Tribeca Plastic Surgery Blog - New York Plastic Surgeon Dr. Sydney Coleman » Facial Reconstruction

Treating Facial War Injuries with Coleman Fat Grafts Update

Dr. Coleman — Sun, 20 Mar 2011 20:00:11 +0000

A New Report of United States Department of Defense Project to Study the Use of Coleman Fat Grafts in Facial War Injuries

Dr. Coleman continues to travel monthly to the University of Pittsburgh Medical Center (UPMC) to operated on soldiers with facial war injuries using Coleman Fat Grafts. The Sunday Pittsburgh Post-Gazette updated their previous report of the ongoing studies at UPMC. The following is an excerpt from the news article:

Sculpting with fat can restore faces (excerpt of original article)

New techniques use fat cells to smooth visages of veterans devastated by injury

Sunday, March 06, 2011
By Mark Roth, Pittsburgh Post-Gazette

Robin Rombach/Post-Gazette Jeremy Feldbusch lost his sight after a piece of artillery shrapnel tore through his skull in Iraq in 2003. He underwent a new procedure that transferred fat from other parts of his body to fill in the side temple area of his head

Jeremy Feldbusch lost his sight after a piece of artillery shrapnel tore through his skull in Iraq in 2003. He underwent a new procedure that transferred fat from other parts of his body to fill in the side temple area of his head.

Jeremy Feldbusch can’t see the results of the special cosmetic surgery he recently got — but he’s pleased when people tell him what a good job the doctors did.

Mr. Feldbusch is blind because a piece of artillery shrapnel tore through his skull in Iraq in 2003. In January, UPMC surgeon J. Peter Rubin took fat from his abdomen and thighs and injected it into cavities that his war injuries had left on his face.

Dr. Rubin, recently named chief of the Division of Plastic and Reconstructive Surgery at UPMC, has received $4.5 million from the Department of Defense for his fat resculpting project, and so far has performed the surgery on 11 injured veterans.

Using techniques developed by New York plastic surgeon Sydney Coleman, who has assisted on the surgeries here, Dr. Rubin’s team removes fat cells from a patient’s body, centrifuges them to collect the most active cells, and injects theminto injury sites using tiny tubes that can be as narrow as an intravenous needle .Fat injections have been used in cosmetic surgery for years, but the problem has been that in many cases, the fat is absorbed by surrounding tissues and the work has to be done over.

Dr. Coleman’s centrifuge technique is designed to prevent that by concentrating the fat cells, which helps them to thrive and grow new blood vessels once they are injected.

In a broader sense, Dr. Rubin’s project is part of a fast-growing movement around the world to use fat stem cells to generate new tissues for all sorts of conditions, from breast reconstruction to growing new bone.

Most human tissues contain stem cells that can generate new cells of the same type to promote healing. Fat stem cells can not only grow new fat cells, but in the lab, they have been turned into bone, cartilage, skin and muscle.

In Japan, doctors have now used fat stem cell injections in hundreds of women for breast enlargements, and report that the women think the results feel and look much more natural than synthetic implants, he said.

UPMC’s Dr. Rubin is also working with fat stem cells for reconstruction in women who have had breast cancer. Because stem cells can promote tissue growth and new blood supply, there has been some concern that these injections might trigger a recurrence of the breast cancer, he said, “but our best evidence now shows if you have dormant cancer cells present, they are not likely to be reactivated by fat stem cells.”

While some of the fat that Dr. Rubin injected into Mr. Feldbusch and the other injured soldiers consists of stem cells as well, the next step of his research will be to grow additional fat stem cells in the lab and “enrich” the mixture of fat cells that are put into the injury sites.

Fat stem cells, like those now growing in Mr. Feldbusch’s face, have two complementary benefits

In some cases, they remain fat cells when they are put in the body, but can promote blood vessel growth and healing in other tissues, which has been shown in experimental work on heart disease patients. In other cases, they can morph into completely different kinds of tissue

And they have one other advantage, Dr. Gimble said: People are happy to donate them. “There is no other tissue that someone will actually pay their doctors to take out of them,” he said.

First published on March 6, 2011 at 12:00 am

Read more: http://www.post-gazette.com/pg/11065/1130053-114.stm#ixzz1Gtdir2DF

Further reading:

The first report in the Post-Gazette back in November 2010

Update on Coleman Fat Grafting to the Nose

Restoration of Missing Facial Tissue Important Alternative to Traditional Surgeries

The treatment of face and neck scars with structural fat grafting

Dr. Sydney Coleman presents LipoStructure to maxillofacial and craniofacial surgeons

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

Coleman Structural Fat Grafting to the Nose

Update on Coleman Fat Grafting to the Nose

Dr. Coleman — Mon, 07 Mar 2011 19:38:41 +0000

You may remember this person who I showed you on my blog 2 ½ years ago (at that time she was only one year after her first procedure). She returned to my office for a Zeltiq treatment, extremely satisfied with her appearance now. I was able to obtain photographs of her that are now one year after her second (and final) nasal procedure with me.

She had been operated upon by some of the most famous nasal surgeons in the world. One year after her second procedure, you can see remarkable softening of the irregular cartilages along with an apparent thickening of the skin over the entire nose.

Patient presented after 12 procedures which left her as a nasal cripple (left) with irregular cartilage, bone and GorTex visible through her thin nose skin. Placement of LipoStructure® over the entire surface of the nose from brows to the tip transforms her nose (right)

: One year after her second fat grafting procedure her nose finally looks normal (right)

A thin layer of fat placed immediately beneath the skin creates support for the skin and covers irregularities from visible pieces of cartilage and bone. Concentration of the fat grafts into specific areas may improve the light reflex down the middle of the nose or change the proportion of one part of the nose to another.

. Written by the office staff at TriBeCa Plastic Surgery

Read about Dr. Coleman’s development of these special procedures in Cosmetic Surgery Times.

For more information please refer to earlier posts:

Dr. Sydney Coleman presents treatment of radiation injury

Dr. Coleman — Wed, 04 Aug 2010 21:41:11 +0000

Sydney Coleman of New York City Presents Studies which Validate the use of Fat Grafting to Reverse Radiation Damage

At the annual meeting of the European Association of Plastic Surgeons this year, Sydney Coleman presented cutting edge studies which verified in animal models the healing effect of structural fat grafts on skin that had been exposed to therapeutic radiation. For over a decade, Dr. Coleman has been treating patients with damaged tissue due to radiation injury. Not only has he witnessed the survival of the fat grafts, but also he has noted a significant improvement in the quality of skin in almost every patient.

The research was performed in the laboratories at NYU Medical Center. Dr. Coleman reports, “Our research verifies my observations over the last ten or more years that fat does not just survive when placed into irradiated tissues, but it reverses the radiation damage in almost every case.”

In the NYU study, mice were exposed to enough radiation to cause hair loss (alopecia) and skin damage over a four-week period. At four weeks, fat grafts that Dr. Coleman personally processed using the “Coleman technique” were transplanted under the radiation damaged skin. Other mice were treated similarly using normal saline (saltwater). In the mice treated with fat grafts, first the blood supply increased and then the hair grew back, the scarring reversed and the skin softened. In the mice treated with normal saline, the hair loss and scarring progressed and the mice never healed.”

Dr. Coleman further comments, “these findings verify that this type of fat grafting alleviates radiation damage to skin and underlying tissues by improving the blood supply and softening scarring.” This process is probably due at least in part to stem cells and hormones present in structural fat grafts. “The best way to think of these primitive cells present in fat grafts is as ‘repair cells’ that actively maintain your body by repairing damage as it occurs daily.” (If you scratch your skin, or break a bone, et cetera). ”When placed into an area of subacute damage such as a radiation injury, the ‘repair cells’ and hormones heal the tissues. This is truly an example of using a person’s own body to heal themselves…regenerative medicine.”

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 inthe irradiated skin, muscle and bone.

Dr. Coleman and several plastic surgeons in Europe, have been using his fat grafting technique to cure radiation damage in many breast cancer patients. An extraordinary reconstruction of a jaw deformity from therapeutic radiation was mentioned in this blog last year. Click here to read the posting. Dr. Coleman and other plastic surgeons in Europe have had success in reversing alopecia (hair loss) and other scalp damage from therapeutic radiation.

Dr. Coleman published his experiences with the treatment of therapeutic radiation damage first in 2006 in the Journal of Plastic & Reconstructive Surgery.

. Written by the office staff at TriBeCa Plastic Surgery

More examples of reconstruction using Dr. Coleman’s specific technique can be found at www.lipostructure.com.

Further reading:

Dr. Sydney Coleman Introduces Improvements to Fat Grafting

Dr. Coleman — Tue, 27 Jul 2010 21:41:55 +0000

Sydney Coleman, a plastic surgeon in New York City, continues to improve fat grafting methods

Dr. Sydney Coleman is recognized as the world’s leading expert on fat grafting. It has been through his perseverance and insight over the last 22 years that fat grafting is becoming an important part of medicine. In the last four years, Dr. Coleman has improved dramatically the method he uses for fat grafting. The advanced methods he now uses for fat grafting not only increase the predictability of fat graft survival; but also, more importantly, the new techniques maximize the reparative effect of grafted fat on the tissue around which it is placed. Using his newly developed method, fat grafted under sun damaged and aging skin repairs the overlying skin. The eyelid of the patient below demonstrates the dramatic change that grafting fat in one procedure can have on overlying wrinkles.

Before (above) and two years after one procedure to lower eyelids in a 76 year old with no other treatment to her lower eyelids

Fat grafted under skin in the lower eyelid repairs the skin to a more radiant, youthful appearance

Probably through the same mechanism of repair, grafted fat has been shown to repair the tissue damage caused by radiation from cancer treatment. Dr. Coleman has been actively participating in laboratory research at NYU Medical Center, which has enabled him to verify his new advances in grafting fat. This new way of grafting fat increases the predictability of the volume of fat grafted, but more importantly, it maximizes the effect of grafted fat on the tissues around which it is placed.

Dr. Coleman has been speaking at meetings worldwide over the last few months to relate the advances that he has made in the last five years in fat grafting. In June alone he has given lectures in Manchester, UK; Ghent, Belgium; Aachen, Germany; Iceland; and Halifax, Nova Scotia. Earlier this year, he gave a series of lectures at a maxillofacial/craniofacial meeting in Baltimore, at the Egyptian Society of Plastic Surgery meeting outside of Cairo, at an international hand meeting in Paris, at a meeting in Los Cabos in Baja California, at a symposium of the Plastic Surgery Education Foundation meeting in Snowbird, Utah, at a breast meeting in Miami, at the American Alpine Workshop in Plastic Surgery meeting in Jackson Hole, Wyoming, and at a Regenerative Surgery meeting in Rome.

And Dr. Coleman continues to travel to Pittsburg monthly to use fat grafting on soldiers with facial war injuries. This is part of an Armed Forces project at University of Pittsburgh Medical Center supervised by the US Department of Defense.

. Written by the office staff at TriBeCa Plastic Surgery

To read the Cosmetic Surgery Times article on the use of fat grafts with stem cells for rejuvenation, please click here.

For further articles about this subject

Dr Sydney Coleman Joins Surgical Team to Treat Facial War Injuries with Fat Grafting

Dr. Coleman — Thu, 19 Nov 2009 18:59:03 +0000

The Department of Defense just awarded a $1.6 million grant to help soldiers recover from devastating facial injuries using innovative surgical technologies based on the biology of fat tissue. Peter Rubin a noted scientist and plastic surgeon, will head up a surgical team that will use the fat grafting techniques developed by Sydney Coleman to reconstruct 20 American veterans.

In a news article released on Veteran’s day last week, Dr. Rubin noted that to counteract certain basic biological challenges the surgical “team will use techniques and innovative equipment developed by Dr. Sydney Coleman, a New York plastic surgeon who will be part of the research group.” The news article goes on to say, “Dr. Coleman has developed a centrifuge …that concentrates the fat…and raises the proportion of stem cells…that can help the fat tissue grow new blood vessels. Dr. Coleman has developed special surgical tools for facial reconstruction work, Dr. Rubin said, particularly tiny tubes called cannulas…that can be used to implant the fat cells beneath the facial skin.”

Dr. Sydney Coleman used three sessions of fat grafting to reconstruct the missing portion of this man's face. Similar techniques will be used to reconstruct the war casualties

“As many as 26 percent of wounded soldiers suffer some kind of facial injury, which can have a huge impact on quality of life,” said Dr. Rubin in a recent press release. “While we can reconstruct bony structures very well, it is the surrounding soft tissues that give people a recognizable face. This project will investigate how soft tissue grafting can more precisely restore facial form and improve the lives of our wounded soldiers.”

The use of fat grafting for serious facial injuries, such as those resulting from roadside bombs is facilitated in this project by using specially designed devices and instruments for harvesting fat tissue and implanting it into regions of scarred tissue.

“Fat grafting, or moving fat tissue from one part of the body to another, has been used as a cosmetic procedure for decades,” said Dr. Rubin. “We are now applying these same techniques for reconstructive surgery to accurately restore facial form after battlefield injuries.”

More examples of reconstruction using Dr. Coleman’s specific technique can be found at www.lipostructure.com.

Further reading:

Restoration of Missing Facial Tissue Important Alternative to Traditional Surgeries

The treatment of face and neck scars with structural fat grafting

Dr. Sydney Coleman presents LipoStructure to maxillofacial and craniofacial surgeons

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

Coleman Structural Fat Grafting to the Nose

Facial Reconstruction New York City

Dr. Coleman — Mon, 20 Jul 2009 19:20:08 +0000

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.

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.

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.

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

Coleman Structural Fat Grafting to the Nose

Dr. Coleman — Wed, 29 Oct 2008 21:44:20 +0000

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.

Dr. Sydney Coleman presents LipoStructure to maxillofacial and craniofacial surgeons

Dr. Coleman — Fri, 03 Oct 2008 01:12:17 +0000

In Bologna, Italy, during the 19^th 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.