone is ready to have fat grafting, do you dissolve the fillers just prior to surgery? If so, are there any adverse effects to the skin or the body's own hyaluronic acid from using hyaluronidase over such large areas?

Thanks so much Dr Lam

great question. in general, i much prefer to dissolve the area a week before to allow time for:
1. reduction of the product (which takes 3 hours to 72 hours to work)
2. reduction of swelling (to get a good read on it)
3. possibly so that any collagen disturbed will be more stable (obviously collagen can take longer than this but i think it is unreasonable to have someone wait months before deciding to convert to fat. plus, typically hyaluronidase seems to affect the restylane much more strongly. third, i simply have not had a problem with this method.)
best,
sml

Thanks for your reply Dr Lam.

Obviously, with the logistics of a fly-in patient, I understand that it's best to dissolve the fillers all at once prior to having fat grafting. However, if you have the luxury of dissolving them gradually (with local patients), do you prefer to do that?

I mean, is there less risk when dissolving fillers using a series of smaller dose injections?
When you refer to possible collagen disruption, is this generally temporary? I'm assuming the skin kind of bounces back and rehydrates? Have you heard or read of collagen disruption remaining permanently?

Sorry if these questions sound silly! Generally, there's very little info on the net about this enzyme. Some say that it can't act on natural collagen, while others maintain it definitely can.

Thanks again

no, i do the same thing for fly in and local. no one locally can stand going back to their old selves completely for too long. the dissolver is temporary on the collagen and is principally on the product so i find it to be very safe and use it quite often. hope that is clear.
best,
sml

Awesome - it's nice to know the transition period is short.

I look forward to contacting you in future about having fat grafting.

Thanks so much for answering all of my questions

my pleasure! look forward to having you as my patient in the future!
best,
sml