LAM FACIAL PLASTICS

Dr. Lam:

Why most doctors in the US do not use Dr. Amar's fat grafting technique? Someone told me it's a lot more work than regular fat grafting I'm wondering about it, especially because it's known to be effective for lips, whereas regular fat grafting is not? What's the future of this technique, in your opinion?

Also, once one puts silicone in the lips, can FAMI or any other filler be used later in life, or once you go silicone, there is no other alternatives for the lips?

Thanks so much!

sometimes more work does not mean a better result, ditto here. filling in muscles does not help increase fat take. my opinion is that it decreases fat take because it is only in one plane. i place the fat instead into multiple layers: muscle, fascia, and subcutaneous fat depending on what area i am targeting. i think it is an interesting technique but really has zero advantages.

silicone i do not believe should preclude fat but there is almost no reason to go with fat in the lips. i don't think the recovery and the high absorption rate no matter what the technique is is helpful. i simply do not like fat in the lips. it is also the one area with weight changes that does not look that great if the fat stays.

fat grafting is highly dependent on the injector. no matter how experienced the injector is, results vary based on who is doing the work. it is 50% technical and 50% artistic. no two injectors have similar results. worrying if it is fami or otherwise should not be too much of a concern. i think we pay too much attention to the technique and what we should pay attention to is how the results blend and appear as whole for a specific injector.

it is interesting i ran a course in fat transfer just recently and will be doing another one in las vegas and the amount and distribution between me and my other esteemed colleagues is radically not subtly different. it does not mean that i am better but different based not on "fami or not fami" but based on how much i put in and where i put them. even the book that i wrote, i do nothing like what is in it anymore. refinements continue not based on name but on a physician's own developed aesthetic judgment. ultimately, that means find the surgeon whose work you like. you only have one face. that is the key to decision not whether it is fami or o/w. just my thoughts.

even silicone radically is different between injectors. most silicone injectors just enlarge the lips. i prefer to create three gently curving mounds in the upper lip and two tapering mounds in the bottom lip with a cleft and visual break. even two silicone injectors will not get the same results. focus on the physician who can do the best work for you regardless of a named technique. we put too much credence on a name. ok, i'll get off my soapbox now. lol.

best,
sml

Dr. Lam:

You believe that there might be a "dip" at 3 or 6 months after fat grafting, when patients look almost like before they had fat transfer (or not as good as they look at one year or at two years). I am looking at this galery you created http://lamfacialplastics.com/gallery2/v ... gallery_6/
and although I do see great results, I'm not sure which case could be a good example of such dip. I'm wondering which patient / case, in your opinion, can prove this point.

Many thanks!

this is my worst dip i have seen:
http://lamfacialplastics.com/gallery2/v ... case_9_39/

this is my best dip (or lack thereof) i have seen:
http://lamfacialplastics.com/gallery2/v ... case_3_33/

i actually present those two to show you extremes. most people are in between and most do not dip a lot. however, in almost all cases minus say 5% people improve over 1 to 2 years afterward even if they do not "dip".
best,
sml

Do you think these "dips" might have something to do with people losing and gaining weight? Do they occur (if they do) at 3 months or they can happen any time pretty much?

Technical question: I tried to look at these links on three different Window computers, and the left side of the page looks blank, whereas the right side has some pics (I'm missing some pics, in other words). Is this gallery page working fine as you look at it?

Absolutely no relation to weight gain. It can occur at Amy time but basically between 3-6 months again this is for my patients only. In many other surgeons' hands it just goes away completely by this point. The links seem to work on my computer. Hmmmm.

I got the Gallery work when I started to use MozillaFox. Interesting.

For this lady (case 9) lower face transfer makes a big difference. It really softens up her face, like you said. The gallery doesn't contain all of your fat transfer cases, I'm sure. Would you say she's an example of your "biggest dip" among the gallery examples or your fat transfer patients in general? This lady's face wasn't too drawn to begin with, so, her "dip" doesn't look like a big deal.

hard to say as i have seen all kinds of dips. in general even when someone does not dip, they should continue to look better with my work in the first year or two. again, remember my comments have no bearing on anyone else's work, just mine.
best,
sml

Yes, I understand that you're speaking for your patients only.
Although I have a hard time recognizing "dips" in your Gallery, I do see improvements over time: these are a lot more obvious. Does it necessarily prove though that fat acts like a life graft; could it be just that it acts like an irritant / stimulant of collagen?
Thanks!

i don't think that my photos "prove" anything. all of this is mere conjecture on my part. however, seeing the idea that fat acts just exactly like a hair graft in terms of timing and what is known as donor dominance (which i can explain more in a moment) really help support this idea. in fact, i was moderating a panel of fat grafters in vegas and everyone was blown away by this concept. one person on the panel said that he thought i was going to explore the idea of "donor dominance" more, i.e., transplanted grafts from the donor area behave like the donor area. that is why fat grafts do not really go away with weight loss but can be sensitive to 20 pound weight gains (that is why i put half the amount of fat than most of my colleagues so i think my fat is much less sensitive to weight than other people's). also, they are very estrogen rich as the lower body has tremendous estrogen in the fat allowing the skin to look richly smoother (whether there is stem cell or other hogwash, at least i believe the estrogen is making the skin look better).

further, if you argue that collagen stimulation is the issue the time period makes no sense. collagen growth peaks at 90 days, exactly when there is a dip. collagen does not keep growing over from 6 months to 1.5 years. it peaks much earlier then declines. could i histologically show that there is collagen growth. absolutely, almost any kind of injection leads to collagen growth including restylane and also including lasers that do nothing for the skin. how do i know that? because i won an award for my research in 2002 that showed even the N-lyte laser grows collagen amazingly well and that laser is off the market because it sucks. i think collagen growth is way overrated but i do leverage it in small degrees when i work with fillers and botox because i think it can add to small but definable changes to the skin. that is why i look at the face like a bed with the deeper structures being treated beautifully with fat and the superficial ones treated better with fillers and botox. when we try to clobber the face with one technology, we get distortion.

as far as seeing dips, you are right, not many people dip a lot. only a small percentage of people. however, most would say that they are much happier by 12 to 18 months because that is when the result is maturing. i truly believe that my hair transplant model of seeing fat is a unique contribution to the literature and it helps to keep fat grafters who offer touch ups at 3 months from doing that any more. people just put way too much fat in the face.
best,
sml

Thanks for this uber interesting response, Dr. Lam. I didn't know about this 90 days mark for collagen... I guess, this is why Sculptra starts working after 3 months or so?

You're saying that you don't transfer too much fat. What's the average amount of fat you use for full face graft?

Do you often use other fillers at the same time or you wait and see what a patient looks like in several months after FG in order to determine what else might be needed?

Thank you!

thanks. these are my numbers on average: about 15 to 30 cc in someone in their 30s. 25 to 45 cc in someone in their 40s, and 35 to very rarely 55 cc in someone beyond that age. basically the upper limits of what i put in is about 45 cc but i had a lady in her 50s the other day who was so super gaunt that i put in 60 cc, which is a record for me. it is not so much total cc's that matter as how much i put into each area of the face and how i do it that counts. for example, the buccal area i mentally divide into 3 areas rather than one area. by targeting various areas, i am able to create a much more subtle transition into the lower face. also for example, i have been working for the past 2 years on transitions from the brow to the lower eyelid. i use only 0.3 cc into this area. does that make a difference? huge! these subtle changes make all the difference.

as far as fillers go, i typically wait a year before doing a micro touch up unless it is something like artefill for folds then i can go back sooner like 3 to 6 months to do it. but i still stay conservative because even though the fat will not make profound changes i do see nice small changes over time. fat grafting is truly an art. the science follows the art. hope that makes sense.

best,
sml