LAM FACIAL PLASTICS

Hello,
I watched your video about "Those Smile Lines" but am obsessed about my n/l folds so have some questions. I am caucasian, pale skin, 46 yrs old, and prone to keloids, had a large ropy horizontal keloid scar on my chest from surgery at 8 years old, and needed two further plastic surgeries to flatten it. That said, I am very worried about developing scarring from filler injections, as I have seen some horrid pictures on the web, and also read about permanent bruising/discolortion from restylane.

So with my concern for possible scarring, which filler would you recommend--restylane or perlane? Also, why do you think they are a waste of money, don't they last 9 months, and encourge collagen formation? Is silicone injection an option in this area since it is permanent? Do you recommend needle injection or canulla, and what gauge? If needle, do you do multiple injection sites, for someone prone to scarring or just one per fold? And finally, because of concern for keloid would a dermatologist be preferable injector vs. a plastic surgeon (in general)?

Thanks in advance for answering all these questions.

1. as in that video i think smile lines are a waste of money because if you are 46 years old most likely you would benefit from a fat transfer for more important areas like the eyes and cheeks and chin but are overly focused on something in my opinion that is a waste of money like the folds. that takes your reviewing my videos and before and afters to really understand what i am saying.
2. the chest ALWAYS KELOIDS IN EVERY RACE. the face NEVER DOES. i hope that is clear. this is why i always say do not remove a mole from the chest because it will keloid in every person. the face will not keloid or scar from an injectable. the bruising that can be bad around the eyes is caused by staining of tissues. that is why i am one of the very few people not to use needles around the eyes but only microcannulas. how many people use microcannulas? very few. how many do it well. practically none. i have developed all major techniques with this that will blow your mind. the blue color you are referencing comes from placing the product too close to the skin, another mistake. for the folds you do not need a microcannula and you should not have the complications you are mentioning which really involve difficult to treat areas around the eyes.
3. i personally prefer artefill for the folds because in my experience per lane and restylane do not last that long in that area. however, if you go permanent with artefill you really must have an incredibly experienced injector because it is not reversible. per lane lasts longer but it can feel harder for the first 2 to 4 weeks when you smile.
best,
sml

Hello again,

Went for a consultation today for N/L fillers, the PS said I would need two syringes, 1 per side, I asked if they woud need to be injected deep and he said not deep, just into the dermis.As I said before, I am concerned with scarring, and have seen pictures of bad, raised scars of the smile lines, possibly due to too shallow of injections? I asked how many millimeters beneath the skin and he could not answer me.

1.How many ml beneath the skin do you usually inject?

2.Also, I have heard that juvaderm is inferior to restylane for n/l folds. What do you think?

3. He said results last for nine months; in your experience do they last that long?

4. Do you think that these fillers help buid collagen?

Finally, he recommended Ultherapy for lifting of the skin of upper brow, cheek, jowl area. The procedure costs $3800. That is a big expense, and, I am afraid it would result in loss of volume to face (by reducing/melting fat).

5. What is your opinion on Ultherapy, do you think the benefits outweight the costs/risks? Could ultrasound potentially result in loss of fat/volume? Thanks.

the trick is to inject the product subdermally. once you are below the dermis you should not see the beading (it is not scarring. it is just material placed too close to the skin.) i think juvederm and restylane are about the same IMHO. i think areas of high mobility like the folds last closer to 3 to 6 months. i personally think most people do not need facial tightening. they need volume. as you probably know i think the nasolabial folds are useless to fill. the tear troughs, brows, temples, cheeks, and chin are the real key but they are not done well and done badly out there because unlike the folds a monkey cannot do them. someone with taste and artistry and tons of experience needs to do it. i now do them with microcannulas so bruising, bumps are practically avoided and the results are drop dead stunning. if you are over 38 then as you probably know fat transfer in my opinion (for someone with stable weight) just blows away my fillers. those are my opinions. i really try to help my patients get out of this mental funk of needing to fill folds and lips all day. it really is a practical waste of money until you start to really understand what aging is all about. sorry to be blunt but just want you to start thinking out of the box.
best,
sml