LAM FACIAL PLASTICS

Hi Dr. Lam,

I'm 34 yo male 6'2 160. Due to aging and exercises at gym my body is very lean and I like it that way. My face on the other hand is too gaunt. My upper cheeks separate from my middle cheeks through what you call 'mallar septum'. My lower cheek, laterally from my mouth and a little up, are very hollow. I am thinking of getting one vial of sculptra for the mallar septum to smooth the transition there and for the lower cheek area but I am not sure it will create enough volume in those areas (especially for the lower cheek).

I don't really wanna pay $1000 for a 'subtle' difference noticed only by me.

Have you seen sculptra to create enough volume from one vial? In your posted before/after pic you have a pic of one woman treated with sculptra. http://www.lamfacialplastics.com/before ... rlane.html

Was that one vial or several?

Great question. I have been totally underwhelmed with sculpta's ability to achieve and deliver results that are impressive. The result you are seeing in that one photo is 2 vials built over several months.

I have pretty much given up on sculptra for several reasons:
1. it takes way too long to see a difference on the order of 6 to 9 weeks. most people want to see an immediate result.
2. it takes 2 to 3 vials to see any real change.
3. it costs way too much for the patient.
4. it is painful even with the administration of topical and extended dental blocks. my other treatments are really pain free since i inject only 1 to 2 times versus multiple multiple passes.
5. i can't fill the lower eyelids, which is a TOTALLY unsafe area to fill in my opinion. way too much risk of lumpiness.
6. i have to premix the product the night before and if you don't show up or miss your appointment i have to charge you and not give you the product, which expires in 1 to 2 days. that also means you can't just show up for consultation and get treated.
7. risk of nodules that can show up early or late. i have seen this problem.
8. uncertain long-term effects in non-HIV immunocompetent individuals.

need I continue? hope that helps.
best,
sml

Thanks for your reply. That's what I thought. Probably I'll go with Silicone 1000 for the cheeks.

About filling the lower eyelids - I had juvederm there 4 days ago. The injector has a very good reputation BUT she uses very conservative technique where she injects only right beneath the tear trough which in my case didn't fill in the lower lid just moved up the edge with the upper cheek. I don't like it cause to me it makes almost no difference in the appearance and I had to pay $500 for it.

I know you use blunt cannulas for injection in that area. Do you try to fill in the whole area up to the eye ball like with Fat Grafting or you concentrate on the tear trough mostly?

two things:
1. i fill the entire rim. i miss a little bit about 10% of the outer rim but the whole rim is filled. Just look at my before and after gallery. i use the same technique as i do for fat grafting. i find that one syringe for each eyelid is ideal. the cost would be $1000. i have not had problems with juvederm around the eyes but almost EVERY major injector in the U.S. has had problems with juvederm around the eyes, specifically prolonged swelling and spreading of the product. Therefore, I have stopped using it around the rim. I prefer restylane and only restylane. In my opinion there is nothing else safe for the rim other than fat and restylane.
2. as far as silikon 1000, even though i am a big fan of it, i would HIGHLY RECOMMEND that you reconsider rebuilding your entire cheek at 34 years of age with silikon. God knows what will happen to that much silikon over the course of your lifetime especially if you have an inexperienced injector do it for you. I use silikon 1000 to manage acne scars, lips, nasal defects, and occasionally minor touch ups for fat grafting and smile lines. that is about it. although people can get safe and good benefit with silikon in the face in large quantities, i would not recommend it, ESPECIALLY since you are only 34 years old. It may look weird with aging and with possible weight gain. No matter what you say, you may gain weight. You may also lose volume around the treated area. Okay, enough said, be careful.
best,
sml