Use of Fat Grafting in Facelift Surgery

According to new research, the use of fat grafting during facelift procedures has become an accepted technique in the United States.  In a recent random survey of ASPS (American Society of Plastic Surgeons) Member Surgeons, 85 percent responded that they are currently using fat grafting techniques and 70 percent reported that they have been performing facial fat grafting for the past two years.

Led by plastic surgeon, Dr. Sammy Sinno of New York University, researchers collected data on techniques used to transfer fat as well as usage and technical considerations in using fat grafting for facelift surgery.  The technique involves harvesting a small amount (between 11 and 25cc) of fat through liposuction on a patient’s thighs or abdominal area, processing the sample and transferring it by injection into specific areas on the face. Most commonly, the fat is added to the cheek area, the area below the lower eyelids, the nasolabial folds and the corners of the mouth. The grafted fat adds volume, providing for a more rounded and fuller appearance of the cheeks.

It was reported that after four to six months, follow-up procedures are performed to improve the results. Although some of the fat is reabsorbed, plastic surgeons reported that most of the fat was present up to a year after the facelift.

From the results of the study, the researchers concluded that the combination of the addition of volume through a fat grafting technique along with facial fat repositioning appears to create a more youthful facial shape.

 

 

 

 

Reconstructive Surgery Using 3-D Printing Tools

In addition to the medical applications of 3-D technology, surgeons are able to plan and perform complicated reconstructive operations through the use of printed surgical guides and jigs designed from 3-D CT scans of the patient. These guides assist surgeons in preoperative planning as well as during actual surgical operations.

Oren Tepper, MD, of Montefiore Medical Center, Albert Einstein College of Medicine and Children’s Hospital at Montefiore began to use 3-D technology to create surgical guides, templates and jigs to accurately place bones during lower jaw reconstructive surgery. The process has led to 3-D printed tools being used in facial trauma surgery from the virtual planning process and printing of surgical jigs and templates, to the use of these same tools to hold pieces in place during the actual surgery. This process is particularly beneficial to surgeons performing complicated reconstructive surgeries where there are no landmarks.

From the preoperative planning process to actually performing reconstructive surgery in the operating room, the use of 3-D technology is an exciting advancement.

Improve Skin Rejuvenation with Pulsed Electrical Fields

Current skin rejuvenation treatments that directly target skin cells, such as fractional lasers can lead to scarring and discoloration of the skin. Researchers have developed a non-invasive treatment that has been shown to reset skin metabolism without any unintended side effects. Non-thermal pulsed electric field, or PEF treatments have been shown to temporarily increase cell proliferation in an animal model for a period of two months after treatment.

By modifying a known method of food preservation in which PEF is utilized to kill bacteria, researchers at Massachusetts General Hospital have found that a certain strength, duration and number of PEF impulses will cause cells in the area to rapidly reproduce and release factors that promote the growth and repair of tissues without scarring. In studies performed on rats, the team reported an increase in the synthesis and density of collagen fibers and in skin metabolism. Within a period of two months after the treatment, the characteristics of the skin had returned to pre-treatment levels.

Further studies are needed to examine the impact of PEF treatment on aged skin as well as damaged skin.

Measuring the Effectiveness of Botox™ and Dysport with 3-D Imaging

Following treatment with injectables, such as Botox™ and Dysport, wrinkle reduction is currently measured by subjective individual appraisals and still photographs. New research using three-dimensional speckle tracking photogrammetry will allow physicians to analyze the movement of speckles displayed on a color-coded heat map, resulting in an accurate and objective measurement of wrinkle reduction and vertical stretch.

The use of photography to measure distances between objects is known as photogrammetry. In a recent study at the University of Pennsylvania, researchers randomly applied white foundation and black speckle makeup to patients before and after treatments using injectable fillers in the frown lines between the eyebrows. A comparison of the movement of the speckles over a two week period was tracked and analyzed resulting in precise measurements of the reduction of horizontal wrinkling and vertical stretch.

Through the comparison of pre-treatment and post-treatment heat maps, physicians will have the ability to objectively evaluate the specific measurement of wrinkle reduction which will assist in determining the ideal dosage of a particular injectable for maximum aesthetic benefit and effectiveness. Further research may determine specific therapeutic regimens for males and females and for people of different age groups.

For more information, please refer to: University of Pennsylvania School of Med. (2015, May 28). “Study reveals novel use of 3-D imaging for measurement of injectable wrinkle reducers.”

Nipple-Sparing Mastectomy

Preliminary studies show that nipple-sparing mastectomies result in similar survival or recurrence rates when compared to full breast removal. The surgery is safe in women with early stage breast cancer, however nipple sensation is dramatically decreased.

A meta-analysis of nineteen previously published studies totaling over 5,000 patients found that the nipple-sparing procedure was as safe as standard full breast removal when comparing patient survival and outcomes of cancer recurrence at the nipple area.

Over the past fifteen years, nipple-sparing surgery has been performed in the United States on appropriately selected women, ie., women whose breast cancer is located away from the nipple. Although it is an uncommon surgical procedure, its use has increased markedly in the past ten years.

The nipple-sparing operation is more challenging for a surgeon than a full mastectomy and patients will have an altered nipple sensation, however when compared to other techniques, the nipple-sparing surgery provides a more natural look after reconstruction.

Botox Appears to Provide Temporary Reversal of Skin Damage

Reports of a recent study of women who underwent wrinkle reducing Botox™ injections indicated that, in addition to increased pliability of the skin, the injections appeared to reverse damage to skin elasticity caused by exposure to ultraviolet radiation.

There are three biomechanical features of human skin: strength, pliability (ability to stretch) and elasticity (ability to recoil). During the aging process, these properties change and the most prominent change is the loss of skin elasticity. According to an article published by JAMA Facial Plastic Surgery, two Canadian doctors observed that onabotulinum A injections in the facial skin of women with mild wrinkles resulted in increased pliability and elastic recoil. The changes lasted four months which coincides with the duration of the effect of the injections.

Continued studies on elasticity of skin injected with Botox™ will help plastic surgeons design new non-surgical therapies, scar treatments and anti-aging treatment options.

Incontinence Relief After Cosmetic Abdominoplasty

Current treatments for stress urinary incontinence are aimed at relieving the symptoms, rather than addressing the underlying causes. In addition to improving body contour, a recent study indicates that cosmetic abdominoplasty may also alleviate symptoms of incontinence in women without a previous Caesarean section.

Muscles, nerves and supportive tissues that are necessary for good bladder control are often weakened or damaged due to hormonal changes during pregnancy, the increased weight of the uterus and a vaginal delivery. Non-surgical techniques, such as medication and muscle exercises are typically used to improve bladder control, however surgery may be considered if these treatments are unsuccessful.

The findings of a recent study published in the Aesthetic Surgery Journal, indicate that six of ten women described an improvement in their symptoms of urinary incontinence following a tummy tuck. Physicians noted that this may be due to certain surgical techniques used in some abdominoplasty procedures in which soft tissue is pulled from the pelvic area to suspend the urethra which creates a small outlet around the bladder. Data from the study analyzed many other factors, such as demographics, pregnancy weight gain and loss, number of pregnancies and symptoms of incontinence before and after abdominoplasty.

Further studies are needed to determine specific surgical techniques to provide relief from incontinence. Additional research studies should also be conducted to identify the women who may benefit the most from the surgery.

More Complications After Plastic Surgery in Patients with Excess Weight

A study published in the May, 2015 issue of Plastic and Reconstructive Surgery reported that people with excess weight were 35% more likely than people of normal weight to visit the hospital within 30 days of a cosmetic surgical procedure. The results highlight the importance of carefully managing health conditions of overweight patients prior to surgery. Furthermore, it is important to note that most insurance companies will not cover the cost of complications of elective cosmetic procedures.

Data on 48,000 adults who had undergone outpatient plastic surgery was examined by researchers at Wright State University in Ohio. The surgeries included liposuction, tummy tucks, breast reduction or eyelid surgery. About 4% of the adults who were considered to be carrying excess weight had higher rates of other health issues. The researchers reported that 7% of the overweight patients had to visit the emergency department or be admitted to the hospital within 30 days after surgery as compared to under 4% of the normal weight patients. Moreover, overweight people with three of more health conditions who received a tummy tuck had the highest number of complications requiring a hospital visit.

The conclusions of the study emphasize the importance of educating overweight patients about the risks and complications involved with surgical procedures.

Weight Loss Surgery Unbalanced Between Men and Women

Evaluation of research data on patients who underwent bariatric surgery over a twelve year period identified a number of factors that explain why significantly more women than men have weight loss surgery.

Investigators at the University of California, San Diego examined data on more than 190,000 patients who had weight loss procedures between 1998 and 2010 and the findings were reported this week in the Journal of Laparoendoscopic & Advanced Surgical Techniques. Investigators concluded that eighty percent of the patients were women.

The study concluded that women tend to have a greater overall recognition of the risks of obesity and are less satisfied with the status of their health as compared to men. Men tend to delay surgery until they get older and it was statistically reported that the gender gap for weight-loss procedures actually narrows as men enter their 70’s.

Although an even division in obesity rates exists among US men and women, the results of this study suggest a need for increased awareness of the health risks and complications of obesity in men.

Minimally Invasive Procedures with Subtle Results

For those seeking improvement of their skin with natural looking results, there are several minimally invasive options. The use of fillers and peels can rejuvenate the appearance of the face and, if further improvement is desired, surgical procedures can be performed.

Botox and Dysport

Mechanism:
Injections of the toxin weaken the muscle by blocking muscular nerve signals. Since the muscle can no longer contract, facial wrinkles are diminished.

Purpose:
Helps with smoothing of wrinkles specifically,
Frown lines between the eyes
Forehead lines
Crow’s feet and skin bands on the neck

Soft Tissue Fillers

Mechanism:
A naturally derived or synthetic material is injected into the face
Add volume to areas of the face that have lost subcutaneous fat through aging, heredity, sun exposure and lifestyle.

Purpose:
Helps restore volume and fullness in the face
Softens facial lines and plumps thin lips
Used to fill shallow contours, soften wrinkles and facial creases
Augments facial rejuvenation surgery, often used in combination with Botox or Dysport

Chemical Peel

Mechanism:
A chemical solution is applied to the face (and hands and neck) to remove damaged outer layers of skin caused by sun exposure, acne or aging. Newer, healthier skin cells are exposed.

Purpose:
To peel away or diminish blemishes or other imperfections
Enhance skin tone and texture, helps erase scars
Lessens acne and acne scars and irregular skin pigmentation
Improve age spots and liver spots, rough and scaly skin
Diminishes freckles and fine lines and wrinkles

Laser Hair Removal

Mechanism:
A highly concentrated beam of light is used to penetrate hair follicles
The light is absorbed by the pigment which damages the actively growing hair follicle

Purpose:
Future hair growth is slowed but may not be permanently removed
Several treatments may be needed to provide desired hair reduction
Periodic maintenance may be needed
Effective for most parts of the body

Microdermabrasion

Mechanism:
Skin is gently sanded with a minimally abrasive instrument
The thicker, uneven outer layer is removed

Purpose:
To treat light acne scarring and reduce or eliminate enlarge pores
Lessens the appearance of stretch marks
Reduce fine lines and wrinkles
Exfoliates the skin for a refreshed appearance
Improve age spots and diminish hyperpigmentation and discoloration from sun damage

Millions of minimally invasive procedures are performed annually with excellent results. Be sure to discuss your expectations with a certified plastic surgeon, cosmetic surgeon or dermatologist to determine your best options.