LAM FACIAL PLASTICS

Hi Dr. Lam,

As tommorow I am going in for a check-up so he can look at my tear trough, I am also considering using some of the restylane that I have left. My tear trough rim (orbital rim area) will not be able to handle any more injections as the skin is too thin there. I think I definately need more filler as the area is flat to the bone with essentially no fullness to it. I am afraid that the job is only a quarter done to my dismay and understanding which means more injections.

I am wondering if it is possible to inject the higher cheek area just below the rim where the skin is thicker and then push the restylane up to the eye area, is that possible, does that make sense to you?

Actually, let me clarify that last remark. rather then say push the restylane to the tear trough area if it is inserted into the upper cheek just below the rim where the skin is thicker, I am wonderieng if it can be molded to where I would like it in the tear trough, does that make more sense? The problem I am also noticing is that I have massaged the lumps out of my eye from the filler, but I can still see some formation that looks like product under my eye. It looks like something was put in there if that makes more sense, so superficial is the word. It is like the product binded together like molecules and formed a string of restylane that can be seen under my skin. If this product is a natural occuring hydro acid that occurs in our bodies, it sure doesn't look natural on me.

to reiterate and summarize:
1. less than a syringe into the cheeks or whatever is left over is pretty little to fill a cheek. plus most docs just fill the entire cheek. in order to get maximal fill, i focus everything into the malar septal depression. that way i can maximize half a syringe. if you are filling less than a quarter or less syringe into the entire cheek expanse you will probably get very little result. however, it is worth a shot (literally) since you have product left over.
2. i can't comment about squeezing product from the cheek up to the eye for two reasons. first, i place the product precisely every time. i don't have to move product around except a simple slight massage to keep the treated area slightly more blended. therefore, i have no experience in what you are asking. to move it from one geographic area to the next is a tall order, especially into the lower eyelid. you need to place the product directly under the muscle to avoid lumps. how can you squeeze product from the cheek and slide it under the muscle? even for me that is impossible. DON'T TRY IT. an experienced injector places the product where he or she intends. period. anything else is dangerous conjecture.

Thanks for the comments. Where is the malar septum depression, I have heard that term before. Is it along the orbital rim area that lines the tear trough? I will mention that to my dr. tomorrow.

don't worry about it. it will only scare him. look at the discussion thread on the malar septum. i tried my best to explain this to a layperson. if you want to know perhaps the world's most protracted and detailed discussion of the malar septum, read that thread. there is close to 14,000 views on that thread. you can't miss it as you go down.

don't bother mentioning it to your doc. either he knows about it and will do it or he doesn't and he won't. he will probably be offended by your asking him about the malar septum. just let him fill the cheek. you don't have that much product to fill that area anyway so it should be safe.
best,
sml

one more thing: interestingly i googled malar septum and a chapter that i wrote for a book that i edited shows up on page one. also, you will see my glossary in which i define it. all you have to do is go to my glossary section and go down to "M" to find my definition. my glossary section is under the "resources" tab.

You are right about that. I mentioned the malum septum to anther person at a consulation on my tear troughs and they sent me out the door to another doctor. I think it is best I don't mention it to my doctor as he is pretty moody most of the time I have talked to him. Thanks for the advice.

Tell him a joke. Maybe he will lighten up.

Hi Dr. Lam,

I told you I would update you on my follow-up that I had with the PS today. The swelling has gone down on both my eyes. He basically told me that he won't do anything further for me. I asked him about the restylane I have left and he said I can't have it because he won't do anything on me. My cheeks could use major volume and I have bags of unevenness under my eyes. I asked him about dissolving the product and he said he again doesn't have anything and then he said to live with it.

Dr. Lam, this doctor I saw was really rude. He did not listen to my concerns. He did not appreciate my concerns. He doesn't understand volume. My tear trough area is such a mess and so unbalanced I would do anything to reverse it. I wish you were in the area. Well, that is my update.

well, when you are ready fly down here and let me do it right, let's talk. if you haven't read wendy's testimonial in the patient submitted testimonials section about her experience with my restylane versus her previous experience in LA, you will be blown away. ideally, we do the fat transfer and get it over with for many years. whatever you desire.
best,
sml

To all of you who have read and followed my posts, you should know that the issues with my tear trough are resolved and that is because I got juvederm injected into my upper cheek which made all the difference in the world and gave me a cheek lift. It took years off my face and looking in the mirror it is the teenager I once remember looking like staring straight back at me.

I saw a woman who was an RN and she totally understood my concerns unlike the previous doctor who did my tear troughs who sent me out his door in distraught. As a woman, I knew she would understand where I was coming from. She injected juvederm deep into the perifixial bone whatever it is called and I felt absolutely no pain. She molded my face and took great interest and care in helping me look my best. I did all my sole searching for only a board certified plastic surgeon because I thought that I needed one, but an RN can be exceptional.

Dr. Lam, thank you for empowering me with knowledge on the importance of cheeks. Before, I never thought about the cheeks, and would have never figured it out if you hadn't revealed how important the cheek plays in looking youthful and rested. I love the result and just know that something good can come out of something bad.

Dr. Lam,

I still plan on flying out to see you in the future and I am going to always highly recommend you to everyone I come in contact with that is interested in plastic surgery or fillers.

thanks linda. i'm glad you got what you wanted.
best,
sml