LAM FACIAL PLASTICS

Hello Dr. Lam,
I hope you are doing well and I want to thank you again for all the work you do. I have a new question. My mother is seriously considering getting a ...lift. What do you know about that procedure? I don't know much about it and I want to be able to help care for her and help her recover when the time comes. Is there any information that you can offer me about the actual lift and what she should expect? Anything at all would help! Thanks Dr!

sorry, had to remove the reference to the other place for legal purposes but to answer your question, i truly think they are a chop shop. multiple procedures performed under a day under local anesthesia. i really do not think you can get quality work that way. you meet and are sold by a salesperson and the interaction with the surgeon is minimal. it is uncomfortable and in the time it takes for them to do the entire lift it takes me that time to contour the incisions because i care about how you ultimately look after a procedure. sorry to be honest but that is how i have seen their results.
best,
sml

Hi Dr. Lam,
I am not talking about the place that we can't mention for legal reasons, but I had a general question about doing a neck/minilift under local anesthesia in the doctor's office.
Many surgeons are doing this to offset costs and use small amounts of anesthesia, and work on one side of the face first, using local there, and then moving on to the other side. Valium, Epi, and ?
Not a lot of anesthesia used.....is this safe? I tend to think that there are less complications from local than general. However, it is not in the hospital setting and no anesthesiologist present.
Is this a recipe for disaster? I am afraid of the Epi since I did have palpitations before when used a the dentist....what are your thoughts?

i really should not speak about it but i always like the experience to be easy and comfortable. facelifts under local anesthesia are uncomfortable and can lead to some mental trauma afterward in my opinion. i always believe surgery should be done in an accredited safe facility but you must discuss those thoughts with your provider.
best,
s.

Dr. Lam,
Thank you for your promt replies about scarring, silicone and local anesthesia.
I had additional questions for you as well. I know some doctors place the incisions on the short scar lift completely in front of the tragus, using a curvilinear line, following along the natural curve of the ear, rather than a straight line. Others put the incision in the front, then going inside the tragus, and then back out around the ear and to the back, which is what I believe you do, as looked at your photos. If you have a little natural wrinkle in the front of the ear, or "line" is it better to go all the way in front of the tragus rather than going inside of the ear, then out?
This way there is no chance that the tragus is deformed in any way or flatten out. I have that history of not healing well scar-wise, so I thought perhaps it safer to do the post tragal incision for this reason. Can you explain your thoughts? Also, you do not at all go back into the hairline at the temple at the top of the sideburn area? How far behind the ear do you go if you are doing a platysmaplasty and the neck lift at the same time as the mini lift? cont.....next message

Would you always do a mini lift with a neck lift/platysmaplasty if there is redundancy in the neck and prominent neck bands, and only some very mild jowling and marionette lines, or can I wait to do the face later? I assume it is better to combine the two procedures for synergy and a better result. I was told with the neck alone, there would only be a small incision behind the ear and small one under the chin. Do you put the incision for the platysmaplasty vertically or horizontally? I remember reading somewhere on your site that sometimes it isn't always that obvious to put incisions necessarily in horizontal creases, but to take into consideration the way the collagen forms for better healing....If there was a problem with scarring after a mini lift,
do the same methods of laser, 5-Fu, silicone sheeting, or that cream you mentioned apply?
How soon after? Or is it better to not leave the sutures in as long to avoid hypertrophic scarring, or that really doesn't contribute to the problem of scarring? Thank you in advance for all of your advice. Best, J

if i can avoid going in the neck i will. i have found too many problems with slight contour issues in the neck when i go in there. also platysmaplasties tend to fall apart over time and also limit the lateral pull so unless there is extra fat in the neck my entire procedure is a lateral pull that is going vertically for 80% and slightly posteriorly as a vector for the remaining 20%. for a facelift, typically you don't need silicone, 5FU, laser, etc.

Very interesting what you say about not doing a platysmaplasty with the mini lift.
I tried to pull my face vertically and then laterally and it does help tremendously with the banding that I see...but I do still see the separation of the bands in my neck unless I pull so much that I doubt that it would end up being a "natural" result. I had lipo in my neck 2x. Once in my 40's and again in my 50's - probably a big mistake. After the last lipo is when the bands appeared & they have been getting worse ever since. I am now 57, and my face is not bad really, but my neck is the thing that really looks bad to me. Now I am wondering if I really need the platysma bands corseted, but my guess is yes. However, you did mention about the fat under the neck & w/o excess fat, you do not do the corseting. Would a photo to you help determine this? THANK YOU!

Hi, If you could address my previous post about the placement of face lift incisions, pre or post tragal, and shape and contour of suturing? I would appreciate your thoughts. Thank you very much for all your responses thus far as I gather the information to make a good decision on my surgery. Best wishes, J

always post-tragal. it just looks bad pre-tragal. however, if you go post-tragal, that is not just the only criterion. obviously, tension free but also it must curve and never be straight in any one point, especially it must curve back like a"hockey stick" at the bottom of the tragus otherwise it can look fake as a straight line going down from the base of the tragus. the tragus must be sufficiently thinned down so that it looks natural. if you are asking for exact sutures that i use i use 4-0 PDO barbed quill sutures to close under the skin, 6-0 prolene for the front of the ear on the skin, 5-0 nylon under the temporal tuft in front of the ear, and 5-0 chromic for behind the ear. is that what you are wanting to know?