Trusting My Expertise in Facial Plastic Surgery

I was giving a lecture a few years ago in Hilton Head when the surgeon before me who is about 30 years older than I am said, “Give a patient what they want not what they need.” I went on stage right after him and said, “I give a patient what they need not what they want.” What the other surgeon meant by this is that if you do something that you want to do and the patient does not like it, she may be angry at you for doing something you wanted and she didn’t. However, I believe that my expertise in this field allows me to create beautiful changes in your face in ways that you simply could not even imagine.

Dr. Sam Lam, Dallas Plastic Surgeon

I use the example of a shoe salesperson. If you want a type of shoe, and the salesperson says that it will hurt your feet, you should probably trust him because that is all he does all day. He lives, breathes, eats, and sleeps shoes. I do the same with faces. An example is a lady that I just saw two days ago who had recently moved from Los Angeles. She had googled cheek augmentation and found me and came to my office wanting more cheeks. All I could see were these very unnatural full cheeks and sunken eyes and chin. I rebuilt her entire face except the cheeks with fillers and now her face is completely balanced and natural. She looks amazing. If I had listened to her, I would have made her look even more unnatural and not rejuvenated but I chose to help her see what I saw, which she could only appreciate when I was done with it. Am I taking a risk? Sure, but it is worth it because I truly know what will help your face oftentimes more than even you do because all I do is live, breath, eat, and sleep the face.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s cheek augmentation or facial rejuvenation procedures please call (972) 312-8188 to schedule a consultation. If you would like to ask Dr Lam a question about facial plastic surgery please visit our Plastic Surgery Forum.

Avoiding Bad Eyelid Surgery: Preserve the Canthus At All Costs

I oftentimes hear a patient come to me to say, “I don’t want to look like celebrity…” who has had too much surgery done or a friend that has been subject to similar bad work.  If the surgery has to do with the eyes, there is almost always some component of distortion of the outer eye canthus (where the upper and lower eyelids meet) that causes the observed problem.  I truly believe that canthal distortion accounts for the majority of unnatural identity changes that occur following eyelid cosmetic surgery.

This blog article will discuss what causes canthal distortion and how to prevent it.  The cause of canthal distortion is simply put lower eyelid surgery that tucks or manipulates the outer canthus.  This onerous result arises from cutting the lower-eyelid skin, which causes a loss of tone and strength to the lower eyelid that must be reconstituted.  Subsequently, the canthus must be suspended to the lining of the bone so that the lower eyelid then does not sag.  Unfortunately, swelling during the surgery and variable scarring after the procedure can cause the canthus to drift either too far in, too far out, too far up, or too far down; any direction of which can cause an unnatural distortion and result.  Just take a finger to the outer canthus (again where the upper and lower eyelids meet on the side closer to the ear not the nose) and pull up, down, in, or out and look at the way that it completely changes the way that you appear.

Corrective fat transfer to correct bad previous eyelid surgery that distorted the can thus and bad cheek implants (removed) that distorted the cheek areas.

How do I avoid this complication?  Simply put, I never cut on the lower eyelid skin except in major trauma cases, which fortunately I do not do anymore.  I prefer to use fat grafting to manage the aging lower eyelid with or without non-incision based eyebag fat removal, Botox, and/or skin laser treatments.  However, despite all of these treatments methods I entirely avoid cutting the lower eyelid skin and thereby almost entirely eliminate risk of cutting on the outer canthus and the related problems that can ensue.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s eyelid cosmetic surgery, and fat grafting procedures please call (972) 312-8188 to schedule a consultation. If you would like to ask Dr Lam a question about facial plastic surgery please visit our Plastic Surgery Forum.

Eyebags, Shorelines, and Rocks

When we talk about eyebags, we are focused on the obvious, which is that there is a protuberant bag of tissue. However, is this really the case in the majority of situations? My answer is no. What I oftentimes see is that the lower orbital bony rim becomes exposed over time so that what we have instead is a hollowness and exposure of bone immediately below the perceived fat bag. Sometimes, yes, there is an obvious fat bag protuberance but I think this is more oftentimes not the case. An analogy to understand this better that I have heard from an esteemed colleague of mine is that when we are young the shoreline is high (i.e., we are replete with fat in our face) but as we get older the shoreline recedes exposing the rocks on the shore (i.e., the so-called eyebags).  Instead of removing the rocks, it might be better to increase the shoreline.  What is meant by this is that instead of removing the fat bags, I prefer to fill the hollowness around it so that the eyebag literally disappears from view. In about 1 in 20 cases I combine a traditional fatty eyebag removal (without an incision by the way) with fat grafting placed into the bony orbital rim.  In general, I rarely if ever only remove the fat bag, as I believe that it is insufficient to get the best results and sometimes can make someone actually look older by making them hollower.

No eyebags were removed, just fat added to the bony orbital rim.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s fat grafting procedures please call (972) 312-8188 to schedule a consultation. If you would like to ask Dr Lam a question about facial plastic surgery please visit our Cosmetics Surgery Forum.

The Plastic Surgery Trifecta:  Education, Experience, and Results

Many times my patients say that all they care about are the results.  However, although I agree that results are king, everything else matters too.  First, education is the cornerstone to every consultation and even every postoperative visit that I make with a patient.  If I do not help educate you on why are you doing what you are doing, you may choose the wrong procedure or at least not know what procedures could help you.  If you just want your smile lines done, and I do them well for you with great results but that was really not the problem but your hollow eyes were then did I really help you?  Education truly is the first step in building trust, creating an effective strategy, and thereby to get results.

Plastic Surgery - Education, Experience and Results

I really believe that experience is the second most important item on the agenda.  If you have a really unpleasant experience with me, i.e., rude staff and painful injections, then you will be hesitant to return.  That is why for me the experience is critical.  I would like you really to enjoy coming back to my office for the warm hospitality but also for the favorable experience you have in my office or surgery center.  This is especially true for procedures that must be repeated like Botox injections or fillers.  If I make your experience completely or nearly completely painless, you will be more inclined to return.  Better education, experience, and results are truly the trifecta in excellent plastic surgery.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s plastic surgery procedures please call (972) 312-8188 to schedule a consultation. If you would like to ask Dr Lam a question about facial plastic surgery please visit our Plastic Surgery Forum.

Priscilla Presley and Bad Silicone

Unfortunately, celebrities seem to be victims of shysters and crooks.  As far as what I have heard, Priscilla Presley had silicone injected into her face by an unlicensed individual leaving her permanently scarred.  As you can see in this photo, her cheeks were made way too large, whereas her upper and lower face was left relatively untouched (except for the bad lip work of course).  The problem with this is that she already looks unnatural and will continue to look even more unnatural as she ages.  The reason she looks unnatural now is that the cheeks are too full for her age and they stand out because they are not blended in with the rest of the face.  As she ages, this situation gets even worse because the rest of the face continues to lose fat and soft tissue whereas the cheeks will remain the same size making her face even more disproportionate.  The best solution for her would be to have fat transferred into the brow and upper face and into the buccal zone and lower face so that the face can look more balanced since silicone really is impossible to remove.  I recently saw a lady from New York who suffered the same problem with fat grafting, too much of which was placed into the cheek area and nowhere else, in order to correct acne scars of all things.  Ouch!  I used Restylane to sculpt her brows, temples, buccal area, and chin to make the cheeks look less chipmunk like and to make her face more balanced.

Priscilla Presley and Bad Silicone

Silicone has had a bad rap in the media because most people think that it is unsafe.  In the quantities used for Priscilla Presley I would definitely agree.  By performing only small amounts in discreet areas of the face like the lips slowly with repeated small injections, the silicone should not lump up or age poorly as you see in this case.  I use silicone all the time for lip enhancement procedures but in select patients with proper technique and in very small, subtle amounts.  This case clearly is one of poor judgment and frankly was illegal, as the provider was unlicensed to perform the procedure.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon. To learn more about Dr Lam’s facial rejuvenation procedures in Dallas, Texas please call (972) 312-8188 to schedule a consultation. If you would like to ask Dr Lam a question about face rejuvenation please visit our face rejuvenation forum.