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Harold D Clavin [Articles] Hand Rejuvination using the Fat Transfer (Fat Injection) TechniqueWith so much focus on facial rejuvenation, we frequently lose sight of our hands. Our hands are aged by sun exposure and of course, time and gravity is a big factor in showing aging over other areas of the body. These sign of aging include age spots and loss of fat under the skin resulting in a bony appearance. More recently, placing fat in the dorsal aspect of the hands for hand rejuvenation is becoming more in vogue. A variety of injectables are being used for rejuvenation of hands. I have found that, rather than using synthetic material, I prefer to use a person's own fat, which is called autologous fat grafting, to the hands. During this procedure, small amounts of fat are placed carefully with small needles over the dorsal aspect of the hands. Often, the patient prefers to have an anesthesiologist standing by in order to lessen the discomfort from the procedure. This procedure is done usually in multiple sessions spaced three months apart. It is best to use small amounts of fat on the dorsal or top part of the hand and do it in several sessions spaced, as mentioned, three months apart in order to get optimal results. The results from hand rejuvenation using fat have been very encouraging. When done properly in multiple sessions, the thin skin over the hand is rejuvenated to become thicker and younger, and veins and a variety of tendinous structures are more hidden, which is obviously more desirable than the atrophy or thinning that you see on the top portion of their hands as patients get older. There is some swelling involved postoperatively, but for the most part, patients have been so encouraged by the results that they come back for the second and third sitting to complete the process. Fat transfer is a very interesting and new approach to all types of rejuvenation. It seems that fat, when placed under the skin, actually helps increase circulation and thickness and youthfulness to the skin. We think this is because we are adding a layer of subcutaneous tissue which has been atrophying as people get older, and the fat actually adds to fat absorption, which happens to all of us as we age. I will continue to give proper informed consent to those individuals who wish to move forward and consider hand rejuvenation using their own fat taken usually from the abdomen or thigh area. Fat Transfer (Fat Injection) to the Breasts: A New Revolution for Augmenting BreastsFat injections has worked beautifully for augmenting lips, laugh lines, frown lines, and defects throughout the body, including indentations from injections, trauma, or irregularities from liposuction. Finally, with the blessing of research as well as the American Society of Plastic Surgeons, fat grafting is coming into vogue for augmenting breasts for reconstructive purposes, even irradiated breasts to help in skin tone and begin to soften scar tissue around the breasts. Fat transfer to the breasts is nothing new. It was done almost 30 years ago but was not encouraged, as it was felt that it might perhaps hide early detection of breast cancer using mammography. However, more recent studies and information coming from a variety of sources have shown that this may not be as much a worry as it has been in the past. In fact, there has been tremendous interest in transferring one's own body fat from perhaps the hip or abdominal area to the breasts in breast reconstruction. There are studies, in fact, encouraged by the American Society of Plastic Surgeons to further evaluate fat grafting to the breasts both using direct fat from another body area of that same individual to the breasts as well as fat stem cells to the breast area. Early preliminary studies with Plastic surgeons performing this procedure have been nothing less then encouraging when performing fat transfer to the breast area. There have been encouraging results in loosened skin and getting better skin texture and tone when putting fat under mastectomy scars or even under irradiated tissue. Also, encouraging results are shown when augmenting breasts either primarily or after removal of breast implants with fat. Candidates have to be chosen carefully and understand the procedure involved. Usually, this is done over a 3-12 month period in multiple sittings. The patient has to have good donor sites to take the fat from the abdomen or thigh area and transfer it in a variety of sessions to the breast area and allowing for adequate blood supply to surround all the fat cells and allow viability and growth. Fat grafting is usually done over several sittings spaced three months apart. The three months allows for the fat to get blood supply and, therefore, further sittings can be done on top of the older fat cells that were placed several months earlier. Therefore, if a person is a good candidate after a thorough physical examination and informed consent, a qualified surgeon can start the process. Fat transfer to the breasts can be done just for routine augmentation and/or for a patient who desires to have their breast implants removed and replaced with fat. It also, as mentioned above, is excellent for breast reconstruction or scarring about the breast area or patients who have had radiation following a mastectomy. Smaller volumes of fat in the range of 50-100 cc at each sitting is preferable spaced three months apart and slowly build up either breast with that amount of fat. If too much fat is placed at one time, not enough blood supply gets to the fat cells and, therefore, the viability of the fat cells is jeopardized. It is much better to use smaller volumes of fat and build up the breast over several sittings spaced three months apart for the most desirable result. More and more research is coming out that is showing this potentially could be a very viable procedure without the risks and concerns that have been voiced in the past about potential masking or difficulty in detecting early breast carcinoma. The positive feedback that are received from patients has been exuberant, and it gives one encouragement to continue their cautious and careful ongoing fat grafting sessions to the breasts. These are done in an accredited operating room facility with often an anesthesiologist present and under a very controlled circumstance. Discomfort to the patient is minimal. Combining Cosmetic Fillers and Rhinoplasty for Best ResultsThe combination of surgical Rhinoplasty, either primary or secondary, combined with injecting Juvéderm or Restylane into the nose has gotten superior results and excellent patient satisfaction. Juvéderm and Restylane are hyaluronic acids which can last up to a year and sometimes longer when injected into various facial irregularities, defects, or deep facial lines, such as laugh lines, crease lines, or chin lines. Juvéderm and Restylane have also been known to be used to inject around the mouth area, vertical lip lines, or into the lips themselves. These Cosmetic Fillers are also highly successful when injected into a variety of nasal defects. Ju The nose, nasal dorsum, or tip can be revised substantially and improved tremendously, by injecting these cosmetic fillers. A recommended combined approach for Rhinoplasty or Revision Rhinoplasty using Juvederm or Restylane are to use these fillers as an ancillary procedure during the Rhinoplasty rather than operate on a certain part of the nose, which can be difficult and not as predictable. The Cosmetic Filler is then injected into the nasal tip, the dorsum, or the sides of the nose resulting in a improved surgical result with very minimal downtime to the patient and an extremely fast recovery. Therefore, in summary, the combination of Juvéderm or Restylane with surgical Rhinoplasty and/or Juvéderm or Restylane alone to nasal defects can significantly improve patient surgical outcome and improve patient satisfaction significantly. Rhinoplasty and Fat Injection (Fat Transfer): Combined for Best ResultsThe combination of surgical Rhinoplasty, either primary or secondary, combined with fat injection to the nose has achieved superior results and excellent patient satisfaction. Fat transfer can be used to inject fat into various facial irregularities, defects, or deep facial lines, such as laugh lines, crease lines, or chin lines. Fat transfer has also been known to be used to inject fat around the mouth area, vertical lip lines, or into the lips themselves. Fat transfer is also highly successful when injected into a variety of nasal defects. A By using the fat injection procedure on primary or secondary Rhinoplasties, one can improve the aesthetic result without actually doing further invasive surgical procedures to the nose. Some irregularities throughout the nose and tip area, especially those in patients who have had several nasal operations, can often be readily improved in an office setting without surgical intervention using the fat transfer technique with a small gauge needle with minimal patient discomfort. The fat is injected into the nasal tip, the dorsum, or the sides of the nose resulting in a improved surgical result with very minimal downtime to the patient and an extremely fast recovery. The nose, nasal dorsum, or tip can be revised substantially and improved tremendously by fat injection. Therefore, in summary, the combination of fat injections with surgical Rhinoplasty and/or fat transfer alone to nasal defects can significantly improve patient surgical outcomes and patient satisfaction significantly. Anesthesia For Rhinoplasty - Cosmetic Nose SurgeryRhinoplasty can be done without intubation. The surgeon and the Anesthesiologist work as a team to provide the best possible patient experience. Anesthesia for Rhinoplasty is a combination of intravenous propofol given by the Anesthesiologist together with local anesthesia injected in and around the nose by the surgeon. The intravenous use of propofol for anesthesia is sometimes called total intravenous anesthesia or TIVA. Propofol is a gentle, safe, non-opiate medication with rapid smooth action, and quick offset. It is exceedingly unlikely to cause any allergic reaction, and does not cause nausea. In the proper hands, it is easily controlled, and can be used for mild sedation to general anesthesia. It can be used for very short operations, lasting a few minutes, to long procedures lasting many hours. For cosmetic nose surgery without intubation, the patient is fully monitored for respiratory, heart and cognitive function. The TIVA with propofol is continuously adjusted with the aid of a computerized pump. Initially, enough medication is given to eliminate the discomfort of the local anesthesia injections. The local anesthetic also includes a vasooconstrictor,epinephrine, to eliminate bleeding during the operation. The local anesthetic used is long acting, and the pain relief lasts long after the rhinoplasty is completed. As soon as the nose is numb, the propofol dose is decreased to the minimum required to keep the patient asleep. Since the nose is completely numb, the dose of propofol is usually quite small at this point. The patient continues to breathe naturally, remaining asleep and unaware until the end of the Rhinoplasty procedure. Patients wake up shortly after the TIVA is stopped, and are fully alert, ready to eat drink and ambulate minutes after nose surgery is done. A combination of oral and intravenous anti-inflammatory medications are given before, during and after surgery resulting in minimal swelling and pain after surgery. General anesthesia with intubation typically involves the use of propofol together with paralyzing drugs and inhaled anesthetic gases. A tube is placed through the mouth into the windpipe. In medical terms, this is called oral endotracheal intubation. The patient depends on the anesthesiologist to help with breathing using a manual and/or powered ventilator for most if not all of the duration of the surgery. Since the patient doesn't move (paralyzing medications are used), the nose does not have to be as thoroughly numbed as in the TIVA technique. There is more likely to be bleeding, and gauze packing is frequently used in the nose and throat. When blood is swallowed patients are also more likely to wake up nauseated. Before patients wake up, they are often given medications to reverse the paralyzing drugs. These medications and intravenous opioid narcotics, and inhaled gases and contribute to a significant incidence of post operative nausea and vomiting. Even in experienced and gentle hands, many patients complain of sore throat, and less frequently, hoarseness and vocal irritation. TIVA and local anesthesia for rhinoplasty require the Anesthesiologist and the surgeon to work together as a team. The Anesthesiologist needs to monitor the patient closely, both visually and electronically. The surgeon needs to thoroughly and carefully numb the nose with the appropriate propofol dose adjusted constantly by the Anesthesiologist. Once the nose is completely numbed, a few minutes are required for the anesthetic and vasoconstrictor (epinephrine) effect to fully work. At this point the rhinoplasty can proceed with total sedation and minimal medication until the surgery is completed.
Chemical Face Peels Including TCA PeelsThere are a variety of chemical facial peels of the market. The most common chemical facial peels include phenol, TCA , and glycolic acid peels. Also, many lasers are available to refreshen the skin and rid the skin of a variety of pigmented skin lesions and fine lines; however, lasers are very expensive and often can go deeper into the skin than is desirable. For fine wrinkles, blemishes, and pigmentation a TCA peel might work best. This peel is considered a medium-depth peel as apposed to a deep phenol peel. It takes only 20 minutes to apply and causes minimal discomfort to the patient. There is mild stinging for approximately two minutes, and there is even less stinging that lasts up to three to four hours. It takes approximately seven to ten days for the skin to go through its peeling process. Because TCA , or trichloroacetic acid, is a very light peel, there is never any rawness to the skin, and there is only a very superficial peeling of the skin with the skin turning dark and peeling off. When the new skin underneath the peel is present, which is at seven to ten days, the skin looks cleaner, finer, and more aesthetically pleasing with fewer blemishes and fewer fine lines, particularly around the crow’s feet in the lower eyelids and around the mouth area. A TCA peels can be done and repeated every three months because they are very safe and the risk factors exceptionally low. However, a TCA peel should only be done by MDs, particularly physicians or plastic surgeons, who are well-trained in this technique. They should not be, done by nurses or spas because they are not under absolute direct one-on-one observation by a trained plastic surgeon. Patients are very satisfied with light peels because they get rid of dark circles around the eyes, help the fine lines, and have a high success rate of getting rid of age spots or pigmented lesions that are present throughout the face as one gets older. A TCA peel can also get good results at a fraction of the cost of laser treatments. After the chemical peel is applied, the patient is asked to use ointment, such as Vaseline or Aquaphor Ointment, on the face three times a day for one week until the peeling is complete. They are also to avoid the sun for approximately two weeks and to use sunblock thereafter and a hat for another two to three months. Rarely does a patient need more than two peels if they take good care of their skin, avoid the sun, use a good sunblock, and wear a hat when going out in strong sunlight. A variety of other products can be used following a TCA peel that can help sustain the results of the peel, including glycolic acid products, vitamin C products, bleaching agent products, and a non-irritating sunblock. The Art of Revision Rhinoplasty using the Closed TechniqueThe art of revision rhinoplasty has been revised over 35 years of performing this type of surgery using the closed technique. The open technique limited the surgeon in many aspects of revision surgery. The open technique does not allow certain degrees of finesse in placing cartilage grafts in exacting locations in order to correct deformities that are found in revisional rhinoplasties. In my experience, using small incisions and taking cartilage from the septum or the ear, you can accurately place small millimeter-type grafts into various locations throughout the tip, the dorsum, and sides of the nose and spare the patient extensive surgical intervention, which is the case when open technique is used. The open technique distorts the normal anatomical attachments of the skin to the nasal bones and nasal cartilages, further complicating the surgeon’s ability to perform a natural revision rhinoplasty. After harvesting cartilage from the nasal septum or the ear, and occasionally the rib, small incisions are made inside the nose in order to accomplish the reconstructive aspects of this rhinoplasty procedure. Anesthetic used is local in the nose plus intravenous sedation. Intubation and deep general anesthesia is avoided and, therefore, much less nose bleeding is encountered during the procedure, allowing for even further improvement in technique because of the limited amount of blood loss. The small cartilage grafts are placed where the surgeon marks the external aspect of the nose with ink in order to allow for exacting placement of the reconstructive cartilage grafts. The patient is seen in the treatment room preoperatively and in the upright position. The surgeon has direct communication with the patient prior to surgery, and exact locations for cartilage grafts are discussed and agreed upon by both the patient and the surgeon. Once the various ink marks are made on the external part of the nose, the patient is then taken to the operating room and given intravenous sedation, avoiding all narcotics and anesthesia gases, which help very significantly in reducing postoperative nausea. There is very little discomfort to the patient postoperatively, since packing is never used, and nausea after surgery is a rare event. Discomfort and pain are absolutely minimal because the open technique has been avoided, which prevents unnecessary incisions and unnecessary dissection throughout the nose area. The exact appearance of the nose is noted right after surgery, and minimal swelling takes place postoperatively. This avoids the long two to three-month delay in seeing the final result when the open technique is used. In conclusion, excellent results are obtained with minimal patient discomfort and quick recovery using the above-described technique. The Natural Nose After Rhinoplasty - It Is PossibleRhinoplasty surgery is considered the most difficult of all cosmetic surgical procedures. One of the reasons this is considered the case has to do with the aesthetic talents of the operating surgeon. Plastic surgical training is extensive, and the surgeons that finally get credentialed by the American Board of Plastic Surgery are highly qualified. They’re intelligent, smart, have mastered the academics and skill required by this prestigious organization, and are very capable. However, rhinoplasty surgery, or cosmetic nose surgery, requires an aesthetic skill that is not teachable. A special talent is needed, which is born with that individual or is not. Just like you can teach art and can teach individuals the academics of painting and sculpture, there are only a few artists that turn out to be shining lights. The reason for this, is that inherent genetic trait that gives them a special edge to create masterpieces. To achieve the natural nose, a surgeon has to have that special talent. A natural nose can be created and is absolutely doable no matter what type of nose an individual was genetically born with. It could be a large nose, large hump, wide tip, and thick skin. Surgery can always be performed by a competent surgeon to make the nose better and improved. However, to achieve that truly “natural” look requires a special inherent talent that lets the surgeon look at the individual as a whole, all the facial anatomy as a whole, the size of the individual, the size of their head, the shape of the skull, the facial bones, the location of the eyes, the lips, and the ears, and the location of the eyebrows and cheeks, and putting this whole picture together and basically having the nose blend in with the patient’s total body and, in particular, blend in with their face to look totally natural and unoperated. This can be done with primary rhinoplasty or revisional rhinoplasty. The skill to create such a natural nose requires a special eye that the surgeon inherently must have to visualize the total picture plus the academic knowledge to create surgically such an end result. Patients should be aware that a natural-looking rhinoplasty result, or cosmetic nose surgery result, is absolutely possible, but they must be inherently careful in choosing a plastic surgeon and being sure that they feel comfortable that the surgeon has this particular talent, which is not teachable, by observing his results, talking to his patients, and truly checking out very carefully to be sure that that surgeon’s rhinoplasty results fit into the category of “the natural nose.” Revision Rhinoplasty to Create the Natural Nose Dr. Harold Clavin’s Presentation at the 28th Annual Los Angeles Society of Plastic SurgeonsI have had the opportunity to perform Rhinoplasties and a whole variety of nasal septal reconstructions over a 30-year period. This has allowed me the opportunity to closely evaluate my long-term results. Close observation has ingrained in me that conservatism is the key word in cosmetic nose surgery. The nose keeps changing for 10-15 years following Rhinoplasty. Inevitably, it gets slowly smaller, the skin thins, and one can get more retraction of the nostrils and thinning of the tip over time. What might appear to be an excellent result one year postoperatively can often change over time into an undesirable result or at least not as aesthetically pleasing as the one-year result. I have followed many patients over 12-15 years. These patients had a portion of their dome cartilages and lateral crus of the lower lateral cartilages removed to a certain extent through intranasal approaches. One year postoperatively, they looked excellent. When I saw the patients 12 years later, even though they were happy, I personally felt that the tip had thinned too much and I wished, in hindsight, that I had taken out slightly less cartilage. I present this so the younger plastic surgeons in the audience will learn that conservatism is critical in cosmetic nose surgery. The patients always ask for a smaller, smaller nose, and yet they want to look natural. The surgeon tries to please the patient, but he must inform them that, if he makes the nose too small or removes too much cartilage support in the tip, 10-15 years later, the patient could potentially have pinching or too small a tip that could look like a nose job or certainly not aesthetically pleasing. In addition, I feel that lateral osteotomies are overdone in many cosmetic nose surgery procedures. Often you can remove a large nasal dorsum on a person with a large hump, and yet lateral osteotomies and/or breaking of the lateral nasal bones is not required. Often in crooked noses, you just have to perform a unilateral osteotomy, in which only one side of the nose is fractured, and that alone is a very neat way of making the nose look more symmetrical without actually fracturing both nasal bones, which would make the nose look too thin. Another favorite procedure for me to perform to make a nose straight is by adding cartilage grafts that are trimmed and sculptured individually and placed through a small intranasal incision in an area of indentation or curve which will help give the nose a straighter appearance without having to do any fracturing of any bones whatsoever. I also find that cartilage often taken from the ear or septum, crushed and pulverized and made like putty, and placed in the tip area gives a very excellent refinement to the tip without any obvious signs of cartilage grafts, which, when not crushed or morselized, can be sharp and noticeable. Another favorite approach of mine is to give the appearance that the nose is elevated by placing a piece of cartilage through a right rim incision into the base of the columella. This gives the appearance that the nose is raised without actually raising the tip. This is a wonderful procedure for those patients that have large nostrils and really could use a raising of the tip but would not be ideal in their particular circumstances because of their anatomy, poor maxillary protrusion and/or inferior migration of the base of the nasal vestibule and nasal nostril. Therefore, bringing down the columella, particularly the base, makes the profile look much better and gives the appearance that the nose has been elevated without truly raising the tip. Cosmetic nose surgery is considered probably the most complicated of all the cosmetic surgical procedures, and rightly so. I have been doing cosmetic nose surgery for 30 years and, to this day, I still learn on every case. The learning curve never ends on performing cosmetic surgery of the nose and, therefore, every time I operate, I evaluate the case, the patient, their facial features, the size of their whole body, head size, shape size, and 20 other items in order to determine the best result for them. Just looking at the nose alone will never give the ideal result. You must fit that nose to facial features of that individual. This is often missed by many physicians, in that they just truly concentrate on trying to “improve the nose to make it look better” without thought as to whether that truly is the proper fit for that individual face, feature, and body type. I have enjoyed doing noses over 30 years and consider every nose a new challenge, even after performing so many thousands of noses over the years. I find cosmetic nose surgery to be a very satisfying operation and, when done properly, the patients are so very much appreciative. I do feel that the closed procedure is a more appropriate procedure to do because it causes less scar tissue and allows for more leeway if any future revisional surgery is needed. Fat Transfer Combined with BotoxThe combination of Botox with fat transfer, particularly the frown lines, has led to truly outstanding results. Frown lines are significantly improved for longer and more permanent periods of time using the combination of Botox and Fat Transfer. Fat transfer or fat grafting sometimes require several sittings spaced several months apart; however, the end results are outstanding and permanent. They can be used for traumatic defects anywhere on the chest, trunk, or extremity area, but also fat transfer can be used very successfully for frown lines, crow’s feet, and lip areas. On the other hand, Botox is a purified protein that smoothes the muscles by blocking nerve impulses. Botox weakens the muscle action in specific areas of the face and, therefore, leads to significant improvements, particularly in the forehead, frown line, and crow’s feet area. Fat transfer and the actual individual fat cells have a higher chance of permanent results when the muscles are not being moved in the frown line; therefore, this is where Botox plays an important role in quieting down the frown line and forehead area, allowing more fat cells to survive and live resulting in better permanent results with the fat cells. Therefore, fat transfer is needed only once or twice to get the permanent result from the fat, plus Botox being used every three months leads to excellent results. Combined Use of Restylane and BotoxBotox and Restylane have become exceptionally popular with patients in the last several years. The success rate of both of these products has proven to be excellent with minimal risk and very, very high patient satisfaction. The combination of Botox and Restylane achieve outstanding results for patients with tremendous feedback and satisfaction. Botox and Restylane work in two different ways. Botox weakens the muscle action in specific areas of the face and, therefore, leads to significant improvements, particularly in the forehead, frown line, and crow’s feet area. Restylane is a soft tissue filler and has proven very successful for filling in soft tissue indentations throughout the face, including areas such as the frown lines, laugh lines, cheeks, lips, and any other area where augmentation of the soft tissues is beneficial. Patients have found the results of Restylane very satisfying. Botox should be repeated at three-month intervals to get the optimal result, and Restylane should be repeated every six months to get the optimal result. Outstanding results are achieved by the combination of both of these products. In particular, the following areas can be treated, which increases the final ultimate result an additional 50% beyond the use of just Botox or Restylane alone. Areas that are best treated by the combination are: 1. Frown lines The combined effects of using Restylane and Botox have eliminated the need for more invasive or surgical procedures and yet can give superb results that, in many cases, mimic the results of more extensive and involved surgical procedures. Fat Transfer - A Permanent Solution?Fat transfer has been successfully performed for the last 25-30 years. It has a long track record of success with proven permanent results. It has been documented that fat transfers do live through techniques used by many plastic surgeons. Fat transfer has fallen into more respect in recent years. In the past, many physicians and plastic surgeons believed that fat taken from one part of the body and put into another part of the body absorbed in its new location. Photographic documentation has shown this not to be the case, as a few examples have occurred in which a person having had fat transfer into the face gained a significant amount of weight, as much as 80-100 pounds. In locations where the fat transfer took place in the face, the area was actually overly protruding and did not look like a normal contour. These are rare exceptions but, in fact, it is advisable for a person who has had fat transfer not to gain large amounts of weight because the living fat cells that have been transferred into their face can, in fact, enlarge and potentially even distort the area where they are located. Physicians doing fat transfer need to have experience in performing this procedure, which takes approximately one hour under local anesthesia and should be done in a clean, certified operating room facility. Many physicians who do cosmetic surgery are not equipped to do fat transfer because of the technical considerations and the sterility needed along with the one hour of operating time under local anesthesia. This is why fillers made by pharmaceutical companies have come into favor, in that they take only a few minutes to place into position and can be ordered directly in a sterile vial and injected to fill in soft tissue areas throughout the face; however, all of these are temporary and ultimately do absorb; therefore, in the long-term picture, they are much more expensive. However, fillers are favored by many physicians because they do require a far less degree of surgical skill and are ultimately absorbable, therefore, any over-correction would self-correct after several months. Any filler that is permanent, I feel, is potentially risky because it is a foreign body injected into the face, which could cause problems in the future. Many new fillers are coming into the market on an almost monthly basis. Many have not had a proven track record, and the consumer should be wary of having the newest and latest filler injected into the facial area. Fat Transfer usually takes one to three sittings in order to increase the subcutaneous tissue where it is injected. Common areas for fat transfer are in the upper and lower lips, laugh lines, frown lines, and cheeks. Fat transfer is also used to fill in soft tissue defects from various traumatic injuries or possibly even cortisone injections that cause fat atrophy in the trunk or extremities. Fat transfer is highly successful. The only uncertainty is whether the end result can be accomplished in one, two, or three sittings. There is an absorption rat of anywhere from 20% to 60% of the fat that is transferred from, let’s say, the abdominal or hip area into the facial area; however, a certain portion of the fat does live forever. These are living fat cells and, whether they represent 20% or 50% of the fat that is transferred, they will stay permanently in that location. Fat transfer sessions are usually spaced three months apart and, at that point in time, the experienced physician would know that percent of the fat has survived and what portion of the fat will have absorbed; therefore, a decision is then made between the physician and the patient as to whether any further fat transfers are indicated to get the ultimate result. In summary, fat transfer is by far the most proven technique and the safest technique to augment various facial features, including the lips, laugh lines, frown lines, and cheeks. As a person ages, fat atrophy occurs throughout the face and often, with age, a person looks thinner. This occurs commonly in all parts of the face and, therefore, fat transfer would be the most logical choice for reversing signs of aging. Fat is taken from areas where normally fat will even be more prominent as one ages such as the abdomen, thighs, or the lower back area. This is one of the favorite spots to take fat from and to transfer it into areas where the normal aging process has led to absorption of fat cells. Other Articles in news
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véderm and Restylane can be used in both primary and secondary rhinoplasties to help improve the aesthetic result on cosmetic nose surgery without actually doing further invasive surgical procedures to the nose. Some irregularities throughout the nose and tip area, especially those in patients who have had several Rhinoplasty operations, can often be readily improved in an office setting without surgical intervention using approximately 1 cc of Juvéderm (or Restylane) or less with a small gauge needle with minimal patient discomfort.
