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Liposuction: New Hope For A New Figure Through The Art Of Body Contouring
By Dr. Leon Forrester Tcheupdjian, M.D.
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Dr. Leon Forrester Tcheupdjian, M.D., respected scientific researcher, teacher innovator and surgeon. As the Medical Director / Chief Surgeon of a Chicago, Illinois Plastic Surgery Practice, Dr. Tcheupdjian has supervised and performed probably more liposuction procedures than any other American doctor.

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Chapter XXI

Fat Injections: Autologous Fat Transplant

We have seen how, through the "miracle" of liposuction, it is possible to remove unwanted fat cells permanently from certain body areas. Sometimes, however, there are parts of our bodies where more fat is desirable.

FACIAL AGING
As you become older, many things happen to your facial appearance.

For instance, many men and women develop deep, unattractive lines around the corners of the nose and upper lips as they grow older. Often, tiny "crows feet" wrinkles spread out in a fan shape around the outside corner of the eyes. Your forehead may be deeply furrowed with frown lines or wrinkles, even though you are not unhappy.

Aging also brings other changes. The lower part of your face may lose tissue as you grow older, giving you a receding chin. In addition, you may develop a "marionette" or "sad" look if your face has lost its youthful, high-cheeked appearance.

FACTORS IN CHANGES
These changes in your appearance are the result of several factors. Heredity plays a part in the condition of your skin. Another factor is your collagen and elastin network, a collection of tiny, fiber-like threads running throughout the dermis, or deeper portion of your skin. The collagen, the elastin, the soft tissue, and fat cells keep your skin soft, smooth, and elastic, and help you continue to look youthful.

With age, however, comes change. The collagen in your face changes through the years. Our constant war with gravity means that as we age, as one woman put it, "What was North has moved South." Collagen also changes when sebaceous (oil) glands in the dermis or skin begin to slow down production, somewhere around the age of 50. Excessive exposure to sunlight, or constant cigarette smoking, can also accelerate the changes in collagen. So can infection, disease, or periodontal problems.

At the same time your facial collagen is decreasing, the elastin in your face is increasing, and becoming coarser. In addition, the membranes of the cells that make up tissue are becoming rigid. The fatty tissue of your face is being gradually absorbed. Your bones are losing calcium, and your muscles are losing protein, gradually shrinking in the process.

Changes in metabolism, some related to decreasing physical activity, also play a role.

All these changes (which happen as a normal result of the aging process) affect appearance. They cause skin to stretch and sag, and to develop wrinkles, giving it a somewhat leathery appearance.

COLLAGEN INJECTIONS
Traditional cosmetic and reconstructive surgery has used techniques of collagen injections for the face or other skin area.

Collagen has been used to fill out and round skin depressions. For the most part, collagen injections have worked well, with few complications. They have improved the appearance of thousands of persons.

Nevertheless, there are drawbacks to collagen injections. Although a skin test is required before the injection of collagen is made, the test still does not rule out completely the possibility of being allergic to the injected collagen. The improvements in your appearance from the collagen injections are not permanent. "Touch-ups" with further injections must be done as you continue to age.

Because of these drawbacks, surgeons have been looking for alternatives to collagen injections. The search for these alternatives has led researchers to take a close look at the fat cells obtained by liposuction, as donors.

THE ROLE OF LIPOSUCTION AND LIPOINJECTION
Used together, the techniques of liposuction and lipoinjection can help improve facial appearance. Wrinkle lines and frown lines can be erased. Hollows can be discreetly filled in. The end result? A younger-looking face, with a more natural appearance.

Liposuction, as you already know, means taking the fat cells out of your body in places where they are not wanted. Lipoinjection means placing cells into the body again in a different location. Another name for what we are doing is Autologous Fat Transplant. The word autologous comes from two Greek words, auto, meaning self, and logos, meaning relationship. The fat cells which are extracted and then injected come from the same individual. In an autologous transplant, then, there is virtually no chance for an allergic reaction or rejection, since you are receiving cells which lived in your own body. Your system does not respond to the cells as if they were foreign.

Autologous transplants are not new. When liposuction was developed, however, many surgeons recognized the potential for using fat removed from under the skin by this surgical procedure to help correct many skin contour problems. Today, most surgeons who perform liposuction along with lipoinjection believe that very delicate techniques must be used when the fat cells are removed. The high-powered suction equipment used in routine liposuction may injure the fat cells, making them far less suitable for injection later. Instead, the experienced liposuction surgeon removes the fat cells which are to be replaced in other locations cautiously and carefully, using a hand-held syringe or a low-powered suction device.

KAY'S STORY



1. Fat injection into forehead creases.



2. Deep wrinkles around the mouth.



3. Reshaping, or chin augmentation, by injection of fat.



4. Cheek augmentation by injection of fat into sagging area.

What can these techniques mean to patients? Let's look at a few stories about those who have benefitted from the procedures. Kay was a woman who didn't mind growing older, but who didn't want to "look old." Yet the aging process had not been particularly kind to her face. She had developed deep grooves between her cheeks and her nose, making her look more matronly than she wanted to. The lower corners of her mouth drooped, even when she was happy. Her jawbone had begun to be reabsorbed, giving her a slightly receding chin. And her cheeks had begun to look hollow.

At the same time that her face was visibly aging, Kay was having figure problems. Her abdomen had become enlarged, so she looked about four months pregnant, though she was in her early 50s. Rolls of fat hung over her lower abdomen. Kay was distressed about her condition, and had come to me for help. Liposuction took care of her excess abdominal fat.

During surgery, I removed 400 cc of fat (13.5 oz.) from her lower abdomen. We had previously agreed that I would transplant some of those fat cells into her face. Using great care, I injected 2 cc into each groove between Kay's cheek and nose. In order to fill out the receding chin, I injected 2 cc on each side of Kay's chin, below her lips and at the jawbone. Kay's cheeks became fuller when I injected 5 cc just below each of her cheekbones.

You will notice that the amounts I injected into her face were extremely small in any one location, compared to the total amount of fat I removed from her abdomen. Too many fat cells would have created a grotesque and unpleasant appearance. Skill and experience of the surgeon are extremely important in fat transplants. They enable the surgeon to judge just how much fat can be injected to create the desired appearance.

Additional work we have done since we began autologous fat transplants in 1982 illustrates this point. We have found, for example, that when we injected fat cells extracted from the abdomen into other locations in the body, not all of the fat cells survived. We were extremely careful during liposuction, taking precautions to avoid damaging the fat cells we removed. Each patient received cells taken from her or his own body. Yet even with the best of care, approximately 30 percent of the injected cells disintegrated and were absorbed by the body after the operation.

One important reason, I believe, is vascular insufficiency. Each cell in your body needs a constant flow of blood in order to survive and remain healthy. Tiny capillaries, or small blood vessels, bring oxygen to the individual cells and carry cell wastes away. Cells are nourished by the blood, which brings them what they need. When the fat cells were living in their original part of your body, such as your abdomen or buttocks, a network of capillaries had grown up around them. These tiny blood vessels were damaged or destroyed by the liposuction process that removed the fat cells.

When the fat cells are injected into a different body part, such as the face or breast, a network of new capillaries must develop at the same site of the injection or close by, so the fat cells can be kept nourished and receive the nutrients and oxygen necessary for survival.

It takes several days for these new blood vessels to form. If the injection of fat cells is larger than the existing blood supply can handle, not all of them will survive during the time your body needs to get the enlarged vascular system ready and working. In other words, if a surgeon injects too many fat cells at one time, so the body cannot create enough of the new blood vessels needed to supply them, a portion of the transplanted cells will die, disintegrate, and be absorbed.

Currently at The Liposuction Institute, we are studying some new methods of extracting the fat cells, freezing and storing them for future injection. I will presently be reporting on my findings at meetings of various medical societies to which I belong.

If this technique is successful, and preliminary results indicate that it is, many patients can be helped, since we will be able to repeat the injections of their own fat cells whenever it seems desirable. Of course, the chance of allergic reactions is virtually nil, since the patient is receiving her or his own cells. Although long-term studies are not yet available, it appears that the beneficial effects of fat injection will last for years.

KAY'S RESULTS
Kay was pleased with the way her surgery turned out. Not only had her abdomen become considerably smaller, but the combination of fat cell transplants in her face gave her a much more pleasing and youthful look. She felt relaxed and confident about her new appearance, and said many people had commented on how good she looked.

ACCIDENT VICTIMS HELPED
The technique of transplanting fat cells can be used to improve other body areas. It holds special promise for those victims of disease or accident who have lost considerable amounts of tissue.

By the time she came to me, it had been four years since Carolyn's auto accident. The crash had pinned her leg against the car frame, and she had spent many weeks in the hospital, recuperating. She lost considerable tissue from her right leg. Although skin grafts had helped, Carolyn was left with a sizeable depression in her leg - a depression that bothered her. She believed it was obvious to everyone she met, and had become quite self-conscious and shy. At the same time, since she no longer felt comfortable exercising in front of others at the health club, she had put on considerable weight. She had come to me originally for liposuction of fat deposits on the buttocks, but I learned the story of her accident, and her deformity during her initial consultation.

 

1. Traumatic scars of the ankle, showing avulsion of tissue.

2. Scars of the thighs, showing a depressed area.



3. At right the unfavorable result of a liposuction surgery performed by an unqualified physician, which, under the care of a qualified physician will now be treated by use of autologous fat transplant.

Liposuction helped Carolyn with both her problems. Her sagging, drooping buttocks were tightened and recontoured, and I removed 400 cc (approximately 13.5 oz.) of fat. Thirty cc (about 1 oz.) of that fat was injected into the depression of her leg. Carolyn had no adverse reactions to the injection, since she was receiving her own cells. That fat transplant helped to fill in the depression, making it far less noticeable. "It's two benefits in one," Carolyn said, describing the surgery. "That's twice as much as I expected."

Autologous fat transplants will almost certainly become significantly more popular in the future. I base that belief on the changing perspective about aging. No longer are men and women content to let preconceived ideas about calendar age rule their lives. Vitality, energy, and a desire to look one's best are coupled with maturity. Liposuction, combined where appropriate with lipoinjection, can help people to improve their appearance, making them feel confident and proud of the way they look.
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Liposuction: New Hope For A New Figure Through The Art Of Body Contouring - By Dr. Leon Forrester Tcheupdjian, M.D.
ISBN 0-9621284-1-4 | Library of Congress registration #: 2-414-199
copyright © 1988-2006 Dr. Leon Forrester Tcheupdjian M.D.
Published by Dr. Leon Forrester Tcheupdjian M.D. 875 Rush Street Chicago, IL 60611


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