LAM FACIAL PLASTICS

hi Dr.Lam,

I had fat grafting with another doctor (sadly i dont live in the states so coming to you was not an option for me), and i know how you prefer not to comment on other peoples work, but i was hoping you could please answer some general questions for me.

Im about one week away from four months now since the fat grafting, and id like to ask about the dip that you always mention. I only had grafting to the orbital rims (im in my early 20s and this is the only part of the face i needed done owing to a hollowness that has persisted my whole life), and since the procedure it has always been very firm to the touch in that area. not hard, but firm. in the beginning i put this down to swelling and as the months went on i could feel it going down which affirmed my belief, but in the last month it has really gone down. at the moment it almost looks and feels like the graft isnt there any more. the area is now soft to the touch and i can move it around a little more whereas before i could not.

So my discussion is really about telling the difference between fat and swelling.a) should the fat feel firm to the touch under the skin or would that still be an indication of swelling? and b) if that firm feeling disappears around this time(4 months after), does that mean that im going through the dip you spoke about where all the swelling disappears, or is it possible i have lost fat as well. after the six month to a year period where you say things start to look good, what does the area feel like where the graft has occured?


thanks for your time doctor, really appreciated

as my standard caveat, i really should not comment on another doctor's work. however, in general, firmness is probably due to swelling only. my fat grafts feel soft after the first 1 to 2 months. that is normal. in fact, you should not be able to feel any fat at all in most cases after that time.

obviously, since i did not do the case, i don't know if the graft is resorbed or if you are just in the dip phase. my one advise though is NOT to fill it again for at least 8 months to a year and following the area with serial photos with your surgeon (unless your surgeon has a different advise since he knows how his fat works). i truly think the lower eyelid in particular is an unforgiving area and you do not want to overfill it. the fat will start to grow and shape after 6 months if the graft is intact.

the truth of the matter is also that men don't hold fat quite as well as women do, even though the results are very good still. i think men look better a bit gaunt anyway. also, you would in my hands still probably see a little line under the eyes but it should be a lot softer than before. all of this is difficult to relate to you since you were operated on by a different person. i am just explaining to you how i would handle someone in your situation IF I WERE THE SURGEON. please ask your surgeon what his thoughts are about the matter. it is the only fair and right thing to do. however, if he expresses that he does not have much experience with following fat transfer results over the long-term, i would suggest for you to wait patiently and use serial photos (with standardized lighting and cameras) as your guide for how things are progressing.
best,
sml