Sunday, August 26, 2007


The future of plastic surgery according to renowned plastic surgeon Richard Ellenbogen, M.D. will be all about injecting stem cells into the target body areas and procedures will have no scalpers or scars and require no surgical operations. But you’re still going to need a surgeon and you’d be lucky to be in the hands of Dr. Ellenbogen.“I am convinced that in the future facial aging surgery will be operationless. Stem cells being extracted from other areas of the body and being compressed and concentrated and injected in the proper areas will rejuvenate the face without surgery,” says Dr. Ellebogen, one of the world’s best face lift surgeons.

Dr. Ellenbogen was already revolutionary 25 years ago when he went against the industry convention of tightening inner facial layers and realized that the key to achieving most natural-looking face lift entails adding fat to areas that have lost volume, not tightening the face. Now, many plastic surgeons follow his lead in this important trend in face lifts. As one of the world’s best face lift surgeons, Dr. Ellenbogen is always on the cutting edge of plastic surgery. At the recent annual American Society of Aesthetic Plastic Surgery meeting held in New York City, Dr. Ellenbogen received a standing ovation from his colleagues after presenting information on how he uses the stem cells found in fat to mold, sculpt and rejuvenate his patient’s faces. Known in plastic surgery circles as the “father of fat grafting”, Dr. Ellenbogen has been using a patient’s own fat to restore volume and youthfulness to the face for nearly thirty years. Now, Dr. Ellenbogen is back with another major breakthrough as he has discovered that not only does fat help give back volume to weakened and aging facial structures, but it also rejuvenates the skin because it contains stem cells.

In this exclusive Make Me Heal interview, Dr.Ellenbogen talks about his philosophy on face lifts, reveals a few of his secrets, and gives the lowdown on how the future of plastic surgery will be all about stem cells and scar-less procedures that require no incisions.

Make Me Heal: As a doctor who’s been on the scene for the last 25 years, what are the major innovations in face lifts that you have seen? How are you doing face lifts differently today than say 10 years ago?

Dr. Richard Ellenbogen: I have actually been performing plastic surgery at my office on Sunset Boulevard in Los Angeles for 31 years. The facelifts of today are totally different than the facelifts of yesterday. The scars are shorter and the actual principal that most advanced plastic surgeons use nowadays is different. Previously we felt that there was a layer within the face, called a SMAS, that we had to tighten, and that aging was a loss in the elasticity and the sagging of this inner part. So the operation was done in two layers. The patient had long scars, a high incidence of nerve damage, and looked quite pulled, because that was all that was being done. The whole principal of aging today has changed. When I introduced this principal almost twenty-five years ago, the other doctors thought I was missing the boat. Basically, the principal is that the face simply deflates as you get older. Fat is lost and descends in the face and if this fat is not replaced someone will simply look pulled because that is all the alternative facelift is. So what I have been doing for the past fifteen years is adding fat to the various areas that have lost fat and not tightening the inner layers at all because in certain studies with MRI’s these inner layers have been proven not to have fallen at all. Consequently, my operations look very realistic and this is why I have had such a healthy facelift practice with every patient bringing in another patient. I can actually tell my patients nowadays that you will look even younger, whereas fifteen years ago I could say only that you will look more rested. Adding fat and understanding the addition of fat in the amount and how to make it last has been the greatest innovation in facelifts in the past 31 years and I am glad that this is something that I am responsible for and many other plastic surgeons are now following my lead.

Make Me Heal: What are the main types of face lifts that you perform? When discussing each face lift type, please briefly describe with technical details (i.e. incisions, anesthesia, etc.) how the facelift type is performed, what aesthetic concerns it addresses, and who is the ideal candidate for each type.

Dr. Ellenbogen: Most plastic surgeons become comfortable with a facelift technique and perform it on most of their patients with varying degrees. Unfortunately, some of these facelifts that are used for much older women do not work very well for early aging women in their 40’s and can make them look pulled, strange, and actually accelerate the aging process. I too perform a certain operation which I call the volumetric facelift. I presented this to a number of peer reviews, plastic surgical societies, and published it in the major plastic surgical aesthetic surgery journal. I am the director of a postgraduate plastic surgery training program and almost all of my students now practice this technique. The volumetric facelift takes into consideration that the greatest cause of aging is a loss of fat in the face and this fat is replaced in various areas of the face to reconstruct the shape of a young woman’s face. It is combined with a removing of the fat in the neck and the tightening of the muscles in the neck and also removing some fat underneath these muscles in an extremely heavy neck. So there are variations of this operation I do; putting in more fat, less fat, tightening the skin more, tightening it less, tightening the muscles less, tightening it more, varying it to the person. I was so pleased to recently at the Aesthetic Surgery Meeting in New York take the course of William Little who I consider my worthy competitor in Washington, D.C. He also has undergone an amazing transformation to modern day facelifts and performs almost the same operation that I do. He has gone through many complicated steps to come to the simple operation and simple conclusion that I have, and it is interesting that just as heart transplants were performed at the same time in South Africa and in Stanford, two heavy facelift practices like his and mine, have come to the same conclusion in the operation that we do.

Make Me Heal: You have pioneered your own face lift procedure that you call the “volumetric face lift”. How is the procedure performed and what makes it unique from other available techniques?

Dr. Ellenbogen: The volumetric facelift takes into consideration the face that as it ages changes shape. Almost all of this change in shape is a loss of fat and I have pioneered a way of replacing the fat in the face and making it last. I wrote the first article on fat replacement in the American Literature in modern times and for five years, although I lectured on it, it was not accepted in the Peer Review Journals. The difference in my facelift is that it depends on the lifting of the face by placing fat in certain areas as well as a tightening of the skin. It also depends on removing fat underneath the jawline and tightening the muscles there to get a perfect 90 degree jawline. The whole operation has minimum scar and probably nine out of ten patients do not even take a pain pill during the entire course. There is no bandage after the first day and patients can wash their hair the first day. I actually allow patients to drive their car within the first week because they can turn their neck comfortably. And a great California question, “when can I go back to the gym,” I have cut that time in half for most of my patients.

Make Me Heal: There’s been a lot buzz made about “lunch-time”, scarless, and weekend facelifts. Do any of them work and if so, which ones do you recommend?

Dr. Ellenbogen: Lunchtime and weekend facelifts, “do any of them work?” Quick answer, “no.” Even the doctor who started the barbed sutures and the quick suspensions now tell patients that this is an alternative to Botox or injectables. It is a short-lived operation and will probably need to be redone.Most patients that I have seen in my facelift practice who have had this procedure are quite displeased not only with the look of it, but the fact that they were misled somewhat that it was very noninvasive and easy, whereas in fact it requires incisions, local anesthesia. One patient, in particular, who went in during her lunch break spent the rest of the day recovering in the doctor’s postoperative facility with another patient and heard that this is actually the norm, not the exception.

Make Me Heal: What procedures (i.e. brow lift, blepharoplasty) do you often combine with a facelift? When naming a procedure please explain which issues the procedure addresses.

Dr. Ellenbogen: What operations do I combine with a facelift? Frequently, a browlift to change the expression, get rid of the wrinkles in the forehead, and less frequently eyelid surgery (upper and lower). We no longer perform the deep upper eyelid that was so popular in the last ten or fifteen years. We leave the eyelid a little bit heavier which is more like what an eyelid would look like. We do not like that bug-eyed look that was so popular in the 1980’s and the 1990’s. In all facelift procedures, I replace fat. I replace it in the jawline, in the cheeks, in the cheekbones, in the temples, in rather thin patients, in the eyebrow area to assist in lifting the eyebrows; it is all known to reshape the face to a younger shape of a face. There is only so much that can be done by pulling in a facelift; the rest has to be done by volume replacement and thus I call it the volumetric facelift. Only recently we have discovered that liposuction fat is the richest source of stem cells next to embryonic fat cells and these are utilized in many uses now in surgery. We have noticed for many years in using fat in the face that people’s skin has gotten wonderful after the surgery. Pores have gotten smaller and pigmentations have gotten less. At first we thought the reason for this was just writing on a balloon; you write with a magic marker on a balloon and you blow it up and the writing gets lighter. But it is actually more than that. We biopsied various pigmentations that have been fat grafted and there is actually a work of the stem cells in getting rid of some of these pigmentations. A chin implant is also a very important addition to the facelift. It can be done in many cases just with fat grafting because not only does the chin implant give a strong jawline it also lifts up the corners of the mouth and improves the expression of the face. In my course that I gave at the Aesthetic Society on expressional surgery, improving the expression in people who are starting to look old, the most important thing that I mentioned was the lifting of the corners of the mouth with a chin implant.

Make Me Heal: You’ve recently spoke at a plastic surgery convention about using stem cells through fat grafting to fill in wrinkles and rejuvenate the skin of your patients. Please describe this technique. Are you using stem cells for any other purposes?

Dr. Ellenbogen: The highest concentration of stem cells besides embryonic stem cells is in our own body fat. Consequently, when we inject liposuction fat to build out a cheekbone or fill out a gaunt face we also inject stem cells which are contained within the fat which treat the area. We have noticed for years that people who have fat injections in the face that their pigmentations are less visible and the pores are much smaller. Many experience a decrease in wrinkles in the area. A few patients with chronic acne are improved. In some patients we simply inject a thin layer of liposuction fat under the entire facial skin and within weeks the improvement is seen. It is essentially treating skin from the inner layers not from the outside. The surgery is performed under general anesthesia in un anesthsized skin. Once local anesthesia is used we believe the stem cells and fat cells do not survive as well. We remove the fat and have found back fat or love handle fat survives the best. The fat is centrifuged, purified and injected with special needles from inside the mouth. There is no bandage and the swelling subsides within weeks. The entire procedure takes 30 minutes and the only complaints of pain are usually from the donor site.

Make Me Heal: What role do you think stem cells will have 5-10 years from now on plastic surgery? Please describe what procedures stem cells will be used in and how they will benefit the patient and surgeon?

Dr. Ellenbogen: The future of plastic surgery and all surgery I believe is stem cells. I believe that someday in the future we will be able to take a purified extract of stem cells and inject them in various areas of the body, and the face and the organs or facial structures which are aging and breaking down will be rejuvenated. At present, we are cognizant of the fact that liposuctioned fat itself, something we used to throw away, is replete with fat cells. Including this in various areas of the face, in our article that we wrote, actually improves the skin, gets rid of wrinkles, gets rid of pigmentations, and hypothetically prevents the facial skeleton from decreasing in size as people get older which is one of the major causes of the sagging and change in the shape of facial structures. I am convinced that in the future facial aging surgery will be operationless. Stem cells being extracted from other areas of the body and being compressed and concentrated and injected in the proper areas will rejuvenate the face without surgery, but I am sure this is many years to come.

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