Archive for the ‘Plastic Surgery’ Category

African American Facial Feminization Surgery

September 26, 2017

Feminizing the African American Face

If you are of African American heritage and seeking to have facial feminization surgery (FFS) it’s critical to understand that what constitutes a typically female African American face may be vastly different — aesthetically and structurally — than a typical European, Asian, or even Hawaiian (Polynesian) face.

So before you select a plastic and craniofacial surgeon for your facial feminization surgery, it’s imperative to ensure that they have an in-depth understanding of the differences between the facial structures of people of different ethnic backgrounds, and most importantly proven experience with performing FFS on African Americans.

The forehead is the critical to feminizing the African American face.

The shape and size of the forehead and the brow should be the main focus of facial feminization for those of African American heritage. Typically the forehead will project a little further outwards than that of a person of Asian descent, but not as far as that of a person of European descent.

Forehead feminization typically includes forehead reduction and contouring to create a smoother, rounder, and more feminine forehead. Also, a feminizing brow lift and/or brow shaping procedure is recommended to reduce the distinctly ‘heavy’ African American male brow bossing and to “open up” the eyes to create a more feminine and rejuvenated appearance.

The hairline position on the forehead will also be different because African American women tend to have naturally higher hairlines than European women. Therefore, when we perform feminizing hairline lowering we make allowance for the fact that African American women have slightly higher hairlines to begin with, so we may not lower the hairline as significantly as we might in others. Ultimately, it all depends on your newly feminized facial features to ensure aesthetic balance and a natural looking result.

Feminizing the lower half of the African American face.

Typically, feminization of the nose via feminizing rhinoplasty is recommended for those of African American heritage. Often gender transition patients are seeking a narrower, more streamlined female nose. However, we also want to make sure that your nose will maintain a size and shape that is in harmony with your natural African American facial features, so that you still look like you.

Feminizing jaw surgery is also recommended because often the male African American jawline is quite broad and angular – often wider and squarer than what we see in other ethnicities. The jaw will often need to be narrowed and softened via feminizing jaw contouring or reshaping.

Read more about the cluster of surgical and non-surgical procedures that comprise facial feminization.

Read more

If Your Plastic Surgery has “Gone Wrong” There are Several Options Available to You

February 26, 2017

If Your Plastic Surgery has “Gone Wrong” There are Several Options Available to You

It might seem like an uncomfortable thing to talk about, but sometimes a plastic surgery procedure may not turn out as you expected causing great stress and a lack of confidence. Either your surgeon was not as skilled or qualified as you were led to believe, and/or, as the weeks and months wore on after surgery, the outcome was not as satisfactory as you’d hoped.

The good news is that most – if not all – botched plastic surgery procedures can be remedied by a skilled and US board certified plastic surgeon.

What are your options if you have a botched plastic surgery procedure?

If your previous plastic surgery procedure has gone wrong, there are several things you can do. And indeed, taking immediate action will help you feel better about your situation right away, even if you might need to wait for a few weeks or months for your revision surgery.

First, don’t panic. No matter what your situation, there is a good chance that it can be remedied.

Second, it’s good to know that almost 15% of our patients come to us for revision plastic surgery, with the most commonly requested “do over” procedure being rhinoplasty or “nose job” revision surgery.

Revision Plastic Surgeries

A “revision” or “do over” plastic surgery is its own art and science. Typically, there are several plastic surgery procedures that can be revised with great success. Following are some of our most common. (Note: if you don’t see a particular procedure here please call our office.)

Facelift Revision Surgery

One of the more frequent requests at our office is for a revision, or “corrective” facelift. There are many reasons why you may feel dissatisfied with a previous face and/or neck lift:

  • Lack of longevity, early loss of results, or natural ageing: most facelifts have a natural shelf-life of approximately 5-10 years
  • Lack of impact: your facelift didn’t effectively “lift” or rejuvenate
  • Previous surgeon lacked an “artistic eye” causing lack of aesthetic harmony
  • Looking like someone else syndrome: not looking like “you”
  • You’re simply unhappy, or unsatisfied with the previous surgeon’s work

The good news however, is that many facelifts that fell short of their original goals can be improved upon via revision or corrective facelift surgery.

Read more about faceflift revision surgery here.

Rhinoplasty “Nose Job” Revision

Revision rhinoplasty is one of the most common of all “revision” plastic surgeries mainly because it is one of the most difficult of all plastic surgery procedures to begin with, so there is a large demand for corrective, or secondary surgeries.

Reasons for revising a previous “nose job” range from a thoroughly “botched” procedure performed by an unqualified or unskilled surgeon, to unexpected healing issues such as difficulty breathing. But most commonly, our rhinoplasty revision patients are simply unhappy with the appearance of their “new” nose; it doesn’t aesthetically “work” in balance with their other features.

Revision rhinoplasty is actually a very common procedure, and the benefits to your sense of self-image and level of confidence are significant enough to make it worthwhile.

Read more about revision rhinoplasty surgery here.

Eyelid Revision Surgery (Blephorasty Correction)

Blepharoplasty correction or eyelid revision surgery is a surgical procedure intended to correct the results of previously performed eyelid surgery or blepharoplasty with unsatisfactory or unwanted results. However, eyelid revision surgery can often be more challenging than the initial procedure.

There are primarily two types of blepharoplasty correction:

  1. Revision of “under corrected” eyelid surgery where too much extra skin or fat was left behind and you are unsatisfied with the results. Eyelid revision surgery can also correct ptosis or “drooping” eyelids.
  2. Correction of “overdone” eyelid surgery where too much skin and/or fat was removed giving the eyes a misshapen or unnatural appearance, known as ectropion.

Read more about Blepharoplasty correction or eyelid revision surgery here.

Revision Ear Surgery (Otoplasty Correction)

Otoplasty (ear pinning) is commonly performed on children at a young age to correct prominent or “sticking out” ears, and as they grow into teenagers and young adults, it may be necessary to revise the original surgery.

Also, depending on the skill level of the surgeon who performed the original surgery, patients may find that the ears were “over corrected” giving them an unnatural or “pulled back” look. Other common complaints include unnatural-looking creases where the ear meets the skull. Revision ear surgery can correct these issues.

Read more about Revision Ear Surgery (Otoplasty Correction) here.

Fat Transfer Revision

Fat transfer revision surgery can help address issues that appear after a single fat transfer procedure or a series, such as uneven or unnatural appearance, lumps and bumps, dissolution of implants, and facial asymmetry. Unskilled application of fat transfer may also result in the face appearing too puffy, swollen, or symmetrically uneven and lopsided.

Read more about fat transfer revision surgery here.

Asian “V-Line” Revision Jaw Surgery

Asian V-line revision surgery is most often requested by patients who do not feel that the original procedure addressed all their concerns, leaving them unsatisfied with the results. For example, a square jaw or protruding may not be “softened” or V-shaped enough, or an unwanted “double chin” may still be apparent reducing the contouring effect of the V-line procedure.

Read more about Asian V-line revision surgery here.

Revision Chin Surgery

Chin revision surgery may be necessary if you are unhappy with the results of your initial procedure. In fact, chin revision surgery is one of the most common procedures we perform, often because the previous surgeon has inserted a chin implant, and this approach has not been successful and the chin needs correcting.

Read more about revision chin surgery here.

Corrective Jaw Surgery

The term “jaw surgery” refers to the most common jaw surgeries: lower jaw surgery, double jaw surgery, and bite correction. Revision corrective jaw surgery is any type of orthognathic surgery that is used to correct a previous surgical procedure.

Most typically, patients are unsatisfied because they do not like the look of their “new” jaw. It may be too masculine, or too feminine, or aesthetically not complementing the rest of their facial features. The most common reason for a poor aesthetic or cosmetic outcome is that while the previous surgeon may have had the technical skills to perform the jaw surgery, he may have been lacking the aesthetic appreciation for how the altered jaw would appear with the patient’s other facial features.

Read more about corrective jaw surgery here.

Skull Reshaping Revision

If skull reshaping and augmentation is performed by an inexperienced or unqualified surgeon you may experience an unsatisfactory result. Negative results may also occur due to infection or if the body rejects a skull reshaping implant. In fact, revision or correction of skull reshaping surgery is actually quite common — about 15% of all or our skull reshaping procedures are revision surgeries wherein we are asked to correct a previous surgeon’s work.

Read more about skull reshaping revision surgery here.

Facial Feminization Revision Surgery (FFS)

To capture authentic gender expression, your surgeon needs to be able to surgically integrate the subtle science and intrinsic differences between the male vs. female craniofacial skeleton. One of the most common types of facial feminization procedures we perform is to correct another surgeon’s work. The main reason for this is that while a surgeon may know technically what is required for feminization, they may not have a comprehensive understanding of the subtle aesthetic qualities of what makes a face “feminine” versus what makes a face simply “beautiful”.

Read more about facial feminization revision surgery here.

Read more

Is Long Format Plastic and Craniofacial Surgery Safe?

August 28, 2016


Long format surgery may take 6-12 hours, is it safe to be “under” for this long?

Sometimes it is recommended to undertake several plastic surgery procedures during one session. This is known as a long format surgery, which may take anywhere from 6-12 hours in duration. Most often we recommend long format plastic surgeries for either Pan Facial Rejuvenation, Facial Masculinization, or Facial Feminization.

These are complex surgeries that involve several procedures that need to be performed together to ensure a successful result. For example, if you need Forehead Feminization, it is ideal to combine this procedure with Hairline Lowering, a Brow Lift, and possibly even a Feminizing Rhinoplasty.

How safe is long format surgery?

One of the great concerns often expressed by our patients is:

How safe is it for me to be under anesthesia for this long?

This is a valid concern, and one we wish to address to dispel any myths or fears around long format plastic and craniofacial surgery.

Two elements are critical to understand:

First, it’s critical that your doctor is board certified, and that the procedure is performed in a hospital or certified ambulatory surgery center setting with a board certified physician anesthesiologist in attendance.

Dr. Deschamps-Braly has a stellar professional reputation and is cross-trained in both general plastic surgery, orthognathic (jaw) surgery, and craniofacial surgery. He works with highly qualified board certified anesthesiologists and has admitting privileges at various hospitals in the Bay Area in the event extended postoperative monitoring is necessary.

Second, the duration of long format surgeries can range from a couple of hours for a single procedure, to 10-12 hours for a multi-procedural surgery. This is why we carefully screen our patient’s health before surgery with lab and other tests to assess their suitability for long surgery. We may require additional input from other healthcare professionals prior to long surgery should anything be irregular on your health screening.

However, while a long format surgery can be safely be done in a single stage, it can also be broken up into parts—typically an ‘upper face’ and ‘lower face’ phase that would encompass a few procedures that closely relate to each other. Phases can be performed as close as two days or as long as several years apart.

Because long format surgery involves general anesthesia for an extended period of time, certain precautions must be taken. While undergoing 6-12 hours of surgery is typically safe, it is best to minimize the amount of anesthesia that is required–to also minimize postoperative sequelae.

Although delirium and confusion are rare after long format surgery, we require admission to the hospital for observation for any cases lasting longer than 5-6 hours. We work with anesthesiologists to tailor your anesthesia in such a way as to minimize any post operative confusion.

What type of anesthesia is needed for long format surgery?

Long format surgery is performed under a very light general anesthesia. We typically limit the amount of narcotics and other agents that circulate in the body for extended periods which also improves the recovery process.

Although staging surgeries into two smaller surgeries is possible, it rarely is necessary to do this way, and often increases costs by creating two separate trips to San Francisco.

Your surgeon will explain to you how much and what level of anesthesia is required for your specific series of surgical procedures.

During preoperative testing and evaluation, Dr. Deschamps-Braly will determine how safe general anesthesia will be for your particular situation, particularly if you have any other medical problems or conditions to consider. Local anesthesia is always combined with general to decrease the amount of general anesthesia medications that are necessary.

Your general health and lifestyle habits are also important predictors of outcome:

  • You should also have clearance from your family doctor to make sure you are healthy enough for a long surgery.
  • You should be put under anesthesia only by a board certified anesthesiologist and plan to spend the night of your surgery in the hospital.
  • You will be observed in the hospital overnight to make sure that you recover as planned.
  • Additionally, you should make sure that your surgeon does everything to ensure you have good circulation throughout long format surgery and during initial recovery time.

Have any major studies been undertaken in terms of long format surgery and patient safety?

Several studies validate that long hours for surgeries are not a higher risk to patient safety. In fact, one study noted considerable improvements in patient safety.

A 1999 study on the complications of long operations determined that reconstructive surgical procedures often take a long time to perform and duration of surgery is frequently cited as a major risk factor for postoperative complications. Yet, the study suggests that duration of surgery alone is not a major determinant of postoperative complications, and that the type of surgery performed and the patient’s general health are more important predictors of outcome.

A new national study published in the New England Journal of Medicine and presented at the Academic Surgical Congress in February of 2016 showed that allowing surgical residents the flexibility to work longer hours did not pose a greater risk to patients. The highly anticipated seminal study was led by Northwestern Medicine.

In addition, we have performed over 1,700 long format cases without a single serious health related complication. We maintain a successful track record through very thoughtful patient selection and screening.

What precautions do you take to ensure patient safety?

Dr. Deschamps-Braly and his team are highly regarded for their surgical expertise and exemplary patient care. Your pre-op planning consultation with Dr. Deschamps-Braly is an ideal time to discuss all the practical and important ways you can prepare yourself for a safe surgery and an optimized recovery, both initially and in the long term.

There are preliminary protections to take well in advance of surgery, the day of, and post-operation which include:

  • Follow all recommended pre-operative recommendations for optimal emotional, psychological, and physical well-being prior to surgery.
  • Specifically, your surgeon will discuss what level of sedation is needed, and will aim to keep the anesthesia as light as possible.
  • Per your surgeon’s instructions, discontinue any medications before and after surgery that could further alter brain activity.
  • Be well hydrated and nourished before surgery, to improve blood flow to the brain. Ensure you drink plenty of water and even electrolytes if you feel dehydrated.

Your safety is always our highest priority and primary concern.

Dr. Deschamps-Braly and his team take every step to ensure your utmost safety so that your entire patient experience is a positive one–that yields you the desired aesthetic outcomes as well as the best postoperative recovery experience possible. If you have any further questions, please don’t hesitate to ask Dr. Deschamps-Braly during your initial consultation.

Read more

Surgery With World Class Instruments

March 25, 2016

STILLE Instruments: Setting a High Standard

STILLE Instruments are the highest quality surgical instruments available in the world. They are created to provide the sharpest, most precise cutting while reducing surgical hand fatigue. Based in Sweden, STILLE has been developing and creating leading edge medical devices since the 1800s.

The Importance of Quality Instruments

Dr. Deschamps-Braly could be described as a perfectionist. He performs highly specialized plastic and craniofacial procedures. And, in order to achieve the best possible results, he only uses the highest quality surgical tools available.

As a surgeon, tools and instruments are almost an extension of your hands and you want the best “feel-driven” option available. STILLE tools including forceps, needle drivers, and scissors offer precise movement and tactile feedback in a different way than other instruments.

Because he is so particular about the tools and instruments he uses on patients, Dr. Deschamps-Braly only uses STILLE and KLS Martin instruments, even taking them with him when he performing surgery outside of his office. He is also a STILLE Ambassador, representing the brand within the medical community. (more…)

Read more

Debunking Three Common Myths About Female Hairlines

February 9, 2016

Demystifying 3 Common Myths About Feminine Hairlines

By Dr. Sara Wasserbauer, Surgical Hair Restoration Specialist

If you are trying to achieve a more feminine facial appearance, you may know that hair, and specifically the shape and height of your hairline, is a major component of this transformation.

Your hairline frames and defines your face, making it a particularly important component of feminization or Facial Feminization Surgery.

For example, a masculine-shaped hairline will make a small nose or long eyelashes appear more masculine; whereas a softer, more feminine hairline can feminize a face, even if you have a strong jaw line and thick brows.

There is a wealth of information—and misinformation—on the Internet about the female hairline, including shapes and heights. With this in mind, we want to demystify some common misconceptions and debunk popular myths to ensure that you have all of the information you need when considering your options. (more…)

Read more

Pain Relief After Plastic Surgery

January 5, 2016

Our approach is to reduce the chances of pain before, during and after your surgical procedure. To do this we utilize the most cutting-edge, non-narcotic painkillers to reduce pain and swelling resulting in faster recovery time and less discomfort.

Why do we choose non-narcotic painkillers?

The problem with narcotics is that they often have significant side effects, such as nausea, vomiting, constipation and even dependence and abuse for some people. All great reasons to avoid their use.

All of our patients receive a regional nerve block injection before surgery begins, which according to the Gate Theory of Pain, prevents pain from taking hold to start with. A nerve block is numbing medication (local anesthetic) injected near specific nerves to decrease pain during, and after, surgery.

Our patients receive a very specific block containing long-acting marcaine analgesics along with injectable steroids. We also provide a number of non-narcotic analgesics that are proven to be more effective than narcotics for our post-op patients.

This approach essentially relieves the majority of the discomfort that patients have after surgery, and limits narcotic use to rare circumstances and also speeds up recovery time.

What to know more? Call our office in Downtown San Francisco:

To make an appointment with Dr. Deschamps-Braly, please contact our San Francisco office +1.415.624.3922.

Read more

The Latest in Facelift Techniques

October 22, 2015

Many people are hesitant to get a facelift (rhytidectomy) because they are afraid that they will no longer look like themselves. But thankfully, the old Hollywood cliché of the tight-faced, pulled-back, artificial-looking facelift that was your grandmother’s facelift is a thing of the past.


In recent years plastic surgery techniques have evolved rapidly.

Previously, facelifts only pulled back the loose or sagging skin. Today’s facelift techniques work much deeper by actually lifting the underlying tissues and muscles under the skin upwards – rather than just back, resulting in a more natural-looking and longer-lasting result.

Today’s facelift is also as much about restoring lost volume due to aging, as it is about lifting. Fat Transfer or Fat Grafting as it is also known, is a very significant part of today’s facelift procedure and involves harvesting your body’s own fat and using it to restore facial volume while lifting your face.


Today’s facelifts are tailored to your needs and desired results.

One of the most significant improvements in facelift procedures is the understanding that there is no “one size fits all” to having your face lifted. These days we take a completely customized approach to your facelift. Everyone’s face is 100% unique and individual and a facelift must therefore also be fully customized to each individual’s desired results and facial features. Therefore your plastic surgeon needs to be as much an artist with a keen eye for the aesthetic, as he is a surgeon, to ensure that the end result is a natural looking one.

Today’s facelift techniques are a great improvement on the past, with many benefits including:

  • Improved recovery and healing
  • A more natural-looking result that enhances your existing features
  • Significantly longer-lasting results: 10-15 years depending on your procedure

Facelift techniques that we use and recommend:

There are several different types of facelifts available today. A good plastic surgeon will take the time to ask you about your desired results, listen to your concerns, and then make recommendations for a procedure that is right for you.

The different types of facelifts reflect the type of incision, the level of invasiveness and the area of the face to be lifted. We usually utilize one of the following two facelift techniques:


There is a facial layer known as the Superficial Musculo Aponeurotic System (SMAS) that consists of ligaments that hold cheek fat, and therefore the cheeks themselves in their normal position.

The SMAS or Deep Plane face lift is ideal for those with sagging jowls, mild to severe skin laxity, and/or mid-face sagging. One of the biggest benefits of this type of face lift is it has longer-lasting with effects – lasting about 10 to 15 years with fewer revisions.

The procedure works by re-suspending and then re-securing the SMAS layer. This rejuvenates the face by counteracting skin laxity caused by aging and gravity.

During the Deep Plane face lift, your plastic surgeon separates the skin from the Superficial Musculoaponeurotic System (SMAS) layer. He then works in underneath the layer to release attachments, allowing him to literally “lift” the layer and its’ accompanying skin, to a more natural and youthful position.

The SMAS system is then tightened with sutures, and any excess or redundant skin is removed and remaining skin is stitched closed.

What to know more about facelift or necklift procedures? Call our office in Downtown San Francisco:

To make an appointment with Dr. Deschamps-Braly, please contact our San Francisco office +1.415.624.3922.

Read more

Patient Safety & Plastic Surgery

October 21, 2015

One of our most frequently asked questions is: “Is plastic surgery safe?”

Caitlin Sacher works alongside Dr. Deschamps-Braly as his Surgical Physician Assistant and together they have built a surgical team dedicated to ensuring outstanding excellence in patient-centered care and the utmost patient safety.

While every surgical procedure carries it’s own inherit risks, she explained, certain systems can be set in place to help ensure a safe surgery by minimizing unnecessary surgical complications.

“Much like a pilot running through a “pre-flight checklist” prior to take off, we strictly adhere to the use of a “pre-operative checklist” to ensure all potential complications or difficulties that could arise during your surgery are caught early and addressed appropriately.

“For weeks prior to a patient undergoing surgery, we take all necessary measures to ensure we can perform the safest surgery possible by verifying medications and any allergies, preforming pre-operative testing or work-up, reviewing your prior medical and surgical history, obtaining imaging, and, if necessary, reaching out to other physicians to coordinate additional patient care outside of surgery.

“By starting this pre-surgical preparation process well in advance of your surgery, it allows enough time to obtain any and all information we need in order to proceed with the safest surgery possible.

Additionally, Caitlin Sacher or Dr. Deschamps-Braly will have a pre-operative meeting with you a few days prior to your surgery to answer any last minute questions you may have, and also to review the surgical ‘game plan’.

We truly pride ourselves on our open and clear communication style and fine attention to detail because this translates into our patients’ knowing they can trust us in delivering not only a beautiful aesthetic outcome, but a safe one as well.




Dermabrasion (also known as Dermaplaning) is a safe and effective way to smoothen fine lines and wrinkles, reduce the appearance of acne scarring and alleviate uneven skin pigmentation and sun damage. Dermabrasion is relatively painless and can be performed at our office in downtown San Francisco.

The procedure can also be used in combination with other treatments, such as scar revision, facelift or a chemical peel.

TCA Chemical Peels is a facial skin peel treatment ideal for treating wrinkles and fine lines, acne scarring and other scars, enlarged pores freckles, blemishes and uneven skin pigmentation caused by sun damage.

The TCA peel is much deeper and more powerful than the more common exfoliation peel performed by a beautician or cosmetologist, but it is not as invasive as laser resurfacing resulting in a faster recovery time.





Micro Needling – also known as Skin Needling – involves the use of tiny and very short needles to penetrate the skin. The procedure causes a very mild sensation and only very superficial punctures of the skin.

These “micro-injuries” catalyse the skin’s own natural healing response to produce and rebuild collagen and elastin, which results in a smoother appearance and a reduction of fine wrinkles and lines.

Microneedling is ideal for:

  • Reduction of fine wrinkles and lines due to aging or smoking
  • Improving skin texture and smoothness
  • Evening out colour & skin tone
  • Reducing broken capillaries or spider veins
  • Large pores, acne or burn scars
  • Firms, lifts and sculpts to help tone sagging skin





The aging of the upper lip is influenced by several factors: sun exposure, genetics, cigarette smoking, and natural aging. Wrinkling and flattening of the upper lip causes small vertical cracks and wrinkles to extend outwards into the skin around the lips – causing lipstick to ‘bleed’ into the surrounding skin. Thankfully, there are several surgical – and non-surgical – solutions to rejuvenate and enhance your lips and restore them to a more youthful appearance.

Treatment options for Lip Rejuvenation include:

1. Lip Augmentation using Restylane® Dermal Filler
Lip augmentation is a non-surgical procedure that plumps and “augments” the lips using an injectable dermal filler such as Restylane®. Augmentation especially works for increasing lip volume and reducing lip wrinkles and fine lines.

2. Surgical Lip Augmentation using Dermal Fat Grafts (Fat Transfer)
Fat Grafting is very popular because it uses your body’s own fat rather than any artificial or foreign material that is grown in a lab. Most patients successfully experience permanent results with Fat Grafting and do not require subsequent treatments.

3. Lip Lift or Lip Reduction
This is a surgical procedure that is performed on those who feel that their upper or lower lips are disproportionate or too large. The incisions are hidden in natural creases beneath the nostrils or on the inside of the lip, leaving no obvious scarring.

4. Perioral Dermabrasion for Wrinkles Around the Mouth
Perioral Dermabrasion lessens the appearance of wrinkles around the mouth or “smoker’s lines” to create a youthful appearance. The procedure removes several layers of skin to stimulate collagen production for a permanent improvement.

5. BOTOX® Cosmetic for Smile Lines
When BOTOX® is injected with the correct skill and aesthetic artistry, it results in a very natural-looking result so others won’t know you have had “work done”. You will still be able to smile naturally without appearing “frozen” or without emotion.


Want to know more? Call our office in Downtown San Francisco:

To make an appointment with Dr. Deschamps-Braly, please contact our San Francisco office +1.415.624.3922.

Read more

Fat May be the Right Filler for You

February 28, 2013

In an age where the predominant health topic seems to revolve around trying to rid ourselves of excess fat, why would anyone want to discuss why adding fat to certain areas may be something to consider?

This discussion is suited to anyone who has ever had fillers injected into their face or considered having such injections.  I would like to introduce considerations for when and why someone might consider using their body’s own tissue rather than a pharmaceutical product that comes in a syringe.  The takeaway from this article should be for a patient to have a better understanding of fat grafting and to generate awareness of this modality so that patients may ask more informed questions.

Non-surgical treatment to treat wrinkles and signs of aging have rapidly increased over the past five years.  In a fast-paced world with shrinking expendable income, people often turn to what are perceived to be less costly alternatives to surgery to address concerns about visible signs of aging.   Often, personnel delivering these treatments don’t have the experience and training to offer alternatives which a well informed patient should know about when making important decisions about their care.

Usually, people first turn to fillers and botulinum toxin to treat wrinkles.  Botox and similar compounds are used to treat wrinkles that appear when facial muscles contract.    These are called “dynamic” wrinkles.  However, Botox does not treat wrinkles that are present when you face is relaxed.  These wrinkles are called “static” wrinkles. Treatment of “static” wrinkles is why most people first come to use pharmaceutical fillers.

Modest improvement of “static” wrinkles is usually accomplished with fillers, however, that is not where the story ends.  As we age, there is more going on than the wrinkles that we see on our face.  As we age, there is a general deflation of the deeper layers of fat that defines a youthful face.  Take a look at a picture of your yourself 20 years ago.  Assuming you are about the same weight, one cannot help but notice that some modest deflation has occurred.

The loss usually first becomes apparent in our mid 40’s and continues throughout our lives.  It happens in our temples first, then in our cheeks, our lips, and other places.  At the same time we tend to accumulate excessive amounts of fat under our chins, and we see descent of the more superficial layers of fat.  It is this progressive shifting of facial fat that leads to very important signs of aging that should be addressed as part of a comprehensive plan to restore youthful features.

Borrowing fat from areas where we have excess accumulation of fat is one way to restore the contour of a youthful face.  But why would someone choose to have this “surgical” procedure versus a filler from a pharmaceutical company that can easily be performed in under an hour by a dermatologist or in some offices a nurse?

There are many advantages to using your own fat for restoring volume in the face, however, what if I told you that in some situations it might even be cheaper then all of these “easy” fillers.  In an era of people looking for cost effective treatments that is a very important consideration.

The most common fillers are only temporary solutions.  Depending on the filler used, they typically last for a period of 6-12 months.  These injections need to be periodically repeated to maintain their effect.  Fat on the other hand, when injected, tends to shrink a little at first but what remains is with you indefinitely.  That is one of the large advantages to using your own fat for this purpose.

When the goal of treatment is to comprehensively treat loss of fullness and volume in the face, the amount of volume needed is often anywhere between 10-30cc.  At these volumes the cost benefit of using pharmaceutical filler products tends to disappear and the cost advantage lies with using your own fat.  This is especially true when considering the need for periodic repeat treatment with these fillers.

Fat tends to move and feel more natural when injected into areas such as the lip when compared to some of the fillers.  For instance, some of the fillers can feel firm when placed into areas such as the lips which should be supple in a youthful individual.

There are other less obvious considerations. Fat is one of the bodies most plentiful sources of “mesenchymal” stem cells.  These are the cells that are able to replicate and turn into cells that contribute to improvement in circulation and elasticity in the skin.  Though much has been written about these cells, most surgeons who perform fat grafting will tell you that an improvement in skin quality is often seen after performing fat grafting.

Please keep in mind that no matter what filler you choose, trying to fill a face that has lost its elasticity can result in an overly inflated appearance and should be avoided unless also addressing the excess skin and descent of tissues.

So, I hope I have made a strong case for why you as a patient should consider speaking to someone who has experience with fat grafting.  However, to be fair, I would like to take a moment and describe when a pharmaceutical filler might be the right choice for you.   Pharmaceutical fillers are good for patients who don’t need a lot of volume to accomplish the intended treatment goals.  Fillers are also ideal for someone who needs to be ready for an important event or meeting as fast as possible as fat transfers tends to cause relatively more swelling and recovery time.

To make an appointment with Dr. Deschamps-Braly, please contact our San Francisco office +1.415.624.3922.

Read more


August 5, 2013

The facelift has evolved significantly since it was first performed over 100 years ago. The first facelift procedures were simple operations removing of a small piece of skin in front of the ear and then pulling the skin back. This was a novel and exciting idea at the time. The first facelift technique gave people options they never had before to combat the effect of gravity on the soft tissue of the face.

Innovators in the field, however, saw shortcomings with that procedure. The procedure did not drape the skin of the face in a natural way and it did not reposition the sagging tissue of the cheek or jowl. Therefore, additional lifting and re-draping of the skin around the face and neck were introduced in order to make the facelift and necklift procedure more effective. This became the “standard” facelift and necklift operation for the next 50 years. Many surgeons currently still use this technique.

This procedure evolved again in the 1980s to improve upon the necklift and facelift procedures we had at the time. Because skin is an elastic structure, it serves better as a cover for the deeper layers rather than as a structural element. French Surgeons who used deeper layers of the face to reposition sagging tissue led the philosophical shift to approaching this procedure in this manner. Facial structure and shape is now a much more importation issue than skin.

Skin now plays a secondary role to the deep layers of the face. Skin is re-draped gently to cover what we do underneath. In addition, we no longer need to pull tightly on skin because the important part of the operation is the repositioning of sagging cheeks, jowls and neck skin. Necklifts have similarly evolved over time. The necklift no longer uses the skin to reposition the sagging neck. A modern necklift in our practice now focuses on deeper structures to allow the contouring and tightening of the neck.

Fat grafting, which we have written about before, has been the largest advance in treating the aging face since the advances of the deep layer facelift and necklift. Fat grafting has allowed us to contour and finesse our results in cases where we could not otherwise get such a nice result.

For more information, or to make an appointment with Dr. Deschamps-Braly, please contact our San Francisco office +1.415.624.3922.

Read more