Breaking down the Cheek into Aesthetic Subunits: Avoiding Chipmunk Cheeks

There is nothing uglier than big, chipmunk cheeks other than perhaps a devil looking arched brow or a duck-like lip.  How do you avoid this problem?  Should one not fill the cheeks at all then?  The answer is no since the cheek is one of the most important areas to fill to make an individual look much more youthful.  The answer is understanding that filling the cheek requires one to fill all the areas around the cheek as well so that it does not stand out like a weird, unnatural entity.

A few days ago a patient of mine who was starting to model for the first time in her 50s I think due to what I was able to do for her face with fillers said her new boyfriend warned her not to do any fillers because she would look unnatural like her friend.  However, little did he know she has had probably 25 syringes of fillers so far but he could not tell because I applied them not just to the cheek but to every little nook and cranny of the face to create a seamless, balanced, and natural result.

In order to create a balanced cheek result, one must understand all of the subcomponents of the cheek starting with the famed anterior cheek, where everyone tends to overfill it.  The lateral cheek to me is critical since it covers the cheekbone and allows the anterior cheek to blend seamlessly laterally.  Below the zygomatic arch near the ear the sunken concavity must be filled to create a better result. Further down below the cheek, I fill various parts of the buccal area (the area where you suck your cheeks inward) and subdivide this area to the central region, the region further back near the ear and the medial part near the mouth where it becomes hollower with more advanced aging.  My medical assistants are so adept at seeing these facial hollows that they are always helping me look for these transitions to create the best and most natural results.

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

Heidi Montag Plastic Surgery:  What Are My Thoughts

Obviously, when a famous celebrity gets plastic surgery, there is a thunderstorm of opinions that surround that event.  Mostly these opinions originate from the lay press, and at other times these opinions appear as sound bites from a media-hungry or media-savvy plastic surgeon.  My goal in this blog article is to express my thoughts on Heidi Montag’s plastic surgery and what may have motivated the procedures and what perhaps could be the long-term consequences of the surgery.

When an individual has a significant number of plastic-surgery procedures at a very tender age, the red flag that comes to my mind is a condition known as body dysmorphic disorder (BDD).  Obviously, I am not saying that is what Ms. Montag has since it would be gross speculation and unfair.  However, I would at least venture to state that it would be a sincere concern of mine.  BDD as a definition in short is a psychological condition in which someone has an obsession over a body part that is disproportionate to what in actuality it may appear to be and that may in turn socially cripple that person.  When an older person seeks a fat graft, a facelift, and related procedures to aging, I am not as concerned if that person fits the psychological profile of someone who is reasonable and not socially handicapped by his or her looks.  However, when someone in her early 20s has a significant number of procedures, then the question certainly must be raised or at least properly investigated.

Safety of having so many procedures all at one time regarding anesthesia risk should also be considered.  The occasion of individuals having experienced anesthetic risk has arisen when facial procedures were combined with extensive body surgery.  Body procedures, especially aggressive liposuction, alter body fluids and chemistries and poses risk when extended surgical times are required.  Again, surgeon judgment and patient selection are mandatory here when deciding the right, safe combination of procedures to be performed at any given time.

Finally, this is a big one for me:  how are all of these procedures going to age for Ms. Montag.  My opinion, not well.  Aggressive rhinoplasty with a revision procedure can lead to unfavorable nasal changes over time.  To me (I may be wrong) she appears not to have had a conservative approach to her nasal surgery, as indicated by some early nasal notching that I see. In addition, if you know me, you know that I have come to despise browlifts.  With the fullness in her brows now, they don’t look too bad (but in my opinion not very good either).  I think as her brows hollow out, she will look particularly bad by her late 30s.  Fat grafting is my specialty and I am very careful in selecting the right patient for this procedure.  I believe that her having had this procedure done at such an early age with future metabolic changes and bearing children could lead to the fat aging very poorly.  How?  The fat may enlarge if she gains significant weight with further aging, and the remaining part of the face that was not transplanted will probably look unusual as the areas that were transplanted start to separate from untransplanted areas.  In general (but not always) I prefer to operate on women for fat grafting who are at least mid-thirties in age.  For all of the above reasons, I remain circumspect about Ms. Montag’s motivations and the safety in the long run of her many procedures that she underwent.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. For more info about Dr Lam’s fat transfer procedures, or to schedule a consultation please call (972) 312-8188. If you would like to ask Dr Lam a question please visit our plastic surgery forum.

Madonna’s Cheek Implants

Madonna has had some amazing work done and also some very bad work done as well.  The one thing that gained my attention was her cheek augmentation she had a couple of years ago.

Madonna’s Cheek Implants

I believe she underwent cheek implants to make her look younger but the opposite effect occurred, she looked older and more unnatural.  As many of you know, I am not a fan of cheek implants.  I think their indication is very limited and almost non-existent for someone in their 30s in age or beyond.  The reason is that we all become older by losing mainly soft tissue (fat, muscle, and collagen), that exposes our cheekbones over time.  A cheek implant in most cases makes this even worse because the boniness of the cheek area then becomes even more exaggerated and the areas surrounding the cheeks look hollower.  Even though I am a big proponent of volumization for the face, I think cheek implants ultimately fail when working on the face.  The goal for the aging face is not simply volume (which a cheek implant should seemingly address) but instead to cover bone and to soften facial transitions, two things that a cheek implant worsens.

The other element to discuss when it concerns Madonna’s cheeks is balance.  When the face is only augmented in one area like the cheek area, it simply does not look good.  I had a woman in her 40s recently who had her cheeks augmented with fat grafting and then with fillers and then more fillers.  She told me she went to a reputable plastic surgeon in Dallas to do her work.  What I saw were cheeks that did not match her face.  What I did instead to fix her face was to augment everything around her cheeks, i.e., her eyelids and brow, her buccal area, and her chin.  She not only looked much more attractive and youthful, but she looked more natural and balanced.  When looking at the face for improvement, you must find an artistic physician who exercises good taste, discretion, and judgment.

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 visit our website www.LamFacialPlastics.com or call (972) 312-8188 to schedule a consultation.

Rethinking Facial Implants

When considering a cheek implant, consider truly what would benefit you most.  In many young individuals with weak bone structure, a cheek implant made of silicone or other material can be an ideal choice since it is reversible, easily inserted and can provide a better, more attractive structure to the face.  However, cheek implants today are becoming much more rare because they do not help in the process of rejuvenation but in many cases can hurt the situation.

When the aging process begins to manifest in one’s early to mid thirties, there is an ongoing flattening effect to the cheek area that may prompt someone to desire a cheek implant to replace the lost volume.  However, if one truly looks carefully you will see that the cheekbone becomes progressively more exposed.  Adding a cheek implant over this exposed bone will only worsen the degree of bone exposure and thereby age the face more.

This woman had undergone a brow lift, cosmetic eyelid surgery, and cheek implants — which had taken her identity completely away and not rejuvenated her at all. She underwent corrective surgery by having her cheek implants removed and facial fat transfer to blend the enlarged cheek structures back into the face.

Facial aging is a process of loss of both soft tissue and hard tissue.  However, there is a greater percentage of fat to bone loss with aging, especially aging that occurs in the 30s to 60s.  With better dental hygiene, there is a significantly less bone loss with aging than what occurred over a hundred years ago.  Therefore, the mantra “like replaces like” is a good one.  Instead of placing bony implants that worsen bone exposure and the transitions of the face, i.e., the shadows on the face, replacing the lost fat with fat can make the most sense.

Fat transfer is a process of removing fat from the belly and thighs and putting it back into areas of the face that have lost fat.  With proper technique, one can achieve a permanent, natural result that replaces the lost fat from aging.  In the past, the technique was plagued with problems of shortened longevity, lumpiness, or overfilled appearances.  In a skilled surgeon’s hands, the results can be artistically created so that the face appears balanced and natural appearing.  Facial fat transfer in the right candidate can be the most powerful way to restore lost facial volume from aging.  Patients must however have a relatively stable weight and be at least in the mid 30s or beyond to be eligible for this procedure.  When choosing your surgeon, find someone with considerable experience in this procedure that is both technically proficient but also matches your artistic sensibility, as both are equally important when addressing a face for facial aging.

Click to learn more about Dr Lam’s fat grafting procedures, including photos, videos, forums and FAQs or call (972) 312-8188 to schedule a consultation .