For the best results following any plastic surgery procedure it’s important to choose your board certified surgeon carefully, discuss your goals and options very specifically, and follow your surgeons post-op instructions completely. These include the compression garment.

Not wearing your compression garment after surgery might not seem like a big deal, but in fact, it is very important to your surgical result! I ask all of my patients to wear a compression garment after their Liposuction and/or Tummy Tuck surgery.

a compression garment is very important to your final surgical result

-Dr. Rodriguez

A compression garment is similar to a girdle or Spanx. I require all of my Tummy Tuck and Liposuction patients to wear this garment around the clock for the first two weeks post op. This garment is essential to getting the best possible surgical result.

What does a compression garment do?

In a nutshell, the compression garment will allow your new body shape to heal evenly and smoothly. It will prevent lumps and bumps forming in the recovery period.

After the trauma of surgery, fluid from blood vessels and capillaries leak into the tissues. This can interfere with proper healing, or even cause fluid accumulations which  can lead to inflammation, infection, and wound separation.  A compression garment will prevent this leakage, and help prevent complications like fluid accumulations or seromas.

To get the most out of the compression garment, I also insert Topifoam pads .The use of topifoam pads inserted between your skin and the compression garment with help you achieve the smoothest possible surgical result. In the photo below, the topifoam is the white pad under the black garment. This combination will keep the tissues in place and help the skin to mold to the tissue below in an even distribution.

What is the best type of compression garment for a Tummy Tuck?

Compression garments come in a wide range of styles and sizes. My staff will order your custom size depending on your measurement. However, in addition to getting the ‘right size’, quality post operative medical garments should be adjustable.  This allows me or my patient to further customize the garment to the new shape of the body.

Adjustable garments have a closure system using a combination of hook and eyelets overlaid by zippers. This combination allows you to release some of the compression by undoing the zipper but leaving the hooks attached if you want less pressure over a broad area. If you want a more limited area of pressure relief,  you can undo a couple of adjacent hooks and zipper over.

How should a compression garment fit?

A compression garment should stay in place and not fold or form rolls.  A garment that folds or rolls can cut off circulation or exert too much pressure underneath the fold or roll.

Garments with shoulder straps prevent the garment from folding when the patient sits. It will stay in place. The garment should also have a panty extension to keep the garment from rolling up. This also provides compression in the groin area and below the tummy tuck incision which can also get very swollen.

Why is it important to have a good fit?

An improper fitted compression garment can do more harm than good! If the garment has no shoulder straps and is more in the shape of an ‘abdominal band or binder’ , it runs the risk of not staying in place and creating rolls. A garment that folds or rolls can create indentations or depressions in your final surgical result!  Likewise, an improperly fitted garment following a tummy tuck can even cut off circulation to the skin flap and result in healing probems.

Proper Garment and Fit for the best surgical result

In summary, make sure you get the right kind of compression garment and make sure it fits properly! By wearing the compression garment following Liposuction or Tummy Tuck, you will get the smoothest result possible.

By Ricardo L Rodriguez MD
Baltimore, Maryland
©Cosmeticsurg.net (must link to article with original source URL)
Ricardo L Rodriguez on Google +

See Before and After Tummy Tuck Photos with Dr. Rodriguez

In 2007,  I wrote a blog post about Hydrogel for Buttock Augmentation. In the post I detailed my reasons why I did not think it was a good idea to do a Buttock Augmentation or Butt Lift with hydrogel.  The only thing that has changed since I wrote that post is that I have seen many patients who have suffered terrible damage from hydrogel injections!  My position remains the same: Hydrogel to buttocks: Don’t do it! To recap….

Reasons not to have hydrogel injections for Butt Augmentation:

1) For the amount of filler neded to get a proper butt augmentation or buttocks lift, the costs are prohibitive. Even if the costs were not an issue, the use of hydrogel for buttock augmentation is not FDA approved in the USA as far as I am aware.

2) The long term results are not very well documented in the scientific literature, but there are plenty of well documented cases in the media of deaths, disfigurement, amputations, and organ failure as a result of these non approved injections.

Essence Magazine detailed the exclusive story of Apryl Michelle Brown (photo: Kawai Matthews), who lost all four limbs due to silicone butt injections. To learn more about these tragic events with various injections, read Shot Girls by Vanity Wonder  or the details of the very sad story of Apryl Michelle Brown.

3) There is a virtual cottage industry of “injectors” plying their trade in hotel rooms and backdoor clinics. Having an ‘injection’ is a medical procedure. It should be performed in a sterile environment.  Medical procedures should be performed by a physician who went to Medical School.  These ‘injectors’ are  generally unlicensed,  dangerous and unscrupulous.

hydrogel to buttocks–don’t do it!

-Dr. Rodriguez

Despite all this, what is truly puzzling in the responses I get to my 2007 blog post discouraging hydrogel usage. In the comments a lot of people are asking me if I do the hydrogel, or could I recommend one who does. ??. I do not recommend it. Would you pay any amount of money for a procedure that can disfigure you, maim you, or even kill you? Even if it is cheap?

Recently I received a sad phone call from an out of town patient. Her buttocks are disfigured because of hydrogel injections from a fraudulent practitioner. Like most patients, she did the hydrogel because it was cheap.  Medical Procedures should never be evaluated with cost as the primary factor. It is OK to look for bargains with clothing because you can throw clothes away. It is not OK to look for bargains with surgery because you only have one body

So what is the right option to enhance your buttocks?

Fat Transfer by a Board Certified Plastic Surgeon

If you want a bigger more prominent buttocks, the best option is a Brazilian Butt Lift procedure performed by a Board Certified Plastic Surgeon.   The Brazilian Butt Lift uses Fat Transfer techniques.  Fat Transfer uses your own natural fat,  and the technique produces long lasting results.  It is not just a matter of making your butt bigger but improving your whole figure. When expertly done it’s as risk free as you can get. In over 300 cases of Fat Transfer I have only had one minor infection which resolved without any consequences. There is practically nothing else I do that has this record of safety.

If you want more prominent and perky buttocks, look for a Board Certified Plastic Surgeon and have the Brazilian Butt Lift procedure. It is possible to get not only a beautiful Buttock Augmentation or Buttock Lift, but a beautiful new figure. The Brazilian Butt Lift not only augments your buttocks, but it resculpts your entire body torso. View our procedure photo gallery to see some of our patients’ before and after pictures.

Some patients are also candidates for the B’more Butt Lift , which is a sculpting around the buttocks area to make them look more prominent. The B’more Butt Lift is a more affordable option than the Brazilian Butt Lift because the procedure can be performed in a much shorter period of time.

However, if you can not afford either procedure, then don’t resort to Hydrogel Injections.
Either save your money to have the right procedure with an experienced surgeon, or don’t do anything at all!

By Ricardo L Rodriguez MD
Board Certified Plastic Surgeon in Baltimore, Maryland
©Cosmeticsurg.net (permission to link to article with original source URL only)
Ricardo L Rodriguez on Google +

What is a Mommy Makeover? The Mommy Makeover is a combination of cosmetic surgery procedures done at the same time to address the changes in the body after pregnancy.  After pregnancy, the common areas of concern are the breasts and stomach areas.  There is no one single way to do the procedure, as each Mommy Makeover is customized to your concerns. However, the Mommy Makeover should address 3 main issues.

Mommy Makeover Concerns

1. BREAST: Changes in the Breast Shape and Volume
Usually during pregnancy the breast glands multiply and expand in preparation for breast feeding. This leads to a stretching of the skin and in some cases stretch marks in the breasts. After pregnancy, whether the mother breast fed or not, the breast milk glands shrink, but the skin may not be able to retract. Thus you get a deflation of the breast, which then sags because of the skin excess.

no matter how many sit-ups you do,…separated muscles have to be surgically repaired.

-Dr. Rodriguez

2. TUMMY: Separation of the abdominal muscles
In some women, hormones released during pregnancy weaken the fascia, or membrane connecting the rectus muscles of the abdomen at the midline. The muscles then separate at rest. No matter how many sit-ups or crunches you do the membrane does not shrink, and the muscles have to be surgically repaired. To learn more about how to self examine yourself for separated abdominal muscles, please  read my blog post entitled “Flat Stomach: Tummy Tuck or More Exercise” .

3. BODY: Changes in fat deposition
In most women changes in hormones during the normal ageing process change the places where fat goes in your body. Pregnancy may do this too. Thus some women notice after pregnancy that they get new fat pockets that are very hard to get rid of.

So now that you know what the problems are, here’s how I address them in my version of the Mommy Makeover:

Mommy Makeover Solutions

Breast Aug, Breast Lift, or Breast Lift with Implants
Many women actually like how their breasts looked during pregnancy.  During pregnancy, the breasts are usually larger, firmer and have fullness in the upper pole of the breast.  The upper pole fullness is known as cleavage. Breast Augmentation with implants will increase the size of  your breasts and create more cleavage.  Read more about  types of cleavage with Breast Implants.

In order to achieve perkier and fuller breast, I  typically perform either a  Breast Lift alone or a Breast Lift with implants. If the Breast Lift removes more than 500 cc of tissue it can be considered a Breast Reduction.

A Breast Lift alone will take excess skin to make your present breast perkier and a little firmer. However, without an implant,  I prefer the lollipop scar rather than the donut (periareolar) scar.  Although the donut scar is less visible, without an implant, it does not always provide the perkiness that the lollipop scar will. For more information on the various types of ways to lift the breast, please read my blog post on breast lift scars.

A Breast Lift with implants gives you larger, firmer, and perkier breasts., The implant itself gives some firmness, and will also help to occupy the volume of the extra skin. This procedure will also will give you better cleavage.  In many cases, for Breast Lift with Implants,  I can use the peri-areolar scar which is barely visible. It’s a win-win!

Tummy Tuck or Dermatolipectomy
If there are no stretch marks and the skin is not too saggy, one may repair the rectus abominis muscle through a scar in the belly button. This is great because the scar is hidden in the belly button.

However, if there are stretch marks or the skin is saggy, it is better to  perform a Dermatolipectomy or  full Tummy Tuck  to take out the excess skin and get rid of the pouch and stretch marks. We can place the scar low so it is hidden below the bikini line. I take great care to discuss the exact location of the scar in your pre-op appointment, as well as the morning of surgery when I make the surgical markings.

The Tummy Tuck is different than the dermatolipectomy as it also repairs the muscles , in addition to removing the loose skin. For the Tummy Tuck, I use the Lockwood method , which leaves the skin tighter, has less scarring,  and heals with less complications than the traditional way. It is my preferred method for the Tummy Tuck Procedure.

Liposuction of the love handles to remove fat deposits
Most women will develop fat deposits in the love handles after their mid twenties, and this can be more marked after pregnancy. Even if there is not significant marked fat deposition, I  usually recommend Liposuction in this area because of the way the body redistributes fat.  After a Tummy Tuck , fat may settle in the love handles unless they too were liposuctioned.

The other reason is that the objective of the Mommy Makeover is not just to get a flat tummy, but to get a beautiful figure! Even the extraction of small amounts of fat from the love handles can greatly compliment a Tummy Tuck and Breast Procedure.

Before and After Mommy Makeover Photo Gallery

Please view my patients who have had a Mommy Makeover, as well as patients who have had  a component of the Mommy Makeover.

• Mommy Makeover Before and After Photos
• Tummy Tuck Before and After Photos
• Breast Lift Before and After Photos
• Breast Lift with Implants Before and After Photos

My thanks to these patients for giving consent to use their photos at our website!

By Ricardo L Rodriguez MD

Board Certified Plastic Surgeon
Baltimore, Maryland
©Cosmeticsurg.net (permission to link to article with original source URL only)
Ricardo L Rodriguez on Google +

Patients today are doing a lot of research about the upper Lip Lift, so one of the most frequent questions I get is if I work with the muscle of the upper lip. Patients want to know if my technique involves only the skin, or if I lift the muscle in any way. My Lip Lift technique involves lifting the skin only, and I do not involve the muscle.

It seems one of the biggest proponents of technique incorporating the muscle is Dr. Randal Haworth in California. In 2008, he and I met on a trip to China representing the American Society of Plastic Surgeons, and I enjoyed his company. But I have a different approach to the upper lip lift and I will explain why.

Muscles around the Lip

On this photo you can see an artistic representation of the muscles around the mouth. As you can well see it is not just one muscle. All those muscles act in concert when your mouth is moving to speak, eat, or express your emotions. They act in a complex balance of forces, each one acting independently and contributing to the unique way your facial expression works. If they are working well, I see very little reason to mess around with them. Sort of like if it ain’t broke, don’t fix it. You do not need to alter the muscle, because the muscle is not the problem. The problem is the skin.

Secondly, even if I decided for some reason that I definitely must deal with the muscle, there is the issue of the possibility of nerve damage.

Nerves (yellow) around Lip

If the Lip Lift technique does involve the muscle, this photo shows the anatomy of nerves around the lip area, where the surgery is performed.

You can see the nerves in yellow going thru the upper lip right where the muscle is being worked on. The potential for damage is too much for my taste.

If your upper lip is too long, the muscle (or nerve) is not the problem–it’s the long length of the skin space. My mantra is, ‘don’t go looking for trouble where there is none.’ For this reason, I just cut the skin, I leave the muscle alone.

The lift in a Lip Lift comes from fixing the skin of the lip to the septum cartilage of the nose and the though membrane surrounding the nasal bone openings. It is this fixation that prevents distortion of the nose, thickening of the scar, or migration of the scar.

Just take a look at our patients’ results, and remember that after the procedure what your friends will see is not just a picture of your lip, but how it moves.

By Ricardo L Rodriguez MD
Baltimore, Maryland

Ricardo L Rodriguez on Google +

Recovery from a Tummy Tuck has to balance two things: the need to get your body going as quickly as possible, versus the need to keep things quiet until your body has had a chance to heal well. So what is the recovery time for tummy tuck?

In the past, patients were told to stay very still for a long time following Abdominoplasty, but that created its own set of problems such as blood clots in the legs, or problems with the lungs. Nowadays patients are encouraged to get moving soon, but that can also have its own set of problems such as wound separations, infections, or fluid collections.

Like most things in life, the best answer is found somewhere in the middle. Here is how we advise our own abdominoplasty post op patients who have undergone surgery in our Baltimore surgery center. We hope you find it helpful as you contemplate whether a tummy tuck might be right for you.

TUMMY TUCK RECOVERY : WEEK 1 (First 5 Days)

The first few days after surgery should be quiet time. Your body needs to rest and recover. Here are more details about what to do in the first five days following your surgery:

Bed Rest and Diet

Following Abdominoplasty surgery, you should be in bed with the head of the bed elevated and multiple pillows under your (slightly bent) knees. This is important because keeping your torso elevated helps expand your lungs, decreasing the likelihood of lung problems. This position also relaxes the skin on your belly, which was stretched at the time of closure. With the relaxed skin you have less tension on the wound, so less wound problems and better blood supply for healing.

During these first five days you should not be walking around. Walking should be goal-driven only–such as to the bathroom or to the refrigerator. Too much motion can cause the skin layer to slide against the muscle layer so the two tissues cannot knit together. This results in either fluid collections (seroma) or blood collection (hematoma). Drains can helkp prevent this, but if you move too much fluid will accumulate despite the drains.

You can resume a normal diet as tolerated, but be sure to drink LOTS of fluids, especially in the first 72 hours following surgery. Fluids should not be diet sodas, but rather fluids such as juices or gatorade.

Compression Garment

We have our patients wear a compression garment to diminish swelling and prevent fluid accumulations. It is extremely important that you do NOT take off the compression garment during the first five days post op! It not only helps you heal faster, it also influences your final surgical result!

The compression garment extends at least to mid thigh and has suspenders to prevent folding or displacement of the garment while you are resting.

You should wear the garment 24/7 during this initial post op period. The garment should NOT be removed during the first 5 days.

Drains and Pain Pump

The pain pump is optional, but it is highly recommended and most patients do opt for it. It is inserted at the end of the procedure while you’re still in the Operating Room. It will dispense local anesthetic to the incision area and will provide pain relief. Most patients are able to stand upright much sooner IF they have the pain pump! Learn more about how the  pain pump reduces pain from cosmetic surgery in my video journal.

All tummy tucks surgery patients will have drains put in to collect fluid. Without the drains, the fluid would stay in the wound area and create problems! The drain bulb should be emptied when full and the amount of fluid should be recorded each time you empty it. This process is repeated until the drain is removed in my office. The pain pump is often removed at the same time as the drains.

Bathroom and Hygiene

Get up to go to the bathroom as often as necessary, but always be accompanied by someone who can provide support. You will need the help!

You should be able to use the bathroom without removing the compression garment.

During the first five days, do NOT take a shower. Without removing the compression garment, you may sponge bathe your arms, legs, and face. However, you should not be getting the garment wet and you must not remove the garment.

Pain Medications

Following surgery, it is normal to have pain and discomfort. If you have pain, don’t be afraid to take pain medication.

Pain meds help you to get rest, to breathe better, and to get up as needed with less discomfort. It is absolutely fine to have a pain pump *and* still take the pain meds. Doing both is not too much!

The pain pump is only a local anesthetic, so it works very differently than the pain pills, which are a narcotic. When both the pain pump and pain meds are used together during this initial period, they can really speed up your recovery!

First Post Op Office Visit

On the 5^th day post op, I usually see my tummy tuck patients in my office. Most patients have their drains and the pain pump removed at this time.

With all of the tubes and drains removed, you are feeling more mobile. During this initial post op visit the compression garment is also removed and you’re given a new, clean garment. We then determine the plan of action for yout o follow during the next week of post op.

After this post op office visit, you can shower or bathe. However, the new garment should be put back on immediately to prevent swelling and fluid accumulations.

TUMMY TUCK RECOVERY : WEEK 2

After the sixth day following your surgery, the muscle layer is beginning to knit against the skin layer, but things are not quite set. But now I want the patient to start moving around. I recommend getting up and walking around the room at least 3 times a day. The purpose is to get your muscles moving again, expand your lungs more, and prevent blood clots in the calves.

But remember, don’t over do it because you could still cause the muscle layer to slide against the skin layer and separate, causing a hematoma or seroma. That is why we recommend that you keep wearing the compression garment at all times (24/7) during the second week.

At this point, it is also still important to keep the skin layer relaxed, so keep the head of the bed elevated and your knees bent while resting in bed. When walking, stay a little bent over. Do not try to stand up straight yet, as this will pull on the wound.

During this second week post op, you may still need help getting the compression garment on and off, so it is a good idea to have family and friends nearby. When you go into the shower, use cool water. Don’t take a warm shower at first because when you remove the garment, the blood vessels relax, and the warm water makes them relax even more. If they get relaxed enough, blood can flow away from your veins to your lower body and you may faint. So be sure to use cool (not cold) water.

As far as pain medications, I usually recommend at this time to start tapering the dose. There are several reasons. First, pain can be a feedback mechanism for your body to tell you if you are doing too much. And second, sometimes patients feel too good with pain medications and tend to do too much. Finally, pain pills can make you very constipated, and straining at stool can harm the muscle repair.

TUMMY TUCK RECOVERY : WEEK 3

At this point we begin the recovery phase. Start by going around the house, but refrain from doing much outside activity. You are now beginning to get a feel for your activity level and how much you can tolerate. Let your body guide you. If you can stand completely straight, it’s great, but don’t push it!

Don’t overdo the walking and do not lift anything heavier than a gallon of milk. You should still not be driving at all.

At week three, you are no longer required to wear the compression garment 24/7, but you must still wear it at least half of the time. You can take the garment off at night, but if you don’t feel totally comfortable, keep it on. Most patients do keep it on the whole month, stating it makes them feel more secure. This is your body telling you things are still a little tight or there is still swelling. Listen to your body and don’t push it.

TUMMY TUCK RECOVERY : WEEK 4

You can now venture out the house, but it is still not time to go shopping at the mall or go on prolonged trips! Many patients do go back to work, provided that there are no physical demands.

Start trying to stretch, gently. Don’t try to lift anything over 5 pounds. You should still not wear any tight garments other than the compression garment.

Even though you are in pretty good shape, it is till not a good idea to drive. During the fourth week post op, sudden turns or slamming on the brakes can still damage your muscle repair.

At this point you may feel a hardness along your wound. Don’t panic, it’s called a healing ridge, and it’s the collagen your body lays down to knit the wound together. It will disappear over the next few weeks. You are still swollen here and there and some areas are numb. This will all get better.

TUMMY TUCK RECOVERY : WEEK 5

At week 5, you can now start to resume normal activities! I should see you sometime during this week for the one month follow up appointment. You may still have some swelling, but your new body profile should be obvious. Start enjoying it!

In summary, if you’re considering a Tummy Tuck you should plan for 3 weeks off of work, with no driving during that initial recovery period. Every body is unique and it’s my hope that this detailed explanation of the first five weeks following abdominoplasty helps you be prepared for your own tummy tuck recovery time.

By Ricardo L Rodriguez MD

Board Certified Plastic Surgeon
Baltimore, Maryland
©Cosmeticsurg.net (permission to link to article with original source URL only)
Ricardo L Rodriguez on Google +

Very often a patient will ask me:

“How much fat is taken out during Liposuction?”

The answer is dependent on two things: (1) the liposuction area and (2) the patient’s height and weight.

Therefore, to answer the question here in my blog, I will give my answers for a body frame type that I see most frequently. We’ll use, as an example, a woman of average height (5’3″-5’6″) who weighs about 150 pounds.

How to count the amount of liposuction fat extracted

Liposuction is performed by using a long thin cannula to remove the fat. However, before the fat is removed, surgeons using the ‘tumescent liposuction technique’, will inject a numbing solution in the area to be liposuctioned. When surgeons extract the fat, not everything removed via the cannula will be ‘fat.’ It will be a combination of fat and tumescent fluid.

The upper back can store more fat than you think

Dr. Rodriguez

I inject a lot of fluid (tumescent solution) to diminish blood loss. Diminished blood loss during liposuction is good because losing too much blood can be dangerous. Therefore what gets taken out is not pure fat, but a mixture of the tumescent fluid and fat. After the procedure, if your surgeon shows you a picture of a cannister full of liposuction stuff, or quotes you an amount of fat taken off, it is usually about half tumescent fluid and half fat.

Using the tumescent liposuction technique, how much fat is taken out?

Common areas of liposuction include the love handles (flanks), tummy, upper back, inner thighs, outer thighs and arms. Most patients have more than one area of liposuction performed at the same time. The totals I’m going to quote you are of the fat after the fluid has been drained off. Therefore, the weight estimate represents more closely the actual amount of fat taken.

• Love handle area: I usually take about 1.5 to 2 pounds of fat from this area. It is also referred to as the flanks. This is a really high impact area as it makes you look heavy from the front or the back views so I tend to be very thorough in this area. In addition it helps give your butt better definition. So this amount may not seem like much but it makes a big impression. It is the most underestimated area for liposuction.
• Tummy area: I usually take about the same amount of liposuction fluid as in the flanks, maybe a little more in some cases. So here we’re talking about 2 pounds of fat. If the person does have a lot of fat in the tummy you have to be very careful so the skin below the belly button does not create a fold. Whenever I do the tummy area I also recommend doing the love handles because the love handles is what makes your waist appear narrow.
• Inner thighs: I am a little more conservative in the inner thighs, as taking too much may cause sagging of the skin. So here we might take maximum about 1 pound of fat. If I’m doing it together with a Tummy Tuck where the skin of the inner thighs is getting pulled up, my level of comfort is higher so I will take out more fat.
• Upper back: This is an area that many surgeons neglect because the fat in this area is really tough. I use a specialized grating cannula for this area, and I find myself recommending it more and more. Many women have a broad appearing back, and liposuctioning here makes a huge difference. Here I usually can get up to a 1.5 pounds. It seems like a lot, but the back is such a large area that it can store more fat than you think.
• Outer Thighs: Although a lot of women focus on this area, commonly referred to as saddlebags, I find myself taking less and less from this area. The reason is that if you take out too much from this area the butt can sag and look long and droopy. If you take too much out, the patient’s legs may look boyish instead of sensuous. Now I take no more than 2 pounds total, even in a woman with big saddlebags.
• Upper arms: This area always surprises me because I almost always tell my patients that their skin my sag a little and that they may need a little skin tuck later on. Amazingly, the skin always snaps back, unless the patient has a history of massive weight loss. Here a little goes a long way and I rarely take out more than 1 pound.

You might think that this is not a lot of weight taken off and you would be right because liposuction is not a weight reduction technique. But, the changes in your figure can be dramatic, because liposuction is a great contouring technique.

Interested in learning more about liposuction, consider these other blog posts: Liposuction cannulas: Video Journal with Dr. Rodriguez and Liposuction Cannula Size Affects Surgical Results.

Ricardo Rodriguez, Board Certified Plastic Surgeon
©Cosmeticsurg.net in Baltimore, MD
(permission to link to article with original source URL only)

The short answer is yes, and we are using Fat Grafts and Adipose Stem Cells more and more for this purpose. We are just beginning to understand how this process works, and it has to do with the nature of scar tissue itself and the basic behaviors of stem cells.

HOW DOES A SCAR FORM?

Let’s first describe how a scar forms. After an injury, whether it was radiation therapy, burn, or trauma, the body responds by activating a sequence of responses. The responses can be summarized in three stages:

Stage 1- Damaged Tissue Destroyed
First the body tries to get rid of the damaged tissue. It does this by the inflammatory process, which destroys bacteria, foreign objects as well as partially damaged native tissues. If the damage is severe, a lot of native tissue can be destroyed by inflammation causing a tissue deficit.
Stage 2- New Cells for Repair
The second stage of healing is the proliferative phase where the body brings in new cells to begin the repair process. It is in this phase that there is a lot of collagen deposition.  It is this abnormal amount of collagen that makes the tissue stiff and bulky.
Stage 3- Remodeling Phase
The final stage of healing is the remodeling phase. Here the body slowly pares away the excess collagen and restores the surrounding tissues to normal function. That is why in the normal scar process the scar initially feels thick but then softens with time.

HOW DO FAT GRAFTS AND STEM CELLS HELP?

Lumpectomy and Radiation performed

lumpectomy scar after fat injections

Plastic surgeons have been performing Fat Grafting, aka Fat Transfer, for more than 100 years. Fat Grafts contain a small population of Adipose Stem Cells, and we are currently using them to help heal scars.

To perform a Fat Transfer procedure, adipose tissue is extracted from unwanted areas of your body, processed to remove the mature and dead cells, and reinjected into the damaged scar.

The stem cells in a fat graft help to heal a scar in several ways:

1) Stem cells have anti-inflammatory properties that prevent excessive scarring
2) Stem cells help replenish normal cells in the tissue by differentiation or directing other cells in the tissue to multiply. Since the normal population of cells under the skin is fat tissue anyways, the fat graft itself provides most of the tissue that is needed.
3) Adipose Stem Cells dissolve the excess collagen in scar tissue by secreting large amounts of enzymes whose specific function is to dissolve scar tissue.

Carefully processed Fat Grafts can restore the missing tissue under the skin, dissolve the tight and bulky scar tissue, as well as helping restore better function to tissues surrounding the scar. All of these things help to repair the scar.

SUPER CHARGED FAT GRAFTS

If certain enzymes are added to adipose tissue during processing, a 10 fold  higher population of stem cells can be yielded. This is referred to as the Stromal Vascular Fraction (SVF). Using the SVF with fat grafts is a way to super charge the healing process.  Many Clinical Trials and Investigators are currently using Stromal Vascular Fraction (SVF) with Fat Grafting  for an even better scar result!

By Ricardo L Rodriguez
Board Certified Plastic Surgeon
Baltimore, Maryland
©Cosmeticsurg.net (permission to link to article with original source URL only)
Ricardo L Rodriguez on Google +

Other related posts:

Fat Grafting to the Breasts: Will it Affect Mammograms?

This year marked the 10th anniversary of IFATS, the International Federation for Adipose Therapeutics and Science. It is an organization which includes scientists and Medical Doctors from a wide range of specialties. The conference was held in Quebec, Canada and included over 100 abstracts, most of which focused on on Adipose Stem Cells.

Adipose Stem Cells (ASC’s) are a type of adult stem cell which can be easily extracted from your own fat tissue. They have huge application in the treatment of various diseases and injuries. Unlike Bone Marrow stem cells which have to be culture expanded for several days, ASC’s can be isolated and reinjected into the same patient in a few hours time. Due to their ease of extraction and abundant quantities, ASC’s are currently being studied in Clinical Trials and Pilot Studies for a wide range of diseases. The meeting in Quebec presented abstracts and keynotes from three categories of research:

• Basic Science – What’s being done by researchers in labs to study theoretical mechanisms of adipose stem cells
• Translational Science – Taking the Basic Science and applying it to animals in a lab, or Pilot Studies
• Clinical Research – Applying Basic Science and Translational Science to humans in Clinical Trials/Case Studies

There were many exciting findings, but here are some highlights:

ADIPOSE STEM CELLS (ASC’s) PROVIDE BLOOD SUPPLY

At IFATS, many researchers concluded that Adipose Stem Cells (ASC’s) provide vasculature or blood supply to their surrounding environment or tissue. This is important because vascularity promotes tissue healing and skin rejuvenation. Many doctors presenting at the conference reported positive changes in the skin texture and pigmentation of their patients after treatment with ASC’s.

The anti-inflammatory properties of adipose stem cells was another topic frequently reported. Researchers concluded that these anti-inflammatory properties are made possible by the cytokines secreted from these stem cells. Cytokines are molecular signals used by cells to communicate or influence cellular behavior. In summary, tissue healing comes from the signals that the cytokines send, rather than cell differentiation.

ANIMAL STUDIES SHOW ADIPOSE STEM CELLS ARE SAFE

Many labs and investigators reported no adverse events or tumor formations with the use of Adipose Stem Cells (ASC’S). The overwhelming concensus is that delivery of ASC’s are safe.

In one study, researchers from Indiana University School of Medicine studied the use of ASC’s with a mouse model for peripheral arterial disease (PAD). They presented data to show that after administration of freshly isolated stem cells with the Tissue Genesis Cell Isolation System, no macroscopic or microscopic forms of tumor formed in mice during a 90 day period.

In another pre-clinical study, University of Indiana Medical School researchers studied Diabetic Retinopathy (DR) in mice.  DR is the leading cause of blindness in working age adults. The study successfully demonstrated the safe use of ASC in the treatment of Diabetic Retinopathy. A single intravitreal injection of ASC’s limited the features of the Diabetic Retinopathy disease. More study is underway.

Dr. Ra of RNL Bio in Korea concluded that mice can tolerate very high dosages of adipose stem cells. In his study, mice were injected via IV for 13 consecutive weeks with 50 Million cells/kg with no adverse events. It was only in extremely high dosages, 100 Million cells/kg, representing a 10 fold normal dosage, that mice died after the 8th consecutive injection. His lab also compared level of tumor markers from 93 patients who had each received cumulative dosages of 1 Billion cells intravaneously (IV) over a period of 18 months. In this group, there was no increase in any tumor markers, aka no cancer. PET scans were also obtained from these patients to show no evidence of cancer or tumor. In a testament to the safety of ASC’S, Dr. Ra himself stated that over a 3 year period, he personally had received a total of 8 Billion ASC’s.

CLINICAL TRIALS SHOW SAFETY AND EFFICACY

Currently, there are many Clinical Trials underway with humans to test safety and efficacy of ASC’s. To learn more about Adipose Clinical Trials, please see our previous posts.

At IFATS, data was presented from Clinical Investigators who are studying the use of ASC’s in the treatment of Heart Disease, Pulmonary Disease (COPD), Chronic Limb Ischemia (CLI), and Osteoarthritis.  No adverse events were reported and there is continued evidence of safety and efficacy. Early results are very exciting!

Ageless Regenerative Institute reported on their Clinical Trials of both Congestive Heart Failure and  Chronic Obstructive Pulmonary Disease (COPD).  They collaborated with Bioheart in the heart trial and  The Regenerative Medicine Institute of Tijuana, Mexico for both trials.

In the Congestive Heart Failure study, freshly isolated  ASC cells from autologous Stromal Vascular Fraction (SVF) were delivered directly into the heart muscle  of 15 patients using a catheter. The most recent data showed a average 11% improvement in the EF (ejection fraction) and were able to walk 128 more meters in the ’6 Minute Walk Test’.  To put this in perspective, a football field is approximately 91 meters. Therefore, these patients were walking more than an extra football field length after the treatment. Ejection Fraction (EF) is a measurement of the volume fraction of blood which pumps out of the heart with each beat. An 11% improvement is a big deal.

In the Pulmonary (COPD) study, a total of 34 patients participated. Patients received freshly isolated ASC’s from 60 cc of their own fat by IV infusion. This equals a dosage of greater than 30 Million ASC’s. At the end of the trial, 83% of the patients demonstrated a statistically significant improvement in quality of life. In addition, at the 3 month mark,  these patients were able to walk an additional 7o more meters in the ’6 Minute Walk Test’.

Dr. Carlos Garcia presented a case report series for treatment of Lumbar Degenerative Disc Disease (LDDD) with freshly isolated autologous ASC’s from SVF. He used 50 cc of adipose tissue. After 6 months, MRI showed increased disc height (recovery) and the patients reported a 90% reduction in pain.

A Korean group, SMGSNU Boramae Medical Center, presented findings from their Phase I and II Clinical Trial to treat Osteoarthritis in the knee with autologous culture expanded ASC’s.   Up to 100 Million cells were injected into the knee.  Range of motion for all patients improved and MRI’s demonstrated that cartilage was regenerated.

A Phase I Critical Limb Ischmia (CLI) Phase I trials was presented by Dr. Louis Casteilla of StromaLab. Seven patients were injected with autologous culture expanded ASC’s. The trial established the endpoint of safety and these patients experienced a significant benefit in wound healing.

STEM CELL HOMING- CELLS MIGRATE TO THE INJURY

Several investigators presented data to prove the affect of Stem Cell Homing. Homing is the term used when stem cells ‘home’, or find the path to injured organs or damaged tissue. This is most evident when stem cells are administered via IV form. Researchers from Case Western Reserve University induced a pelvic area injury in mice and then injected adipose cells via the tail of the mice. This would be similar to an IV infusion in a human.

In the experiment, the adipose stem cells (ASC’s) were tagged, injected into the mice, and then tracked with an MRI to show what part of the body they traveled to. A control group of mice (with no injury) was used to show where ASC’s migrate to without any injury. In the injured mice, the ASC’s homed to the pelvic injury within 24 hours. These findings support the theory that once injected, stem cells are signaled to ‘home’ to the site of injury to do their magical repair. Also of note is that in the control group of mice with no injury, the ASC’s immediately migrated to the lungs.

METHOD OF DELIVERY OF ASC’S

Researchers from Macquarie Stem Cells in Australia reported on their Clinical Series for Osteoarthritis with 29 patients using autologous ASC’s. Patients were divided into three groups:

(1) Direct infusion of ASC’s into joints
(2) IV infusion of ASC’s (stem cells home)
(3) IV infusion + direct infusion of ASC’s into joints  (both combined)

All groups showed improvement. The group with the most amount of improvement was the group treated with both IV infusion and direct infusion into the joints! What was even more amazing was that all patients showed continued improvement in their condition, even after the 6 month period.

ASC CELL PROCESSING METHODS AND STANDARDS

Adipose Stem Cells are typically isolated from adipose tissue using enzymatic digestion.  The entire process can be done in a couple of hours. The fat is extracted by liposuction, decanted, centrifuged, and enzymatically digested with collagenase. The resulting pellet of fat is referred to as the Stromal Vascular Fraction, or SVF. This is the golden nugget of Adipose Stem Cells, a combination of mesenchymal cells and endothelial cells.

Dr. Alexandra Conde Green of JHU reported her findings that the use of enzymes with fat yield much higher stem cell populations compared to fat that is only mechanically processed. Enzyme digestion of adipose tissue yields 10 fold the amount of SVF compared to fat that is only centrifuged (no enzymes). This confirms the importance of enzymes for  the highest yield of SVF, but also points to the fact that standard fat grafting (centrifugation only) does contain a small amount of stem cells. Our Surgery Center collaborated on this paper and Dr. Conde-Greene has written about her stem cell research in our blog.

Mary Pat Moyer, Ph.D. of private company INCELL, presented her findings regarding various methods used to count the number of stem cells in a cc of adipose tissue. During the past few years some commercial companies like Intellicell (SVFC.pk) have been reporting crazy high values for ASC counts per cc of tissue. She concluded that some cell counting meters were greatly exaggerated. As if Intellicell were not in enough trouble already with the FDA, the data presented would push their marketing claims even further under the bus.

Cytori (CYTX), a manufacturer of fat grafting equipment and a point of care ASC processing device, presented values for the average composition of SVF, and estimated  the maximum theoretical number of adipose stem cells equal to 4 Million cells/cc. In  a jab to exaggerated stem cell count claims by competitors, “anybody reporting cell counts higher than that number is ‘creating life’” . In the Q and A, Dr. Ramon Llull, of GID group, congratulated Cytori in defining this metric. Cytori also presented a methodology to characterize biomarkers from stem cells populations. It is based on microRNA and could help with creating standards and characterization of therapeutic efficacy. This would have direct application for identifying the ‘mechanism of action’ and ‘safety’ in cell populations used in the various Clinical Trials. Certainly, this is right up the FDA alley.

Dr. Sammy Sliwin, a Canadian surgeon, reported that ASC’s separated from lipoaspirates harvested by water-jet liposuction technique lost properties of stem-ness and therefore might (negatively) affect outcomes of fat grafting procedures.

In a study that compared stem cell counts from fat extracted from different parts of the body, a team from Cooper Medical School concluded that stem cell counts from fat extracted from the flanks, abdomen, and waist were basically equal. However, there was a suprising finding that the ‘arm’ area contained much higher cell counts–a four fold difference!

DOSE RESPONSE CURVE

The general finding was that dosage of ASC’s matter. At this point in time, the range of IV dosages reported (in humans) was anywhere from .5 Million ASC’s to 10 Million ASC’s per kg of body weight. Direct injection of 100 Million cells (total) into  an injured areas was tolerated well.  Many investigators reported highest efficacy with their highest dosage. Likewise, we are in the early stages of plotting a dose response curve for treatments with Adipose Stem Cells.

The dose response curve ultimately defines the number of adipose stem cells required for the treatment of each particular disease or injury.

Who would have ever thought that treating or curing a disease would come down to counting the stem cells from your own unwanted, unloved tissue, known as fat!

Leeza Rodriguez
CosmeticSurg Staff Writer

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lease see our series on Adipose Stem Cell Clinical Trials:

• Part 1: Adipose Stem Cell Clinical Trial Summary June 2012
• Part 2: Adipose Stem Cell Clinical Trials by Donor Source, Autologous vs. Allogeneic – What’s up with that?
• Part 3: Adipose Stem Cell Clinical Trials by Country- Spain Dominates,  Spain rocks at soccer and Adipose Stem Cells
• Part 4: Adipose Stem Cell Clinical Trial Update-August 2012, 8 trials added

While the decision to augment your breast is usually an easy one, the decision to have a Breast Lift with Implants is not always so obvious.

To help you better think this through, I have come up with some questions that you should think about . These questions should help you decide IF you need a lift with your Breast Augmentation.

1. Can a breast implant by itself give you a small lift?

The Breast Implant does give the illusion of a lift because you get upper pole fullness. This works for women who have a nipple that is at or above the level of the skin fold beneath the breast. If the nipple is further down below the inframammary fold, it may cause the nipple to look like it is pointing south with the implant above it. If the implant is placed low to match the nipple then you defeat the purpose because you get a low hanging breast.

2. Do you like the size your breasts are when in the bra?

If so, you may only need a Breast Lift. All that would be needed is a skin tightening procedure, also known as Mastopexy. There are various types of skin tightening procedures, some with less scarring than others. We prefer the periareolar (Donut scar) scar because it is the least visible and leaves the smallest scar.

3. Do you like fullness in the upper pole of the breast?

Some patients cup their hands around the breast and lift it saying “I want it to look like this” referring to the fullness in the upper part of the breast. Although in the beginning a breast lift has fullness in the upper pole, it does tend to settle after a few months. You may need an implant to give you that upper pole fullness. When an implant is placed under the muscle, it will give the lifted breast a fuller appearance in the upper pole.

4. What if you like the size of your breast but you want more fullness in the upper pole of the breast?

In these cases it is possible to take some tissue off your breast and then replace it with an implant that is the same volume as the tissue that was taken off. The implant is then placed behind the muscle to give you the desired upper pole fullness.

5. Can you do a lift without a scar?

Whenever you do a lift you have to change the position of the areola, or nipple. This means that at a minimum you will have a scar around the areola. When done properly, this is very well disguised as it blends with the change in color and texture between the areola and the surrounding skin. Additionally, most lifts can be done without any kind of vertical scar.

6. Is my nipple at or below the inframammary fold?

The Inframammary Fold line is the place where the breast meets the chest wall. It is the crease line under your breasts. If the nipple is below the inframammary fold you should definitely get a lift.

implants with low nipples will cause them to point south or downward

If the nipple is at the position of the Inframammary Fold, you should still consider a Lift. To best illustrate this very important question, I would like to show you a case study of a patient who desired Breast Augmentation. Her nipple complex was at the Inframammary Fold.

Her first surgeon elected to place an implant without a lift. Following the surgery, she was not happy and decided to redo the surgery with a Lift. Her second procedure was performed by me. The patient realized the importance of the Lift and I performed a Breast Augmentation with a Lift.

Case Study – Breast Augmentation With & Without a Lift

	Pre Op Breast Augmentation This patient was initially seen by another surgeon for Breast Augmentation. You can see that this patient’s nipple, or areola, is at the inframammary fold line. The inframammary fold line is the place where the breast meets the chest wall. It is the fold line under your breasts.
	Surgery #1 (another surgeon)- Breast Augmentation without a Lift The patient opted to have a Breast Augmentation with No Lift. You can see that with no lift, the implants caused the breast to droop even more. While the breasts were augmented to a bigger size, the whole nipple complex is low and the nipples are pointing south. The patient was not happy with the results.
	Surgery #2 (with me) – Breast Augmentation with a Lift Following her first surgery, the patient was unhappy with the way her breast sagged. We decided to do a Breast Aug with a Lift. The existing implants were removed and a Breast Augmentation with Lift was performed. The entire nipple complex was moved up, but the scar is barely noticeable because it blends into the areola. The nipples no longer point south, as they are now pointed straight forward. You can see that the Breast Lift did wonders to make her breast look perky and youthful!

I hope the questions and answers above help you make the right decision for you. Please see my photo gallery for before and after pictures and, as always, feel free to ask me questions here in the comments!

By Ricardo L Rodriguez
Board Certified Plastic Surgeon
Baltimore, Maryland
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Ricardo L Rodriguez on Google +

I get this question asked often, “How do I get a lift in the Brazilian Butt Lift?”. The patient will then push her own buttock up to help me understand what she wants. They ask me, “Can you do it?” I have answered this so often, it is time to write about it here on our blog.

How do I get a lift in the Brazilian Butt Lift?

The Brazilian Butt Lift is a type of Butt Augmentation performed with your own Fat injections. As a matter of fact, in this procedure the butt is physically lifted very little, if at all. But after a Brazilian Butt Lift, the buttock definitely looks perky, and definitely looks lifted!

How does this happen?
It’s all about how the eye perceives shapes. When you look at the back of a typical woman what you think is the butt is really a combination of two separate fat pockets:

1) the buttock itself, and sitting right above it is 2) the flank, or “muffin top” fat pocket.

The combination of the two fat volumes creates a visual unit. It is longer than it is wide so the butt appears to be droopy or sagging. From the side it appears there is no shelf but a long slope that makes the buttock look like it is hanging. If you eliminate that extra fat pocket above the buttock there are a lot of perception changes that result.

Brazilian Butt Lift Before and After Back View:

As you see in this first picture above, the butt on the left (preoperative view) looks like a long droopy oval. On the right (postoperative view) you see the perky bubble butt, because the flank fat pad, or muffin top, has been eliminated and you are seeing the rounded, shorter buttock contrasted against a narrow waist.

So instead of having two fat pats joining to form a long rectangle or oval, you get a rounded buttock contrasted against a narrow waist. This is an improvement in the waist to hip ratio which is also an important esthetic marker.

Brazilian Butt Lift Before and After Side View:

And on this side view photo above, the arrow shows that the apparent length of the buttock on the left is much longer than the buttock on the right! So the buttock looks shorter and rounder, not long and droopy. Furthermore, when the patient looks at the slope of her back and butt (before) it looks almost like a straight line, so the patient thinks she has little or no butt. This is because the flank fat pad is hiding the buttock shelf from her view.

The Brazilian Butt Lift works so well because by eliminating the fat above the buttock it creates a shelf. By just adding a little fat at the buttock there is a radical change in the slope from her lower back to shelf.

If you look closely at the bottom of the butt, you can also see the butt has not been lifted at all. There is no lift, but there is a real dramatic change and the butt is perkier, rounder, and prettier, a bubble butt, as if by magic. Maybe it should called the Brazilian Magical Butt instead of the Brazilian Butt Lift?! Then again, what’s in a name?

By Ricardo L Rodriguez
Board Certified Plastic Surgeon
Baltimore, Maryland
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Ricardo L Rodriguez on Google +