The Best Filler: Your Own Fat?

Our surgeons are constantly learning by keeping up to date on the most contemporary advancements in plastic surgery.  A great practice is highlighted by surgeons that continually refine and stay at the “cutting edge” of their specialty. Our surgeons meet monthly and discuss these advancements as more clinically proven results are tested and discussed in the medical literature. Recently, a panel of surgeons presented the most current literature on facial fat augmentation using one’s own body fat. This is not a new concept, but as plastic surgeons get better at obtaining and purifying fat for use as a natural filler, patients are the one’s reaping the benefit. Here are some common questions we get about fat grafting:

Q: When should you consider facial fat grafting?

A:  When we age, there is a decrease in facial fullness due to changes that occur in the structure of the face. For instance the prominent bony protrusion of the cheeks decreases as the bone is absorbed and the fat pads begin to thin and droop. This is seen starting in the late 30’s and early 40’s. As this occurs, we begin to see patients in the office looking for non-surgical restoration of volume with injectable fillers. After successful restoration of volume with fillers, patients love the new “re-volumized” look and continue to come in yearly for repeat injections. At some point, transitioning a patient from injectable fillers to natural long lasting fat volume does come up in the consultation. If you have been happy with the results of facial fillers, now may be the time to discuss fat grafting with your surgeon.

Q: Can I have fat grafting at the same time as eyelid or face surgery?

A:  As an adjunct to eyelid, brow or facelift surgery, fat is truly the best substance imaginable when harvested and injected appropriately using reasonable quantities. Fat grafting ads youthful, long lasting volume to the face, while surgery removes the excess skin and improves drooping of the facial structures. In addition, there is an incompletely understood rejuvenating effect of the transplanted fat to the skin itself. Studies demonstrate that stem cells, which are naturally present in harvested fat, can have a dramatic improvement on skin thickness, collagen production and stimulation of new blood vessels. The look, texture and feel of the skin all improves. These are all key components of regeneration and restoration of facial volume and youthfulness. In fact, sun damage, smoker’s lines, prior injuries, scarring and pigmentation can all be improved through fat volumization. By recreating cells that are lost as a person ages, fat and the stem cells are apparent keys to slowing, even reversing, the aging process. At Ponte Vedra Plastic Surgery, all of our surgeons agree that the addition of fat to facial surgery can dramatically improve the post operative results. In addition, the fat forms new blood vessels and becomes living tissue, in turn growing along with the patient. This may decrease the need for additional fillers over time as the patient ages.

Q: How is this procedure performed?

A:  Fat is obtained from other sites on the body through a gentle extraction system similar to liposuction.  The fat is then washed, cleaned and then injected in very small amounts to the desired area (face, old scars, breasts, etc.). When done in combination with other surgery, the patient is usually asleep. However, this can also be done as a stand-alone procedure using only local anesthesia when appropriate.

Q: How long will fat grafting last?

A:  Fat becomes living tissue when injected carefully and correctly into a new location. This fat then stays with you permanently and therefore provides a long-lasting result. However, of the total fat injected, only about 40-60% remains behind and becomes permanent. This “fat survival” amount varies based on the characteristics of the tissue to which it is injected. For example, areas that are scarred or that have received radiation, do not “take” as well as areas rich in collagen and blood vessels.  For this reason, we tend to slightly over correct the treatment area hoping for around a 60% “take.” In some cases, a second treatment is necessary 4-6 months after the first as a touch up procedure.

To learn more about structural micro-fat grafting, facial rejuvenation, or anything else, call our office to schedule a consultation with one of our six board certified plastic surgeons.

By Erez Sternberg, MD

Stretch Marks: Will Anything Help Me Get Improvement?

Striae distensae(SD), the medical name for stretch marks, affect a substantial proportion of the worldwide population and pose a psychological and cosmetic burden to those affected. A multitude of companies and over the counter agents target pregnant women and others affected by SD, with the aim of preventing or treating these cosmetically undesirable marks.  We are always presented with this issue in our practice, and patients frequently ask, “Does anything work?”

Q:  Do any creams or topical formulations help with improving Stretch Marks?

A:  SD are caused by tearing of the dermis during rapid growth of skin (ie. pregnancy or puberty). This tearing is at the deepest layer of the skin, and therefore, for any topical treatments to work they would have to penetrate the protective top layers of the skin. No topical known currently can effectively do this.  In fact, there are no high-quality, double-blind controlled studies in the literature that supports the use of creams and lotions in the prevention of pregnancy-related stretch marks. Furthermore, most evidence points to a lack of effect with even the “medical grade” topical preventative agents sold by television or online retailers.  Additionally, most articles that evaluate the use of lasers, and other energy based devices for treatment of SD are also low quality studies. Significant side-effects may occur with both topical treatments and laser devices when used in a non-clinical setting or without physician guidance. So be careful and seek the advice of medical professionals when anything sounds “too good to be true.”  I always tell my patients that the best thing you can do is to keep your skin well moisturized, and hydrated. Massaging areas that are most prone to SD during growth and pregnancy is also helpful.

Q: Is there anything I can do for Stretch Marks?

A:  In short, the only real treatment available today to remove stretch marks is actual surgical excision. This is the only procedure that will eliminate the problem and improve body image. The downside of surgical treatment, however, is that we will leave a resulting scar. But today, that is the only acceptable tradeoff.  Nevertheless, as plastic surgeons, we always try to hide scars in the natural skin folds, or underneath regular clothing to make them less noticeable. Tummy tucks, breast lifts, arm lifts, and body lifts are all performed to improve body shape and remove stretch marks. Some day we will likely have some “non-surgical” method of removing stretch marks, and believe me, when that day comes, we will be the first to offer it!

By Erez Sternberg, MD

Skin Pen Also Known As Dermal Needling

SkinPen also known as Dermal needling… A natural approach to skin rejuvenation.

By Debra Knight, PVPS Aesthetician

Question: What is SkinPen or Dermal Needling?

Answer: SkinPen is a unique device used to create microscopic wounds in the skin.

Question: How does it work?

Answer:  The device looks like a large pen. At the end of the pen is a disposable cartridge with twelve, 25 gauge needles. When the pen is turned on it begins to vibrate up and down, penetrating the skin to create microscopic wounds. Your skin responds by releasing Growth Factors which aid in the healing process. 

Question: Does the procedure hurt?

Answer: Your Aesthetician will apply a numbing agent prior to the procedure which helps to minimize discomfort. Therefore most patients experience very little discomfort. In most cases the patient tolerates the procedure just fine.

Question: How much down time should I expect with this treatment?

Answer: Recovery time can vary from person to person. However, most heal within 72 hours.

Question: What can I expect during the first 72 hours following the treatment?

Answer: Directly after the procedure the skin is tight dry and very red. Most of the redness is gone within the first 12 hours, but your skin will remain tight and dry for several days following the procedure. Some flaking and peeling have been reported.

Question: What will I use after the procedure to help in the healing process?

Answer:  Hyaluronic Acid serum is applied directly after the treatment and should be applied frequently for the next 8 hours. Keep in mind, your hands should be sanitized before applying the serum. After 12 hours, you may cleanse the skin then apply the Hyaluronic Acid Serum, followed by a Chemical Free sunscreen. Make up can also be used if needed. 72 hours following the procedure you may go back to your normal skincare regimen. However, I would not recommend using any aggressive products such as Retin-A / Tretinoin, Glycolic acid or Salicylic acid for at least 5 days. A Growth Factor product such as TNS Recovery Complex will aid in the healing process, but not before 72 hours following the procedure.

Question: When can I expect to see improvement?

Answer: In most cases patients will notice a slight improvement about two weeks after their 2nd treatment. Realistically though, you should not expect to see much of an improvement until 28 days after your 3rd. treatment. The wonderful thing about SkinPen or Dermal Needling is that you will continue to see improvement in your skin for a full 2 years after you last treatment.

Question: How many treatments will I need?

Answer: For skin rejuvenation you should plan on 3 to 4 treatments, 4 to 6 weeks apart. If the treatment is for acne scarring or surgical scars then you should plan on 6 to 8 treatments, 8 weeks apart. Surgical scars should be at least one year old before dermal needling is performed.

Question: What type of improvement should I expect with SkinPen?

Answer: SkinPen or Dermal Needling helps with texture issues such as enlarged pores, fine lines and wrinkles, acne scarring, surgical scars over one year old and hyperpigmentation.

Skin Care Products 101

Skin Care Products 101

By Andrea Bailey, PVPS Aesthetician

Question: What is the difference between OTC and medical grade skin care products?

Answer: There is actually a big difference; the depth into the skin in which they work is the main difference.  OTC products only work on the very surface of the skin, which is dead tissue. However, medical grade products work deeper into the skin, at the live cellular level, where the real difference takes place. This is due to a legality that only licensed professionals can provide you with products and treatments that work in live tissue.

Question: I have been using high-end department store skin care products for years. Why is medical grade the better choice?

Answer: Although many OTC (both department store and drug store brands) now contain important ingredients, such as antioxidants, peptides and exfoliants, the vehicle that can deliver these ingredients to live tissue is not present. Medical grade products do contain the vehicle to deliver these key nutrients to the live cells of the epidermis and the dermis.

Question: Is there also a difference between medical grade products and spa grade products?

Answer: Yes. Medical grade products may also contain prescription ingredients (i.e. retinoic acid, 4% hydroquinone) which are only available from a licensed medical provider; spas simply cannot provide these products with prescription ingredients.

To experience the most efficacious skin care products available, schedule a complimentary consultation with one of our highly experienced aestheticians.

Suggested CC’s For Breast Augmentation

How many CC’s should I choose for Breast Augmentation Surgery? 

While there is no correct answer to this question, it is one we get asked all the time during our consultations. Here is an attempt to answer to that complex question:

Q: I am a small cup size and want to be a full C-cup. How many CC’s should I choose?

A: A much generalized rule of thumb is that one cup size is about 175cc. Therefore, if you are an A-cup and desire to be a full C-cup you should expect to try implants around 350cc.

Q: My girlfriend was a small B-cup and she is now a D-cup with 350cc implants.  I love the way she looks, but when I try that size on, I don’t look like a full D cup, Why?

A: Everyone is different, that is why a breast consultation with one of our board certified surgeons is so important. This is not a “one size fits all” type of procedure. We take detailed measurements of the patient’s chest wall and breasts in order to find the best fitting implant for that patient. For example, a 5 foot 2 inch female with a very narrow frame and small breasts will easily be a D-cup with implants over 300cc, whereas, a 6 foot tall female with broad shoulders will barely increase one cup size with those same implants.

Q: So what is the best way for me to choose?

A: Let us help you make the best decision. Our consultations consist of a full examination, trying on sample sizes to see what you would look like in clothes, and finally, a 3D imaging software program to show your simulated post-surgical results. After that, we have usually identified one or two sizes that would likely look the best. During surgery, your surgeon will choose the final implant based on that discussion.

Q: Anything else I can do?

A: Come prepared to your consultation with photos from the internet of how you would like to look. This helps us tremendously in understanding what your ultimate goals truly are. Try to find a couple of photos with girls who look similar to you and have results you think are really pretty.