LAM FACIAL PLASTICS

Hi Dr. Lam,

I stumbled upon you while doing research for facial fat transfers which I thought was my best option but from reading your forum I am reevaluating my decision and thinking maybe facial fillers are best for me at the moment. The reason why I am reevaluating my decision is that I am 34 and plan for children in the future.

My main areas of concern are my hollow eyes (both upper and lower) which unfortunately are hereditary in my case. I also would like to add volume to my somewhat long, flat face (anterior cheek especially). Other signs of aging include my prejowl area as well as my nasolabial folds.

So here are my questions: With a budget of about two thousand dollars and using Restylane , how would you distribute the filler in each area to simulate your facial fat transfers? Second of all, to keep my results without going back to zero when would I have to come in again and would I need the same amount of filler (or more as volume loss continues with age)? Lastly how far in advance are you booked?

fillers sound good and $2000 i should be able to hit a lot of the areas that i would do for a fat transfer, that would include but not limited to temples, brows, lower eyelids, anterior cheek, and chin. may not have enough for buccal if that is what you need and may be slightly shy on the outer cheek but not be. depends how hollow you are. but given your age group, you should be very satisfied with $2000 worth of fillers. i would say that if you came back between 6 months to 2 years that you could build on your previous work and typically after 2 to 3 rounds i start to see results that can last years. typically the nasolabial grooves are not that important but let me see you. also, i don't know how far booked i am. i think about 2 months but you need to call my office to determine that 972-312-8188. as mentioned, you will probably need decreasing fillers as you age if you keep up some basic fills every year or so.
best,
sml

Wow, sounds very promising and no buccal area is not as big of a concern for me:) My only concern with your response (which was very prompt, thank you) is that between 6 months and 2 years seems like a wide range (to get "refilled" so to speak)... Would you recommend that one come back midway before the previous filler disappeared to get refilled (say maybe at 6 months) and that we use half as much filler? I know they do that with Sculptra (which I know you don't use and am not interested in getting) but I'm wondering if you also practice this with fillers. Would you do Botox on the same day as the fillers? Have you had any problems with hyperpigmentation with Restylane under the eyes? And finally, could I maybe see some before and afters of fillers in 30 something year olds to get an idea as to what to expect?

Sorry, just a few more question... Would you use artefill on someone like me? How much is artefill and are have you had any negative side effects (lumps, etc) from using Artefill? Is it possible to use artefill in some areas like the nasolabial folds and Restylane in others?

bingo, that is probably what i would recommend is artefill in the folds and restylane elsewhere. no, i am not worried about lumps if i do it. i am very good at it.
best,
sml

thanks dr. lam,

how much is each artefill syringe with you and how much do you typically use in someone my age (34)? Would I need a skin test and how would we go about doing that? (Would it be before consultation?) Also dr, I think that maybe you missed my second post which I posted a few minutes before my third... do you think you could take a look and answer some of those concerns?

1. artefill is $950 a syringe. you need a skin test several days to week before. honestly, at 34 there is enough "aging" that i can do anywhere between 2 to 5 syringes depending on what you would like without risk of overfilling. i personally would recommend the restylane because it might be "cheaper". artefill to do a whole face even young is expensive. if you really want artefill you might want to get a skin test from a local doc before coming here if you don't live here. you can also come and get restylane first, get a skin test, then slowly transition over.
2. yes, you could come back at 6 months. typically you probably would not need a lot at that point but it may boost you to get greater longevity.
3. yes, yo can do botox the same day. no problem.
4. no, with the hyper pigmentation because i don't use needles that causes the problem with bruising and staining. i use the microcannulas that avoids this problem all together.
5. 34 year old (marcy who works with me): http://www.lamfacialplastics.com/galler ... e.jpg.html
36 year old (with botox): http://www.lamfacialplastics.com/galler ... 9.jpg.html
36 year old: http://www.lamfacialplastics.com/galler ... 0.jpg.html
28 year old:
http://www.lamfacialplastics.com/galler ... 5.jpg.html
believe it or not 26 year old: http://www.lamfacialplastics.com/galler ... rlane.html

sml

I think what i would do is Artefill in the nasolabial folds and Restylane on the rest of the face until I get the fat transfer which I think I would do until I'm closer to 40 and am done having children because as you have mentioned I did notice some aging with my prior child. I suppose you meant is 2-5 syringes for adding volume to the whole face? What about nasolabial folds only?

that is about right: 2 to 5 for the whole face using restylane (not including folds). the nasolabial folds would typically need one artefill done probably a couple of times (at most 3 times unless you have really deep ones). i don't like to overfill them, especially with permanent fillers. artefill comes down about 20% after the first 1 to 2 months as the collagen is absorbed. the one thing (you might not want to hear this) is that if you do restylane repeatedly it is much harder to do fat because the restylane really has lasting power. that is also a good thing. if you do restylane for a few years with me, you probably will look amazing and not need the fat grafting at 40. just look at some of my staff when you come to visit.
best,
sml

omg... does this mean after the 2nd, 3rd, or 4th injection, that you can't every get fat transfers?

really, my fillers last so long if you do enough of them that you probably simply won't need a fat transfer, on a positive note. on a negative note, yeah it is harder to do a fat transfer when i have like 15 syringes in there because i have to dissolve everything out, which can be done but may not be worth it.

I've seen in this forum that for a few of your patients that have already tried your temporary fillers, you will do artefill as a permanent alternative. Do you do the whole face with artefill, including the upper eyelids and undereye area? I also see that you normally recommend temporary fillers and not artefill so much. Is this because a permanent filler won't age well? Just wondering why not get a permanent filler once you've tried a temporary filler and have liked the results? Also once you get artefill, can you do fat transfer on top or is there a smaller chance that it will survive, or maybe cause lumps? Is artefill really permanent or around 5 years then disappears?

i am always cautious with permanent fillers in very young people because i would like it to age well. i typically wait until at least mid-30s. however, yes i do daily fill the entire face with artefill including upper and lower eyelids safely using specially designed cannulas. i can do fat over artefill or the other way around. i typically do not like to do fat on top of temporary fillers since i do not like putting an expensive permanent surgical option on top of a temporary filler. i am ok putting artefill on top of restylane because i can always add more artefill in the office setting and does not require a surgical procedure to add more of it. hope all that makes sense. artefill is truly permanent minus the effect of ongoing aging and fat loss.
best,
sml

Ohhh so you do artefill on the upper eyelid... I've spoke to a couple of dermatologist and have been told that artefill can develop lumps in that area? That being said, you're the only doctor that I've contacted that seems to understand the importance of the upper eyelid. Mine seem to have hollowed significantly during the past year (stress, genetics, etc) and I feel it has made me a look a few years older and tired looking. How do you feel about doing artefill a little at a time (1-2 syringes a few months apart)? How many syringes do you typically use on someone in their mid 30's? When do you see final results with artefill? What is your advise on artefill with ongoing aging (say 5-10 years down the road) : temporary fillers like restylane or full facial fat transfer? Thank you for your prompt responses

yes, i do artefill in the brows almost every day. the reason i can do it there safely is that i practiced extensively first with HAs. also i use a Japanese cannula. without that, i simply could not fill it smoothly. i do not use needles to do it. yes, you do lose 20% of the product because the collagen vehicle gets reabsorbed after 6 weeks so doing it in stages makes sense. i typically need about a half to a full syringe for correction, especially for someone young like you. i think it will age well for you over time if i am conservative with the correction. any of the techniques: restylane, fat, artefill, can work for you. hope all that makes sense.
best,
sml