Rhinoplasty (Cosmetic Nose Surgery) and related Cosmetic Surgery Topics

Fat Grafting versus Fat Transfer versus Fat Injection - What is the Difference?

Answer:  There is no difference.  Fat grafting and fat transfer are used interchangeably; they both mean the same thing.  Originally, when fat was being moved from one location to another, it became noted under the title of “fat grafting”.  This is similar to other types of grafts, in which skin or hair are moved from one part of the body to another by plastic surgeons.  When you take a hair follicle and move it from the back of the head to the front of the head, it actually grows because that hair knows here it came from, and it is not destined by its genetic profile to eventually fall out.  Skin grafts have been used for over 100 years to cover a defect when it is taken from one part of the body using healthy skin and moving it to another part of the body where there is burned or disfigured skin.  That is why fat grafting came in to play as a word because plastic surgeons were moving fat from one location of the body to another to replace fat that was lost.  The new fat taken from another part of the body is programmed to live; whereas, the location where the fat is being placed has been lost.  Probably because the general public did not quite understand what the word “fat grafting” actually meant, many people in the media, as well as plastic surgeons, started to use the word “fat transfer” to basically mean the same thing, that being to move fat from one part of the body to another.  Fat grafting or fat transfer has been becoming more mainstream recently because of the tremendous amount of publicity in stem cell research.  There are ongoing studies being done that may take a decade to be substantiated.  There is ongoing research that may prove that fat cells can represent a certain percent of stem cells.  Fat grafting and/or the word “fat transfer” are becoming very popular, and this article is for informational purposes to help the public better understand that these are used interchangeably, and they basically mean the same thing.

How to Save Money on Plastic Surgery

Dr. Clavin has been performing cosmetic plastic surgery for over 35 years.  Even though he is a surgeon by trade, he has noted that there are many ways a patient can get a very desirable result by having an injectable, chemical peel, or laser treatment instead of actually having surgical intervention.  In today’s modern world, there is a whole variety of safe, proven materials that can help the facial appearance.  These include Botox, hyaluronic acids, for which two of the better known ones are Juvederm and Restylane, and fat grafting.  The latter procedure, fat grafting, has been used by Dr. Clavin for 30 years with exceptional results, which are permanent and help both in the nasal area as well as facial area and even in body areas.  Even though there are large numbers of doctors that are using a variety of injectables, Dr. Clavin feels that your best chance for success would be with a surgeon who actually operates and does cosmetic surgery.  The reason for this is that a physician who is performing plastic surgery and is well-trained has spent years honing his aesthetic eye and understands contouring.  With that particular aesthetic eye, the physician can better visualize the result achieved using an injectable, such as Juvederm, Restylane, or fat.  Dr. Clavin actually encourages many of his patients to have an injectable rather than surgery if they wish to have no downtime, wish to save a significant amount of money, and do not mind coming back once a year to have a touch-up.  Basically, it is a win-win situation and is a tremendous adjunct to the whole field of plastic surgery.  Therefore, a qualified plastic surgeon can save the patient a considerable amount of money if they wish to have one of the alternatives to actual surgical intervention, which include a variety of peels, laser skin treatment, Botox, and injectables.

Avoiding Nasal Surgery by Using Injectables

Dr. Clavin is finding that the trend toward nasal injectables is taking off and replacing in some cases the need for rhinoplasty or surgical intervention to correct a nasal deformity.  Fortunately, there have been some excellent injectables that have come onto the market, namely those being hyaluronic acid and Juvederm and also a patient’s own fat cells used to reimplant in locations on the nose and correct deformities that normally would require rhinoplasty or nasal surgery.  For patients not wanting to have surgery or not wanting to spend the money to have a surgical procedure, the modern injectables are proving very advantageous to help a variety of nasal conditions, including those that are caused by surgical intervention to the nose and/or congenital defects of the nose that the patient wishes to have corrected.

Even patients who have never had their noses done but wish to have  rhinoplasty can sometimes benefit by using an injectable to the nose, again, either fat, Juvederm, or others.  This would result in reshaping of the nose with beneficial results for at least one year or longer without surgery.

Stem Cell Research and Fat Grafting

Dr. Clavin has been performing fat grafting for almost 30 years and has noted that the skin tone on top of the areas where fat grafting has taken place appears to transform into more vibrant and less aged skin.  This observation was far in advance of the more recent excitement in stem cell research.  Companies are sprouting out throughout the world advocating that they have better ways of taking fat and using those cells to be reinjected into a body part to rejuvenate the area accepting the fat cells.  Dr. Clavin feels the public should be very much on guard and watch out for charlatans and/or unsubstantiated companies promoting stem cell research and procedures having to do with rejuvenating body parts with stem cells.

There is no doubt that there could be a significant future in stem cell research using fat cells.  With time, there will be more and more substantiated research by reputable companies and universities that will find good and safe use for stem cells.

In the meantime, Dr. Clavin continues to use fat cells taken from one part of the body and reimplanting them into other parts of the body, particularly in the facial area, the nose, the cheeks, the jaw line, and other locations.  He has always been very satisfied with these results and has noted that, after one to three sessions, the fat survives and is permanent.  It is also his observation that the skin on top of the area of fat grafting appears to be less atrophic and/or thin and seems to have a more youthful appearance compared to the areas where no fat grafting was placed.  This is his own personal observation, and more scientific data will have to come out through documented research to determine if, in fact, there is some effect in which the fat cells rejuvenate skin.  Dr. Clavin is looking forward to a very bright future of stem cell research to determine a truly beneficial and potentially helpful method of improving the whole field of plastic and cosmetic surgery.

Dr. Clavin’s Talk on Nasal Injectables is Well-Received

Dr. Clavin gave a talk at the quarterly meeting of the Los Angeles Society of Plastic Surgeons on nasal injectables on Wednesday, May 19, 2010.  He was well-received by the approximate 25 plastic surgeons that were in the audience.  He presented cases of both primary and secondary nasal surgeries that were benefited using a variety of injectable materials, including fat, Juvederm, and Restylane.  He gave examples in which surgical intervention was avoided by the simple use of injectables that can be permanent, such as fat, or temporary, such as Juvederm.  Much discussion was stimulated in the audience, and other plastic surgeons gave their feelings and experience using similar materials.  The overall sentiment in the audience was that the doctors are getting more encouraged by the results of using injectables to the nose and, therefore, avoiding surgical intervention.

Hand Rejuvenation with Fat Grafting (Fat Injection)

I have been performing fat injections to a variety of locations throughout the body for well over 25 years.  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.  I use small amounts of fat and place it 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.  I perform the procedure in an accredited operating room facility, and it 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.  I have been very encouraged by the results of hand rejuvenation using fat.  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 the 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 Breasts

I have been performing fat grafting for over 25 years with excellent success.  Fat 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 about 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.

 

I have noticed very encouraging early preliminary studies in my own practice of performing fat transfer to the breast area.  There have been encouraging results in loosening the skin and getting better skin texture and tone when putting fat under mastectomy scars or even under irradiated tissue.  In my own practice, I have been augmenting breasts either primarily or after removal of breast implants with fat with very encouraging results.  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.  Experience plays a significant role and, therefore, my 25 years of performing fat injections throughout the body with excellent results has made my transformation to applying fat, which is called autologous fat grafting, to the breast area with, as mentioned above, very encouraging results.  I usually like to perform the fat grafting 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, I will 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.  I like to use smaller volumes of fat in the range of 50-100 cc at each sitting 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 that 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 I have received from patients has been exuberant, and it gives me encouragement to continue my 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 Results

The 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.

Juvéderm 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.

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 Results

The 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 patient is able to achieve permanent results by taking a small amount of fat and placing it into the nasal area. Sometimes one to three sittings are needed spaced three months apart to achieve the final end result but, when finished, the result is permanent, which is different than using a hyaluronic acid type material, such as Juvéderm or Restylane, which give results that last about one year. Fat injections are slightly more costly than Juvéderm or Restylane in the short term but is far cheaper in the long term. Fat cells under the skin of the nose appear to make the skin of the nose healthier, and in the case of revision Rhinoplasty, fat injections under the nose help the texture of the skin and help soften irregularities that show through the skin on previously operated noses and, therefore, can give high patient satisfaction.

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.

Can Medical Schools or Residency Training Programs Teach a Surgeon to Have an Aesthetic Eye?

No.  No.  In order for a doctor to go through medical school and get into good residency programs, he or she has to have a certain degree of intelligence.  This allows them to gather the material, digest it, learn it, pass examinations, and become a qualified physician.  Then, they can move on and take residency programs to learn the art of plastic surgery, cosmetic surgery, and a variety of other types of specialties.  Certain types of specialties and particularly that involving plastic surgery and cosmetic surgery require a talent that, in my opinion, is not teachable, and that is the aesthetic eye.  Intelligence and training does not teach something that, in my opinion, is genetic, and that is looking at features, not just one feature but the whole feature, and be able to discern what is beautiful, what is natural, what fits that particular individual the best, and symmetry.  It’s a certain way of looking at a patient, it’s an art, it’s a talent, and it is not teachable.  Talent is not teachable.  You can teach a person with talent to be better at their talent, but a person with no talent cannot be taught.  Therefore, when it comes to cosmetic surgery and the talent of the plastic surgeon, it is a genetic event, and either a surgeon has that genetic propensity to see beauty, see symmetry, see the whole and not just the part, and combine them all in order to make his form of surgery aesthetically pleasing to the eye and not appear to be operated, artificial, or look weird.

Therefore, to summarize this little writing, I feel quite strongly that talent and the aesthetic eye cannot be taught, and it is a talent.  If that person has that talent, then it can be tweaked further by proper training by other surgeons that have the same genetic propensity.