LAM FACIAL PLASTICS

I am a 32 year old female with one child (1 year old, would like 1 more) who had buccal fat pad removed at age 20 to achieve a higher cheekbone look... BIG MISTAKE! (i now know). My face is kind of flat and long and I would like to restore buccal area, and maybe widen it by adding fat to jaw, chin, and maybe cheekbone (anterior) as well as my undereyes circles which I've had all my life. But what do you think? Also I've heard you mention that you shouldn't get fat grafting at a young age? I can't afford any other type of filler(spending thousands yearly)but would like this taken care of and I would like fat grafting. So does my age affect me and how about a future pregnancy?

all great questions. as you know, i tend to be more conservative than my colleagues who are more prone to fat graft anyone at any age with any amount of fat. but i truly think about long-term aspects of fat grafting for my patients because it is a permanent graft. like anything in life there are blacks, whites, and grays. you are in the gray zone. someone 22 years old without kids yet would be a black/white no. someone 45 years old after kids would be a black/white yes. here are the pros/cons you must weigh:
1. if you are planning to have more kids the risks that you would incur are threefold: a) weight gain during pregnancy that may look distorted if it is significant, b) you can actually lose more volume in the face after having more kids (don't know if you saw that with your first one). for some reasons kids age you and i am not just talking about wearing you out. interestingly, to me this is a pro and a con: you have some safety because you lose some more fat but you have some lack thereof because you may "lose" some of what you have paid for. c) your metabolism may change and become slower, see point 2. now.
2. the real key with fat grafting is that you do not gain excessive weight afterward. because you are young the one concern i have is that when you hit 40 and get lazier with your diet you gain weight. with fat grafting you cannot afford to do that because the fat will show up in your face if you gain 20 to 30 pounds. now if your entire family is thin and you have not fluctuated much in your weight over your adult life then i feel more comfortable. if your mother ballooned up in her 40s and you have fluctuated in your weight a lot that would be two strikes against you and make you less of a candidate.
3. now even though fat is pemanent you are very young meaning you will age further and at such a young age you might need another fat graft in 10 years with further aging. i tend not to need that in someone who is 40 plus years of age as often as someone very young when the volume is more conservative.
4. fillers may not be as expensive as you think given your age but still there is a maintenance but then again fat transfer has a "maintenance" either with fillers or with fat grafting since you will continue to age.

i hope those thoughts are clear to you, as safety always comes first. there is not a simple answer to this question. i have to take it on a case by case basis, but i hope that helps a bit. let me know your thoughts.
best,
sml

Thank you. I see what you are saying. If I get it done at this age i would have to be very careful in maintaining my weight more so than someone 10 years my senior. Also I understand that I would incur greater volume loss with age and will probably need a "refill" in some years. And YES! I did notice some volume loss after having my boy (even though I only gained 30 pounds...). So it will happen again with a second child? Will it be to a lesser degree? I guess my only other question is your artistic opinion? Would my face benefit from fat grafting to make my face a little wider and less flat? By the way I must say I am impressed by your before and afters, all very natural yet you can see the vast improvement. Where were you when Suzanne Somers needed you?

hi,
1. glad you understand what i am saying.
2. i do not think based on the photo that your buccal area would need very much. although i am a big buccal fan for filling i go by a total aesthetic benefit and i do not think you need much or anything there but i am basing it on a single photo rather than seeing you in person. that being said, i think volume done right for you would make you look significantly better. i think the flatness of your central and upper face (brow, lower eyelid, anterior cheek) are principally where i see the aging and yes fat would look very good for you with the aforementioned considerations.
3. will you lose more fat after a second child? probably the same as the first one. hard for me to know but that unfortunately is very common situation.
4. thanks for the compliments regarding my work. i take a lot of pride in creating a very balanced result. even though you would look better with a fat transfer than a filler i would suggest for you one of two options:
a. wait until you have had another child before considering fat grafting and maybe when you are closer to 35 ish.
b. or do fillers for the meantime to get you to that point. in general i do not like to do fillers before fat transfer but given the recommended delay in time to do fat grafting i don't think it would "mess things up" so to speak. i truly believe that i would do a much better (and painless) work for your fillers than most docs out there because what i do with fillers is simulate a fat transfer (like a mini-fat graft). if it is at all possible for you to come in for me to help you you can fly back out the same day. my guess is that it would cost you probably 1000 to 2000 depending on your budget and it should last most of it for a year with good benefit for a couple years to 3 years after that in my experience. i personally think it would be worth it.
best,
sml

Hi,,
I want to inform that facial fat don't happened because of healthy food and calories.. Its another case of medication..
so you should contact to a professional doctor to resolve your problem...

no too sure what you are talking about here.

What type of non-permanent fillers do you use and would you use them on the brow area also? By the way, do you use Sculptra?

i would use restylane. i don't use sculptra. there is a ton of reasons why not. do a search in this forum for why. i am going to write a blog on it soon so i don't have to keep answering the same question. i think you should find the answer somewhere in one of these forum threads.

best,
sml

I've noticed that when you do fat transfer you do various areas of the eyes, cheeks, jaw, etc. When you use temporary fillers do you do the same thing. For hollow upper eyelids for example, would you use restylane in the same areas as you would fat transfer. I'm interested in the maybe doing fillers while I wait for children, or getting past 35 but I'm wondering how the results will compare to your fat transfers.

i have developed techniques with microcannulas now that actually simulate my fat graft very well. i think you will be tremendously pleased.

Hi Dr. Lam,

I'm thinking about coming to you for a consultation, but first I'd like to know if there's hope for me.
I had radiation treatment on my face in 1995, and over the years it's been eating up the fat on my face. I've had 6 facial fat injections done over the last 2 years, and more than enough fat was injected to fill up my face, but it didn't last and continues to lose fat after 2 months....
I understand radiation can stay in my body for a long time, but is there something that can be done to help me look and feel better?
Thanks.

Lian

honestly, despite being a very experienced and qualified facial fat grafting expert, i am also a realist and believe that the definition of insanity is doing something over and over again and expecting a different outcome. i would honestly have you consider Artefill injections, which are permanent and will last. however, you do need a collagen skin test first and you also would need possibly to have a second round down the road since you do lost a little bit of the collagen component since it is not 100% replaced with your native tissue. that is the best alternative to fat that i can offer you and it may be better for you long term given your unique situation.