LAM FACIAL PLASTICS

Hi Dr. Lam,

I am thinking about getting your fat injections for cheek/under eye and silicone in the lips. I love the concept that they are permanent (and am impressed with your technique and artistic abilities). But, I have a dilemma; I currently have sculptra in my cheeks, restatylne under my eyes and in my lips. The question is, if I want to get fat/silicone injected, do I have to wait until the sculptra and restaylne is TOTALLY gone?? I hope not, because I do not want to go au natural and would prefer to "transition" from sculptra to fat, rather then having to wait unitl scupltra is TOTALY gone to finally add the fat. My thought is that I can wait until a point where I think I might want another sculptra injection (but I would still have some left), and at that point, instead of adding sculptra, you add some fat. Then, maybe 6 months or so down the line, the remaining of the scupltra dissolves and you add fat again, possibly achieving the final effect (assuming all sculptra dissolved). If not, add more again. As for the lips, I was thinking you could either dissolve the restaylne with the hyaluronidase, and then add the silicone OR my other thought was to go from restaylne to collagen which is short lived. Then when the timing is right, I let the collagen dissolve (which should be gone in a few weeks to a month) and come see you as soon as it does so you can start silicone injections with a “clean paletteâ€￾.

Please advise me how I can transition from sculptra to fat, and restaylne to silicone without having to go “filler-lessâ€￾. Thanks so much and I look forward to your reply!


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Hi,
I fully understand your situation, as I have encountered it many times before. That is in part why I prefer hyaluronic acid treatments like Restylane so that I can easily convert to fat grafting anytime. Nevertheless, I think the game plan you proposed makes a lot of sense, as follows:

1. As far as the sculptra goes, I would wait until you are losing most but not all of the effects and then proceed with fat grafting to bolster and correct the volume loss at that point. I can always come back and add more fat later. I think waiting until you are ready to do your next sculptra injection and then going with fat grafting instead of another round of sculptra makes a lot of sense to me. Just out of curiosity, how many bottles of sculptra over how many sessions have you had in total? That would be helpful information for me. Also, if you had some restylane used for volume at that point, I could dissolve that a day or two before the procedure.
2. As far as lips are concerned, I really think that silicone provides a more beautiful and softer result than Restylane besides having the luxury and economy of being permanent. You can enjoy your Restylane until you are ready to do the silicone, then I can do the silicone with the Restylane about gone. It does not have to be entirely gone for me to do it. You could theoretically have collagen performed if you wanted if the Restylane goes away to have something cheaper and shorter acting if you are timing the sculptra for your fat grafting just to carry you over. I can layer some silicone over the collagen if you want.

Here are some thoughts as far as timing goes, everything is sort of based around most of your scuptra going away to time the "big thing" which is fat grafting. Remember also that silicone injections in the lips takes 2 to 3 rounds to really get a good result. Accordingly, let's say you are beginning to see that your sculptra is fading quickly and you are about ready for fat. At this point, you still have some Restylane in your face somewhere. You could come down to Dallas for your first round of silicone lips and also dissolve any remaining Restylane in your face (not lips only because I think I will be causing too much distortion with a lip dissolver the same day I apply silicone). Then come a day before the fat grafting a month later, then I could take a look and dissolve any remaining Restylane the day before and also then time out your second silicone lip injection while you are having your fat grafting. Remember to have safety in silicone application, you need to wait a month between sessions.

Anyway, there are many right answers to your question. It will all depend how your Restylane and Sculptra hold up and which one gives out first. As you proceed, you can blog me another question and I can guide you further at that point.
Best,
SML