LAS VEGAS – When using fat and stem cell transfer for facial volume enhancement, it's disingenuous to tell patients a stem cell face-lift is being performed, said Dr. Mark Berman.
The accurate description is to tell patients a stem cell fat graft is being performed. "Tell them 'we're using a fat graft, and the reason it works is because your fat is loaded with stem cells, which can turn on, proliferate, and grow new fat cells,' " Dr. Berman said at the annual meeting of the American Academy of Cosmetic Surgery. "This is a dynamic process."
Courtesy Dr. Mark Berman
A patient is shown before (left) and after undergoing stem cell fat grafting for facial enhancement.
In 2008, Dr. Hee Young Lee introduced Dr. Berman to a system he created, known as the Lipokit (Medi-Khan, Korea and currently distributed as the Adivive system by Palomar), a closed device approved for condensed autologous fat transfer. Dr. Berman said he began using the system at his Beverly Hills, Calif.–based cosmetic surgery practice for facial volume enhancement.
A key component of the device, he said, is the fat-processing unit, a single-use, disposable syringe with a bidirectional moving piston, a microfilter, a fluid gate, and a weighted metallic ring. "What makes this syringe unique is that it allows you to compress and filter the fat at the same time, so you actually increase the concentration of cells," said Dr. Berman. "You can also put in tumescent anesthesia in this system real easily."
Early in his clinical experience with the Adivive system, he said he would spin harvested fat in a centrifuge at 4,000 rpm for 8 minutes. Now he spins the harvested fat at 2,800 rpm for 3 minutes. "The difference is, at the lower rate, the stem cells tend to have increased viability, while at the higher rate you get increased concentration of stem cells," Dr. Berman explained.
The results of stem cell fat grafting for facial volume enhancement are generally superior to those achieved with dermal filler injections because the process restores facial volume naturally. "Most of our face-lift patients don’t want to look different; they want to look like they used to," he said. "Aging is not about sagging skin caused by gravity. Gravity does not cause aging; it just affects how you look in different positions."
Aging, he continued, is caused by "loss of facial fat, loss of skin elasticity, and loss of bone volume very late in life or related to tooth loss. Your face is basically skin, fat, muscle, and bone. You have about 60% of fat between the first layer of skin and muscle, and the rest is under the muscle."
Stem cell fat grafting can restore a three-dimensional appearance to the patient's skin, said Dr. Berman, who coined the term "space lift" to describe the concept of lifting the skin away from the facial bones by fat-grafting techniques.
"I have traveled around the world talking with people who are experts on fat grafting, and we all agree on one thing: The variable is not our technique," he said. "The big variable is the quality of the stem cells mixed in with the patient's fat. I tell the patient, 'If you're not willing to repeat the operation, don't do it at all,' because at some point noticeable losses of the transferred fat may occur. Some people find that frustrating."
Dr. Berman disclosed teaching the technique in courses sponsored by Palomar.