LAM FACIAL PLASTICS

No, not the same I think, although there must be overlaps in terms of being a stickler for detail and accuracy.

I have one more question - regarding long haul flights: should I come to Dallas, I would have to fly 24 hours approx. Yegods. As you know this kind of journey puts a strain on the body and can cause swelling, dehydration, exhaustion etc. Do you think this could
a)impair the receptivity of the body to fat grafting on arrival
b) mess up the results when flying back afterwards?
Do you think it's better to wait a few days after surgery before flying home, or rush back before your body knows what's hit it?

Thanks Dr Lam.

Personally, I do not think that such a long flight will impair the fat at all. However, it may make your body feel overwhelmed and may predispose toward a cold or something you do not want. My recommendation is not to make such a long flight a day later but to stay a few days. I would also recommend getting an intravenous immune booster upstairs (MNIT, micronutrient infusion therapy) in my anti-aging/vitality center upstairs. It takes about 45 minutes to infuse the therapy. I do that all the time before long flights to ward off a compromised immunity. If you want that, I will cover the costs of the treatment for you, just mention that when you call or email my office to schedule things. Of course, I need to review your photos and preferably do a phone consultation or something more than just this forum exchange before moving forward.

Of course! I am working on the photo thing...will be back to you when I have that sorted. Many thanks Dr L.

you're welcome. good night.

Hello again

May I PM you a PDF of images for your assessment? Sorry, they took a while to get together...

Kind wishes,

Frangipani

yes.

I had trouble emailing you the PDF through the PM system, so have sent it to your yahoo email address. Hope you don't mind and that you receive it okay.

F.

yes, you have had volume loss. interestingly, you mention that you would really not prefer the fat too much in the anterior cheek and buccal area. those are exactly the two areas where you need it most. i am a bit confused. i rather not do your fat transfer if our aesthetic is misaligned. of course, there is some loss in the brow and lower eyelid and jawline but the most pronounced is the anterior cheek and buccal area. thoughts?
sml

I'm thinking about your observations. I looked at the photos I sent and I can see why you say that - in a few of the shots I can see that my lower cheek looks gaunt. The thing is, when I look in the mirror, I don't see this, I just see a softly 'sculpted' lower cheek - it looks fine. Is this the slippery nature of photographs...? in which case what can we do...? As to the anterior cheek I'm afraid I do like it better as it is than it looked when I was young and pudgy, but I can see that a bit of blending makes sense too.

As I say, my issue is the places that were changed by the light treatments and I obviously should have sent you more recent 'before' photos so you could guage this. I sent the ones from my mid-20s because they seemed to form a useful sequence, whereas the more recent photos I have are a bit all over the place. I will see what else I can find. In my late 30's, like most women, I looked more defined and it was good. What the treatments seemed to knock off were the gentle swell along my cheekbone up to the back of the face and the smoothness of my jawline. Those are what I saw change (overnight) and what really sadden me. Do you think my jawline is fixable? Do you think there is any hope for 'us' ?

Appreciate all you are doing for me.

Frangipani

here are my thoughts in a nutshell:
1. i KNOW women don't like their face in their 20s after they pass their mid 30s when they look back in time at their 20s that is. they are always worried about looking fat and they then see their early to mid-20s as being too fat. i have written about this extensively. most women prefer their early 30s then all of a sudden out of nowhere they hit this delicate drop in their mid-30s and beyond where they start to look gaunt and they want that fixed but not to the level of their 20s.
2. photographs are photographs. they only do so much, especially with non-professional cameras and lighting. there is nothing like an in-person consultation if possible.
3. i truly believe you need the volume in the anterior cheek and buccal area. not necessarily back to a round face of 20 something but early 30s. that is what we can do to look together at photos of when you thought you looked the best.
4. if you believe that you absolutely do not want volume there after our discussion then i WILL NOT TOUCH YOU. i do not simply placate patients because ultimately i do not do good work. i compromise what my aesthetic is and if you are not disappointed, i will be. i can't allow that to happen.
5. strategy: if you come for consultation and you still don't believe me or we can't get together on this, then i would suggest some restylane there to see if you like it. that is an easily reversible thing. hopefully we could go straight to FT but i wouldn't if we are misaligned aesthetically.
best,
sml

Oh look,If I were in the States I would be there tomorrow for discussion, restylane, strategy. Whatever! With me being 20 thousand miles away though, it's just not easy.

Perhaps as a part of a general makeover a little in these areas make sense...it's just not what I saw tipping the balance of my face 18 months ago and i would worry about it changing me into someone else..it is hard to tease out what is what though, that I admit. It has been breaking my head for way too long now...I don't really know what to think at all any more..So, in the grand tradition of all great decisions I guess I am now going to sleep on it, if that's okay...

Thank you again Dr Lam. Good wishes to you.


ps

I am curious though - why would you not be satisfied even if your patient was?

Also, it's a confusing area isn't it, I am asking to be returned to what I was 18 months ago. If I could produce really good photos of then it wouldn't really be about an 'aesthetic' would it? It would be about facts. Aesthetic is opinion (in the form of artistic sensibility), but in the absence of those photos and measurements etc I guess how I think I looked is also opinion? Even though it's my face?

BTW Could you define the term 'buccal area'? I just want to be sure we're talking about the same thing!

great questions. here are the reasons why i don't just do what patient wants.
1. sometimes the patient thinks she knows what she wants and does not. then i do it, and the patient becomes upset that what was done was not what she wanted. i have a very good eye and i know in most cases what would best help someone look better. i am just preventing someone from doing something that he or she thinks she wants but doesn't. when i am really uncertain with a patient then i let that patient try something temporary to try it on. if you are from a great distance (i'm sorry i can't recall and did not review the entire thread so i couldn't recall where you were writing from) then obviously restylane is not a great idea per se. the reason that i don't trust someone else doing the restylane is that they oftentimes do it badly and then you get scared and really can't understand why i would do that because their aesthetic sense does not match mine. a good example of this is a nice lady who came from the Northwest U.S. who had reported volume loss from I believe Thermage then wanted to get it fixed. She had an unnecessary facelift followed by in my opinion (and she would admit) terrible terrible Restylane where it was not the problem of it being smooth it was just done inartistically and made the face look like a bloated whale. In fact, it just looked unnatural. Again, not unsmooth or lumpy just simply in a word, ugly. I dissolved all of the Restylane out over 2 rounds, then did her fat transfer (also fixed her facelift) and she is only a couple of months out and she sent me a photo. I lined up the before dissolve, after dissolve, and after my FT and I believe surprised her at how amazing the correction has been. Sorry for the long digression. If we can come to a mutual understanding of what would be beautiful, then great. If not, then we should not progress. There is a third option. If someone comes here and wants to see how the buccal area looks, then I can use salt water there. Even though it is distorted and not great looking the result will be gone in a few hours. That way you can try it on.
2. the second reason that i do not do whatever a patient wants is that i have a reputation in the community. if i do an area that you think would look good and i don't, you will walk around saying, "this is dr. lam's work." and it won't be a fair representation of my work.
3. i cannot intentionally do ugly work. if a patient comes to me and they want to do something that would be against my better aesthetic judgment, i have a very hard time complying. now, if you just want less of something then i could negotiate with you with the understanding you will probably be unhappy with what i did for you but i can always add more fat. it is much harder to take it away. therefore, i can make that accommodation if we are not very far off in our aesthetic vision. this is really going to sound out there but it is honest. i am an artist. i know what i would do for you to make you look better. however, if you disagree with me, we part ways. if we come to a compromise where i truly am just doing less of what i would like to do for you, then perhaps i can accept that. if you are on a totally separate page from me, then i really should not take you on as a patient.

i was having dinner with my interior designer who has done a remarkable (understatement) job with my spa and my house. i mean amazing. i told him how i turn away many patients who may not fit my aesthetic vision, and he says he does the same. he can just simply predict that to explain to someone else that aesthetic that he sees and they can't see it will drive him bonkers. simply put, he is an artist much more than i am in the traditional sense. he hand built the furniture, hand painted it, hand etched the windows, hand built the kimono in the spa, even handrolled some of the paint, designed the wall treatments. he is beyond a "designer". i remember my mom's first designer (no names here). she said, "oh, i know your aesthetic. let me take you to this house i designed." her aesthetic was so far off from mine that it would take me 30 pages to explain how far away it was from what i wanted. we were not even on the same planet let alone universe. i knew that relationship needed to end and end immediately.

I know for a fact that all of this is a bit against the grain so to speak. Most plastic surgeons will do ALMOST ANYTHING you want if you open your mouth. I don't. If you are way off base from what I think looks good, please let's have you pick someone else. Remember as much as you pick me as a surgeon, I pick you as a patient. I mean that with absolute passion and love in my craft.

Okay, I want to take a step back and say that I am absolutely in love with my work and I am even more so in my patients. I hope you did not take this massively long response as a negative against you. It is said in hopes that anyone reading it would understand who I am in principle and in spirit. I would be more than honored to take care of you. You have a simply beautiful face, and I always like to work with a nice canvas. Simply put, I can do more with a nice starting point. Let's take our time with this "relationship" and make sure it is a right fit before we make any hard and fast decisions.

P.S.: the buccal area is the area where you suck your cheeks in you see some hollow. actually it is a bit higher than that. it is right below the cheek bone.

There is one more thing that I wanted to add. I hate doing things that waste people's money. If you want to really get into my brain of how I run my practice, please watch my video log on how to make safe and effective plastic surgery decisions:

http://www.lamfacialplastics.com/plastic_surgery/dallas/content/view/1393/425/

I really take pride in my job and do not want to do something that would be just wasteful. I spent most of Friday talking people out of useless treatments that would have wasted their money. Am I crazy? Perhaps. Why don't you ask my medical assistant Darla who helped me Friday morning if I did not do that. I basically had an entire morning of losing money. You know why? Because simply put it was the right thing to do. That level of fiduciary responsibility that I exercise as a surgeon is how I would like to be treated if I were a patient. Bottom line is I don't sell someone. I always say there are two elements to a consultation: education and trust. Without those two things, all I am is a dishonest salesman. But I am not. Okay, I will stop this long rambling.

Thank you for allowing time for our dialogue Dr Lam: It is very generous and humane. I have been through a lot of self recrimination since undertaking the light treatments which ate my face, so I am inclined to scrutinise much more closely now any possible solution..i do not want to make another mistake, but conversely I don't want to be paralysed into inaction either.

I am in no doubt of your dedication to your work or to your patients and I understand that this means you would want to do the best thing for them - this is one reason no doubt why folks like you so much and feel they can trust their faces to you.

In approaching you I was hoping merely to fix the recent damage - I was quite happy with my funny old late thirties face before. Your technique however focuses on replacing several years of lost fat and so in this regard we have been at slightly cross purposes (which I compounded with the old photos I sent). Of course, as I have been looking over more old pictures in the last couple of days, I can see that it is not just the tops of my cheeks and my jawline which have suffered over the past decade and that wasn't really a surprise. I can see from your point of view - why fix my face back to 2 years ago, when the margin for slippage into 'disaster' was so small? It is very tempting to be made to look younger. I guess philosophically, I was okay before about looking my age, but what I did with the RF changed the shapes in my face in an unpleasant way and yes, I felt like some of my identity had been stolen. That being so, to have this fixed to any degree at all is also going to be an approximation and artificial (although hopefully it won't look it). So, do I just try to do the minimum, to fix the damage I saw happen which felt like a travesty, or do I go the whole hog and get completely rennovated, running the risk that the more I get done perhaps the more potential there is for a problem in my self perception and self acceptance?

Regarding the front cheek area, I did manage to find some shots taken a couple of months before the RF nightmare (which I will send you, unprepossessing as they are) and yes, even then my front cheeks were more pronounced. So the treatments killed that off too. As I say, I didn't like the more pronounced NL line that this gave me (although I didn't lose sleep over it) and losing or softening that felt like the one benefit of the RF. I do see that in the past I had more flesh down front there, and I guess just under the cheek bone too..Many of the surgeons I have seen say not to consider putting fat below the cheek bone as it leads to bottom heaviness - either now, or further down the line. I don't know exactly what your take is on this?

If I may, I have three more short questions tonight (my tonight, sorry, not yours ) and they are:

How much fat would you estimate using for me if you were to graft me? ( I don't know why it helps me to know this, but if I can look at the volume I might become 'friends' with it.)

Also, not to be facetious, but a reverse of the question I asked you last time...

How would you feel if YOU were happy with an outcome, but the patient was not. ie if it suited your aesthetic, but not hers?

Lastly, when we talk about 'aesthetic', I just want to triple check, as the word makes me a little nervous: you would be trying as far as possible to re-create the natural shapes in my face,yes? not to fashion something new? Forgive my insistence on this point, I think you see the importance of it.


Kind wishes for a good day

Frangipani

So, do I just try to do the minimum, to fix the damage I saw happen which felt like a travesty, or do I go the whole hog and get completely rennovated, running the risk that the more I get done perhaps the more potential there is for a problem in my self perception and self acceptance?

I WILL NOT DO ANYTHING UNTIL YOU ARE READY. AS I SAID, I CAN OBVIOUSLY DO LESS AND COME BACK AND DO MORE DOWN THE ROAD IF YOU CAN'T MAKE UP YOUR MIND. HOWEVER, I DO NOT WANT TO DO SO LITTLE THAT YOU AND I ARE JUST WASTING YOUR TIME. I TRULY THINK A LITTLE IN THE ANTERIOR CHEEK AND BUCCAL AREA ARE VERY IMPORTANT FOR YOU. BUT WE NEED TO COME TO AN AGREEMENT ON THAT.

Regarding the front cheek area, I did manage to find some shots taken a couple of months before the RF nightmare (which I will send you, unprepossessing as they are) and yes, even then my front cheeks were more pronounced. So the treatments killed that off too. As I say, I didn't like the more pronounced NL line that this gave me (although I didn't lose sleep over it) and losing or softening that felt like the one benefit of the RF. I do see that in the past I had more flesh down front there, and I guess just under the cheek bone too..Many of the surgeons I have seen say not to consider putting fat below the cheek bone as it leads to bottom heaviness - either now, or further down the line. I don't know exactly what your take is on this?
OF COURSE, NO. IT IS AN IMPORTANT AREA FOR BALANCE. HOWEVER, IF YOU ARE AGAINST IT COMPLETELY, WE COULD POSSIBLY (I WOULD HAVE TO SEE YOU) DO THE ANTERIOR CHEEK. I THINK YOU ARE MISSING THE BOAT IF YOU DO NOT DO THE ANTERIOR CHEEK. I WOULDN'T KNOW WHAT WE ARE TRYING TO ACCOMPLISH.

If I may, I have three more short questions tonight (my tonight, sorry, not yours ) and they are:

How much fat would you estimate using for me if you were to graft me? ( I don't know why it helps me to know this, but if I can look at the volume I might become 'friends' with it.)

HARD TO SAY BUT GIVEN YOUR YOUNGER AGE, PROBABLY 2O TO 30 CC

Also, not to be facetious, but a reverse of the question I asked you last time...

How would you feel if YOU were happy with an outcome, but the patient was not. ie if it suited your aesthetic, but not hers?

OF COURSE NOT. I WOULD HATE THAT. IF WE DO NOT MEET ON THE RIGHT TERMS. YOU WILL NOT BECOME MY PATIENT. I WILL NOT ALLOW YOU TO CHOOSE ME AS A SURGEON. THAT WILL LEAD TO A DISASTROUS RELATIONSHIP. THERE IS A GOOD SAYING FOR PLASTIC SURGEONS: YOU NEVER REGRET THE PATIENT YOU DID NOT OPERATE ON. YOU NEED TO PICK ME FOR THE RIGHT REASONS. IF NOT, MOVE ON.

Lastly, when we talk about 'aesthetic', I just want to triple check, as the word makes me a little nervous: you would be trying as far as possible to re-create the natural shapes in my face,yes? not to fashion something new? Forgive my insistence on this point, I think you see the importance of it.

YES, IN YOUR CASE YES. SOMETIMES, I EXERCISE A LITTLE CREATIVITY IN WHICH THE FACE LOOKS BETTER BUT NOT DIFFERENT. AN EXAMPLE IS A LADY WHO IS REALLY WIDE IN HER FACE, I WOULD PUT LESS OUTSIDE TO BALANCE THE OUTER LOWER FACE. THE OPPOSITE I WOULD DO FOR A LADY WHO IS TOO GAUNT. I DO NOT NEED TO EXERCISE THIS SMALL DEGREE OF BALANCING IN YOUR CASE. AGAIN I WOULD HAVE TO SEE YOU, BUT AS I SAID I CAN BE MORE CONSERVATIVE IF THOSE ARE YOUR WISHES SO LONG AS YOU DON'T FLY HERE AND WASTE YOUR MONEY WITH ME.