Pillow Faces Can Look Weird and Bad

Recently, I had a lady who at the age of 57 started modeling for the first time in her life thanks in large part to the syringes I have put into her face to make her look better.  Her new boyfriend remarked that she looked better than she had when he saw her 7 years ago and was so attracted that they were now going out together.  However, he admonished her never to get any fillers like the modeling agency owner because that person looked artificial.  Little did he know that she probably had 10 times more fillers than her modeling agency owner friend.  How can so many syringes look absolutely natural and not overfilled whereas a few syringes look dreadful?

The answer lies in the artistic distribution of the product.  Unfortunately, I see too often the two areas where product is placed are the central, anterior cheek and the lips.  These areas are very unforgiving and they look very unnatural especially in a face that is volume depleted elsewhere.  It is so important that temperance be executed when filling these two facial zones.  The trick of filling a face naturally and beautifully is to fill other areas of the face so that the face actually looks good.  Balance and restraint is the key.  However, to make a face that is over 50 years of age to truly look amazing requires enough syringes placed all over the face rather than too much in just one area.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call (972) 312-8188. To Learn more about Dr Lams’ plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forum.

I love stories because in a story I am able to convey a lot and make it memorable for a person.  I remember a couple of stories that involved the Transport Security Authority (TSA) at the airport.  I had one lady in whom I had done many fillers to make her face look a lot more youthful.  She had passed through the TSA and was stopped because her driver’s license, as the agent reported, looked like her grandmother.  She was not allowed through.

Another time, a patient of mine was passing through the TSA with her best high-school friend and the agent remarked, “Are you guys mother and daughter?”  They were of course born within a year or two of each other.  The point of these stories is that we all make very quick, snap judgments about another individual and we do so based on a summary of physical attributes.  My goal is to make a face look bright, balanced, youthful, more feminine for women and more masculine for men, and in a word more attractive.

We have talked before about Malcolm Gladwell’s book, Blink, in which we make summary judgments about one another in a blink of an eye.  My goal is to make one’s blink effect significantly better.  Why? Because honestly nothing else matters as much.  If the small parts of one’s face look a tad bit better but he or she still looks tired, sad, or unattractive then I have done little to help that person look better.  However, if one receives a lot of compliments from others then I have improved one’s “blink” in a measurable way.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call (972) 312-8188. To Learn more about Dr Lams’ plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forum.

Notched Nostrils Following a Nose Job (Rhinoplasty)

Another problem after a bad rhinoplasty that to me is a telltale sign of bad work is a notched or V-shaped nostril.  The curvature of the nostril rim should form a gentle upside U-shape.  When it has been operated on in the past, it can look like an inverted V shape, which to me is a very obvious sign that a rhinoplasty was performed.  To help correct this problem, you can put a graft to lower the nostril rim or I have had success with putting a permanent filler in there like Artefill or silicone to lower the rim to make it look less notched in appearance.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call (972) 312-8188. To Learn more about Dr Lams’ plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forum.

Correcting Fat Loss in IPL Damage: My Thoughts

Unfortunately, I have heard a lot on the Internet about facial fat loss following a laser treatment like intense pulsed light therapy, or IPL.  Fortunately, I have never seen a patient of mine with this outcome.  I think partly because this phenomenon is rare and partly because I use much lower-energy lasers than what are out there on the market so as to limit this risk.

There is great question of whether this phenomenon actually is real.  I personally believe that it is since there are enough people claiming that they have suffered this problem, and there are lasers on the market targeted to reduce excess fat.  The problem that I have on my forum relates to questions pertaining to the nature and evolution of this fat loss and how to manage it properly.  In general, I cannot answer these questions very well because I simply do not have enough experience to discuss the subject with authority.

If I am planning to perform a fat transfer the problem is I do not know when exactly the injury has stopped.  It could be a few months, a year or greater, as some individuals claim ongoing fat loss.  In my opinion (and this is only conjecture), if there is damage, it should be self-limited if there is injury to the blood supply to the fat and should not be ongoing.  My best guess is that I would wait at least a year before contemplating performing a fat transfer on that individual.  Also, of course, I would like that person to clarify that he or she thinks that in fact the fat loss has stopped before considering a fat transfer.

The biggest problem that I have encountered with individuals who have had an IPL injury to their fat is not physical but psychological.  Too often a patient becomes so obsessed with their fat loss that no treatment will ever make him or her satisfied.  They are living in the past and constantly evaluating in the mirror whether there is more fat loss or whether the surgery did enough to correct it.  This is a very dangerous thing because the individual can be psychologically unstable and cannot appreciate the improvement in the face.  In addition, some individuals experience further fat loss only due to stress from the initial incident causing them to age in appearance from stress rather than by physical insult.  Or after 1 to 2 years it is normal to lose a little more fat due to aging that could then be blamed on the IPL treatment.  For all of these reasons, treating patients who have reportedly lost fat after an IPL treatment can be difficult and problematic.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call (972) 312-8188. To Learn more about Dr Lams’ plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forum.

One of the biggest concerns that I have from prospective patients is that they not look weird, the fear stemming from seeing unnatural celebrities that are frightening to them in magazines and on television.  The question I get all the time is “If celebrity X has all the money in the world, how can she look so bad?”  Great question.  I think the answer is that the celebrity went to a physician who lacks artistic taste and therefore is incapable of seeing that his work is ugly.

In Nancy Etcoff’s book, Survival of the Prettiest, she talks about something called the “Uncanny Valley”.  On one side of the valley, we have normal-looking human beings that obviously do not garner any negative physical reaction from the average human viewer.  On the opposite side of the valley, we have things that do not look human at all like a robot, which also typically does not engender any negative sentiment.  In between, we have an “uncanny valley” in which we have quasi-looking humans that can create revulsion, fear, and dread in us.  That is why bad plastic surgery can elicit so many bad stares even though one may not be able to pinpoint exactly what is so “uncanny” about the person.  It is important as always when I see an individual that even when that person comes in for something else that I help him or her determine what would be the best procedure because sometimes one may not know one is already in the uncanny valley and certainly one should not be requesting a procedure that will land one in that dreadful valley.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call (972) 312-8188. To Learn more about Dr Lams’ plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forum.