from LES NOUVELLES ESTHETIQUES, May 2005

Medical - Plastic surgery
by Dr. Brian P. Maloney

Fat, Fat and More Fat
The American way of life: work hard and eat hard. Unfortunately, with decreased exercise thrown in, we wind up with health problems - heart attacks, strokes, and increased cancer rates.

What is fat and why do we have it - especially in so many places we don't want it? Keep in mind though, not all fat is bad.
As we take in more calories than our body needs, fat is stored. Thousands of years ago, this primitive, protective mechanism helped us get through lean times. In storage mode, men and women respond differently. Men tend to store fat around the waist and women around the hips. Genetics can alter this, but it basically holds true for most individuals.

Sometimes, all the exercise in the world can't eliminate fat stored in these areas . . . that's where plastic surgery can offer some solutions.

Liposuction on the scene
Dr. Giorgio Fischer is credited as the father of liposuction, which he invented in 1974. In today's plastic surgery culture, many might consider liposuction one of the great medical developments of the century.

Later, Dr. Jeffery Klein combined liposuction with tumescent anesthesia to help decrease bleeding and swelling. With this advancement, body-contouring procedures took off. Stomachs became flatter; thighs became thinner. Liposuction became the most popular cosmetic procedure performed in the United States.

Most patients, in the early years of liposuction, had hereditary fullness or asymmetry in certain areas and liposuction helped these individuals achieve the body they desired. Today, it is used more indiscriminantly, but it is still not regarded or used as a substitute for weight loss. However, there may be some indications for large-volume liposuction in certain patients. This type of radical surgery requires an experienced surgeon and thorough patient screening to minimize complications.

Areas we want to plump
As time has passed, we have learned more and more about the aging process. One of the first things that happens as we age is the loss of fat in our faces. The lips begin to thin; the fat in the face - especially the cheek area - begins to melt away and leaves deep grooves along the cheek. Finally, the eyes begin to sink into hollows.

To defy the facial fat loss that aging causes, doctors introduced the fat transfer procedure many years ago. In the early years, cosmetic physicians removed fat with a liposuction cannula and a suction machine. The fat was collected in a large, plastic container and placed in a strainer. The strainer often came from a home store, found in the kitchen aisle - it was the same device one might use to wash fruit or vegetables or strain pasta. The technique was very crude and because the methods used to be so primitive, it's not surprising that most of the transferred fat melted away leaving patients back at square one. Patients were overcorrected to combat the melt factor. More fat than desired was placed in the area with the hope some would remain. Unfortunately, this made for a prolonged recovery while the swelling resolved and fat melted away. Patients eventually reached their desired results but only for a brief time. With this older method of fat transfer, swelling and fat continue to disappear. Fat was branded as a temporary filler and most surgeons abandoned the procedure.

A better solution
Over the years, surgeons started using all kinds of parts including muscle, tendon, fascia and skin to try and fill areas that Mother Nature wastes away. Unfortunately, these living tissues need a blood supply quickly or they die and are absorbed in the body, which, again, leaves the patient back where they started.

Fat resurfaced as an implant because it has a very slow metabolism compared to the other tissues. Because its metabolism is slower, it doesn't need to immediately develop a new blood supply. Therefore, it can last if it is harvested gently and intact.
Dr. Sidney Coleman refined a technique to harvest fat by hand in a syringe. Fat is collected in small syringes, which are then placed in a centrifuge. This high-tech gadget spins the fat around and the contents in the syringes separate into layers. The intact fat layer is identified and then transferred to a small syringe. Dr. Coleman discovered that if fat is placed in tiny droplets, instead of big blobs, it will last indefinitely. Because of his advances, fat has gone from something that we all dislike to a girl's best friend when it comes to implants.

This is a confusing time for patients as they talk to their cosmetic surgeons about fat. Doctors still using the old technique will say it is a temporary fix. Doctors who use the new microdroplet technique will be excited about the long-term results for most patients.

Brian P. Maloney, M.D., F.A.C.S., is a nationally recognized facial plastic surgeon based in Atlanta whose client roster includes celebrities and sports figures from throughout the world. He lectures internationally on breakthroughs in cosmetic surgery and publishes extensively. Dr. Maloney is often asked to conduct research studies or participate in programs seeking upgrades and improvements in surgical technique. For more information, please visit www.maloneycenter.com or call (404) 252-5438.

Dr. Brian P. Maloney
Facial Plastic Surgeon
Atlanta, GA