LAM FACIAL PLASTICS

Hello dear Doctor!! Hope you are having a great day.
I watched the reconstructive procedures gallery and was utterly impressed. Utterly does not even describe how impressed I am. You really changed for good these people's lives!!! Congrats!!

Now, on to the matter that I was reading about (I love to read old entries, I always learn something new)... I am not sure I understand too well how good versus risky botox can be in the undereye area (botox for the "crepey" undereye look, not for crow's feet -for the latter botox is obviously ok).

You said:

"BOTOX INJECTED BOTH ON THE SIDES OF THE EYES AND A BIT TOWARD THE MIDDLE. Okay, now you may have one of several problems:
a. If Botox was injected immediately under the eye in someone with a mild fat bag and weak muscle tone, the muscle may relax and cause the eyebag to be bigge.......the other reason to avoid this type of injection is injecting Botox really close to the nose wrinkle can weaken the orbicularis muscle that surrounds the lacrimal sac (tear duct) and cause dry eye temporarily. b. If Botox were injected into a festoon or malar bag, the area can enlarge either due to a weakeed muscle or aggravation of a malar bag...."

And in another post:
"... the muscle directly under the eye which i refer to as the jelly roll can be easily injected in combination with the crow's feet. however, one: do not expect all wrinkles to disappear. two: the jelly roll area can affect tear drainage and cause dry eye or lower eyelid laxity and rounding of the eye".

You meant that injecting botox in the undereye area (not only the sides) is "doable" and ok... although it can carry some risks, right?

Now, in a rather young patient, injecting in the undereye area is then worth the risks? What areas can definitely *not* be injected under the eye?
Do you think botox is then ok as a complementary treatment after restylane injection for the "tough" crepey-like lines? Or a no-no?

Second, speaking of eyes... I have heard that some doctors work with mesotherapy under the eyes, specifically, inject Restylane but intradermally (with the mesotherapy method). Isn't using many needles in that area, even if rather superficially, a bit dangerous? And doesn't that Restylane stay too close to the epidermis to not "go away" too soon?
Doesn't Restylane, for it to really have an effect in the undereye area, be injected a bit deeper than in a mesotherapy treatment?
(I have never seen someone who has had this treatment, I only heard of it, but it does not sound like something that would really work, or that would not carry some risks, for the eye/sight on itself and for the esthetic aspect ... after a mesotherapy treatment there, aren't bruises very likely to happen??)

And finally, sorry this has nothing to do with the abovementioned... I am the one who warned (thank to you) a friend about the lypolitic substances used for undereye bags, and then I have accompanied her see *another* doc. (another I didn't know neither).
Ok, so I was in this doc's office and without my asking for it, she told me I would benefit from hyaluronic acid injections in the nasolabial area, to look less tired, especially as I have a thin long face.

(On a sidenote: I really don't like it when docs or cosmetologists or whomever gives you "advice" on how one should change this or that when UNasked!)

It is true, I have a thin long face. Therefore, I am wishing to have (until I get the fat transfer) some hyaluronic acid injected in the cheek area, to make the face proportionally wider. But I don't have marked nasolabial folds! I don't know if I am "blind" to my flaws, but I really think those lines are too too faint to require filling and I personally can't imagine how filling that and not the cheek area would make my face wider. Wouldn't that make my face fuller on the lower cheeks? therefore creating even a more marked "rectangle" long face??
I don't see how that would balance my face in any way.
But she is the doc... then again, some docs know nothing of the "art" of balancing a face.
Did the doctor have a point or was she totally off??
Am I being partial to thinking that she was totally off because it annoyed me that she commented on me even though I did not ask her anything about it?

(If you'd need to see a pic of me I can send them by PM, although I normally smile on pics -> my face looks a bit less "longish" and narrow because of the smiling)

You meant that injecting botox in the undereye area (not only the sides) is "doable" and ok... although it can carry some risks, right?
YES.
Now, in a rather young patient, injecting in the undereye area is then worth the risks? What areas can definitely *not* be injected under the eye?
Do you think botox is then ok as a complementary treatment after restylane injection for the "tough" crepey-like lines? Or a no-no?
YES. THE YOUNGER AND LESS OPERATED THE SAFER. IN ANY CASE BOTOX IS TEMPORARY AND WORTH A TRY IN MOST CASES.
Second, speaking of eyes... I have heard that some doctors work with mesotherapy under the eyes, specifically, inject Restylane but intradermally (with the mesotherapy method). Isn't using many needles in that area, even if rather superficially, a bit dangerous? And doesn't that Restylane stay too close to the epidermis to not "go away" too soon?
Doesn't Restylane, for it to really have an effect in the undereye area, be injected a bit deeper than in a mesotherapy treatment?
GO DEEP BUT GO WITH SOMEONE EXPERIENCED. GO TO MY INJECTABLE BEFORE AND AFTER GALLERY TO SEE RESTYLANE DONE WELL UNDER THE EYES. THAT CLOSE TO THE SKIN IS A DISASTER. YOU WILL GET A TYNDALL EFFECT, I.E., IT WILL BE UNEVEN AND YOU WILL SEE A BLUISH HUE FROM THE RESTYLANE.
(I have never seen someone who has had this treatment, I only heard of it, but it does not sound like something that would really work, or that would not carry some risks, for the eye/sight on itself and for the esthetic aspect ... after a mesotherapy treatment there, aren't bruises very likely to happen??)
I DON'T USE NEEDLES THAT I WHY BRUISING IS RARE AND VISION PROBLEMS ARE VIRTUALLY ELIMINATED.

And finally, sorry this has nothing to do with the abovementioned... I am the one who warned (thank to you) a friend about the lypolitic substances used for undereye bags, and then I have accompanied her see *another* doc. (another I didn't know neither).
Ok, so I was in this doc's office and without my asking for it, she told me I would benefit from hyaluronic acid injections in the nasolabial area, to look less tired, especially as I have a thin long face.
NASOLABIAL FOLDS ARE A WASTE IN 95% OF PEOPLE. WATCH MY VIDEO LOG ON "HOW ABOUT THOSE SMILE LINES?" FOR MY OPINIONS.

(On a sidenote: I really don't like it when docs or cosmetologists or whomever gives you "advice" on how one should change this or that when UNasked!)
I DO THAT ALL THE TIME ONLY IF SOMEONE COMES IN FOR A CERTAIN TOPIC. FOR EXAMPLE, IF SOMEONE COMES IN FOR AGING FACE, THEN I WILL MOVE THEM AWAY FROM A MISGUIDED PERSPECTIVE AND HELP THEM SEE WHERE TO SPEND THE MONEY. HOWEVER, I AGREE WITH YOU IF SOMEONE YOU ARE SAYING HI TO SAYS, "BOY, YOU NEED BLAH BLAH BLAH" THAT IS NOT COOL.

It is true, I have a thin long face. Therefore, I am wishing to have (until I get the fat transfer) some hyaluronic acid injected in the cheek area, to make the face proportionally wider. But I don't have marked nasolabial folds! I don't know if I am "blind" to my flaws, but I really think those lines are too too faint to require filling and I personally can't imagine how filling that and not the cheek area would make my face wider. Wouldn't that make my face fuller on the lower cheeks? therefore creating even a more marked "rectangle" long face??
FILLING THOSE LINES ARE STUPID. AGAIN SEE THE POINT ABOVE AND THE ACCOMPANYING VIDEO.
I don't see how that would balance my face in any way.
But she is the doc... then again, some docs know nothing of the "art" of balancing a face. BINGO.
Did the doctor have a point or was she totally off?? TOTALLY RIDICULOUS AND I DON'T EVEN HAVE TO SEE YOUR PHOTOS.
Am I being partial to thinking that she was totally off because it annoyed me that she commented on me even though I did not ask her anything about it? SHE IS TOTALLY OFF.

(If you'd need to see a pic of me I can send them by PM, although I normally smile on pics -> my face looks a bit less "longish" and narrow because of the smiling) I CAN BUT I DON'T NEED TO. JUST WATCH MY SMILE LINES VIDEO.

Thank you Doc, and thanks for pointing out those videos!

All very clear!!

>GO DEEP BUT GO WITH SOMEONE EXPERIENCED. GO TO MY INJECTABLE BEFORE AND AFTER GALLERY TO SEE RESTYLANE DONE WELL UNDER THE EYES. THAT CLOSE TO THE SKIN IS A DISASTER. YOU WILL GET A TYNDALL EFFECT, I.E., IT WILL BE UNEVEN AND YOU WILL SEE A BLUISH HUE FROM THE RESTYLANE.

Glad you say that. I was not planning on getting that done,nope, I only heard of it and imagined it would not be ok. But glad to know exactly why it would not work.

I DON'T USE NEEDLES THAT I WHY BRUISING IS RARE AND VISION PROBLEMS ARE VIRTUALLY ELIMINATED.

Oh, I so wish your clinic was closer!
I wish doctors visited you and asked you to learn your techniques.

NASOLABIAL FOLDS ARE A WASTE IN 95% OF PEOPLE. WATCH MY VIDEO LOG ON "HOW ABOUT THOSE SMILE LINES?" FOR MY OPINIONS.

Great video, thanks!!

[i](On a sidenote: I really don't like it when docs or cosmetologists or whomever gives you "advice" on how one should change this or that when UNasked!)
I DO THAT ALL THE TIME ONLY IF SOMEONE COMES IN FOR A CERTAIN TOPIC. FOR EXAMPLE, IF SOMEONE COMES IN FOR AGING FACE, THEN I WILL MOVE THEM AWAY FROM A MISGUIDED PERSPECTIVE AND HELP THEM SEE WHERE TO SPEND THE MONEY. HOWEVER, I AGREE WITH YOU IF SOMEONE YOU ARE SAYING HI TO SAYS, "BOY, YOU NEED BLAH BLAH BLAH" THAT IS NOT COOL.[/i]

Oh, what you do is not what annoys me!! Actually, you are doing what people want, need and benefit from: you gently help people who come to you precisely to get your help. You address their esthetic concerns by helping them at analyzing those esthetic issues they have, with the bonus of your having a wider perspective of their concerns, thank to your expertise. Totally unlike the "unwanted and unasked help" I got

Thanks again for the wonderful answer and videos!

Hugs!!

I'm glad I could be of service.
best,
sml

I just reviewed your photos. You look very beautiful and charming. I can tell you have a warm heart by your smile. I don't really think you need anything, at least by those photos. Definitely not your smile lines!!!

[quote="dr. lam"]I just reviewed your photos. You look very beautiful and charming. I can tell you have a warm heart by your smile. I don't really think you need anything, at least by those photos. Definitely not your smile lines!!![/quote]

Thank you! I think you are being too kind and too forgiving over my imperfections but of course I am very thankful for your nice comment... especially the warm heart part... after all, our heart is the one feature that never ages and that we can't "fix" in any way. . Thanks again.

you're welcome.

Oh Doctor, forgot to ask you something. Does that change anything if a person tends to need "artificial" tears and tends to suffer from dry eye "naturally" (which is already a problem when using contacts ) when it comes to daring to get undereye botox?

If not injected too close to the lacrimal gland, does a person risk to have his/her problem worsened?

Are small doses of botox at many points under the eye not too close to the inner eye safe for people like that? (like me, in case one day I might think of botox in that area -I have contact lenses and tend to suffer and have to deal with dry eyes!) - or is that safety rather *dose* than placement of the injection dependent?

Hugsss

under the eyes and especially near the nose can risk dry eye especially if you already have dry eye. if you really wanted to try i would probably hit your "jelly roll" under your eye but not do the "bunny lines" near the nose to minimize the risk. the good thing about botox is that it is temporary so that it might be worth a slight risk if you can get long-term gains (and short term ones). however, i would say that there is no reason to take undue risks even if it is temporary.
best,
sml