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FAQ – LipoStructure®

LipoStructure® – General and Face

1. What is LipoStructure®?

LipoStructure® is a process in which fat from one area of the body is used to build lasting structural changes (i.e. fill in lines, dents or irregularities or augment the breasts or buttocks) in other parts of the body and/or face.  It is commonly known as fat grafting or fat transfer.

2. How long has Dr. Coleman been performing LipoStructure®?

LipoStructure® has been under development by Dr. Coleman since 1987. He has performed the procedure over 5000 times.

3. How long has Dr. Saboeiro been performing LipoStructure®?

Dr. Saboeiro is the only physician in the world who has had hands-on intensive training by Dr. Coleman in the LipoStructure® technique.  She has been performing the procedure since 2004 and has done hundreds of cases.

4. How long does the fat last after being placed by LipoStructure®?

Fat placed by the LipoStructure® technique has shown every indication of permanence. Dr. Coleman published studies in 1995 in the Aesthetic Surgery Journal documenting the long-term survival of transplanted fat.

5. Why have I heard that fat grafts don’t work?

Fatty tissue is extremely fragile and is easily killed. Most techniques used to suction and place the fat traumatize the tissue causing unpredictable results. LipoStructure® is a specific technique that allows the fat to survive long term.

6. Do you freeze or store fat?

At TriBeCa Plastic Surgery, we do not freeze or store your fat, as we feel that this kills the fat cells.  Fresh, living fat tissue is therefore always removed and placed in a new area on the same day.

7. Do you use cell assisted transfer in your practice?

Dr. Coleman has been an advisor to several stem cell companies and we are knowledgeable about current clinical trials and uses of cell assisted transfer devices.  To date, cell assisted transfer is used only for experimental purposes and is not approved by the FDA.  We are using a safe, approved method of processing and concentrating the fat we graft.

8. Is fat grafting safe?

Yes. People have been grafting fat in humans since 1893. Over the last century the controversy has always involved questions about the survival of the fat, not its safety.

9. Is LipoStructure® safer than regular plastic surgery?

It is much less invasive than most traditional plastic surgery procedures.  Most other cosmetic surgeries involve introducing sharp objects (such knives and scissors) under the skin. Damage to nerves, arteries, veins and other vital structures is a real possibility with more traditional plastic surgery. Dr. Coleman has minimized this risk by developing a line of soft-edged, blunt instruments for suctioning and placement of fat tissue. With LipoStructure®, no sharp instruments are placed under the skin.

10. Where is the LipoStructure® procedure performed?

Most fat grafting procedures are performed in one of our two state-of-the-art operating suites located in the lower level of our building, the C.A.R.E. FACILTY.  This is an AAAASF-certified facility, complete with a pre-op area, full anesthesia and resuscitative equipment and first and second stage recovery areas.  If a patient has a complicated medical history or if insurance is involved, surgery may be scheduled in a local hospital.

11. What type of anesthesia do you use for the grafting procedure?

Most procedures are performed using deep intravenous sedation provided by one of our board certified anesthesiologists.  Some longer procedures are done under general anesthesia and some smaller procedures can be done under straight local anesthesia.

12. Do you use a machine to suction the fat for grafting?

No.  We suction the fat by hand using a small syringe attached to the harvesting cannula.  We feel that this method of hand suctioning is more gentle, making it more likely that the fat survives the grafting process.  This takes considerably longer than suctioning with a machine, however we feel it is extremely important.

13. What is the best place to remove fat from the body for the grafting procedure?

To date, no studies have clearly demonstrated that any particular donor area is better than another.  We therefore remove fat from the area(s) that will give you the best improvement in contour, or where fat is most readily available.

14. If a patient has cheek, chin, or breast implants, can you still have fat grafting?

Yes, you can definitely graft fat around implants in the cheeks, chin, breasts, or elsewhere.  Often these implants can be visible through the skin.  Placing fat around the implants can disguise and soften the appearance of the implant, making it look much more natural.

15. Will the fat move after it is placed by LipoStructure®?

Your body accepts the fat as an integral part of you unlike silicone or other non-living implants. With LipoStructure® the fat immediately anchors to the surrounding tissues. Once it has a blood supply, the fat is extremely stable.

16. What are the potential complications of fat grafting?

Complications are rare with fat grafting.  However, we always worry about and take great care to avoid problems such as bleeding, infection, scarring, irregularities and placing too much or too little fat.

17. Are you swollen and bruised after fat grafting?

In general, yes.  The placement of tiny bits of fat requires multiple passes with the cannula.  This tends to create a fair amount of bruising and swelling.  In general, bruising will resolve in 2-3 weeks.  Swelling where the fat grafts have been placed is usually acceptable in 2-3 weeks, but will take several months to completely heal.  Like any other surgery, there is a small amount of swelling that can be felt more than seen that can last a few months.  The areas that take the longest for the swelling to resolve are the eyelids and the lips.  Swelling in the donor, or harvesting sites can take 3-6 months to completely resolve.

18. Why would I want fat in my face?

As you age and lose the fullness of youth, your face literally becomes smaller. The skin remains the same size, but the layer of supportive fat and connective tissue shrinks with time.  Without the underlying structure, your skin retreats into wrinkles and folds. As the missing structure under the skin is restored with LipoStructure®, the wrinkles and folds will disappear.

19. Why do the doctors ask for patients to bring in photographs of how they looked in their youth?

To make a person look more like they did when they were younger, Dr. Coleman and Dr. Saboeiro must know how a patient’s face has changed over the years. They study old photographs to determine the volumes and shapes needed to restore the healthy, desirable structure of youth.

20. What if I don’t want to look younger?

The goal is to look healthier and to achieve the changes you desire (such as bigger cheekbones, larger lips, and/or a sharper jaw line). After speaking with you about your concerns, Dr. Coleman or Dr. Saboeiro will often suggest that you find photographs of celebrities, relatives or other persons whom you resemble and find attractive. This gives the doctors a chance to understand what you consider desirable.

21. Why do the doctors take so many photographs before procedures?

The doctors’ goal is to make precise three-dimensional alterations in each patient; they do not feel surgery should be “cookie-cutter.”. They study these photos to determine the volume and shape of the structural alterations that will give you the best result.

22. Why don’t they just look at my face?

They do. But the photos and drawings they create allow them to analyze your face with you to arrive at a plan that will give you the best result.

23. Why do the take so many photographs after procedures?

The doctors want to be sure that they obtain the planned result on every patient and in every part of the face and/or body. Fat placed by this method is almost impossible to feel after the swelling subsides. The only objective way to demonstrate the change induced by the fat placement is to compare before and after photographs with the same lighting and same angles.

LipoStructure® – Breasts

1. How long have Dr. Coleman and Dr. Saboeiro been grafting fat to the breasts and how many have they done?

Dr. Coleman’s first breast augmentation with fat was done in 1995. His first breast cancer reconstruction with fat was in 1996.  He has now performed well over 100 breast augmentations and reconstructions with fat. Dr. Coleman has followed some of these patients for over 10 years who have maintained excellent results. No other plastic surgeons in the world have reported grafting fat to the breasts for anywhere near that long.  Dr. Saboeiro has been grafting fat to the breasts for over 5 years, and has done over 100 procedures as well.

2. How much larger can I make my breasts with fat grafting?

Fat grafting to the breasts for augmentation requires a large volume of fat.  Generally speaking, we can enlarge the breasts by one cup size per surgery.  We can usually turn an A cup into a B cup, or a B cup into a C cup.  Enlargement beyond one cup size usually requires additional procedures.

3. How long does it take to do a fat grafting procedure to the breast?

To obtain the long-term results (augmentation and shaping), the procedure is meticulous and time-consuming. Fat grafting to the breast by this method involves three separate parts: (harvesting the fat, concentrating the fat, and meticulous placement into the breast). Each step must be done without damaging the fat. Harvesting the fat with careful manual syringe- based liposuction (no machines used) is a huge procedure in itself.  First, care must be taken to remove fat in an aesthetically appealing manner so that the patient’s body shape is improved without creating new problems at the removal sites. Next, the non-living components of the fat are removed via centrifugation to concentrate the fat.  Finally, the fat is layered into the breast both to ensure access to a good blood supply, and also to sculpt the breast in a three-dimensional manner.  The procedure takes from 3 to 5 hours  on average.

4. What is your average graft survival rate?  I have heard surgeons claim everything from 10-90%.

Fat is a fragile tissue that can be easily damaged.  The techniques used to harvest fat, concentrate it by removing the non-living components, and place the tissue in a fashion that ensures it will be close to a blood supply are extremely important. The Coleman technique for transplanting fat has been acknowledged as yielding a higher percentage survival than others.  In addition, the patients themselves (health, weight, access to donor tissue, hormonal status, scarring at graft site, etc.) can influence fat survival.  To date, no studies have followed the survival of transplanted human fat over a long period of time. Recent studies at NYU involving the transplant of human fat into mice using the Coleman technique, have demonstrated a survival rate of up to 85%.  Further studies are ongoing.

5. Do Dr. Coleman and Dr. Saboeiro use pre-expansion devices (like the Brava system)?

Dr. Coleman and Dr. Saboeiro recommend use of the Brava device in cases where they feel the patient would benefit from external expansion, such as in very thin, small-breasted women or in someone who has had breast cancer surgery.  They often recommend using the device to prepare the breast before surgery by expanding the “envelope” into which fat can be placed, and by helping to increase the blood supply.  After the procedure, Dr. Coleman and Saboeiro believe that the use of the Brava device may improve the fat graft survival. They do not feel that the Brava is needed in every breast fat grafting case.  The doctors will determine if Brava is needed at your consultation.

6. What is the recovery after fat grafting to the breast?

Recovery after surgery is determined primarily by how many areas we need to use as fat donor sites.  If most of the fat can be harvested from the lateral thighs, for example, recovery is generally easier and quicker.  If we must go to many donor sites to harvest adequate volumes of fat, there will be more body parts which are swollen, bruised and uncomfortable.  The breasts themselves will be swollen and bruised, but patients rarely complain about pain in this area.  For the first few days after surgery, moving about is uncomfortable, and we require that you have someone to help you for at least 24 hours after surgery.  Most patients will feel fairly well at about one week after surgery, and may return to work if they feel up to it.  However, most patients are still sore and tired for at least 2 weeks.  We encourage out-of-town patients to stay in theNew York area for approximately a week after surgery.  Bruising will last for about three weeks.  Much of the breast and donor site swelling will be gone after 3 weeks, but some will remain for 4-6 months after surgery.

7. When will I be able to exercise after fat grafting to the breast?

Patients are encouraged to walk as much as possible beginning the day after surgery.  Most patients can return to light exercise at about 10 days to 2 weeks, but may be limited by discomfort in the donor sites.  Also, we do not want patients doing anything that could interfere with the success of the fat grafts.  In other words, for about three weeks after surgery, we do not want patients to put any pressure on the breasts, so we like patients to sleep on their backs, and avoid any excess upper body activity or lifting. After three weeks, patients can ease back into their pre-operative routines.

8. How long am I swollen after fat grafting to the breast?

The majority of swelling in the breasts will be gone at 2-3 weeks after surgery.  The donor sites will be swollen much longer.  It can take 4-6 months for all of the swelling to resolve, but patients feel they look pretty good at 3-4 weeks.  The donor sites will be hard and “woody” feeling for a few months.  The size and shape of the breasts are not expected to change after the first 4-6months.  However, we have occasionally observed a patient’s breasts increase in size a year or more after surgery, even without weight gain.

9. How thin is “too thin” for fat grafting to the breast?  Is a person with a BMI of 20 likely to have enough fat?

Many our patients have low BMI’s, but are able to have breast shaping and augmentation with fat grafts.  Most women have localized collections of fat in their lovehandles, flanks, abdomen or thighs. For patients with a normal or low BMI, we may remove fat from multiple areas to obtain enough volume and to avoid problems with liposuction.

LipoStructure® – Body

1. How long have Dr. Coleman and Dr. Saboeiro been grafting fat to liposuction deformities and to the body in general, and how many have they done?

Dr. Coleman’s first correction of a liposuction deformity with fat was done in 1987. He has now done hundreds of these procedures over the last twenty-four years. No other practicing plastic surgeon in the world has grafted fat to correct liposuction deformities and to the body for anywhere near that long.  Dr. Saboeiro has been grafting fat to liposuction deformities and to the body for over 6 years.

2. How long does it take to do a fat grafting procedure to correct liposuction deformities or to augment the body?

To obtain the long-term results (filling and shaping), the procedure is meticulous and time-consuming. Fat grafting to liposuction deformities and to the body by this method involves three separate components (harvesting the fat, concentrating the fat, and meticulous placement of the fat). Each step must be done without damaging the fat. First, care must be taken to remove fat in an aesthetically appealing manner so that the patient’s body shape is improved without creating new problems at the removal sites. Second, the non-living components of the fat are removed via centrifugation to concentrate the fat.  Finally, the fat is layered into the deformed areas both to ensure access to a good blood supply, and also to sculpt the deformities in a three-dimensional manner.  The length of the procedure is determined by how large the defects are, as well as how many there are and where they are located.  A simple procedure may take less than 2 hours; a complicated one may take as long as 5 hours.

3. What is your average graft survival rate?  I have heard surgeons claim everything from 10-90%.

Fat is a fragile tissue that can be easily damaged.  The techniques used to harvest fat, concentrate it by removing the non-living components, and place the tissue in a fashion that ensures it will be close to a blood supply are extremely important. The Coleman technique for transplanting fat has been acknowledged as yielding a higher percentage survival than others.  In addition, the patients themselves (health, weight, access to donor tissue, hormonal status, scarring at graft site, etc.) can influence fat survival.  To date, no studies have followed the survival of transplanted human fat over a long period of time. Recent studies at NYU involving the transplant of human fat into mice using the Coleman technique, have demonstrated a survival rate of up to 85%.  Further studies are ongoing.

4. What is the recovery after fat grafting to correct liposuction deformities or for augmentation of the body?

Recovery after surgery is determined primarily by how many areas we need to use as fat donor sites and the extent and number of the corrections planned.  If most of the fat can be harvested from one or two areas, for example, recovery is generally easier and quicker.  If we must go to many donor sites to harvest adequate volumes of fat, there will be more body parts which are swollen, bruised and sore. For the first few days after surgery, moving about is uncomfortable, and we require that you have someone to help you for at least 24 hours after surgery.  Most patients will feel fairly well at about one week after surgery, and may return to work if they feel up to it.  However, most patients are still sore and tired for at least 2 weeks.  We encourage out-of-town patients to stay in theNew York area for approximately a week after surgery.  Bruising will last for two to three weeks.  Much of the swelling will be gone after 3 weeks, but some will remain for 4-6 months after surgery.

5. When will I be able to exercise after fat grafting to correct liposuction deformities or for augmentation of the body?

Patients are encouraged to walk starting the day after surgery.  Most patients can return to light exercise at about 10 days to 2 weeks, but may be limited by discomfort in the donor sites.  In addition, we do not want patients to put any pressure on the grafted areas for approximately three weeks.  After three weeks, patients can ease back into their pre-operative routines.

6. How long am I swollen after fat grafting for liposuction deformities and for augmentation of the body?

The majority of swelling in the grafted areas will be gone 2-3 weeks after surgery.  The donor sites will be swollen much longer.  It can take 4-6 months for all of the swelling to resolve, but patients feel they look pretty good at 3-4 weeks.  The donor sites will be hard and “woody” feeling for a few months.  The size and shape of the treated areas are not expected to change after the first 4-6months. We recommend waiting at least 6 months before considering a second procedure.

7. Can scarring under the skin be a problem when correcting liposuction deformities?

In liposuction deformities created by simple liposuction, adhesions or scars causing the skin to be stuck down to the underlying muscles and other tissues are not common.  However, after laser liposuction,  ultrasonic liposuction, mesotherapy, or liposuction complicated by collections of fluid, adhesions and deep scars are more common.  Similarly, deformities induced by trauma or injections are more likely to have troublesome scarring under the skin.  We approach such scarring by first placing as much fat into the scarred area as possible.  Sometimes this will be enough to release minor adhesions.  If an adhesion persists, we can use specially designed instruments to manually separate the scar from the tissue to which it is stuck.   The area is much more likely to be smooth if the adhesions are released.

8. Is massage good to improve recovery?

We encourage lymphatic drainage massage to speed recovery.  This is a very light massage to help your body remove swelling, and it should be done by a massage therapist specifically trained in this technique.  We discourage deep massage for the first two months or more after surgery.  The transplanted fat will usually have blood vessels growing into it by two weeks, but deep massage can disrupt the new vessels in the grafted fat.  Touching the skin gently for washing and application of lotions, etc., is not a problem.

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Sydney Coleman Video on Fat Grafts, Stem Cells & Regenerative Surgery
August 20, 2013
Interview with Sydney Coleman, MD Sydney Reese Coleman is the physician who first observed and announced to the scientific community the amazing regenerative ability of fat grafts and the associated stem cells.  Beginning in 1987, he has developed procedures that...

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