by dr. lam » Sun Feb 08, 2009 7:10 am
okay, here are my comments:
1. the cannula used in that video is a weapon of mass destruction compared with mine. the cannula i use is 1/3rd the length and much thinner and made of a coated inner and outer material that is much smoother than the one you see. i used to use one that was the size of my current one that looked like the cannula featured in the video but even that same cannula in my size is a very rough instrument. it caused a lot of bruising and tissue trauma.
2. as you know, my feeling of filling a nasolabial groove is that it is pointless for 3 reasons. first, the individual will not look any better. second, there is high resorption of the result. third, fat is too soft to knock out a fold in most cases. is it impossible to get a good fold result with fat. no. it is just not reliable a method to manage that area.
3. do i fill nasolabial grooves? yes, in almost every single full face fat transfer, i will put fat in there for 2 reasons. first, fat is free and i will typically have enough to put some in there. well, wait, i thought it does not work? well, my goal is not to fill the fold but to create a more balanced transition from the augmented cheek to the unaugmented upper lip area. i look at fat transfer as a way to create balance to the face and softening the transition to the upper lip is the reason to work on the groove.
4. my technique for filling a smile line when doing it in conjunction with a full face fat transfer is to go perpendicular to it not parallel. perpendicular treatment has 2 distinct advantages in my opinion. first, it breaks up the ligamentous hold so that the result should be better just as i do for under the eyes and the cheek. second, it makes sure that i do not accidentally place it just outside of the fold that can cause the fold to actually deepen. in experienced hands, the parallel technique should be fine.
best,
sml
Samuel M. Lam, M.D., F.A.C.S.
Diplomate, American Board of Facial Plastic & Reconstructive Surgery
Diplomate, American Board of Otolaryngology Head & Neck Surgery
Diplomate, American Board of Hair Restoration Surgery
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