LAM FACIAL PLASTICS

Dear Dr Lam,

I am interested in cheek implants and was recommended to your website in order to inquire about them. What is your opinion of malar implants and such proceedures. I am especially intereste din hearing your opinion regarding:

1. Possibility of obtaining the results desired
2. Risk

Thanks,
Mike

i personally dislike them. read this blog to understand my thoughts:
http://www.lamfacialplastics.com/celebr ... -implants/
i think also that the procedure is essentially flawed. the risk of infection is around 10% since the mouth is dirty. i don't do cheek implants. if you are interested and you are 20 something you should find another surgeon who believes in them. if you are 35 or older and want it for facial rejuvenation, it is a mistake in my opinion.
best,
s.

Thank you for the link and your thoughts doctor. I've been considering getting cheek implants and from talking with people and hearing what you have to say I am having second thoughts. I was also wondering about jaw implants. Do you have an opinion on that type of surgery as well?

You also mentioned risk of infection being 10% because the mouth is dirty. Does that percentage apply to all proceedures involving the mouth (e.g. tooth implants as well)? Or is it different when it comes to plastic surgery? The reason I am asking is because I am planning on getting a tooth implant and I think your concerns about infection is somethin I need to consider and address. Do tooth implants and other cosmetic implants share the same infection risks due to the fact that they are in the mouth?

Thank you for taking the time to address my concerns. I really appreciate it.

no tooth implants are completely different and should be fine. of course, for actual risks, speak with your dentist. i don't have experience with jaw implants but i have heard similar statistics due to the same reason.
s.

Thanks again for the information doctor. Much appreciated.

you are most welcome.

mike30 wrote:Dear Dr Lam,

I am interested in cheek implants and was recommended to your website in order to inquire about them. What is your opinion of malar implants and such proceedures. I am especially intereste din hearing your opinion regarding:

1. Possibility of obtaining the results desired
2. Risk

Thanks,
Mike

Hi,
Unfortunately, all surgeries have risks and complications. Although chin augmentation is not a comparatively difficult and invasive procedures, complications can and do happen. These include allergic reaction to the anesthetic used. You will have a chance to review the risks associated with anesthesia by a typical resource. You could develop a post-operative infection and need to have the implant removed, the infection dealt with and still have to wait for several months before an additional surgery can be performed to re-implant. Infections usually occur with the first few weeks. Some possible infections and a more common one being Staphylococcus, or simply Staph. A more severe one is Methyl Resistant Staphylococcus aureus, or MRSA. This strain is a Methycillin-resistant "bug", but is not considered a "super bug" and is usually sensitive to at east 3 types of antibiotics. In itself it is very rare, much less with BA.
Thanks

Sonia,
Please do not give advice here. Thanks.
S.

Thank you for sharing your blog. I was considering cheek plants myself, but now I am a bit conflicted. I suppose that it is good that I understand the risks before making such decisions. Thank you Dr lam for the education you provide here, it is great to have somewhere that I can ask questions and seek information from a professional. Should I decide to go ahead with the procedure, I suppose that I should find an experienced doctor to do it, since this is not something that you do. I wonder what you might know about lifestyle lift, have you heard of them? Would this be a good place to have this type of work done?

my pleasure. glad i could be helpful.
s.

After doing some research over the last few months I think I am leaning more towards having fat transfer to the cheeks to enhance my cheekbone area and I have a few questions.

1. How long do the results last in your experience? (some people say that it doesn't last at all, other say 10-15 years etc, so I don't know what to believe)

2. Along with the cheek area, I am looking into adding some fat at the tear trough to achieve more balance around the eyes. I am a little concerned though due to how close it is to the eyes. What is your opinion about fat grafting in the under-eye areas?

3. I am also looking to add some minor width on the temple and angle of the jaw (for some minor increase in definition) so I am looking at a comprehensive treatment overall but with no extreme demands in terms of huge increases in size. I am currently 31 years old and do have a stable weight. Do you think a global strategy (eyes, temple, cheeks, jaw) to tweak rather than dramatically alter the face is a good choice for me?

Thanks!

1. How long do the results last in your experience? (some people say that it doesn't last at all, other say 10-15 years etc, so I don't know what to believe)
IT IS PERMANENT ONCE BLOOD SUPPLY FORMALIZES OVER A PERIOD OF 6 MONTHS TO 1.5 YEARS. HOWEVER, AFTER 2 PLUS YEARS, ONE PROGRESSIVELY GETS SLIGHTLY OLDER SO ONE MAY NEED A DROP (VERY LITTLE) OF FILLERS TO MAINTAIN AGAINST AGING. IF FAT GRAFTING IS DONE POORLY BY AN INEXPERIENCED SURGEON IT WON'T LAST AT ALL. I HAVE SEEN MY PATIENTS MANY YEARS OUT (6 TO 7 PLUS) AND SEEN IT STILL HOLD WELL.

2. Along with the cheek area, I am looking into adding some fat at the tear trough to achieve more balance around the eyes. I am a little concerned though due to how close it is to the eyes. What is your opinion about fat grafting in the under-eye areas?
IT WORKS GREAT AT THE ORBITAL RIM (BONY RIM). IT IS UNSAFE TO MANAGE RIGHT NEAR THE EYELID NEAR THE SKIN SURFACE BUT MOST PEOPLE DON'T NEED IT THAT CLOSE. FAT TENDS TO MANAGE THE LOWER EYELID AREA VERY SAFELY AND IN MINORITY OF CASES NEED TO BE COMBINED WITH OTHER TECHNIQUES LIKE FAT REMOVAL AND LASER/PEELS TO BE DONE AT THE SAME TIME.

3. I am also looking to add some minor width on the temple and angle of the jaw (for some minor increase in definition) so I am looking at a comprehensive treatment overall but with no extreme demands in terms of huge increases in size. I am currently 31 years old and do have a stable weight. Do you think a global strategy (eyes, temple, cheeks, jaw) to tweak rather than dramatically alter the face is a good choice for me?
YES, FAT AND FILLERS ARE BOTH GREAT BUT FILLERS ARE MORE PRECISE TO MANAGE SMALL AREAS OF THE FACE. FAT IS BETTER FOR GLOBAL REJUVENATION TO PROVIDE THE NICE OVERALL HIGHLIGHT TO THE FACE.

S.

Thanks for the information Dr. Lam.

A clarification on your last answer if you don't mind...

Let's say I were do do some fat grafting to better define my cheeks and I also wanted to enhance the angle of the jaw only (small area) by a few millimeters would you use fillers for the jaw or would you use fat just like you would for the cheeks? I am a little unclear on that. Also, are fillers permanent or will I have to redo them every 6-12 months?

I have read that some fillers form lumps when injected does that also happen with fat transfers? Do fat transfers cause the creation of lumps or is that only will fillers?

answers in all caps:
Let's say I were do do some fat grafting to better define my cheeks and I also wanted to enhance the angle of the jaw only (small area) by a few millimeters would you use fillers for the jaw or would you use fat just like you would for the cheeks? YES, I WOULD DO FAT AT THE SAME TIME THERE. HOWEVER, I TYPICALLY ONLY DO FAT IF IT IS JUSTIFIED. THAT IS, IF THERE IS ENOUGH HOLLOWNESS IN THE ENTIRE FACE TO MERIT THAT? WHY, BECAUSE WITH A TOUCH HERE OR THERE, FAT IS MORE EXPENSIVE SINCE IT REQUIRES SURGERY TO DO. WHEN I HAVE TO PUT IN 30 TO 40 CC OF FAT, THEN FAT IS LESS EXPENSIVE BECAUSE FILLERS AT THAT RANGE CAN BE COST PROHIBITIVE. ALSO, IF SOMEONE IS IN THEIR EARLY TO MID-TWENTIES I DON'T DO FAT BECAUSE OF RISK OF FAT NOT AGING WELL BECAUSE OF CHANGES IN METABOLISM. PLUS FAT IS ALSO A SOFTER TREATMENT SO IT MAY NOT FILL IN AN AREA PRECISELY BUT PROVIDES AN AMAZING FOUNDATION FOR THE FACE. WATCH THIS VIDEO TO UNDERSTAND THE FINER POINTS:

http://www.youtube.com/watch?v=dbdzuZVDgnA
I am a little unclear on that. Also, are fillers permanent or will I have to redo them every 6-12 months? PERMANENT OR TEMPORARY. I CAN DO EITHER ONE. ARTEFILL IS MY PERMANENT OPTION AND JUVEDERM/RESTYLANE IS MY TEMPORARY OPTION. HOWEVER, I HAVE NOTED IN MANY CASES THAT IF SOMEONE DOES 2 TO 4 ROUNDS OF TEMPORARY OFTENTIMES ENOUGH OF THE PRODUCT STAYS THAT IT IS ALMOST PERMANENT. I SEE THAT IN MY STAFF THAT I INJECTED MANY YEARS AGO.

I have read that some fillers form lumps when injected does that also happen with fat transfers? THAT IS A TECHNICAL ISSUE. I GET VERY GOOD RESULTS WITH FAT AND FILLERS OF ALL STRIPES. Do fat transfers cause the creation of lumps or is that only will fillers? THAT IS WITH CRAPPY INJECTION METHOD NOT WITH A HIGHLY EXPERIENCED INJECTOR. LESS THAN 1% OF INJECTORS USE CANNULAS TO DO THE WORK. I REALLY DO WONDERFUL WORK WITH CANNULAS (BLUNT INSTRUMENTS) TO SCULPT FACES WITH FILLERS OR FAT AND THAT COMBINED WITH TECHNICAL PRECISION AND ARTISTRY ALLOW ME TO CREATE RESULTS THAT ARE MORE AESTHETIC AND SAFER THAN MOST OUT THERE.

Dr Lam,

Thanks again for your reply. One final question if you don't mind. I know you are not a fan of implants but I was wondering if you do fat transfers on top of implants (if the implants were done by another doctor 1-2 years before the fat transfer)?