Cosmetic surgery like the rest of medicine is constantly evolving. In my opinion no other area is showing the exciting improvement seen in facial surgery for aging. The traditional way of viewing aging is to consider it as a process largely involving descent of tissues. I like to think of this as "vertical" aging. The surgeries evolving from this view point are designed to lift up the fallen tissue. These are facelifts eye lifts etc. For most of the past thirty years "improvements" in facelifts and other procedures have emphasized increased invasiveness to create larger plains of dissection to mobilize the tissues and increase elevation. These more extensive operations carry more risks, longer recovery periods and the possibility of distortions.

We are now beginning a period where there is a shift in our thinking about surgery . To understand this shift it is necessary to more carefully examine the changes that occur in the face during aging. As we grow older two important changes occur in the tissues under the skin. The first is that cells, fat, muscle, fiber which are normally lost to wear and tear and are normally replaced by cell division, are no longer replaced as the body's cells begin to lose their ability to divide. The second change is aging cells begin to lose their ability to retain water as the cell membranes become "leaky." By age fifty five the average person has cells containing thirty percent less water than was present at age twenty five. There is significant bone loss as we age. The overall effect of these changes is to reduce the bulk and the firmness of our tissues. It is very much like letting air out of a balloon. An added feature to this process is it also thins the facial cover over the bony structure creating a more skeletal look to the appearance. This is evidenced by the hollowing of eye sockets and increased prominence of our lateral cheek bones. These effects produce what I refer to as "horizontal aging". Non of these problems are adequately addressed by "lifting " procedures. If aging is understood as largely caused by the above changes the "vertical" component the sagging can be seen as a secondary effect similar to a balloon developing folding and sagging as it begins to lose air. In aging and in the balloon the problem is mainly loss of volume. The solution is principally to replace volume. Does this mean the end of facelifts and eyelid surgery? No there still exists a vertical component . What it does mean however is is filling should be the primary treatment with more conservative and less invasive lifting procedures which have fewer complications and produce more natural results.

FACIAL SCULPTURING WITH MICRO GRANULAR FAT GRAFTS

At first glance the idea of injecting fat into the face might not seem to appealing.Yet, in the past twenty years I can think of no other technique which promises to have as great an impact on treating facial ageing as facial sculpturing by fat injection. As noted elsewhere our ideas on what happens to our face as we get older is changing. The principal change is loss of volume, soft tissue and bone. The effect is similar to air out of a balloon. Many of the changes seen in facial ageing can be improved by "Re-inflating" the balloon.

Substances which are used to "re-inflate" are termed "fillers". Fillers include commercialproducts such as Collagen, Restylane(TM), Radience(TM),etc. Tissue from an individual's own body can also be used.In plastic surgery these are known as grafts. Fat is the most common material used and has been used for over thirty years. Fat has several important advantages over all currently available commercial fillers. First of all since it is completely bio-compatible. It is generally available in amounts which would be prohibitively expansive if a commercial filler was use d. It is it it is notunusual to use up to 30 cc of fat during facial rejuvenation. If this was Restylane(TM) at a cost of $600/cc, the cost would be $18,000.00. With the exception of liquid silicone which is not recommended for bulk injections. All other currently available "fillers" are temporary, ranging from 2 months to one and a half years. Fat is a graft and though it is not possible to predict the percent "take" in individual cases, fat which is able to establish a blood supply in the area it is injected into will remain long term.

If fat has been injected for thirty years why is it's importance being recognized now? What has changed is the method we now use for harvesting the graft. Previously the fat was extracted using small cannulas similar to those used in liposuction. Even though the cannulas were smaller, the fat obtained was too granular and nodular and thick to use around the eyes where it is of greatest benefit. The lid skin is very thin and even small nodules will produce unsightly irregularities which are very difficult to improve. What has changed is the cannulas. Cannulas have been developed with extremely small extraction ports. When fat is extracted with these it comes out smooth in an almost cream-like consistency. The smooth consistence and the "micro-fat" globules provides several advantages. The first is it avoids irregularities due to fat nodules. The second is it can be molded and smoothed somewhat like modeling clay.Finally though not proven. The rule in grafting is given similar type recipient sites, the smaller the graft the more likely it is to survive.

Micro-fat technique is particularly impressive around the eye area. The eye area has been shown to be the cosmetically most important area of the face. Plastic surgeons have focused on the upper and lower eyelid "bags" which frequently arise from tissue loss around the eye sockets which uncover the underlying fat pockets. "Old looking" eyes frequently feature hollows around both the upper and lower bony orbital rims. Conventional eyelid surgery does nothing to improve these.

GRAFTING PROCEDURE

During your consultation you will be evaluated for your suitability for micro fat grafting. Facial aging is due to a combination deflation representing tissue volume loss and descent which is the result of deflation and gravity. In many cases simply reinflating with fat may suffice. In other cases it may be advisable to perform some type of lifting procedure in addition to fat grafting. One benefit of volume expansion is even in cases where elevation is still necessary the lifting procedures can less aggressive, less invasive with lower risks and generally better results.The one thing necessary for fat grafting is enough body fat. If you are extremely thin you may not be a candidate for this technique.

Once you are scheduled it is important to avoid aspirin, ibuprofen, and other medications which prolong bleeding. These meds should be avoided for a week before surgery and three days afterward. Remove all make up the morning before surgery. You may have a light meal if you are not undergoing additional surgery.