LAM FACIAL PLASTICS

Hi Dr. Lam I have been in contact with Marcy with regards to a phone consult hopefully she'll get back to me early this week.

I am a male turning 30 in a couple months and I'm in excellent physical condition. My primary area of concern is the eye area, secondary would be the upper cheek/cheek area and tertiary would be the jaw line. I am hollow around my eyes and have very thin skin in that area and because of this one can see the bluish veins/muscle underneath the skin above and below my eyes. I have had restylane in the tear trough which did improve the contour(and I liked very much) but the tyndall effect made it even more dark BLUE...it looked like I had black eyes!!! It is my understanding that you put the fat underneath the muscle to countour it without it looking lumpy, but this would not correct the blue around my eyes, am I right? Is there anything you can do in this case?

I have a pretty flat face and in two other consults I have had one surgeon recommended infra orbital rim, cheek and paranasal implants and the other suggested fat grafting (though the one who recommended fat grafting said he would not touch anywhere around the eyes because the skin was so thin it would be visible). What is your take on countouring around and framing the eye which has thin skin?

With regards to my other areas (cheeks/jaw), I have seen most of your patients are women and there is no question you have an eye for making a female face more attractive......what is your aesthetic when it comes to the male face? Mine includes high cheekbones, strong jawline and rested looking eyes. I sent Marcy my pics but I don't think you had time to see them yet but I would like you to see them because I am interested in knowing what you would do to make my face more balanced and attractive.

Can I PM you pics?

Thanks for your time and consideration

Hi,
Basically, I am very comfortable working with thin skin with almost any product, more specifically Restylane and fat grafting. However, the blue color there from the Tyndall effect should not happen with me even in thin skin. However, the blue color from veins, etc. is really hard if not impossible to treat. The only concern I have with fat grafting someone 30 years of age is the changes that might occur if you pack on the pounds in the coming years. If you are particularly lean recently, I would be more careful using fat transfer. I don't believe in implants because they start to show up with aging if not sooner in individuals with very very thin skin already since there is no "padding" between the implant and the skin. I agree with your assessment with men. I am not into fuller faces with men but more gaunt. I still think that fat grafting allows me to blend in all the areas better. I just try to keep the anterior cheek a bit more suppressed but without support there the eyes look too tired looking. Yes, you can send me photos as a PM.
Best,
SML

I have posted your PM questions here to respond to for the edification of the general public:
1) No question the eyes need work to look more rested and attractive. A fill of the tear trough undereye and a nice smooth transition of fat fill of the side and upper cheek I think would get rid of the hollowness shadow created by the tear trough and improve the contour and aesthetic appeal creating more pronounced high cheekbone look (though I'm pretty sure the blueness will remain even though a better contour would be present which I would be okay with if you could all but guaruntee smoothness under the thin skin of the eye).
IT IS HARD FOR ME TO APPRECIATE THE DEGREE OF BLUENESS YOU ARE SEEING. I REALLY WOULD LIKE TO BE CAREFUL MAKING ANY PROMISES IN THAT DEPARTMENT. IF THAT IS YOUR BIG THING, DON'T GET FAT TRANSFER. POSSIBLY DO RESTYLANE WITH MY DOING IT FOR YOU SO YOU DON'T RUN INTO THE TYNDALL AGAIN.
2)Another question I have is regarding the upper and inner part of the periorbital area. When you talk about "framing" the eye....I wonder if I would benefit from a fat fill of the upper and inner part of the eye in order to create a fuller upper lid and creating the illusion of a lower heavier brow. I never really realized it, but might my upper eye be hollow as well?
YES, YOU ARE PRETTY HOLLOW THROUGHOUT. I WOULD CONSIDER A BIT OF FAT INTO THE BROW TO CREATE MORE BALANCE.
3)Now my nose is pretty prominent and I am considering a nose job but I wonder if by accentuating the cheeks and the paranasal area with fat it will create the illusion of a less prominent nose. I mean I could probably use some tip work and remove the slight hook but the eye and cheek area are my biggest concern and I am concerned that because I am so "blue" around the eyes already that the bruising from a nose job would last many months. I have heard some pretty bad stories of dark circles lasting a year on some people and I would be ripe for the pickin' if anyone is seeing that my skin is pretty much translucent in that area. Though out of curiosity and you nose expertise.......do you think you could fix my nose and how much would you charge in conjunction to a f/g procedure?
I NEED TO SEE A PERSON IN REAL LIFE TO MAKE THAT DETERMINATION. THAT IS IF YOU ARE MAINLY THICK SKIN AND WEAK CARTILAGES, YOUR NOSE RESULT WILL NOT BE THAT GREAT. IF YOU ARE THICK CARTILAGE AND THINNER SKIN THEN YOUR RESULT WILL BE MUCH BETTER. I CAN USUALLY ONLY TELL THAT WHEN I TOUCH YOUR NOSE. I RARELY GET BRUISING AFTER A RHINOPLASTY BUT I DON'T WANT YOU TO BE MY EXCEPTION TO THE RULE. IF YOU SEE MY VIDEO JOURNEYS SECTION, YOU CAN SEE QUITE A FEW "TYPICAL" RESULTS A WEEK OUT FROM RHINOPLASTY INCLUDING HUMP REDUCTIONS IN ALMOST EVERY CASE. AS FAR AS THAT IS CONCERNED, I HAVE TWO CONCERNS TAKING A HUMP DOWN ON YOU. ONE, MEN OFTENTIMES LOOK GOOD WITH A LITTLE HUMP. SECOND, YOUR TIP IS SO MUCH LARGER THAN YOUR BRIDGE, THAT IF I LOWER YOUR HUMP, I MAY NOT GET THE TIP THAT YOU ARE LOOKING FOR. THAT IS A QUESTION OF HARMONY. I DON'T KNOW IF THE ILLUSION OF THE NOSE WILL LOOK THAT MUCH SMALLER IN COMBO WITH FAT. I WANT TO BE CAREFUL WHAT I SAY HERE. FINALLY, THE COST IS APPROXIMATELY 8K FOR THE NOSE INCLUDING RELATED CHARGES. THERE IS A 5% BREAK ON SURGICAL FEES WHEN COMBINED WITH ANOTHER PROCEDURE.
4)My jaw I never really thought of as a strong jaw, or a weak jaw....but stronger is definitely better. Do you think that fat grafting would help or hinder that area? Do you think sharper jaw implants would help or nothing at all?
I THINK IT COULD HELP IN GENERAL. I TEND TO BLEND THE JAWLINE IN MOST CASES. HOWEVER, IN YOUR CASE, YOUR UPPER FACE LOOKS DISPROPORTIONATELY HOLLOW SO I WANT AGAIN TO BE CAREFUL NOT TO OFF-BALANCE YOUR FACE. I MAY NOT PUT ANYTHING IN YOUR LOWER FACE. THAT AGAIN DEPENDS ON WHAT I SEE IN PERSON.
best,
sml

Thank you very much for your reply....you must REALLY love your work to be answering questions on a weekend.....and a long weekend no less!

With regards to the blueness/darkness around the eye you said you can't appreciate what I'm seeing. You must see that I look unrested and could use some volume under the eye to get rid of the hollow and some volume in the the upper cheek area to give my face more fullness and contour? I can't be nuts can I...????....wait....don't answer that....hehe.

My impression is that unless you see me in real life you will not get a true idea of what you can do for me...which is fair.....there is nothing that can substitute for an "in person" consult. I just think that a phone consult would be redundant as I have pretty much expressed my concerns and I kinda of get the idea that in my case you would need to see me to really get an idea of what steps are best to take.

Being from out of country, I wonder if we can just skip the phone consult and book an appointment for "some" procedure because whether we decide on fat transfer, a rhino, both or merely Resty....I would like to have you work some sort of wizardry on me...lol.

Thanks a bunch again for taking a look at my pics.

I do love my job. Actually, I have been working all weekend (including now) on a book that I am writing (fat grafting etc.) that is due to the publisher tomorrow.

We cannot just book a procedure if it is fat grafting because we need to coordinate anesthesia, surgical time, ancillary staff, etc. and make sure that you have had a history and physical examination to be safe to do the procedure (even though you are young). Restylane on the other hand can be done the same time that I see you with the caveat that you don't have any lumps and bumps left over by the other doc. If so, I would have to dissolve the product, then go back a day later and put my stuff in. Ideally a couple of days.

Since we are taking care of this without a phone consult, I just want to clarify a projected pathway:
1. if you are looking for something more durable and over a wider expanse of upper facial hollow, then fat transfer is better.
2. if you are really focused on the "blue" quality and you just want that fixed and to sort of "try out" fat grafting, then it would be less expensive to work with Restylane. However, you do have to factor in the long haul coming this way for a temporary filler.

Those are my thoughts.
best,
sml

Yeah I've went the long haul for a consult and temp filler before (to LA, from Canada) and well it left me "blue" on so many levels....haha. I'm ready for a major permanent improvement.

I'm going to send you pics showing you my ideas on what I'd like filled in either with filler or fat so perhaps you can give me further analysis and that we can be on the same page.

Thanks again and good luck with your book!

Here are my responses:
1. as far as the photos, yes, you get it. that makes sense to me. however, i would also add a bit throughout the brow complex not just inner eye.
2. if the tear trough is that important, i just want to respect that with whatever filler i use including fat i just can't promise no line there at all. i just want to be careful with what i promise you.
3. as far as the # of cc's for fillers, i am guessing 3 to 4 cc, meaning about 2000 but i can use less if you want a preview and not the whole hog.
4. all my noses are open. they give me a much better capacity to read the nose with direct vision. the reason my noses look so good is that the instrument i use to realign the bones is microscopically small. only 3 mm without a big clunky guard. most docs simply don't know how to do nice bone reshaping without training wheels, i.e., massive instruments. i rarely see bruising and when i do it is typically very minor. again, no promises.
I FINISHED MY BOOK!
good night,
sml

I understand that there more than likely WILL still be a semblance of a tear trough there just a marked improvement. I am not looking for perfection, merely an obvious improvement

The above the eye (upper lid) opinion of mine was merely an estimate and a more minor concern and I trust that you can and will make the right decision for that area.

I am comfortable that we are on the same page with regards to f/g.

With regards to my nose, I still would like to know if you can help the projection issue (sticking off my face too far).

In a previous post you were concerned about the taking my bridge down then not being able to give me the tip I would want. I assume that what you can do with the tip is directly related to the cartilage and skin attributes.

What I'm thinking is to go ahead and book a surgery/procedure date for fat grafting and make a gametime decision on the rhino after you evaluate me in person. Unless of course you need different staff for different procedures.

What would be the best way to relay this info to constance/marcy in order to bypass the phone consult and shoot straight for a fat grafting date. I'd love to get in late nov early Dec.

Congrats finishing the book!

I continued recording a song a wrote today....it's coming along nicely!!!
cheers Dr. Lam

please send me a PM with the profile of your nose. for time estimates, it would be much better to have a look at your nose to see it from frontal and side views. i have seen the frontal view. also, i need a shot of your abdomen and possibly thighs. you sound like a gaunt guy. i need these two first before proceeding. i will inform constanze about matters.
best,
sml

ok, no promises, but it looks doable. what it looks like to me is that you don't have a classic hump, but you do need your bridge brought down. basically you have a bit of a ptotic tip (droopy tip) or your hump has pushed through your tip making your tip look big. the profile view REALLY helps. i now understand why you think you need your bridge reduced, because you DO. you just need it reduced way down low above the tip but all the way up, principally low. that will make your tip look smaller. i just did a middle eastern woman who had a very similar "hump" about a month ago. i would book the nose if you want because the profile view makes things much more doable to me. if i can't do it when i see you, i'll eat the booked time and refund you that portion, but i feel i can do it. email constanze at constanze@lamfacialplastics.com to proceed. look forward to take care of you.
best,
sml

ok, i hope i can get enough. i will have to see when you get here. at least we can do the nose +/-restylane. i really need to take a good look but i usually can get fat from a stone so you should be okay.
best,
sml

Sounds good. Regardless, I WILL be coming to see you. If we can fix the face....good. If we can fix the nose....good. If we can fix both...well.......fantastic! I have already emailed Constanze and if you could give her a heads up I would be most appreciative. I told her she could reference this thread if she needed confirmation of our "consultation" in turn bypassing the phone consult.

I really appreciate your time and consideration during off work hours.

I hope to have some good news regarding a surgery date booked soon.

Thanks for all your help!

spiderone

my pleasure. just got into montreal for the hair transplant meeting but i have wifi so i get to still answer some questions and write my blogs. i already gave constanze a head's up before i left. look forward to meet you.
best,
sml