LAM FACIAL PLASTICS

Dear Dr. Lam,

I would appreciate your thoughts and professional advice on the following:
I have a lip reduction done 7 weeks ago, both upper and lawer.
The lawyer one was big, handing and on the left side of the lawer lip I have a bump.
By the way, 12 years ago I injected silicon, since then, trouble, trouble, trouble.
Upper lip - had my first reduction 10 years ago, needed another correction so I had it 7 weeks ago. now as you can see in the picture, the right side is much thinner then the left side, don't like it at all, I would like to fix this problem, what do you suggest? can this be fixed with silicone? or better the other fillers that are not permanent?

How long does it take for the lips to get their final shape? as for now, it is very uneven, one side is less, the other one is still swallen a little (I think), middle of the top lip have a tissue that I think that will need to be removed, how long do I need to wait until another correction can be done? how long until the augmentation? been suffering for the past 12 years from these lips, can't stand it, do you think you can assist with the uneveness?
Any input is much appreciated.
Best regards.

i would wait at least 6 months before contemplating anything but that little groove could be helped with a little silicone or other filler. personally, i think you look fine. don't know if i would do too much more.
s.

Hi i have a similar problem with you as one side is thinner than another after lip reduction. Doctor I wanted to ask whether the filler u use is permanent because i do not want to have too many injections to my lips.

yes, it is permanent but remember you really should not chase asymmetry or you will get into the same position you found yourself in the first place, i.e., too big a lip. i always say that the two sides of the body are not the same and can never be made the same. that is in my consent form. leave asymmetry alone or you will have a problem.
s.

Hi Dr Lam,

my name is Renee and I too had a lower-lip reduction in 2002, and have been displeased with the results ever since. The pic of the gentelman you replied to named "Lindo" looks very much like my lips except mine are much bigger. Never the less in the pick you can see that the right side of his lower lip pulls slightly to the right, whereas for me its the left side of the lower-lip and it pulls to the left. Okay I have had countless consultations with surgeons to correct the initial procedure; however they all say they don't "appreciate" the asymmetry and refuse to do anything further. Aside from the Asymmetry which causes my lower-lip to pull slightly to the left when I speak (something I actually see is common for a lot of people who've not had surgery), what I hate most about the results is the puffiness it has created in the area following the incision line; which in my case extends from just beneath the lower-lip (by the left corner) out to the area of the cheek / jaw directly at the bottom of the line that is my naso-labial fold. The best way to sum it up is to say it looks as if I have stuffed a small piece of cotton between the left corner of my lower lip and another piece of cotton right next to that between my jowl and gums. Again the swelling is slight, but it throws off the symmetry and attractiveness of my face as well as obscures the taught / gaunt look to my face that I highlights my cheekbones. Again most Dr's say they "see it" but don't want to do anything about it because they don't want to make it worse or they say asymmetry is a possibility with all surgeries. I had asked for and been denied a steroid injection to that area until recently, because they all said cannot feel or see scar tissue. I can see the incision line myself, and pointed it out only to have one Dr say to me that it is something called a "bite-line", That's the most ridiculous thing I have ever heard. However 2 months ago I finally received an injection to the area it was 2.5 % Kenalog but it has done nothing. The other explanation I have received for the puffiness is that it might be a "bunched nerve", but no one has offered a solution. I really hate the way it makes my face looks.



Also the lip reduction caused my mouth area to widen and flatten-out. I had a nice bit of prognostication before the surgery ( my mouth area had that pushed out slight "feline"look) but I no longer have that. I have added filler to the underside (mucosa) of my upper lip which draws my whole mouth area "in" as it causes my upper lip to be "raised-up" and pushed-out as if i had an upper-lip lift. This alleviates the asymmetry to the lower-lip believe it or not and helps with the puffiness to the jowl area and gives me back the pursed /pushed-out look, but it is a a very temporary fix; filler being injected into the side of the lip that rests against the teeth metabolizes very fast. So my issue is only fixed for as long as the upper-lip is still swollen from the injections. My question to you is based on your experience, is a bunched nerve .neuroma a possibility for the puffiness to the side of my face by the lip, and if so can x-rays show this? When Dr's feel inside my mouth they all say they can fell "something" but again they say it's slight. If I can definitively prove the existence of something to these Dr's how would you propose I treat the puffiness? If it's not a neuroma, but is scar tissue making that area puffy should it be treated with steroids or 5FU? I only learned of 5FU from your site. I live in Manhattan and have gone to several different surgeons none of whom have ever mentioned 5FU. In an effort to make sure you have all the info, the Dr who did the surgery said he only took out a 1/4 inch of tissue and then "rolled the lip inward". The puffiness that I complain of is at the bottom of both corners of my mouth, it looks masculine, and I have been told by one Dr that it's a feature typical on White males ( I'm a Black female). The puffiness on the right corner of my bottom lip doesn't bother me because it doesn't extend out to the jowl/ "chipmunk area" like it does on the left side. Also 2 months ago before getting the kenalog injection I was going to do Lipodissovle, but got scarred when signing the release form because it states that persons prone to keloids (such that I am) may develop a keloid at the injection site of the Lipodissolve. I am totally at my wits-end. I feel as if they don't appreciate my issue because I am currently overweight and so some of the Dr's think its just a typical fat face issue, but other Dr's have seen me when I was thinner and the puffiness was still there. I am 32 yrs old, and I don't know what to do. Please help. Thank you so much for taking the time to read this email.

puffiness would not be due to a neuroma or bunched nerve. does not make sense. 5FU won't work unless the tissue is very hard and firm. asymmetry is something that should not matter and i would not surgically try to fix it because i may make it worse or not change it. something that you really should not obsess over. we all move our mouths weird in different ways and in most cases we did that before the surgery but we just simply never noticed it. honestly, from your long description of what you are looking for, most likely you probably would not be a good candidate. sorry.
s.

Hi, thanks for your advice. i know assysmetry is normal. But i wanted to fill the gap,may i ask what is the permanent filler that you are using? And will it feel weird and look unnatural?

silicone micro. should not look or feel weird.

I have seen the article about lip enhancement through silicone mico, i wonder if it is possible for one session if there is only a little enhancement to make?

yes, possible but always possible that it may still take 2 to 3 as swelling resolves.