PLASTIC SURGERY
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spend the week witnessing and assisting in these extremely complex
and rare surgeries. I saw the impact of Dr. Tessier’s genius as a large
number of acclaimed surgeons were present in the operating room
to learn from this giant. The exposure to the passion and intellectual
stimulation that resulted from this week set the course for the rest
of my training as I finished residencies in otolaryngology, plastic
surgery and fellowships in facial plastic surgery, pediatric plastic
surgery and craniofacial surgery.
From that chance encounter, I have witnessed and participated
in the growth of the field of craniofacial surgery. These principles
and surgical techniques, originally innovated for the congenital
craniofacial malformations, changed the way all surgeons approach
surgeries of the facial skeleton. Critical follow-up of these early
surgeries led to innovations such as technique modification and
new research questions. For generations, wires were used to fixate
the craniofacial skeleton and the failures of this practice lead to
the development of titanium plates and screws. Issues related to
the changing pediatric facial skeleton led to absorbable plates
and screws. These innovations changed the entire discipline
of craniofacial surgery as other specialties adopted the basic
principles and technologies to expand utilization by numerous
surgical specialties for the management of all surgeries related to
the craniofacial skeleton.
Another innovation that has transformed the field of plastic
surgery is the utilization of fat grafting. Though the transfer of fat had
been attempted for nearly a hundred years, the results were largely
failures. Failure can be an opportunity to recognize drawbacks and
turn a setback into a victory. Incongruities inspire people to change
what they used to do. In the early 1990’s, Dr. Sydney Coleman, after
frustration with failed fat grafting by the then-accepted standards,
developed protocols for injecting small aliquots of fat that led to a
significant increase in volume retention. Dr. Coleman’s manuscripts
are the most often-cited papers in plastic surgery.
There is currently an expanding body of literature and clinical
experience on the use of fat grafting for aesthetic and reconstructive
options in plastic surgery. Not only does the fat grafting improve
contour irregularities, but there may be an element of local tissue
repair or regeneration as a result of the lipocytes or adipose-derived
stem cells in the new environment. There is evidence that the
mechanism of repair or regeneration of the overlying skin may be
related to stem cells or lipocyte breakdown products within the
fat grafts.
Many studies have demonstrated the regenerative potential of
autologous fat transfer, presumably because of its adipose-derived
stem cell content. This includes angiogenesis, peripheral nerve
regeneration, enhancement of dermal thickness and elasticity,
reversal of fibrosis (secondary to radiation therapy, scarring, or
inflammatory conditions, such as scleroderma), treatment of
Peyronie’s disease, urethral strictures, stress urinary incontinence,
rheumatoid arthritis, and osteoarthritis.
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LOUISVILLE MEDICINE
The future of plastic surgery is bright, as bright young innovators
are drawn to this specialty. The history of plastic surgery contributions
to all other disciplines promises many continuing innovations that
will benefit all patients.
Dr. O’Daniel owns and practices within Louisville Plastic Surgery Studio.
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