LAM FACIAL PLASTICS

Dr: Lam:

I read that your best results with fat grafting are woman in their 40's.

I am a 36 year old male with very high metabolism and I struggle to hold
on to fat in my face. Have had fat grafting done before and it only lasted
a year or so. Now I'm on the Radiesse program and getting very tired
of repeat injections and lumps.

How are your results with males with my type of history? I also have slight jowling as a result of the fat loss/lax skin.. Are you generally opposed to performing fat grafting with an mini-lift or something less invasive as an S lift, etc?

Tks

fat holds a little less well in men (see my evolution photos in the fat grafting gallery in the before and after section), but i think that is good. men look good a little more angular than women do. my fat still holds well in men. a mini lift in a 36 year old in 95% of cases is a joke. you most likely do not need one. most people then say, "yeah, but when i do this (pull up face) i look better." that is not a facelift. that is a threadlift which pulls skin. and threadlifts are off the market because they do squat. i know, i tried them. a skin pull is not what any kind of lift does. that being said, when i perform a facelift in someone who needs one, my incisions are as short as an S with a little extension on the back side of the ear but with a powerful vertical suspension lift.
best,
sml

Dr Lam,

There is no question I can benefit from your fat grafting skills but here are my concerns..

1. I know it's unusual for a 36 year old male to have sight jowls but I have a very difficult time
holding fat or radiesse in my face. That, coupled with thick skin, has caused the jowls decent
and a week jawline. I'm not sure fat grafting will help this or not. Most of your before/afters seem to focus
on the top 2/3 of the face and they seem to look better for woman. Would some type of chin implant
with extensions that run up the jawline help create stability or make my appearance even more bottom
heavy?

2. What happens if I come in a year or so from now for a touch up and THAt fat desolves within a few years?
This is also a big concern.

I plan on coming down in a few weeks for a consultation but I'm still a bit apprehensive.

Kerouc, just out of curiousity, which regions have you grafted? I have the exact opposite problem, the areas that should go down is remaining whereas the depression in the midface has sunken in, hopefully it will demonstrate growth with time but it looks like I'll need more grafting in the future for that area and liposuctioning for the other area.

By any chance, did you have any grafted on the upper cheek region closer to the eye? Also, theres different types of fat grafting, did you have micrografting done because I heard these are permanent (which can either be a really really good or bloody horrendous), or did your surgeon use another technique? I'm PRAYING for hope right now, and that what I'm seeing is temporary but if its happened to you maybe I'll happen to me?

Kerouc,
Here are my responses:
1. My fat grafting results show improvement throughout the entire face. Of course, the most dramatic areas are the central face because that is the area that tends to age someone the most. A chin implant is good to rebuild lost bony structure. Suffice it to say I need to see you to make that determination.
2. Once fat has blood supply after 6 months to a year it should hold pretty well. Of course, fat is undergoing evolution over typically a 2 year period so fat should not be lost after a year, at least I have not seen it. I have seen about 5% of my patients who do require a touchup but I can see that their result was not beginning to improve 6 months post and that continued in the same level until a year so at that point I decided it was time to do a touch-up. Since fat is a free graft there are no guarantees. I typically do not charge now for a touchup at a year but I also ask that you let me be the judge. Safety is the first priority. I want to fill you appropriately.
best,
sml

Hi Dr. Lam,

I have read this post and find it very interesting. I do have a question I am curious about that may be silly but I still want to know. As I have read and watched your forums and videos, fat grafting goes through evolution for about 2 years and blood supply helps retain the fat, correct? Because fat is estrogen rich it is likely to retain in the face as it is naturally found in the body.

I have seen some ads on TV such as juvederm and such and they say HA products; perlane, juvederm, restylane are natural products since HA is naturally found in the body. If you inject a HA product into the face and it is natural in the body like fat is, why wouldn't HA undergo evolution and why wouldn't blood supply help retain the HA like it does the fat when someone undergoes fat grafting. This would be nice, maybe more research may make a HA product do that as that would seem to make sense to me to work. Just curious, what are your thoughts?

Simply put, you can't have blood supply to something that is not alive. Fat that is injected are "fat cells". They are live grafts. The part that does not get a good blood supply does not take root and survive. HAs are synthetic or animal based (I only use synthetic) so they are still a foreign substance that cannot take root because blood supply cannot supply an inert substance. Hope that is clear. Thanks for the question.
best,
sml