LAM FACIAL PLASTICS

Dr. Lam,

What is your opinion on Fat Transfers to the jawline and underneath the chin to fill in areas oversuctioned from smartlipo? There are two areas, one underneath the chin and this is probably a dime sized area but not very deep. I also noticed when I tilt my head back the muscles appear. There is some fat even in the areas oversuctioned....it's not a total cobra deformity but it's close. The spot on my jawline is maybe the size of a pea. I have read that jawlines are hard to get a successful fat transfer on since it's mainly skin and bone. I would say the area is more right below the jawline but borders on it, if that makes sense? I am in my early 30's with no kids. I have small fat deposits on my inner thighs that don't gain much weight if I put on a few pounds, and don't really ever shrink much either. My stomach does tend to gain more, so I would be scared if I did got pregnant one day it would cause the transfer area to expand a lot? I maintain my weight without much effort, and am still within 5-10lbs of my high school weight. What do you suggest in my situation? How succssful are the areas under the chin and jawline as far as working and lasting?

Here is a few things: I personally do not like using fat to reconstruct one part of the face and not another. The reason is that I do not believe that it ages well if done that way since the fat is different from other types of fat. That is why I like to blend my fat into multiple areas. Yes, I know I am one of the most conservative surgeons out there but I truly understand long-term ramifications of fat transfer both the good (which there are many great things about it if done well) and the bad (unnecessary risk). in your case, i would probably recommend restylane, which I know is temporary but with repeated treatments it can start to last a very long time until perhaps you are a better candidate for fat transfer. Those are my opinions. Hope you are ok with them.
best,
sml

As far as under the chin goes, I could use fat everywhere, but there is an area that is depressed a little. If I were to have fat injected in that entire area, just a small amount would that work? Or do you mean the entire face and under the chin?

If I were to have restylane under the chin would the constant inflating and deflating eventually cause the skin to thin or sag faster? I don't mind temporary fillers if that is what I have to do to correct this. How long does restylane last and have you ever seen it in this area? It looks more like I would need the entire area under the chin done but down the center maybe due to the muscle I would need a little more. It's almost like a triangle area between the muscle that makes the underneath look like a dent in the middle. If you picture a cobra deformity but not as severe. The sides under the jawline are fine besides that one small dent. I can pinch maybe 2mm underneath the chin and I feel like it looks a little too skinny.

i have used fat and restylane to correct cobra deformities with success. however, as anything when doing a correction nothing is perfect just an improvement. if i see a photo of you i could better read a better course of action, which you could do on here or as a private message. also, restylane does not cause the skin to sag faster. if anything the scar tissue that develops around it tightens the tissues over time after repeated injections.
best,
sml

I will send you some pictures via private message. If I use restylane is that going to make a fat transfer in the future impossible, or make it more difficult because of more scar tissue? It's been 6 months post op from smart lipo, at this point I don't think the area will improve on it's own. I had nerve bruising on one side of my bottom lip (the marginal mandibular nerve) and worry that it could happen again with injections or another procedure.

1. if you have tons and tons of fillers placed all over the face, then yes fat becomes more difficult in the future not so much because of scar tissue but because product is all over the place with some of it on the way out or going away. i would not worry too much about that.
2. nerve damage is practically impossible with fat transfer since there are no needles just cannulas.

sml

Would I need to worry about possible nerve bruising with temporary fillers?

honestly, having done probably 10,000 syringes of fillers at least i have not seen it. anything is possible but not highly likely.
best,
sml