20
August
2008
Rhonda Rundle of the Wall Street Journal today wrote an article entitled “Stem Cells and Breast Surgery” in which they discuss the process of “super-charging” fat grafts with stem cells and other factors by a special processing method. This process has been developed for commercial use by Cytori Therapeutics. Ms. Rundle does a nice job of explaining the process and the controversy.
She used the diagram below from Peter Rubin of the University of Pittsburgh, recent recipient of the Presidential Early Career Award for Scientists and Engineers (PECASE). I think that the diagram is helpful in understanding this process. Click on the image to open up the diagram in another window.
More discussion of this the impact of stem cells on fat grafting and breast surgery will appear in future posts.
Posted under Breast LipoStructure
18
August
2008
There is a new filler on the market! An innovative form of collagen for injection, Evolence was approved by the FDA in June 2008 and will be available in the US soon.
Collagen Corporation introduced the original collagen for injection into the skin, Zyderm and Zyplast, over 25 years ago. They were made from cows (bovine), lasted two to five months after injection and required skin testing to determine potential reactions to the product. Evolence is made from pigs (porcine), can last over a year and requires no skin testing. Porcine collagen is more similar to human collagen, and has been used safely in the production of heart valves for years.
Hyaluronic acid based products like Restylane and Juvaderm produce their effect by attracting water to the surrounding tissues. The advantage of a collagen-based product such as Evolence is that it mimics human collagen by providing a matrix like support structure for the skin.
Colbar of Israel asked me to be on their medical advisory board over three years ago. I met with the executive from the company who I knew from Q-med and the Restylane products. She said that the company wanted me to be involved in the evaluation and development of Evolence. She explained the GlymatricTM technology used to link the collagen dramatically increased its stability and longevity.
Even though I did not join their board, as I attended many plastic surgery meetings in Europe and Asia over the next years, I heard many positive comments from the physicians using Evolence: They claimed less bruising and swelling and noted a different effect than filling with hyaluronic acid fillers. Finally and perhaps most importantly, the European and Asian physicians claimed that Evolence lasted much longer than other non-permanent fillers, up to two years.
I was not surprised when over a year ago I heard that Johnson & Johnson acquired Evolence for international distribution by the Aesthetics Group of OrthoNeutrogena. Another executive from Q-med who now works for Johnson & Johnson invited me early this year to fly to Cayman to inject Evolence in patients, so I could understand better the advantages of the product.
In the Cayman Island, I was able to perform injections into many areas of the face, using both Evolence and Evolence Breeze (the formulation for lips). The products exceeded my expectations, and I was pleased to hear that Evolence was approved by the FDA in June 2008 and will be available in the US soon. Evolence Breeze will probably be available in the near future.
The patients that I have already treated with Evolence have apparently had great results. I think it is a welcome addition to the tools in my practice for rejuvenating the face.
Before and after photos for Evolence coming soon.
Posted under Facial fillers
13
August
2008
The degree of sculpting possible with structural fat grafting to the breast is particularly advantageous in the challenging correction of tuberous breast deformity. The tuberous breast is a deformity in which the lower skin of the breast (the lower pole) is abnormally constricted (tight) and short. In addition, the normal fold of the breast (the inframammary fold) is higher that it would be under the normal breast. These two combined make the breast shape distinctly abnormal, and prevents the fluid roundness of a normal breast. In the more problematic cases, the tightness of the lower breast makes the nipple and areola appear much larger and more puffy than in a normal breast. treatment for this problem using structural fat was first described in the journal of Plastic and Reconstructive Surgery last year by Coleman.
In the case below, the skin envelope of the breast was selectively expanded with fat placed immediately beneath the skin. No fat was placed under the central breast (the nipple-areola complex). This changed the relative proportions of the breast creating a natural appearing and shapely “A cup” after one procedure (see below). The patient desired larger breasts after the first correction, so further augmentation with fat grafting was performed (see below) to bring her up to a “B-cup.”
The time requirement of such a fat grafting procedure should not be underestimated. The time to harvest, refine, and place fat into the breasts in this fashion will take many hours. In the patient shown placement of fatty tissue into the breasts took about seven hours for the first procedure and five hours for the second. The reward of the time and effort is a dramatic change, which is much more natural than if implants had been used. Fat grafting for correction of tuberous deformity leaves the patient with natural appearing, normal breasts. As with any breast procedure, patients must be aware of the potential risks and complications of fat grafting to the breast.
28-year old woman with a bilateral tuberous breast deformity before any procedures(left ). Result after first fat grafting procedure with placement of 370cc on left and 380cc on right (middle). Photo on the right was taken at almost 5 years after the second fat grafting procedure in which 300cc was placed into the left breast and 340cc into the right.
For more details about fat grafting to the breasts, please refer to the article in Plastic and Reconstructive Surgery.
Posted by SR Coleman
© Coleman 2008
Posted under Breast LipoStructure
12
August
2008
Zeltiq Aesthetics has developed a breakthrough biotechnology for reducing unwanted fat. The Zeltiq device uses cryolipolysis to precisely cool fat and induce lipolysis (the breakdown of fat) apparently without any permanent damage to other tissues (skin, nerves, muscle and bone) around the fat. The technology allows for natural body sculpting.
Harvard Medical School and Massachusetts General Hospital performed the pioneering research that evolved into a non-invasive system to reduce subcutaneous fat. They first presented their research at the 2008 meeting of the American Society of Laser Medicine and Surgery. Please refer to the scientific paper on cryolipolysis from this meeting for a detailed explanation.
Dr Sydney Coleman is on the physician advisory board and an investigator for Zeltiq Aesthetics.
More information about this and other non-invasive or minimally invasive methods of fat removal will follow.
Posted by SR Coleman
© Coleman 2008
Posted under Minimally Invasive and Non-Invasive Fat Removal
16
June
2008
Problems that women experience after silicone and saline breast implants include visible implant edges, rippling, hardness, and scarring. Also, the breast can be left with an unnatural shape: for example with poor cleavage, inadequate upper breast volume or deficient fullness up into the armpit. The Coleman technique, which moves a woman’s own fat to her breasts, may be a solution for all of these problems.
These photos illustrate what can be done to improve the look of artificial implants without removing them. Photos on the left were before fat grafting. Photos on the right are 8 years after placement of about 2 ounces of the patient’s own fat around the visible implant edges and over the bony breastbone and ribs using the Coleman method. No surgical procedures or implant exchanges were performed. The grafted fat softens the appearance of the bony chest allow natural cleavage to occur. The scar around the implant has softened so much that the orientation of the implant has changed from an obvious hard, vertical position to a softer, more horizontal position. The result is a natural appearance and softer breast with despite the presence of the original silicone implants .
On the current website of the American Society of Plastic Surgery the advisory: “Fat Grafting for Breast Augmentation – What Women Should Know” asks the question, “Is there an acceptable application for this procedure currently in use?” They advise women that fat grafting to the breast can be effective in breast reconstruction and to soften the appearance of existing implants, specifically in thin women and those with visible rippling.
Even though fat grafting around breast implants may be “acceptable,” women need to know that there are potential complications or problems. Women should go to plastic surgeons that are familiar with those problems and have the experience necessary to minimize possible complications. The results of fat grafts are incredibly dependent on the technique used and fat must be placed with extreme care.
I have been grafting fat to the breast in New York City since 1995, and published my initial experiences in the main plastic surgery peer review journal in 2007. Since then, I have lectured on fat grafting to the breastat every major plastic surgery meeting in the United States . I have also been invited to lecture at many major meetings in North and South America, Europe, and Asia on the topic.
Long-term studies still need to be completed. I am currently working with other plastic surgeons, oncologists and radiologists at NYU to develop a multi-center prospective study examining the use of fat grafting in the breast.
For more detailed information about fat grafting to the breast, please refer to LipoStructure.com.
Posted by SR Coleman
© Coleman 2008
Posted under Breast LipoStructure
10
June
2008
In the 1980’s, deformities and irregularities from liposuction were new problems that the world had never seen. During that time, no solution existed for treating these problems. Most authorities in plastic surgery felt that grafted fat did not last longer than injectable collagen. In 1986 soon after I started practicing in New York City, I began developing a new method of fat grafting to treat deformities after liposuction. The technique eventually became known as LipoStructure® or “structural fat grafting.”
To harvest fat for structural fat grafting I use a syringe connected to a blunt cannula that I invented. I also devised another much smaller blunt cannula to infiltrate the concentrated, purified fat into the irregularities. The fat is transplanted to maximize stability and give the newly placed fat access to a blood supply so that it can live and thereby potentially be a long-lasting correction.
Using this technique, I found that I could fill in areas where too much fat had been removed on thighs, hips, arms and abdomens. Immediately after the procedures, there was remarkable smoothing of the liposuction irregularities, and to my surprise, a big portion of the fat infiltrated remained. In fact, even my first patients had changes that now appear to be permanent. For over twenty years, I have used this technique to correct liposuction deformities in hundreds of patients, from subtle, barely perceptible problems to large irregularities.
55 year old after excessive liposuction of her inner thighs (left) and 6 years after her second LipoStructure procedure (right).
35 year old woman after outer thigh suctioning left her with minor irregularities (left). Two years after one infiltration of a total of of one ounce of refined fat was placed into the irregularities, significant smoothing of the area is noted.
Further references:
Treatment of liposuction deformities
LipoStructure for Correction of Liposuction Deformities
My book Structural Fat Grafting Chapter 6: Iatrogenic Corporal Deformities.
Watch for future related topics on liposuction deformities and irregularities:
•Restoring body proportion with LipoStructure
•Buttock crease correction after liposuction
•Body scars treated with fat grafting
•Challenges of treating liposuction deformities and irregularities
Posted by SR Coleman
© Coleman 2008
Posted under Liposuction deformities
