LAM FACIAL PLASTICS

Hi Dr Lam,

I had injected 3 years back a permenat filler for high check look, then 2 years later i had a buccal fat removal I hated the result, very bad. after 1 year i had a fat transfer operation twice to correct this, but everytime after 2 months i do notice that the fat has been absorbed, I twice Sculptra's nodules, we can say that it has corrected 30% of the damage in the mid hallow area, but my face is not like before anymore, all the time i had a nice checks and all i wanted with more high bones, i have been advised to do more 2 times with Sculptra, but i do not feel that this will give me the high check look i wanted, what do you think and is face left is an option after doing these injections.....! I am 30.

Thanks.

i am a bit confused when you say "high cheek look" since the buccal area is a lower portion of the cheek.

the doctor who did the operation for me, advised me to remove the bucal fat as it will make my check bones appears more, but actually this does not happen, it made my face looks very think and very tired

ok, i think i now understand. at 30 years of age even though you probably want a lifelong correction of previous surgeries, i am actually more hesitant to give you that option because i always want it to age well for you. permanent options include artefill and fat transfers (which you have had) but i would be cautious because your face changes and the product should look good when you get older. i tend to do more permanent options after 35 years of age and do so very conservatively with increasing aggressiveness as you get older.

you will continue to lose fat as you get older. sometimes that high cheek look will be there before you know it. in fact, it will be too gaunt and the cheek too exposed by your late 30s. it just happens. i am 41 and i am seeing my cheek bone start to stick out. be careful of pushing yourself too hard for what you may want now because you are at the front end of aging.

if you have not had kids yet, children will make the lower face heavier and the upper face hollower making it another moving target variable. i personally do not perform sculptra. i am sure it is a good product and may be your best option for midfacial volume since it has great longevity and it is good for isolated midfacial volume enhancement. there are a ton of reasons why i do not perform sculptra but nothing bad. i think it is not a good product for the upper and lower face where nodules are more prevalent. the midface is not bad but i rarely find an indication for just doing the midface. in someone older than 35 years of age, isolated midfacial augmentation does not look balanced. also, sculptra is unpredictable in my hands. i never know how much result i am going to get by what i put in there. accordingly, i prefer not to do it. in any case, you may be one of those exceptions of a younger patient who needs midfacial augmentation that lasts a long time but is not permanent.
best,
sml

Thank you doctor for your detailed explanation, actually i am not fan with implants i do feel it outsider from body which might look hard or un-natural, can you do for me a permanent filler material, or for example material which stays for 2 years, so I can redo it every 2 years, I have attached one of my old photo before the operation and one from my face now, do not u think I can go for fillers or face lift. You can see that I have hallow in the upper face now, I feel he mid part is fine now after Scupltra, what do you think and advise

All I want is to return my old look again, no more no less

And please let me know the best option, and how many days I have to stay in Dallas if I will go for it? thank you doctor very much

hmmm, i do not think i have an answer for you. i reviewed your photos. i feel fat grafting and other permanent options are probably not safe for you. i would probably do sculptra but as i said i do not do that. i do not think i can help you with your situation. i am really sorry. i wish i could give you a better answer but sometimes safety is much more important than anything else. i am giving you a safe answer.
best,
sml

I do thank you doctor for being honest with me, and for the time you gave. and i am sorry for posting again, but i did not get you in your last part,
[*]you mean in term of filler i can't you use any to solve the issues i have?
[*]check implants is the only option we can do however it is not permenant? i have no problem to use it if it is the only way
[*] which i consider face lift or this will solve my issue

i am really sorry dr for posting again but i want to finish my nightmare abt my face

[*]you mean in term of filler i can't you use any to solve the issues i have?
no, of course, you can. you can use perlane, restylane, radiesse, sculptra, etc. i personally only use perlane and restylane. of the two i use, i would use perlane. given your young age, i probably would not use artefill, which is the permanent option i prefer in someone a bit older. however, given the isolated buccal area that you want filled perhaps sculptra may give you the longest longevity when dealing with isolated midfacial hollows. i just do not inject it myself for the reasons i have stated.
[*]check implants is the only option we can do however it is not permenant? i have no problem to use it if it is the only way
cheek implants may not be a bad option because you can always remove them if you don't like them (if you get an easy to remove kind like silicone). i do not prefer doing them because i again have such limited reasons to do them. i do not think they work well in the buccal area as they tend to do better resting on top of bone. remember that you have a soft tissue loss. trying to replace them with hard tissue like an implant is not in general a great idea because it tends to show more bone rather than less bone. watch this video to understand why i don't like cheek implants:
http://www.lamfacialplastics.com/galler ... heeks.html
[*] which i consider face lift or this will solve my issue
no, that is quite awful. a facelift does not correct volume it makes it worse. if you are just lifting your finger to stretch your skin to show that the area looks better you are completely missing the point. read this: http://lfp-blog.com/dr-lams-blog/2-fing ... nger-rule/
best,
sml

thank you doctor for concerning about safely, but what can be done to enhance the soft issue or to replace it, as you have checked my photos do you think now after my face become very thing should i go to nose operation.
last point, it is about my lips, ex-doctor has injected me with a material "i have the name" in my lips, but as you can see it is injected in mid only, when i do smile now i look like a rabbit, is there a way to fix this, through injection for counters, or to reduce the upper lips

as i suggested, there is nothing permanent that i would recommend. maybe just use fillers for now, as i have explained. i do a lot of lip corrections and based on the photos i don't think you need anything done. in short, i do not believe i can help you based on what you are asking and what i am seeing. you can always do an in-person consultation but i will most likely tell you the same thing.
sml

Hello Dr. Lam,
hope you are doign great, i hope i am not bothering by posting again but i would like to keep you updated as i am taking your opnion as a final opnion in my DO not TO DO procedures
i have sent you my lastest Pics, this is 3 months after last scupltra session, i feel tha bucal fat area of my cheeks now is looking better, but what is annoying me is the smiley lines under my eyes as well as my nose, it start to become un-symateric.
my syrgon advised about optation called three happy lift + nose jobs, i would like to hear from you before i am replying him.
as suaul thank you for the whole effort you are doing in this fourm,

Dina

i don't have your photos. where did you send them? as far as doing a lift to manage wrinkles that sort of makes no sense at all. dynamic wrinkles cannot be cut on but only botoxed aways. hope that makes sense. btw, no problem with the questions. that is the point of this forum is for me to answer them, and i enjoy doing so.

honestly, at 30 you probably should not be needing any lifts whether they are happy, silly, fun, or whatever marketing term appended to it. it sounds as if you have had your fill of plastic surgery. i cannot give you direct medical advice on here about your nose and face but i can say in short, i think you might want to refrain from more and more plastic surgery. and that is coming from someone who is doing this for a living. honestly, there may be another reason you are wanting all of this plastic surgery. look deep within (your subconscious) to see if you have any holes in your life you are trying to fill with cosmetic surgery because at your age with serial treatments you risk being overdone by an unscrupulous physician. please think hard before having any more surgery.
best,
sml