July
2009
Facial Reconstruction New York City4
Restoration of Missing Facial Tissues Important Alternative to Traditional Surgeries
NEW YORK CITY, NY - Sydney Coleman, a Plastic Surgeon in New York City, has demonstrated that fat grafting has an important place in facial reconstructive surgery. Dr. Sydney Coleman has shown at international meetings throughout the world that fat grafting can replace many more complicated, less effective methods of reconstruction. A patient whose case was published previously in Plastic and Reconstructive Surgery returned recently 18 months after his last procedure with an exciting result.
BEFORE FAT GRAFTING Radiation and surgery cured this young man of cancer, but left him missing one quarter of his face.
This 23 year old patient was discovered to have a rhabdomyosarcoma cancer of the masseter muscle (the muscle on the side of the face used for chewing) when he was eight years old. He was successfully treated with removal of many of the muscles of his face and therapeutic radiation to the left lower face. In the areas of the radiation, his facial and skull bones did not grow normally, and he was left with a severely deficient lower left face (see above). In addition, the skin of the irradiated area was extremely fragile and beard growth abnormal. He had had no procedures done since his original cancer surgery.
BEFORE (left) and AFTER (right) Three sessions of Coleman fat grafting.
Between 2004 and 2008, three Coleman fat graft procedures were performed to arrive at the above result (which is eighteen months after the third procedure. The fat was layered through tiny incisions over the lower one-quarter of this young man’s face and over the lower part of the skull (mastoid) using special tools developed by Dr. Coleman. The layering started at the bone each time and extended out to the skin.
BEFORE (left) and AFTER (right) Tilted views reveal more of the profound loss of structure.
BEFORE (left) and AFTER (right) Oblique views further demonstrate the extent of missing bone and muscle.
One of the most important reasons for using fat grafts in such situations is that the stem cell and growth factors present in fat grafts may promote healing of the damaged tissues.
Surgeons are hesitant to operate on body areas which have been treated with radiation because they heal poorly or not at all after a surgical procedure. Recent evidence points to the healing of radiation injury and even improvement in the appearance of aging skin by fat grafting to an area. The healing most likely takes place by bringing in stem cells (or repair cells) which build new blood vessels and capillaries to the irradiated skin, muscle and bone.
In addition to treating acquired deformities from radiation therapy or accidents, Dr. Coleman has successfully treated facial deformities such as birth defects, Romberg Syndrome, Treacher Collins Syndrome, problems from childhood cancers, radiation damage, vascular tumors and cleft lip deformities with Coleman fat grafting.
© Coleman 2009
More examples of reconstruction using Dr. Coleman’s specific technique can be found at www.lipostructure.com.
Further reading:
The treatment of body scars with structural fat grafting
Fat Injection: From Filling to Regeneration
In Dr. Coleman’s book Structural Fat Grafting
In Chapters 17 & 18 of Dr. Coleman’s book Fat Injection: From Filling to Regeneration
Treatment of the aging hand with LipoStructure
NY Times shows photos of progressive improvement in skin quality with Coleman Fat Grafting
This photos inspired me, because I look exactly like this man, but live in South Africa with no hope of ever raising money for such an operation. My maseter muscle was damaged by radiation of 60 gry which apparently was too severe for a beningn tumour of the parotis gland. please send me more info to show my specialist.
If you are unable to travel to New York, we would suggest that you contact a plastic surgeon in your area who travels to meetings frequently in France and Italy, and treats radiation injuries with fat grafting.
Office of Dr. Coleman
I also have a remarkably similar profile as in the patient on your site. After cancer surgery and Neutron radiation the right side of all my facial tissues were damaged. In 2007 I had the right mandible resected and an attempt to do a titanium transfer failed. With no options left, I tried fat grafts inserted in a tubular form with poor results, I was told that the scar bans prevented the transfer. Now,in Chicago, I met a doctor who said fat injections might work. Obviously,I am very afraid of another failure and wonder if injections might give a lumpy effect because of the scar bans and tissue adhesions.
Could you give me an opinion as to whether fat injections versus fat grafts could achieve a result as shown with the patient shown on your website.
.
Maureen,
You need a thin layer of extremely concentrated fat placed over the damaged parts of right side of your face next. Therapeutic radiation damage rarely if ever gets better with time. Rather the injury is progressive over the years, only worsening. The clinical experience and now the studies we have done at NYU show that such a layer can decrease the fibrosis (hardness) of your irradiated areas and improve the blood supply. The manner of concentration, the method, level and amount of placement are critical, especially at this stage.
The first stage should be done and then we should wait three or four months to give the infiltrated concentrated fat grafts a chance to bring in a new blood supply and reverse the hardening of the area. Only after the healing has begun should we consider placing a volume of fat to correct the contour deformity.
The technique used to harvest the fat, concentrate or refine the fat and place the fat can influence the result remarkably. Plastic surgeons have been grafting fat since 1893 and they have been injecting fat since at least 1908. Some have reported great results, and others have reported variable results. A big part of that difference is due to the technique used. With radiation injury like you have, the approach becomes even more complicated because the timing and level of the fat placement is even more important.
By the way, “fat grafting” or “fat transplants” just means moving fat from one part of the body to another. It can describe many, many different techniques. The method that you describe in your note is cutting out a piece of fat (often attached to the skin dermis), surgically opening a hole in the face and literally stuffing the section of fat (and skin) into the hole.
I hope this helps you.
Sydney Coleman