LAM FACIAL PLASTICS

After reading everything here, it appears that you don't really understand what tissue is actually lost when trhe face loses volume, but just that it does occur. So like when you do a fat graft, you are not necessarily replacing only volume that was lost due to actual fat loss but also due to other tissue atrophy? Is this correct?

When I first had problems with atrophy in my face, I didn't even realize that is what it was. I simply noticed the skin appearing to get 'stuck' in certain positions and creases seeming to form there. I went to one doctor in Pittsburgh, and she told me from looking at different IDs over time, that the only real difference was that I got progressively thinner in the face. I didn't believe her. It was only after a period of dehydration/starvation that I finally realized she was right.

Growing up with the bodybuilding fat-hating culture, I naturally assumed muscle atrophy was the problem. I then learned that other than the chewing muscles, most of the muscles in the face do not have significant bulk. Then I was under the impression from talking to more people in the field that it was mainly due to actual adipose tissue loss.

However, now I am wondering if maybe both don't play a significant role?

It is easy enough to do some pretty strenuous exercise for the muscles if it is of some benefit, and I haven't figured out a way to get fat back - sleeping with ice packs on my face didn't work.

So would some muscle hypertrophy be beneficial or maybe even detrimental? I won't be training the masseter or the temporalis. I definitely would want any growth there.

I am thoroughly confused though, because of how you really advocate botox, which seems to me would have to encourage some muscular atrophy, which I can only see as a bad thing, that is when the goal is to return to a person's own best look and function like mine is.

Thanks.

Interesting questions. I would say that there is probably a loss of some muscle, bone, and fat as we age. However, we have a lot more subcutaneous fat loss than muscle and bone. As we REALLY get older, I think we lose a proportionate amount also of muscle and bone. Fat grafting works well to replace all three structures except in my opinion in the chin area. When you have a really weak chin, you need a chin implant to give you a "solid" look compared with a fat looking chin. If you are just having normal aging, then fat grafting to that area is all that is needed and is also much better than a chin implant.

I really would discourage you from trying to plump up your muscles by doing exercise. All you will cause are wrinkles. Remember life is about tradeoffs. Perhaps you will gain very tiny amount of volume gain (in my opinion not enough to see any real difference) but you will start to have inordinate number of wrinkles because of all the facial animation. Remember also that my job is primarily to fight off facial aging. Therefore, Botox to manage wrinkles and fat grafting to manage volume loss is ideal. Also, I really only use Botox in the forehead, sides of the eyes, and between the eyes so they are not in areas where volume loss is a major factor.

Thanks for the reply.

Well, in addition to just muscle hypertrophy I thought there might be some other benefits from heavy exercise. Most people seem to think that when muscles grow there will also be an increase in fat and improvements to the vascular system. Some say that the increased circulation would help the cell turnover rate increase in the skin and allow it to actually repair itself to some degree.

I am pretty sure that my cheek area and under the chin can only be fixed by getting a copious amount of fat in there, but I was more wondering how muscle growth would contribute in basically the areas where you favor botox. I thought that in an area that has a thin overall girth like the forehead, that the muscles might contribute a higher percentage of the total girth. I was also hoping maybe there was some thickness to the obicularis oculi and the muscle on the sides of the nose, but probably not. I need to see a model or something and learn what sizes are actually involved.

So far, from the short time I have been doing it this time around, I notice that I do get a nice pump when doing it and do notice the veins up the middle of my forehead - no doubt you are correct and it is fat I need 2 cover these just like veins in other parts of the body, but I was hoping maybe procerus growth would would contribute. One interesting thing is that the pump from the one exercise that works the obicularis oris by pulling at the outer side of both eyes while trying to close them actually seems to simulate the best improvement; I would haven't thought that thickness in the region of that muscle would be the main thing I need(though I know I need some tissue around the eyes) or have that much effect on even the cheek region but it seems to.

As far as using the one tissue type to replace all 3, I'd be concerned about movement being unnatural in certain situations. I realize that sometimes you have to make compromises like you said, and you work with what is available to do. In my case, I'd like to put back what is actually missing as far as might be possible.


Also, since my particular case somewhat involves the effects of starvation/dehydration rather than just normal 'aging', maybe I have more muscle loss. I don't think I have any bone loss at all; in fact in may have grown some.
I was thinking maybe of having an MRI done to measure the relative amounts of each tissue. Too bad I don't have one of me before to compare it to though.. I saw that someone was doing a study, involving measuring amounts of fat in the face, but I don't think that 1 involved also measuring the muscle.

In my particular case, I really think that if I had my original girth back throughout the face, that I wouldn't have any real wrinkles to speak of; I could be wrong though. I think I need a lot more than a few cc's though(as I am more concerned with restoring the shape).

I understand that you believe that muscle use causes wrinkles, but before I was asking how you arrive at that theory. Do you have some scientific data to support this?

Thanks. It's good to be able to discuss these topics with you.

Not to be offensive with the muscle and wrinkle thing, but I think it is pretty obvious that if you smile all the time you start to have wrinkles around the eyes. If you squint all the time, you start to have lines between the eyes. If you lift your brows all the time, you start to have lines on your forehead. When I Botox each of those areas, that scientifically stops the muscle from moving, your wrinkles start to fade and over time can disappear if they are not too far gone, as I have demonstrated in my short-term and, more importantly, in my long-term botox before and after gallery under the "resources" tab.
sml