LAM FACIAL PLASTICS

Dr. Lam, how long should I wait to consider facial fat grafting after an S-lift.
Some say at least one year to see the final result , others say six months is ok.
There could also be a problem when there is too much scar tissue created because of the facelift and the fat would not take in some places.
Is this correct?

I feel that the PS who did my facelift , took away too much skin and pulled the skin way too high in an unnatural vertical vector.
All this together left me with an extreme thin face.
She said that no fat was taken out of my face, but why is my face then soo thin.
Is it possible when so much skin is removed and pulled that some fat went out as well?
Is it possible under this circumstances to widen my face with fat transfer.
Do I have to wait until the skin has completely relaxed?
It still feels tight on the sides.
The PS also tried to correct some assymetry on my face resulting in a bigger assymetry and now one cheeck is puffier then the other which was not like that before.
She pulled the skin on one side more upwords and sidewords then the other side.


Thank you in advance for answering so many of my questions .
I feel really depressed of this bad result and hiping to correct the damage.

I reaaly appreciate your opnion.
Martina.

In general, you don't have to wait really much time at all. I do fat grafts and facelifts at the same time all the time. However, if you are still troubled by your face lift and see some changes you might consider waiting 3 to 6 months after your face lift.

I don't know if fat was removed or if some was lost during a facelift. That is possible but in general you should not have lost much. The face can be easily widened with fat transfer. I would have to evaluate your situation to make sure that is the case.
best,
sml

Hi dr. Lam,
I have spoken to 4 different dokters that do fat grafting, they all dont recommend fat grafting AFTER facelifts due to the scar tissue and the possible lumps as a result from it.
Ny facelift is not done assymetrically as the PS tried to correct some assymetrie in my face and she also damaged some skin and there is a lump there now due to excessive scar tissue that has formed.
Is this statement true that fat grafting is not an option any more, what about fillers ?
Should a complete revision facelift with fat grafting at the same time be possible or still give the same problems.
Thanks for answer, I am really worried about the fat grafting.

All four PSs are dead wrong. Now ask them how many do they do a year? Most PSs that are opposed to fat grafting don't do it or say, "I couldn't get good results so I quit." or "I see these real problems with it, so don't do it." I get consistently excellent results even in people with a prior facelift. This should really be a non-issue. Of course, I would have to consult with you to make a more accurate determination but not only do I do fat grafts in patients who have had extensive facelift surgery, I perform a facelift and fat transfer AT THE SAME TIME all the time. If you had the S-lift less than 3 months ago, you might want to wait 2 to 3 more months to just give yourself a psychological break. Just let me know.
best,
sml

Hi Dr. Lam,
I understand that doing a facelift and at the same time fat grafting is fine. But most people warn me that doing this after a facelift (mine was more then six months ago) in time always gives assymetrie and lumps.
On the Makemeheal board there are people replying me , do never have fat grafts after facelift as in there own experience the fat takes in some places and not in other places from the face leaving them with abnormal and assymetrical faces which are very difficult to correct.
Is there indeed a possibility that this can happen, those bad results.
These people had fat grafts after there facelift and it went wrong and sometimes they needed another facelift to correct the bad result.
You seem so positive but other people with their own experience do not.
Can you give me an indication as why some people have those bad results and your patients and in your experience this is not the case.
I dont understand.

Thanks for answer but I need to know as much information possible before making this important desicion.

Forgot to ask you, I was left with an indented scar from a brutal face cleaning from my ps that gave me a bloodcollection under the skin and the skin came off but healed with an indented scar and a visible edge on one side. The scar is shiny white.
Does the scar need to be cut out in time when there is enough skin or can fat grafting make the scar more even.
What is the best solution for this.

Thanks for reply,
Martine.

that is a really hard question to answer. if there is a large white scar, then blood supply could be compromised in regard to fat grafting. blood supply is not an issue when it comes a standard facelift. i would have to evaluate your situation personally. as far as treatment, there are a million ways to treat it but i would have to see it to determine it. to give you a laundry list of ways to do this would not be instructive.

Dr. Lam, Please also read my previous question about fat grafting.

The question about the scar was the second question I asked.
The scar is a small scar just in front of my ear and according to different dokters nothing can be done at this moment.
The only can cut it out in one year or later , thats what they tell me.

Any ideas? Can you give me a few options regarding the scar. Is there anything that can be done sooner.

But please also read my previous question, it is very important to me.

Martine.

1. as far as fat grafting is concerned, i do not need to put that much fat in. that is a huge thing. many people put way too much fat in and get uneven resorption over time. also, doctors have a rough way of handling the fat that can lead to variable resorption. either way you can have uneven resorption. i have never seen that following a facelift. that does not mean it is impossible to happen but highly unlikely in my hands. if it does occur and there is a small area of unevenness, i can usually address it with a few drops of silicone micro to blend it in but do not think you would need that.
2. as far as the scar is concerned, waiting a year in most cases really makes sense because a lot of scars fade over time. premature intervention can lead to a more robust scar or unnecessary surgery. i would have to see the scar. but if it is truly depressed with abnormal skin, you can do a cheek flap to rotate skin from the cheek into that area. however, that would only be appropriate if the skin over the scar is grossly abnormal and you have a wide area of scarring. you can see my cancer before and after gallery to understand that (but it might scare you to see those photos). also, i would have to see how much laxity and where the original facelift incisions were made because that would alter or modify my surgical plan of the flap design. these options are really impossible for me to talk to you about without seeing the scar in person.
best,
sml

Hi dr. lam,

One more question,
How much of the fat would stay in the face, do you always averfill a bit?
In some people only 20 percent of the fat stays , in others 50 percent?
Do you do FAMI fat transfer (in the muscle).
Would that be better, what is the advantage?

At this moment I dont have much laxity on the skin of my face , the facelift was that tifgt and unnatural pulled as well in vertical way as in diagonal way leaving me with a complete differentand hollowed face which is very depressing for me.

I hope that fat transfer could improve the shape of my face again.

I have to tell you that I am living in a sunny climate and since last year (when comming into menopauze) I found out I have solar elastosis especially on arms and legs.
I dont want to start with lifting procedures in those areas, Is there another way to reverse this condition. As I also used to be slightly overweight years ago, now not any more, there is together with that also some skin laxity but not that worse. It is more the skins texture, it has the appearance of chicken skin , like I would have alwaya cold, but it is not.
People ask me , even when its hot, Are you cold?


Thank you once again for reply on my questions, I need to have as much information possible before I make a decision about fat transfer or not, possible with a revision facelift.

Martine.

1. most of my fat stays very well. however, in a few people i need to do a touch up. i think the reason people do way too many touchups is they intervene too early, i.e., before the fat starts to shape, blend and grow. what percentage of my fat stays? no idea. but my patients look stunning months to years later.
2. I don't do FAMI. The reasons are enumerated in a separate forum entry. In my experience, it does not hold as well. I firmly believe that.
3. Skin changes occur because of chronic damage by the sun to the collagen. Plus, in addition to that, your hormones are off balance even premenopausally. I have an anti-aging center upstairs in my building designed to balance your body. If you decide to visit them during your visit, they are already booked out 2 months in advance and possibly the wait list is getting longer. The trick is understanding that when your testosterone and estrogens are better balanced, your skin can look amazing. (I am on it myself.) Obviously, if you have had significant damage otherwise, you may need other treatments like Accent XL to tone, etc.
best,
sml

Dear dr, Lam,

Can you please explain me a bit more what is the difference between your way of fat grafting and fami fat grafting, and the reason why your technique is better then the fami .

I can not find any specific information about your technique.

Thanks,
Martine.

Hi,
Basically, to use a term out there that will probably have more resonance with you, I use the Coleman technique. Now, I am TOTALLY different from Coleman in many respects. First, I put far less fat than he does. Second, I have a completely different aesthetic than he does. Third, I do not put fat in areas where he does. In summary, both FAMI and Coleman techniques are placed using blunt tiny cannulas. However, Coleman places fat into three dimensional spaces irrespective of muscle. Amar's FAMI technique is focused on putting fat into the muscles themselves. Why? I have no idea. As I have said, the people that I have seen do the FAMI have not gotten great holding power. I think FAMI is not bad for the perioral region (around the mouth) but everywhere else it does not hold as well. Now, if you ask ten surgeons, you will have ten answers. You are asking my opinion so I am giving it to you. I have also seen many surgeons who use the "Coleman" technique and get bad results that don't hold. I am not one of them.

Just remember, I get great results that hold tremendously well in over 90% of patients with about a 10% touch up rate which I now include in the cost of your initial procedure. Don't get enamored with a technique, you must get enamored with surgical results. Find a surgeon whose results you like that can show holding power and safety. Beyond that, you will probably confuse the crap out of yourself. Because you will ask 5 FAMI devotees and they will swear by it. You will ask 5 Coleman devotees and they will swear by it. At the end of the day, you will have analysis paralysis. Homework and research are good. However, at the end of the day, go by your instinct of who can show you the most substantial number of results you like, who stand behind their work, and who achieve safe results, with less of a recovery time than others.
best,
sml

Hi. Dr, Lam,

Is the fatretention dependant on your metabolism?
And if you were a former smoker does it influence the results.

How long must someone not been smoking to obtain the best results, I mean how many months non smoking to have no influence from that factor.
Is there anything that can be done to improve blood circulation before or after the grafts in order to retain more fat.

Regarding HRT, how long after starting HRT , results are showing on the skin and other benefits.

Thanks for respons.

i have done smokers before with great success. if you want to see a lady who had only one fat graft who STILL SMOKES and she is 2 years out, go back about 2 pages in my written blog and check out kim's testimonial (video). ideally, you stop smoking though as i cannot guarantee results if you do smoke. at a minimum try to be off 2 weeks before and after. there is no science behind that. just trying to make sure you get the best results. as you know, i stand behind my results so you might need a touchup (on me) but let's try to avoid that.
best,
sml
p.s.: as far as HRT, i am not an expert. you need to call or email my antiaging center. antiagingandvitality.com.