LAM FACIAL PLASTICS

Hello Dr Lam,

I have a couple of questions.

I notice there is a post about fat grafting after fat loss from Thermage. I contacted you a few months back as I also had fat loss from a radio frequency device. Sadly I am still looking for a solution to my problem and would have been to see you long since were I not on the other side of the world! I won't rule out making that journey, but meanwhile, continuing my search for help closer to home, I have seen one surgeon recently who suggested that what happens with these devices is that they damage the blood vessels and this is why the fat dies. He suggested to me that there may be a problem with fat retention after grafting for the same reason - I wonder what you think of this? (He would enhance the fat with platelet growth factors to try to improve retention he said.)

My other question is the pregnancy question. I know it comes up elsewhere on the board but am still not entirely clear why the face would swell unduly with weight gain. Is it because the fat transplanted still behaves like the fat where it has come from - ie a body area such as the tummy with a tendency to show weight gain more quickly? If so, which is the best, most stable area to take from? And is there a danger that the face would be 'stretched' even after the weight returns to normal.

Many thanks for your advice Dr Lam - your site is so informative. A bit of a lifeline, actually. I so want this episode to be behind me but don't want to make the wrong decision in my need for that to be so.

Frangipani

1. I think the idea that the blood vessels are affected is simply conjecture. We don't know. If it were truly blood vessels, why then would in some patients with Thermage they would have spot holes in their face where fat was damage that matches the Thermage handpiece? It makes more sense that the damage is to the actual fat itself. However, I have no proof of this nor does your surgeon. We don't know.
2. My fat holds well so I don't use variables that I don't routinely like platelet derived growth factors. I simply do not need them and since my fat holds well I don't want to change the recipe so to speak.
3. I have never seen a problem with pregnancy. However, I always put that warning out there only because fat transfer can be affected with significant weight gain or weight loss. I use fat from parts of the body that are estrogen rich and hold much better. However, the point of the comment is that fat transferred is a live graft so if you gain or lose weight the fat acts like fat. Let's say I don't even transplant you at all, if you gain weight, is your face not going to look bigger simply because your fat cells get bigger? Of course. Now, if I added more fat to your face, could you not look fatter if you gained weight. Of course. That's all I am saying.

Yes, I gather that your fat holds well, I guess this guy just put the worry into me that I could spend a lot of money/ travel a long way and find that my tissues are not immediately receptive due to damage sustained. However the RF treatments I had are well over a year ago now, so hopefully that makes a difference. Thank you for considering my question and I am relieved about the pregnancy thing - I was getting the impression that the face might distort (grafted fat swelling at a different rate to local fat).

Hope not to hijack the thread (just one question, really, this way)... but radio frequency treatments that can cause fat loss are which ones? Thermage, I assume... but IPL risks to cause fat loss too?

yes! in some cases! it did for me. very upsetting. please be careful x

Hello. Beatrice
You mean IPL, when you say that sometimes it does, right?
I never tried Thermage (nor was planning to) but I had a couple of IPL treatments in the past... should I be careful about not getting more of those?
Hugsss

I offer IPL in my office but the IPL is a very gentle one. I do not want to offer brand names here because I do not want to endorse or bash a company. However, I will say that Thermage of the face is probably not a great thing in many cases but has been used I believe better on the body.

For anyone's information, there are devices out there other than 'thermage' which involve radio frequency energy (which seems to be a wild card) - such a one was used on me with long term consequences. So, be careful, investigate thoroughly the treatment you are planning to receive. May I say, check with someone knowledgeable and reputable such as Dr Lam if you are not sure. I only did my research after I realised something had gone wrong. Also, Dr Lam mentions that his IPL is gentle - that's another thing, there seem to be some IPL machines out there so powerful that their operators do not know how to use them safely.

Going back to my last, may I just double check, Dr Lam:

1. There is no particular reason to think that I would have sustained damage from the RF treatments which would make it difficult for me to retain a fat transfer?

2. With weight gain and weight loss, transferred fat will swell and subside at the same rate as local (native) face fat, or at the rate of the site from which they were taken?

Sorry to be pedantic, I value your opinion and I want to be clear.

With many thanks.

YOU ARE NOT BEING PEDANTIC. I ALWAYS SAY, "DO YOU KNOW THE DIFFERENCE BETWEEN AN EDUCATION AND AN EXCUSE?" AN EDUCATION IS WHAT I TELL YOU BEFORE THE PROCEDURE. AN EXCUSE IS WHAT I TELL YOU AFTER THE PROCEDURE EVEN THOUGH THEY ARE THE EXACT SAME WORDS FROM MY MOUTH TO YOUR EARS.

1. There is no particular reason to think that I would have sustained damage from the RF treatments which would make it difficult for me to retain a fat transfer?

MY MAIN GOAL IS NOT TO LIE TO YOU. I SIMPLY CANNOT STATE WITH CERTAINTY WHETHER YOU WILL HOLD THE FAT WORSE OR NOT. AT LEAST RECALL THAT IF I HAVE TO DO A TOUCHUP FOR YOU, I OFFER THAT TO YOU FOR FREE. I STAND BEHIND MY WORK.

2. With weight gain and weight loss, transferred fat will swell and subside at the same rate as local (native) face fat, or at the rate of the site from which they were taken?

AGAIN, THAT IS A GREAT QUESTION. BECAUSE IT IS BODY FAT, THERE IS ALWAYS A CHANCE THAT IT COULD SWELL MORE. I HAVE NEVER SEEN THAT BUT IT IS ALWAYS POSSIBLE. I WAS SPEAKING WITH A SURGEON FROM EUROPE WHEN I WAS LECTURING IN CARTAGENA, COLOMBIA, IN SOUTH AMERICA WHO DESCRIBED A CASE OF A WOMAN WHO HAD FAT TRANSFERRED TO HER JAWLINE JUST TO THE RIGHT SIDE WHERE SHE HAD RADIATION THERAPY AND THAT AREA SWELLED MORE WHEN SHE GAINED WEIGHT COMPARED WITH THE REST OF THE FACE. THAT IS WHY I USE FAT ONLY FOR SYMMETRICAL FILLS AND BALANCE AND FILL THE FACE EVENLY RATHER THAN TARGETING LITTLE TINY THIS OR THAT. IT IS ALWAYS A RISK BUT I THINK I TRULY MANAGE THAT RISK IN 3 WAYS:
1. SELECTING SAFE CANDIDATES: NOT SOMEONE 70 POUNDS OVER WEIGHT WHO GOES FOR THE CRASH DIET AND SAYS DR. LAM, "LET'S DO IT."
2. I USE MUCH MORE CONSERVATIVE VOLUMES OF FAT THAN MY COLLEAGUES AND I THINK MY RESULTS ARE MUCH MORE NATURAL BECAUSE OF THAT.
3. I PLACE THE FAT BLENDED OVER THE AREAS AND NOT JUST HITTING A FEW SMALL AREAS OF THE FACE. THIS IS IMPORTANT.
THESE POINTS MAY BE SUBTLE BUT THEY ARE NOT. THIS IS WHAT SEPARATES A SAFE AND SUPERIOR SURGEON FROM AN AVERAGE ONE. SORRY FOR THE MILD ARROGANCE.
BEST,
SML

I enjoyed that answer thanks.
At the risk of being alarmist, just say, in my case, the fat took barely at all. How would you want to proceed? Would I still have to wait a year for a re-treatment or would there be a case for going back in sooner rather than later? I have heard that the stimulation of the tissues from a first treatment can prepare the body to better receive a second.

the preparation for the second round from a first round is probably a crap idea to me. oftentimes, if people go in for a touchup at 3 to 6 months after a procedure, they are looking square on at the "dip", the time when the result is not so obvious and people would be tempted to go back in. that can lead to an overfilled result at a year or 2. i always strongly recommend not going back in sooner than a year if at all possible to avoid overfilling. only about 20% of people go through this dip but i always have you put your seat belt on before going in too early. so to be honest about the "crap idea", i think what the person is seeing from the "wonderful second result" is that the first result is starting to take at about 6 to 12 months post. that is my honest opinion.
best,
sml

So the fat doesn't just die when you're in that dip, it's kind of waiting to 'firm up'?

I guess the question that's hovvering round my mind now is whether you've had other fat transfer patients who came to you because of damage from a laser/IPL/RF device and if so how they responded to surgery?

I appreciate your time here Dr Lam.

the last lady i can remember just did it 6 weeks ago so it is too early to tell. just like hair transplant, the grafts don't come alive until after 6 months. there can be a dormancy phase (not in everyone) between 6 weeks and 6 months.
best,
sml

So would it be fair to say that, so far, you have noticed no obvious difference in fat retention in this category of patients? (I am a pedant)

i don't have a large enough series of patients that i can recall that i could clearly say that. i just want to be fair. you may be a pedant but i am a scientist. are those the same thing though?
sml