LAM FACIAL PLASTICS

Hi, I'm 35 year old asian and underwent 3 fat transfer surgeries to correct my hollow eyes and flat cheeks. All of them didn't give satisfactory results, the last one I had (Feb 2009 done to eyelids and cheeks) the fat only lasted 2 months so I'm planning to have another one and would want it done by an expert, I came across your web site and would love to know more about your techniques :

1. I know I have high metabolism rate and face is the 1st place that I lose fat. So have you had any patients like me but the transferred fat could still last for a long time?
2. Like I said I have done several surgeries before by different doctors. One of the surgeries made my eyelids extremely bruised afterwards, and the one I did early this year, had no bruises at all. I noticed that the fat transferred in the bruising surgery lasted much longer. I have no idea what techniques the doctors used, I only know that the bruising surgery made use of syringes to graft the fat, versus the other one using liposuction method. I know you also use syringes, so do you know why would the surgeries differ in bruising? Does your fat grafting technique cause bruises?
3. Recently my under eyes are also losing volumne, do you do fat transfer to the under eyes as well? In terms of appearance how will it differ from injecting temp fillers?
4. To do a complete facial rejuvenation using fat volumizing e.g. under eyes, eyelids, cheeks, dimples, etc. will you need to do many injections? How will you handle anaesthesia?
5. I do not want general anaesthesia, for a complete facial rejuvenation, is it possible to perform under local anaesthesia or IV sedation (not the completely asleep type)?
6. Recently I'm experiencing pain in Trigeminal nerve (somewhere near the gum of my upper teeth). My doctor said it might be caused by the fat injection (done to the cheeks) done early this year. She was saying after fat cells are "gone" (or dissolved, or metabolized) or "moved" there will be tiny left overs materials (membrane) that may affect or press the nerve, which is causing the pain (even though the cheek is so far away from the upper gum). So does this make sense to you? Will the fat cells cause problems once they dissolved or mobilized? Will they run around my face and stucked with some part of the tissue and cause more pain? The reason I'm asking is, although I'm in the stage of treating the pain but once I'm cured I still want to do fat transfer!!

1. I know I have high metabolism rate and face is the 1st place that I lose fat. So have you had any patients like me but the transferred fat could still last for a long time?
YES, I USUALLY DO NOT HAVE AN ISSUE WITH THAT. OBVIOUSLY, NO PROMISES.
2. Like I said I have done several surgeries before by different doctors. One of the surgeries made my eyelids extremely bruised afterwards, and the one I did early this year, had no bruises at all. I noticed that the fat transferred in the bruising surgery lasted much longer. I have no idea what techniques the doctors used, I only know that the bruising surgery made use of syringes to graft the fat, versus the other one using liposuction method. I know you also use syringes, so do you know why would the surgeries differ in bruising? Does your fat grafting technique cause bruises?
YES, IT CAUSES BRUISES. TYPICALLY NOT MUCH, AND IF IT IS OUTSIDE OF THE EYE AREA I CAN LASER THE BRUISE DOWN AT A WEEK.
3. Recently my under eyes are also losing volumne, do you do fat transfer to the under eyes as well? In terms of appearance how will it differ from injecting temp fillers? YES, I DO. I GET GOOD RESULTS THERE BUT NOT ALWAYS. IN OTHER WORDS, SOMETIMES PEOPLE ARE SO HOLLOW THEY NEED A LITTLE MORE FILLER TO TOP OFF THE FAT. I DO HOWEVER GET VERY SAFE RESULTS THERE.
4. To do a complete facial rejuvenation using fat volumizing e.g. under eyes, eyelids, cheeks, dimples, etc. will you need to do many injections? How will you handle anaesthesia?
I PREFER GENERAL BECAUSE I CAN GET AWAY WITH LOW ANESTHETIC VOLUMES THAT MINIMIZES DISTORTION,SWELLING AND BRUISING. I USED TO GET MORE BRUISING UNDER LIGHT IV SEDATION BECAUSE I NEEDED TO USE NEEDLES TO MANAGE THE ANESTHETIC. NOW, I ONLY USE CANNULAS FOR EVERYTHING SO THE BRUISING IN GENERAL HAS GONE WAY DOWN IN GENERAL.
5. I do not want general anaesthesia, for a complete facial rejuvenation, is it possible to perform under local anaesthesia or IV sedation (not the completely asleep type)?
SEE ABOVE. IN GENERAL, I DON'T LIKE TO DO THAT. BUT MY ANESTHESIOLOGISTS ARE TRAINED FOR EVERYTHING.
6. Recently I'm experiencing pain in Trigeminal nerve (somewhere near the gum of my upper teeth). My doctor said it might be caused by the fat injection (done to the cheeks) done early this year. She was saying after fat cells are "gone" (or dissolved, or metabolized) or "moved" there will be tiny left overs materials (membrane) that may affect or press the nerve, which is causing the pain (even though the cheek is so far away from the upper gum). So does this make sense to you? Will the fat cells cause problems once they dissolved or mobilized? Will they run around my face and stucked with some part of the tissue and cause more pain? The reason I'm asking is, although I'm in the stage of treating the pain but once I'm cured I still want to do fat transfer!!
I HAVE NO IDEA WHY YOU ARE HAVING PARESTHESIAS THERE. MOST LIKELY IT WAS DUE TO AN AGGRESSIVE DENTAL BLOCK IN THAT REGION. THAT CAN OCCUR AND HOPEFULLY SHOULD RESOLVE. FAT SHOULD NOT BE CAUSING THAT. IT IS TOO SOFT. UNLESS IT WAS INJECTED WITH A NEEDLE THAT DISTURBED THE NERVE. FORTUNATELY, I USE NO NEEDLES OR ANYTHING SHARP UNDER THE SKIN.

OK, HERE IS WHAT I REALLY WANT TO TALK ABOUT. I AM AFRAID ACTUALLY TO DO A FAT TOUCH UP THAT EARLY IN YOU. THE REASON IS THAT I TELL EVERY PATIENT THAT THERE FAT WILL GO AWAY AT 2 TO 3 MONTHS THEN COME BACK BETWEEN 6 MONTHS TO A YEAR. WHY? WATCH MY VIDEOS IN THE FAT SECTION ON HOW FAT IS LIKE HAIR TRANSPLANTATION FOR A DETAILED ANSWER AND WATCH THE PHOTOS IN THE BEFORE AND AFTER SECTION THAT TALK ABOUT HOW FAT ACTUALLY IMPROVES OVER TIME AFTER THE DIP CALLED THE FAT GRAFTING EVOLUTION SECTION. I GENERALLY EXPECT IMPROVEMENT OVER 1 TO 2 YEARS AND AM WORRIED ALMOST ALWAYS TO DO A FAT TRANSFER IN MY OWN PATIENTS SHY OF ONE YEAR. I HAVE NO IDEA WHO DID YOUR WORK AND DON'T PUBLISH SOMEONE ELSE'S NAME HERE. I WILL HAVE TO DELETE. I WANT TO KEEP THIS FORUM CLEAN OF BLAME, ETC. PLEASE DO MORE WORK IN UNDERSTANDING MY WORK BEFORE YOU DO ANYTHING FURTHER. YOU NEED TO UNDERSTAND HOW FAT CHANGES OVER THE FIRST 1 TO 2 YEARS AT LEAST IN MY HANDS BEFORE PROCEEDING. I JUST GAVE 2 LECTURES LAST WEEK IN SAN DIEGO ON THIS OBSERVATION.
best,
sml