LAM FACIAL PLASTICS

I apologize if this question is redundant to anything else posted on the forums, but I couldn't find anyone asking exactly this. I have two questions. First, how long would you wait after a patient finished taking Accutane before performing 1. a cheek or chin implant or 2. fat grafting. I realize the primary concern is with skin scarring, which is why you would not perform laser surgery before 18 months off Accutane, but does the drug interfere with bone healing after, say, a cheek implant as well?

Second, most of your gallery pictures appear to be of people at least in their late 20s, more often in their 30s and beyond. Is fat grafting reserved for older people who are experiencing fat loss and consequent facial thinning, or is this procedure sometimes appropriate for a young person in their late teens/early twenties who has a small, narrow face with flat cheekbones and very little natural fat, causing her to look ‘aged’, even when actual aging has not begun to occur. So in other words, the person is not losing facial volume, but never had it to begin with. You have mentioned that many women gain weight in their 20s, but if someone has a genetically thin face, often their faces seem to just get thinner from the teen years onwards. Would you be more likely to perform cheek/chin implants on such a patient to correct the underlying weak bone structure, or use fat grafting to provide more volume and a softer look? Do you ever use both, or do you prefer simply not to operate on patients in their early 20s?

Thanks very much for your time.

those are good questions.
1. As far as Accutane, with fat grafting I do not make an incision so I have done it as short as 6 weeks following stopping Accutane. As far as a chin implant, because there is an incision I would wait a minimum of a year after stopping. If we talk about skin resurfacing, I am even more conservative and would wait 1.5 to 2 years.
2. As far as fat grafting in young people, I am not a big fan of doing fat in the early to mid 20s only because as you get older you can gain weight and that in turn could show up in your face. remember that i am using fat that is truly a live graft. it could look overfilled if you get older and gain 20 to 30 pounds. that is important to know, especially for women who have not gotten pregnant yet. That is because when you gain weight during pregnancy and it can look too full but will resolve after you lose weight. as far as cheek and chin implants, they tend to look good in someone young who has enough padding to "cover" them appropriately. i know a lot of people who like to remove cheek implants after the age of 30. if you are young and have really a bony face, adding more "bone" through a cheek and chin implant will not be effective. a chin implant is great for someone who has a weak chin. it is much more predictable and looks better for someone with a congenitally weak chin than fat transfer to this area. if you are only slightly weak in that area, fat transfer works well (...if you meet the criteria for fat transfer, as alluded to above). it also tends not to show up as you age, unlike a cheek implant. that is why i prefer chin implants in those who need it compared with a cheek implant in many who do not. i hope that helped a bit.
best,
sml