Q: Dr. Eppley, I am interested in enhanced fat injections, but was told by a doctor that it was no longer allowed but see you are discussing it so you must be using it. I have a couple questions. I had a lumpectomy nine months ago with radiation. Can not get implants so I am looking at fat injections to fill the hole and add some volume as my beasts are quite small. Is this a procedure you would recommend for someone in very good health and 69 years old? Can injections be done on my other breast to increase volume?
A: The term ‘enhanced’ fat injections can have various meanings. Some use the term to simply refer to liposuction-harvested fat that is concentrated and then injected. Other interpretations refer to actually adding a stimulant to concentrated fat such as PRP (platelet-rich plasma), stem cells or even insulin. I prefer to use this latter definition of enhanced fat injections as adding something to the concentrated fat.
Currently no one really knows if adding any agent to concentrated fat is helpful in creating better fat survival but it remains biologically appealing. The addition of stem cells to fat is the most intriguing and captures the greatest public interest. But the harvesting of stem cells, growing them in cell culture and putting them back into a patient is not presently permitted by the FDA unless it is part of a sponsored clinical study. (as no one knows what such concentrates of stem cells will really do) Fat, by its composition, already has a lot of stem cells so every fat injection is technically already ‘enhanced’ to some degree.
Since the addition of extra stem cells is not permitted, I prefer to add PRP to smaller volume fat injections. PRP is an extract of your own blood that contains platelets which are full of various growth factors. These have well known stimulant properties on wound healing, take a few minutes during the procedure to harvest and concentrate and are easily mixed in with fat.
Fat injections are an excellent treatment for lumpectomy defects particularly in tissues that have received radiation, regardless of the patient’s age. While fat can also be injected into breasts for general volume enhancement, the success of that breast augmentation approach depends on what your breast currently look like and what result you are expecting to achieve.
Dr. Barry Eppley
Q: Dr. Eppley, Do you use stem cell therapy to fix atrophic rhinitis…to regenerate nasal bone, tissue and mucosa, particularly, nasal mucosa? I have a bad dry nose which is primarily atrophic rhinitis three years after the partial removal of nasal turbinate. All the medication from doctors does not help much. So I can’t wait to find out how stem cell therapy and tissue engineering are going on for help with atrophic rhinitis. I read on other webpages that one plastic surgeon says you are the only doctor in the states doing this. Is that true? Thank you very much for your time. I’d really appreciate if when you kindly answer my question.
A: The treatment of atrophic rhinitis is a difficult problem for which there are no known therapies that are universally effective. The use of injectable autologous therapies offer promise for a lot of difficult clinical conditions in which some regeneration of function or regeneration of actual tissues would be therapeutic. Current autologous injection therapies include PRP (platelet-rich plasma) fat and stem cells. PRP is an extract of one’s own blood that contains platelet concentrates which have numerous potent growth factors in them. Fat concentrates are centrifuged or filtered aliquots of fat and stem cells. Stem cells can be isolated from fat but must be done concurrently as a direct isolate from the patient’s fat and immediately re-injected. The FDA currently bans the growth of stem cells from the patient as an isolated step in cell culture as a delayed reimplantation procedure.
The best approach currently for treating non-healing wounds and dysfunctional tissue elements, in my opinion, is the combination of PRP with a fat/stem cell concentrate. The entire nasal lining, septum and middle turbinates could be injected with up to 5ccs of this combined autologous therapy with the goal of reducing the degree of atrophic rhinitis. Understand that this is not exclusively stem cells but is a mixture of autologous elements that does partially include some stem cells. Whether this would be effective for atrophic rhinitis is not known as the primary problem is that the main producer of the moisturization of air (inferior turbinate) is missing. But whether the middle turbinate and other areas of nasal lining can compensate for it but being stimulated is the theoretical basis of the injections. Because it is an autologous therapy, there is no harm…it is just a question of how much benefit, if any, can be achieved.
Dr. Barry Eppley