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.
Posted: 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: Breast LipoStructure
15
October
2008
The New York Times recently mentioned Sydney Coleman’s fat grafting treatment, LipoStructure®, for hand rejuvenation.
“Dr. Sydney Coleman, a plastic surgeon in New York, has developed a procedure over the last 10 years that involves putting up to a thousand tiny injections of a person’s own fat into their hands; the procedure, which costs at least $12,000, is done in-office and the results last over a decade, he says. The patient is likely to endure about three weeks of puffiness and redness, he said.”
This article used photographs of the back of the hand after Coleman fat grafting. The photographs demonstrate progressive improvement of the quality of skin over eight years (above) after only one treatment.
Grafted fat does more than simply restore fullness. After placement of the fat, changes occur in skin overlying the grafted sites over the next few week, months and years (for instance, immediately after implantation, in the first months, at one year, three years, five years, eight years et cetera). The volume of the fat appears to stabilize four months after the procedure, but the texture of sun damaged or scarred skin appears to improve in the ensuing months and years.
For more information of fat grafting to the aging hand, please refer to earlier post “Hand Rejuvenation with Coleman Fat Grafting”
© Coleman 2008
Posted: Hand Rejuvenaton
2
October
2008
In Bologna, Italy, during the 19th Congress of the European Association for Cranio-Maxillo-Facial Surgery (EACMFS) Dr. Coleman presented a special one-hour lecture. The lecture was entitled, “The Role of Structural Fat Grafting in Aesthetic and Facial Reconstructive Surgery.”
Dr. Coleman reviewed patients from his 22-year experience of treating patients using structural fat grafting in facial reconstructive problems.
The use of fat grafting was demonstrated to aid in the correction of a large number of facial deformities, including hemifacial atrophy (Parry Romberg syndrome), hemifacial microsomia, Treacher Collins syndrome, phlagiocephay, secondary cleft lip problems and cancer survivors with significant face and neck deformities from surgery and radiation.
Patient with a significant deformity 15 years after removal of cancer from the left lower face along with muscles and other tissues followed by irradiation (left before). One year after only two fat grafting sessions (right after), the face appears and feels normal.
© Coleman 2008
Posted: Facial Reconstruction
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.
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.
