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On the Today Show yesterday, many may have seen the burned triplets who had their scars treated with a laser technique. This is a very interesting story from both the perspectives the girls themselves as well as the form of laser scar treatments that they had.
The Berns triplets were just 17 months old when they were trapped in a house fire in Texas that took the life of their mother. With burns that covered up to 30% of their body, they underwent a long initial hospitalization with multiple burn debridements and skin grafts. Fortunately they recovered and healed and have gone on to have a relatively normal life. Like most children with disfigurements, they were not overly focused on their scars until they passed puberty and were in high school. As is unfortunately common, others then pointed out their scars and they began to suffer the ridicule that such differences can bring.
Like all burn victims, the scars that result fall into two categories. Hypertrophic scars, which are thick and raised scars, from burned skin which has healed but did not necessarily need skin grafting. And scarring from areas that had been skin grafted, which looks like pebbly thickened skin, creates a very uneven skin texture. Either way, the healing of burned skin (unless it is a very superficial burn) does not result in skin that looks or feels remotely normal. To the surprise of many, skin grafting in general and in burns in particular (due to the need to mesh it to allow it to expand to get more surface coverage out of it) does not make for a normal appearance.
These triplets, like many thousands of burn victims, have to live with these burn scars forever. Over the years, numerous non-surgical methods to improve burn scars have been tried, including laser resurfacing. Significant improvements in their appearance have yet to be consistently obtained.
The triplets were showcased on TV because they were treated with fractional laser resurfacing. While touted as a medical miracle and a new laser innovation, this is a significant overstatement. Fractional laser resurfacing as well as more traditional out surface laser skin removal is not new. The fractional or fractionated laser approach to skin treatments has been around for several years now. It is based on the concept of punching holes into and through the skin over just a portion or fraction of the treated area. By going deeper into the skin, its deeper layers or dermis is stimulated to heal by creating more collagen. This is in contrast to superficial laser resurfacing where 100% of the skin that is treated undergoes more superficial layer removal.
The one innovation, from a laser design standpoint, that these triplet scar treatments represent is that the manufacturer has combined both types of laser treatments into a single laser device and treatment. But their combined use is certainly not new. I have used this combination superficial and partial deeper approach in my Indianapolis plastic surgery practice now since early this year. I am certain that the recognition of the skin benefits to treating both depths simultaneously is recognized by many other plastic surgeons as well. My current approach is to use a needle roller of up to 2mms to get the ‘aeration’ of the scarred area and then do a more superficial (up to 50 micron) total laser resurfacing of the scarred area. Whether fractionating the skin (cutting these deeper holes) with a hot method (laser) or cold method (needle) is better, or any different, is as of yet unknown.
By attacking both the deeper and superficial levels of difficult scars, this is clearly a better biologic approach than anything that has been done before. This approach in my experience is particularly helpful for refractory scar problems such as acne and burn scars. Two points should be emphasized however. We are talking about improvement in the scar appearance, not complete elimination. Multiple or a series of laser treatments are required to obtain a significant level of improvement in the appearance of the scars.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The past five years has seen numerous injectable fillers come onto the market. From just a few in 2002 to now over a dozen presently, the rush to enter the multi-billion dollar injectable anti-aging market has been near feverish. In my Indianapolis plastic surgery practice, I have seen more sales representatives for injectable fillers this decade than any other single device or implant services that we offer.
But with the emergence of different filler compositions from various manufacturers, there was bound to be some eventual casualties as well. It is a very competitive business nowadays and there is a lot of players with materials that virtually do the same thing. As I tell patients when it comes to injectable fillers, it is merely a matter of how long do they last and how much they cost. Therein lies their major differences. They all work and can do the job.
The first injectable filler casualty was ArteFill in 2008. Despite years of clinical trial, a novel beaded composition, and tens of millions of dollars of investment, ArteFill was only commercially available for a few short years before they ceased manufacture and sales. While only the company officials can say for sure why this occurred, rumors abound that it was the result of mismanagement and internal corporate squabbling. And when you are a company selling but one product, there is not much margin for error in marketing and distribution of it.
We now have just seen the second casualty, Evolence. Ortho Dermatologics announced on November 3 that they are discontining its manufacture and marketing…and thus sales. No specifics reasons have been given for this ‘difficult decision’. We are left to conjecture as to whether this was due to poor product performance, way underperforming sales or some combination thereof. Given that it has been on the market just over a year, it is hard to know whether it was either. With its unique combination of hyaluronic-acid and collagen, it theoretically appeared to have the marketing advantages of both. Plus, unlike ArteFill, it was aligned with a company who had other dermatologic products for sale.
Interestingly, there is one similarity between ArteFill and Evolence. Neither one was approved or even clandestinely advocated for lip augmentation. As an injectable filler, that is a significant sales problem. Eliminating use in the lips narrows the filler market for many physicians by almost 50%. Since injectable fillers is largely a ‘southern’ facial procedure (lips and nasolabial folds), you have made your product fight for use in an even narrower market.
In the next few years, we will undoubtably see a few more injectable fillers go by the wayside. At the very least, some will temporarily disappear and re-emerge with other companies with whom they may be better aligned from a marketing and sales standpoint.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Breast reduction remains as a very popular and commonly performed plastic surgery procedure. It provides a dual reconstructive and cosmetic benefit by making the large breast better shaped and more uplifted and improves back, shoulder and neck pain by breast volume reduction. As part of the breast reduction procedure, segments of breast tissue are removed and almost always sent to pathology for examination. While I have yet in my Indianapolis plastic surgery practice to have positive cancer findings from submitted breast reduction tissues, prior published and anectodal reports confirm that it does occur.
The finding of breast cancer during a reduction procedure can occur in two circumstances. The first is during the course of the operation some suspicious tissue is found and sent to pathology for an immediate evaluation, known as a frozen section. The second is when the submitted tissues are examined by the pathologist and cancerous tissue is found. In a November 2009 issue of Plastic and Reconstructive Surgery, Drs. Ambaye and colleagues from Vermont looked exactly at this second issue. From 202 breast reduction patients, the incidence of significant pathologic findings (cancer or atypical hyperplasia) was present in 12.4% of the patients. This translates into a rate of 4% of all patients with no real difference when the age of the patient is taken into consideration. (6% under age 40, 8% above age 40)
This is a rather surprising finding given that prior published reports do not have near this high an incidence of abnormal findings in breast reduction. I suspect this is a function of specifically looking for it as this report had both gross and microscopic examinations done in some detail. However, given the general incidence of breast cancer in women, it does seem logical that a significant number of yet symptomatic women have the disease.
This raises an interesting question that I have always had. Does breast reduction surgery decrease the incidence of breast cancer? Will it decrease the risk of some women from eventually getting breast cancer? The answer to that is an emphatic yes….for some but not all women.
In 2004, a study published in the June issue of Plastic and Reconstructive Surgery reported a difference in risk of breast cancer after breast reduction surgery. This appears to be especially true in women who are over 40 years old at the time of surgery. Risk of cancer reduction in this age group was 28 to 50 percent. No reduction was seen in women having the surgery before the age of 40. Although the complete removal of a woman’s breasts (prophylactic mastectomy) can virtually eliminate the risk of breast cancer, most women find it extremely difficult to elect to remove all of their breast tissue. Women now have an additional preventative option to have their breasts partially reduced rather than removed. This represents a real alternative for someone who is a candidate for breast reduction, even though the amount of tissue removed may be small.
Given the occult incidence of breast cancer found is the pathology of asymptomatic breasts during routinue breast reduction surgery, this can be viewed as an additional benefit of the operation. However, I would emphasize that breast reduction is a risk reducer, not a preventative guarantee
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Rhinoplasty is one the most challenging and unforgiving operations of all facial plastic surgery operations. Due to the complexity of nasal anatomy and how its multiple parts interrelate, many different surgical maneuvers and changes are possible. Some of these changes are more significant while others are more subtle. But they all can make a difference in the final result, whether it be how the nose looks or how well it breathes.
Because of the importance of the nose to one’s facial appearance and the many different maneuvers that can be done in rhinoplasty, communication between patient and plastic surgeon is absolutely critical. In my Indianapolis plastic surgery practice, I use paper diagrams of the anatomy of the nose during a rhinoplasty consultation and computer imaging forwarded to the patient after the appointment. Both visual methods are essential in having the patient understand what the problems are and what is surgically possible.
In the course of this communication, some appreciation by the patient of the anatomy of the nose and the terms we use in rhinoplasty surgery are necessary to make sure we are really communicating.
Most people underestimate the complexity of the nose because they are thinking only about its visible external appearance. But beneath the skin lies an intricate arrangement of cartilaginous- and bone-based structures that give the nose both its form and function.
The surface of the nose features a number of distinct regions and structures.
· The root or radix of the nose is the area between and just below the eyebrows. It is the uppermost part of the bridge.
· The bridge lies below the root and forms the upper one-third of the nose.
· The middle vault lies between the bridge and the tip of the nose.
· The dorsum (roofline) is the shape and height of the nose as it runs between the root and the tip of the nose.
· The tip of the nose is where the dorsal line of the nose meets the columella.
· The columella is the strip of skin between the nostrils which extends down from the tip to the upper lip.
· The ala are the sidewalls of the nose forming the roof of the nostrils
· The nasal base extends from one side of the nostril to the other along where the nose meets the upper lip.
Beneath this surface topography lies the bone and cartilage structures which give it both shape and support. Some of these important structures are:
· The paired nasal bones (root and bridge)
· Two upper lateral cartilages (middle vault)
· The septum which runs between the upper lateral cartilages
· Two lower lateral cartilages (tip and nostrils)
· The medial crural footplates (columella)
Contemporary rhinoplasty is focused on conservative and subtle anatomical changes accomplished by preservation, reconstruction and modification of the osseo-cartilaginous framework of the nose. There are two surgical approaches to these structures – the open and the closed approach.
The open approach is performed by making a trans-columellar skin incision combined with internal incisions, followed by skin envelope dissection and elevation. The open approach offers full exposure to the nasal framework, allowing for accurate diagnosis and precise manipulation of its external structures. If extensive changes are needed in a first rhinoplasty or if a secondary rhinoplasty is needed, the open approach is usually better.
The closed approach does not require any skin incision and does not leave external scar since all the incisions are made inside the nose. The lower lateral cartilages can be dissected and freed from the surrounding tissues and “delivered” outside. This approach is best suited for isolated hump deformities or minimal tip changes.
Armed with this basic nose anatomy and surgical terminology, may your rhinoplasty consultation and discussion make you a better educated patient!
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Breast cancer continues to be a major health issue for women, averaging just under 200,000 new cases per year. It is the second leading cause of cancer-related deaths in women. From a plastic surgery standpoint, cosmetic breast surgery cases well exceed this number with over 500,000 procedures being performed per year. The crossing of these two breast treatments places plastic surgeons in a position to help improve breast cancer screening. Because all forms of cosmetic breast surgery produce irreversible changes to the breast parenchyma, the importance of presurgical screening is even more important.
In the November 2009 issue of Plastic and Reconstructive Surgery, Drs. Selber, Wu and colleagues looked at this very issue. Their study looked primarily at the behavior of plastic surgeons in knowledge and adherence to the American Cancer Society (ACS) Breast Cancer screening guidelines. The greatest relevance of their report, however, is to create awareness as to what preoperative breast screening should be done when cosmetic changes are anticipated to be done.
As a review of the ACS guidelines, women at average risk should begin self-breast examinations at least every 3 years for women in their 20s and 30s and yearly for woman over 40. Mammogram screening begins at age 40. This means that any woman undergoing cosmetic breast surgery under 40 should at least have a breast examination. Once over 40, all should have a mammogram as well.
These guidelines change for women at increased risk. A more aggressive screening program which may include MRIs should be done for women who are BRCA mutation carriers, a first degree relative of BRCA carrier and radiation exposure between the ages of 10 and 30 years of age. Women at increased breast cancer risk include two or more relatives with breast or ovarian cancer, breast cancer occurring before age 50 in an affected relative, one or more relatives with two cancers, male relatives with breast cancer, or a family history of breast or ovarian cancer with Ashkenazi Jewish heritage.
Because of the frequency in which cosmetic breast surgery (breast augmentation, breast lift, breast reduction) is done, plastic surgeons are in a unique position to screen women for breast cancer. Often, this would be the first and in some cases the only breast cancer screening that they may receive. Taking a family history, performing a breast examination, and referral for a preoperative mammogram if indicated are in the patient’s best interest. Women over age 40 should not undergo any form of cosmetic breast surgery unless they have been baseline screened regardless of their risk factor. Women under age 40 with moderate to high risk should have the same baseline breast information obtained prior to surgery.
Barry L. Eppley, M.D., D.M.D.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Rejuvenation of the aging face through ‘facelift’ techniques continues to be one of the most understood of all facial plastic surgery procedures. In talking to patients every day in my Indianapolis plastic surgery practice, here are some of the most common misconceptions that people have about facelifts.
Myth: I need to wait until I am older before I can have a facelift.
The fact is you don’t have to wait until you are at least 50 to have a facelift. Despite that many believe a facelift is just for older people, there are different variations of facelifts and necklifts that you can have as early as your 30s and 40s that will help erase those early signs of aging. It is possible to have a fresher looking neck and jaw line now by having a smaller or more limited operation than waiting to have a big one later in life.
Myth: I don’t like my saggy neck but I don’t want a facelift.
A facelift is not what many people think. It is not a total overhaul from the scalp down to the bottom of the neck. It is a variety of procedures that work on the neck and jowl area…the lower third of the face only. It can be as simple as liposuction of the neck and neck muscle tightening only or it can also include different amounts of skin lifting and tightening of the neck, jowl or cheek areas. Facelifts can be partial or more complete…but they are never as big of an operation as people think.
Myth: If I have a facelift now, I will keep needing more of them as I get older.
While it is true that no facelift lasts forever, the aging problems that return are usually less severe. As a result, if one wants to do a little freshening up years later, a simple or limited tuck-up procedure of the cheek and jowl can be done. This is a minimally invasive procedure that is not similar to a full facelift. These are the same procedures that are now done for younger women and men who are just beginning to see the initial signs of aging. By doing these smaller procedures when one is younger, there will not be a need to have a more extensive facelift later in life. Maintenance now can avoid the need for a big oiverhaul later.
Myth: People who get facelifts often look pulled too tight and unnatural.
That classic ‘movie star’ look or old facelift look from years ago is the result of pulling skin too tight. I have yet to see a patient who wants that as the end result. That very look is exactly what we are trying to avoid. A facelift should create a natural look, not an operated look. The tight look is avoided by tightening the tissues under the skin, rather than having the outer skin do all the work of lifting. This provides a good foundation onto which the skin can be redraped naturally amd not pulled up too much.
Myth: I would like to have a Facelift but am afraid that the scars will be seen.
Well-placed facelifts incision are designed to be hidden. Incisions are no longer placed in front of the ear, but inside it. Incisions around the hairline are placed so that the position of the hairline does not change. Using this approach, even short hairstyles (including men), can comfortably have a facelift without visible scarring afterwards.
Myth: I hear now that I can get a facelift result without having surgery.
While the use of Botox, injectable fillers, and lasers can make real visible change in one’s facial appearance, none of these treatment methods can truly replace a facelift. Forehead and crow’s feet wrinkles can be reduced, brows can be lifted slightly, nasolabial folds can be reduced, lips can be made bigger, and skin can be made smoother by these non-surgical injection and laser methods. But that saggign neck and jowl line, the lower third of the face, can only get better by a facelift.
Barry L. Eppley, M.D., D.M.D.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Blepharoplasty (eyelid rejuvenation surgery) is one of the most common facial cosmetic surgeries. According to the American Society of Plastic Surgeons procedural statistics for 2008, nearly 200,000 such surgeries were performed. Lasik (corrective vision) surgery is done even more frequently with roughly one million done as of last year. It should be no surprise, then, that these two eye-related procedures can cross paths in the same patient. Either someone has had Lasik and presents sometime after for blepharoplasty or one has had blepharoplasty and is now interested in vision correction.
This raises the question of how one impacts the other and does it pose a problem? Blepharoplasty and Lasik are compatible procedures that can, and often are, done in the same patient. But they are never done together. They must be staged and timed so they do not create functional eye problems.
Blepharoplasty can interfere with eyelid closure with the potential for a temporary period of eye dryness as a result. The blink reflex is slowed and the loose amount of eyelid skin and laxity has been removed. In short, the safety net for competent eyelid closure has been reduced…even if it is only temporary. This can be revealed when one sleeps where only a small crack of opening between the eyelids can cause lack of adequate eyeball lubtication. This is evidenced by crusty eyelids in the morning and a feeling of dry or itchy eyes.
LASIK is an elective laser eye surgery that reshapes the cornea (front surface of the eye) to improve vision. It is the most popular vision correction procedure performed in the United States and worldwide. LASIK can correct a wide range of nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. Dry eye is not an uncommon problem after Lasik and an estimated 20% of patients having the procedure suffer some temporary period with it.
While Blepharoplasty and Lasik can be done before or after each other, there should be a sufficient time period between them. If blepharoplasty has been done first, one should wait until their eyelids are completely healed and that any symptoms of dry eye are completely resolved or do not exist. Usually this should be at least a three month waiting period. It will also depend on what type of blepharoplasty has been performed. The issue is really the lower blepharoplasty. ‘Low-risk’ blepharoplasties include those done through a transconjunctival approach (inside the eyelid with no external skin excision) and pinch and peel techniques where minimal lower eyelid skin is removed.
If Lasik is initially performed, one should wait at least 6 months (if not longer) before undergoing a blepharoplasty. This time is need to ensure that the cornea has healed properly and to protect it from any stress from potential dryness. One’s ophthalmologist should be consulted to get clearance for a blepharoplasty procedure.
Barry L. Eppley, M.D., D.M.D.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Blepharoplasty and Browlift Surgery on Indianapolis Doc Chat Radio Show
Author: barryeppley
On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 12:00 - 1:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon, the topic of periorbital rejuvenation was discussed. Blepharoplasty (eyelid tucks) now rate as the number one facial plastic surgery performed, exceeding facelifts, rhinoplasties, and chin augmentation. Becuase the eyes are of great social significance, most people feel that they are their most important facial feature. The eye area is the first region of the face which shows aging. Rejuvenation of the eyelids and brows can make a big difference on one’s appearance. Topics discussed with listener questions included blepharoplasty and its many variations for the upper and lower eyelids, browlifts, botox, injectable fillers, orbital implants, micropigmentation (permanent eyeliner), eyelash extensions, and Latisse eyelash growth stimulant.
Free plastic surgery consultation with Dr. Barry Eppley can be arranged by calling his Clarian North office in Carmel Indiana at 317-814-4100 or his Clarian West office in Avon Indiana at 317-217-2200.
In reading a recent entertainment article which I came across in researching a plastic surgery topic, the writer presented an opinion on the top ten plastic surgery disasters in men. Using before and after photographs, they compared the ‘before’ and ‘after’s of several well known male celebrities- of which there is no doubt that these men have had facial work done. And I am not referring to in-office procedures such as Botox and injectable fillers. All had obvious surgical manipulation of aging facial features.
Those listed are well chronicled and include often cited celebrities such as Kenny Rogers, Gary Shandling, Carrot Top, Sylvester Stallone, Bruce Jenner, Burt Reynolds and David Gest to name a few. While I am certain that they don’t feel unusual looking, most women would disagree. This begs the question of what is it that makes them look unnatural? Is there a common problem that they all share?
In reviewing the ‘after’ images the problem lies for many of them in the work around the eyes and cheeks. On the whole, the appearance of these men has changed to more of a feminine look. This is the result of a variety of changes that include over-elevation of the brows, a ‘pulled too tight’ appearance around the eyes, and unnatural cheek bone augmentation giving an ‘apple-cheeked’ effect. In an effort to rejuvenate the aging and sagging face, they have been overlifted and augmented. Neck and jowl line work, even when done well, can often reinforce a more feminine look.
This may make the skin much smoother and eliminate a lot of skin wrinkles and folds, but the end result is anything but ‘natural’ in appearance, and is a red flag that screams ‘facelift!’ to even the least discerning eye. (even though a true facelift works on the neck and jowl area) Certainly, men care about their appearance as they age, and want to look as young as they feel. With regard to celebrities, it’s a usually a foregone conclusion that plastic surgery is a necessity in order to keep pace with the up and coming younger entertainers. However, great work – and natural looking results are never a guarantee in Hollywood surgical circles, and paying top dollar to a well-known or famous surgeon really has nothing to do with the final outcome.
To get a natural looking result in men, facial rejuvenation really has to be ‘underdone’ in comparison to the female equivalent. Women can aesthetically tolerate more significant tissue movements. The goal of very smooth skin and sleek facial features simply looks better on women. Even when women have gone too far, they rarely look as bad as what can happen in men. Nips and tucks are very helpful to slow the aging process down in men, but dramatic sweeping changes simply trade-off one problem for another. Facial rejuvenation in men illustrates the age-old concept that less is often more.
Barry L. Eppley, M.D., D.M.D.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Many may have heard of the Volumetric Facelift and it is easy to find it on an internet search. While it is a catchy name, it can be confusing for patients as to what that exactly means….and if and why it may be an improvement over a more traditional facelift approach.
It is now recognized that how our face looks as it ages is more than just droopy skin alone. The sagging skin is more of a symptom of what is happening underneath it than the sole cause of an older and tired looking face. The real culprits are the looseness of the underlying tissues, known as the subcutaneous muscle–aponeurotic system or SMAS and the loss of volume or fat. The balloon, so to speak, becomes deflated and sags as fat is lost and the SMAS support system under the skin gets looser. These three layers (skin, SMAS, and fat) must often be treated simultaneously and by different techniques to get a rejuvenated look that does not look unnatural.
The looseness of the skin and the underlying SMAS are what is addressed by numerous facelift methods. The spectrum of facelift operations used by plastic surgeons goes from more limited procedures such as a short scar facelift or a Lifestyle Lift to fuller facelifts versions that have more extensive incisions around the ears with more extensive SMAS manipulations.
These facelift techniques work on anatomy that has fallen but do little to restore the loss of volume that can occur with facial aging. Here enters the concept of the Volumetric Facelift. This more comprehensive approach involves replacing fat in facial areas where it has been lost (usually below the cheeks and around the mouth) as well as skin tightening and redraping. Together, this approach provides results that in some patients provide a better rejuvenated look as the face is plumped up in volume-depleted areas.
As most everyone can afford to have some fat ‘redistributed’, the Volumetric Facelift does not significantly extend operative time or one’s recovery. In essence, it is a relatively easy thing to do as part of any type of facelift. Where fat should be injected is as much of an art form as science and should be marked out with the patient in detail before the procedure.
The science of the Volumetric Facelift, however, is not as established as that of the surgical technique. How much fat survives and what it does in its new recipient site is variable and open to considerable speculation. We certainly know that injected fat in many facial sites does survive. But it is rarely 100% and some volume loss does occur. A hard number of what amount survives is influenced by numerous factors and will vary in each patient. I tell my Indianapolis plastic surgery patients that about 50% will be retained, give or take. That is why the facial areas are overfilled, accounting for some volume loss after.
Because fat contains stem cells, there is great enthusiasm and hope that these stem cells provide a positive influence on fat survival and changes in the overlying skin. Some have even gone so far as to call their technique a ‘Stem Cell Facelift’. Claims have been made that the stem cells in fat reduce wrinkles and give patients more radiant glowing skin. Suffice it to say that this is marketing which is way ahead of actual science. Just because it seems that it should be true doesn’t make it so. The science of fat-derived stem cells is in its infancy. Whether significant stem cells survive the preparation and injection process has not yet been proven, let alone what complex interactions go on if they indeed do. It has yet been shown that what happens in cell culture actually happens in human faces.
Despite the lack of good science, the Volumetric Facelift makes good theoretical sense for facelift patients that have evident volume loss. Facial fat restoration does not add any significant risks to a facelift and does make an immediate visual improvement. It can help avoid that tight stretched skin look in thin-faced patients that looks unnatural. Whether stem cells in such fat is the fountain of youth, however, remains to be proven.
Barry L. Eppley, M.D., D.M.D.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis