LAM FACIAL PLASTICS

I'm nearly 50. Three weeks ago, I had Sculptra injected in my cheeks. I had it injected two years ago (two vials) as well. This will be the last time I do Sculptra. My PS is conservative with Sculptra (which is good!), so the results are too subtle and non-specific for me. I would rather invest my $ in fat grafting as a long-term solution.

In view of the long-term implications of Sculptra, how long should I wait before you will consider seeing me for a consult / do surgery?

If it's one to two years, I'd like to get Juvederm as a filler in the meantime. I would like to get an idea of what I look like with filler because Sculptra has been too non-specific for me at targeting areas. Is that okay?

Another concern I have is recovery time. How long before I can return to work and look presentable? Would 10-14 days be enough?

I have no wrinkles on my forehead but I do have a noticeable vertical indentation as I approach 50. (I guess my skin is thinner in that area now.) Is there anything that can be done to fill this out again, or should I just accept it?

Finally, my PS placed gortex implants in my nasolabial folds back in 1998. It's been 12 years and I still love them. Will Juvederm injections directly at this site create any issues? I don't want to jeopardize what I already have there.

I understand it takes 2 years to see results from fat grafting. Do people commonly get filler during the interim period (until they see results), or is that a big no-no? Just curious.

Thanks, Dr. Lam!

hi,
hope i can answer all of these questions succinctly:
1. i do not like to do fat grafting over any kind of filler that was recently done, as it is putting permanent product over a temporary product. when the temporary product goes away then the permanent product is still there so you may need more. plus i tend to design my face as if the product were not there so you may need slight to significant alterations in 2 to 3 years with fat transfer. if you layer juvederm and other things on top it adds even more confusion since this product can linger for quite some time and when i go in there i have no idea how much temporary product is in there still even at a year. ideally no more temporary fillers until you do a fat graft. the ideal time to wait for sculptra is 2 years afterward but most people cannot tolerate a two year wait and also with no fillers to bridge them over. in that case, i would wait at least a few months until the sculptra declares itself as a result and then consider a fat transfer with the understanding that you might need more fat transferred or additional fillers in 2 years to compensate for the eventual sculptra loss. see this video to understand timing of fillers and fat:
http://www.youtube.com/watch?v=cTfVutz-hSQ
2. as far as the vertical indentation, the only safe and reasonable option is botox. i always say treat the cause not the effect. the cause is the movement. if you block the habit long enough (typically 1 year at every 3 months), the wrinkle will go away by itself. fillers in that area can be both dangerous (blood supply issues) and useless since it is not addressing the cause. please watch all the videos in the following section to truly understand this vital concept that most patients and even doctors have no idea about:
http://www.lamfacialplastics.com/galler ... Tutorials/
and also the following:
http://www.lamfacialplastics.com/galler ... ateau.html
and
http://www.lamfacialplastics.com/galler ... ainer.html

3. as far as putting juvederm into the folds over gore-tex that should not be an issue with a skilled injector. plus it won't interfere with my fat grafting since fat typically does not work there anyway. however, i always say if you are going to have a fat transfer soon just don't put any juvederm in there until i do the fat transfer.
hope all this makes sense.
best,
sml

Thanks for taking the time to give such informative replies, Dr. Lam. It's been very helpful!

It is encouraging to hear that you would consider me as a patient after this injection of Sculptra settles down. I was afraid I would be told to wait two years. So far, at week 4, Sculptra has made no apparent difference in my face and I expect I should be seeing 50 percent of the results by now. That's disappointing from the standpoint that I spent $800 for minimal results, but beneficial in view of the fact that it would not interfere too much with a future fat grafting!

Cheers and happy holidays!

you too. happy holidays!