One new technique is provoking extensive debate among plastic surgeons: fat transferring.
Also called fat grafting, fat injections or fat recycling, the procedure involves suctioning fat from one part of the body (usually the buttocks) and injecting or grafting it to another to fill in wrinkles or augment depressions, such as pitted scars.
Some doctors are recommending fat transferring as a substitute for injections of collagen, a fibrous protein found in the body's connective tissues, bones and cartilage.
Filling In Depressions
For years now, doctors have been using Zyderm, the trade name for an injectable bovine-derived collagen, to fill in skin depressions such as wrinkles or pockmarks.
Zyderm has a 3% to 4% allergic reaction rate and is not a permanent solution, doctors say. Results vary, with the average treatment lasting six months. Treatments cost from $150 to $200 per injection. Fat transferring costs $250 to $300.
Some plastic surgeons won't comment on fat transferring because no reliable information about it has been published in major medical journals. However, the technique was discussed at a recent meeting here of the American Society for Aesthetic Plastic Surgery, according to Dr. Eugene Worton, chief of plastic surgery at Cedars-Sinai Medical Center.
"There is no true scientific study to show that it's permanent or that it even lasts longer than collagen," Worton said. "It may be helpful, but no one is saying it's a permanent thing. There are many variations on the technique. You talk to four doctors and find they're doing it four different ways. Which is the right way?"
Dr. Garry S. Brody, a Downey plastic surgeon, said: "The problem with fat grafting is that it's been tested in the press before it's been tested in scientific circles. At the moment it's very controversial; no one is certain that it really works on a long-term basis."
Yet some who have used the technique prefer it to collagen injections because fat transfers have virtually no chance of an allergic reaction.
"Collagen is basically for fine lines and smaller depressions," said Dr. Richard Fleming, head of the division of facial plastic surgery at USC. "If the volume is too great, it's just not feasible. With fat you can treat more severe defects. But for minute lines, like around the upper lip, fat is still debatable; it's not as good; it's thicker, bulkier.
"The downside to collagen is that it doesn't last. For example, I did two patients today who I've been doing for the last several years. At first they'd come in every nine to 10 months, then ever six, now it's down to four. The body breaks it down."
Fleming has been doing fat injections and grafting for 1 1/2 years and reports that results have lasted that long, with no loss of correction.
"Our initial question (with fat transfer) was how long it would last. Time will tell. Ask me a couple of years from now."