Hello! I need a Fat grafting doctor in Manhattan for the loss of volume in my cheeks. Does any one know of a good doctor? I'm noticing a drawn appearance in my face since 43. I am a 46 year old female. It's getting a little worse every year. I think it's also because I am very thin.
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Finding the Best Plastic Surgeon for Fat Grafting
Finding a plastic surgeon to perform fat grafting should start with finding a surgeon who performs a lot of fat grafting
Structural fat grafting is a powerful tool for correcting one of the primary processes of facial aging: the gradual loss of facial soft tissue volume, which primarily represents the atrophy of facial fatty tissue. The importance of restoring facial fullness cannot be emphasized enough, for without it, very few facial cosmetic surgical procedures are truly rejuvenating. As we age the skeletal features of the face become more obvious, and create subtle visual clues that tell the observer 'this is an older person'. Fat atrophy is often very obvious when it appears as hollowness in the temple area and as flattening of formerly full cheeks, but can also exist as more subtle changes that still convey an appearance of advancing age, such as the development of a hollow in the space between the upper lid and eyebrow, or as indentations in a formerly smooth and gently curving jawline.
Lifting skin and trimming the excess has been the standard approach to the treatment of facial aging for centuries, but when performed without some means of restoring the youthful fullness of facial soft tissues, the result is an older-looking person with tighter skin. The word 'rejuvenation' means literally 'to restore youthfulness' or 'to make young again', so if the goal of surgery is to rejuvenate the face then it cannot be accomplished solely by means of redraping the skin and removing the excess.
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.
As with any cosmetic surgical procedure, there can certainly be 'too much of a good thing'. Over-grafting of fatty tissue will distort facial features and produce unnatural proportions that look like surgery rather than appearing to turn back the clock. An important part of my preoperative evaluation is reviewing photographs with patients from their twenties and thirties (and from their forties for patients in their sixties and seventies). Such photographs are invaluable in confirming the manner in which a face has aged, and in planning a surgery that is designed to help a patient look more like their youthful self.
One guiding principle of reconstructive plastic surgery is short and simple: "Replace like with like." Specifically, where tissue is missing, restore the defect with the same tissue whenever possible. If bone is missing, use a bone graft. If muscle is missing, use a muscle flap. So if fat is missing, the ideal solution is obvious.
A number of terms are currently used to describe varying techniques for harvesting and delivering fat in small quantities to produce long-lasting soft tissue augmentation: structural fat grafting, microfat grafting, lipostructure, orbital pearl fat grafting, etc. These terms all describe techniques for harvesting living fatty tissue with minimal trauma, refining the fat (in most cases) in some manner such as by centrifugation, and meticulously introducing the fat into the recipient area a small amount at a time to produce new soft tissue structure.
When is a graft truly a graft?
For fat grafting to truly represent 'grafting', the grafted tissue must gain a blood supply in its new location which provides a source of oxygen and nutrients and allows the tissue to persist indefinitely. If the grafted fat does not acquire a blood supply in the first few weeks after surgery, the body will gradually break it down and dissolve it, and no long-term benefit will be achieved in terms of soft tissue augmentation. Successful fat grafting surgery therefore requires a great deal of focus and attention to detail, to ensure that the fat which is harvested is viable tissue (i.e. not damaged by the harvesting process), and that the fat is delivered in such a way that the potential for ingrowth of blood vessels is maximal. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
Fat grafting has been performed by plastic surgeons for decades, but it is just in the last ten years or so that techniques and instruments have been refined to the point that it can be accomplished reproducibly and reliably, making it an increasingly important part of facial rejuvenation surgery. The term 'structural fat grafting' refers to a specific surgical technique in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist long-term.
Structural fat grafting requires specialized training and specialized surgical instruments, as well as patience, finesse and attention to detail on the part of the surgeon. When performed properly, permanent and natural-appearing improvements in facial contours are possible. This revolutionary technique provides a means for restoring a youthful facial appearance that cannot be accomplished by means of traditional facial cosmetic surgery techniques, which have in the past focused primarily on skin excision for the purpose of 'tightening' facial features.
For patients in my practice undergoing major facial rejuvenation surgery such as facelifts, structural fat grafting is one of the most important parts of the procedure and it is what I perform first. All areas of facial hollowness are restored to a more youthful fullness before any incision is made to address skin laxity and the need for some 'redraping' of the skin and deeper soft tissues. The eye area is filled out and the temples are restored to fullness before blepharoplasty or browlift is performed. The result is a patient that looks like a younger version of themselves, not like a person who has obviously just had a facelift.
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How to pick a fat transfer plastic surgeon.
This is such a common issue that I wrote an article for RealSelf on tips for picking a good cosmetic surgeon (for fat transfer or other procedures). You may find it helpful and you can read it on my profile.
Manhattan Fat Graft doctor recommendations
Add to your list Dr. Anthony Sclafani, Chief of the Plastic Surgery Service at the New York Eye and Ear Hospital and Dr. Leonard Grossman.
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.