“The Surgeon Who Injects Women with Fat

Well, they do ask him to… Just when we’ve got used to fillers for the face, along comes a remarkable body resculpting technique”

Dr. Sydney Coleman holding a fat grafting cannula in his operating theater surrounded by his nurse, physician's assistant, and centrifuge Photo by Mike McGregor

“It is the last place in the world you’d expect to hear someone praising fat. But, in a chic Manhattan plastic-surgery clinic populated by impossibly lean women, Dr Sydney Coleman is doing just that, while explaining a new technique with radical implications for cosmetic and reconstructive work.

LipoStructure, or lipomodelling as it’s also known, involves taking a patient’s own body fat and reinjecting it to sculpt, fill, correct and enhance other areas. We may have got used to the idea of injectable fillers for the face; now it’s body recontouring that’s the growth industry. And, for more and more surgeons, fat is the tool of choice. In the right hands, the results are extraordinary: it can fill scars and hollows, smooth creases, retouch cellulite dimples, as well as plump and sculpt breasts and bottoms.

One of the most popular procedures Dr Coleman offers is taking fat from the abdomen and reinjecting it into the breasts, which is, as one surgeon puts it, “the answer to a maiden’s prayer” – weight loss, waist definition and breast enhancement all in one procedure.

But aren’t people squeamish about using their own fat? “They love it,” Dr Coleman says, with a big smile. “The abdomen and love handles are always my first choice because that makes the woman thinner.” Fat can, of course, be taken from anywhere it’s not wanted on the body and, as Dr Coleman says, “There’s no blood and no cuts. There are just these little puncture sites.”

Coleman first started investigating fat-grafting in the late Eighties when, he explains, “I’d go to a cocktail party and women would pull me aside and complain about their thighs and abdomens after liposuction. So that was the original motivation – to help these women who were coming to me saying, ‘What am I supposed to do now?’?”

Back when liposuction was a new procedure, many surgeons would remove too much fat from thighs, leaving them hollowed and irregular, he says. “I visited people in California and Virginia and spoke to people in France who were doing fat-grafting for the correction of liposuction deformities, but they’d never had good experiences. So I looked at what they were doing and tried to do it a little differently. I tried to bring it down to more basic principles.”

The principles may be basic, but the work is also extremely precise. Coleman’s technique involves harvesting fat very gently through low-vacuum cannulas before using a centrifuge to separate the oil and water. (Traditional liposuction techniques, which involve exerting a lot of negative pressure, can harm the fat and increase the chances of it dying once it’s been grafted, meaning it forms hard lumps.) The treated fat is then reinjected, one droplet at a time, in a lattice formation. It’s a delicate and painstaking process, with no room for error.

The surgery’s “two-for-one” aspect is not its only appeal. Unlike most conventional breast augmentation surgery, there is no scarring. There are also none of the aesthetic and practical problems that come with implants, and fat-grafting affords the surgeon more control – and room for artistry. “With silicone, you’ve got a bag and you make a hole and stuff it in the hole,” says Dr Coleman. “It’s a prefabricated volume. But with fat-grafting, you have to completely visualise everything in three dimensions. You can really shape the breast and improve projection and I’m able to go anywhere – to make cleavage, to feather into the side.” Some of the most impressive before-and-after pictures he shows involve subtle but radical changes to breast shape: an obvious implant, for example, is edged with fat and instantly becomes natural-looking.

Linda Francipane, a 44-year-old hairdresser from Queens, was an early patient of Dr Coleman’s and underwent breast augmentation surgery having spent “many, many months” researching her options. This included speaking to a lot of strippers about their implants. “I’d say 40 to 50 per cent had some kind of issue with them – whether they leaked, or the look, or the feel,” she says.

She was nonetheless determined to do something about her flat chest. “You’d be out clubbing,” she says, “and all the hot girls had tremendous boobs and I really had nothing, like nothing. This was the time when everybody was getting implants and I was like a little boy. I just wanted to get in the game.”

When a friend told her about Dr Coleman’s technique, “It seemed like a fabulous alternative to putting something foreign in my body.” She went from “below an A” to a 36C and says, “The way he did them, you can’t tell. It’s terrific. It changed my life.” She says she’s still receiving compliments.

Tal, a 36-year-old from Portland, Oregon, is another of Dr Coleman’s patients. She had implants when she was 19 but was so dissatisfied, she had them removed after just nine months. “I couldn’t breathe properly. It was just a very foreign feeling,” she explains.

As soon as she heard about breast augmentation by fat-grafting, she booked a consultation with Dr Coleman. “I thought nothing could be worse than what I had, so, even if he messed up, it would still be better. I had nerve damage from the breast implants, and stretch marks, and some scarring from under the nipple where it had been cut open. The tissue gets so stretched that I was actually flatter after breast implants.”

She wanted “breasts that were heavier at the bottom – a kind of Seventies look. I wasn’t comfortable being showy – my identity is really that of a flat-chested girl. It’s hard to create a natural-looking shape; I don’t know how he does it, but it’s just perfect – exactly what I wanted. He’s an artist. I don’t know if I’d trust anyone else.”

Tal also adds, “I don’t even wear a bra,” before laughing and reflecting, “I probably should, since I made such a large investment.””

CREATING CURVES WITH FAT GRAFTING

by Catherine Piercy

“For bigger jobs, fat grafting by injection—reinjecting one’s own fat into areas that have steadily deflated with time—is emerging as an exciting recontouring tool.

Once something of a fringe procedure, fat grafting was pioneered by Coleman in the mid-eighties, when the emergence of liposuction meant that large volumes of fat were suddenly available.  These days, surgeons travel from around the world to learn his trademark LipoStructure technique.  And while pharmaceutical giants are racing to develop synthetic counter-parts for big-picture recontouring—like Macrolane, the hyaluronic acid-based filler that has received mixed reviews in Europe, where it’s approved for use—plastic surgeons agree that the unique advantages of fat, which is easily recognized by the body and, once grafted, may last anywhere from several years to a lifetime, make it

a particularly appealing body-sculpting medium.”

Buttock Augmentation before (left) and one year after one fat injection session

Before (left) and eight months after correction of liposuction deformity of the hips and abdomen

…in its present incarnation, doctors agree that fat grafting offers some uncommon advantages…to address common liposuction deformities, a corrective dose of fat can restore feminine angles and lost definition to overtreated arms, abdomens, or thighs…fat grafting to the posterior can add back some significant lift.  For an extra boost, a few c.c.s in the crease where your bottom meets your thigh pushes everything out and up.”

6 years after one injection of fat into the left buttock crease, a remarkable change of the relationship between the thigh and the leg is created by LipoStructure

Please read our previous post on October Vogue’s article

.   This post brought to you 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:

• Improvements in Structural Fat Grafting
• The possible role of stem cells in facial rejuvenation

• The treatment of face and neck scars with structural fat grafting
• Dr. Sydney Coleman presents LipoStructure to maxillofacial and craniofacial surgeons
• 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

Blow Up

by Catherine Piercy

“If a definitive picture of twenty-first-century aesthetic medicine is beginning to emerge, its one in which the boundaries between science fiction and reality are slowly giving way.  Take, for instance, Sydney Coleman, M.D.’s TriBeCa practice.  Inside his sleek state-of-the-art facility, the Manhattan plastic surgeon holds the tools to erase, retouch and even rescale your most stubborn problem areas.   It’s like stepping into fantasy Photoshop—and the possibilities for redesigning your body are endless.

Your options include:

• the C cup you’ve never quite been able to fill out (or that has fallen with age);

• the rounder, fuller backside of your 20s;

• the ability to retouch cellulite dimples and sunken scars;

• all of the above.

What’s novel here is that his weapon of choice isn’t a scalpel, a laser or a silicone implant.  It’s a syringe.”

We will post more excerpts from the article soon, so stay tuned!

.                    Brought to you by the office staff at TriBeCa Plastic Surgery

Before (left) and after (right) Dr. Sydney Coleman placed about 200 cc of fat into each breast

2 years after one LipoStructure by Dr. Coleman to correct over-suctioning of the thighs

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

For more information please refer to earlier posts:

• Improvements in Structural Fat Grafting
• The possible role of stem cells in facial rejuvenation

• The treatment of face and neck scars with structural fat grafting
• Dr. Sydney Coleman presents LipoStructure to maxillofacial and craniofacial surgeons
• 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

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.

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.

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