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Dermal Filler FAQs

I don’t like the fine lines on my face. What can I do?

There are many options to treat facial lines. There are also many types of facial lines: lines that only appear when you smile or frown, fine or deep lines that appear all the time that have come about from repeated animation like smiling or frowning, and folds around the mouth that arise from gravity and loss of facial fat and bone like the smile lines (nasolabial folds) and puppet lines (marionette lines). Depending on the depth and location of the line as well as when the line appears, the treatment options are different. Although this brief FAQs section can offer some general guidelines, only a personal consultation with Dr. Lam can offer you a tailored answer to what solution would best fit your budget, aesthetic desires, anatomy, desired surgical versus non-surgical intervention, temporary versus permanent correction. Generally speaking, fine lines that appear around the eyes and forehead are difficult to fill with an injectable filler. BOTOX (see BOTOX FAQs) is the best preventative and therapeutic treatment for these types of lines. Like a shirt that gets constantly wrinkled with wearing, the skin will continue to develop wrinkles that become worse and worse without something to prevent them from becoming deeper like BOTOX . With very early lines around the eyes and forehead, ongoing BOTOX can actually make these lines completely disappear with repeated usage over time. For deeper wrinkles, BOTOX will only prevent them from getting worse (as well as make you look better when you smile and frown) but will most likely not completely manage the deeper wrinkles. Instead, for lines around the eyes and forehead (as well as the rest of the face), a therapeutic skin treatment like plasma skin resurfacing or PIXEL microfractionated therapy (see Skin Rejuvenation FAQs) will correct or improve these deeper wrinkles more definitively. Nevertheless, to prevent or limit these wrinkles from coming back over time, BOTOX is an integral component to an overall strategy of maintenance.Fine and deeper lines around the mouth are managed differently. Oftentimes, certain habits can predispose toward the occurrence and worsening of these lines like pursing one’s lips, smoking, and using a straw. Although BOTOX can be successfully used for these kinds of lines, there are two major drawbacks. First, BOTOX lasts only a shorter amount of time around the mouth than around the eyes and forehead. Secondly, BOTOX therapy can only be used on some of the wrinkles, as over treatment of BOTOX in this area can lead to a speech impediment. BOTOX however is very safe around the mouth if done properly. It can be used to treat fine lines around the mouth that appear during animation and soften lines that appear as creases over time. BOTOX can also lift the corner of the mouth slightly and reduce the appearance of the nasolabial fold and a gummy appearing smile. However, BOTOX can reduce your ability to drink soup and to purse your lips around a straw or cigarette after each treatment. That limitation must be kept in mind.For very fine lines around the mouth, filling these lines with a filler like Restylane is problematic, as the area may be converted into a bump. However, for slightly deeper creases around the mouth, Restylane and Juvéderm Ultra provide wonderful temporary solutions for these kinds of lines. Resylane Lyft, and Juvéderm Ultra Plus are too thick and are not helpful with these kinds of fine lines. For definitive treatment of these lines, a skin resurfacing option like plasma skin resurfacing or PIXEL microfractionated therapy may be ideal (see Skin Rejuvenation FAQs).For deeper folds around the mouth, fillers like Restylane, Resylane Lyft, and Juvéderm Ultra and Juvéderm Ultra Plus can be beneficial depending on your budget, anatomy, and desires. If the fold has a deep visible crease or overhang of the cheek, most oftentimes, fillers simply won’t work.

Will a facelift or a fat graft take care of the lines around my mouth?

Unfortunately, no. Dr. Lam has seen many patients from other surgeons who have come to him dissatisfied and disillusioned with fat grafting or a facelift because they were promised that either method would correct folds around the mouth. Dr. Lam believes that there is no long-term correction of the folds around the mouth with fat grafting or a facelift. These lines must be addressed through office-based (non-surgical) methods as outlined in the response to the previous question.

Does Dr. Lam use fat grafting to plump up lips?

No. Although Dr. Lam performs numerous fat grafts, he believes that fat grafting is not an ideal method to enhance one’s lips for three reasons. First, fat in the lips most often simply will not last. Dr. Lam can achieve a natural, permanent, soft, and non-surgical enhancement of one’s lips. Second, the swelling/deformity with fat grafting in the lips is both protracted and can be quite alarming. For the results that you eventually obtain with fat grafting in the lips, Dr. Lam does not believe that it is worth it. Third, the ability to sculpt natural looking lips with fat grafting is harder than with Restylane in Dr. Lam’s opinion so he will not use fat in the lips.

Do Dr. Lam’s injectables hurt?

No. No. No. If you have been to other surgeon, dermatologist, or physician’s offices and had significant discomfort with, for example, lip enhancement, you will not have that experience with Dr. Lam. His injectables simply do not hurt. You will not feel any needles or burning of the anesthetic. You must experience a session with Dr. Lam if you have had an unpleasant experience elsewhere.

What is my recovery time after an injectable filler?

The recovery time for a filler depends on how much filler and what type of filler you prefer to use. All hyaluronic acid products like Restylane and Juvéderm are what are known as hydrophilic, i.e., they love water and soak up water. For this reason, you will be swollen for 2 to 3 days. However, Dr. Lam uses a special pre-treatment medication at no extra cost that cuts that time in half. With a gentle touch, Dr. Lam is a skilled injector and can offer you a far reduced amount of swelling and bruising than you may have ever experienced. In addition, his special use of blunt cannulas can also truly minimize and/or reduce the incidence of bruising. If you do bruise, Dr. Lam also can apply his laser to virtually eliminate your bruise within 24 to 48 hours at no additional charge. He prefers to wait for 5 to 7 days later when the bruise (if it should occur) becomes more mature and can receive optimal reduction/elimination.

I would like to fill the emptiness under my eyes and cheeks with a filler. Is that safe?

The way that Dr. Lam fills the lower eyelids is with a specialized disposable cannula (a blunt instrument). He has had numerous patients who have learned about his unique method of lower eyelid filling and have flown to Dallas for his care. Dr. Lam does not use any sharp needles around the eyes due to the risks of using needles around the eyes. He also places the Restylane or Juvéderm around the eyes in a deeper plane so that he has almost never seen any bruising and never seen any lumpiness with this technique. Although Dr. Lam does fill many lines around the mouth, a personalized consultation with Dr. Lam will help you understand the areas of most importance. Oftentimes, patients that Dr. Lam sees have been having their smile lines filled for years without much discernible difference, whereas Dr. Lam can offer a profound rejuvenation by understanding where and how to distribute the filler for optimal rejuvenation.

I am interested in having my lips enhanced with an office-based injectable filler. What are my options?

Please read the Lip Enhancement FAQs section for more information. Also review the chart below for the benefits and limitations of each type of filler for lip enhancement.

Does Dr. Lam perform any permanent injectable fillers?

Yes, as mentioned, he prefers fat grafting for overall facial rejuvenative purposes and uses principally for lip augmentation and to manage acne scars. He prefers Bellafill (polymethylmethacrylate or PMMA suspended in bovine collagen) to fill the nasolabial grooves (smile lines) since with typically 2 to 3 sessions the results are permanent. Dr. Lam believes that fat grafting is unreliable to improve the smile lines and silicone does not work effectively to improve this area. In addition, temporary products like Restylane and Resylane Lyft oftentimes are very short lived in the folds of the face, he typically prefers Bellafill as the ideal solution. In general, he prefers to inject permanent fillers more conservatively in younger patients but is more liberal with their application in each passing decade to ensure that the permanent filler will age well for you. He will discuss with you what options would be best for you and what risks would be involved with a particular filler in your circumstance.

I have acne scarring. How can Dr. Lam help me?

In the past, Dr. Lam used mechanical dermabrasion to manage acne scarring. However, he believes today that dermabrasion (not to be confused with microdermabrasion) does not offer sufficient improvement to be warranted in most cases. The major pathology in acne scarring is a depressed scar. Traditional dermabrasion tries to level the field by lowering normal skin down to the level of the abnormal skin. Instead, Dr. Lam believes it is important to elevate the depressed scar to the level of the normal surrounding skin. The way in which Dr. Lam accomplishes this task depends on the problem at hand. For small pits and depressions, he uses what he calls the CROSS technique which elevates the microscars up toward normal skin tissue levels using a series of very concentrated micro-acid treatments. He has used this technique safely in many skin types, including Hispanic, Middle Eastern, and East Asians without loss of skin color or scarring, having performed hundreds of procedures to date. In wider areas of depression, Dr. Lam uses microdroplets of Silicone to elevate these depressed scars and to bring the atrophied (depressed) tissues up toward the level of normal skin.

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