LAM FACIAL PLASTICS

Hello Dr. Lam,

I have attempted to create contour and angularity on my long, narrow face with cheek and mandible angle implants - without much success. In fact, I had the mandible angle implants removed altogether.

While I still have the cheek implants, I do not feel they are necessarily the correct shape for my face. Specifically, they seem to be widest toward the back, which leaves the fleshy part of my cheek looking flatter by comparison. I even went so far as to have a sub-periosteal mid facelift to recapture that "heart shape", and I loved it when it was swollen. However, I am nine weeks out and it is already too flat again (I suppose I experienced what you refer to as "honeymoon swelling").The surgeon who performed the mid facelift offered to swap the implants but also suggested that I may want to investigate fat grafting for both the cheek and mandible angle area.

I always regarded fat and/or fillers to be a last resort because neither has a very good reputation for sculpting features effectively or permanently. However, I am intrigued by your technique and professed longevity. Therefore, can you address the following before I fly to Dallas for a consultation:

#1) How long would you suggest I wait to have anything (fat or filler) injected into the cheek area? As I mentioned, it has only been nine weeks since the mid facelift, so I want to ensure I am fully healed before trying anything else. Also, is it even possible to perform fat grafting over the cheek implants?

#2) Have you ever used fat or filler to create lateral projection in the mandible angle area? I am female, so I'm not looking for too much bulk.

#3) If I were to visit and decided to try Perlane or Restylane as a preview, is this something you would be able to do that same day? I would be coming from Chicago, so I am trying to be as efficient as possible.

#4) I have heard that not all fat is created equal. Is it true that abdominal fat is best for grafting? I have virtually none there (I'm in my thirties, so it still all goes to the buttock, hip and thigh area!).

I apologize for the length of this message but thought it best to pose such preliminary questions before visiting.

Thank you.

Kayla

Hi Kayla,
You have found what you are looking for, finally! Now, you see why I don't use cheek implants (they exacerbate transition, accentuate the wrong part of the face, and flatten further the very feminizing anterior cheek) nor midface lifts (they don't do very much for volume). Yes, fat lasts tremendously well in almost every person I do. Occasionally, less than 5% of the time, I need to do a touch up but even then you already look so much better. Okay, here are the answers to your questions:

1. You can perform a midface lift at the same time as a fat graft. However, given the fact that you may be still sore and slightly swollen you may want to give yourself at least 3 months between procedures. If not, you will also be more swollen after my fat grafting if it is just a short time following the midface lift. I am booked out now 2 to 3 months anyway so that would be okay. I have no problem with putting fat over cheek implants. I do that all the time. When they look terrible, I take them out but usually I just leave them in. I think taking them out can actually compromise the fat longevity a bit so if I can leave them in, that usually is a better option. I have done it both ways.
2. Yes, I have done that. I usually do it to strengthen a male jawline or to round out a very gaunt feminine face. I just had a gentleman who flew in from Argentina a couple of days ago to have my fat grafting and he wanted to have fat in the outer jawline. Looking at his facial shape, it would have looked very weird as he already had a very flared jawline. Part of what you will have to do is trust my artistic sense. I can show you different faces during consultation in which I have widened and narrowed and also added fat to the jawline.
3. Yes, I can do the Perlane and Restylane as a preview. Once you see that, you will be sold on fat. I know how to simulate fat very well with that injectable. I can do it in 5 minutes without any pain so it is very doable the same day. Of course, I would recommend the fat grafting alone to save costs but if you were to come down just for consultation then I could do the Restylane to show you. However, in a way, you already know what fat looks like in the anterior cheek since you were swollen a short time there after the midface lift.
4. All fat is not created equal. I use fat from your best zones, typically abdomen and thighs. I actually take more fat out of thighs than abdomen because some women have already had a tummy tuck or just don't have a lot of fat there. Almost 80% of the time, I will use at least some or if not principally thigh fat. It is great fat to use.

I look forward to meet with you.
Best,
SML

Dr. Lam,

Thank you VERY much for your quick and thorough response! I will contact your office to schedule a visit.

Regards,

Kayla

You're welcome. Look forward to hear from you. It will truly be my pleasure and honor to take care of you.
Best,
SML