LAM FACIAL PLASTICS

Good evening Dr. Lam,

Thank you very much in advance for taking the time to answer my questions. I'm sorry if my query's a little long-winded; my main questions are at the bottom of this post, however.

I am a young female, in my early 20s. Having always disliked my weak jawline and 'gaunt' facial appearance for a long time, I underwent fat transfer to my mandibles (jaw angles) 6 months ago. The aims (which have been achieved) were to widen my jaw angles from a front-on view, and also to balance the width of my wide cheekbones with the much lesser width of my jaw angles.

Although the aforementioned issues have been resolved, I feel that a more conservative approach with less ccs of fat would have been better for me. This is probably because my facial features are quite small (close together eyes, etc.), so the excess width has made me a little too 'pie-faced'. I've waited patiently for a reduction in volume for the past 6 months and have lost a little weight, but I now feel that I've been 'overcorrected'. I would've preferred about 30%-40% less fat to have been used in each area, which would have achieved a more natural and subtle result. The fat itself is hard, not soft, and each graft forms an oblong shape, extending vertically from the base of my jaw angles to the base of the cheekbones. When I press down, I can feel them through my skin (luckily they're not visible externally), although I can also feel these 2 deposits when I put my finger along them from inside my mouth (the fat was tapered off widthways under my cheekbones to prevent a demarcation line). In all, I do feel a little too 'neanderthal' for my liking, and feel that it's obliterated some of the finer points of my cheekbone definition. I feel that less would have most certainly been more.

The fat on each side is not fragmented in any way, nor does it form lumps (it's more like one big 'block' on either side). My questions are as follows:

1) Would it be possible to undergo a conservative microliposuction on each area, in order to reduce the volume of the fat graft slightly, whilst maintaining its general shape and structure? I'd definitely want to avoid having the areas liposuctioned out as I'd be back to square one and I think this could look worse. A reduced graft on either side, with less thickness and width, would look great I think. It's just a little too much at the moment. The desired effect would be akin to changing a medium-sized facial implant for a small one, i.e. I'd want the fat to remain, but the shape to be smaller and more proportional to my pre-existing bone structure.

2) Can microliposuction reduce or slightly 'melt' areas of overfill (in the case of a large lump of fat, would it flatten it slightly or make it smaller, for e.g.), or would it eliminate such areas of overfill entirely (e.g. would it cause a lump to become indented in certain ways or change its shape)?

3) At 6 months out, will the fat potentially reduce more of its own accord? Will its positioning in front of the jaw angles make it deplete more than say, overfill of undereye hollows, due to my using of the jaw muscles?

4) If this method isn't the best, is there anything else I could do to 'soften' the fat or reduce the volume a little - for e.g., 5-fu injections, very light and conservative radiofrequency treatment(s), or facial massages/exercises?

1) Would it be possible to undergo a conservative microliposuction on each area, in order to reduce the volume of the fat graft slightly, whilst maintaining its general shape and structure? I'd definitely want to avoid having the areas liposuctioned out as I'd be back to square one and I think this could look worse. A reduced graft on either side, with less thickness and width, would look great I think. It's just a little too much at the moment. The desired effect would be akin to changing a medium-sized facial implant for a small one, i.e. I'd want the fat to remain, but the shape to be smaller and more proportional to my pre-existing bone structure.
YES, MICROLIPOSUCTION COULD HELP BUT I DO NOT PERFORM THAT, AS MY EXPERIENCE IS THAT IT IS VERY HARD TO DO RIGHT. MOST OFTENTIMES YOU EITHER DO NOT GET ENOUGH OUT OR THE RESULTS CAN BE LUMPY AFTERWARD. YOU NEED TO FIND A GOOD SURGEON WOULD HAS EXPERIENCE DOING THAT.

2) Can microliposuction reduce or slightly 'melt' areas of overfill (in the case of a large lump of fat, would it flatten it slightly or make it smaller, for e.g.), or would it eliminate such areas of overfill entirely (e.g. would it cause a lump to become indented in certain ways or change its shape)?
SEE ABOVE FOR IN #1 FOR THE ANSWER TO THIS QUESTION.
3) At 6 months out, will the fat potentially reduce more of its own accord? Will its positioning in front of the jaw angles make it deplete more than say, overfill of undereye hollows, due to my using of the jaw muscles?
THE MUSCLES WILL NOT AFFECT IT. HOPEFULLY YOUR GRAFTS WILL GO DOWN OVER TIME BUT IN MY EXPERIENCE THEY GROW SLIGHTLY FROM 6 MONTHS TO 18 MONTHS IN MANY CASES. DO NOT GAIN WEIGHT. THIS GROWTH IS NOT ALWAYS THE CASE AND MAY NOT BE APPARENT IN YOUR SITUATION. YOU NEED TO ASK YOUR SURGEON THAT QUESTION. I AM AN EXPERT AT FAT GRAFTS BUT I ONLY CAN ANSWER FOR MY PATIENTS WHO HAVE HAD SERVICES WITH ME NOT SOMEONE ELSE.
4) If this method isn't the best, is there anything else I could do to 'soften' the fat or reduce the volume a little - for e.g., 5-fu injections, very light and conservative radiofrequency treatment(s), or facial massages/exercises?
5-FU CAN HELP ONLY IF THERE IS HARD SCAR TISSUE. YOU SUGGESTED THAT YOU HAVE SOME OF THAT BUT YOU ALSO SAID THERE ARE NO LUMPS. 5-FU DOES NOT DISSOLVE FAT JUST SCAR. RADIOFREQUENCY COULD HELP BUT IT COULD LEAD TO UNEVEN RESORPTION OF FAT. BE CAREFUL WITH THAT. YOU COULD ALSO TRY MESOTHERAPY/LIPODISSOLVE JUST MAKE SURE THAT IT IS NOT UNDER THE EYE IN THE ORBITAL REGION AS THAT HAS BEEN KNOWN TO CAUSE BLINDNESS. IN THE CHEEK YOU SHOULD BE VERY SAFE. MASSAGE DOES NOT HELP NOR DOES ANY FORM OF EXERCISE. SORRY THAT YOU ARE GOING THROUGH ALL OF THIS.

Dr. Lam, thank you so much for answering my questions - I'm very grateful for all your advice, and very glad about knowing what to avoid. I'll certainly take on board your weight gain warning (I have 10-15lbs to lose anyway still), so this may help, even just a little.

Regarding your answers (and sorry to be a pain), I do have 2 more questions for which I'd really appreciate your thoughts.

I hadn't heard of mesotherapy/lipodissolve before you mentioned them - which out of the 2 is the best and most predictable? Would these require small or large injections, spread out over a few treatments or not? I'm not even sure I'd ever manage to find an injector I could trust in my country, so I may even come to you if time and weight loss don't resolve my issues.

I also had another thought, which could potentially offer the most promise - could botox in the jaw muscles be a remedial option? From the before and after photos I've seen on the internet, this would give the perfect angle reduction/slimming effect I'd want. However, I don't know whether the presence of fat would impede this?

Thank you once again!

i do not perform lipodissolve so you would have to find a qualified individual to comment further. as far as botox jaw reduction, it could help but you must have an enlarged muscle to see the difference. it should be very hard and firm to the touch when you feel it while biting down. the other problem is that it is only temporary solution. that may be an expensive option over your lifetime to fix this permanent problem. i would focus on fixing the fat but if you want to do the botox as a temporary maneuver over the year and you are a candidate then that may make sense. hope that helps.
best,
sml

Hi guys...
I feel irritate when i have to pass through number of dieting programs.. I use just fresh juices in my dieting plan and take the light food in eating scheduled. I want to become attractive, so i join gym for all this...
Cerritos Gym

ok, thanks for the input.