Category Archives: What’s New in Plastic Surgery

Your Fat May Be Your Best Filler

We all have often thought, “If only I could move this stubborn fat around my waist to somewhere else where it might look better.” That concept today in Plastic Surgery is becoming more of a reality. The process is called fat transfer and has exploded in its usefulness in our Plastic Surgery practice. The technique involves removing fat from where it is in excess, like around the midsection and transferring it to where it may help increase the size or fill in areas where fat has been depleted. Common areas to place fat are for increasing breast size, matching size or shape of breasts, making buttocks larger, and filling out of the face that has sagged with weight loss or age. Several rather new modalities have made fat grafting better over the last few years. We now know that the addition of growth factors from platelets, when added to fat grafts make the fat grafts heartier and more likely to gain a blood supply and survive the transfer. In our office, we have used PRP (platelet rich plasma) as a source of these growth factors for over 2 years now and have seen better results with fat grafting since its implementation. Also, it has been recognized that placing fat into muscle which has a better blood supply makes it easier for the fat to survive. We have used ultrasound now to actually see where the fat goes and place in places that will make it more likely to survive. There have also been fair amounts of research into better ways to both harvest the fat and separate out those components that represent the cells most likely to survive.

At the Salzman Institute of Plastic Surgery in Louisville, KY we have been utilizing these advanced techniques with great success in the last few years. One of the new concepts this fat grafting has helped is in High Definition Liposculpting. The fat is removed from the areas where it is in excess and replaced into where accentuation of natural underlying muscle mass is needed. Under ultrasound guidance, these fat grafts can by placed directly into the underlying muscles safely. We also use this same technique in reshaping of the breast. Rather than relying on breast implants alone, fat usually taken from around the belly and hips can be placed into the breast to enlarge and reshape it. Nice contours of natural feel and look can be accomplished in this way.

Fat, it turns out, can be a nice commodity if moved to a more desirable location with newer plastic surgery techniques.

Dr. Salzman as an expert on Exilis.

Recently I was interviewed by a trade journal for my thoughts on a relatively new non invasive body shaping modality called Exilis. The holy grail for plastic surgeons is a totally non invasive method of shaping the body by reducing the amount of fat in areas of the body that are disproportionally large. Liposuction of some type, usually utilizing some power assist, presently is the gold standard in fat removal. This new Exilis machine, while not as effective as a surgical result can be used after liposuction to help skin retract and to smoothe out the result. There are those patients that either can not, or will not, opt for an invasive procedure like liposuction and yet still want to reduce some areas of the body. The Exilis treatment is perfect for these patients. You can read more about it and my comments here. Exilis-Dr. Salzman.

Dr. Salzman in National Print Media

Recently, I was asked to provide insight into the newest photographic methods used for patient education and demonstration of results in the field of aesthetic plastic surgery. I have had an interest in photography since the early inception of 2D morphing for simulation of post op results in plastic surgery almost 15 years ago. Now we have 3D imaging and facial color analysis software that can really demonstrate what adverse skin conditions as well as body irregularities can be addressed with modern plastic surgery techniques. The article is included below.

Picture This

Real life breast implant imaging is here!

Plastic surgery has always been a visual science. Its all about peoples perception of their own visual persona that they feel they represent to those around them. We, as plastic surgeons, provide to our patients the ability to improve that image. We, therefore at consultation for these visual improvements, need to convey to our patients what visual changes they can reasonably expect and provide some information about the risks, benefits as well as other optional treatment choices that exist. We call this process a consultation.

Vectra 3D imaging for breasts

Consults for improvement in breast size, shape, or symmetry issues has been dealt with in the past with photographic aids. Beginning about 1996, 2D imaging of breasts with a “Photoshop” like program in which the photo taken at consultation could be manipulated with software tools to depict the possible result. We, as plastic surgeons were kind of guessing as to what the breast would look like with a certain size implant, but with a fair amount of practice, 14 years or so for me, we got pretty good at it.

However, the best manipulations were only viewed on a side view of the breasts where the blue background of the image was behind the actual photo. Not infrequently, the patient or her husband or boyfriend present at the consultation would say “can I see what that would look like from the front?” I would reply, “It’s hard to show that since we are manipulating pixels and without the blue in the background it is difficult to show a 3D change from the front. Someday we will have a camera software combination that can interpolate the change seen from the side to that seen from the front.”

Well, that is day is finally here. We have just installed the first Vectra 3D imaging system in the state of  Kentucky. I have watched the introduction of this technology grow over the last year or so and felt that it was  finally good enough to incorporate into our practice. There are only some 40 of these systems around the US now. The Vectra 3D camera takes  a single image of the breasts or face from 6 different 6 megapixel images then stitches them together and using a very sophisticated mathematical model creates a 3D image of the patient that can be moved around on a large screen display in any direction. Both the results of breast augmentation as well as the facial procedures like facelift, nose surgery,(rhinoplasty), chin tucks can be visualized in 3D.

For the breast augment patient, the choice of the size of the implant was always challenging. I believe that the best, most natural, and longest lasting results are achieved when the base diameter of the implant best fits into the natural size of the women’s chest wall. This photo system actually measures in real dimensions those parameters and can display them on the screen. The data of size, width and projection for all of the implants made by Mentor and Allergan are stored on the system.

3D image of breast implants

We simply click the type and size of the implant and the software applies that to the breast and shows an enhanced version on the screen. We can then rotate that image sideways, vertical, up and down and compare it to the natural untreated image. The view from the top, as the women sees herself is especially compelling. No more guessing, stuffing implants on top inside a bra or adding baggies of rice to estimate the size of the implant is needed to get the job done. We can even adjust for dissimilar size breasts by using different size implants on each side. The look on the few patients faces that have seen this technological advance has been quite satisfying. No you can really “try on” the different implant sizes to get a feel of how you will look after breast augmentation surgery.

Our national plastic surgery meeting

I recently attended our national plastic surgery meeting in Chicago.  One of may favorite sessions is called hot topics.  In this full day course, all of the new technologies and products that are already or soon to be available are reviewed with regard to the science, effectiveness and proven results.  We spent a fair amount of time discussing the newest Botox like injectables.  Reloxin and Puretox will both be available sometime later this coming year. While they are not exactly the same as Botox, it will be nice to have some choices and this may keep the cost of Botox in check. There were some new ways of melting fat using ice and targeted high power ultrasound.  The results after one treatment with these modalities were modest at best but if they can be done in an office setting without the need for anesthesia or cutting, they may have a place.  Stay tuned for more information in the coming months.  None of the cellulite treating machines (Velasmooth, Velashape, and Smoothshape) generated any positive lasting results.  I’m glad we did not buy into any of these technologies as the vast majority of patients are disappointed in their results after multiple treatments. Laser lipolysis did however look very promising.  In the technique I have helped to develop using a blended mode of two different laser wavelengths, many nice results with better skin retraction were demonstrated. Many of the newest fractional lasers that use an ablative wavelength to improve the appearance of wrinkles, discoloration and texture were compared.  It is still not clear what depth and size of injury will produce the best result with the shortest downtimes.  We are going to try a few of these and pick the best one.  All in all it was a day well spent to reinforce to me that we try to evaluate and choose the best technologies for our patients.