LAM FACIAL PLASTICS

I saw your dimple presentation on youtube. I am interested in getting one. I am very fond of the asian culture in how they view them. Can you give me an estimate at how much it cost for one. Also, is the dimple permanent? Amy

hi,
thanks for your interest. the dimple costs $2000 for one, and $3000 for two. as you know, i prefer to make one since it is very hard to ensure symmetry when you make two. yes, it should be permanent.
best,
sml

I have read a few comments in the foram and read your comments and have learned so much, so thanks for sharing your knowledge. I am 29 and just had juvederm ultra (two syringes) injected into my nasolabial folds in Oakland, CA. I had my first injection done on March 21 with one syringe and then went back for another syringe, only I paid the 550.00 again (I like how you give a discount on second syringe, most doctors in CA don't do that and charge the same as the first one) for another syringe. Now it has been three weeks and I have this really bad discoleration that has formed a bluish grayish line where my nasolabial fold was filled with juveder,. It is not going away. Do you know why I have this discoleration forming a blue line?

Yes, I have a pretty good guess. Most likely the product was injected too close to the skin causing what is called the Tyndall effect. Either that or you have a persistent bruise (less likely). You should go back to your doctor and have the superficial component dissolved with Vitrase. Fortunately, Juvederm and Restylane are both reversible with hyaluronidase within 24 hours. You can do that anytime after the product is in. There is no time limit. You do not have to dissolve the whole thing. If the product is really superficial, you can also just nick the skin and squeeze it out. Do not do this yourself. I have been preaching about not injecting too superficially inside the dermis at every major meeting this past year (Boca Raton, 2007; San Francisco, 2008) to avoid this problem. I really hate the look of filling the fold too superficially. It looks like little beads too that can be spotted 10 feet away. I truly believe that a slightly deeper subcutaneous injection does not limit your longevity but ultimately provides a smooth and natural result, which are the key. Hope that helps.

That info helps a lot. I went to a guy in Oakland, CA. On his website he got voted as one of america's top best so I decided to go to him. You probably have heard of him as most people know of his name from all the publicity he has gotten. This was my first time, so I didn't ask too many questions and I am not familiar with technique so I just trusted him. I could feel the needle just barely going into my skin so I know it wasn't deep at all. I also was not numbed the second time only the first time. It didn't hurt at all. I was hoping it was bruising and that it would go away, darn. I read another comment from someone else about the "shadow effect." I really have the shadow effect on the right side where my nasolabial fold was injected with juvederm. In certain lighting angles I see no shadow as well as the bluish gray line on the left side also being gone with certain lighting. What causes the shadow effect to be so apparent on the right side, it makes my NL fold look deeper then it is? So if I go back to him, will he charge me, what he inject more deeper, now I know he would charge me for more product no doubt. He may be voted as good, but I had to go to see him three times and my NL folds are still there. Why are so NL folds so hard to treat, are they supposed to be that hard to fix. I feel I need a third syringe because it is totally uneven on the left and right side and the shadow effect is so noticeable. Also, on the right side, there was left a rectangular looking design where the juvederm was injected and it looks so superficial , it is hard to describe.

I hope you don't think I am too vain because I really am not. I have just always had deep NL folds and very hollow eyes and was always asked if I was tired. It is a genetic trait I have had my entire life. So, I finally decided to get my folds done and now I still look tired because I have extremely hollow eyes or deep tear troughs I think that is what that area is. Because of that, I have extremely dark circles under my eyes. The skin is so loose and thin that I am nervous about getting juvederm injected under my eyes. Not even concealor help. I definately need some volume under my eyes and I am wondering if you recommened juvederm for my under eye area? I thought I would use some of the juvederm to touch up some areas of my NL folds that were recently injected with juverderm ultra as well. Again, my under eye area is so thin, you can feel the bone, there is no fat or anything. Would a needle injected into that thin skin cause damage, I am concerned but need advice. Thanks for your advice by the way.

A lot of questions:
1. First, if you were my patient and I injected it too superficially I would remove the product with Vitrase at no charge and give you another syringe (if needed) at no charge. However, your physician could have a different policy.
2. The nasolabial fold may not be corrected for 3 reasons: 1) the product was injected into the fold instead of the groove making the area worse, 2) you have a very overhanging fold so it would be impossible to inject it no matter how much you inject. That's judgment. However, typically that problem exists in usually older men. 3) unrealistic expectations on your part for what a NLF improvement should look like...or poor education from the physician. Remember having no fold at all can look quite unnatural. As you know, I truly believe in 90 plus percent of people even a single syringe in the fold is a waste of money. But that is my opinion.
3. I think Juvederm is a great product for lips but terrible around the eyes. I have stopped using it there a year and a half ago. There are 2 major problems with juvederm around the eyes: 1) it can spread to areas that you did not intend because it is so soft, 2) it can lead to in rarer cases abnormal swelling. For these reasons, I prefer only Restylane around the eyes. Also, I never use needles to inject the area around the eyes for 3 reasons: 1) too much bruising, 2) uneven results, 3) risk of eye problems (albeit rare). Instead, I use a cannula technique that I invented. 99% of injectors don't know about this technique. And btw, my injections are virtually painless because I do a painless dental block. I find that topical anesthetics are simply not enough to make the experience a pleasant one. Also, cannulas allow me to stay deep just above bone to decrease concern regarding thin skin. Believe it or not, 10% of my Restylane users fly into Dallas to have me do the work. I did close to 800 syringes (that I personally injected) in the last 6 months.
4. The reason you look tired actually has very little to do with the NLF and only partly to do with the hollow lower eyelids. 60% of your problem most likely has to do with a hollow anterior cheek. To test this theory, simply lift up on your cheek and look at your eye in the mirror then let go, you will see that the eye goes from looking rested to tired. Oftentimes for those individuals who look tired and want to look rested and who also have a very tight budget, I do one syringe in the anterior cheek and they look tremendously more rested. Again, I use only cannulas to inject.

Sorry for all my ridiculous questions. I thank you for your advice. Your amazing knowledge has made me realize a few things. I am just going to be at peace and accept my nasolabial folds. When the juvederm absords through time, I will allow my nasolabial folds and not get any more fillers. I am going to just accept my natural aging as it is and not get fillers unless my hollowness under my eyes get really bad in time. You truly are the best doctor every and thanks for everything you have done to help me.

my pleasure.