Viability of Autologous Fat Calf Grafting

Research shows that autologous calf fat grafting is a viable alternative to traditional implant-based calf augmentation for congenital calf discrepancies and aesthetic pseudo-varus deformity.

According to the study published in the official publication of the American Society for Aesthetic Plastic Surgery (ASAPS), Aesthetic Surgery Journal, fat grafting for slender calves provides results that are comparable to those obtainable via traditional methods. 

Some patients who want to undergo calf implants are concerned with the risks associated with the surgery and the possibility that strenuous exercise may cause the implant to move. Some plastic surgeons use silicone implants that is selected based on the patient's anatomy. These implants are placed under the fascia of the original calf muscle that is strong enough to withstand physical sporting activities.

Researchers Gerhard S. Mundinger and James E. Vogel pointed out in the research that there are few studies published regarding the advantages of fat grafting for calf augmentation and re-shaping compared with the traditional silicone calf implants.

According to Dr. James E. Vogel,

Autologous fat augmentation offers a number of advantages over calf implants, including liposuction in adjacent areas to improve calf contour, smaller incisions, additional augmentation through subsequent fat grafting, durable results, lack of foreign body reaction, and precise patient-specific adjustments not possible with off-the-shelf implants.

Medial and lateral calf augmentation was accomplished with injection of prepared autologous lipoaspirate intramuscularly and subcutaneously.

Thirteen patients underwent calf augmentation and reshaping with autologous fat grafting over a period of five years. Ten patients underwent bilateral calf augmentation, and three cases were performed for congenital leg discrepancies.

Prior to the fat transfer, local anesthesia was injected to utilize the smallest amount of effective anesthetic volume. This was also done to precisely place it into the muscle resulting in less sedation and more rapid postoperative recovery.

Fat was harvested from the abdomen, lateral thigh, medial thigh, waistline, flanks, axilla, upper back, and hips. Irrespective of the fat harvest site, liposuction was also performed at the knee to improve contour.

A mean of 157 cc of separated fat was transferred per leg, with roughly 60% and 40% transferred into the medial and lateral calf, respectively. Injections were first performed directly into the calf muscles and then into the subcutaneous calf tissue.

Four patients underwent a second round of autologous fat injection for further calf augmentation because they desired additional volume. Fat volume was judged to be sufficient when the calf was minimally firm but not tense. At a mean of 19.6 months of follow-up, durable augmentation in calf contour was documented by comparison of standardized preoperative and postoperative photographs.

The research concluded that the use of autologous fat transfer is a viable option compared to the use of traditional silicone implants.

Read more on: http://asj.oxfordjournals.org/content/early/2015/09/01/asj.sjv166

Arturo Muñoz Meza MD, A Plastic Surgeon In Tijuana

A short visit with Dr. Arturo Muñoz Meza, a Guatemallan plastic surgeon practicing in Tijuana, Mexico.

Name: Dr. Arturo Muñoz Meza
Location: Tijuana, Mexico
Website: haimastemcelltherapy.com/
Facebook: Dr. Munoz

That’s Interesting: Dr. Munoz is a plastic surgeon at HAIMA Stem Cell Therapy Clinic which is located in Tijuana’s financial district; just 5 minutes from the international border of San Diego, CA.

Yes. In Mexico Stem Cell Treatment is currently being practiced at a clinical level; it is mandatory to have a license from the Health Department COFEPRIS (FDA in Mexico) This license allows the use of stem cell types beyond those approved in some western countries such as the United States, and some parts of Europe

Several years of education and training is involved to become a leader on the field. Can you share on how you started your career?

I was trained as a general surgeon in the Social Security General Trauma Center in Guatemala during the civil war. There was a large demand for medical services that time. That was the beginning of the acquisition of my expertise in the surgical arena. When I went to Mexico to complete my plastic surgery training, I was asked to stay and teach in the Resident Program by my mentor, Dr. Jose Guerrerosantos who is an all time recognized master in modern plastic surgery.

I was chosen by Dr. Guerrerosantos as his own Post-graduate fellow in Aesthetic and Cosmetic Surgery. This was considered to be a privilege in the Guadalajara University’s “Instituto De Cirugia Plastica y Reconstructiva de Jalisco”—an honor to be the master’s right hand.

Consequentially, I was exposed to the best plastic surgeons around the world, most of them are esteemed members of the American Society of Plastic and Reconstructive Surgery and the American Society of Aesthetic Plastic Surgery.

Why did you choose to specialize in aesthetic cosmetic surgery?

From what I remember during my younger years in school, I had exceptional A+ grades in Arts-drawing, sculpture and music. From then on, I felt that I needed to fulfill something in my life. When I started medical school, I wanted to be a Gynecologist so that I can advocate women’s health. But then, things changed when I was in my fourth year of General Surgery training. During a rotation in the Emergency Room, a patient came in with a chief complaint of cardiac arrest due to a gunshot wound. There were no vital signs so I had to proceed with a direct cardiac massage. In two minutes, we were in the Operating Room and I have successfully completed the anterior thoracotomy to access the pericardium and I found the right ventricle’s rupture and it took me seconds to set the suture. To cut the story short, my patient survived this!

The following day, I was asked by the Department Chief to report in his office. I admit that I was scared by the tone of his voice. The patient I treated wasn’t an ordinary citizen—he is an authority of the Police Department. I was a hero to my mates. After that, I was chosen as a candidate for the Cardiovascular Surgery Program.

I saw my patient again after 30 days for the revision of his scar. He brought me a thank you gift. I felt blessed. Before he left, he asked me a question:

“Can you please tell me why you left an ugly mark on my chest? Didn’t you promise that this will be removed?”

We just both laughed. I concluded my residency program with that in mind.

For some people, to live and be good looking is the same.

That’s where I began to look into plastic surgery. It is truly an art of giving the human body anatomical modifications to restore and rehabilitate until it is aesthetically pleasing.

Your practice is located inside HAIMA Stem Cell Therapy Clinic which is located just over the US border in Tijuana, literally five minutes from San Diego. Can you tell us more?

Several of us are business partners. We have a CEO who manages administrative issues and we have 80 attending doctors whose specialty range from Orthopedics to Neurosurgery.

Because of the geographical situation of Tijuana City, we are the first alternative choice of the American population in California as medical providers because of the cost and quality of our services. Before the crisis, this city was considered to be “Tiny Houston City” for medical services.

In my office, we have 3 nurses, 2 front desk assistants and 3 patient coordinators to run the consultation services. Before hiring them full time, we check their performance with a trial period to make sure that the're a fit.

I have a high compromise with my personal quality standards and try to radiate a persona that I’ve learned during the Guatemallan Civil War. It is something that the “Kaibiles”, the elite forces of the army, shout: “The possible is already done, the impossible is going to happen now.” It reminds me to do the best I can even without the latest ideal technological support and resources.

We give bonus's to our staff depending on the number of referrals that come in and the number of patients that decide to undergo surgery. For example, if we have 1-5 patients, they will have 5% of the total cost of services and treatments done. If we have 5-10 patients, they get 10% and if we have more than 10 patients, they get 15% per week.

Extra bonuses are given to our staff when we hear good comments from patients. They also get discounts on their own plastic or cosmetic surgery.

What IPL or laser technologies are you using?

I have SmartLipo which is a Nd Pulse Yag Laser, 1064nm WL,18W. It is expensive but this one’s a very useful state of the art tool for liposuction. We use this on selected body areas with limited adipose tissue like on the neck and waist. We also use this for axillary hyperhidrosis, lipomas and pseudogynecomastia. We also have Vaser for patients who have previously undergone more than 2 liposuction procedures. We have used the Microair machine in the past but it takes twice as much time in the Operating Room. Results are basically the same (or none at all) and patients reportedly had swelling, pain and numbness after the procedure.

You clinic is unusual in that it's inside a much larger clinic. How is it marketed?

Thankfully, word of mouth has been the most valuable resource for us. We always educate our patients with the procedures. I will never compromise quality over quantity. I take a number of patients I know I can handle daily. If I am saturated, I refer my patients to my colleagues. As much as possible, we try to be organized for our patient’s satisfaction.

We used to advertise in the Yellow Pages but that didn't pay off.

Personally I feel that my work is good enough to compete with the best. Patients feel that my services are also affordable when they evaluate the whole surgical experience.

The hospital has it’s own marketing program and we have commitments and policies in taking part to make it successful.

What is the most popular and profitable treatment in your clinic?

Sometimes, before we sleep,  I jokingly tell my wife “I am going to pray that everyday is “Lipo Day” because this particular procedure is in demand and very good in terms of outcomes. Basically, expenses are based in the O.R. charges and hospital rooms. Rhinoplasty is also perfect. We just need Lidocaine with Epinephrine, a couple of sutures, saline solution, nasal packs, antiseptics, micropore and external ferula.

We have good quality equipment and replace 1 or 2 pieces every year when we attend symposiums, congresses or meetings.

I left hair transplantation because it takes a considerable time of consultation and it requires me to train and supervise technicians as well. Honestly I don’t love this procedure enough to give this a substantial time in my practice.

I am a member of the Board of Specialists in Stem Cell Therapy. I am excited to offer this soon in our office.

What are the lessons you learned as a plastic surgeon? Can you share memorable moments?

Plastic surgery has given me a lot of experiences whether it be challenging, interesting or successful. But above all, the most fulfilling experience is observing the patient’s reaction when they look at the mirror for the first time to see the result.

On May 1997, I attended the ASAPS meeting in New York. I had the honor to meet many of my favorite authors like Jack H. Sheen and George C. Peck and took the courses with them. It felt great when I went back to Guadalajara and performed a reduction and balance rhinoplasty on Karla, an 18 year old who asked for rhinoplasty because she had a problem known as nose kyphosis. This is my most unforgettable experience, as this was my first rhinoplasty. 

After 4 weeks, I finally removed the patch and told her that it’s done. For me, the result was okay, a little swollen than normal. But I didn’t know what she was thinking and so I instructed her to look at the mirror on the next room to check her self. I couldn’t see her for a while and then suddenly I heard her crying. Jesus Christ!! I’m dead! I waited patiently for her to come back.

She looked at me and exclaimed “This is beautiful! All I can say is thank you!”.

For me, that is truly a gratifying experience.

What advice would you give to other physicians?

I think the best advice I can give to everyone in the cosmetic industry is to never perform anything that you are not trained for. If you are not qualified and naturally skillful, you are not the best option available for the patient. What people expect from plastic, aesthetic and cosmetic surgeons are natural, longlasting results and safe procedures. There is no one surgeon who is good at every procedure. He doesn’t exist. In time, he may develop his specialty. The procedure you do often which have exceptional results are highly recommended to your patients. Always do your best when performing a procedure because patients want to achieve perfection.

Avoid disasters in the cosmetic industry by eliminating greedy thoughts. As for myself, I don’t feel good with calf or gluteal implants, neither with hair transplantation. I am knowledgeable of those procedures but I am not passionate of these. When a patient asks for those, I usually refer them to an expert in order to eliminate the potential risks and fake unnatural results. I want to be honest to the patient. In this way, we can increase our credibility and gain the public’s confidence.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers around the world. If you'd like to be interviewed, just contact us.

Interview With Brazilian Plastic Surgeon Alan Landecker, MD

Visiting Brazil with plastic surgeon Dr. Alan Landecker in his Sao Paulo clinic.

Physician: Alan Landecker, MD
Location: Sao Paulo, Brazil
Website: www.landecker.com.br

That's interesting: In 2005, Alan Landecker, M.D. specialized in primary and secondary rhinoplasty at the University of Texas Southwestern at Dallas, Texas, USA, under Jack P. Gunter, M.D. and Rod J. Rohrich, M.D. For a period of 2 years, he was part of the Adjunct Faculty at the world-renowned Dallas Rhinoplasty Symposium and participated actively in the production of the second edition of the Dallas Rhinoplasty: Nasal Surgery by the Masters book. This book is currently the world´s best-seller in rhinoplasty.

Brazil has some of the busiest plastic surgeons anywhere in the world and it's not uncommon to find those who have been trained in the US.

When did you decide to specialize in plastic surgery?

The attraction began during medical school, when I rotated in the Plastic Surgery Department. The precision, difficulty, and level of detail of the operations enchanted me. However, I believe that an important personality trait (visual attraction to beautiful things) contributed significantly.

Can you tell us more about your clinic and how your staff operates it?

The clinic offers last generation plastic surgery and cosmetic procedures that can be surgical or non-surgical to all age groups. Some of the latter include laser, skin treatments, and postoperative physiotherapy. The clinic is located in one of the most sophisticated areas in São Paulo and is run by professional managers. Most remarkable 'inside' the clinic is the contemporary architecture and interior design, offering patients a unique experience.

The clinic offers IPL for hair removal, dark circles around the eyes, and some vascular lesions. We also have diode laser machines for rejuvenation and hair removal. Our newest machine is a radiofrequency device that is combined with electromagnetic energy. This kind of machine is very popular because splendid body contour is a priority for both men and women in Brazil. So far all of them have worked well for us.

How are you finding staff?

We've had some real issues with staff and due to past problems, we currently hire using only professional headhunters. Although more costly, this increases the chances of getting it right the first time! All staff have top class working conditions and receive a fixed salary plus bonuses depending on how well they perform. The secret is keeping them motivated!

How do you market your clinic?

In terms of marketing, the best is always to do a good job. In other words, the most solid marketing consists of word-of-mouth referrals. Complementary strategies should include a good website with SEO, use of social media, internal programs, and good exposure in the press. If all these are well structured, precise, and especially ethical, good results are inevitable.

What treatments or services are most profitable for you?

Plastic surgical procedures are the most profitable, followed by Botulinum toxin (Botox) and dermal fillers. We are currently developing a high-end aesthetic center to give patients a more complete type of treatment.

What have you learned about practicing cosmetic medicine? What stories can you tell?

The most common situations involve patients who bring tons of photographs of their noses into the consultation. They flog themselves trying to find minute imperfections which are normally invisible to most of us.

On the 'most unusual' side, one patient actually brought the head of a clothing store mannequin to the office, wanting a nose just like that one. As a result, we took the head into the operating room and used it as reference during the rhinoplasty. (Fortunately, the patient was extremely satisfied with the final outcome!)

What advice would you give to other physicians?

Based on my experience, it is very important to get the best training possible and preferably in something that no other surgeon performs. That will necessarily include tremendous dedication and inevitable sacrifices but you just can't succeed if you only do what everyone else does and you don't have a reputation for being the best at something specific.

Physicians must always be ethical and honest, keeping in mind that the most important outcome is patient satisfaction. In other words, never make decisions based on financial factors instead of doing what is best for the patient.

About: Alan Landecker, M.D. is a member of the Brazilian Society of Plastic Surgery and the the prestigious International Society of Aesthetic Plastic Surgery (ISAPS).

Dr. Landecker obtained his medical degree and general surgery training at the University of São Paulo Medical School, Brazil. He was then trained in plastic surgery at the Pontifical Catholic University of Rio de Janeiro and the Ivo Pitanguy Clinic, where he worked directly with Professor Ivo Pitanguy for 3 years.

After passing the ECFMG/USMLE examinations, Alan Landecker, M.D., spent a total of 2 years refining his plastic surgical training in the USA. During this period, he participated in clinical rotations, Research Fellowships, and Clinical Fellowships with some of the country's best surgeons at the Universities of Miami, Alabama at Birmingham (UAB), Pittsburgh, New York (NYU) and Texas Southwestern.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.