This section of the forum is dedicated to discussions on various surgical techniques for facial rejuvenation, including fat transfer/fat grafting, browlift, blepharoplasty (cosmetic eyelid surgery), facelift, etc. Also, this category includes questions on hand rejuvenation via fat grafting. (Of note, Dr. Lam does not perform body rejuvenation except for hand fat grafting)
Is there somewhere on your huge web site a map showing the parts of the face that we are talking about? Where they start and finish? I feel like I know only approximately and that that isn't quite enough! Thank you.... Fran
i can't recall if it is on this site. so here is a photo of a lady who is photographed 2 years following a single session of fat grafting where she has had no skin treatments, no sleep, and no makeup on the after with consistent lighting. the areas of deficiencies are circled on one side and color coded on the preoperative view, and you can see the balanced result. does that help a bit?
Yes, thank you - that does help! I notice you painted the walls in bewteen shots!
I have taken the liberty of sending you another private message c/o your yahoo address (because it's easiest for me to put together in PDF but not to mail a PDF to you through this site for some reason). I hope this is okay
Hello Fran, The lighting is the same and I did not paint the walls. Sometimes when the camera picks up more light in a fat transferred face, the color balance is a bit thrown off. In the spirit of scientific integrity I did not re-color balance the photo. It is the same wall.
I have finished reading your pdf file and I think I can at least help dispel some of your fears. I am not trying to fill out the entire buccal area if your aesthetic is leaner. Believe it or not as I have said many women do not like the fullness of their 20s but prefer a slightly leaner look of the early 30s. That is why some older photos are important to start with.
You are also right by saying that if I fill just the outer cheek or anterior cheek it will truly make the buccal area way to sunken (which already is too sunken) and would make your face look worse. I appreciate you like Annie Lennox's photo and not the fuller photo you showed me. Obviously, I cannnot promise you a perfect volume result down to the cc because fat does take and blend differently in different people. However, I am very skilled at what I do and the 190 cc you quoted me is far beyond anything imaginable for me to put in. Not every face that you see in my gallery is leaner. At times I have widened the buccal area but that was only done with patient assent and understanding. I think the patients look better. In the photo that I sent you, I truly like the buccal area but if it is too much for you obviously I can temper that. However, if you tell me nothing in the buccal area I think that is a dreadful mistake. We can take this slowly and I could show you more if you were to come here to Dallas preoperatively.
As far as what your surgeon does by charging per area, that is something absolutely verboten for me. I like to create a balanced face. You either do it or you don't. I don't like my patients picking parts of their face and not others. This is not paint by numbers. It is your face. Each area that is augmented and the other area that is not are all related so by making one area bigger can make the other area smaller so the face must be in balance. I am also glad to hear that two small areas of treatment by the other surgeon are more expensive than my whole face. In short, I like a face that looks good not a certain part of the face. Even a small amount of 0.6 cc in a certain area can make all the difference.
I begin to feel that we are hewing out a good channel for communication. What do you think? Would it be precocious to think now about booking for surgery? While I may like to send a few more questions to you this way - if that's okay - I agree with you that things much will be made easier by being face to face .
I say this because I am aware that you are very booked up and like many of your patients I have a time consideration - mine is that I am due to go back home to see my family in Europe at the end of December and I was hoping to be bonny for them by then. I was therefore looking at the first week of November to come to you. Of course, if you think this is rushing things I will think again.
no, that sounds fine to me. i am booking now through october so i think that sounds good. i look forward to take care of you. my phone is 972-312-8188 (888-866-3388) and email to schedule is firstname.lastname@example.org or email@example.com. best, sml
I am getting ready to start booking things tomorrow (surgery, flights, hotels). I know it is natural to feel anxious, but like someone packing and then repacking a suitcase I wanted to send you a checklist to really make sure we have a clear agreement on the basic plan. I have had a couple of misunderstandings with surgeons in the last year which make me feel I would rather do this and run the risk of annoying you, than get there and for us to be 'at odds', which would be devastating.
If you agree with my numbered points, please feel free to just respond with a 'smiley stamp'
1. We can retrieve my lost jawline.
2. We can put a fine layer of fat along the cheek bone and out towards the side of the face to subtly bring back the definition of a high cheek.
3. We will negotiate in person a soft pedal approach to the front cheek and buccal area which will harmonise my face but not make it round/bottom heavy/chipmonky or undermine the effects of 2!
4.We are aiming to recreate the shapes natural to my face and I will find as many photos as I can to help with this.
That's all for the checklist Thanks.
I also have 3 more questions:
a) You mentioned salt water testing as a way to explore putting volume in the areas I am unsure about. How much time ahead of actual surgery do we need in order to do this? I imagine it would cause some swelling which could then interfere with your reading of volumes when it comes to surgery itself?
b) If the above is an option, how many appointments and with what spacing should I be booking with you in total?
c) This is a broader question and perhaps a bit tricky to answer... Do you think, a month out from surgery, it will be obvious that my face has been altered? To people who see me every day? To friends and family who I haven't seen for a couple of years?
That's all this time. Many thanks for your indulgence.
1. We can retrieve my lost jawline. I WANT TO BE CAREFUL WITH THIS ONE. I DON'T KNOW WHAT YOU MEAN BY THAT. I HAD A LADY FROM ANOTHER CITY COME WITH A THREE-PAGE QUESTIONNAIRE FOR ME IN WHICH SHE ASKED ME WOULD I FIX THIS LITTLE FOLD AROUND HER MOUTH AND MAKE HER JAWLINE STRAIGHT. FOR THE SAKE OF SAFETY, I SAID NO. NOW, SHE IS A FEW MONTHS OUT AND SHE LOOKS AWESOME. HOWEVER, I DO NOT WANT TO MAKE ANY PROMISES ABOUT FIXING A LOST JAWLINE TO THE LEVEL OF SATISFACTION YOU MIGHT HAVE. HOWEVER, I DO WORK ON THE JAWLINE AND PROVIDE MORE FULLNESS IN THE AREAS THAT ARE BONY. FAT GRAFTING DOES NOT GET RID OF A "JOWL" ENTIRELY AND DOES NOT WORK ON FOLDS AROUND THE MOUTH ALMOST AT ALL. SO LONG AS I CREATE REALISTIC EXPECTATIONS, THEN YES. IF YOU ARE LOOKING TO BE "EXACTLY" SOMETHING IN YOUR MIND'S EYE OR LOOKING TO HAVE NO FOLDS OR NO JOWLS, THEN THE ANSWER IS NO. REMEMBER I TRULY BELIEVE THAT MANY WOMEN MICROMANAGE THE FACE DOWN TO LITTLE THIS OR LITTLE THAT. I JUST MAKE THE FACE BRIGHTER, SOFTER, MORE BLENDED AND MORE BEAUTIFUL WITHOUT MAKING SOMEONE LOOK DIFFERENT. 2. We can put a fine layer of fat along the cheek bone and out towards the side of the face to subtly bring back the definition of a high cheek. REMEMBER THAT YOUR CHEEK BONE IS ALREADY STICKING OUT LIKE AN OASIS WITH THE MARKED DEPRESSION OF THE ANTERIOR CHEEK AND BUCCAL AREA. IT IS ALREADY TOO DEFINED. SO WHEN YOU SAY DEFINITION I DON'T KNOW WHAT YOU MEAN. I WANT TO BLEND THAT BONE THAT IS STICKING OUT WITH THE ANTERIOR CHEEK AND BUCCAL AREA SO IT DOESN'T STICK OUT LIKE A SORE THUMB. HOWEVER, I WILL COVER IT SOMEWHAT AS WELL TO BLEND IT IN AND NOT HAVE BONE SHOW UP AS MUCH. IF I PUT TOO MUCH FAT THERE WITHOUT BLENDING IT, THE FACE WILL BE LESS BALANCED. YOU NEED TO SEE THIS FACT BEFORE WE CONTINUE. 3. We will negotiate in person a soft pedal approach to the front cheek and buccal area which will harmonise my face but not make it round/bottom heavy/chipmonky or undermine the effects of 2! YES. OF COURSE. 4.We are aiming to recreate the shapes natural to my face and I will find as many photos as I can to help with this. OK. That's all for the checklist Thanks.
I also have 3 more questions:
a) You mentioned salt water testing as a way to explore putting volume in the areas I am unsure about. How much time ahead of actual surgery do we need in order to do this? I imagine it would cause some swelling which could then interfere with your reading of volumes when it comes to surgery itself? 1 DAY BEFORE IF NOT 2 DAYS BEFORE. I THINK THIS MIGHT JUST FRIGHTEN YOU TO BE HONEST. I HAVE RETHOUGHT THAT BECAUSE YOU MIGHT NOT BE ABLE TO DISCERN A SLIGHTLY DISTORTED SWELLING FROM JUST VOLUME. HOWEVER, I WILL OBLIGE IF YOU AND I AGREE TO IT IN PERSON.
b) If the above is an option, how many appointments and with what spacing should I be booking with you in total? SEE ABOVE FOR ANSWER. ONE TIME RIGHT BEFORE THE PROCEDURE IF I AGREE TO DO IT.
c) This is a broader question and perhaps a bit tricky to answer... Do you think, a month out from surgery, it will be obvious that my face has been altered? To people who see me every day? To friends and family who I haven't seen for a couple of years? I PERSONALLY DO NOT THINK SO BUT I CAN BE HONEST WITH YOU, THE ONLY THING THAT I CAN PREDICT ABOUT HUMAN NATURE IS THAT IT IS ENTIRELY UNPREDICTABLE. MANY TIMES, YOU RESPOND WEIRDLY TO OTHER PEOPLE BECAUSE YOU THINK THEY NOTICE SOMETHING AND THEN YOUR FREAK OUT THAT THEY ARE NOT RESPONDING TO YOU NORMALLY. FOR MY ENTIRE VIDEO ON OTHER PEOPLE'S PERCEPTION OF YOU, WATCH MY VIDEO (IT IS IN MY POSTOP VIDEO COMPANION SERIES BUT RIGHT NOW I THINK THERE IS A LITTLE GLITCH IN THE VIDEOS PLAYING. MY WEBMASTER SHOULD FIX IT IN A DAY OR SO). THESE ARE ONE OF THE VIDEOS I FORCE YOU TO WATCH EVERY DAY FOR A WEEK AFTER THE PROCEDURE. IT WILL HELP CALIBRATE YOUR EXPECTATIONS AND PREPARE YOU FOR THE RIGHT PSYCHOLOGY. I HAD ONE LADY AT A MONTH STILL FREAKED OUT THAT IT WAS TOO SWOLLEN. THAT IS PRETTY DARN RARE. EVEN FOR MY PATIENTS, THE ONLY THING THAT I CAN PREDICT ABOUT MY PATIENT'S RESPONSE IS THAT I CAN'T PREDICT IT. MOST PEOPLE AT A MONTH LOOK PRETTY GOOD. THEY STILL HAVE A LITTLE SWELLING BUT HAVE NOT DIPPED AT 3 TO 4 MONTHS WHERE IT CAN LOOK A LITTLE LESS IMPRESSIVE. THEN IT STARTS TO LOOK BETTER AGAIN AT 6 MONTHS AND BEYOND, INCREASINGLY STEADILY TO 2 YEARS POST.
MY GOAL IS ALWAYS HONESTY AND MAKING SURE THAT I CALIBRATE EXPECTATIONS. AS YOU SAID YOU HAD SOME MISUNDERSTANDINGS WITH SURGEONS BEFORE. I DON'T WANT TO BE NEXT IN LINE. I HAVE NO PROBLEMS IF YOU DON'T BOOK ANY FLIGHTS YET. I WANT TO BE DEAD CLEAR WITH EVERYTHING. WE CAN CONTINUE THIS DIALOGUE OR YOU CAN SET UP A PHONE CONSULTATION WITH ME IF YOU LIKE. THE COST IS $100 BUT APPLIED TO THE SURGERY. BEST, SML
One more thing: if you have time please go take a look at my before and after gallery for primary fat transfers. I have added descriptions to all of them so that you can see what I did to create the right look. Yes, I am not trying to create a new identity for you just bring you back in time a bit. Yes, not back to the twenties when you did not like your face. Nevertheless, you can see how I can shape faces that look nice within parameters to maintain identity. In your situation, I am not trying to be creative, but there are areas of aging that would really benefit from a little treatment like the anterior cheek and buccal area. Yes, I shall remain conservative.
Dear Dr Lam I think what you're saying is that having read my last you now don't want me to book flights/surgery for November? If I wait for a phone consult (some time in late September) then November of course is blown.
Just for the record, the misunderstandings I had with previous surgeons were one who said he did saline testing when I wrote, then when I got there, said he never does saline testing, the other was a surgeon who, the first time I saw him, described how he would put fat onto my cheek bone and then the second time I saw him said that I didn't have enough fat on the cheek bone for him to inject the fat into and that he would only use a temp filler there. So not really about unreasonable expectations on my part .
My hopes about fixing my jawline and replacing fat on my cheeks are based on what I saw happen post radio frequency. It is my perception that fat loss caused the sudden change in my jawline and so it seems logical that replacing fat will fix it. I don't have a huge jowl - my jawline is just kind of 'misshapen' now. I suspect there was fat loss right along it and back onto the angle of the jaw (although, of course I cannot prove this). I also saw my cheeks flatten out and it seems to me that the slackness that went through my face immediately thereafter (including down to the jaw) was a result of this loss higher up. I am only trying to work logically by reconstructing what I saw happen. I know there is a possibility that these changes were coincidental with the treatments I had, but frankly I feel this unlikely.
I guess for my part I don't want to get to Dallas and for you to be attending to everything but the areas I saw damaged. You understand, I wish I had never had those treatments, I am looking to reverse what they did, but I want it done sensitively with regard to my whole face. I don't like the shapes in my face now, I miss the old me. I don't think this is micromanaging...
By the way, yes I did try to watch that video and also the one about the cheeks, but had problems so will try again soon.
Many kind regards and thank you for your concern to be honest with me,
no problem. i really value a physician-patient relationship, and i mean a relationship. i never rush a patient or jeopardize that relationship through selling someone a procedure. i don't "sell". that being said, i saw your photos and i think i can help you. i just want to be careful how I answer your questions regarding will this or that FIX this or that. will basically ANYONE perceive this or that. i know those are not exactly the words you used. i just want to be honest and clean in my responses. i just want you to absolutely love what i do for you and not feel that you came this far for me and i let you down. i couldn't stand that. if you would like to proceed given my frank responses, that is fine with me. and i look forward to take care of you soon. (i hope that i didn't scare you too badly.) best, sml
Oh look, I had a little cry and now I'm going to have a little think. I wish there were not all this distance between us, it makes everything so much more momentous. Thank you again for answering everything I asked: I know it's not fair to send you a list of 'demands', it wasn't really the way I meant it, but from your end I can see it might have felt like that.
I just sent the photos I sent you to a very good friend of mine and her comment was how little needs 'fixing' and actually I agree with her and I think when you see me you might feel this too. Even so, the photos don't actually show me the way I see me in the mirror. It's a mystery. When I look in the mirror I see still quite a lot of fat midface and just the swell atop the cheek gone awol, which is why I'm so insistent about it! But I appreciate what you say about not isolating this area. I hope when we meet, you and I, we will be able to work out just what it's all about.
If I could, I would pop over, as I would really like to talk face to face before booking in for surgery, but realistically I think I only have one trip in my budget, which makes it a bit tricky: I expect you can hear my brain working from there...or perhaps you thought it was the aircon?