Raleigh-Durham Facelift doctors

Many plastic surgeons who perform structural fat grafting report that patients often describe a variety of improvements in their facial skin following fat grafting surgery. This observation has led to the use of fat grafting in reconstructive surgery, for instance in the management of chronic wounds such as those seen in some patients following radiation treatment for cancer. Fat grafting into the tissues below a chronic, non-healing wound has been shown to stimulate successful wound healing in a number of studies.

So what is responsible for this effect? Many of us suspect that it is produced by 'stem cells' which are known to be present in abundance in human adipose (fatty) tissue. Stem cells are very dynamic human cells which have the capacity to be transformed into any number of cell types (fat, muscle, skin, fascia, etc), and which are capable of producing a variety of proteins which promote the repair of damaged cells and tissues.

Much of the evidence has been anecdotal, i.e. the personal observations of physicians made while treating patients in their usual clinical practice, outside the setting of a specific scientific study. A great deal of basic science research is now being done to specifically determine cause and effect, and it is certain that over the next few years we will gain a much clearer understanding of the healing properties of fatty tissue and stem cells.

Be aware that the term 'stem cell' is increasingly being used in what I feel may be an irresponsible manner - as a marketing gimmick to attract patients to a particular practice or surgeon. Nobody has an exclusive claim or right to the use of stem cells, and as yet no one has demonstrated an objective, quantitative method for measuring any 'stem cell effect' in facial rejuvenation surgery, if it is truly present. I believe that this effect exists, but it currently is not objectively and reproducibly measurable and therefore should not be used to 'sell' surgery.

In my practice fat grafting is not an afterthought that is thrown into the surgical plan for the occasional patient. It is a key component of almost every major facial rejuvenation surgery that I perform. It is in fact that very first part of the surgical procedure for my patients undergoing a full facial rejuvenation surgery.

There are supplements, both vitamin and herbal that may be beneficial prior to facial surgery. The most important consideration is to disclose all supplements to your plastic surgeon. Most plastic surgeons will provide you with a list of recommended supplements in addition to vitamins, herbs and medications to avoid before and after surgery.

The specialty of Plastic Surgery has been undergoing a 'paradigm shift' in the approach to surgical treatment of facial aging changes over the last two decades. This shift has consisted of a departure from older 'subtractive' techniques to newer 'restorative' techniques.

Surgery which consists mainly of removing (subtracting) skin and fat and pulling tissues tight will lead, in many instances, to a 'skeletonized' and therefore more aged (or "done") appearance. Facial soft tissues (and even the facial bones) actually lose volume and projection with age, and it is thus inevitable that surgery which focuses only on removing tissue will in some fashion 'age' the face.

The contemporary approach to surgical rejuvenation of the face consists more and more of an attempt to restore facial volume and contour, in an attempt to emulate youthful facial features. My personal approach to facial rejuvenation is to first maximize repositioning and recontouring of facial aesthetic areas, and to remove only as much tissue as is necessary.

I also find that structural fat grafting, using a patient's own fat from the abdomen or hips, is an extremely effective means to help restore the facial volume associated with a youthful appearance. The importance of restoring facial volume is readily apparent when I review with a patient a number of photographs from their twenties and thirties. The meticulous addition of soft tissue volume by means of fat grafting is one of the most powerful means now available for 'turning the clock back.'