"Reputation Is Everything" & the Magic of the Multipotent Stem Cell in Fat.

When I commenced in this field of minimally invasive facial rejuvenation some medical colleagues remarked: "aren't you frightened of treating faces in case something goes wrong?"
The answer was then and remains: that I am not frightened but do take I take my work very seriously.

Without any disrespected intended it should be understood that  an aesthetic facial procedure is not a visit to hairdresser or beauty salon. A salon is not the appropriate setting for medical procedures for many reasons including hygiene, safety and ready access to effective medications and equipment.

Unintended complications can even happen with injected fillers yet many patients (along with some injectors) fail to properly appreciate these risks.

This week alone I have consulted 3 patients from other clinics with persistent and unsightly facial lumps after a certain fillers were poorly injected. These injectors failed to respect anatomy and also failed to appreciate the complexities of facial aesthetic treatment.

The best advice is to seek out a practitioner with a good reputation and to generally avoid medical treatments in salons. Also a caution about procedures in  high turnover entrepreneur operated clinics where a sweat shop environment prevails and good outcomes are viewed in terms of financial success rather than pleasing results.

On a positive note this latest report confirms an impression that many fat grafting doctors have observed for years-that something in fat not only improves the appearance but also skin (and even scars in certain situations). We now know the magic ingredient is the mulitpotent stem cell.
http://www.medicalnewstoday.com/releases/266660.php

Suture/Thread Lifting Book Publication

I was delighted recently to be informed that a chapter I was invited to write was recently published in a book freely available online:

Miniinvasive Face and Body Lifts - Closed Suture Lifts or Barbed Thread Lifts. 

My chapter titled "Suture Lifting and Liposculpture Integration in the Creation of Facial Esthetic Harmony" can be reached by clicking on the link

http://www.intechopen.com/articles/show/title/suture-lifting-and-liposculpture-integration-in-the-creation-of-facial-esthetic-harmony

Platelet Rich Plasma "Wow" Factor

A recent visit to attend the Biobridge congress in Venice

http://www.biobridge-event.com/site/index.php/2013-preview/day-1-plenary-session.html

 has convinced me of the potent advantages of using Platelet Rich Plasma (PRP) in healing and rejuvenation aesthetic procedures.
Some amazing outcomes are being achieved boosting healing in cases of bone, leg ulcers and damaged joints. There is little doubt that the improved outcomes that we are achieving with fat grafting in facial aesthetics are due to enrichment with platelet rich plasma PRP).

Neck Liposculpture, Fat Transfer & Platelet Rich Plasma

I noted an article in one of those international airline magazines recently about people paying mega-bucks for "new" sensational non-invasive procedures like Platelet Rich Plasma (PRP) fortified fat transfer graft associated with suture face lifts. We have been performing these procedures for some years now and in fact performed the first PRP enriched facial fat graft case in Australia  4 years ago. Nice to see we are ahead of the game down in olde Castle Hill! I have been astounded by the really transforming outcomes in many of our cases and continue to be enthused by these scarless "in-clinic" procedures.

Beautiful Queenstown, New Zealand

I had the privilege of being an invited speaker at the annual meeting of the New Zealand College of Appearance Medicine which was held last week in Queenstown NZ.

The meeting was very informative with outstanding  guests speakers from as far away as Holland-Dr. Helga van den Elzen. & Professor Richard Boyd the stem cell scientist and world authority from Monash University Victoria.  

www.nzcam.co.nz/CONFERENCE+2013/Speakers.html

Excellent presentations were delivered from several other Australians & New Zealanders. It was my first visit to beautiful Queenstown but not my last. Just returned from the impressive Milford Sound which is of course part of a world heritage listed region

http://activeadventures.com/new-zealand/about/about-new-zealand/destinations/milford-sound

So what was the most ground breaking issue? Certainly Adipose Derived Stem Cells (ADSC)
It seem certain that in the next 5 years medical treatments (including cosmetic medicine and surgery) will
be increasingly addressed by the manipulation of stem cells to improve tissues and the body's resistance against threats like viruses, resistant bacteria and markedly improve tissue health.
We have a very exciting time ahead in this regard.

New Zealand College of Appearance Medicine 2013 Conference

Very honoured to be invited as an international speaker and to conduct a workshop at the New Zealand College of Appearance Medicine 2013 annual conference.
http://www.nzcam.co.nz/CONFERENCE+2013.html
Interesting subjects to present on include fat transfer grafting and neuromodulators in aesthetic enhancement.

Blepharoplasty Upper Eyelids Start to The Working Week

Love starting the week with a significant rejuvenating procedure like blepharoplasty upper lids.

Only 5mls total of local anaesthesia used after careful marking of the upper lids. 2 hours later left the clinic with her husband driving her home.

No pain, no fuss, no general anaesthesia and a new result already evident. All performed with almost bloodless radiofrequency energy incisions, excisions, tightening of the subcutaneous tissues and orbicularis oculi muscles. Skin incisions were closed with a very fine 6/0 grade suture.

Very happy patient already can view the initial outcome.

Pre-operative marking

Immediately post operation

1.4mm skin excised each upper eyelid and some fat as well. 

. 

"A Wallet-Ectomy" The 11 most Overrated Cosmetic Procedures.

"A Wallet-Ectomy."

As cosmetic doctors we do get rather excited about promising advances in our field.
Sadly however quite a significant number of such advances prove to be in the nature of ‘vendre un canard à moitié’ (to half-sell a duck)!

The 11 Most Overrated Cosmetic Surgery Procedures from Allure magazine:

http://www.allure.com/beauty-trends/2013/overrated-cosmetic-surgery-procedures#slide=12

Interviewed in the June edition of Women's Health & Fitness Magazine:

"There comes a time when you'll have to choose between your rhymes-with-farce and your face, so the saying goes. That time is now, as the next big thing in facial filling doesn't gel with single-digit body fat. 'Autologous fat transfer facial filling' uses fat from one part of your body – liposucked out of your butt, thighs, abdomen or jowls – to plump up your face.




"It's rich in stem cells, fortified with autologous blood derived growth factors.
The results can be breathtaking with long lasting youthful re-contouring and scarless outcomes," says Cosmetica cosmetic physician Dr Ronald Feiner. The bonus is an improvement in overlying skin. But chicken breast dieters beware: "In slender patients without body fat (and always for cases of lip enhancement) commercial fillers remain the mainstay of treatment."

Read more:

http://www.womenshealthandfitness.com.au/home

https://www.facebook.com/womenshealthandfitness

The Australasian College of Cosmetic Surgery (ACCS) Liposuction Workshops – May 2013, Sydney

According to our Regen www.regenlab.com/site/  representative, we probably performed the first PRP enhanced fat graft (extracting abdominal fat and transfer grafting it into the face) in Australia and actually videoed that event. We did not fully appreciate the exciting future of this development in facial aesthetic enhancement practice.

I had the pleasure of participating as one of  four trainers at the ACCS Liposuction Workshops event last weekend http://www.accs.org.au/pdf/ACCS-liposuction-workshop-program-2013.pdf.

My fellow trainer colleagues Dr. Soo-Keat Lim, Dr. Sarojini Nair  www.ashbrookecosmetic.com.au/surgery-staff/
& Dr Ralph Bright www.cosmeticmedicine.com.au/world-class-facility/cosmetic-surgeons-sydney/  are masters in this field of work. It was a great pleasure to work with them, passing on our collective  experience to enthusiastic doctors from a variety of medical craft groups eager to introduce these techniques into their own practices. The trainees were of a very high standard and included general surgeons, neurosurgeon, facio-maxillary surgeon, breast cancer surgeon and medical generalists.

Dr. Bright is also a respected expert in the clinical application of adipose derived (i.e. from fat) Stem cells and platelet derived (i.e. from blood) growth factors. His insights into this brave new world are fascinating and reinforce our own intuitive perceptions about the value of both fat reduction by liposculpture and fat transfer grafting for facial rejuvenation.

Among many interesting topics Dr. Bright explained how fat, being full of stem cells, is important for immunity and how successfully grafted fat improves the tissues into which it has been injected.

As an aesthetic injectable filler it is amazingly bioactive in function  in contrast to comparatively inert commercial filler products. Injected fat not only has the propensity to improve facial contours but also improves the adjacent tissues and overlying skin.

Dr. Bright has stated (http://www.macquariestemcells.com/wp-content/uploads/2012/01/R1.-Introduction-to-Macquarie-Stem-Cells.pdf):

"Stem cells and stem cell therapy have been surrounded by myth and magic. As we have learnt more about stem cells and their use fact has begun to replace Myth. At Macquarie Stem Cells for many years we have been moving fat and all the cells it contains around the body (Fat transfer)."
 &

"This rich cocktail of cells is known as the Stromal Vascular Fraction (adipose-SVF cells) also contains many growth factors and cytokines. The adipose-SVF cells when grafted into a new location will aid in repair and regeneration of the tissue in their new location. Vast numbers of these cells are available in fat and we routinely transfer hundreds of millions of these cells for each patient."
Dr Bright writes "stem cells release anti-inflammatory messengers, called cytokines, that have an effect on the entire system."

Dr Bright referred to the pivotal work of Dr. Patricia Zuk on Adipose Derived Stem Cells-amazing reading!
http://www.molbiolcell.org/content/21/11/1783.long
 

News Releases - ASAPS Annual Meetings - ASAPS Press Center - Do Stem Cell Claims in Aesthetic Surgery Hold Up?

Do Stem Cell Claims in Aesthetic Surgery Hold Up?
“There is a lot of marketing hype about the role of stem cells in aesthetic procedures,” said Dr. Singer of La Jolla, CA.  “We are hopeful that this is the next frontier, but, unfortunately, there is no current scientific evidence that stem cells improve aesthetic outcomes.”
News Releases - ASAPS Annual Meetings - ASAPS Press Center - Do Stem Cell Claims in Aesthetic Surgery Hold Up?

Certainly in my practice a sample of blood that allows us to extract growth factors from platelets do appear to enrich harvested fat, improving the success rate of that grafted fat. However there is a lot of science to evolve before the impression is proven.

US plastic surgeon Dr Sydney Coleman is a longstanding leader in this field. A link to his website appears below.
http://www.lipostructure.com/fat-graft

"Professional Beauty Magazine" previews our Cosmetex 2013 Paper

"With Cosmetex just around the corner, here is a sneak peek of the talk “Blood, Sweat and Tear Troughs,” which Dr Ron Feiner and Dr Naomi McCullum will be presenting on Saturday 20 April,  2013".


http://www.professionalbeauty.com.au/2013/04/03/article/Cosmetex-2013-Blood-Sweat-and-Tear-Troughs/LHVLMZTDAU.html

Hold the Muscle Relaxants!

Hold the Muscle Relaxants- (at least a little)! The gorgeously curvy, feminine and mega-talented Italian Mezzo Soprano Cecilia Bartoli could not achieve her exquisite & expressive musical heights if she was injudiciously injected with Muscle Relaxants. Natural beauty must
http://www.youtube.com/watch?v=mDeFdGzthV0
http://www.youtube.com/watch?v=VhNRWduBPmY
http://www.youtube.com/watch?v=p4EVNbHX1lI
http://www.youtube.com/watch?v=oYnZqRVmOCw
At last some degree of expression is important for communication and thankfully patient demands for rather naïve "no wrinkle" outcomes have finally plateaued over the last 2 years. This has allowed us to be creative in much more intelligent ways enhancing natural feminine curves and proportions.
 Natural beauty must shine through.

Happy Easter, Passover and peace to all.

Upper Eyelid Reduction-"Take a Pair of Sparkling Eyes....".

I see many cases of post upper eyelid reduction during my clinical week and find myself analysing post surgical outcomes. Some cases have merit with sparking natural results. Other cases demonstrate overly operated-on features such as hollowed out orbits and ridiculously manufactured and unnaturally high positioned lid creases. There is very little chance that these silly, unaesthetic outcomes can be corrected. As a general rule the patient's naturally positioned eyelid crease should be retained and redundant tissue above resected while allowing the eyelids to close in order to maintain corneal protection. Ideal outcomes are natural sparkling eyes. The big bonus is that future botulinum toxin injections are enhanced dramatically after successful upper eyelid reduction. There is much synergy in our minimally invasive cosmetic treatments which may explain why "less is truly more"in our craft.    www.youtube.com/watch?v=rvn9lIfQRZU

Multiple 9 Yearly Facelifts-?Acceptable Contemporary ProceduralAesthetics??

I was surprised today to read about a study extolling the virtues of 2nd & even 3rd facelifts after the first lift being performed in the patients' early 50s. Each facelift lasted some 9 years. In the era of minimally invasive cosmetic procedures it is extraordinary that some plastic surgeons should view this as an acceptable treatment plan . The reality is that patients usually develop an "operated on" appearance even after the initial facelift. Recurrent radical procedures in this way are in my view inconsistent with modern aesthetic principles & expectations. However it should be appreciated that plastic surgeons are unlikely to surrender their scalpels while patients can be convinced that such a radical approach to facial rejuvenation is in their best interests.
In fact we have now followed up patients for up to 10 years who, despite the passage of time, appear more beautiful than they did before using only minimally invasive procedures with natural outcomes.
http://www.medicalnewstoday.com/releases/257036.php

A Smile Is The Shortest Distance Between Two People

A charming observation attributed to the wonderfully talented Danish/American pianist- comedian, the late Victor Borge http://www.youtube.com/watch?v=E3QejAk4exw  "A smile is the shortest distance between two people". This epitomises what we strive to achieve with non or minimally invasive cosmetic procedures. In females a smiling face is more than the warm fulsome lips that we recreate with injectable fillers. Females also smile with their eyes. So ideally we enhance and beautify both the lips and eyes and connect them with curvaceous cheeks.
The outcome is the creation of an engaging femininity as exemplified in the beautiful face of young singer-songwriter Cassandra https://www.facebook.com/Cassandrasingslive
http://www.youtube.com/cassandrasingslive

I am impressed by the confidence so evident in patients returning after such treatments. All are created without scars or artificiality. Always such a pleasure for me as well to see these happy outcomes.

V>W=F (Volume creation more than wrinkle treatment =Femininity)

Attended 2 presentations in Sydney in the last week on injectables

Excellent presenters Dr. Danny Vleggar (Switzerland) http://www.youtube.com/watch?v=ldezLZKQlaM & Dr Glenn Murray (Perth) http://www.youtube.com/watch?v=0z6xA1GCM0A while demonstrating different injectable products both focused on Volumisation in preference to Wrinkle treatments in modern aesthetic facial rejuvenation.
This trend to volumise rather than to "chase" wrinkles is completely correct in my opinion and is certainly  reflected in the wonderful outcomes achieved by informed cosmetic aesthetic practitioners.
In this regard the disappointing outcomes we frequently witness with formal radical face lift outcomes are founded on the erroneous objective of stretching the face (achieving wrinkle reduction) rather than creating aesthetic contours. We frequently see patients who have spent near $20,000 on face lifting with unnatural and rather "de-contoured" faces who require their faces aesthetically "re-contoured" with appropriate fillers. They leave the clinic generally delighted with their feminising outcomes. A few have stated I had the wrong procedure having a face lift?? We try to be diplomatic!
http://www.youtube.com/watch?v=p3hYzRIOJrs
http://www.youtube.com/watch?feature=endscreen&v=yfPO147wxYs&NR=1
http://www.youtube.com/watch?v=g1D666k0nvA

Tweaking Facial Rejuvenation with Muscle Relaxant Injections

Traditionally teaching encouraged cosmetic injectors to over-treat faces with muscle relaxants,  often resulting in cases of stunned and rather expressionless features. Add to that droopy brows, droopy cheeks, asymmetrical smiles diminishing character. Generally the effects are to be endured for some 3-4 months. The following celebrity examples attest to this unfortunate trend.
http://pinterest.com/barbiegurl29/botox-gone-bad-celebs-with-out-make-up/

For some years now many Australian injectors have appreciated that less is more and that subtle treatments should prevail. Judicious tweaking with these injections can enhance other the outcomes of other facial enhancement procedures.  So we are effectively value adding with such injections.

Will expand on this interesting topic in a future blog.

Weird Therapies and Procedures

Fringe if not bizarre cosmetic procedures abound, with questionable professional ethics only matched by gullibility of some patients.

Women considering genital enhancement surgery should first consult the following paper just published online: http://whv.org.au/static/files/assets/ca7e9b2f/Women-and-genital-cosmetic-surgery-issues-paper.pdf
 A short excerpt from this article follows:   Women and Genital Cosmetic Surgery. Women’s Health Issues Paper No. 9, February 2013 Page 1 © Women’s Health Victoria

9.1 Reduced sensation
It is ‘not yet understood exactly how labia minora engorgement during sexual arousal may be involved in sexual pleasure and how labia removal might affect this’4. However, there is evidence to suggest that female genital cosmetic surgery involves removal of tissue that may contribute to sensory sexual arousal28, 66, and is likely to interfere with innervation and sensation in the genital area10, 34, 66, 67. The outcomes of genital surgeries suggest decreased enjoyment of being caressed, impaired arousal and lubrication, and an inability to reach orgasm12, 36.

There is a particular risk of providing female genital cosmetic surgery to younger women who may not fully understand the implications for their future sexual lives
68. Genital surgery during adolescence risks damaging sensitive genital tissue and may require reoperation68 if puberty is incomplete. The risk associated with operating too early in a woman’s development is highlighted in the case of a ten-year-old pre-pubescent girl who underwent one procedure on her left labia minora and, nine months later, had the same operation on her right labia minora. The surgeons themselves reflected that ‘in retrospect we feel that she could have had both operations after puberty’32.

There is no information to demonstrate how female genital cosmetic surgeries will impact on childbirth



http://www.iol.co.za/lifestyle/love-sex/sex/the-disturbing-rise-of-the-g-spot-jab-1.1464150
http://www.dailymail.co.uk/femail/article-2245450/Cosmetic-fillers-destroy-looks-The-truth-botox.html

Non-invasive Body Contouring alternatives to Liposculpture

While patients and cosmetic doctors enthusiastically embrace non-invasive technologies as alternatives to liposculpture, a recent review article seems to suggest that, to date, outcomes from these technologies are either only fair to modest or simply disappointing.  Focused ultrasound and cryolysis seem to hold the most promise thus far but patient expectations should be realistic before committing to rather expensive treatments that may come to little or no improvement. In my view Tumescent Liposculpture remains the gold standard in the quest for a reliable and durable outcome. Additionally there would appear to be very little if any difference in costs. http://www.plasticsurgerypulsenews.com/13/article_dtl.php? QnCategoryID=130&QnArticleID=262 In Summary:

ULTRASOUND CAVITATION aims to induce fatty tissue disruption. However, the frequencies associated with cavitation are difficult to focus with precision. There are several ultrasonic cavitation devices on the market, but there appears to be little evidence that they produce a true cavitation effect resulting in cell lysis with lasting effects. RADIOFREQUENCY The permanence of RF as a body-contouring treatment has not been well proven and newer technology platforms have taken the spotlight. CRYOLIPOLYSIS Treatments are generally well tolerated but are limited to areas that can be lifted into the suction head of the device. Each application takes about 1 hour, and an average of 25% reduction in thickness of the adipose layer has been reported. Each area is treated once, though re-treatment is possible after a period of months if desired. FOCUSED ULTRASOUND Though this may be associated with greater discomfort during these procedures, focusing may be more precise than it is with frequencies used for cavitation however the effects are mostly modest. LASER There is skepticism as to the clinical mechanism of action and long-term results. No histological studies of tissue treated in vivo have been presented despite the marketing claims of efficacy.