Author: Sydney R. Coleman, MD
Publisher: Quality Medical Publishing – 404 pages
Book Review by: Nano Khilnani
Structural fat grafting (sometimes known as ‘fat transfer’) is done when sometimes, too much fat has been removed through liposuction from a patient, and the surface of the skin becomes uneven. At other times, it is done after a severe injury has caused a deformity such as for example a ‘hole’ on the face.
This book on fat grafting as a relatively newer aspect of plastic surgery has been written, edited, and developed entirely by one person: Dr. Sydney R. Coleman, a plastic surgeon.
He writes in the section on Fat Grafting in his Preface:
“In 1985, I moved to New York City to set up practice. Some of my first consultations were with women I met at dinner parties who would show me their arms, thighs, and even abdomens where too much fat had been removed through liposuction procedures by respected plastic surgeons. The deformities made it increasingly obvious to me that liposuction, which was on its way to being the most popular procedure in the world, was far from problem free. It was frequently associated with surface irregularities.
This recognition prompted me to investigate fat grafting for correction for the correction of the new problem of iatrogenic liposuction deformities. In 1986, I visited or spoke to plastic surgeons around the world who had been known to me for grafting fat. The consensus was growing that grafting fat was unpredictable, but definitely worked some of the time.”
In our mission to present reviews of books on less widely-explored topics, especially in medicine, we chose this book for review in our Books section. It consists of 12 chapters, and we present below their titles to give you an overview of what you will find in it:
Concept of Aging: Rethinking the Obvious
- Part I. General Considerations
- Consultation and Preoperative Planning
- Harvesting, Refinement, and Transfer
- Overview of Placement Techniques
- Problems, Complications, and Postoperative Care
- Part II. Clinical Applications
- Hand
- Iatrogenic Corporal Deformities
- Nasolabial Folds and Marionette Grooves
- Lips
- Chin and Jawline
- Neck
- Infraorbital and Cheek Regions
- Supraorbital Area: Brow, Upper Eyelids, and Temples
Dr. Coleman found limited literature on fat grafting and decided to research into its history. He found that as early as in 1893, fat grafting had been done through open incisions. He also discovered that in 1926, Charles Conrad Miller has used hollow metal cannulas to inject fat, and the results we better with this method than through open incisions.
Miller noted “a better long-term correction and a more natural-appearing change in facial and body contours with infiltrated fat that with other methods of fat grafting.” But despite the report of good results with injected fat, “the technique he described never became widely used,” Dr. Coleman writes.
About 30 years later in the 1950s, Lyndon Peer studied the long-term effects of fat grafting through incisions and found that about 50 percent of the fatty tissue survived after it was cut into small pieces and transplanted into other sites. But because the other half of the fat tissue died, the surgeons at that time did not continue to do fat grating into patients.
Dr. Coleman writes that his experiences since 1986 with fat grafting on patients with iatrogenic liposuction deformities have been positive. He states: “my earliest attempts at fat grafting yielded long-term structural changes with every indication of permanence,” and his follow-ups with some patients up to seven years later “showed no diminution in the volume of fat.”
He also writes with confidence: “Since 1988 it has been my consistent observation that fat grafted in the manner described in the following pages has every indication of permanence” and “from 1987 to 1992 I developed the approach to fat grafting for changing facial contours that is described in this book.”
At the end of his Preface, Dr. Coleman explains the process of aging by showing a series of women’s faces at ages 20, 50, and 75. He shows how the loss of fat in different parts of these faces causes us to look older. He emphasizes the importance of augmenting the fat that is lost as we age. He writes:
“Augmentation represents the past and the future of rejuvenation. It also holds the key for possible new developments such as tissue repair. Examination of the photographs on these pages reveals promising post-treatment changes in the quality of the patients’ skin after placement of grafted fatty tissue under it.
In addition to restoration of youthful contours, intrinsic qualities of skin texture, elasticity and color return to a more youthful state for an extended period of time. Stem cells have been shown to present in significant quantities in harvested fat tissue. Perhaps they are mending the undamaged, aging epithelium.”
Author:
Sydney R. Coleman, MD is Director of the Centre for Aesthetics, Rejuvenation and Enhancement in New York, New York.
Illustrator:
Kathy M. Grey
For more information and insight about fat grafting, watch this video:
