It seems like, on a weekly basis, we are bombarded by advertising and glossy brochures which arrive in our Practice describing the latest offerings of the cosmetic surgery industry to rejuvenate and revive facial appearance. Clients should perhaps forgive us for not believing all the claims that are made for these products and indeed for taking time to assess the evidence the efficacy of individual products prior to adopting them into our cupboards. There is no doubt that certain products have revolutionised the market of the non-surgical facial rejuvenation in recent years. The use of botulinum toxin injections to selectively weaken certain muscles offers significant advantage in terms of reducing facial wrinkling, particularly around the eyes. Similarly, the use of products hyaluronic acid such as Juvederm and Restylane are very useful in redressing the deepening folds around our mouths and indeed enhancing lips. These products have a strong track record for safety and for effectiveness and we commonly use them.
In contrast, there is a litany of other products which we have not used because of concerns with regard to safety and efficacy. The withdrawal of some of these products from the market and indeed subsequent concerns about their safety I think proves the point.
There is, however, one treatment that has demonstrated to be effective both in terms of costs and results. This is the use of the patient’s own fat to enhance and rejuvenate their facial features. We sometimes refer to this as “Coleman fat transfer”. This technique was popularised by Sidney Coleman, one of our colleagues from New York. The technique involves a small incision around the tummy button usually, and sucking some excess abdominal fat. The fat is then spun down in a centrifuge and small lines of fat can be injected into fine tunnels in the face to enhance the volume of certain areas. This is very safe because it is the patient’s own tissue. The concept is not dissimilar to the use of skin grafts for burns.
When it comes to other forms of facial plastic surgery, we also prefer to use the patient’s own tissue whenever possible. For example, with rhinoplasty, there have been a multitude of suggestions in the media and in brochures that injections of foreign material could be used to change the appearance of the nose. While this is undoubtedly true, we have grave concerns over the long term safety of permanently injected products. Similarly, the fashion for inserting foreign bodies surgically into the nose such as silicone and porous plastic is by and large going out of favour. We now, whenever possible, prefer to use cartilage from the patient. This can be harvested from either the bowl of the ear, the septum or, occasionally, the rib. The advantage of using your own cartilage is that it is safe, is not rejected, has a low incidence of infection and survives minor trauma in the same way as normal tissue.