LAM FACIAL PLASTICS

I have been thinking about getting fat grafting by you and thought of some questions I have. Because I will be coming from out of state, I thought these questions might be more important to address.

1. Does the fat injected, being a yellowish in color, ever show through skin or reflect light, I notice that my current filler does in my outer eyelid area a bit. (tear trough region) because i notice my outer eyelid area is more bony with less fat; is that typical in most patients, because the restylane product seems to reflect some light and show at certain light angles in that area in particular. Wondering if fat can do the same.

2. I had restylane injected under my eye but noticed a dip in the outer eyelid area. I went back and was injected along the bone. There is not a lot of fat in that area and the filler tends to show, would I have better result with fat in that area?

3. After the fat grafting is done there is swelling so it is hard to know if more fat is needed at the time. Do you often recommend patients stay at least a week until swelling goes down so they know to come back in for more fat (out of town patients only obviously)

4. i know you are excellent at this, but if there is a dip in the tear trough area, can you fix that with more fat or do you not recommend fat in the outer eye area/

5. Finally and sorry about these questions. Can you give me an idea what I would like like after fat grafting so I would not be in for a total suprise. I hope it is subtle and not too dramatic.

Thanks, and I hope to see you some time next year hopefully.

1. Does the fat injected, being a yellowish in color, ever show through skin or reflect light, I notice that my current filler does in my outer eyelid area a bit. (tear trough region) because i notice my outer eyelid area is more bony with less fat; is that typical in most patients, because the restylane product seems to reflect some light and show at certain light angles in that area in particular. Wondering if fat can do the same.

NO, IT DOES NOT LOOK YELLOW, OTHERWISE YOU WOULD SEE THE COLOR OF YOUR OWN FAT, WHICH IS ALL OVER YOUR FACE JUST UNDER YOUR DERMAL LAYER OF SKIN SO NO. WHAT YOU ARE SEEING WITH RESTYLANE IS KNOWN AS THE TYNDALL EFFECT. IT WAS MOST LIKELY PLACED TOO CLOSE TO THE SKIN. PLACING MY RESTYLANE WITH A CANNULA TRULY ALMOST ELIMINATES THAT ISSUE.

2. I had restylane injected under my eye but noticed a dip in the outer eyelid area. I went back and was injected along the bone. There is not a lot of fat in that area and the filler tends to show, would I have better result with fat in that area?
YES, THAT HAPPENS EVEN WITH MY RESTYLANE. IT IS HARD TO ENTIRELY ELIMINATE THAT DIP WITH RESTYLANE. FAT IS MUCH MUCH BETTER. HOWEVER, IN A FEW HUNDRED CASES OF DOING FAT TRANSFER I REMEMBER A COUPLE OF CASES WHERE I STILL SAW THAT SMALL DIP CLOSE UP. I FIXED IT WITH A FEW DROPS OF SILICONE WHICH IS PERMANENT AND GIVEN WITHOUT A CHARGE.

3. After the fat grafting is done there is swelling so it is hard to know if more fat is needed at the time. Do you often recommend patients stay at least a week until swelling goes down so they know to come back in for more fat (out of town patients only obviously)
NO, IT IS IMPOSSIBLE TO MAKE A READ OF THE RESULT AT A WEEK. I WOULD ALMOST NEVER GO BACK AND DO A TOUCHUP AT A WEEK. THAT IS DANGEROUS MIXING SWELLING WITH A RESULT. SIMPLY PUT NO. THE ONLY REASON TO STAY 5 TO 7 DAYS IS THAT IF YOU HAVE BRUISING THAT OCCURS AT LEAST 1 INCH OUTSIDE OF THE EYE, I CAN LASER THE BRUISING DOWN SO THAT YOU DON'T HOLD THE BRUISING FOR A FEW WEEKS. NOW, IN THE MAJORITY OF MY PATIENTS, THEY DO NOT HAVE ANY BRUISING OR VERY LITTLE TO SPEAK OF.

4. i know you are excellent at this, but if there is a dip in the tear trough area, can you fix that with more fat or do you not recommend fat in the outer eye area/
PLEASE SEE ANSWER #2. JUST REMEMBER THAT MOST WOMEN IN PARTICULAR ARE SEEING DIPS AND LINES WHEN MOST OTHERS DO NOT (BECAUSE THEY ARE TOO CLOSE TO A MIRROR). I JUST TRY TO SOFTEN THE TRANSITION AND IF IT IS GONE GREAT. IF THERE IS A SLIGHT PERSISTENCE, DON'T FREAK OUT. I SHOW THEM OFTENTIMES THEIR PHOTO AT 22 YEARS OLD STILL HAD A SLIGHT TEAR TROUGH DIP (NOT EVERYONE'S). THE POINT IS THAT I SOFTEN TRANSITIONS AND CREATE A BEAUTIFUL FACE SO I ALWAYS TRY TO RECALIBRATE YOUR EXPECTATIONS.

5. Finally and sorry about these questions. Can you give me an idea what I would like like after fat grafting so I would not be in for a total suprise. I hope it is subtle and not too dramatic.
THAT IS WHAT YOUR OLD PHOTOS ARE FOR. WHEN I REVIEW THEM WITH YOU WHEN YOU COME IN, I SHOW YOU THINGS THAT ARE POSSIBLE AND THINGS THAT ARE NOT. IMAGING A PATIENT FOR FAT TRANSFER IS NOT POSSIBLE, NOT REALISTIC, AND EITHER DISTORTING (SCARY) OR A LIE. THE BEST WAY TO TRUST MY WORK IS TO SEE MY BEFORE AND AFTER PHOTOS. YOU MUST REVIEW A SURGEON'S WORK BEFORE CHOOSING THAT PERSON. IT IS MY PORTFOLIO SO TO SPEAK. FOR EXAMPLE, BEFORE YOU PICK A PHOTOGRAPHER, I ASSUME YOU REVIEW HIS WORK. BEFORE YOU PICK AN INTERIOR DESIGNER, I ASSUME YOU LOOK AT HIS OR HER PORTFOLIO. THAT WILL MINIMIZE THE CHANCE OF ANY SURPRISES.
best,
sml

Thanks Dr. Lam,

I am getting more excited about getting fat grafting done. It is nice because it is a natural fat in our bodies so I know I would be satissfied.

To be honest, my face has always been gaunt even as a youngster. I will bring in old photos, but I am wondering if the results could be better then my old pictures, just in terms of more fat on my face. Again, my face has always been very thin.

I had perlane, restylane and juvederm injected with first injection back in may. The juvederm in my cheek has worn down tremendously, but the perlane is holding longer for some reason. Do you want my fillers completely absorbed before you do this. How do we know if they are compltely absorbed because you can't see the product in my cheek area like you can in my eye area. I am curious however. You use blunet canulas to do fat, right? Do other doctors use needles to inject fat in people when they do fat grafting? Thanks, Dr. Lam and next year or longer I will see you depending on what you recommend.

hi,
1. i can make you at times actually look better than when you were young partly by getting you the volumes you need partly because i can shape your face to make it look more attractive without changing your identity.
2. fortunately, everything you have in your face is dissolvable. i can either dissolve it or you can wait until it goes away. whatever you desire. i would say when you are ready to convert to a much better looking permanent result, start dissolving the product 1 month prior to make sure it is all gone. you can have someone in your home town do it or i can. i usually like 2 attempts at getting all of it down before doing fat transfer.
3. some docs use blunt, some use sharp. i only use blunt. as you know, just using a blunt cannula does not ensure success, longevity, safety, or beauty. that is where the doc using the cannula comes to play.