Hand Rejuvenation using Fat Grafting

Apart from the most obvious region (face & neck) where aging can be seen and where most aesthetic surgery for rejuvenation are performed,  the dorsum of the hand is the next obvious area where aging can be seen and is continuously visible in daily life.  What they used to say,"If you want to know a woman's age, look at her hands" still holds true.

The region of the hand exhibits laxity of the skin with subcutaneous atrophy and age-related pigmentations in a comparable manner to the face. Fat transfer to the dorsum of the hand enables subcutaneous regeneration by refilling the subcutaneous space and hence reducing some of the age-related degenerative process.

Areas of Concern of the Aging Hand

• Bony-looking hands due to loss of some of the fat beneath the skin that occurs with age
• Prominent veins
• Brown aging spots (liver spots)

Rejuvenation Treatment for the Aging Hand

•    Chemical peels to improve the overall appearance of the skin on the back of the hand 
• Fillers or Fat transfer onto the dorsum or back of the hand to make them appear less bony.  Fat transfer is ideal since this may improve the texture of the skin.

Please consult your plastic surgeon regarding hand rejuvenation.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon, and Hand Surgeon

References:   

• Coleman SR.  Hand rejuvenation with structural fat grafting. Plast Reconstr Surg. 2002 Dec;110(7):1731-44; discussion 1745-7. 
• Villanueva, et al.  Technical Refinements in Autologous Hand Rejuvenation.  Plast Reconstr Surg. 2015 Dec;136(6):1175-9.

Brazilian Butt Lift

Harvesting for Fat Transfer in Brazilian Butt Lift

The success of an autologous fat graft depends in part on its total stromal vascular fraction (SVF) and adipose-derived stem cells (ASCs). This is important when it comes to harvesting of fat for fat transfer such as in Brazilian Butt Lift. 

• Subcutaneous fat tissues from the abdomen, flank, or axilla were harvested in the study conducted by Iyyanki from patients of various ages by mechanical liposuction, direct surgical excision, or Coleman's technique with or without centrifugation.
• Compared with Coleman's technique without centrifugation, direct excision yielded significantly more ASCs (P < .001) and total SVF cells (P = .007); liposuction yielded significantly fewer ASCs (P < .001) and total SVF cells (P < .05);
• Coleman's technique with centrifugation yielded significantly more total SVF cells (P < .005), but not ASCs.
• The total number of SVF cells in fat harvested from the abdomen was significantly larger than the number in fat harvested from the flank or axilla (P < .05).
• Adipose tissue harvested from the abdomen through direct excision or Coleman's technique with centrifugation was found to yield the most SVF cells and ASCs.

Reference: 

Iyyanki, et al.  Harvesting technique affects adipose-derived stem cell yield. Aesthetic Surgery J. 2015 May;35(4):467-76. doi: 10.1093/asj/sju055. Epub 2015 Mar 18.

Emmanuel De La Cruz MD, PLLC

Plastic Surgeon, Houston Texas

Fat Graft Harvested via VASER liposuction is Suitable for Brazilian Butt Lift

Fat Graft Harvested via VASER Liposuction is Viable and Suitable for Fat Transfer in Brazilian Butt Lift Patients

Although there's clinical evidence of successful autologous fat transfer (AFT), such as in Brazilian Butt Lift, using VASER liposuction is readily available, no study has quantified adipocyte viability using standardized methods until recently.

• The UAL system (VASER; Sound Surgical Technologies, Inc, Louisville, Colorado) was set at 60% amplitude in pulsed mode with vacuum aspiration of 15 in Hg or less.
• Laboratory analysis included free lipid volume, viability via lipolysis and propidium iodide staining, and cytological analysis, including cell surface protein examination and hematoxylin and eosin staining.
• The lipolysis assay revealed metabolically active adipocytes with a mean (SD) correlative viability of 85.1%
• Direct measures of acute viability via propidium iodide staining resulted in a mean (SD) viability measure of 88.7%
• Adipose tissue acquired via VASER liposuction is viable at harvest and isa suitable source for autologous fat grafts, especially for Brazilian Butt Lift.
• Adiposed-derived stem cells (fat for fat transfer) obtained via VASER liposuction were of equal quality when directly compared with the current gold standard harvest method according to a study conducted by Duscher.   "UAL- and SAL-derived samples demonstrated equivalent ASC yield and viability, and UAL ASCs were not impaired in their osteogenic, adipogenic, or chondrogenic differentiation capacity."

4D VASER Liposuction performed by Dr. Emmanuel De La Cruz of Houston, Texas

Reference:

Duscher, et al. Ultrasound-Assisted Liposuction Does Not Compromise the Regenerative Potential of Adipose-Derived Stem Cells.  Stem Cells Transl Med. 2016 Feb;5(2):248-57. doi: 10.5966/sctm.2015-0064. Epub 2015 Dec 23.

Schafer, et al.  Acute adipocyte viability after third-generation ultrasound-assisted liposuction. Aesthet Surg J. 2013 Jul;33(5):698-704. doi: 10.1177/1090820X13485239. Epub 2013 May 29.