Medesthetics

OCT 2017

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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Fat grafting has been used for years to replace lost volume in the face, particularly during facelift procedures. In the arena of noninvasive cosmetic enhancement, dermal fi llers have largely supplanted fat as the top tool to restore con- tour to the aging face. The variety of fi llers, each designed for specifi c indications, has helped fuel their widespread use. Now, there is a new system that allows practitioners to harvest and prepare adipose cells—without surgery— while also creating concern-specifi c injectable products that behave like fi llers while harnessing the regenerative benefi ts of fat. "When you fat graft somebody, one fat graft does not fi t all, just like one fi ller doesn't fi t all," says Steven R. Cohen, MD. "You have to modify the fat into components that allow it to be used under an eyelid, where you need a more liquid graft, or in a cheek or a chin where you need more contour and structure." In conjunction with Tulip Medical, he developed two kits that can be used to develop three different types of fat grafts for facial fi lling and contouring. "The kits include the harvesting, delivery and processing supplies needed for full-face injectable rejuvenation," he says. "The Injectable Facial Rejuvenation Kit can be used to create millifat grafts (2.4mm diameter) for structural replacement in the deep fat compartments and microfat grafts (1.2mm diameter) for superfi cial fat compartments of the face and for the hands. The Nanofat Kit for Injectable Dermal Regeneration allows you to prepare nanofat grafts (800µ diameter) for intrader- mal injection and topical delivery to improve fi ner rhytids, scars and thinning skin." The fat is harvested through a syringe draw that can be done the same day as the injectable treatment. In his prac- tice, Dr. Cohen recommends the procedure for patients who would normally undergo treatment with multiple fi llers. "If a patient walks in and says, 'I want to do fi llers to my face, how much do I need?' And the answer is, 'You need 10ccs of Voluma for the midface, 2ccs of Belotero for the eyes and 1cc of Volbella for the lips,' when you add that up, you're looking at $10,000, and the minute the fi llers are gone, the effect goes away," he says. "Not only does fat last longer but we see progressive improvement in the face and skin." Dr. Cohen recently co-authored a paper, published in Aesthetic Surgery's July/August 2017 Supplement on Fat and Regenerative Medicine. "Regenerative Cells for Facial Sur- gery: Biofi lling and Biocontouring" reviews the evidence of tissue regeneration for fat grafts and stromal vascular fraction (SVF) and outlines Dr. Cohen's procedure using the three preparation techniques mentioned above. In the paper, the authors note that while the regenera- tive effects seen with fat and SVF are modest, histology has shown defi nite regeneration of tissue. They posit that these effects may be cumulative. "In 2015 Italian research- ers biopsied the skin of facelift patients who had undergone SVF-enriched fat grafts. They saw regeneration of collagen and elastin fi bers and a new blood supply," says Dr. Cohen. "In my research, we've seen improvement at two years so far, but it may go on for up to four to fi ve years due to the dynamic changes that occur in the tissue." Inga Hansen is the executive editor of MedEsthetics. NEWSMAKERS | 64 OCTOBER 2017 | Med Esthetics By Inga Hansen Steven R. Cohen, MD, has developed an off-the-shelf fat processing system for facial rejuvenation. Injectable Tissue Regeneration Steven R. Cohen, MD "When you fat graft somebody, one fat graft does not fi t all, just like one fi ller doesn't fi t all."

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