Surgical Aesthetics

JAN-FEB 2014

For plastic surgery and cosmetic surgery trends, techniques and equipment, plastic and cosmetic surgeons turn to Surgical Aesthetics for the latest on breast augmentation, liposuction, rhinoplasty and more.

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| Patient, Heal Thyself | the chosen method, speed is important; the longer the fat cells are exposed to oxygen, the greater the chance of the cells dying. Researchers are also seeking ways to streamline fat transplantation and make it more appealing to patients. The harvesting procedure typically requires the patient to undergo anesthesia, and patients may experience pain, scarring and some downtime for recovery; transplanting the harvested fat, on the other hand, can be performed as an outpatient procedure. "Patients want quick procedures and minimal down time," Dr. Roth says. "They want minimally invasive or noninvasive." In an effort to increase fat graft survival rates, physicians are combining harvested fat with enhancements such as concentrated stem cells and platelet-rich plasma. "As we learn to get more viable fat cells and to preserve the important other factors in the fat, we're going to figure out the ideal concoction of fat that we should be transferring," says Dr. D'Amico. "While the results up to now are very good, I think we'll be doing even better in the next three to five years." The animal studies, on the other hand, were more promising. They all revealed higher fat graft survival rates in PRP plus fat transfers as well as increased density of viable adipocytes and blood vessels in PRP-enriched fat grafts. In addition, there was a larger number of necrotic areas and fibrosis in the fat-only treatment groups. A review published in the March 2013 Journal of Plastic, Reconstructive and Aesthetic Surgery evaluated 40 studies on the use of PRP in plastic surgery. The authors noted that 36 of the 40 studies reviewed through PubMed and The Cochrane Library demonstrated favorable outcomes with the use of PRP. The studies included the use of PRP for several indications, including better wound healing rates, increased survival rate of fat grafts and "Wouldn't it be great if you could just open up a box and have fat that you don't need to harvest?" Blood Benefits – Platelet-Rich Plasma Platelet-rich plasma (PRP) is made by placing whole blood—usually the patient's own—in a centrifuge to separate out blood components and increase the concentration of platelets. PRP contains growth factors believed to stimulate wound healing and collagen formation. It is used in several specialties, including orthopedics and plastic surgery. In a review of studies comparing the use of fat graft alone and fat combined with PRP, Jin Rong, et al, of the department of plastic and reconstructive surgery, Shanghai Jiao Tong Univeristy School of Medicine in Shanghai, China, found conflicting results (International Journal of Clinical and Experimental Medicine, June 2013). Zeroing in on five animal and two human studies that included controls, the authors reveal that one study comparing 50 patients who received fat plus PRP and 50 patient who received fat alone, showed a 69% maintenance of the fat graft at one year in the PRP plus fat group vs. a 39% maintenance after one year in the fat-only group. A second study comparing the rate of necrosis found that PRP-enriched fat was not superior to fat alone in reducing fat cell necrosis. 22 Surgical Aesthetics ❘ January/February 2014 enhancement of bone graft regeneration. Jon M. Grazer, MD, a plastic surgeon in Newport Beach, California, and assistant clinical professor of plastic surgery at the University of California, Irvine, is using PRP in his practice for facial rejuvenation and as an adjunct to fat grafting and facelifts. He uses the PRP topically in conjunction with microneedling and fractional lasers, and injects it in areas where he wants to improve skin texture and tone. "PRP is not a facelift in a jar, nor are lasers or microneedling," says Dr. Grazer. "But it all adds cumulatively to the effect. Typically when I use PRP, patients are seeing improved skin tone and texture in 10 to 12 weeks." He notes that PRP also offers a volumizing effect, "because it coagulates and forms a fibrin mesh network." Dr. Grazer finds that, when used in conjunction with fat grafting, PRP allows him to reduce the amount of fat injected, particularly in the tear trough area. "It's the thinnest skin on the body, so if you get any fat nodules, they are palpable or even visible," he says. "With PRP, I can put less

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