Plastic Surgery & Cosmetic Surgery in Dallas

Frequently asked questions (FAQs) are intended to answer a lot of the most commonly asked questions that you may have about a specific procedure. By dividing the sections into procedural categories, you may be able to find the answer to the question you are seeking more easily. Please remember that what you read in this section is only intended to provide you with a general answer to a question and should not be considered in any way a substitute for a personal consultation with Dr. Lam.

What kind of implants does Dr. Lam use?

There are many types of implants that are available for cheek augmentation. The two major types of implants that have been used in the market are Gore-Tex and silicone. Recently, it was announced that Gore-Tex would no longer be supporting the implant market. Accordingly, Dr. Lam exclusively uses a specialized type of silicone implant called a "Conform" style that is very soft and pliable and molds gently to the facial bone so that it is virtually undetectable to touch and to sight.

Cheek augmentation can enhance overall facial balance and harmony. In younger patients, cheek augmentation can help create a more beautiful shape to the face and also make the nose appear more alluring in certain circumstances by establishing improved facial harmony. During the consultation process, Dr. Lam will discuss with you options for cheek enhancement with the use of plastic sizers to help determine what degree of cheek enhancement you are seeking. Dr. Lam believes that digital imaging analysis is more difficult as a tool to provide useful information compared with chin augmentation. However, he does use digital analysis in select cases when indicated. Usually, the side profile view can be used to show the desired changes. In a few cases, injection of sterile water into the cheek can also be an informative method to permit you to "try on" your implants for a few hours and to ensure that the size of the implant is properly communicated.

Dr. Lam typically performs cheek augmentation with implants in two circumstances: younger individuals and in older individuals without enough fat for fat grafting. In the younger individual who simply lacks good bone structure to the cheek, Dr. Lam believes that cheek enhancement with cheek implants is an ideal way to achieve an improved facial contour. However, with aging or extreme facial thinness, there is a loss of volume throughout the entire face including around the eyes, the cheeks, below the cheeks, and the chin. This facial volume loss that occurs with aging can even occur at the same time as weight gain that is also part of the aging process. However, weight gain usually manifests in the lower cheek and lower jawline and neck areas. Accordingly, Dr. Lam believes that fat grafting is the most important way to achieve global facial balance in the aging face. In fact, a cheek implant in an older individual without fat grafting poses three problems. First, it simply does not provide the level of rejuvenation that fat grafting (see Facial Rejuvenation FAQs) can afford for the aging individual. Also, remember that aging can even begin as early as the mid to late 30's. The second problem with an isolated cheek implant is that the hollowing around the eyes that occurs can actually be worsened with a cheek implant. Finally, in a very thin person, the cheek implant can actually be visible through the skin. Accordingly, in the very gaunt, or athletic person who lacks sufficient fat for grafting, Dr. Lam prefers to use the implant as a foundation and then to tailor fat grafting over and around the implant. In the very thin person, a cheek implant and/or fat grafting may not be possible and dermal fillers (like Perlane, Radiesse, Juvéderm Ultra Plus, etc.) may be options for you instead (see the answer below and the Dermal Fillers FAQ section).

Dr. Lam uses exclusively an intraoral method for cheek augmentation, i.e., all incisions are undertaken from inside the mouth. This technique minimizes the recovery process and also eliminates any external skin incisions. The process is undertaken usually under general anesthesia for patient comfort in Dr. Lam's own surgery center. However, based on patient and anesthetist dialogue and preferences, a lighter level of anesthesia (conscious sedation or twilight anesthesia) may be undertaken. The procedure itself is relatively short, taking usually less than one hour to complete. Dr. Lam uses a small bolster dressing in which the implant is secured through the skin to minimize the chance that the implant will rotate or shift during the healing process. The bolster is removed 3 to 5 days following the procedure. Typically, no other external dressing is required.

No. Dr. Lam does not perform bony reduction surgery of the cheek that is popular particularly in South Korea. Most people who reside in the Western hemisphere do not like the look of a flattened cheekbone so Dr. Lam has decided not to include this procedure in his clinical practice. Dr. Lam also does not believe in removing buccal fat, as this procedure can accelerate the aging process and can create an unflattering appearance over time.

Yes, there are two principal alternative methods for cheek augmentation that were introduced in a previous question. For the aging cheek, as explained, Dr. Lam much prefers facial fat contouring to achieve the most natural, permanent, and balanced look (see Facial Rejuvenation FAQs for more information.)

For those individuals who would like to try on how a cheek implant would look like or who simply are adverse to have surgery performed, office-based cheek enhancement with an injectable filler (see Dermal Fillers FAQs) can be undertaken both in the younger and more mature individual. The recovery time for such augmentation is very short with typically very little to no bruising and swelling. This method is also ideal for someone who has very little downtime or must look good in a relatively short time, e.g., for an upcoming wedding or social/professional event.

Dr. Lam has trained extensively in the midface lift, and his first textbook, Comprehensive Facial Rejuvenation, explained his method for midface lifting. However, given a new aesthetic philosophy today, Dr. Lam has completely abandoned the midface lift for two reasons. He does not like the look that a midface lift imparts, and he believes volume contouring with fat transfer provides a better improvement in overall balanced and natural facial rejuvenation.

The recovery process for cheek enhancement is relatively short. As mentioned, Dr. Lam typically uses what is known as a bolster dressing, which is a small cotton pad that attaches through the skin to hold the implant in place for about 3 to 5 days. This small dressing is removed in the office. During that time, it is obvious that you will not be ready for social interaction with your friends and peers. Thereafter, there is still some degree of cheek swelling but the deforming look of that swelling generally subsides after the first week. Although a mild degree of swelling may persist for several weeks, any noticeable swelling usually has mostly dissipated by the end of the first week or toward the middle of the second week. Also, Dr. Lam can virtually eliminate or significantly reduce your bruising with his laser after your first week. Sutures that are used to close inside the mouth are entirely dissolvable and therefore do not require removal.

Besides nasal implants (see Rhinoplasty and Asian Rhinoplasty FAQs for more information), Dr. Lam does not use any other solid implants in the face other than for cheek and chin augmentation. Dr. Lam believes that solid implants are best used to recontour bony shapes of the face that do not move, e.g., nose, cheeks, and chin. He prefers fat grafting and soft-tissue fillers for other soft-tissue deformities or other areas for volume contouring. Using solid implants, e.g., in the lips or other mobile areas, are problematic in that you can oftentimes feel the implant and also the implant is more prone to shift, migrate, or become infected.