Fat grafting to the face is one of the best ways to rejuvenate your face to a more youthful look.   Patients seeking fat grafting, also known as fat injections,  are usually composed of two types:

• patients whose dermis has thinned due to the aging process and the face looks tired or sagging
• younger patients who have a volume deficiency in the upper areas of their face

In both cases, these patients have a loss of volume in the face . This makes the face seem tired and aged. Fat injections can restore the volume to your face to give you a youthful glow.

Examples of how fat can be used in the face

Ways that fat injections can be used to help you rejuvenate your appearance include:

• eliminate or reduce bags in the lower eyelids
• substitute for cheek implants if you are seeking a higher profile in your cheeks
• increase general volume in the mid face area with a natural distribution of fat
• substitute for a mid facelift

Regenerative properties of your own fat tissue

In addition to making your facial structure look younger, fat injections can also improve your skin.  More than a decade ago, researchers discovered that your own adipose tissue contains adult stem cells. These are cells found in your own fat that have regenerative properties. When the procedure is performed correctly, fat grafting can provide a new source of blood supply for your existing tissue and skin.   Thus, the fat not only adds volume to your face, but it also has these natural regenerative properties to make your face look more youthful.

In summary, fat injections are a natural way to make a more youthful you. To read more about regenerative fat grafting please see my video, Stem Cells from fat-Plastic Surgery’s New Frontier.

Ricardo L Rodriguez, MD

Board Certified Plastic Surgeon

Some women think of liposuction as a way to look slimmer. Indeed, most plastic surgeons also think of liposuction this way, using liposuction to shave off pockets of fat. While this may have been an ideal of beauty in the past, today’s concept of female beauty is more sensuous. This requires skill not only in taking out fat, but also in adding it where needed.

Fat Removal and ReInjection into the Hips

Let’s examine the before and after photos of a woman who wanted a curvier figure with more prominent hips. Prior to surgery (left side before photo), she had an apple figure, where a lot of the body fat is concentrated on the upper body. If one were to liposuction this patient to make her look slimmer, the result would be a slightly thinner version of the same body, no curves. A slimmer apple, so to speak.

However, if you combine liposuction (non-laser) with fat injections, an entirely different result is achieved.

Post operatively, you can see that I successfully changed her body type to not only look slimmer, but to look more feminine. Thus the apple shape was transformed into more of a pear shape. Fat was taken out from her central body and reinjected into her hips. Her new body profile has a narrower waist compared to the hip. It is what is referred to as a pear figure. The curvy pear figure does appear more feminine than her previous shape. Liposuction alone would not have been able to create this feminine profile.

The use of your own autologous fat to create a more feminine sculpted body is a great tool for enhancement. Fat grafting results are long lasting if proper techniques are used. Therefore, be sure to ask your surgeon if he expects long lasting results!  With proper techniques and post op he should have full confidence in a long lasting result.

To learn more about why fat grafting is long lasting when done correctly watch my video which explains why. If you have any questions, please post them to my blog.

Ricardo L Rodriguez, MD
Board Certified Plastic Surgeon

Patients often ask for post operative advice on the web. I think the web is a great information gathering tool, but in the post-operative period, it is not a good place to start.

Why is this?

Giving you advice on any medical conditions depends on many things. These include:

• intimate knowledge of what procedure was performed
• detailed familiarity with symptoms
• a physical exam

Clearly, none of these 3 conditions can be found in an internet correspondence. At best, you will be getting well-intentioned, but possibly misguided information. At worst, you could be delaying proper treatment.

The best person to answer questions about your surgery is the surgeon who operated on you.

It is in the doctor’s best interest to make sure all post operative issues are handled quickly. The only way that can happen is if you communicate with him. You should always try to contact your surgeon first, rather than go online to get answers. If your problem occurs outside of normal office hours, his answering service should be able to get in touch with him within the hour.

Do not be afraid to be insistent in getting in touch with him.  The doctor may be at home with his pager or phone in another room. Sometimes the doctor may simply not hear the phone ring. Call again.  The doctor’s answering service should have several back up numbers which include the doctors’s cell phone number,  home phone number, and in some cases even his spouse’s phone number.  A doctor’s spouse  can sometimes tell the answering service where to find the doctor or when to expect a call back.

If you have a problem or a question in the post-operative period you should be able to have immediate access to your surgeon. If after two calls to the answering service you do not get an answer, demand to speak with someone from the practice.  Only if you are unsuccessful after doing this should you consider going online to get answers.

In certain instances that you can not find your doctor, you should call 911: If you are having shortness of breath, a high fever (above 101.5 degrees Farenheit), or extreme pain, then you need to go to the emergency room. Once there, let the emergency room physician know your Plastic Surgeon’s answering service number so he can inform your doctor of your condition. Sometimes hospitals have more effective ways of getting to the surgeon. Remember, your Plastic Surgeon can give the emergency room physician very important information and clues about what to be on the lookout for, so keep him in the loop.

The best way to make sure this does not happen to you is to find out the protocol for gettting in touch with your doctor after surgery.  You should ask this question at your pre-operative appointment, if the information is not provided at that time.  If no information about post op communication is given to you, tell the surgeon that you expect to be able to access him/her in the postoperative period. You want a commitment from your surgeon that you will get prompt access. If the surgeon appears uncomfortable or evasive, that is a red flag.

Personally, I give my cell phone number to all my patients for their use during the post operative period. The beauty of it is that patients will text me for more routine questions, but telephone me if they are experiencing problems. Alternately, others will send pictures over the phone and ask if it looks OK. Digital photos are a great communication tool. It is the best of modern technology combined with personal access.

I hope this information helps you. If you like what you’ve seen and read, tell your friends!

Ricardo L Rodriguez, MD
Board Certified Plastic Surgeon
© Cosmeticsurg.net

Read more about: Board Certification - What Board? And what does it mean?

In many internet forums I often see the question asked:

Can I have another procedure with the brazilian butt lift?

The brazilian butt lift is a butt augmentation procedure which uses your own regenerative fat to enhance your buttocks. In my own practice, it is very common for patients to request a brazilian butt lift and a tummy tuck in the same operative session.  I have performed this combination of procedures for many years and I assure you they can be safely performed together.

One factor which allows me to do multiple procedures in the same operative session safely is that I use IV anesthesia instead of general anesthesia.  General anesthesia carries much higher risks for long procedures .  IV anesthesia allows you to breath on your own , thus dramatically reducing pulmonary anesthesia risks. With IV anesthesia, I can comfortably perform multiple procedures which require 8-10 hours of operative time.

The most common procedure that is performed with the brazilian butt lift is the tummy tuck.  The abdominoplasty or tummy tuck actually enhances the effect of the brazilian butt lift, as your tummy and waist line are trimmer.  When you combine the two together it is a dramatic transformation!

Occasionally, somebody will ask about combining the breast augmentation with the brazilian butt lift. In most cases, I do not recommend that combination.  The brazilian butt lift recovery requires you to lay on your stomach. While that is ok for the tummy tuck recovery, it is not ok if you have just received breast implants.  Laying on your breasts immediately following the breast augmentation can cause problems.

To learn more about combination procedures with the brazilian butt lift, watch my video.

Dr. Ricardo Rodriguez

Learn more:

Types of anesthesia used in Cosmetic Surgery

What is the recovery period for the brazilian butt lift?

Stem cells from fat: Plastic Surgery’s new frontier

As we age, our dermis thins, facial skin loosens, and wrinkles develop.  There are several alternatives to treat the aging face. If a patient is not interested in a face lift, but wants a long lasting result, the two alternatives are:

1. laser resurfacing
2. regenerative fat grafts

What is the difference between these two techniques? A LOT!  In summary, laser resurfacing technologies destroy tissue (which the body repairs), while fat grafting (fat injections) builds up and regenerates tissues. Most lasers shoot a high energy beam which vaporizes cells, whereas fat grafting techniques mobilize teams of repair cells to bring more blood supply and nutrients to your face.

I believe that stem cell enhanced fat grafting offers an advantage to lasers currently being used by plastic surgeons and dermatologists. Fat grafts are the most natural way to get a long lasting youthful rejuvenation of your face. Fat grafting is your own Fountain of Youth.

How do lasers work to tighten the skin?
With laser, a beam of energy is used to obliterate layers in the epidermis and dermis beneath your skin. The cells in those layers are totally vaporized. Once that layer has been destroyed the body sends a signal to repair. Your body repairs the tissue by forming a scar (or “building collagen”) in the destroyed tissue layer. The scar which forms beneath the skin has the effect of tightening the skin and and adding a little mass to the subcutaneous tissues. However, this does come at the expense of scar tissue and reduction of the dermal layer which gives structure to the skin.

Another problem with laser occurs when a patient loses weight following laser resurfacing treatment.  I have seen some patients have a collapse of the structure of the dermis in the face. As the patients loses her own fat, which provided structural support, the laser treated skin sometimes does not hold up well. Fortunately, I have been able to offer these patients fat grafting, which restructures the dermis and adds volume back to the face.

So what is fat grafting and why is it considered a regenerative technique?
Fat grafting harnesses the power of stem cells that occur naturally in your own fat.  These naturally occurring fat stem cells are carefully extracted by liposuction from unwanted areas, processed with minimal manipulation, and then reinjected during the same operative session into areas that need rejuvenation.  The stem cell enriched fat restores volume and youthful fullness to your face. The naturally occurring stem cells in your own adipose fat tissue, or ADSC’s, make new blood vessels which bring blood supply and nourishment to your aging skin.

Fat grafting is a natural way to restore volume and a youthful glow to the aging face. I use fat grafting as a stand alone procedure and also in combination with the face lift procedure. An added bonus with fat grafting is that the skin continues to improve months  after the surgery. The newly created blood vessels in the fat graft continue to re-energize the tissue with a new source of  nutrients.

Ricardo L Rodriguez
Board Certified Plastic Surgeon

*Read more about adipose derived stem cells and the future of plastic surgery.

**How long do fat transfers last?

Baltimore, Maryland

Getting snowed in has it’s advantages. Fifty inches in one week is enough for any human being. If you are a plastic surgeon fascinated with adult stem cells from adipose fat, it gives one time to transcribe your thoughts. One has more time to reflect, pontificate, and borrow ideas.

You’ve gotta credit Sarah Palin–the stuff you write on your hand–it’s important stuff.

Here’s the hand that describes the future elixir of heath care:

(Translation:adipose fat contains a higher population of adult stem cells than bone marrow. Stem cell therapies will move much faster to market if  the FDA allows your own autologous minimally manipulated stem cells to be considered as a ’tissue’ and not a ‘drug’.)

To learn more about adipose stem cells (ASC’s) and how they heal tissue and have the capacity to cure diseases visit our fat stem cell archives.

Staff Writer
CosmeticSurg.net

We do a lot of brazilian butt lifts. The brazilian butt lift augments and enhances your buttocks using fat from unwanted areas of your body. The procedure is a total body resculpting of your abdomen, flanks, and buttocks. The question I often get asked is “Doctor will I lose the effect of the brazilian butt lift if I lose weight after the surgery?”

The answer is: If the fat is processed and grafted correctly-you will not lose the effects.

To illustrate the point, I went back and looked at the photos of one of my patients who had the brazilian butt lift surgery, lost approximately 10% of her body weight after the post op period, and then gained all of the weight back at the end of the one year period.

In the video below , her pre-op is on the left. Eight months following the surgery, in the photo on the right, she lost a little over 10 pounds. You can see that her buttocks are still prominent ,and her new curves show off very nicely. Watch the video to see all of the details.

Even with her weight loss, her buttocks are prominent and she maintains the buttocks ’shelf’. If the procedure is done correctly, your new curves should stay with you. Properly processed fat will engraft and take. You will have a new body shape. Weight fluctuations after the brazilian butt lift will take the shape of your new body shape. If you gain or lose weight you will not go back to your curveless body figure. The wonder of fat grafting is that it can truly change your body proportions. Any weight gain or loss should correspond with the new figure.

Below is the summary of the patient’s history : Pre-op, 8 months post-op with 10% weight loss, and 1 year post op with full weight gain back to original weight:

Note: This video is part of my ‘Stem Cell Series’ as properly processed fat will contain a population of your own naturally occurring adult stem cells. These stem cells enable your fat graft to survive and ‘take’ as the stem cells help to build blood supply to the fat graft. Stem cells from your own autologous adipose fat is Plastic Surgery’s New Frontier. Stay tuned for more!

For months, we have been hearing the debate on ways to reduce healthcare costs.  Thus far, nearly everything introduced requires vast amount of government expenditures and seriously upsets people who actually like the health care plan that they currently have.  It is astounding that the most important way to lower health care cost rarely , if ever, gets discussed. Curious?–read on. How do we lower health care costs? As the Governor of Minnesota would say—prepare to be dazzled. . . . . .

The answer to lowering health care costs is to require all providers (doctors, hospitals, surgery centers, labs, anesthesia)  to disclose what things cost before the service is rendered. Yes, as a matter of informed consent, the cost of a routine medical service should be disclosed to the consumer.

If  this one mandate was made (to disclose pricing), health care pricing would be in the ‘free market competition’ and prices would start dropping like a rock. Consumers would start to shop for scheduled services and prices would come down, quickly. This is exactly what happens in a free market economy   and this is what has been happening in Plastic Surgery for decades.

Plastic Surgery is one of the few elective areas of medicine where most services are NOT covered by insurance. Thus, Plastic Surgery has always been subject to free market forces. Well guess what?–prices (adjusted for inflation) of most cosmetic procedures have gradually gone DOWN over the years , not up. Since there is a well trained supply of Plastic Surgeons in the U.S.,  pricing disclosure CREATES COMPETITION of these medical services and prices are forced down.

A facelift performed now is less expensive (inflation adjusted) than a facelift performed 20 years ago.  Since there is a high supply of qualified Plastic Surgeons performing Breast Augmentation procedures, breast augmentation prices keep going down. Since many medical specialties are now offering Botox,  there is a high supply, and  prices fall year over year because patients can price shop among the competition. However, highly specialized procedures, such as the brazilian butt lift or stem cell enhanced fat grafting, with limited supply of experienced surgeons delivering excellent results can command higher prices.

It’s good ole supply and demand and Larry Kudlow’s free market path to prosperity.

With Plastic Surgery, there are only a couple of insurance covered procedures, so let me walk you through health care’s current mode of pricing secrecy.

Let’s say you want a breast reduction procedure. The major components of the breast reduction surgery are:

Total Cost= Surgeon’s fee + Operating Room Fee + Anesthesia.

You have a insurance policy that will pay 80% . So, you, the patient are responsible for paying 20% of the allowed procedure amount. So, you, the patient want to find what your 20% will cost. How do you find out?

Here in Maryland, your plastic surgeon performing the breast reduction WILL tell you his surgeon’s fee in advance of the surgery. However,  there is no consumer database of operating room fees so a patient can compare costs between a  hospital and an out patient surgery center. Furthermore, if you call a hospital  to ask what the procedure will cost, they basically give you a run around. It takes a while to get a straight answer. I know because I have picked up the phone myself to get prices of a breast reduction procedure–and I know how to ask it.   I wanted to know the difference in cost between having a breast reduction done in a Maryland  hospital vs. having it done in our own out-patient surgery center.  What is the difference in cost for a patient?

It is important to note that your surgeon can perform a breast reduction the exact same way, under the exact same type of anesthesia whether it is in a Hospital or an accredited Out Patient Surgery Center.  Your surgeon’s fee is identical regardless of where the procedure is performed. However, the difference in operating room costs at a hospital vs. an out patient surgery center are world’s apart.

Estimated Average Operating Room fee (with recovery for a 4 hour breast reduction prodedure):

Hospital OR= $6,200

Accredited surgery center= $1200  (based on BCBS participating allowable)

HUGE difference! The additional cost to have the procedure performed in the hospital is:
insurance company: $5000 addional for the insurance company,
patient: if the patient has a 20% co-pay, her co-pay is either $1240 in the hospital, or $240 in a surgery center.

So, why aren’t patients choosing surgery centers over hospitals for this particular procedure?? It’s so much cheaper and it’s the same procedure! The answer is that patients DO NOT KNOW what the difference is. Hospitals and other health care providers do not have to disclose what they charge to the patient BEFORE the procedure is rendered.

Can you imagine if the rest of the world operated this way?

The simple solution is for Congress to mandate that ALL health care providers disclose their pricing BEFORE the service is rendered. This should be mandatory for all routine services and scheduled surgeries.  Services that should  obviously be exempt would be ACUTE care, where there is really no time for disclosure.

Congress should require doctors, hospitals, surgery centers, labs , anesthesia providers to disclose their fees. This mandate would set forces in motion to lower health care prices. It could be as easy as requiring each company to list the prices at their website. Many plastic surgeons have been doing this for years. Mandatory health care pricing disclosure would be a wonderful FIRST EASY step to reform health care pricing.  Except for the cost of writing the bill, it wouldn’t cost the taxpayers a single penny.

Leeza Rodriguez, staff writer

CosmeticSurg, http://www.cosmeticsurg.net

Here are my top predictions for cosmetic surgery trends in 2010:

1. Stem Cells from Adipose tissue- The year 2010 ushers in a new decade where science , beauty, and your own fat consummate a marriage that promises to deliver one of the most disruptive medical technologies of the century. Stem cells from our own autologous fat have the power to rejuvenate tissue , heal wounds, and cure diseases. Adult stem cells derived from your own adipose tissue is the new elixir of healthcare.
2. Fat injections -There will be a dramatic increase in cosmetic surgery procedures ultilizing fat injections. Fat injections are used to restore and revitalize tissue in your face, breast, hands, buttocks, and other areas of the body. Done correctly, fat injections are permanent.
3. Butt augmentation -For butt augmentation, fewer surgeons will use buttock implants due to their notorious complication rates. Instead, the Brazilian Butt Lift Technique of fat grafting becomes the main method of butt augmentation.
4. Stem cell facelift- After a well known Hollywood actress has the stem cell facelift , this autologous stem cell enhanced fat injection technique becomes the new rage for facial rejuvenation.
5. Breast augmentation-Women who are interested in a minimal cup size change for breast augmentation will increasingly elect to have fat injections to the breast, instead of breast implants.
6. Lumpectomy reconstruction- Clinical trials continue to endorse autologous stem cell enhanced fat injections as a lumpectomy reconstruction alternative.
7. Plastic Surgeons in REGEN industry- As researchers come to agreement that adipose tissue is the* most prolific source of adult stem cells*, Plastic Surgeons become the new ambassadors of the REGEN industry. The REGEN industry uses the power of your own cells to treat and cure diseases. The REGEN industry joins Pharma, Biotech, and Medical Devices, as the new pillar of the Healthcare Industry.

Happy New Year!

Ricardo L Rodriguez, MD

Board Certified Plastic Surgeon http://www.cosmeticsurg.net

© copyright  CosmeticSurg.net , 2010  (permission to copy article or part of article  with URL credit to this post URL)

Thanks to the lobbying efforts of the ASPS, Allergan, and plastic surgery portals such as RealSelf.com, women can continue to  improve their cosmetic appearance without taxation! For the past few weeks, the proposed 5% tax on cosmetic surgery became known as the Botax. The cosmetic surgery tax would have discriminated against women, since more than 90% of all cosmetic surgery is performed on women.

A last minute amendment to the new Obamacare Health Care bill, HR 3590, dropped the 5% cosmetic surgery tax , but included a 10% tax on tanning services. This tan tax was put in as a substitute for the initially proposed 5% tax on cosmetic surgery. If this bill becomes enacted into law, the tan tax will become effective  for tan services rendered after July 1, 2010.
Specifically, the tan tax is applicable to tanning booths which use ultraviolet radiation in the frequency of 200 nanometers to 400 nanometers. Exempt from the tan tax is ‘phototherapy services’ .

The exclusion of tax on cosmetic surgery is a win for women and we salute our lobbyist for a job well done!  While we are happy about our own outcome, we can’t help but wonder if this new tax will stifle the tanning industry.

Here is the amendment included in the bill:
SEC. 10907. EXCISE TAX ON INDOOR TANNING SERVICES IN LIEU OF ELECTIVE COSMETIC MEDICAL PROCEDURES.

(a) In General- The provisions of, and amendments made by, section 9017 of this Act are hereby deemed null, void, and of no effect.

(b) Excise Tax on Indoor Tanning Services- Subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by adding at the end the following new chapter:

‘CHAPTER 49–COSMETIC SERVICES

‘Sec. 5000B. Imposition of tax on indoor tanning services.

‘SEC. 5000B. IMPOSITION OF TAX ON INDOOR TANNING SERVICES.

‘(a) In General- There is hereby imposed on any indoor tanning service a tax equal to 10 percent of the amount paid for such service (determined without regard to this section), whether paid by insurance or otherwise.

‘(b) Indoor Tanning Service- For purposes of this section–

‘(1) IN GENERAL- The term ‘indoor tanning service’ means a service employing any electronic product designed to incorporate 1 or more ultraviolet lamps and intended for the irradiation of an individual by ultraviolet radiation, with wavelengths in air between 200 and 400 nanometers, to induce skin tanning.

‘(2) EXCLUSION OF PHOTOTHERAPY SERVICES- Such term does not include any phototherapy service performed by a licensed medical professional.

‘(c) Payment of Tax-

‘(1) IN GENERAL- The tax imposed by this section shall be paid by the individual on whom the service is performed.

‘(2) COLLECTION- Every person receiving a payment for services on which a tax is imposed under subsection (a) shall collect the amount of the tax from the individual on whom the service is performed and remit such tax quarterly to the Secretary at such time and in such manner as provided by the Secretary.

‘(3) SECONDARY LIABILITY- Where any tax imposed by subsection (a) is not paid at the time payments for indoor tanning services are made, then to the extent that such tax is not collected, such tax shall be paid by the person who performs the service.’.

(c) Clerical Amendment- The table of chapter for subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by inserting after the item relating to chapter 48 the following new item:

‘Chapter 49–Cosmetic Services’.

(d) Effective Date- The amendments made by this section shall apply to services performed on or after July 1, 2010.

http://www.cosmeticsurg.net