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When most people think of plastic surgery, they often visualize a series of "nips" and "tucks" to deal with the signs of aging. Plastic surgeons have long been taught to perform procedures that remove excess skin and resuspend "fallen" tissue in order to deal with the effects of gravity. There has been, however, a resurgence of a different approach to the rejuvenation of the face. Instead of excising and tightening, more plastic surgeons are turning to volume augmentation. Dr. Sydney Coleman in New York has been arguing that aging is more a process of the loss of facial volume rather than a by-product of gravity. When the face loses fullness, other problems manifest themselves, such as sagging, skin texture changes, and exposure of underlying structures such as muscle and bone. Dr. Coleman has devoted a significant amount of his career in refining a procedure that would combat facial atrophy by restoring volume or fullness.
His solution of structural fat grafting has been attempted by many before him although with much less success. In order to graft fat successfully, attention to detail is crucial and the surgeon must have the ability to visualize in three dimensions. He must then have the skill to add volume and sculpt in three dimensions to create pouty lips, more defined jawlines, and smoother lower eyelids. In the past, two technical problems have often limited the use of fat injections: the ability to obtain good survival of the grafted fat and the prevention of contour irregularities when "lumps" of fat are injected. Dr. Coleman's techniques address both of these problems through careful harvesting, refinement, and placement of the patient's own fat cells in order to achieve a more natural and rejuvenated appearance.
Because donor fat cells must be harvested from other areas of the body, deep sedation or a general anesthetic is usually used. Special cannulas and harvesting tools are utilized to decrease the amount of trauma to the harvested cells. The fat cells are then spun down to separate the cells of interest from other components such as blood and numbing medication. The donor cells are then injected into specific layers of the face or body through special small cannulas in linear and miniscule amounts in order for the newly placed fat cells to survive. This specific technique allows improved access to recipient blood supply to enhance nutrition, respiration, and subsequent vascularization of the newly transplanted fatty tissues.
In our practice, we have been successful in achieving natural and stable results not only in the face, but also in the rejuvenation of the hands and the correction of contour irregularities caused by liposuction. We are also able to achieve much longer lasting results in areas such as the lips and nasolabial folds where collagen and Restylane® have disappointed us. In addition, areas such as the lower eyelids, cheeks, jawlines and necks can be augmented to produce a much healthier and youthful appearance. With the exception of the lips and eyelids, we have found the downtime to be minimal with fat grafting.
Most plastic surgeons have difficulty abandoning their principles of excision and suspension for structural fat grafting. We have found, however, the addition of this technique to our repertoire of surgical services to be a tremendous asset in reversing the signs of aging in a new time where modern patients want broader range of services that are less invasive and produce more natural and stable results.