Posts Tagged ‘fat injections’
Thursday, January 5th, 2012
Q: Dr. Eppley, I had my buccal fat pads removed nearly fifteen years ago at age 31 for some facial sculpting. Now that I am older, I look completely different. My face is very flat and not as attractive. What can I do to look like before? What are my choices for making my face now a little fuller?
A: As you have aged, your face likely has lost overall fat and the prior removal of the buccal fat pads has only accentuated this natural fat involution process. There are several options available to consider for facial volume restoration. The first approach is fat injections which focuses on replacing like with like. The only question is how much fat will survive after transplantation. This is an overall facial volume approach. The next approach is focal or spot treatment, just adding volume to the buccal or submalar area. This could dbe done with either submalar cheek implants or injectable fillers. The real value of injectable fillers in your case, in my opinion, is to be an initial test to determine if augmentation of this area is what you are looking for. It serves as a test to determine if more formal augmentation (implant) is worthwhile.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek implants, dr barry eppley, fat injections, indianapolis, injectable fillers
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Sunday, November 13th, 2011
Q: Dr. Eppley, I have been getting injectable fillers into my smile lines and lips for several years now. While I really like the effects that it creates, I do tire of having to be stuck by needles and the recurring expense of doing it once or twice a year. Is there any injectable treatment that would be permanent or at least last a lot longer?
A: While current off-the-shelf injectable fillers produce some wonderful facial changes, they are synthetic and will be eventually resorbed and the effect will be lost. While no truly permanent injectable filler can be definitely claimed, there are several promising options that are now being used. Most people have probably heard of using liposuction-derived fat for injection, and it has been used for some time, but its known problem is that its survival is unpredictable. While it does work well is many areas of the face, the smiles lines and lips are not amongst the most favored. Encouraging injectable cell treatments include fibroblasts and stem cells, both harvested and grown from the patient. Taking a skin biopsy from behind your ear allows fibroblasts which make collagen to be grown for later injection. Known as laViv, this is an FDA-approved treatment that allows the injection of millions of fibroblasts into any desired facial site. Comparatively, Cryo-lip (an Indianapolis biotech company) creates large numbers of stem cells for injection into any desired area. Whether any of these cell-based injectable fillers can create a long-term permanent effect is not yet known.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cell based injectable fillers, cryo-lip, dr barry eppley, fat injections, indianapolis, la viv
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Friday, October 7th, 2011
Q: Dr. Eppley, I am interested in using PRP for lip augmentation. I am looking for something more natural and longer-lasting other than the typical injectable fillers. Can PRP be put into the lips and how well does it work?
A: PRP can be injected into the lips just like anywhere else. It is not a question as to whether it can be done but whether it should be done. Will it create a lasting augmentative effect beyond that of a short-term fluid distention is the question. There is no medical evidence that it would nor would I biologically understand why it would. PRP is not a filler material per se but rather an adjunctive healing agent. It has no primary effect on its own such as creating more collagen than would normally exist in an otherwise healthy tissue site. The PRP I have put into the lips has been combined with fat to offer a higher probability of a sustained effect. It is the fat that is the filler and the PRP is added for its theoretical benefit on helping fat cells to survive or in helping stem cells to convert to fat cells. This is the most natural lip augmentation injection treatment but it is unproven as to how sustained or permanent the lip enhancement effect is.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, fat injections, indianapolis, lip auigmentation, prp injections
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Wednesday, September 28th, 2011
Q: Dr. Eppley, I have lost a lot of the fat in my face particularly in the cheeks which has left them very hollow and sunken in. The area below my cheeks looks too full because it is indented above it. I havhe been told that fat injections would be the way to go even though fat transfer may not always stay. I know that cheek implants are permanent becuase they can not be absorbed. But I didn’t know of they come big enough to fill out the entire depressed cheek area. What sizes do they come in and do you think they are big enough to fill out the whole cheek area?
A:Your concept of considering cheek implants for helping restore facial volume loss is only partially correct. Cheek implants are not a substitute for fat injections when it comes to facial fat volume loss. The submalar style of cheek implant can help fill out the buccal area of the cheek (right below the cheekbone) but this represents only part of a larger surface area of the cheek and surrounding tissues which makeup the gaunt or skeletal facial look. Therefore, the use of this type of cheek implant may be a companion strategy with fat injections but is not a stand alone treatment for refilling out the deflated or fat-depleted face. Fat injections are more versatile because they can be placed anywhere. Cheek implants, even the submalar style, can not go very far from the edges of the bone and are more limited as to the facial area that they can cover.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek implants, dr barry eppley, facial fat loss, fat injections, indianapolis, submalar facial implants
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Tuesday, April 26th, 2011
Q: Hello Dr. Eppley, I was wanting to know if you do fat transfers to the arms? I had liposuction done to my arms over a year ago that left me with a lot of dents and irregularities. It has improved a lot over the past year and now there is just some loose skin that bothers me. I think these arm areas could could benefit from some filler. I wanted to get some fat removed from my stomach which has always been a problem area for me. Thank you for your time.
A: Arm liposuction is very prone to irregularities given its thinner skin and that the liposuction technique can not really use a cross-tunneling method, which is really useful to prevent large irregularities in fat removal. It is good that you have waited until the arm sites have matured and all the tissues have settled. Many arm liposuction irregularities will improve with time although they rarely go completely away. For small remaining areas, injected fat would be the only good treatment option. Only a small amount of fat would be needed so your stomach sounds like it would provide more than an adequate donor area. The fat that is harvested is washed and concentrated so that the highest percentage of viable fat and stem cells gets transplanted. This should help fill in some irregularities and expand out some loose upper arm skin.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, fat injections, indianapolis, liposuction arm irregularities
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Tuesday, April 5th, 2011
Q: Hello, I have severe facial wasting. I am not an HIV patient, I had a normal plump face as a young child and by about the third grade my cheeks had completely sunken in and has given me a much older and skull-like appearance. I am only eighteen years old. I would like to have a procedure to correct this done this summer before I begin college in the fall. I would like to know if you handle this sort of procedure and what you would suggest to be done. I have attached some pictures with this e-mail inquiry.
A: Thank you for your inquiry and sending your pictures. You have a classic case of facial lipatrophy, type IV (type V is more consistent with HIV related facial lipoatrophy) Your history is classic for it as most patients convert from the plump face of childhood to a thinner more gaunt facial look during grade or intermediate school. Of the augmentation methods for treatment (implants and fat injections), I think you need a combination approach. I would place submalar cheek implants that specifically builds up the area right under the cheekbone known as the buccal area. This implant is placed through the mouth under the upper lip. Then I would do fat injections with Acell collagen particles to the area below the implants out into the side of the face and down to opposite the corners of the mouth. The goal is to add some fullness to the sides of your face and help reduce your more skeletonized appearance.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, fat injections, indianapolis, plastic surgery for facial lipoatrophy, submalar cheek implants
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Thursday, July 1st, 2010
Q: Hi Dr Eppley, I was wondering if fillers can be used on a sagging elbow area instead of the surgical procedure?
A: Sagging of skin around the elbow area can be the result of age, body type, and weight loss. Most commonly I have seen it to be an issue in the extreme weight loss patient (greater than 75 to 100 lb weight loss) and it is one of the areas dealt with using bariatric plastic surgery techniques. While the usual approach to loose skin is to cut it out, the creation of a scar around a joint area can be problematic. The skin around joints, such as the elbows and knees, is not meant to be fixed. Rather it needs to have some flexibility and movement so the joint can go through its range of motion. Scarring around the joint may cause joint motion restriction in the long run and wound healing problems in the short run. (motion across a suture line) Known as elbow or knee lifts, the excision of loose skin must be carefully done to avoid these problems.
I suspect in this question that it is not a weight loss issue. Rather it likely is aging and the development of some loose skin around the elbow in an otherwise non-overweight person. (can particularly happen in an aging thin person) Therefore, excision and the scar that it creates is not an acceptable solution. This changes the approach to maybe an opposite solution…filling or reinflating the tissues. While injectable fillers can be placed anywhere, their temporary effects and the large volumes needed for a body area make them impractical. The only soft tissue filling option to be considered would be fat grafts. Harvested by liposuction, fat can be purified and then reinjected into soft tissue spaces. This is the only option I would consider when it comes to injecting any body area.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, elbow lifts, elbow sagging, fat injections, indianapolis, injectable fillers, plastic surgery
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Friday, April 16th, 2010
Q: I’ve read your article on calf augmentation using fat transfer. Since 2008, have you performed this procedure? I have finding very mixed feedback on this. Some surgeons are saying this is high risk and will be unsuccessful because the fat will all be absorbed. Another doctor in NY I’ve been in contact with says he has had great success and with little side-effects. Appreciate your feedback.
A: Calf augmentation is most reliably done with implants. There are specific silicone rubber implants made for the calf and they are placed through a small incision on the back of the knee. (popliteal fossa) Because an implant is used, the result is stable and consistent in the amount of size increase obtained. Conversely, because it is an implant there are the associated issues of the risk of infection, malposition and asymmetry as well as a significant recovery and discomfort.
Fat injections, no matter where they are considered and what they me be used for, always have the same appeal. Using a natural tissue that has virtually none of the risks of an implant-associated procedure. Despite those benefits, fat injections have one significant downside…their volume retention is unreliable. At this time, there are no standard techniques for fat preparation and injection and the science behind its survival once transplanted remains to be discovered and utilized for more stable outcomes.
Because of the differing techniques and injection methods, fat injections for larger volume areas (breast, buttocks, calfs) have widely variable results. With these inconsistent results come quite discrepant surgical opinions about their effectiveness. There is now to reconcile one plastic surgeon’s experience vs another at this time.
Calf augmentation with fat injections is relatively ‘new’ and the worldwide experience is still evolving. The issues with the calfs are no different than the buttocks or breasts. It is a very safe procedure with minimal downtime. But one has to accept the reality that how much fat survives is the risk of the procedure. And more than one session may be needed to get the best results. (more likely than not) My experience has been with just a few cases and the early results have been acceptable. But the key is patient selection…don’t ask the fat to do what an implant can do better. (mild enlargement, not big enlargement)
Dr. Barry Eppley
Tags: calf augmentation, calf implants, dr barry eppley, fat injections, indianapolis, plastic surgery
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Friday, April 9th, 2010
Q: Hello, I have a few questions.I’m interested in getting my leftover fat from my entire body put into my boobs. I’d like to get my bmi to be just at 18, although it is at a 20 right now. I was just wondering if anyone would be willing to even work with me since I weigh around 115 and am 5’3″.
A: Breast augmentation using injectable fat rather than a synthetic implant remains in an ‘experimental’ or an investigative phase currently. Since it does not involve an implant and uses your own natural tissue, it is understandable to think that it is a safer and perhaps better procedure.
While fat may be natural, it is not a predictable implant material particularly in the volumes needed for breast augmentation. No standard techniques exist for fat preparation or injection methods and very different results can occur in various hands. At the least, much if not all of the fat can be absorbed rendering it a waste of time. At the worst, the fat may make the breast lumpy with cyst formations or develop sterile pools of liquid fat. What impact fat injections have on mammogram imaging and breast cancer detection remains unknown and not studied.
While much of this discussion sounds negative, the concept of using fat for breast augmentation has appeal and work is ongoing in this area. The only FDA-approved clinical trial that I know of is with the BRAVA system in which injectable fat is stimulated after surgery with an external low-level suction device. Otherwise, any clinical work that is being done is occurring in an independent fashion as an individual-precribed surgery amongst a handful of practitioners.
With the low BMI and body fat that this patient has, she would not be a good candidate for the procedure even if it was proven and widely used. A simple breast implant is so much easier and more predictable that fat injections, which for now, remain as a more complicated and morbid approach for breast augmentation.
Dr. Barry Eppley
Tags: breast augmentation, dr barry eppley, fat injections, indianapolis, injectable breast augmentation, plastic surgery
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