LAM FACIAL PLASTICS

First of all, I'd like to thank you so much for taking the time to answer these questions..I've been reading through some of your posts (and youtube videos) and am pleasantly surprised at the candor and detail with which you explain/show the procedures you do.

With that said, I wanted to get your opinion on my own situation. I realize it'll be somewhat difficult to give an accurate opinion, being that you're not seeing my face to face, but I will try to be as descriptive as possible.

I am a 22 year old African-American (as in, born in Africa) male, who's recently been considering undergoing plastic surgery to create more definition in my face and get rid of a 'tired' look beneath my eyes. I'd describe my face as heart-shaped: Upper face is slightly narrower than mid-face, and everything tapers down diagonally to my lower face. My cheekbones are somewhat wide, but they are also flat. The effect they give is that it appears as if there are lines reaching from my mid-nose (around my lower eye) to my outer face. I'm not sure if there's a terminology for these lines. While I have noticed it (slightly) in others, mine happen to be very deep and very noticeable, and I feel they detract from my appearance by making me appear gaunt and tired in that region.

Now this perceived gauntness goes in sharp contrast to the fact that I do have a very full face, to the point that even at 22, most people think I'm 15 or 16 (and this may be great for women, but I'm not comfortable with this perception as a guy).

I had consulted with a couple of plastic surgeons in New York, initially thinking (wrongly) that I would need a buccal removal and a chin implant. In hindsight, I'm glad I didn't go ahead with that, as I dont think now that the buccal removal would've done much for my issue.

I am wondering if I would be a candidate for fat grafting around the cheekbone area to build up that area (as the cheekbones would appear more 'raised' and those lines would be gone) and maybe some fat placed in my chin to give a little more projection. I'm also curious as to any other procedures you think would help to give me a little more facial definition. My goal would be to lose the 'heart-shape', as I dont think it's a very masculine feature.

Thanks again for your time.

hi,
thank you for the kind remarks. here are my answers:
1. the line you are describing sounds like the malar septum depression. there is a forum thread that is interestingly one of the most popular out there. it is about a page back toward the top if you want to read it. i would probably not read it since it is insanely detailed to the point that you don't need to know but that is what this forum is about is answering people's interests.
2. i would mostly hesitate to do a fat transfer on a young gentleman as yourself for a few reasons. First, you are very young and fat transfer is a live graft, meaning it is yours for the rest of your life. If you gain a lot of weight over the years (who knows), the areas that I fill will look possibly too full. I just did 2 women this week, 28 and 30 years old, who flew into Dallas to have my work done. The 28 year old benefited from subtle changes that will look very good. I used a very low amount considering that she will age and may gain weight and also had not had children yet. The 30 year old needed corrective fat transfer to fix some bad permanent injectables so that is another story.
3. If truly you have a deep malar depression (described in #1 above), you should not have fat placed into the anterior cheek since it will manage the depression but potentially exaggerate the femininity of the face, i.e., INCREASE the heart shape to your face.
4. In alignment with point #2, you HAVE BABY FAT. You will lose it when you get to your late 20s. I know you probably can't wait but please do. It is not a great idea to rush to do something permanent in such a young face. Now obviously I have not seen it yet. Whenever I do fat transfer I am responsible for you for the rest of your life with that graft. I do not take that responsibility lightly. When someone is late 30's and beyond, my consultation about lifetime risk is proportionately shorter. When I am dealing with early to mid 30s, it is more involved. When I am dealing with 20s, it is incredibly lengthy.

My recommendation is to go to an experienced doc with a good eye (possibly me) for a formal in person consultation and then consider doing some fillers like Restylane in areas that you are considering fat transfer. That way you can try it on. Now, remember many docs out there commit two sins: 1) they want to take your money since you are sitting in front of them, i.e., they have a financial advantage to sell you something just because you have approached them, 2) they may not have a great artistic eye to do the right thing for you. I am always leery to send a patient elsewhere for those two reasons (not to mention poor technical skills). I think we have an incredible responsibility to handle a young person such as yourself. I hope that helped even though I have not seen you.
best,
sml