Thanks so much for all the useful content this forum has generated over the months and years. I've learned a great deal about docs, procedures, etc. Here's a bit of input from my experiences:

Several years ago, I underwent 3 facial fat grafting procedures w/NYC doc spaced-out over 3 years.

1st yielded great results 1.5 years post-op – more youthful, improved jawline and face shape, and filled-in eye hollows.

2nd created some irregularities and feminized face (I'm male).

3rd even worse - an overfilled and distorted look with a U shaped chin and square jaw.

Don’t ask why I didn’t stop at 1st procedure, it would be a long addition to this summary.

After 3rd FG settled down, I sought ways to chisel my face back down - perhaps to 1st procedure post-up look but with a slightly stronger jawline. Here is a summary of my doc consults and visits, not in chronological order.

Lam (Dallas): Consulted over phone, visited 18 months later. Told me there was no solution he knew of for an overfilled face. But during visit, he performed a lip reduction – cut open and cauterized the fat out of my overfilled and asymmetric lower lip. 6 months out, it looked smaller, more even, and better. Perhaps even a bit more fat out would have been better but I asked him to be more conservative than his original plan.

He seemed to be a minimalist and ultra conservative. He advised against an endoscopic BL or neck lift for me and thought it would create an unnatural, distorted, and/or feminized appearance. As for what was left of my fat grafts (I had done some lipo-dissolve and micro-lipo w/other docs), he felt the major remaining distortion was my mid-face and that’s where I should concentrate my reduction efforts going forward. He does not do micro-lipo.

Niwet (Bangkok): Visited him. He does lipo-dissolve and I felt comfortable since he trained in fat grafting with my NYC doc and knew what he was up against. Injected jawline twice over 3 months, yielded some modest but visible improvement by tapering down my jaw and chin without creating any new problems. He also comes a cross as quite conservative and has many great B&As in his computer (lipo-dissolve, fat grafting, endoscopic BLs).

Haworth (Beverly Hills): Consulted over phone, visited later. On phone, he recommended micro-lipo, especially along jawline and also a lateral endoscopic BL. When I visited, he was very busy and I didn’t get the sense he was that very interested in my case. Suggested I continue with the lipo-dissolve treatments back in Asia and if any was left over, he could micro-lipo it out and also do the BL. His quotes were high and most of his B&As were of women.

Hoenig (Beverly Hills): Visited him. He suggested some rounds of 5fu followed by microlipo. I had a 5fu injection on the spot and another one a month later. Seemed to soften hard areas. I plan to do a 3rd round soon and follow-up w/micro lipo (my 3rd time at this too). I also talked to him about a lateral endoscopic BL or upper lid blehp. He said bleph would pull my eyebrows down too much so BL would be better. But even for BL, he seemed to be on the fence. His quotes were substantially lower than Haworth’s, he didn’t charge for consults, and really took the time to explain things well.

Ramirez (Boca Raton): Visited him. He proposed the works, micro lipo, neck and jawline lift, and lateral endoscopic BL. Some of his B&As were very impressive and he has written in-depth papers which cover a broad range of neck lift options. But quotes were exorbitant and he came across as modest, weak and getting old; not the high powered doc I was expecting. At the Sanctuary Center, I also met Dr. Posner who seemed experienced with laser treatments (nurse had just gotten on around her eyes an it looked good) and they took photos of me with a state-of-the-art machine which scanned from all angles. I also met Dr. Matez in health and wellness which was a delight.

Holocomb (Sarasota): Visited him. Discussed Acculift as an alternative to micro-lipo and he admitted that he had not yet used it on fat grafts; just natural fat or fillers. Some of the Acculift B&As were impressive but it seemed to have the most visible impact on older patients. He was nice and patient but in the end, I chickened-out. With just 1 year of experience using this new technology, I didn’t want to be a guinea pig case. Also, I didn’t sense that he fully grasped the key aesthetic issues with my face.

Carraway (Virginia Beach): Visited him. Extremely confident and energetic. He typically runs around from room to room so you don’t feel pressured and have time to think of follow-up questions. He also does not charge for consults and will sometimes allow you to make up your mind and pay last minute. I could tell from his observations and comments that he visualized my face and its issues well and had sensible ideas for improvements. I did facial micro with him and he used a blunt canulla and got out 15 ccs or so. He was very conservative and told me I would probably need a follow-up. So 1 year out, I went in for round 2. This time, he used a smaller canulla, removed modest amounts, and put a tiny amount of botox in my masseter (5 units per side). He also added a bit of Restylane to my left malar area to improve symmetry. 6 months out, the results are great with no new problems. Everything he did worked well and its amazing how that tiny amount of Botox improved my squared jaw so much.

One other thing he recommended was a subtle upper lid bleph to open-up my eyes. He thought my brow was well positioned and anyway, did not have faith in lateral endoscopic BLs holding well long term. Given the conflicting advice I’ve gotten (do BL, do bleph, do nothing), I decided to hold off on this for now.

Yaremchuk (Boston): Visited him. This was before I had done my lip reduction and second micro-lipo. He told me my lips looked swollen and I had a big square face. Thus, before anything else, I should focus on getting more fat out. He said there were a couple of approaches – micro-lipo or making face lift cuts, to directly excise it. With the second option, he could also tighten the skin. He was pretty serious but seemed like he sincerely wanted to help, even if it meant being blunt. He spent a good 45 minutes with me. I prefer to avoid face lift cuts if possible and felt micro-lipo would be best handled by the docs who do it a lot – Carraway or Hoenig.

Obagi (Beverly Hills): Visited him. He recommended his Nu-Derm treatment to strengthen my skin plus Accutane to improve the mild rosacea on my T-Zone. After doing some research, I decided to hold off on the accutane due to side effect risks. But I’ve been on Obagi for 4 months now and it seems to have improved my skin quality plus I’ve adjusted to it so my skin may be stronger now. I will visit him again soon for a follow-up. He comes across as very energetic and excited about his products. I think everyone in his office uses his products and some have had blue-peels too. Most of them are middle aged and seem to have good to great skin but not quite perfect or flawless. Mr. Obagi himself is mid-60s and has great looking skin.

At this stage, I'm getting close to 1st FG post-op look. Just need to get remaining fat out of mid-face smoothly. Will probably do that with Hoenig as he can use 5fu to soften it up.

Going forward, I may also consider a BL/upper bleph and neck-lift.

I have a few questions remaining and would really appreciate constructive input from anyone on the forum.

1. Would Hoenig be a good choice for endoscopic lateral BL? Are there any others worth considering for this such as Marten, Guyuron, or the docs at Spalding Dr. Center in Beverly Hills? Who do you rec and why?

2. Which docs would be best for neck-lift of a fairly youthful neck but with a slight amount of excess skin hanging near the neck and chin junction? The ones I’ve considered so far are Giampapa or Ramirez for a procedure which might include suture suspension or Feldman, Marten, or Guyuron a neck lift with no suture. Any suggestions regarding which of these procedures and/or doctors might be a good choice for necks?

3. Which doc(s) do you believe has the best big picture aesthetic vision for patient faces? They’re all supposed to be competent technicians but which ones are also gifted at suggesting procedures which enhance a person’s overall look in a natural way?

Jic -

I have to applaud you for your perseverance !! I was just curious as to how many months/years did you spend going to all these doctors etc. and why did you put filler in your lips - mainly women do that -

Yes, a good post indeed. Very interesting and helpful.

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The greatest way to live with honor in this world is to be what we pretend to be. ~Socrates~ (I pretend to be a cat with a lime carved as a helmet on my head)

1. Buckets! Around 75-125 each procedure. He even did neck during one of those.

2. Although the fat made me quite bloated and ugly at its worst, I'm guessing that the chiseled down version might be better than if I had done nothing. There seems to be a nice youthful fullness which may endure aging well and the skin may have benefited too. The trick is to take it down just enough and not create contour irregularities or other new problems. I believe mainstream taste prefers men to be slightly more gaunt than women. But I don't want to take this to the point of looking older. The balance is delicate.

3. Thanks for the Guyuron rec. That seems to confirm a lot of what has been said on the forum recently. Is there any chance Hoenig, Martin and/or Haworth fall in the same camp?

4. I'll let you speculate as to which Manhattan doc did my grafts as P2 and P3 had poor outcomes. After P3, I was even fuller and rounder than that blond haired Yaremchuk patient who got fat grafted by another doc (I believe he got grafted after his implant work, not before). No wonder Yaremchuk disliked my fat grafts so much.

5. BTW, I forgot to mention that I also visited my FG doc in NYC several times over the years and saw Berman in Santa Monica once. My doc actually liked the post P3 look and Berman seemed OK with it too. That tells you something about the aesthetic leanings of FG docs.

My lips were getting thin and turning inward enough to age me. I tried to improve this with FG procedure. After P1, lips looked somewhat better, fuller but not too full.

I got first FG in 2004. Most of the other doc visits happened from 2007 on.

For overall aesthetics stay AWAY from Ramirez. He is, as you say, a highly skilled technician and does fantastic neck work but he will definitely 'solve' one problem and create another without clueing you in about it ahead of time. I have a friend who got a great neck result from him, but let's just say if she had not had common sense to refuse some of the other procedures he suggested she would look like a train wreck. pick him only if you have a specific issue and you tell him what you want done (i.e. the neck).

marten and ramirez have the best neck work far and away i have seen on anyone male or female.

in terms of overall aesthetics and facial balance, i do think haworth has that 'gift'... he might be worth another conversation. i have found him and the office highly attentive and never rushed-feeling although sometimes he can seem like he's on another planet as he contemplates the case and goes through scenarios in his head.

I have visited Hoenig several times to reduce a bump caused by fat grafting (using the 5FU) and discussed microlipo with him... and quite frankly, after having seen Val Lambros (orange county) I feel that Hoenig may be too conservative or not carefully detailed enough aesthetically for overall balance. Lambros is also conservative in the sense of preferring to undershoot the goal and repeat rather than be too aggressive and cause tunneling deformities, etc.... but he gave my case for microlipo the same time and consideration in the consult and pre-op as a full blown surgery... not so with Hoenig who pinched my cheek and said "I'd take this out of your right cheek and call it a day".

Great update and WOW -all those consults, procedures, and travelling time must have felt like a part-time job. Did Carraway do the second ML on the same area as the first or move to another area? I'm very curious about the Botox to the masseter muscle. How long do you think the 5 units has lasted, and do you want to keep it up? I'm assuming that 5 units is nice and subtle. The complaints I've heard about it came mostly from women who had a greater amount injected.

ML pretty much same areas but he used a smaller canulla this time and took out a smaller amount. First procedure was rougher and generated a lot more of that squeaky noise. Second procedure was more fine tuning. Keep in mind that in the interim, I had gone through a 5 fu procedure which might have helped a bit.

Recovery for 1st ML was fast (about 8 days) and second one even faster (about 3 days). And I never really looked very bad or swollen. There was a bit of bruising but it subsided quickly. Compared to FG recovery, this was a dream. But final result can take 6 months or so to show as subtle changes continue happening for several months.

Botox seemed to take 2 months or more to fully kick-in. @6 months post-op, it's still holding strong. I've been told this can last 8 months or more and on second injection, even longer. Seems Botox works differently here than for forehead where it kicks-in fast and wears-off fast.

Perhaps after an injection, you can consciously train yourself to chew more lightly and extend the effect much longer.

BTW, I read up on this a bit and learned many docs inject 25 units or more. So I asked Carraway to inject more but he refused. Said 5 units would do what we needed.

That doesn't sound good and I've read several cases of patients who got major problems from him. Its a shame since he seems to be in a class of his own for technical skill in some areas.



Sounds like Marten might be the man when I pursue this. Appointments w/him seem to take a lot of advanced planning. He was booked solid for 6-8 weeks when I called.

I'm surprised I don't hear more about Giampapa. I also visited him once in New Jersey and he had a lot of great big and clear neck B&As of his suture suspension patients hanging on the walls. His coordinator had gotten one too and she seemed fine. Ramirez references Giampapa on this procedure in one of his papers on necks. Finally, his quotes seem very modest and he comes across as a friendly and humble but somewhat eccentric.

And what about Feldman? Do Marten and Ramirez do better neck work than him too?



I know what you mean about him being on another planet. To be honest, when I looked through his B&As in the office, some looked a bit done + better made-up. And as I mentioned, almost all were female so I don't know whether or not his aesthetic ability can be extended to male faces. He certainly seems to be gifted at turning plain looking women into stunners. But I wonder if they look natural in real life.



Well at least its good to hear that Hoenig is conservative. I prefer to go in baby steps. I would like to learn more about Val Lambros and will try to visit him at some point. Thanks for the rec.

I don't think I would say Ramirez or Marten does 'better' neck work than Feldman. Feldman pioneered the techniques they both use for their GOOD neck work.

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