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.

Newer is Better When it Comes to Cosmetic Surgery??

Certain new techniques have come into plastic surgery and cosmetic surgery over the years.  Many of them have proved to be unsuccessful and not worthy of further study.  Many lasers have come and gone, many new techniques for liposuction have come and gone, and yet the newer machines and the more expensive machines keep coming and coming and coming.  Occasionally, there is a new laser technique or machine that will work, such as laser hair removals and certain types of new lasers that can help rejuvenate the skin; however, we must not forget there are many much simpler methods to help rejuvenate the skin and give a better texture to the skin that avoid expensive lasers.  Simple things like trichloroacetic acid peels, or TCA peels, at a fraction of the cost of lasers can get a fine result for increasing texture on the facial skin and ridding it of very fine lines.  When it comes to certain types of surgical procedures, such as cosmetic nose surgery (Rhinoplasty), cosmetic eyelid surgery (blepharoplasty), and even face lift surgery, some of the newer techniques are worse rather than better.  The open nasal revisional surgery which has come to vogue and is extremely popular, in my opinion, is going backwards.  It is opening up the nose and causing tremendous trauma when all you have to do is make small incisions inside the nose, and you can get excellent results as long as you have a well-trained surgeon who is very familiar with this type of closed rhinoplasty/nose technique.  The same is true of face lifts.  Newer techniques for face lifts have been developed that, in my opinion, distort the face and cause a cat eye appearance, high cheek bones, pulled looks, and looks artificial.  The same for eyebrow lifts.  The same for certain types of blepharoplasty procedures.  The true art of plastic surgery is for one to look natural without pulled or artificial looks.  Some of the newer techniques, in fact, give artificial, pulled looks, which are far from improved.  Some of the older, more restrained techniques that are more conservative yet get great results are better than some of the newer techniques.  Reason -- they give more natural-appearing faces and looks without the pulled earlobe, retracted corners of the eye, or a variety of looks that look typically operated on.

Revision Nose Surgery Using the Closed Technique - Can It Be Done?

Yes, in the general plastic surgical arena, many patients are told that revision surgery on the nose can only be done using an open technique in order to get ideal results. This is not true because in the hands of very fine surgeons that have used the closed technique for many years, they often have and can get very successful results using the closed rhinoplasty technique.

What are the advantages of closed versus open technique? The advantages are that the patient goes through much less trauma, much less scar tissue formation, no external scars, and a much faster recovery. It also allows for  further possible revision surgeries without the surgeon having to work through extensive scar tissue, which is produced by open techniques. In fact, many doctors who do open technique only cause tremendous trauma to the nose, which decreases the circulation and, in fact, makes revision nose  surgeries sometimes impossible. A closed technique is a harder technique to learn and, therefore, it is not as widely used because of the extensive learning curve required by the surgeon; however, after having performed hundreds of closed rhinoplasties, a competent surgeon can easily do revision surgeries closed, limiting the downtime, discomfort, and chronic edema and swelling that lasts for months following all open procedures. In addition, a major advantage is avoiding external scars. It is a fact that most plastic surgeons will mention to a patient that an open rhinoplasty technique is the only way to get a good result in a difficult nose. When the plastic surgeon has had extensive experience doing closed rhinoplasty, the end result can be exceptionally pleasing to the patient resulting in little discomfort and a faster recovery period. Testimonials to this fact abound on the Internet when patients realize the extreme benefits to closed procedures versus open rhinoplasty.

Open Versus Closed Rhinoplasty Technique

Rhinoplasty, or cosmetic nose surgery is well known to be the most difficult cosmetic surgery performed by plastic surgeons. In order for the physician to perform rhinoplasty, or cosmetic nose surgery, a high degree of skill is required along with judgment and artistic ability. Young plastic surgeons finishing their training usually have difficulty in getting enough experience to perform cosmetic nose surgery in their training, and this is one of the main reasons that the open rhinoplasty technique have become popular. The open rhinoplasty technique, which involves making an incision along the base of the nose and lifting the skin off the bony and cartilaginous structures of the nose, allow better visualization of the structures of the nose and allow for better teaching of young residents in training to perform cosmetic nose surgery. There are drawbacks to the open rhinoplasty procedure, in that it does produce more scarring and requires extra cartilage support in order to reverse some of the disruption of the normal delicate attachments of the skin to the subcutaneous structures of the nose.

Plastic surgeons who ultimately become familiar and comfortable with doing closed rhinoplasty, that being making small incisions in the nose and performing reshaping of the nose through these small incisions, have found this to be a much more desirable procedure. The patients heal much faster, there is significantly less swelling, and the end result can often be more predictable. In order to do rhinoplasty surgery, which, as mentioned above, is already a difficult and a very skillful procedure; it takes years and years of experience and training. When performed properly, rhinoplasty can be very fulfilling and can help change a person’s life by reshaping an undesirable nose that often takes away from certain beautiful facial features that many people have, such as their eyes or lips. Cosmetic nose surgery, when performed properly and with the proper aesthetic balance and natural appearance, can very much enhance a person’s total facial aesthetics.

In Summary, closed rhinoplasty procedures are desirable, in that faster healing with less disruption of the delicate nasal structures occurs. Open rhinoplasty can be performed by many plastic surgeons with success but do cause more inherent trauma to the nose. Open rhinoplasty operations are able to be learned more readily by young plastic surgeons and, therefore, that procedure has increased in popularity. The closed rhinoplasty technique are often a much better choice, especially for people having their noses done cosmetically for the first time; however, it is difficult to find a skilled plastic surgeon with enough experience to perform this procedure adequately.