24
June
2009
Noninvasive Fat Reduction with Cryolipolysis effective and safe in recent study
NEW YORK CITY, NY - Sydney Coleman, a Plastic Surgeon in New York City, is the lead author on the first clinical study published on the effectiveness and safety of cryolipolysis. The study demonstrated significant and safe reductions in fat deposits of humans treated with the new non-invasive fat technology cryolipolysis.
Cryolipolysis treatment causes substantial reductions in subcutaneous fat volume and changes in the contour of the treated love handle without damage to the skin or underlying tissues. The innovative technology brings the temperature of the targeted fat down to above freezing. This apparently programs the fat cells to die over the next two or three months.
View of flanks from the front before non-invasive cryolipolysis (left) and three months after one treatment (right) demonstrate significant change in contour to the flank or "muffin-top".
Lines help to better distinguish the change in contour.
View of “lovehandle” before non-invasive cryolipolysis (left) and three months after one treatment.
Lines help better distinguish the volume changes. Ultrasound studies confirmed about a 25% reduction of fat after one treatment.
The study examined the effect of cryolipolysis on nerves. The treatments were not painful, and temporary “funny feelings” after the treatment resolved quickly. The study concluded that cryolipolysis is not associated with obvious nerve injury.
One patient recently reported at one year after the treatments: “Dr. Coleman, I wanted to tell you that the procedure that you performed on me really works - I can not believe that all of my clothes are big on me - and Ihave not been dieting. This is very exciting, when are you doing the “pouch”? Thanks again,”
In summary, the study demonstrated that cryolipolysis treatment can cause substantial reductions in subcutaneous fat volume and changes in the contour of the treated love handle without damage to the skin or underlying tissues.
A preview of the article can be viewed as a pdf from APS. Or the article can be seen in full by accessing the Journal of Aesthetic Plastic Surgery.
For a review of the paper check out Aesthetic Device Review.
For background on Cryolipolysis, please refer to previous posting entitled Freezing Fat for Natural Body Sculpting.
© Coleman 2009
Posted under Home, Minimally Invasive and Non-Invasive Fat Removal
1
June
2009
Injuries, birth defects and even surgeries can leave scars, depressions and significant deformities to the fat, skin and muscles of the legs, thighs, buttocks, arms and forearms. The type of fat grafting pioneered by Dr. Sydney Coleman is a new tool that is being used more and more by plastic surgeons for reconstruction of the limbs. Fat grafts can be used in the treatment of not only volume deficiencies, but also scars and even functional muscle problems.
Coleman Fat Grafting used to correct depressed scar on thigh
Obviously, simple depressed scars and volume deficiencies can often be treated with structural fat grafting, with not only an improvement of the missing volume, but also an improvement in the surface scar. Even more complex injuries resulting in missing muscle or fat from major accidents or injuries can be treated with fat grafting. Examples of devastating injuries which can be treated with fat are motor vehicle accidents or even attacks from dogs or other animals. Traditional surgical correction of such injuries can be amazingly complex, sometimes resulting in even deeper scars, re-positioned muscles and new deformities. A prime example of such an elaborate reconstruction was recently performed by Dr. Sydney Coleman in New York City on a dog attack victim.
One of potentially important reasons for using fat grafts in such wounds is the stem cell and growth factors present in fat grafts. Not only can the structural fat replace the missing fullness, but also there may be a component of accelerated healing mediated by fatty tissue.
© Coleman 2008
More examples of correction of limb deformities using Dr. Coleman’s specific technique can be found at www.lipostructure.com.
Further reading:
Dog Attack Victim Reconstructed with Coleman Fat Grafting
The treatment of body scars with structural fat grafting
Fat Injection: From Filling to Regeneration
Treatment of liposuction deformities?LipoStructure for Correction of Liposuction Deformities ?
In Dr. Coleman’s book Structural Fat Grafting Chapter 6: Iatrogenic Corporal Deformities.
Lower extremity Reconstruction?LipoStructure for Correction of legs, arms and buttock injuries?
In Chapter 24 of Dr. Coleman’s book Fat Injection: From Filling to Regeneration
LipoStructure® for Correction of Liposuction Deformities
Treatment of the aging hand with LipoStructure
NY Times shows photos of progressive improvement in skin quality with Coleman Fat Grafting
Posted under Extremity reconstruction, Home
10
April
2009
An unattractive buttock crease created by suctioning of the buttock/thigh juncture. This can make a leg look shorter and a buttock look deformed.
As liposuction developed in the late 1970s to the mid-1980s, new problems were created which the world had never seen before: liposuction deformities (deformities created by the suctioning of fat). One of the early liposuction deformities Dr. Sydney Coleman confronted in the mid 1980’s was the purposeful lengthening and deepening of buttock creases in order to create a supposedly more aesthetic appearing buttock. Women were told that a “smiling” buttock was more attractive, so their surgeons would gouge out a long depression running from the lower buttock out to the outer thigh.
Unfortunately deepening the crease below the buttock and extending it out onto the thigh does not usually improve a woman’s appearance. Lengthening and deepening of the buttock creases interrupts the continuous flow of the outer thigh into the buttock, which can create an unnatural looking buttock and the illusion of a shorter leg.
To correct those deformities Dr. Coleman first started injecting fat in 1986. By restructuring the buttock crease with fat grafts, the continuous flow of the buttocks into the thighs can be restored to create a more attractive and youthful line of the leg. In fact, restoration of this buttock-thigh interface can have profound effects on the appearance of the lateral thigh as well as the buttocks, with smoothing of apparent irregularities.
6 years after one injection of fat into the left buttock crease, a remarkable filling in is apparent between the thigh and the leg is created.Side view demonstrates the subtle "lift" that restoring the normal proportion of the buttock crease to the thigh can create.
The left buttock crease correction before (left), one year after (middle) and four years after (right) one fat injection to the buttock crease extending out over to the left outer thigh. Note the remarkable improvement in texture and color of the skin over time. That is a consistent finding with fat grafting close to the skin.
© Coleman 2008
More examples of correction of liposuction deformities using Dr. Coleman’s specific technique can be found at www.lipostructure.com.
Fat Injection: From Filling to Regeneration
Treatment of liposuction deformities
LipoStructure for Correction of Liposuction Deformities
Dr. Coleman’s book Structural Fat Grafting Chapter 6: Iatrogenic Corporal Deformities.
Posted under Home, Liposuction deformities
30
March
2009
The new ASPS Guiding Principles for Fat Injection to the Breast discusses the risks and complications based on a review of all published scientific information. They conclude that complication rates for fat grafting in general is not high compared to other procedures, and serious complications are “extremely rare.” Specific concerns about fat grafting to the breast interfering with cancer detection is not supported by any studies.
However, using some techniques for fat grafting to the breast can result in increased complications and a poor result. Therefore, the ASPS has emphasized, “The safety, efficacy and final outcome of any given case is dependent on the technique used.” They go on to say “studies indicate that results of fat transfer remain dependent on a surgeon’s technique and expertise.”
A patient should try to choose a physician who is an expert at fat grafting and has a long record of success.
This 55 year old woke up to find her silicone gel plant had ruptured. She had both removed along with the surrounding scarring four months before these photographs
6 1/2 years after the last of 2 fat grafting sessions. Her breasts now feel and look completely natural after only two sessions of fat grafting. In addition, her body has improved from the removal of fat from her abdomen and waist.
Patient has completely natural appearing breast 6 1/2 years after second fat grafting.
Subsequent posts over the next weeks will address the other findings of the American Society of Plastic Surgery’s task force on fat grafting to the breast. Stay Tuned!
For more detailed information about fat grafting to the breast, please refer toLipoStructure.com.
Check out these links more information on fat grafting to the breasts:
Dr. Sydney Coleman demonstrates Breast Reconstruction with LipoStructure on The Doctors
Coleman lectures on fat grafting for breast reconstruction at the American College of Surgeons
Lipofilling: a role in breast reconstruction surgery??From “Behind the Medical Headlines” produced by the Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow
Breast Augmentation Via Fat Grafting?From “Plastic Surgery Practice”
Breast Implant Problems Solved with Coleman Fat Grafting
Fat Grafting to the Breast Revisited: Safety and Efficacy.?Plastic & Reconstructive Surgery. 119(3):775-785, March 2007.?Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.
© Coleman 2009
Posted under Breast LipoStructure, Home
18
March
2009
In a new statement by ASPS entitled Fat Transfer/Fat Graft and Fat Injection ASPS Guiding Principles, fat grafting to the breast has been cautiously approved by the ASPS for use in breast reconstruction, breast shaping and breast augmentation.
Before (left) and 8 years 9 months after one fat grafting procedure of 332 ml to the right and 297 ml to the left. Patient had 10 pound weight loss between procedures
After ten years of experience with fat grafting to the breast using his specific technique, Dr. Sydney Coleman began presenting his results at plastic surgery meetings in 2005. Perhaps the most pivotal presentation by Dr. Coleman was in 2006 at the American Association of Plastic Surgery. His impressive long-term results resulted in an active discussion in the Plastic Surgery world on the use of fat grafting in the breast.
The American Society of Plastic Surgery had previously directed plastic surgeons to avoid placing fat in the breast due to safety and outcome issues. Dr. Coleman and others demonstrated that the original concerns were not based in any scientific evidence, and instead the evidence was in support of fat grafting to the breast.
As a result of Dr. Coleman’s many presentations, he was able to persuade Roxanne Guy, then president of the American Society of Plastic Surgery, to form a task force of plastic surgeons to revisit the issue of fat grafting to the breast. The task force began meeting in September 2007. “The task force reviewed the scientific literature, critically appraised the information available, and developed evidence based practice recommendations. The findings of the task force were then submitted to an approved without significant change by the American Society of Plastic Surgery and the Plastic Surgery Educational Foundation executive committees.
The recommendations indicated that “Fat Grafting may be considered for breast augmentation and correction of defects associated with medical conditions and previous breast surgeries.” The society also indicated that people should proceed cautiously because “results are dependent on technique and surgical expertise” as in every other surgical procedure.
Subsequent posts over the next few days will address the other findings of the American Society of Plastic Surgery’s task force on fat grafting to the breast. Stay Tuned!
Before (left) and seven years after (right) one fat placement of 190 ml on the right side and 245 ml on the left. Note the filling of the "cleavage" area and the very natural appearance (and feel) of the breast
For more detailed information about fat grafting to the breast, please refer to LipoStructure.com.
Check out these links more information on fat grafting to the breasts:
Dr. Sydney Coleman demonstrates Breast Reconstruction with LipoStructure on The Doctors
Coleman lectures on fat grafting for breast reconstruction at the American College of Surgeons
Lipofilling: a role in breast reconstruction surgery??From “Behind the Medical Headlines” produced by the Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow
Breast Augmentation Via Fat Grafting?From “Plastic Surgery Practice”
Breast Implant Problems Solved with Coleman Fat Grafting
Fat Grafting to the Breast Revisited: Safety and Efficacy.?Plastic & Reconstructive Surgery. 119(3):775-785, March 2007.?Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.
© Coleman 2009
Posted under Breast LipoStructure, Home
11
March
2009
Undersurface of forearm before (a,c) and 20 months after (b,d) one session of Coleman fat grafting
Back of forearm and hands before (above) & 20 months after (below) one session of Coleman fat grafting.
Whether forearms are small from birth defects, have missing areas as result of scarring from an accident, or have not grown enough despite a bodybuilder’s efforts, there are alternatives. One of the alternatives is structural fat grafting.
A 36 year old amateur bodybuilder presented frustrated because his forearms had not developed as well as the rest of his body after years of trying.
For this patient a thin layer was placed under the skin over a large portion of the forearm and back of the hand. In addition, some of the fat was used to sculpt the appearance of the forearm by filling in areas which the patient felt were especially deficient. A total of 201 ml of refined fat was placed in the right forearm and 192 ml on the left. In addition 29 ml was placed over the back of each hand (30 ml is an ounce). For safety reasons, no fat was infiltrated deeply into the muscles or around the muscles.The patient returned 20 months after the procedure, thrilled with the results, but desiring more volume still. He has obviously continued to exercise, but he feels that most of the change is from the fat grafting. Of particular note, he is surprisingly more vascular in appearance despite the superficial placement of the fat.
Posted under Forearm and Hand Rejuvenaton, Home
5
March
2009
Internet attacks on physicians: This problem has been going on for years, but an Associated Press story on March 4, 2009, has drawn attention to this important issue.
Docs seek gag orders to stop patients’ reviews
This article notes that some Internet reviews or complaint sites are little more than tabloid journalism without much interest in constructively improving practices. It goes on to say that their sniping comments can unfairly ruin a doctor’s reputation.
“Published comments on Web pages, blogs and/or mass correspondence, however well intended, could severely damage physician’s practice.”
Of particular importance is that the privacy laws and medical ethics leave doctors powerless to respond or really do anything. A physician is held to the highest standard of accountability for anything that he places on the internet (a website, blog or posting on a board). On the other hand, the postings on sites are often completely anonymous, so that there can be no accountability for anything said on them. For instance, RateMd’s postings are anonymous, and the site’s operators say they do not know their users’ identities. Furthermore, the operators won’t remove negative comments.
One of the main reasons that the operators do not remove even libelous comments is that they make money from such reviews attracting traffic to the sites. A quick look at the ads on the site will clarify the economic motives of most of the sites.
In the article, the reader is warned, “Online doctor reviews should be taken with a grain of salt, and should certainly not be a patient’s sole source of information when looking for a new physician.”
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Recently the Internet has become a battleground of attacks on physicians by anonymous persons. Below are a few of the numerous articles that have been written on the subject.
Battle of the blogs
Negative web logs targeting surgeons increasing
Plastic Surgery News
This informative article reviews the story of campaign to destroy the reputation of Dr. Coleman by creating websites and posting defamatory entries on multiple medical blogs.
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How my doctor fared on-line by Julie Deardorff’s column Julie’s Health Club in the Chicago Tribune
March 4, 2009
Insightful article which offers advice such as the following:
“Subjective information on user reviews is a little like gossip. On Angie’s List, I read about a genetic counselor (whom I’ve actually seen) who allegedly pushed a woman to terminate a fetus. Another person wrote that her doctor was “friendly, but condescending, and ultimately not helpful,” as she tried to make a major decision about treatment for fibroids.
A patient’s experience can be biased and manipulated—how do you know whether the opinions about a physician even come from that doctor’s patient?—but Given said a bigger problem is that there’s not enough information posted yet. Ratemds.com, for, example, has ratings on 12 percent of U.S. doctors, Given said. In Canada, the site has information on nearly 60 percent of physicians. Moreover, even if the sites start to get more feedback, it’s not necessarily representative…One nasty comment left by a patient who wanted a drug that wasn’t medically necessary, for example, could damage a reputation or career.”
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Gagging patients from online criticism from ZDNet Healthcare http://healthcare.zdnet.com/
This article reinforces that like RateMDs allow anonymous comments that can turn one unhappy visit into an online jihad.
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Doctor ratings: Is your healthcare hot or not?
Online, patients-as-consumers are reviewing doctors. It shifts the balance of power, but raises the question of whether consumers can simply rate an M.D. like they’d review an HDTV. By Shari Roan ?May 19, 2008
Ends her article with the message, “the reviews on RateMDs.com, Vitals.com, DrScore.com and other sites are skewed by disgruntled patients and are thus unfair, pushing some doctors to near-ruin after a single post.
“These sites don’t yield enough power yet to get bad doctors to change. And in the meantime, they may hurt good doctors,” says Dr. Phyllis Hollenbeck, a Washington, D.C., family physician and author of “Sacred Trust: The Ten Rules of Life, Death and Medicine,” a new book promoting patient empowerment. “It only takes one or two scathing comments and a doctor is put in a terrible position.”
The sites, more than two dozen of them, vary in how they operate, their scope of information provided and their efforts to be fair. But the trend is toward free, anonymous, no-holds-barred forums. Some sites have grown out of existing ratings services. Five years after he started the hugely popular RateMyProfessors.com, John Swapceinski and his business partner turned to medicine, launching RateMDs in 2004.”
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Censorship, or Sensible Citizenship? Physicians Take steps to Stop Online Libel Feb 24 2009
Published by Presidio Insurance under National News
More to come!
© Coleman 2008
Posted under Home, Media
26
February
2009
THE DOCTORS television show followed a patient of Dr. Sydney Coleman’s through her breast reconstruction after breast cancer. She had already had a lumpectomy, radiation therapy and multiple reconstructive procedures. Dr. Coleman reconstructed not only the hard, scarred area of the lumpectomy but also placed fat around her hard implants in an effort to soften them. He also treated the opposite breast that had been left with an abnormal shape after a breast lift.
In the segment, Dr. Coleman explains how LipoStructure differs from liposuction and then he simulates the steps of the procedure live on the show. Liposuction is the procedure in which fat is removed from beneath the skin through hollow tube connected to a source of suctioning. On the other hand LipoStructure is a type of fat grafting procedure in which the fat tissue is removed from one area and placed back into an area in which there is something missing.
LipoStructure is a trademarked word, which describes the procedure Dr. Coleman developed.
The first step of LipoStructure is to harvest the fat using a syringe. On the set of The Doctors, Dr. Coleman demonstrated the first step of LipoStructure by placing a blunt needle connected to a syringe into simulated fat. Then by placing a gentle suction on the syringe with his hand, Dr. Coleman was able to suction the simulated fat up into the syringe.
Dr. Coleman then demonstrated the placement of fatty tissue using a clear plastic model. Through one entrance site in the plastic mold, the audience can clearly see Dr. Coleman move the blunt needle back and forth fanning over a large area to demonstrate the method in which he normally places fat into the human body.
After the demonstration of fat grafting, The Doctors reenacted the life of one patient “Kathy” from the time she discovered her breast cancer through multiple cancer and reconstructive surgeries that she said left her horribly scarred and disfigured. After extensive research she was able to find Dr. Coleman. The Doctors television show filmed Kathy’s preparation for surgery and then the entire surgery by Dr. Coleman in New York City.
A brief excerpt from the show can be viewed on The Doctor’s website if you click here.
Toward the end of the television segment, Kathy sat in the procedure room two weeks after her operation and updated Dr. Ordon and Dr. Coleman on her recovery. She said that in a short amount of time she was able to perform routine chores, go shopping and lift her grandchildren. She announced that her scars had faded dramatically and she feels great.
Dr. Coleman’s LipoStructure technique not only changes the shape and size of your breast, but it can take years off your face! On the show, Dr. Travis shows before-and-after photos of another patient. Nearly four years after her surgery, she still retains an amazingly youthful appearance. LipoStructure also can restore a youthful appearance to your hands Dr. Travis says. He displayed a picture of a gnarled hand. The same hand eight years after LipoStructure had a youthful, smooth texture.
This technique is used not only for breast reconstruction, but also creating a bigger buttock or treating liposuction deformities. On the face it can be used for strengthening a jaw-line, making pouty lips, correcting nose surgeries, and even treating birth defects.
__________________________________________________________________________
For more detailed information about fat grafting to the breast, please refer to LipoStructure.com.
Check out these links more information on fat grafting to the breasts:
Coleman lectures on fat grafting for breast reconstruction at the American College of Surgeons
Lipofilling: a role in breast reconstruction surgery??
From “Behind the Medical Headlines” produced by the Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow
Breast Augmentation Via Fat Grafting?
From “Plastic Surgery Practice”
Breast Implant Problems Solved with Coleman Fat Grafting
Tuberous Breast Deformity Corrected with Coleman Structural Fat Grafting
LipoStructure for Breasts
Fat Grafting to the Breast Revisited: Safety and Efficacy.?
Plastic & Reconstructive Surgery. 119(3): 775-785, March 2007. ?Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.
And just published…
Fat Injection: From Filling to Regeneration
© Coleman 2008
Posted under Breast LipoStructure
29
October
2008
Injection of fat grafts into the nose provides surgeons with new tools to compliment their nasal surgery. Fat grafted to the nose by the Coleman method is surprisingly well integrated, assuming the structural a quality of the part of the nose into which it is placed.
Shape
Rhinoplasty surgeries often leave a nose with an “open roof.” The cartilage and bony parts of the nose have been separated so that it looks like a long trough through which the septum can be felt or even seen through the thin skin on the nose in this condition. In addition, the cartilage or bone can become deformed in many ways after rhinoplasties. The skin of the nose in some patients is so thin that irregularities can be amazingly visible, so that many structures are painfully visible through the skin after nasal surgery.
This woman had four nose procedures on both coasts and silicone injections to the nose. Follow-up at one year from one procedure (right) reveals a remarkably more normal appearing nose. The upper nose flows more naturally into the lower nose, with a more distinct central light reflex and many less irregularities. Placement into the nostril rim flattened the notching and appears to have pushed the nasal tip over to the middle from the right.
Coverage
Placing a thin layer of fat under the skin provides support for the skin and can disguise visible irregularities of the cartilage and bone. Concentrating the fat grafts into specific areas can improve the light reflex down the middle of the nose or subtly change the proportion of one part of the nose to another part.
This patient presented after at least 12 previous nasal procedures, including GorTex placement and removal, numerous cartilage grafts from her ears and one from her chest. The markings demonstrate the areas of placement. One year after one procedure, you can see softening of the irregular cartilages along with an apparent thickening of the skin over the entire nose. The area between the eyebrows is slightly fuller with a lessening of the frown wrinkles.
© Coleman 2008
Posted under Facial Reconstruction
16
October
2008
Sydney Coleman presented his experience with breast reconstruction using LipoStructure® at the American College of Surgeons Annual Meeting this week in San Francisco. In the section Reconstruction & Breast Cancer: Techniques & Approaches to Optimize Outcomes in Reconstruction after Partial & Total Mastectomy, Dr. Coleman gave a lecture “Fat Grafting in Breast Reconstruction.” During the lecture, he recounted his twelve-year experience with fat grafting in breast reconstruction. Of particular importance, the effect of grafted fat to reverse the problems of therapeutic irradiation and hard breast implants was presented.
Dr. Coleman began his lecture by discussing a lumpectomy patient (above leaning forward) who had a lumpectomy on her left breast followed by six weeks of therapeutic radiation. A few months after the treatment, she developed severe pain and hardening of her breast. Her treated breast became so hard that mammograms were not possible, and she had to have MRI’s instead. She could barely raise her arms over her head without encountering shooting pain.
When the patient returned at 2 weeks (above) she was amazed at how rapid her recovery had been. She also commented that her shooting pains in the site of the radiation were notably less. When she returned at 6 weeks, she said that the pain had almost completely disappeared, and the hard areas of her breast were much softer. At 13 weeks, she went to see her surgical oncologist, who was so impressed by the softness of her breast that she went ahead and ordered a mammogram, which was now easy on a soft, painless breast. She returned at 7 months ready now for a second procedure this procedure aimed this time at adjusting the contour of the breast.
Dr. Coleman explained that after conservative breast therapy for cancer (lumpectomy followed by irradiation), a woman is left with a defect that is often difficult to reconstruct. Therapeutic radiation is a critical component of breast conservation treatment to decrease the possibility of the cancer returning near the site of the original cancer. Unfortunately, radiation combined with a saline or silicone gel-filled implant remarkably increases the incidence of scarred or hard breasts (breast capsular contracture), infection and rejection of the silicone implant. Therefore, placement of an implant in these conditions often results in a poor cosmetic result. Putting fat to a breast after lumpectomy and irradiation not only restores the breast by adding volume and reshaping the breast, but also promotes the in creation of a blood supply and the healing of the radiation damaged breast. This effect also occurs in the face after treatments with radiation (see facial reconstruction) and may also be similar to the effect of fat grafting on sun damaged skin (see progressive improvement in skin quality after fat grafting).
Dr. Coleman concluded his lecture with the comment that long-term studies still need to be completed. He is 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.
Related articles:
Lipofilling: a role in breast reconstruction surgery?
From “Behind the Medical Headlines” produced by the Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow
Breast Augmentation Via Fat Grafting
From “Plastic Surgery Practice”
Breast Implant Problems Solved with Coleman Fat Grafting
Fat Grafting to the Breast Revisited: Safety and Efficacy.
Plastic & Reconstructive Surgery. 119(3):775-785, March 2007.
Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.
© Coleman 2008
Posted under Breast LipoStructure
