Monthly Archives: September 2015


An area that is sometimes forgotten in our quest for beauty are our hands.  As we age like other parts of our body we lose volume and our hands look thin, shelotonized tendons become prominent.  Now Radiesse has been given FDA approval for hand rejuvenation.

In a randomized controlled study 75% of patients treated with Radiesse at 3 months showed improvement in the appearance of their hands.  I am somewhat surprised more women don’t seek hand rejuvenation because like your face, your hands are there for the world to see.

My preferred method?  Autologous fat grafting.  Great procedure and again using your own tissue. Doesn’t get any better than that!



Researchers at MD Anderson were trying to decide what method was the best to use to get the best fat to re-implant.  Success of a fat graft depends on adypose derived stem cells and the stromal vascular faction.

They found that direct excision of fat from the abdomen or using Coleman’s technique with a centrifugation yielded the most ASC and SUF cells.  Also the abdomen was a better site to harvest from than the flanks or axillae.  I am still not sold totally on centrifugation.


I have always felt that when I do fat grafting that adding PRP improved results.  The addition of PRP improved proliferation.

The net result was that fat grafting with 20% PRP and adult stem cells caused increased graft survival.


So many times we jump on the scale to see how much we weigh but in reality we really want to know how much fat we gained or lost.  It is elusive to say the least.  But now we can track “our body fat”.

The new device is a process called Dual-Energy X-ray Absorptometry – or simply DXA for short. With this device you can actually see how your fat stores are doing or not doing.  The test takes about 3-12 minutes depending on the machine and your body size.  The cost ranges from about $45.00 to $350.00 and insurance does not cover it.  Great way to see how your “crunches” are doing.


An interesting survey was conducted by researchers online to see what areas on the face mattered most to women undergoing facial cosmetic procedures.  There were 603 participants ages 30-65 years of age.  The women rated their aestietic concerns on a scale of 1-6 for 14 facial areas.

The areas likely to be treated first were the crows feet (82%) oral commissures (74%) tear troughs (72%) forehead lines (66%) glabellar lines (65%) nasolabial folds (56%) marionette (50%) and peri-oral lines (49%).  Women younger than 45 years of age wanted their upper face treated first where as older women (50+) wanted the lower face treated.


I recently read an article about a variation of one of my favorite procedures……the facelift.  It was a retrospective study of 1089 consecutive facelifts performed by Dr. Rod Rohrich.  Of these patients 587 received platelet-rich plasma (PRP) and 926 underwent a superwet technique.

The hematoma rate was 0.9%.  The use of superwet technique has benefits of improving visualization and  hemostasis.  PRP decreased edema and ecchymosis.  These are important to the outcome, but control of blood pressure is also critical.


I recently read an article in the white journal that was a review of 27 articles on what factor affects a patients satisfaction with their facelift.  There were several factors identified that led to a patients increased likelihhood of disatisfaction.

What do you think they are?  Male sex, young age, unrealistic expectations, minimal deformities, demanding patients, surgiholics, relational or familial disturbances, obessive personality and narcissiim.

In my 35 years of practicing Plastic Surgery I found that many of these same characteristics can lead to an unhappy patient regardless of the cosmetic procedure being done.


I guesss what is great about Plastic Surgery is there is no single way to achieve a final result.  When I read articles in the White Journal I read it with a discerning eye along with my collective 35+ years of experience and look to see what can I learn and take away.

In many cases I feel what the other doctor is doing maybe over kill or a simplier, easier, safer method maybe employed to achieve the end result.  In one article the doctor did this deep plane vertical lift on 43 patients to see if this procedure would enhance mid face volume in these patients.  They found that they were able to add about 2-3 cm. of volume to the mid face with this technique.
A quicker and safer technique would be to do some autologous fat frafting.  Why go into the tissue planes of the face and risk injury to the facial nerve branches when you can simply add some of the patients own fat –  not to mention it would take LESS operating room time saving money and hopefully less morbidity.