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THE MAN BEHIND THE COLEMAN FAT GRAFTING TECHNIQUE


Dr. Sydney Coleman serves as a plastic surgeon at Tribeca Plastic Surgery in Manhattan, New York. A leader in his field, he is widely regarded as the pioneer of a successful method of fat grafting called the LipoStructure technique, which is known as the basis of all known approaches to fat grafting. To study the regenerative potential of fat, Dr. Coleman has been involved in multiple studies and research with New York University-Langone Medical Centre and University of Pittsburgh Medical Centre with the Department of Defense and the Armed Forces Institute of Regenerative Medicine. In addition to being President of the International Society of Plastic Regenerative Surgery, he is a Member of the American Association of Plastic Surgery, American Society of Plastic and Reconstructive Surgery and International Society of Aesthetic Surgery.

I began fat grafting in 1987 and one of the things I immediately noticed about adipose tissue transfer for filling was that it not only increased facial volume but dramatically improved skin quality as well. Along with continual rejuvenation, and wrinkle and pore reduction, fat transfer also lightened skin tones and reduced pigmentation.

By the early nineties, I attended medical conferences and spoke about my revelations but no one trusted my findings. Not long after however, my findings were further supported when colleagues began sending me patients who had undergone cancer and radiation therapy. Because cancer patients who have undergone radiation therapy lose elasticity and are more susceptible to ulcers and thinner skin, surgeons are apprehensive and choose not to perform procedures like facelifts. In fact, operating on cancer patients would be more ineffective than operating on smokers as the skin has high chances of breaking down. After the cancer patients were recommended to my practice, I treated them with fat grafting and they were remarkably cured.

What I found was that when we graft fat under the skin, it sends in new blood supply where blood vessels grow into the fat. What’s on the blood vessels are stem cells that have capabilities of repairing damage. This was undoubtedly an amazing revelation, as such treatments have never been heard of before. Through personal findings, I understood that fat in particular is a healing organ and if you transpose adipose tissue from one place to another, it recurrently restores and rejuvenates the treated region.

Dr. Sydney Coleman serves as a plastic surgeon at Tribeca Plastic Surgery in Manhattan, New York. A leader in his field, he is widely regarded as the pioneer of a successful method of fat grafting called the LipoStructure technique, which is known as the basis of all known approaches to fat grafting. To study the regenerative potential of fat, Dr. Coleman has been involved in multiple studies and research with New York University-Langone Medical Centre and University of Pittsburgh Medical Centre with the Department of Defense and the Armed Forces Institute of Regenerative Medicine. In addition to being President of the International Society of Plastic Regenerative Surgery, he is a Member of the American Association of Plastic Surgery, American Society of Plastic and Reconstructive Surgery and International Society of Aesthetic Surgery.

Although I knew that something mysterious was happening and that fat had healing properties, no one believed me. Meanwhile in Pittsburgh, they started counting the numbers of stem cells in fat and found that the mesenchymal stem cells in the bone marrow were almost identical to the ones in the connective tissues of fat. I think we now look at fat grafting as a healing component and comprehend that it functions just as well or better than bone marrow stem cells. In other words, if one has a cut, burn or a broken bone, your body in part heals itself by recruiting stem cells from fat. Understandably, if you add more fat under the affected region, you achieve improved results.

Although fat grafting is an amazing procedure, there are times when doctors steer clear of the treatment because of poor expectations. First of all, when doctors offer this procedure, they want 100 percent volume similar to that of permanent fillers. While fat transfer has the ability to provide 65 to 85 percent volume, doctors look at that as a failure. Additionally, doctors don’t consider fat’s ability to restore and rejuvenate the skin; they only look at fat as a filler and aren’t perceptive enough to understand its capacities. I do warn patients that although it’s possible to carry out treatments within a single session, one more touchup may be needed. Fat is a biological agent as opposed to a synthetic product like hyaluronic acid and ten percent of your bodily fat cells die every year and are replaced. Moreover, fat grafting is a difficult procedure to master
and mistakes can be easily made.

Novice fat grafters sometimes over-inject because poor technique and previous experiences have told them to do so. Doctors must recognise that transposed adipose tissue is permanent and over-injection can lead to irreversible and unnatural-looking consequences. Nevertheless, as doctors improve application methods, they will be able to predict outcomes solely based on practice and prior results. To be frank, even if doctors or professors have been practicing cosmetic surgery for years but are only performing fat grafting for the first time, it’s highly likely that mistakes will be made.

Fat grafting and transfer is a double-edged sword. One of the most common misconceptions is that fat is
extremely delicate when it’s actually very resilient and hard to kill. Conversely, if doctors don’t follow the rules or are mean enough to the tissues, fat can be killed. Unfortunately, doctors don’t like to practice tried and true techniques and are always looking for ways to improve procedures. While this may seem like a good idea, changing or ‘improving’ procedural techniques don’t necessarily make things better, it could make things worse. For example, I know a doctor who added steroids to the fat and this probably killed the adipose tissues. My best advice for doctors is to always treat fat with care and practice the right extraction applications.

I pioneered the LipoStructure or Coleman Fat Grafting technique. No one was performing this method before I invented it. My technique involves small aliquots, careful harvesting and refinement. I literally came up with all the procedures and other people took my approach and changed it for bigger volume. While this may be, everyone has acknowledged that the Coleman Fat Grafting technique is the basis of all available fat grafting methods. In fact, 80 percent of surgeons in the United States still apply my practices.

The first step to the LipoStructure technique is to remove tissues via manual and gentle liposuction from areas such as the abdomen, thighs, and love handles or wherever the patient has extra fat to donate. The suctioned tissues are then centrifuged to not only separate unwanted oil and fluids but to also concentrate the fatty tissues and its associated stem cells and growth factors. When fat is centrifuged, we eliminate oil and aqueous solutions or nearly half of the grafted tissues. In other words, if doctors harvest 10ccs of fat, centrifugation will leave them with about 5ccs. According to my findings and studies from New York University, the bottom part of the centrifuged syringe or the portion that doesn’t have oil will contain the most stem cells and growth factors. I will then divide the centrifuged fat into three levels with the first level containing the densest stem cells, which will be injected into areas where the best reliability is needed. For example, I would inject fat with the highest amount of stem cells in regions such as the eyelid to improve elasticity and lighten dermal tones. Furthermore, injecting small amounts will affect in drastic improvements as opposed to injecting large volumes and causing lumps. The centrifuged fat with lesser amounts of stem cells (the other two levels) however, can be injected against the bone because of decreased reliability. Still, there are times when I only use level ones and throw away the rest because I’ll have more of the good stuff.

In conclusion, fat grafting and transfer has the ability to work in lieu of invasive procedures because fat allows the body to continually heal or regenerate itself. While fat grafting with the combination of Ultherapy for example, is able to prevent procedures such as facelifts, it is patient dependent and will be contingent to many variables. For example, a patient with a chubbier face who’s undergone fat grafting probably needn’t undergo facelifts, while older patients with hollowing may choose to undergo invasive procedures. At the end of the day, I always prepare my patients for the future and whether or not patients look better, they may always want more. Fat grafting allows the body to continually regenerate itself and patients that I’ve treated two decades ago still look good to this very day. Even though fat grafting doesn’t necessarily have the ability to stop the ageing process, it does repair the damage, and patients will look good for many years to come.


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