LAM FACIAL PLASTICS

Dearest Dr. Lam,

I have watched your videos on cheeks and I decided to get mine filled with a temporary filler to help give me a more rested youthful look. What I had was a non-surgical cheek lift and it made me look younger and more refreshed looking. On the left side of my face, I notice that my tear trough area is more hollow then before. I guess the extra volume in my upper cheek resulted in that. The right side looks better. Was I supposed to get my tear troughs done too. My left eye looks a little more suken in then I wanted. I have been trying to push some of the product that was injected into my upper cheek into my upper eye area, but it doesn't seem to work. What do you recommened I do to get that suken in eye issue resolved. Is it too late to have tear troughs done after I already got my upper cheek filled.I do not want to add anymore volume to my cheek area because that will only make my tear trough hollowness worse.

You are right. When the cheeks are filled in isolation without the lower eyelid, the lower eyelid looks hollower. That is in part why a cheek implant fails. You will not be able to safely push the product into the lower eyelid. And, yes, you can easily fill the lower eyelids. If you don't come to me, just make sure you go to someone with tons of experience. Given the daily disasters that people write into me about, I don't want you to play Russian roulette under your eyes. They are technically much much much more difficult to fill well compared to the cheeks, especially if you fill the entire lower eyelid.
best,
sml

I have heard conferences that speak about the fountain of youth and the heart shaped face. My face is more on the long oval side. Filling the buccal area (the area on the side of the face and the depression that sinks in with a pucker up) seems to be an important area on my face. All the volume is just in my upper cheek in the center of my face, I don't know if it is just me, but it seems like I need more volume on the sides of my face (just just the center) to give it more balance
Now, the hollowness under my eye is not that bad. But what I am wondering if normal or not is there is a gradual lift of volume from the hollowness under my eye to the upper cheek area. The upper cheek I had filled with volume did create a more youthful look. I am wondering if a little hollowness under the eye and a gradual boost of volume in the upper cheek (right under the tear trough region) is a authentic look. I just want a very natural look and I want your opinion on whether a little hollowness under the eye is okay with fuller volume in the upper cheek in other words. Looking at few pictures of my youth I noticed that equal amounts of volume were from my tear trough to cheek resulting in high cheek bone look with no hollowness essentially. But getting that look is not really possible in a mid-twenties lady I wouldn't think. I know that my face has aged and a little hollowness under the eye is expected; I would expect that not even a doctor could completely get rid of hollowness completely. Hope that makes sense, I wish I could have you look at me to make a more accurate judgement.

The lower eyelid obviously cannot be completely filled but should be if safely possible by an experienced injector. Unfortunately, it is technically the most difficult area to do well so don't go to someone who does this infrequently or never. In most people that are truly gaunt, the buccal area (pucker zone) can be the second most important area to fill, even above priority of the tear trough. (sometimes it is number 1 especially if you have a strong cheek bone). Read a similar thread I just responded to in the last day or so.

Thanks for the answer. Here is a scenrio. If someone came in to your office with a very thin, guant drooping face, hollow eyes, and little volume in the cheek area that is sagging with deep nasolabial folds due to what I think is the fat pad slipping, and asked that you give them a more youthful appearence, where would you put restylane at first. She is not interested in fat grafting right now because she wants to see how she likes fillers first. This person happens to be my sister and she is 45 but looks like she is 65. She never really wore sunscreen. I know you have addressed the cheeks and eyes being important, but picture that sort of face needing the most attention as my sister really is a strong candidate for some work as well as myself except I am in my twenties and still look youthful except for the hollowness in my eye area.

oh, and that is working with one area first, as most important, what would be the top place you would work with?

If she is interested in a preview before fat transfer I would do only a couple of syringes to minimize costs so that she could use the money toward fat grafting with the focus being most likely the cheek and buccal zones first. If she could afford it and wanted a very good preview of fat grafting, then I would typically recommend 5 syringes: one into each lower eyelid, one into the anterior cheek, one into the prejowl/chin (mostly chin if she is gaunt without much hang), and one into the buccal zone. I would give her the 5th free if she buys 4. Now, obviously, 5 syringes does not equal 40 syringes of fat grafting that permits me a true capacity to shape, contour and blend the face. Nevertheless, 4 to 5 syringes are typically very beautiful since I know how to place those syringes in areas of maximal importance instead of spreading it out.

Thanks Dr. Lam, as I mentioned my sister above, I also have a concern I am wondering about. On my left eye area, My outer eyelid area (the area away from the nose) is what is hollower then the inner eyelid region. My right side is what I am comparing it to, because it looks normal. Do you ever see a lot of hollowness or depression in the outer eyelid area? although my upper cheeks were filled they were only filled in the center of each upper cheek, not on the sides, I would like to just have my outer eye lid area with same amount of volume because looking at my outer eye loss of volume it looks like there is a valley or depression and it looks odd on me. It is like I need more then 1 syringe of filler to do the job complete. Does what I am saying make sense, it is sordive hard to explain without showing you.

yes, i can fill the outer eyelid. a small area like that requires very little product, about a 1/4 syringe or less typically. also, remember symmetry is elusive and not worth trying (read my blog on symmetry: it is toward the beginning of my blogs). however, if you have a little hollow there and it bothers you, we can fix it.
sml