What happens to all the fat tissue after it is suctioned out of bloated bellies and flabby thighs? It was being discarded in medical hazmat bins or flushed down toilets before Dr. Richard Ellenbogen found other uses for it.
The West Hollywood plastic surgeon is known as the “father of fat grafting” – though he doesn’t have a coffee mug or sign on his desk sporting the moniker. Ellenbogen, 68, uses a patient’s own fat to plump up her cheekbones, chisel her jaw line and create fuller lips. His results last longer and make patients look younger than traditional facelifts that simply tighten skin, he said.
He began researching fat grafting in the 1970s, after he completed his medical training and set up an office in Los Angeles. “I was de-fatting heavy necks and found I would have a whole stack of fat to throw out,” Ellenbogen said.
He combed through early medical literature and to his surprise turned up more than 800 articles in six languages, dating from 1898, about fat being removed from one area of the body and transplanted elsewhere.
“I was completely surprised. It seems this procedure was used even before World War I but it was forgotten about when we got silicone in the 1950s,” Ellenbogen said.
One medical article, published in 1914, had a particular impact on him: A doctor described how he had taken what he called “pearls of fat” and placed them into implants and to correct deep-set eyes. Ellenbogen began experimenting with similar techniques and found they were long-lasting.
“There are two things that happen when people age: Their skin sags and the facial volume of fat decreases and shifts. We had a facelift operation where we tightened the skin but we had no way to replace that loss of volume,” he said. The results often left patients looking “weird, strange or gaunt.” Then Ellenbogen began replacing the lost fat while doing facelifts, so he was tightening the skin externally and internally replacing fat to fill in the hollows.
The technique he developed is called a “volumetric facelift.” He began lecturing on it in 1979, but it took three tries and a series of biopsy results showing the fat persisted over three years before he could get his findings published in a medical journal in 1982. Since that time, Ellenbogen has traveled around the world teaching his technique to other plastic surgeons. One of his students invented a line of surgical instruments now used widely for fat-grafting.
“We know how to treat the fat so that it lasts longer and we combine that with neck surgery or a facelift,” he said. Brown fat removed from the waist lasts the longest: “This is the kind of fat that bears use to hibernate. It has tremendous energy and does not break down so easily.”
Fat grafting isn’t the only thing he’s been innovating. In recent years, Ellenbogen worked with Korean researchers to test whether activating adipose-derived stem cells with lasers would help it persist longer in the body. There are approximately 1 million stem cells in two teaspoons of fat.
“We figured that since stem cells can become any cell, if they were injected into the face, the skin there would repair itself and people wouldn’t age,” he said.
But the results have been disappointing and his research “didn’t pan out,” Ellenbogen said. “The procedure is tremendously tedious and we did extraordinary follow up, but we could not prove any improvement over standard fat grafting. Stem cells are the wrong tree to bark up.”
He is currently evaluating Cellulaze, a treatment that targets cellulite, which forms dimply skin. The procedure is performed in a doctor’s office under local anesthesia with a special type of laser. Cleared by the Food and Drug Administration in January, Cellulaze was developed by medical device manufacturer Cynosure, headquartered in Westford, Mass., to target bulging fat covered by thin skin. It is designed to break up the connective tissue that creates dimples, typically in the thighs, buttocks and abdomen.
Unlike traditional liposuction, which works on deep layers of fat, Cellulaze breaks up the fat just under the skin using a laser that creates heat and tightens skin as well as melting fat, Ellenbogen said. The manufacturer calls the one-time treatment a permanent solution to cellulite, but Ellenbogen said he’s reserving judgment for now.
“It’s not the result you get in six days but more like what happens in six months and later that matters,” Ellenbogen said.