Plump me up, cut me down

Fat is the surprise magic worker in a range of new plastic surgery options. By Claire Keeton

Fat, once the villain in the world of cosmetics, is now a superhero in the pursuit for youthful looks. Fat is the future. Fat is hot. Fat is the magic "fourth dimension" say South African plastic surgeons, explaining its potential for facial rejuvenation and bodily beautification.

"Fillers are out, fat is in," says Johannesburg plastic surgeon Dr Moshe Fayman. To be precise, adipose-derived stem cells (stem cells extracted from fat) are revolutionising cosmetics with their potential to reverse the effects of ageing.

Fayman says: "This has been receiving a lot of attention in research and in clinics and the ways of using a patient's own fat are increasing. Our understanding of fat-cell metabolism has increased a 100 times in the past 10 years."

He says: "Fat adds a fourth dimension by providing stem cells that produce regeneration."

Stem cells - which scientists say have the "remarkable potential to develop into many different cell types in the body ... and in many tissues serve as a sort of internal repair system" - are making waves in all fields of medicine.

Fayman's enthusiasm for fat is shared by his peers in Johannesburg, Cape Town, Port Elizabeth and East London.

Dr Chris Snijman, national secretary of the Association of Plastic and Reconstructive Surgeons of Southern Africa, says: "We have seen a revolution in fat transfers and fat grafting. This is hot and it is where we are going. Research is being conducted in the US and countries such as Italy, but its application in South Africa is still very new."

Dr Duncan Carmichael, the founder of the Cape Town Anti-Ageing Clinic, says they hope "to trial stem cells later this year and we are in the preparatory stage. Stem cells are the holy grail that can heal inflammation and scarring. We would want to inject them under the skin in micro-globs and hope they will develop collagen."

Collagen is a fibrous protein which supports tissues such as the skin. Collagen production declines at a rate of about half a percent a year with age.

Fayman says: "Fat transfers are like the redistribution of wealth. You take fat from the areas of excess and move it to the areas of deficiency."

Fat is also being used to enlarge body parts such as boobs or buttocks.

"What's relatively new in the last few years is patients wanting a more curvaceous look and asking for (procedures such as) buttock augmentations," says Fayman.

Fat transfers can even give young women a Cinderella-like enhancement that vanishes with time.

"A wealthy father may give his daughter a breast augmentation for a 21st present or a matric dance so she looks fabulous and it will be completely re-absorbed after a year," Snijman says.

Breast enlargements, reductions and lifts remain among the most popular procedures in plastic surgery, along with liposuction, face and eyelid surgery, 10 plastic surgeons report.

The options for implants and breast reconstruction have improved dramatically over the last 10 years, says plastic surgeon Dr Carla Norval, who specialises in breast reconstructions after mastectomies. The latest anatomical models, in contrast to earlier round silicone implants, have a teardrop shape, contain a cohesive gel and have a crystalline textured surface.

Fat transfers to breasts are already taking place, says Snijman.

On the non-surgical side, Botox, dermal fillers, chemical peels and lasers are still in demand, particularly "liquid face-lifts". These combine Botox to freeze facial muscles with dermal biodegradable fillers to add volume.

Carmichael says: "Now the 'wow' factor is from machines like lasers, which are becoming cleverer and cheaper."

Founder of Skin & Body Renewal clinics Dr Maureen Allem says carboxytherapy, known as the "miracle gas", is taking off in South Africa. "It has been described as the biggest beauty breakthrough since Botox. Tiny amounts of carbon dioxide are injected beneath the skin ... to stimulate collagen production."

Allem says their clinics - which offer non-surgical options "to restore youth" - treated about 48000 people last year.

The majority of cosmetic patients are women in their 30s and upwards.

The potential for cosmetic work seems enormous, however, as feminist writer Naomi Wolf warns: "New possibilities for women quickly become new obligations."

One surgeon even did a face-lift on an 87-year-old woman (she didn't want her husband to find out).

East London plastic surgeon Dr Tim Perks says: "Patients are also choosing to put back the clock with smaller procedures such as lasers and peels."

In his practice, Snijman has noticed that patients are requesting more procedures at one sitting, rather than spacing them out over a period of years.

Television shows such as Nip/Tuck seem to have made plastic surgery more mainstream.

Perks says: "Instead of Tupperware parties, people are now having Botox parties."

Patients still want to recover quickly , says Fayman.

"We have a culture of instant gratification and our operations are designed for a faster recovery."

But patients in pursuit of a cheap fix need to be aware of the risks if they use unqualified plastic surgeons who do not belong to the association , Snijman says.

The Health Professions Council of SA ruled on 25 cases of negligence and practising outside the scope of competence last year, including cosmetic surgery. Botched surgery left patients with infections, dents and uneven breasts.

Looking to the future, the next frontier is "tissue engineering", says former Wits professor and reconstructive surgeon George Psaras, now based in Cyprus.

"This is most revolutionary. Colleagues at big centres in the US are producing certain organs in a petri dish. Stem cells are (being grown into) pulsating muscle fibres or breast tissues.

"One day, if you need a left hand, you may be able to order a left hand."

THE WONDERS OF FAT IN PLASTIC SURGERY:

• Fat is safe and biodegradable;
• Fat-derived stem cells have the potential for replacing damaged cells and regenerating collagen;
• Fat cells secrete a chemical ingredient that improves blood supply;
• Fat adds volume and is easy to sculpt; and
• The benefits last longer than those of fillers.

WHO'S NEW IN THE WAITING ROOM

Men are driving the revival of plastic surgery in the US, statistics from the American Society of Plastic Surgeons show. Male surgical procedures increased significantly from 2009 to 2010: face-lifts increased by 14% in 2010, and male liposuction was up by 7%.

"Most of my patients are 'men's men', the kind of guy you might not think would have plastic surgery," said US plastic surgeon Dr Stephen Baker.

Local surgeons say that men in South Africa are also going under the knife. Snijman says requests from men were up 17% last year. The black elite have also started seeking cosmetic surgery, the specialists say. Fayman says: "My practice 15 years ago attracted about two percent of African patients. Now it is about 50% African."

HOW IT WORKS

Dr Tim Perks, a plastic surgeon from East London, describes the process of fat transfers like this: "Much like drawing blood with a syringe, the plastic surgeon draws out fat from beneath the skin which contains some fat cells, some oil and some tissue fluid. This is spun in a centrifuge or allowed to stand or put through a sieve, which potentially concentrates the adipose-derived stem cells. The fat concentrate is transferred into smaller syringes and injected to plump out cheeks or the folds at the side of the nose or into the lips and around the mouth.

"Besides filling in the hollows of older faces and possibly boosting skin quality, fat is also being used to enhance other areas such as breasts or buttocks."