LAM FACIAL PLASTICS

Dear Dr Lam

I wish you could help in my desperate situation.

I had buccal fat removal in 2007 and it left me a hollow face. The area around my mouth looks dented and I feel myself scary when looking into mirror. I am now 29, and I can foresee even greater fat loss in the coming years. I wish some procedures can help save this hollow face. After reading information of some fillers like Juvederm, I wish I could build my real fat with a more natural facial contour.

My worry is, would the scar tissue of buccal fat removal makes me unsuitable for fat grafting? Known from the Internet, if the fat fails to connect with the blood vessels, the fat cells may die and decay under skin, which may even damage skin and ooze out from pores. It is a very terrible picture. I understand that some fat will lose and only around 30% can be retained. But I am worrying if the surgery 5 years ago will make me impossible to have facial fat grafting in cheeks.

I lost trust in the doctors in my region. The doctor never told me about this possible outcome, and he even said buccal fat removal would not leave dents but a smooth curve line. If I have fat grafting, I wish I could have it with your hands.

Thanks so much for reading my post and answering my questions.

in short, fat grafting works for people with previous buccal fat removal. that really should not be a problem. however, if you are just replacing the one area with fat then there are several problems: 1) cost, 2) unpredictability since fat is a graft and works much better to be blended over a wide area, 3) your age. because fat is a live graft from the belly it is more weight dependent and i hate doing one small section of the face with it. i think if you want a permanent option Artefill maybe a good option. and to be honest Restylane and Juvederm can last well with a few rounds of treatments.

Thanks so much for your reply and information.

Before considering Juvederm or Artefill, I have a question i my mind for long.
May I know if the removal of buccal fat pad will lead to faster facial fat loss? The mistake certainly makes my cheeks sunken. But I am not sure if it is getting more and more sunken. Is it due to my minor weight loss (i lost few pounds due to this problem) or actually the surgery will lead to continuous loss of fat due to the loss of the supporting fat pad?

Also, may I know how long the history of Artefill is? Actually I haven't heard about it much and afraid that it is a new treatment without much proof on its side effects and aftermath. Do you suggest cheek implant? Some doctors mentioned it but I am afraid the risk of another incision will be irreversible. The fat pad removal has left me life long scar.

My heartfelt thanks indeed for your professional comment and thoughtful consideration!

no, buccal fat removal will not speed things up as far as fat loss. it is most likely small aging combined with small weight loss plus some unnecessary anxiety. cheek implants will make one bonier and it is hard to specifically target the buccal area so i don't like the look of them and don't do them. artefill is a product that has been out for many years now with a good safety record. i have done a thousand or more injections without any problems. it is permanent and there is some risk of how it will age for someone as young as you but then again a fat transfer is also permanent and carries more risk in my opinion with potential later weight fluctuations.

Dear Dr Lam

Thank you very much for your detailed explanation. As you're an expert in fat grafting, after reading you comments, I have few more questions concerning this area:

1. As you mentioned "unpredictability" of fat grafting in my case, does it mean weight fluctuation which may make the face look too full in future after fat grafting, or the possibility that the grafted fat cannot survive in the area?

2. May I know why it is not suitable to have fat grafting in a smaller area instead of the whole face? Does it relate to the grafted fat survival?

3. I researched some fillers, like Artefill, Juvederm and Restylane as you mentioned. But I am afraid Artefill is rather new and how it reacts to the aging process is really a concern of me. And there is one called "Scultptra", which seems quite new in the market. Is it safe? Would you recommend that for my situation?

My sincere thanks for your patience and time. You professional knowledge has really made things clearer to me and helped me understand the situation.

1. As you mentioned "unpredictability" of fat grafting in my case, does it mean weight fluctuation which may make the face look too full in future after fat grafting, or the possibility that the grafted fat cannot survive in the area? it means two things: weight fluctuation and also % of fat survival is never 100% and when someone pays for anesthesia, the procedure, etc. and the graft take is say 60%, they feel ripped off. when i do a little fat over the entire face and the result is 60% in some and 90% in others the overall result is amazing. it justifies the cost. i prefer fillers to target small areas even to touch up my own fat work as needed.

2. May I know why it is not suitable to have fat grafting in a smaller area instead of the whole face? Does it relate to the grafted fat survival? see above plus also fat from the belly acts differently than other parts of the body so if you gain or lose weight significantly the area in the buccal area may grow or be lost disproportionately to the rest of the face. that is why i like to do it evenly over the whole face so that it will age well for you.

3. I researched some fillers, like Artefill, Juvederm and Restylane as you mentioned. But I am afraid Artefill is rather new and how it reacts to the aging process is really a concern of me. And there is one called "Scultptra", which seems quite new in the market. Is it safe? Would you recommend that for my situation? they are both good products. i do not use sculptra because it is guess work. you stick some in your face and then let the collagen grow sometimes you get not enough growth and sometimes you could have to much growth. when i use fillers, i get precisely what i put in minus a little bit of loss due to swelling and product absorption. i believe that both products (which have been on the market) should age better than fat if we are talking about an isolated part of the face for the reasons i have enumerated above.
s.

Dear Dr Lam

Thanks a million for your patience and advice. I deeply appreciate your help.
So far it seems you do not recommend fat graft for me, and I understand your concerns. However, fat graft means having a real part of mine which would make me feel better and safer. Some doctors recommended me to take it instead of temporary injection due to safety and durability. My intention is to fill the dents (with minimum amount of fat) before I start aging faster in mid 30, therefore I can still have some volume of face and reduce the use of excessive fat. I am not sure if my idea is realistic, but I know that too much fat leads to more difficulties in blood vessels development, and in fact I don't mean to have a face make-over, I really want to keep it as small scale as possible. I know I have asked a lot of questions, and you've been helping a lot, but I'd be grateful if you can share your feedback on my idea. I would consider thoroughly before making any decision.

here are my thoughts with fat transfer:
1. you must realize that you cannot gain significant weight afterward and if you do you must lose it.
2. you have to be realistic with the viability of fat taking in one specific area no matter what previous surgery you did or did not have.
if you are willing to accept those limitations then you could be potentially a suitable candidate. hope that makes sense.
s.

Thanks a lot, Dr Lam.

Perhaps I will take it in future, say some years later when I'm 35, when my weight should be more stable and my metabolism slows down, I'd like to know that if my weigh "gain" will reduce the viability of the fat cells. or weight "loss"will lead t it? or any weight gain or loss in fact affect its life or death?

A doctor mentioned fat graft to me, and he said, no matter how much fat can be ratained, a little is also good. I understand there may be only 30%-20% of fat or even less to be retained, and people said there would be more than one procedure. I am concerned with side effects.Some said clumps, lumps or necrosis form few years after the surgery. Is it quite common indeed? I can't rule out that I will have it in future, as I'm afraid I'll get hollower when aging fastens.

The final question, in my case, in fact, I have received some Radio frequency treatments in a clinic, but they never mentioned fat cell reduction and it was all about collagen boost to me (because i look gaunt so i thought some treatment'd be good), and I even have a TriPollar device at home after quitting the treatment in Clinic. When reading your page, I read some threads of RF fat loss. I was extremely terrified! I am afraid my fat cells all dead under skin, and it's not retrievable and much worse than what I thought! Is it possible that RF worsens the situation? In fact, can i send you a picture of mine via email for your diagnosis (Because i don't want to make it public here)? This made me so terrified and I am afraid my case is worse than only buccal fat removal. Can you tell me some symptoms of the patients who suffer RF damage? Your professional eyes should able to judge if I am one of those victims because you handled many similar cases.

You're a very conscientious doctor who does not only want to have the deal made. This is why I contacted you and sought your advice. Sorry that I asked a lot. Thanks a million for your patience, esp you're a leader in this field and should be very occupied with clients. I understood why people fly over the seas for your help. If I have fat graft, you're the No 1 choice!

Dear Dr Lam
I just want to add one thing about my fear of fat loss due to RF treatment. i didn't feel any pain, no inflammation and no swelling after the treatment. however, will the energy kill the fat cells quietly under skin but I didn't notice? Or there'll be some symptoms on the skin of those affected?
sorry that I may sound ignorant. but I have to understand what leads me to fat grafting. thanks a million.

no, i doubt that there is a problem with your RF treatment.

Dear Dr Lam

yup this is my doubt too.
can you give a bit more info on those people who were affected? like the visible signs on their skin? I consulted a dermatologist but he said it shouldn't be the case. I would be really grateful if you let me know more about this. I can't judge if i suffer fat loss by RF as no signs on the surface on skin is found.
I wish I have not bothered you much. But your answer means so much to me. thanks a million!

unfortunately, in this case i don't have a good answer to give you.

Dear Dr Lam
Thanks for your advice even though you have not charged me a penny for talking with me so much.

indeed i've been really over anxious for the gaunt look and afraid that I would look like an AIDS patient on day - all facial fat is lost and think skin hung over bone. However, i read your advice in another thread that women may gain fat in the lower cheek area when pregnancy, and therefore you don't recommend permanent surgery on face when the patient is too young. Again, i m impressed with your thoughtfulness and kindness. i feel a bit more hopeful as i still have a chance to gain some fat.

In fact, my parents have chubby faces (they're about 60) and perhaps my genes can save me from being a skeleton. i m not sure. But i would take your advice and avoid permanent work when i m still young.

I regret having the wrong doctor for buccal fat removal, and i m lucky to have consulted you when considering fat grafting, If i need it one day, I will fly to US for you. Thanks so much!

glad i could help and yes there is a $5 charge. just kidding.

s.