Robert W. Alexander

Enhancement of Autologous Fat Transplantation with Platelet Rich Plasma

Introduction: Adipose tissue is readily available for autotransplantation. Over many years, the popularity of fat transplantation surgery has waxed and waned as a result of relatively inconsistent and unpredictable survival. Many factors influence the success of autologous fat tissue grafts, some of which can be controlled by the surgeon. Examples include the use of minimally traumatic cannulae, low pressure suction, careful handling of graft tissues, and aseptic techniques. There is emerging evidence that fat grafts may be made more reliable and consistent by careful selection of donor sites and by influencing certain healing mechanisms that control cellular recruitment, migration, and differentiation at the recipient site. Materials and Methods: This paper presents an innovative technique that provides a means to isolate autologous platelet rich plasma for use with autologous fat for the purposes of enhanced tissue augmentation. Results: The apparent concentration and greater quantity of cellular grafts observed after utilization of these techniques seem to yield a higher proportion of graft volume retention. Discussion: This technique is intended to promote or accelerate the healing phase after grafting, enhance the intended augmentation retention volume, potentially reduce secondary calcifications and microcyst formation, and maximize the transplant unit volume by reducing the extracellular fluids transferred with the grafts.

Platelet-Rich Plasma (PRP) Utilized To Promote Greater Graft Volume Retention in Autologous Fat Grafting

Objectives: Autologous fat theoretically provides one of the most ideal mediums for soft-tissue augmentation and reconstruction, although its clinical applications have been marked with skepticism because of its documented unreliable survival. Over the years, numerous unsuccessful efforts have set forth to elucidate modifications in the application process of autologous fat grafts to allow the medium greater clinical predictability. This study aims to investigate the effects of platelet-rich plasma (PRP) on autologous fat grafts when used in conjunction with each other in soft tissue augmentation and reconstruction. Study Design: Retrospective review, over a 30-month period, of consecutive patients with results greater than 6 months in duration. Methods: This study is based on clinical experiences representing 2033 grafts in 448 consecutive patients using PRP additives and in the previous 132 patients who had syringe harvest without use of PRP. All PRP isolates were harvested via the Smart Prep system. Harvest and augmentation techniques are discussed and representative results are presented. Results: Results were based on clinical observations and patient satisfaction. Of the 580 patients in the experimental group, essentially all showed greater graft volume retention over extended time intervals compared with control subjects (nongraft areas). Patients in the PRP-added experimental group displayed less postoperative ecchymosis and edema, which also led to greater patient satisfaction in this group. Conclusion: Adding PRP to autologous fat aids in graft volume retention and survival when used clinically for soft-tissue augmentation and reconstruction.

Liposculpture in the Superficial Plane: Closed Syringe System for Improvements in Fat Removal and Free Fat Transfer

This article reviews and compares early beliefs regarding liposuction with improvements provided with utilization of the Tulip Closed Syringe System for liposculpting in the deep and superficial fat planes. Discussion of the mechanism of action of liposculpting with the tumescent is presented. Clinical series described comparing machine suction versus closed syringe system as the vacuum source. The closed syringe system has also afforded the opportunity to harvest fat cells at low pressure, and improved fat cell survival and predictability. Clinical efficacy, safety advantages, and importance of the closed syringe system relative to superficial plane liposculpting are presented. The article suggests an explanation of the intrinsic changes involved in the contour alterations created by liposculpture in the superficial plane.

Autologous Fat Grafting: A Study of Residual Intracellular Adipocyte Lidocaine Concentrations after Serial Rinsing with Normal Saline

Introduction: With evolution of sophisticated lipocontouring techniques increased interest has developed in utilization of vacuum harvested autologous fat cells for grafting purposes. Transplantation of viable adipocytes for contour augmentation, enlargement, or filling of defects has clinically become more important. Based on evidence that lidocaine solution may alter the metabolic activity, evaluation of the effects of multiple rinsing was undertaken. Materials and Methods: Gas chromatography was utilized to measure changes in intracellular concentration of lidocaine from closed syringe harvested adipocytes following serial rinsing with equal volumes of normal saline in preparation for fat grafting procedures. Results: Use of standard tumescent local anesthesia as a medium for harvesting mature fat cells via closed syringe techniques resulted in substantial absorption of lidocaine. Statistically significant reduction of intracellular lidocaine was accomplished via serial rinsing with normal saline solution. It was concluded that a minumum of three rinses utilizing equal volume of saline to autologous fat achieved significant and substantial reduction of intracellular lidocaine levels, but did not result in complete removal. Discussion: The importance of thorough rinsing and removal of cellular debris from harvested fat cell grafts prior to transfer is widely recognized to improve efficacy and predictability. This study proves that serial rinsing of fat cells harvested with closed syringe system using a tumescent fluid technique does statistically reduce the retention of intracellular lidocaine. It is believed that high concentrations of retained intracellular lidocaine may inhibit the metabolic activity and impact the survivability of autologous fat grafts.

Subpalpebral SMAS Suspension as an Adjunct to Midface Osteoplasty during Orthognathic and Craniofacial Surgery

A method of suspending the subpalpebral SMAS at the time of skeletal reconstruction to improve midface augmentation and enhance soft tissue bulk over skeletal fixation devices is presented. Concepts borrowed from refinements in rhytidectomy that improve soft tissue redraping in patients undergoing extensive midface subperiosteal dissection are described.

Use of Microcannula Closed Syringe System for Safe and Effective Lipoaspiration and Small Volume Autologous Fat Grafting

Introduction: The purpose of this study was to provide background on methods of acquiring autologous adipose tissue as a tissue graft and a source of adult progenitor cells for use in cosmetic plastic surgery; to discuss the background and mechanisms of action of closed syringe vacuum lipoaspiration, with emphasis on accessing adipose tissues for use in aesthetic, structural reconstruction and regenerative applications; and to explain a proven protocol for acquiring high-quality autologous fat grafts with use of closed syringe, disposable, microcannula systems. Materials and Methods: An explanation is provided for the components of and the advantages of using the super Luer-lock and microcannulas system with standard Luer syringes. Equipment selection is described, and a sequential explanation is presented for conducting minimally traumatic lipoaspiration in small volumes, including use of blunt injection cannulas to reduce risk of embolism. Results: Thousands of autologous fat grafts have been used in cosmetic surgery and have proven safe and efficacious for use as part of lipoaspiration techniques for large and small structural fat-grafting procedures. The importance and advantages of gently harvesting the adipose tissue complex has become very clear in the past 5 years. A closed syringe system offers a minimally invasive, gentle system to mobilize subdermal fat tissues in a suspension form. Resulting total nuclear counts suggest that this approach achieves higher yields than use of applied vacuum systems that are always on and use a constant mechanical pump. Conclusions: Use of disposable closed syringe lipoaspiration systems featuring disposable microcannulas offers a safe and effective means of harvesting small volumes (<100 mL) of nonmanipulated adipose tissues and accompanying progenitor cells within the adipose-derived stromal vascular fraction. This article presents a practical step-by-step protocol for acquiring high-quality autologous fat grafts.

Current Practice Standards in Liposuction

Liposuction: Practitioner Profile This paper is the result of the organized efforts of the American Academy of Cosmetic Surgerys Liposuction Practices Task Force, the primary organization providing information, research and training in liposuction. The task force commissioned the worlds largest professional services firm, Arthur Andersen, to conduct an independent survey ofAACS membership during the summer of 1998. The surveys focus includes liposuction practitioners, their training, practice standards, and complications. Collaborative preparation, writing and review of this paper was conducted by task force chairs Richard L. Dolsky, MD and Robert F. Jackson, MD, and task force members Robert w: Alexander, MD, DMD, Guillermo D. Castillo, MD, Claude H. Crockett, Jr., MD, Richard G. Glogau, MD, C. William Hanke, MD, Jeffrey A . Klein, MD, Edward B. Lack, MD, Marc S. Leventhal, MD, Steven E. Nathanson, MD, and Howard A. Tobin, MD. responded. The industry standard for a survey of this type is normally about 10 percent. Twenty-five surveys were received after the agencys deadline and were not included in the totals. Of the remaining 272 responses, 84.9 percent (231) of respondents report they currently perform liposuction.

Fundamental Terms and Considerations in Rhinoplasty

This paper offers a review of important fundamental terms and considerations in rhinoplasty, with presentation of clear and concise terminology necessary to interpret and communicate with rhinoplastic surgeons and the literature. Afundamental discussion of patient selection considerations, surgical planes, incisions and approaches, and support structures is provided. A review of primary and secondary cartilagenous support mechanisms is followed by an overview of basic nasal tip support considerations. Emphasis on performing rhinoplasty in a logical, planned sequence of incisions and approaches that affords maximum intraoperative surgical flexibility for the cosmetic surgeon is given.