LAM FACIAL PLASTICS

Dr. Lam, what do you think of this procedure? The doctor uses hydroxyapatite paste to build up the cheekbones --is this something you would recommend? He's a doctor in Australia and I'm in NA --would you do it? I trust your aesthetic eye more than anyone. Here's his video: What are other ways to achieve the same result?

Sorry had to delete the link. Not allowed to promote or denigrate another doc on here. I have probably done a thousand syringes of hydoxyapatite in the past but have not used it for at least 4 years now because I have noted in the past that over time the product makes the cheeks progressively firmer like cement. It just keeps building up residue. Even some of my staffs' cheeks are very firm over time. I prefer fat, restylane/juvederm, and artefill.

Yes, but Dr. Lam --this doctor in australia uses hydroxyapatite paste to directly mold onto the cheekbones, underneath the fat and muscle --it then hardens and become part of your existing bone structure. So he's not really using it as a filler, but as a substitute for an implant. I believe there was a Dr. B in texas who also used hydroxyapatite in this way to augment the existing bone structure. Fillers obviously would achieve a volume effect on the cheekbone area but they would not augment the bone structure in this way which is permanent. I guess I just wanted to ask you if you thought this was sound -there aren't many doctors who do this --maybe a few maxillofacial surgeons who use it for deficient bone growth.

i personally think that could be fine. however, i do have some concerns.
1. for young faces under the age of 30 that have sufficient soft tissue envelope but just lack structure then this technique could be valid. however, you do lack the ability to remove it unlike an implant.
2. for anyone over the age of 30, the result can be less than desirable. the reason is that the soft tissue envelope (fat, muscle, collagen) starts to dissipate over that age year by year and the bony augmentation you had when you were younger starts to actually make you look older. the reason for this is that the exposure of bone on the face is a hallmark of aging and the more bone you see, the older you look. this is why cheek implants that are done in one's teenage or twenties start to look bad by one's thirties and almost definitely by 40s.
hope that makes sense.
best,
sml

Dr Lam,

For someone around the age of 40 who has always had flat cheekbones - would not the ideal solution be to first get augmentation with hydroxyapatite paste and then get fat grafting on top of this? Or would fat grafting in itself produce a good enough result - in other words, fat grafting can recity fat loss due to aging, but can it rectify a skeletal deficiency?

you do not need to augment bone and fat loss in someone 40. yes, it is true you can lose a little bit of bone but it is so insignificant that the fat alone can cover both. that is not the case if you use an implant which causes too much bone exposed. the people that lose bone would be much older with really bad dentition (dental care). in short, fat grafting is totally sufficient and the right way to go in someone with experienced hands to do it.

Hi,

Thanks for the response. Specifically, I was not referring to hydroxyapatite paste to augment for loss of bone. I was referring to someone who had always had flattish cheekbones due to their bone structure. When they were younger, they had enough ample fat on the cheekbones but still had flattish cheekbones, now they are 40 the have flattish cheekbones and insufficient fat.

From what you re saying fat grafting would rectify the problem - so there is no need to augment the bones with HA and then use fat grafting to restore the youthful appearance.

it depends on how flat. if you truly have very flat bones, you probably cannot use fat to augment the whole thing otherwise you could have a fat looking cheek. i would have to see you. i do not however perform HA paste or cheek implants.