LAM FACIAL PLASTICS

I'm in an unfortunate dilemma, I'm in my mid 20s and I have gaunt cheeks that make me look tired. It seems as though my temple area and cheeks have descended a bit, people who look at me often push up on their cheeks and temple area (so frustrating!) when looking at me. I went to get restylane injections at a medispa from a nurse that has done hundreds of cheek/tear trough injections. She refused to inject me because of my hollowness. She noted that she could feel bone when touching my eye area and she didn't feel comfortable injecting restylane in such a thin area like mine. She said I needed at least 6 syringes too and I refused to do that many (imagine having to do 6 syringes every year! Imagine how much that would cost me! ). She suggested getting fat injection to save money. But reading your posts you suggest not to get fat injection when in your 20s. I have had very stable weight, I'm the same weight that I was when I was in high school, I actually have a very difficult time gaining weight.

I want to get something done but I just don't know what to do. If I go the restylane route I could end up spending $20k in the next 6 years... assuming it even lasts a year each time it is injected. My goal is to get a rhinoplasty done and my cheeks fixed at the same time. I live on the east coast and if I decide to get something done it will be done on the east coast. You seem to be the expert in fat grafting, what is your suggestion? There are some very good rhinoplasty experts on the east coast but it seems to be hard to find an expert in both rhinoplasty and fat grafting. Do you know of any? But this is assuming you suggest I do fat grafting. If not I guess I need to figure out what else I can do.... sigh.

hi,
1. fat grafting at your age is something with which i would be very very careful about, especially for a very gaunt face since your face will age and i think it is a mistake that you cannot correct if you are trying to aggressively fill a gaunt face. sorry, that is my philosophy, although you will have others that disagree with me.
2. restylane i know sounds temporary but in my experience and i have done 1000s of syringes and watched even my own staff with it is since 2004 when it first came out and i believe that after a few rounds of injections (how many? 2 to 4 times perhaps) certain level of it almost becomes semi-permanent if not permanent. i know that is hard to believe and it is not a guarantee but it really does hold well. the folds and lips are highly mobile areas and it may not hold as well there but temples, around the eyes, etc. it really does.
3. i have no problem injecting bony faces no matter how thin the skin is because i have tons of experience doing so and i use the highest quality micro cannulas so they have precision that needles simply do not have by a long mile. but you must find someone with tons of experience.
4. i make it a point on this forum that i do not recommend anyone else since this is something that i do design and precision wise that i don't think anyone else matches either with fillers or fat. you have to find someone's before and after results that live up to what you are wanting. in any case, remember safety first.

Thank you for the reply! What is the worry when injecting fat in someone who is in their 20s? Is your worry about weight fluctuation or is it more to do with what will happen with the fat as you get older? Will it cause pits in your face or some sort of deformity?


What about cheek implants too? Do surgeons often lift the tissue when inserting the cheek implants? I heard a surgeon say that with aging comes "Descension and Deflation". It would seem that would be a great long term solution especially if the cheek implant could prevent the tissue from falling with age. Both D's would be combated. If the cheek implant starts to show couldn't you use fillers to hide it or have it removed (silicone implants)? I've heard some doctors call what I have a "negative vector", where the eyes seem to project further than the cheek itself. I really do need volume.

ANSWERS IN ALL CAPS:
Thank you for the reply! What is the worry when injecting fat in someone who is in their 20s? Is your worry about weight fluctuation or is it more to do with what will happen with the fat as you get older? MY CONCERN IS BEING ABSOLUTELY RIDICULOUSLY CONSERVATIVE, PERHAPS TOO MUCH SO BUT I AM WORRIED THAT AS YOU GET OLDER AND YOU GAIN WEIGHT THAT THINGS WILL LOOK DIFFERENT. TYPICALLY SOMEONE IN THEIR 20S IS NOT MANAGING AGING BUT MANAGING BEING TOO THIN. I HATE TREATING VERY GAUNT FACES FOR THAT REASON BUT I DON'T MIND TREATING AGING GAUNTNESS BECAUSE I FEEL THAT TREATING A VERY GAUNT NON-AGING FACE CARRIES MORE RISK ABOUT WEIGHT GAIN DOWN THE ROAD DUE TO THE AMOUNT OF FAT NECESSARY IN A VERY YOUNG AGE. Will it cause pits in your face or some sort of deformity? POSSIBLY BUT I DOUBT IT. IT IS DUE TO THE REASONS ENUMERATED ABOVE.


What about cheek implants too? THEY WORK BUT ONLY FOR SOMEONE YOUNG ENOUGH TO HAVE FAT TO COVER THE IMPLANT OR IT WILL MAKE YOUR FACE BONIER. ALSO, I DON'T LIKE DOING IT IN GENERAL BECAUSE OF THE RISK OF INFECTION SINCE ABOUT 10 TO 20% OF THEM GET INFECTED SINCE YOU GO THROUGH THE MOUTH. FOR THAT REASON I SIMPLY DON'T DO THE PROCEDURE BECAUSE I WANT AN EXTREMELY SMALL COMPLICATION RATE. Do surgeons often lift the tissue when inserting the cheek implants? NO, UNLESS THEY ARE DOING A MIDFACELIFT IN AN AGING FACE. I heard a surgeon say that with aging comes "Descension and Deflation". It would seem that would be a great long term solution especially if the cheek implant could prevent the tissue from falling with age. IT WON'T. Both D's would be combated. If the cheek implant starts to show couldn't you use fillers to hide it or have it removed (silicone implants)? YES. I've heard some doctors call what I have a "negative vector", where the eyes seem to project further than the cheek itself. I really do need volume. OK, YOU KNOW MY THOUGHTS.