LAM FACIAL PLASTICS

Hi Dr. Lam,

I read about your technique for placing a temporary filler under the eye, such as Restylane, using a blunt cannula similar to fat grafting. Can you tell me what advantages this has over the traditional approach of using an actual syringe? I've heard that there is a remote chance when injecting with a syringe to hit a vessel, which can possibly lead to vision impairment. Is that a very remote possibility? Also, is your technique done entirely using local anesthetic? How long does this procedure take generally?

For a typical older patient who has slightly loose skin under the eyes, can a temporary filler still be placed with great results, or does that skin need to be excised first? The majority of pictures I've seen of periorbital enhacement has been in younger patients, so I'm curious about your thoughts with older patients.

Thank you

Hi Fillerup,
Yes, that is a huge reason why I use blunt cannulas. It virtually eliminates that risk of vision impairment, which can be permanent. In addition, I have even heard of prolonged venous congestion by injecting into a vessel not to mention infarction of a skin island and loss of skin.

Now, all of these issues are fortunately quite rare. However, it would be good to know that you can make something very rare become even less likely or almost impossible by avoiding the use of needles. As an example, even when I do injection with lidocaine for fat grafting, I do not use needles.

Now let's consider why cannulas are better for the 99.9% of people who will never encounter these serious adverse outcomes. First, it reduces bruising by a huge margin. Without needles going into a vessel, you really should have minimal to no bruising. Second, the results look really smooth, especially around the eyes, where I can layer it deeply on periosteum (bone lining). I also can place 4 to 5 syringes in less than 2 minutes meaning that I can reduce risk of bruising and swelling and make the experience far less anxious for you and easier since my blocks last around 30 minutes.

Yes, it is done all under local anesthesia. The difference with my local anesthesia is you FEEL NOTHING not even the blocks go in. no epinephrine so your heart does not race. it is painless.

Yes, all ages will have good results. Obviously, the older you are the more volume you need. With only 4 syringes to 5 syringes placed, you will have a less incredible result than a 35 year old but that is okay if you are realistic. I get fabulous results in all ages. I just finished an 82 year old lady about an hour ago. And no, DO NOT CUT THE SKIN UNDER YOUR EYES. Please watch my vlog on safe methods for lower eyelid enhancement to understand that matter better.

hope that helps,
sml

Thanks for the detailed reply Dr. Lam. Forwarded a PM to you.

Obviously, the photos you sent me are helpful but I cannot promise you an accurate read.
1. You do not need any eyebags removed. You simply have hollowness. 1 cc of restylane a side will definitely help but won't be as good as fat transfer.
2. As far as your upper eyelid is concerned, you actually would benefit from adding fat there. Yes, I know, that makes no sense because they look "heavy" You have to trust my work. A little skin removal might be helpful too. I personally do not like putting restylane in the upper eyelid. I don't like the "look". Also, it is uncomfortable to have done.
3. As far as I can tell, unless the photo was taken at half a blink, you also have some ptosis of the eyelid, i.e., the muscle looks weak and your eyelid is half closed. If that is the case, no matter what I do for you, you will still look a bit tired. You might need to see an oculoplastic surgeon for possible ptosis repair.
4. As you see in my before and after photos, I believe that 50% of the problem of looking tired is due to lack of volume in the anterior cheek. Your cheek (from what I can see) also looks deflated. You would highly benefit from some volume there with fat or with a filler. Just lift your cheek up and look in the mirror. You will see that you look less tired, even though that maneuver actually worsens your under eyelid hollow.
best,
sml