Wilbur Hah, MD (retired)

Hi,
Thanks for the excellent question. My observations agree with your thinking.  I have been performing fat transfer to facial and body areas for over 10 years.  We have found fat transfer to midface and around the eyes to have good take rates of 50 to 80%.  Unfortunately, fat grafting the the lips and around the mouth areas tend to have lower take rate (50% or less in our experience).  It may be due the high degree of movement of lips and peri oral areas that causes this.

Fat at transfer works escellent results also for Brazilian buttock lifts and filling lateral thigh depressions in our VASER Liposelection cases, but just doesn't seem to do as well for the lips.

The Hyuaronic fillers do very well for the lips and perioral lines.


Best regards,

 Hello,

Thanks for your question. You certainly can take fat and from the tummy area and place it into the Marionette lines as a filler.

However, I have learned over 10 years of doing  fat transfer to face and body areas that the Mariontte lines is not one of the best places for fat grafting. In the facial area, fat in the midface. cheek, tear trough, nasolabial fold and even around the sunken areas around the eye orbit do quite well.(just like the fat does well in Brazilian butt Lift what we transfer fat to the buttocks from tummy and waist)

When we transfer fat to lips and marionette lines, it doesn't seem to stay very long and it is difficult to get the tissue support and the angle at the marionette lines to support the corner of the mouth.  We have found that a long-lasting filler like Radiesse or Voluma tends to work very well. Actually, it would be also be less expensive  at most facilities.

Also recommend you seek out a board-certified cosmetic surgeon,  facial plastic surgeron, or plastic surgeon who has significant experience in the type of work that you're interested in. Board certification is certainly the first bar, however significant experience and current competency regarding specific procedures that you're interested in is paramount for patient safety and quality results  in addition to the baseline board certification.

Thanks for reaching out, best of luck to you.

I did my surgical training at UAMS.  Go hogs!

Hello,

I recall that Jacques Joseph is generally credited as a the outstanding pioneer and father of rhinoplasty performed in 1889.  I think I saw reference of the first documented illustrated  rhinoplasty was during the Renaissance in 1597 by Gaspare Tagliacozzi.

Suggest google "The Father of Modern Facial Plastic Surgery".

New materials and techniques are always coming along.  Some are helpful, others not some much. However, after performing rhinoplasty over last 20 years, I have learned to not go with latest and greatest until these techniques and materials have stood test of some time. If it does, then incorporate it into our "toolbox" of techniques that have been been shown to work well. Unlike a smartphone you found out you did not like, that take back for another one, a rhinoplasty of based new technique technique that does not work out creates a set of difficult problems that can be difficult to correct.

If you are interested in rhinoplasty, I would suggest you find a board certified facial cosmetic, facial plastic , and/or plastic surgeon who is quite exerienced in rhinoplasty and perform your procedure in safety of an accredited surgical facility.



best regards and happy new year,

Hello,
Thank you for your excellent question.

You certainly can have a facelift done under local anesthesia +/- intravenous sedation that does not require general anesthesia.  Over the last 20 years, I have grown to prefer local anesthesia + IV sedation for performing facelift/neck lift procedures.

That may be a good option for you.  I think it is still very important to have a cardiologist to get your heart/EKG worked up and cleared for surgery, even if it is done under local anesthesia.  Local anesthetic agents can still cause heart rate to raise. So abnormal EKG changes would make me nervous even for a pure local procedure.

We all want you to be happy with your cosmetic result.  More importantly, we want you to have a safe perioperative course without any cardiac incidents.

You should seek out a board certified cosmetic, facial plastic, and/or plastic surgeon who is interested in working with you on your anesthetic choice to have your procedure done in the safety of a accredited surgical facility.

Happy New Year and Best Wishes!

Hello,

Thank you for the excellent question. Even our medical students and surgery interns asked this question in medical school.

The answer lies in the history of the blepharoplasty operation.

Classically we perform the transcutaneous blepharoplasty for the lower lids removing both excess skin and excess of fat in the lower eyelids. This is done with a external incision. 

However if too much skin is removed or if the eyelid tone is weak , scarring can occur inside the lower eyelids that can change the shape of the eyelid can change lower eyelid droop outward which can be a challenging problem to correct.

For patients only have excessive fat bulging and no skin excess, excellent operation is the transconjunctival technique. First described by Dr Henry Bayliss. This technique is done by going through the pink portion inside the eyelid without an external incision.

This technique avoids those potential problems you pointed out. However if you have quite a bit excessive skin, this will not address that . So, additional skin excision of the skin from. "Pinch technique" or a laser peel to remove the excess skin is also required.

Both techniques have served my  patients well over last 20 years. Choosing the right  procedure for the right patient  is most important for patient safety and best aesthetic result. The lower eyelid anatomy  is not as forgiving as the upper eyelid.

The best recommendation is to find a very experienced board-certified oculoplastic, facial plastic and plastic surgeons in lower eyelid blepharoplasty to  perform this operation.

No surgeon is an expert in all cosmetic procedures. So, in addition to being board-certified,  their experience and results of that particular procedure you are interested in are what you should evaluate when choosing a surgeon.

Traveling in NY last night, first time that I saw the Empire State building and it's Christmas lights, New York city is quite a place in holiday season!

Hope this bit of history has been helpful to you.

Best regards and good luck on your procedure