LAM FACIAL PLASTICS

Hi Dr. Lam,

When I was about four my cheeks hollowed out as a side effect to topical steroids that was applied to my cheeks. It has been like that ever since, I have attached a picture of myself. I am 24 years old and I was wondering what options are available for me? I have been considering fat transfer but from reading your previous posts I realize that you are against doing fat transfer on someone as young as me. So, I was wondering what possible options are available for reconstructing my hollowed out cheeks.

Thanks,
N

if your weight is stable and you want something permanent i would go with Artefill. however, given your age, you may want to consider Restylane, Perlane, or Juvederm and i believe that even though they are temporary they will truly last a long time if not even be permanent after a few rounds. that way you could always dissolve it as necessary down the line if things change in your face.

Thanks for you reply Dr. Lam. I was more inclined towards fat grafting because its my own fat and hence the risks of infections and complications is less. I have always had a stable weight and both my parents who are over 50 have always had stable weight as well. They have also aged well and there has not been any volume loss in their faces from aging, so I am optimistic that I will do so as well. Would you still say that fat grafting is too risky for me? I know future pregnancies may be problematic as I put on weight, but if my face does balloon during the pregnancy, will it return to its normal size once I lose the weight? I have never had issues with my weight and lead a healthy lifestyle and if it were not for the possibility of pregnancy I would not be concerned about weight gain that much.

And how much would temporary artificial fillers like Restylane cost me? Since the depressions in my cheeks are considerable and I would need touch-ups (every 6 months from what I read on the internet) I am a little concerned about the costs. And would using artificial fillers make it a problem for me to undertake fat grafting later on in life, when I am older and have had kids?

I Thank you so much for taking the time to answer my questions Dr. Lam.

i still would not do fat grafting for the reasons you are aware of. plus, fat grafting is truly difficult to predict in one area. you may only have 80% take and then still need a filler. fillers truly last a long time and i would go so far as to say almost permanent in many but not all individuals after they have been injected a few times. it should not preclude you from having fat later on. please trust me that in your case (i put myself in your shoes), fillers would be better and i would go with "temporary".

Thank you very much for your response Dr. Lam. I appreciate you taking your time to reply to my questions. I know that you are not keen on sculptra and I don't want any artificial filler permanently in my cheeks like "artefill". So, which is better restylane or juvederm? Since the hollowness in my cheeks is considerable, how much would it cost me to use them as I know they are very expensive? And what about the risk of granulomas? Are they treatable? Since I will need to have a significant amount injected will the risk of complications increase for me?

And how many times a year would I need to touch-up initially? I have a good metabolism and am pretty active. I have heard these fillers last for shorter periods for people like me. I am afraid that the financial commitment of these "temporary" fillers will be the biggest deterrent for me.

Thanks again!

restylane and juvederm both are almost equally good. i use them interchangeably. in the buccal area (your area), i tend to prefer juvederm because it blends better. it is hard for me to tell you how much you need but i am guessing if it is on both sides 2 to 3 syringes per side. you may have to spend more up front but don't forget about long term safety. granulomas are very very very very rare in almost any injectable product that is FDA cleared in the US. a granuloma represents an infection of the injected material that can clear with antibiotics over a period of 6 weeks. with HA products like juvederm, all you have to do is dissolve it to manage the situation, which is considerably easier.

Thanks again for answering my questions Dr. Lam. I am sure I want to have kids some day so I am worried about the effect of HA fillers during pregnancy. From what I gather from reading online that one should not get HA filler injections while pregnant. What happens if it is already in my system? I was considering the possibility of dissolving the fillers with hyaluronidase before I choose to conceive but I read on your forum somewhere that I will dissolve some of my own tissue in the process. I already have a substantial volume loss and would not want to make it worse.

no, you have got it wrong here. HA fillers have no problem during pregnancy. what you must have read is that it is probably a bad idea to get any kind of procedure DURING pregnancy. having it in there is absolutely no problem.