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Hyaluronic Acid Injectable Filler

Juvederm, Revanesse, and Rystalane are all composed of Hyaluronic Acid. These fillers are not for Ice Pick and very deep Box scars. However, they are very helpful for Rolling atrophic scars. Hyaluronic Acid tolerates by the tissues. Although, it is called an “acid” because of its end of a very long repeating sugar component. So, is the building block which gives skin volume. For this reason, we can call it a natural occurring substance. Though, it is purified for the use in humans. There is little question in regard to its safety. Hyaluronic Acid is used to raise the level of the skin, fill the volume loss, and reduce the depression. Treatment of Acne Scars is the best way to get a beautiful skin.

How many CC’s depends on how much of an area you would like to treat. All acne scars are “depressed” to varying degrees. The fillers inject into the dermis in order to raise them to a “higher” level which causes the skin to appear smoother. The molecule and its water occupy space and new collagen formation may follow. These materials vary in the number of connections or chemical bonds that are present within the sugar molecule.  More of these materials lead to a longer period of time before the molecule is eventually “dissolved” or removes from the skin.

Sculptra: Injectable Dermal Filler

History of Fat Grafting

Fat grafting is actually a century-old medical technique. After the first-ever fat transplantation event, fat grafting has not gained steam for the next 100 years due to procedure-related complications. Until 1990’s, no reliable liposuction techniques developed or standardized for fat purification and processing. Due to this limitation, the extracted fat was of inconsistent quality and the therapeutic outcomes were poor. In the 1990’s, a New York City-based Plastic Surgeon Dr. Sydney Coleman has developed and standardized reliable analytic techniques for fat graft harvesting, processing and transfer of fat into the recipient site. After he published his findings in reputable academic medical journals, the fat grafting procedure gained popularity, and used extensively for a variety of therapeutic and reconstructive purposes. Dr R Sadove performs fat grafting since the 1990’s.

Who performs Fat Cell  Grafting and where?

Fat Cell grafting procedure involves a small amount of liposuction as a preliminary step. Therefore, the procedure generally performs by trained Plastic Surgeons. The amount of fat removes is small and not evident afterwards.  Dr Sadove trains to maintain the standards of care during this small liposuction procedure as well to manage the procedure-related adverse events/complications.

Fat Cell Grafting process and Treatment of Acne Scars

Fat Cell transfer involves three main steps:

• Liposuction – extraction of a small amount of adipose fat from the donor area- usually the side of the lower abdomen

• Processing or purification – decanting and processing of the extracted fat Cells. Often, a blood sample removes at the same time, processes, and the platelet rich plasma mixes with the cells prior to re injection.

• Fat call step of grafting involves extraction of fat cells (lipocytes) and special cells from the donor area by employing standardized liposuction methods.

Manual techniques are the preferred choice of method, in which, thin liposuction cannulas inserts through the small holes to extract fat from the donor site. Ultrasonic or laser liposuction avoids as it can potentially destroy the lipocytes. After extraction, the fat is often processed by carefully spinning the fat cells in a special centrifuge, or mesh. Followed by washing to isolate the viable fat cells from debris, dead cells and excess fluid.

The discarded fat cells are usually dead cells that are unlikely to survive if transplanted. In certain cases, these cells can harm the good cells and hence it should be discarded. Finally, the purified fat cells are re-injected in small droplets into the subcutaneous tissues of recipient areas that need reconstruction/treatment. In this way, adequate blood supply to the transplanted cells and their survival (post-procedural) can be ensured. The amount of injectable fat/special cells  is generally measured in cc’s which varies from one patient to another, depending on patient’s requirement and the recipient site.

Types of Anesthesia Used

Fat/Special Cell grafting procedure is performed by employing a variety of local anesthetic drugs and the choice of anesthetic drug depends on the volume of fat that needs to be extracted by liposuction technique. Small volumes of fat can be conveniently harvested under the influence of local anesthesia. As local anesthesia, administration does not change your level on consciousness it can be performed by Dr Sadove in the office. You are comfortable but awake. However, General anesthesia or IV anesthesia administers by a Board Certified Anesthesiologist at the Surgical Pavilion of NFRMC. Auto fat is not for Ice Pick or Box Scars. It can be very helpful in Rolling Atrophic Scars either with or without subcision.

Treatment of Acne Scars on Face

• Requires 10cc –20cc of injectable purified fat cells in total.

• Efficiently repairs scar tissues including traumatic scars

• Restores youthful appearance by filling-in the hollow cheeks, temples and orbital area

• Corrects wrinkled areas including nasolabial folds and area below the eye(s).

• Enhances the appearance and texture of the skin.

Filler Acne Scar Treatment

There are soft rolling scars that can be improved with “off the shelf” filler injectable products. If injection is not successful in raising the scar subcision should be performed. Rolling scars have smooth, sloping borders, and there are scar injection techniques capable of producing positive results. Only injection treatments which deal with the fundamental loss of thickness of the dermis and underlying fat will raise the skin to the level of the surrounding skin. While injectable fillers may be used successfully, they are best reserved for smaller areas of acne scar. Often the large size of the affected area makes fillers an unappealing financial option. If several syringes of a filler are required, it make more financial sense to use the patients own fat. In softer scars, they are able to push the depressed skin up to the level of surrounding skin. In such cases, fillers become a desirable option.

Juvederm Treatment for Acne Scar– Juvederm is a large sugar molecule commonly used for cosmetic injection in the face. It is an extremely safe material, but not permanent.

Sculptra Treatment for Acne Scar– Dr Sadove has used Sculptra successfully in soft rolling scar acne scar treatment cases where subcision was not necessary. Stem Cells for Acne Scar Treartment

There is no place for injection of ice pick or box scars with fillers.


LASERS AND CHEMICAL PEELS IN ACNE SCAR Treatment of acne scars which are deep cannot come from the top side of the skin. Regardless of the latest “wizbang” laser being pushed on the public via aggressive marketing, laser therapy is of limited value.  Effective therapies will only come from below, pushing the scar area up again to the level of normal skin. rom the top or epidermal side are not very effective in raising the skin to an even level. Laser resurfacing (ablative and non-ablative), intense pulsed light (IPL), chemical peels, and micro-dermabrasion produce limited improvements in the appearance of scars.

The reason for treatment of acne scars is because the problem cannot be treated from above on the top of the skin. The problem lies below in the loss of dermis and fat. None the less, there is some benefit from laser or chemical peels of the skin in many acne scar patients with more minor scars . Acne scar patients often have brown pigmentation which results from the chronic inflammation. It is often of great benefit to even the color and texture with such treatments and creams. Hydroquinone and retinoic and glycolic acids creams are often used successfully.

Lasers are also used to reduce the redness of acne which is no longer infected but not old enough for the redness to fade. Most redness of acne resolves eventually on its own. It may take a very long time. Laser treatments selected for redness can be of help in reducing the period of redness. It is usually best to wait for the redness to resolve on its own instead of investing in the cost of a laser treatment to shorten the period of redness. To know more, contact Dr. Sadove

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