Repair Revolution: Surgeons use fat grafts to address extensive facial deformities

“The effects we’ve achieved in some of these soldiers [are] pretty remarkable,” Dr. Coleman told ENT Today. “We’ve actually filled in some huge craniotomy defects that had left the patients with just skin over metal mesh, with no place to put anything, and yet we’ve been able to get some remarkable filling of those defects and improved facial scarring as well. So it’s not just big holes we’re filling.”

Asked to explain how fat, which does not have much structure or “lift,” could not only fill but also support facial contours in such defects, Dr. Coleman replied that it is probably due to the stem cells in the grafted fat that he maximizes using his harvesting and processing technique. “We collect the fat and then centrifuge in such a way that we are left with only the most dense, stem cell-rich fat,” he explained. “The oily fat residue is either thrown out, placed back into the patient or retained for research purposes.”

As for exactly what those stem cells are doing to help achieve the impressive defect filling he’s reported, “there are lots of theories that have been published by some very well-respected scientists,” Dr. Coleman said. “What most studies have shown, and what I firmly believe is taking place, is that the stem cells promote blood vessel growth and blood flow via some type of angiogenic process. That is absolutely crucial not only for the survival of the fat graft but also wound healing.”

Dr. Coleman stressed that the outcomes he and Dr. Rubin have achieved in the injured U.S. soldiers aren’t attributable just to proper fat-graft harvesting and processing; his methods for injecting the fat are also crucial. The technique involves several steps, including the placement of miniscule amounts of fatty tissue each time the surgeon withdraws a blunt cannula that is used to inject the fat into the defect being repaired. (Dr. Coleman has published extensively on these methods, and his books, “Structural Fat Grafting” [Quality Medical Publishing, 2004], and “Fat Injection from Filling to Regeneration” [Quality Medical Publishing, 2009] are considered major references on the topic.)

He also pointed out that the results he has achieved at UPMC are mirrored in several cases from his own practice. “I’ve had cases in which large craniofacial defects were repaired using these fat-grafting methods,” Dr. Coleman said. In some of the cases, he noted, patients were missing a quarter of their faces. “They still had a rudimentary jawline, so we didn’t have to reconstruct the jaw. But they did have really remarkable defects that I was able to fill in with fat grafts, and the outcomes were very impressive and long-lasting.”