LAM FACIAL PLASTICS

Hi Dr. Lam,

I consulted a plastic surgeon and was told that to help with the hollowness under my eyes which makes me look a bit tired and seems like I got dark circles, he recommended 2 choices 1. fillers like Restylane, Juvederm, Radiesse, etc. and 2. fat transfer/graft to help raise the depression under my eyes. he suggested the fat transfer/graft because he said that fillers are not permanent and might not give me the results that i want and that it was too costly since fillers go away over time. so i wanted to get a second opinion from you and wanted to know what you think about the fat transfer/graft procedure to fix the hollowness under my eyes, I am Asian in my late 20s and hate looking tired especially at times when I am not. If you think fat transfer/graft method is a good way to go, would you mind letting me know how this procedure is performed as well as downtime and the longevity of the results, etc. Do you recommend this procedure for my situation and for someone my age or do you have another suggestion. Thanks for your time. Appreciate it! Traci

hi,
in general, i prefer fillers for someone young and with limited areas of hollowness for two reasons:
1. fat grafting can change with metabolism changes as one ages from the thirties onward.
2. fat grafting is less predictable when trying to correct only one small area like the under eye area.

in general, i prefer fat for someone slightly older with greater areas of hollowness for two reasons:
1. greater safety with potential weight changes as one ages.
2. better results that are more cost effective since it is a wide area of the face that would cost quite a bit in filler costs to accomplish.

accordingly, i personally would probably recommend fillers, as i believe that fillers done a few times actually start to last many years if not even indefinitely in static areas like the lower eyelids. that is my opinion at least.
best,
s.

watch this video i just shot in san diego a few days ago where i say just that:
http://www.youtube.com/watch?v=0eNgiz13bFI

Thank you Dr. Lam for your quick reply! If fillers are be a better choice for someone my age (29 to be exact), what are some fillers that work well for fixing the hollowness under the eyes? I've tried Juvederm before and saw a little bit of inprovement but not enough to my satisfaction and it has since kind of gone away. The plastic surgeon said that if I were to go with the filler route, Radiesse is a good option but I get mixed reviews on other fillers such as Restylane and Juvederm. Now if I were to go with the fat grafting procedure whether now or down the line, is it a minimally invasive procedure? The surgeon told me that everything is done inside the mouth so there are no scarring but I was concern because the mouth is in the south region while the undereyes are in the middle so how will one retain control on where and how much the fat goes if the needle goes through inside the mouth rather than say when you inject the fat outside the face under the eyes like in filler injections.

Also, I am thinking about a rhinoplasty and was wondering once the nose job is done, how long does it take for the new nose to take shape and what part stabilizes first such as the bridge, the tip, the alars, etc. Thank you for your time and advice. Love your forum/blog/everything! Keep up the great work!

honestly, i do not like Radiesse and I am ok with Restylane under the eyes. I prefer a permanent solution like Artefill because it is opaque and does not cause the clear fluid look that can happen with 95% correction with Restylane. but it needs a skin test first. I don't like Radiesse because it creates a cement like quality under the skin over time and sometimes leaves a red streakiness under the eyes for a while. I used to do the mouth technique 8 years ago but it is SO inaccurate. i now use these beautiful petite japanese cannulas that allow me to hit the tear trough near perfectly with almost zero risk of any major bruising. it is a revolution. unfortunately, less than 1% of docs out there use them an i would say only 1 in 200 know how to do it safely and beautifully. also, Artefill needs a skin test first.

rhinoplasty wise, it all depends on what surgeon does it. i tend to zero bruising at a week and minimal swelling (in general but not always). if you have someone who is a bit rougher you can have a much longer recovery. it also depends on how thick your skin is. if is very thick you may have a few weeks where you cannot tell a difference. taping at night really helps to speed the recovery and minimize fluctuations in swelling in the morning that can happen the first couple of months.