Category: Fat Transfer / Fat Grafting

JUVEDERM VOLUMA XC: The New Injectable for Improving Cheek and Midface Contour

Juvederm VolumaThe 2013 calendar year saw a whopping increase of 18% in the number of people seeking injectable fillers to smooth wrinkles and enhance contours of the face. There were 1.7 million injection sessions of hyaluronic acid, a naturally occurring substance in all human tissues. The filler contains a numbing agent, lidocaine, so the injection is only a minor discomfort.

Voluma is a  new product developed to be thicker than its cousin Juvederm so it lasts longer.  It is intended to fill in the cheekbones and chin when these start to lose fullness. The FDA approved its availability to Plastic Surgeons in the final quarter of last year and it is becoming readily available.

As the face loses volume and skin begins to lose its elasticity, the cheek bone region flattens and folds of skin develop in the lower cheek from nose to mouth. None of us like it. With Juvederm, the injection is placed into the creases to camouflage the skin relaxing as the volume goes away. With Voluma, the injection is placed in the mid cheek, elevating the nasolabial skin folds to their natural position. With the skilled hands of a Board Certified Plastic Surgeon it can give an immediate improvement in fullness.

Voluma has been used extensively in Europe, Latin America, Canada, the Middle East and Asia since its introduction in 2005. It is finally available here in the US.

Voluma can last up to two years, whereas Juvederm has an average duration of six months. Longer lasting—wouldn’t that be nice? For a low maintenance product and no more upkeep than your skin care routine, you can experience improved facial fullness for up to two years!

Anti-aging, Beauty, Doctor-Patient Relationship, Facelift, Fat Transfer / Fat Grafting, Skin Care

South Korea: The World’s Capital for Plastic Surgery

Korean Plastic Surgery FaceI  just returned from a week in Seoul S. Korea, visiting with a manufacturer of US medical devices. This first time visit to Korea was eye opening. My pre-conceived images of Korea, probably formed by watching re-runs of MASH, were of a struggling people recovering from the ravages of Japanese occupation and the Korean Civil War. They have reversed the sufferings of the last century. Seoul is now a sophisticated metropolis, ringing with commerce and populated with meticulously dressed urbanites, rushing from offices, restaurants, karaoke bars, health clubs and university classrooms. South Korea has made an astonishing move from shanty-town poverty into a modern high rise industrialized economy in a span of 50 years. 

Of particular interest to me was the Korean attention to beauty. They dress stylishly, pay careful attention to grooming and consider looks to be an important element to success. This value allows them to be very open to plastic surgery as a means of achieving their ideals.

South Korea has the world’s highest per capita rate of cosmetic plastic surgery, according to the 2009 and 2011 statistics of the International Society of  Aesthetic Plastic Surgeons. 

For Korean college graduates seeking employment, 27.4% get plastic surgery to fare better in the hyper-competitive job market. Every year 74 out of every 10,000 people undergo cosmetic surgery, a rate 1.8 times the United States. One in five women between the ages of 20 and 45 is reported to have cosmetic surgery. 

Korea is followed by Greece, Italy and the United States in the per capita rate of choosing plastic surgery. The people of Brazil and Taiwan also value and utilize plastic surgery with a high degree of frequency.

The Asian specialized procedures that are performed frequently in Korea include the double eyelid surgery to make the eyes appear larger, cheek implants to create an “apple” shape, jaw contouring to decrease the width of the face and rhinoplasty to raise the height of the nose.  Forehead shaping with fat grafts, liposuction and breast implants are also popular. 

For more information consult:

International Society for Aesthetic Plastic Surgeons,

Anti-aging, Beauty, Blepharoplasty, Doctor-Patient Relationship, Fat Transfer / Fat Grafting, Rhinoplasty, Skin Care

Asian Eyelid Surgery

AsianWomancropSeattle has a large Asian population of varying ethnicities. I find they express different preferences for beauty in the upper eyelid. Those from Chinese, Japanese or Korean heritage more often favor a narrow crease above the eyelashes. Filipinos, Taiwanese, Malaysians and Indonesians prefer a wider fold. Population genetics show that the narrow or no crease peoples were originally from Northern Mongolia in prehistoric times. The Southern Mongolians evolved different facial features including deep set eyes and a wider crease. Most people want to retain a natural look that is true to their familial background.

The “classic” Asian eye

  1. Slants upward on the outer corner
  2. Has an absent lid crease,
  3. Has a fold of skin that lies over the inner corner, referred to as an epicanthal fold

In reality, the Asian eyelid has a large range of individual variation, including the height of the crease, the width of the eyelid opening, the amount of fat around the lids, and the shape of the eye.

It is possible to vary the blepharoplasty procedure according to each person’s preferences, especially when it comes to the desired fold height. You will want to talk about that when you come in for a consultation. You can make aesthetic changes without  erasing your heritage. A “natural” look is better than a “westernized” look. 

Anti-aging, Beauty, Blepharoplasty, Fat Transfer / Fat Grafting, Skin Care, Uncategorized

Current Trends Show Fat Grafting the Breast Is Popular

Breast Fat TransferA recent survey of board certified Plastic Surgeons confirms that plastic surgeons are using fat transfer with increasing frequency and success.
80% reported using fat in parts of the body other than breast.
70 % actively perform fat grafting to the breast.
62% used fat transfer as a good choice for improving breast shape and
contour in reconstructive breast surgeries.
28% of the surveyed surgeons employ this technique for cosmetic purposes.



Here are some of the ways this valuable technique is being used:

  1. Breast implants in thin women can show wrinkling or visible borders. Fat can provide a thicker soft tissue cover to hide implant characteristics.
  2. Fat grafts can cover prominent ribs or an irregular chest wall.
  3. Congenital breast problems, such as tubular breasts or lack of growth of one breast can be reshaped with fat transfer as part of the procedure.
  4. In breast reconstruction after mastectomy, fat can help camouflage the borders of an implant, or fill in a deficit in a flap contour or after a lumpectomy defect. Fat can treat irradiated tissue and seems to improve skin quality. 

There were nearly 72,000 fat grafting procedures reported by US board certified surgeons for 2012, according to the American Society for Aesthetic Surgery. 

For more detail visit the July 2013 issue if Plastic and Reconstructive Surgery,

Anti-aging, Blepharoplasty, Body Contouring, Breast Augmentation, Breast health, Breast Implants, Breast Reduction, Fat Transfer / Fat Grafting, Mommy Makeover, Tubular Breasts

Stem Cell Facelift, Vampire Facelifts? Buyer Beware!

Vampire faceliftMy office received a phone call last week asking if we offered either stem cell facelifts or vampire facelifts?? We were happy to say no…not that we do not like being early adopters of new technology, but because these two procedures have marketing claims that are far ahead of any science. In other words…HYPE.

So what might advertisers mean by stem cell facelift? Fat is one of the body’s tissues that carry adult stem cells. When a facelift is performed, fat can be added to bring fullness to sites of volume loss. In fat transfer to the face, a small number of stem cells may be moved at the same time. We do not know how many (if any!) are being transferred, and we do not know if they will become activated in their new home, to provide the hoped for repair and youthful, healthy look. The procedure for fat grafting is a good one, but calling it a “stem cell” facelift is hyperbole (HYPE!!).

The “vampire” facelift is also not ready for prime time. The procedure involves drawing a tube of your blood, spinning it down to isolate the portion that contains the most white cells, known as the buffy coat. The theory is that this fraction contains more growth factors and possibly stem cells. To date this is all unproven. Surgeons that use this as a selling point for their services  are trying to win confidence by suggesting that they are employing a “cutting edge” technology, but these claims are unfounded.

The American Society of Plastic Surgery and the American Society of Aesthetic Plastic Surgeons published a joint position paper in 2011 on stem cells and fat grafting. In this paper they state:

“Extreme caution should be exercised when a physician is promising results from any treatment that sounds too good to be true. Stem cells in aesthetic surgery are promising, but marketing claims are far ahead of the science.”

Anti-aging, Beauty, Doctor-Patient Relationship, Fat Transfer / Fat Grafting, Stem Cell Research & Regeneration

Can You Make Bigger Breasts Without an Implant? New Uses for Fat Transfer

Moving fat from an area where you do not need it to some place where it might be an advantage is an old concept in the history of medicine. Techniques have evolved making this more possible today than when it was first tried. Fat transfer to the face and to liposuction defects have been used with success for the last decade. Fat transfer to the breast has proceeded cautiously because of two concerns. The first is the fear that the transplanted fat could interfere with the interpretation of mammograms. The second was that the fat tissue might contain stem cells that could stimulate growth of breast cancer cells. Recent investigations have shown these concerns to be unwarranted. Mammograms taken after fat transfer to the breast have been shown to be no more difficult to read than those taken after other types of breast surgery, such as reductions. Fears of tumor stimulation by fat transfer have also been debunked, as fat in a mastectomy site or partial mastectomy has not been shown to increase local or distant recurrance of breast cancer.  

These findings raise hopefulness for lipo transfer (fat grafting) to the breast. Fat grafting has provided good results when used to give more tissue cover over an implant in breast reconstruction. Fat transfer can bring the same advantages in breast augmentation for cosmetic purposes. Using fat without an implant usually requires several transfer procedures to get enough volume. It works best when there is excess loose skin,particularly with a sagging post partum breast. For the woman with a tight skin envelope, a device (called a Brava) is used several weeks ahead of time to stretch the skin. It takes perserverance and motivation on the part of both patient and surgeon to accomplish an enlargement without an implant. The increase in size is less than can be achieved with an implant, but use of a foreign body is avoided. Stay tuned, as it may be the way of the future.

Breast Augmentation, Fat Transfer / Fat Grafting

Cellulite: Any Treatment Options?

The term cellulite means different things to different people. Cellulite refers to an uneven texture of the skin that varies from skin dimpling to lumps and bumps. Eighty-five per cent of adult women have cellulite so it is an entirely normal finding, and probably under the influence of hormones. In some women the irregular contour is barely noticeable and in others quite extreme. It is most commonly located on the legs, abdomen and buttocks. The contour irregularity worsens with aging. Cellulite can be a source of significant body dissatisfaction.

Because the degree of cellulite changes can vary so much, a classification system was proposed by Curri in 1991. There are four grades in this classification system. Grade I has no noticeable changes to the observer, but under the microscope the tissues show typical signs. Grades II-IV show progressive loss of elasticity, dimpling, waviness and bumps of the surface.

The cause of cellulite has not been clearly shown but the interaction of genetics, hormones, inflammation and weight changes are all being investigated. Connective tissue that crisscrosses through fat is largely responsible. The fat cells bulge over these restraining bands into the deep dermal layer of the skin creating nodularity.

Many therapies have been proposed for cellulite. It has shown itself to be resistant to most. The ineffective treatment modalities include lasers, massage, contact cooling, radio frequency energy, ultrasound, infra red light, suction, topical creams, oral medications and iontophoresis. The long list of unrelated therapies speaks both to the appeal to find a treatment and to the lack of understating of its cause.

Mild cases of cellulite are not worth undertaking frustrating treatment attempts. More severe cellulite may respond to skin tightening surgical procedures, such as a body lift or thigh lift. Fat transfer can help to camouflage surface irregularities. The surface therapeutic tools such as lasers and light based therapies are likely to disappoint. Additional scientific studies are necessary to draw final conclusions.

Cellulite, Fat Transfer / Fat Grafting

What Does Stem Cell Research Have to Do With Plastic Surgery?

Stem cells are multi potential cells that have the capacity to develop into a variety of fully differentiated tissues and can enhance regeneration and repair. There is much excitement in the world of medical research about their therapeutic possibilities, all in experimental stages to date. In the laboratory, stem cells have been able to evolve into heart cells, neurons, skeletal muscle, pancreatic cells, bone, cartilage, and blood cells. Stem cells are present in embryos but have also been identified in bone marrow, umbilical cord blood and in fat. Stem cells from embryos have been highly controversial, but those derived from adult tissues are being explored as more acceptable. Fat tissue is an ideal source as it is plentiful and easy to harvest by liposuction, the most commonly performed procedure by plastic surgeons.

Fat grafting is now used by plastic surgeons for both cosmetic and reconstructive purposes. Harvested adipose tissue is treated and then reinjected for facial rejuvenation, lip enhancement, for contouring bodies and for restoring post traumatic defects. In the future it maybe possible to enhance the restorative properties of the transplanted fat by supplementing it with stem cells derived from the fat. These adipose derived stem cells (ADSC) have properties that include attracting new blood vessels into the area, referred to as angiogenesis. ADSC also are able to reproduce themselves, so it is hoped that they will make fat transfers more likely to thrive in their new area of transfer and more likely to last a long time.

Research is being conducted in hopes of using stem cells to regenerate whole organs. If a person’s own stem cells can be harvested and directed to grow into what is needed (say a kidney or a liver) it may be possible to get around rejection of transplanted tissues from other people. ADSC provided as a byproduct of liposuction procedures could prove to be a valuable resource rather than medical waste.

It is unknown how long it will take to advance to making new differentiated tissues, but their use in plastic surgery for enhancing the take of transplanted fat may be a new and exciting development. Plastic surgeons are watching closely to see how this medical research evolves.

Fat Transfer / Fat Grafting, Stem Cell Research & Regeneration

Fat Transfer: Fat Grafting, a Good Purpose for that Unwanted Extra Pound or So

America’s body conscious culture sees fat as the enemy. Our weight loss industry has grown around a never ending battle of the bulge. Fat may have been an energy depot for the cave man when hunting was unsuccessful, but most of us never face food shortage. Modern man is learning that fat is a metabolically active tissue that may have a variety of uses and may even hold the key to treating some diseases. Plastic surgeons are repurposing fat for its value in contouring and are continuing to evolve new uses.

Whenever a plastic surgeon undertakes to change or improve some aspect of the body he or she will run through a mental list of options before arriving at the best choice in the particular setting. Often there is more than one way to approach any problem. Guiding principles may include “first do no harm,” “substitute like for like whenever possible,” and “the simple solution is not always the best.” Fat grafting requires careful assessment using plastic surgical principles of how to get fat’s contouring usefulness with a minimum of disadvantages. There are pluses and minuses to every choice. 

In recent years fat grafting to the face is used more and more. The transfer is often made from the abdomen because that is where excess fat is readily available in most people. The fat is processed in a manner that separates the fat cells gently so to keep them viable. The treated fat is loaded into syringes and injected in a series of small droplets.

Fat Transfer / Fat Grafting

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