Under your skin: The latest injectables make Botox look like child’s play.

Joan Chen for W Magazine interviewed Sydney Coleman specifically about facial and eyelid rejuvenation with a specific type of fat grafting, the Coleman procedure.  She discusses the improvement in the quality of skin, increased collagen and lightening of the skin:

“In expert hands, fat—usually softer and more fluid than fillers—can also brighten the thin skin around the eyes.  An injection not only smooths wrinkles and fills hollows but also acts as a barrier between skin and underlying facial muscles and blood vessels, hiding dark circles, says the New York plastic surgeon Sydney Coleman.  What’s more, researchers suspect that stem cells in fat can actually promote the production of collagen and elastin—and therefore eventually improve the quality of the skin.  A session for the lower lids takes about 90 minutes and costs from $5,000 to $10,000.”

         “Complications can arise, however—often due to overzealous injecting.  When this occurs, little divots emerge where a dearth of oxygen has caused the fat cells to die.  “You can’t do fat grafting casually,” cautions Coleman, who uses tiny increments and as many as 50 passes to complete a procedure around the eye.”

For a better understanding of facial and eyelid rejuvenation with Coleman fat grafting, please go to the following:  ,

Dark eyelid circles a unique solution.

Upper Eyelids, Brows and Temples

Lower Eyelids & Cheeks

Improvements in Structural Fat Grafting

The possible role of stem cells in facial rejuvenation

To understand how these procedures came about, please refer to the following:  ,

Read about Dr. Coleman’s development of these special procedures in Cosmetic Surgery Times

Recent in depth interview of Sydney Coleman in ISAPS Journal .

The FDA, in a surprising move, has re-classified the BRAVA breast expansion device into a higher risk category for the ongoing BRAVA clinical trials.  We want to assure our patients (those who are currently using the device, have used it in the past, or who contemplate future use) that we are not aware of any evidence of any safety issues regarding the use of the device, and there is no reason to discontinue or postpone its use.

In order to continue the studies with FDA approval, Brava submitted an IDE (Investigational Device Exemption) application to the FDA on March 28, 2013.  In the meantime, any studies involving BRAVA have been temporarily curtailed until the FDA approves the exemption (probably 1-3 months).

We have recommended the use of the BRAVA device for several years, but did not enroll patients in the clinical study.  We have been impressed with the ability of the device to expand the breast tissue, allowing us to place larger volumes of fat; and studies suggest that the use of the BRAVA device post-surgery enhances graft survival.

Dr. Roger Khouri, Principal Investigator in the study, has discussed this issue at length.  He recently announced the following:

“Brava as a stand-alone device to enlarge the breast without surgery has a well established safety record. It has been used by tens-of-thousands of women for over the past 10 years with no significant complications whatsoever…… The American Society of Plastic Surgeons, the most important plastic surgery society condones Brava + Fat grafting. The Society just promoted it with a large teaching course with live surgery out of the Miami Breast Center operating room…… Over the past 8 years several hundred women were enrolled in this IRB study sponsored by Brava. Results show that fat grafting after Brava expansion allows us to successfully graft much more fat and achieve much better augmentation and breast reconstruction results than if Brava was not used. Most importantly, there were essentially no complications. Certainly less than the implant and flap alternatives.”

Should you have any additional concerns, please feel free to contact our office by asking questions on this blog site or one of the following:

•           phone (212 571-5200)
•           email info@lipostructure.com
•           Tribeca Plastic Surgery on FaceBook 

For more information on BRAVA, please look at the following links:

• BREAST AUGMENTATION WITH BRAVA AND COLEMAN FAT GRAFTING
  Patient Testifies how Coleman Fat Grafting Combined with BRAVA changed her life.
  
  DR. SYDNEY COLEMAN OF NEW YORK CITY COMBINES THE BRAVA SYSTEM WITH BREAST LIPOSTRUCTURE

•  

The hand rejuvenation procedure takes a little over an hour, and is usually done under light IV sedation (“twilight”).  Pain after the procedure is usually minimal: none to very little in the hands, and mild in the donor site.  There is usually little if any bruising, but there is some swelling.  We advise keeping the hands at or above the level of the heart when possible for a few days after the procedure to help the swelling resolve. The instruments we use to place the fat are so small, that there is no need for stitches in the hands, but there may be one or two in the donor site.

It will take a couple of months before the last bits of swelling are gone and you can see the final contours of your hands.  However, grafted fat continues to work on the skin for years to come, softening, thickening, improving texture and tone, and even decreasing redness and discoloration.

Younger hands are now more affordable. Call us to schedule a consultation at 212 571-5200.

Back of hands before (above) and three years after (below) Coleman fat grafting in a 48 year old woman. Note the subtle filling combined with the skin thickening dramatically obscures the tendons as well as lessening the wrinkling up onto the fingers.

Close-ups of opposite hand in the patient seen above before (above) and three years after (below) Coleman fat grafting with remarkably improved quality of skin. Note how subtle filling makes the knuckles appear less arthritic, by changing the relative proportions of the hand.

copyright 2013 Coleman

For more information for hand Rejuvenation, please refer to the following:

Hand Rejuvenation by Thickening Skin with Coleman Fat Grafting

Younger Hands with Coleman Fat Grafting and Light Therapy

Hands (in LipoStructure Website)

As the skin of the hand ages, it loses collagen and elasticity causing the skin to thin…often dramatically.  Without the thickness and elasticity of youthful skin, the colors and shapes of what lie beneath in the hand become obvious. White, linear tendons and large, ropey blue veins protrude through the thinning skin.

The hands above are of the same person when she was 20 years old (left) and now when she is 54 years old (right). The younger hand is not fuller, but has thicker skin, which hides the underlying structures. The key to hand rejuvenation is thickening of the skin with Coleman fat grafting.

A youthful hand is not necessarily plump. Thickening of the skin with Coleman fat grafting provides a better result than just using fillers for hand rejuvenation. After grafting a thin layer of a person’s own fat beneath aging skin of the back of the hand, collagen gradually increases over the next months.  Under the thickened skin, veins and tendons become less visible and protuberant.  Over time, the stem cells in fat help to repair the surface appearance and texture of the skin as well.

Some older hands have a dramatically thin and unhealthy appearance from loss of fat and muscles making the joints look larger and arthritic, even if they are not.  In this situation, restoration of volume becomes paramount in creating a normal, healthy appearing proportion of the hand. A youthful proportion is essential for hand rejuvenation.

Artificial fillers such as Radiesse and hyaluronic acids can also be used to simulate hand rejuvenation.  They create a fullness, which mimics the filling that one attains with Coleman fat grafting. However, the effect is not long lasting and does not result in actual thickening of the skin. Fat grafting, however, is not only long-lasting but also appears to create progressive improvement of the skin for years afterwards.

Back of hands before (above) and one year after Coleman fat grafting. Note the subtle filling combined with the skin thickening obscures the tendons and veins as well as lessening the wrinkling up well onto the fingers.

copyright 2013 Coleman

For more information for hand Rejuvenation, please refer to the following:

Younger Hands with Coleman Fat Grafting and Light Therapy

Hands (in LipoStructure Website)

But, there are relatively easy fixes to younger hands.  Spots can be treated with Hand Rejuvenation with BBL, which not only eliminates or reduces discoloration, but also stimulates collagen production and helps to tighten the skin.Hands can also be restored using your own body’s fat. Coleman fat grafting to the back of the hand not only restore fullness or volume but also stimulates thickening of the skin which lasts for many years.

Coming soon:  Technical Advances make Coleman Fat Grafting for Hand Rejuvenation more affordable.

For more information, please visit our website LipoStructure.com.

Call us for a consult at 212 571-5200, and show off your younger hands this spring!!

Hands before (above) and two years after (below) one fat grafting treatment.

On the other hand, journalists are required to have reliable sources and documentation. Newspapers, magazines, radio and television are media that should report only what they believe is the truth.  Dr. Coleman has been a frequent subject of articles and news stories in TV and popular magazines as well as professional journals and symposia.  He has always been presented in a glowing, positive light.  We encourage you to search for sources that can be trusted.  Please review our media section (which we are currently updating) for authentic journalistic reports of Dr. Coleman’s research, innovations and surgical results. 

As far as legal issues are concerned:

1.  The New York Department of Health has no complaints against Dr. Coleman (verified most recently in December 2012).

2.  Sydney Coleman has never had a malpractice judgment against him.

3.  Dr. Coleman is a member in good standing of many prestigious Plastic Surgery organizations:

• American Board of Plastic Surgery
• American Association of Plastic Surgery
• American Society of Plastic Surgery
• American Society of Aesthetic Plastic Surgery
• International Society of Aesthetic Plastic Surgery
• International Federation of Adipose Therapeutics and Science (co-president)
• International Society of Plastic Regenerative Surgery (secretary-general)

Dr. Sydney Coleman is a compassionate, hard-working, intelligent physician who has dramatically improved the world in which he lives.  He has produced innovations over the last twenty-six years, which have revolutionized not only plastic surgery, but other areas of medicine as well. He frequently lectures worldwide and publishes extensively on plastic surgery.

For a more complete picture of Dr. Coleman, please refer to, his biography on our website, LipoStructure.com.  In his biography page, you will find his CV, a list of his worldwide lectures, a list of publications, and patient testimonials.  

Finally, review the blog, The Press Reports Internet Attacks on Physicians

This patient purchased a new bra recently, and found she was overfilling a D cup.  Two years ago (before two sessions of Coleman fat grafting to her breasts) she was a small A cup. She scheduled an appointment to let us know how “amazing” her breasts now are.

Eleven months after her second session of Coleman fat grafting to Breasts. She went from a small A cup (left) to a full D cup (right).      The red lines on her inner breast are stress marks from overfilling her D cup!

In our office she told us,  “People say that breasts are not important, but they are.  As I woman, I wanted breasts to feel feminine.  Now I am also much more confident. The results I have received from fat grafting to my breasts have changed my life.   I am ecstatic looking at myself in a mirror. ”

She had tried silicone breast implants in 1994, but had them removed after nine months because she felt the implants appeared and felt unnatural.

When she came into our office today for photographs, she said, “I’m thrilled with the completely natural results of Coleman fat grafting to my breasts.  And I think it is important to share with other women this amazing technology for enlarging and enhancing breasts using only one’s own fat.”

Concerning the BRAVA reverse expansion, she reported, “I used the BRAVA exactly as Dr. Coleman asked me to do before and after the two fat grafting sessions.  It was not easy to use, but obviously worth the effort.”

This lady came to our office 11 months after her second Coleman fat grafting to the breast. Before (left) she was a small “A cup”. Now she overfills a “D cup” (left). She had only Coleman fat grafting combined with BRAVA.

Eleven months after her second session of Coleman fat grafting to Breasts. She went from a small A cup (left) to a full D cup (right).

Eleven months after her second session of Coleman fat grafting to Breasts. She was a small A cup (left) and is now a full D cup (right). This arms up position emphasizes the volume of the augmentation.

Eleven months after her second session of Coleman fat grafting to Breasts. She was a small A cup (left) and is now a full D cup (right).Shooting from below also emphasizes the degree of augmentation

Usually, women do not experience more than one cup size difference after one session of fat grafting, but combining fat grafting with meticulous use of BRAVA reverse expansion Coleman fat grafting to breasts has the potential to enhances the results.

For more discussion of Coleman Fat Grafting (AKA LipoStructure), please refer to the following:

Dr. Sydney Coleman of New York City combines the BRAVA system with Breast LipoStructure

Catherine Saint Louis wrote an article in the Style Section of the New York Times on fat grafting to the breasts.  Please click on this the following URL to take you to the article:

http://www.nytimes.com/2009/12/03/fashion/03skin.html?_r=1&ref=fashion

Safety concerns with fat grafting to the breast

The American Society of Plastic Surgery’s Position of Fat Grafting to the Breast

Dr. Sydney Coleman Began Grafting Fat to the Breast 17 Years Ago

For information on the consultation, procedure and pricing for Dr. Coleman’s fat grafting to the breast CLICK HERE.

Fat Grafting to the Breast Revisited: Safety and Efficacy. Plastic & Reconstructive Surgery. 119(3):775-785, March 2007. Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.

Coleman Demonstrates Long-Lasting Natural  Breast Results

If you are interested, these posts will help you to understand tuberous breasts, and their potential correction.

• What is a Tuberous Breast?
• How Can We Correct a Tuberous Breast?
• Remarkable case of tubular breast correction with Coleman fat grafting 

© Coleman 2012

Tribeca Plastic Surgery has remained completely operational. Neither the office at 44 Hudson nor the CARE ambulatory surgery center was harmed by the hurricane.  We only closed the office during the time that public transportation was not working.

We learned a great deal during the last few weeks on the importance of modern methods of communication, such as social media and the Internet.

We have been posting periodically on Facebook at LipoStructure Sydney Coleman and Tribeca Plastic Surgery. Also follow us on Twitter @LipoStructure. 

For non-urgent problems, an alternative way to contact us is still by email at info@lipostructure.com or directly to the email of any member of our staff.

Finally, in the interest of accommodating our patients, we have decided to extend office hours on Monday evenings until 8pm.

-Sydney Coleman

After conservative breast therapy for cancer (lumpectomy followed by irradiation), a woman is left with a lumpectomy defect that is often difficult to reconstruct.  The therapeutic irradiation is a critical component of breast cancer treatment to decrease the possibility of the cancer returning near the site of the original cancer. Unfortunately, radiation can damage the normal tissue while it is eliminating potential cancer cells.  This damage from radiation significantly complicates lumpectomy reconstruction.

Lumpectomy Reconstruction with Fat as an Alternative to Implants

Placing a saline or silicone gel-filled implant into the damaged, irradiated breast remarkably increases the incidence of scarred or hard breasts (breast capsular contracture), infection and rejection of the silicone implant.  Therefore, placement of an implant in these conditions often results in a poor cosmetic result.

Mechanism of Lumpectomy Reconstruction with Fat Transfer

Lumpectomy reconstruction (putting fat into a breast after lumpectomy and irradiation) not only restores the breast by adding volume and reshaping the breast, but also appears to decrease scarring and promote the growth of a blood supply and the healing of the radiation damaged breast.

Versatility of Lumpectomy Reconstruction after Lumpectomy

Fat can be grafted in either large or small volumes to address otherwise difficult problems such as asymmetry or breast size, poor breast shape, visible implant edges, or even a hard, scarred implant. Grafted fat can provide missing coverage and may also relax breast scarring.   Recent scientific articles have reported on the efficacy of fat grafting for breast reconstruction and improving the shape of the breast as well as for the treatment of radiation damage.

When fat is harvested and refined with minimal trauma and placed in small volumes with each pass of the cannula, a significant portion of the transplanted fat survives and provides a structure and shape to the breast that cannot be achieved with implants alone or with other types of surgery.

Structural fat grafting using this technique appears to be as safe as and perhaps even more effective than many other methods of changing the contour of the breast. Some reconstructive surgeons are claiming that fat grafting may be among the most significant advances in breast surgery.

Patient Example of Lumpectomy Reconstruction with LipoStructure

Before (right) and 7 months after (left) one treatment of a retracted, deforming lumpectomy scar. After lumpectomy followed by therapeutic radiation, this patient was left with a hard, painful breast. Her breast was so hard, that mammography was not possible. By six weeks after filling the lump and releasing the adhesions, the patient’s pain was almost absent and her breast was soft enough to obtain a mammogram.   Please note the improvement in skin quality of the area around the indentation all the way up to the nipple.

Before (above) and 7 months after (below) one treatment of a retracted, deforming lumpectomy scar.

Before (right) and 7 months after (left) one treatment of a retracted, deforming lumpectomy scar. Profile demonstrates a subtle decrease in fullness in the area above the retracted scar. Before fat grafting, the area just above the scar was hard and full. Placement of a small amount of concentrated fat into the area above the retracted scar with surgical release of the scar resulted in a soft breast without the hard protuberant area above (orange circles).

–Written by the Staff at TriBeCa Plastic Surgery

FOR MORE INFORMATION ON BREAST FAT GRAFTING, PLEASE GO TO THE LIPOSTRUCTURE WEBSITE.

Check out these links for more information on fat grafting to the breasts:

• Coleman Shows Longevity of Fat Grafting to the Breasts

• New York Times Reports on Fat Grafting to the Breast

• Combining the BRAVA system with Fat Grafting to the Breast

• Fat Grafting to solve problems with Breast Implants

• Safety concerns with fat grafting to the breast

• The American Society of Plastic Surgery’s Position of Fat Grafting to the Breast

• Dr. Sydney Coleman demonstrates Breast Reconstruction with LipoStructure on The Doctors

• Coleman lectures on fat grafting for breast reconstruction at the American College of Surgeons

• Breast Augmentation Via Fat Grafting From “Plastic Surgery Practice”

• Fat Grafting to the Breast Revisited: Safety and Efficacy. Plastic & Reconstructive Surgery. 119(3):775-785, March 2007. Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.

Catherine Saint Louis wrote an article in the Style Section of the New York Times on fat grafting to the breasts on.  Please click on this the following URL to take you to the article:
http://www.nytimes.com/2009/12/03/fashion/03skin.html?_r=1&ref=fashion

Ms. Saint Louis did a great deal of research and spoke to me for close to two hours over three different conversations.  She also interviewed one of my patients who has an eleven year follow-up (last paragraph of the article).

© Coleman 2012

There is now a solution for dark pigmentation of the eyelids.  Dr. Sydney Coleman at TriBeCa Plastic Surgery in New York City has developed a new method for grafting fat which not only smoothes eyelids, but also lightens dark eyelid circles.

The Principle for Treatment of Dark Eyelid Circles with Fat

The new technique involves placement of a very thin layer of stem-cell rich concentrated autologous fat (your own fat harvested from a donor site in your abdomen, thigh or lovehandle).  As the skin and underlying tissue heal after grafting, the skin color, thickness, tone and quality change dramatically, as can be seen in these before and after photos. 

Dark eyelid pigmentation is one of the most common cosmetic problems for women and men, and one for which there has been little help.  There are a plethora of creams on the market which claim to improve dark circles, but with little proven relief.  Darker-skinned individuals are particularly prone to this problem.  The skin around the entire eye appears dark, creating an appearance of one who is perpetually sleep-deprived.

The Technique for Placing Fat into Dark Eyelid Circles

Dr. Coleman’s procedure is usually done under light, “twilight-“ type anesthesia, and takes about an hour.  He places the concentrated fat with special tiny instruments through puncture sites in the skin.  There is bruising and swelling afterwards, which can usually be hidden by sunglasses.  The bruising can last for three weeks or more, and the change in skin color may take a few months to evolve.  Patients feel the wait is worth the effort, and are thrilled with the results.

Patient Example for Treatment of Dark Eyelid Circles

Intense lightening of dark eyelid skin before (left) and 18 months after (right) placement of a thin layer of concentrated Coleman fat grafts. Note the improvement in wrinkling of the upper and lower eyelid skin next to the eyelashes. Also note the improvement in the white scar at the end of the eyebrow.

Before (above) and18 months after (below) placement of an extremely thin layer of concentrated fat immediately under the skin. Note the lightening of the dark circles in both the upper and lower eyelids. These photographs taken with a ring-flash allow the viewer to see not only the dramatic lightening of the skin, but also the changes in skin texture and shape. This change creates a much healthier appearance. The patient was extremely happy with her results and felt much more confident about her appearance.

Smiling images before (above) and 18 months after (below) placement of a thin layer of Coleman concentrated fat demonstrate the natural appearance with facial motion. Note decreased wrinkling associated with the increased collagen of the eyelid skin even in this young person.

The upper eyelids before (above) and 18 months after (below) placement of an exceedingly thin layer of concentrated Coleman fat demonstrate a change in color with only a subtle increase in fullness of the area.

Markings placed immediately before the procedure illustrate where the fat is to be placed. This allows the patient to participate in the planning. The green arrows indicate where a change in shape of the lower eyelids will take place. The orange lines represent the limits of placement. No fat is placed outside of the orange lines. Red dots represent where tiny punctures will be made for the small Coleman placement cannulas.

Please note that in these photographs the only color adjustment done was auto contrast and brightness.

Dr. Coleman warns that this procedure is not for everyone or for every type of darkness around the eyes.  Please call TriBeCa Plastic Surgery at +1 212 571 5200 for more information.

.Written by the office staff at TriBeCa Plastic Surgery

Read about Dr. Coleman’s development of these special procedures in Cosmetic Surgery Times.

For more information please refer to earlier posts concerning eyelids and rejuvenation:

• Improvements in Structural Fat Grafting
• The possible role of stem cells in facial rejuvenation