Sydney R. Coleman, M.D.

Fat grafting accelerates revascularisation and decreases fibrosis following thermal injury
Sultan SM; Barr JS; Butala P; Davidson EH; Weinstein AL; Knobel D; Saadeh PB; Warren SM; Coleman SR; Hazen A
2011 Feb;65(2):219-227, Journal of plastic, reconstructive & aesthetic surgery : JPRAS
BACKGROUND: Fat grafting has been shown clinically to improve the quality of burn scars. To date, no study has explored the mechanism of this effect. We aimed to do so by combining our murine model of fat grafting with a previously described murine model of thermal injury. METHODS: Wild-type FVB mice (n=20) were anaesthetised, shaved and depilitated. Brass rods were heated to 100 degrees C in a hot water bath before being applied to the dorsum of the mice for 10s, yielding a full-thickness injury. Following a 2-week recovery period, the mice underwent Doppler scanning before being fat/sham grafted with 1.5cc of human fat/saline. Half were sacrificed 4 weeks following grafting, and half were sacrificed 8 weeks following grafting. Both groups underwent repeat Doppler scanning immediately prior to sacrifice. Burn scar samples were taken following sacrifice at both time points for protein quantification, CD31 staining and Picrosirius red staining. RESULTS: Doppler scanning demonstrated significantly greater flux in fat-grafted animals than saline-grafted animals at 4 weeks (fat=305+/-15.77mV, saline=242+/-15.83mV; p=0.026). Enzyme-linked immunosorbent assay (ELISA) analysis in fat-grafted animals demonstrated significant increase in vasculogenic proteins at 4 weeks (vascular endothelial growth factor (VEGF): fat=74.3+/-4.39ngml(-1), saline=34.3+/-5.23ngml(-1); p=0.004) (stromal cell-derived factor-1 (SDF-1): fat=51.8+/-1.23ngml(-1), saline grafted=10.2+/-3.22ngml(-1); p<0.001) and significant decreases in fibrotic markers at 8 weeks (transforming growth factor-ss1(TGF-ss): saline=9.30+/-0.93, fat=4.63+/-0.38ngml(-1); p=0.002) (matrix metallopeptidase 9 (MMP9): saline=13.05+/-1.21ngml(-1), fat=6.83+/-1.39ngml(-1); p=0.010). CD31 staining demonstrated significantly up-regulated vascularity at 4 weeks in fat-grafted animals (fat=30.8+/-3.39 vessels per high power field (hpf), saline=20.0+/-0.91 vessels per high power field (hpf); p=0.029). Sirius red staining demonstrated significantly reduced scar index in fat-grafted animals at 8 weeks (fat=0.69+/-0.10, saline=2.03+/-0.53; p=0.046). CONCLUSIONS: Fat grafting resulted in more rapid revascularisation at the burn site as measured by laser Doppler flow, CD31 staining and chemical markers of angiogenesis. In turn, this resulted in decreased fibrosis as measured by Sirius red staining and chemical markers
— id: 138703, year: 2011, vol: 65, page: 219, stat: Journal Article,

Human Fat Grafting Alleviates Radiation Skin Damage in a Murine Model
Sultan SM; Stern CS; Allen RJ; Thanik VD; Chang CC; Nguyen PD; Canizares O; Szpalski C; Saadeh PB; Warren SM; Coleman SR; Hazen A
2011 Aug;128(2):363-372, Plastic & reconstructive surgery
BACKGROUND: Autogenous fat grafting has been observed to alleviate the sequelae of chronic radiodermatitis. To date, no study has replicated this finding in an animal model. METHODS: The dorsa of adult wild-type FVB mice were shaved and depilitated. The dorsal skin was then distracted away from the body and radiated (45Gy) using a Varian 2300 Linear Accelerator. Four weeks following radiation, 1.5cc fat or sham grafts were placed in the dorsal subcutaneous space. Gross results were analyzed photometrically. The animals were sacrificed at 4 and 8 weeks following fat or sham grafting and their dorsal skin was processed for histologic analysis. Inflammation was assessed by epidermal thickness measurements on H&E stained sections. Vascular density was assessed using CD31 staining. Fibrosis was assessed using Smad-3 and Picrosirius Red staining. RESULTS: Hyperpigmentation and ulceration were grossly improved in fat-grafted mice compared to sham-grafted controls. Epidermal thickness measurements demonstrated decreased thickness in fat-grafted animals at both timepoints (20.6+/-1.5mum vs 55.2+/-5.6mum, p=0.004; 17.6+/-1.1mum vs 36.3+/-6.1mum, p=0.039). Vascular density was decreased in fat-grafted mice compared to sham-grafted at both timepoints (17.5+/-1.3 vessels/hpf vs 29+/-3.5, p=0.055; 13.25+/-1.4 vs 17.0+/-1.6, p=0.003). Intensity of Smad3 staining was significantly decreased in fat-grafted animals at both timepoints (2.77+/-0.3% vs 4.98+/-0.9%, p=0.004; 3.05+/-0.2% vs 5.81+/-0.3%, p=0.011). Picrosirius red staining demonstrated a diminished scar-index in fat-treated animals at both timepoints (.54+/-0.05 vs .74+/-0.07, p=0.034; .55+/-0.06 vs .93+/-.07, p=0.001). CONCLUSIONS: Fat grafting attenuates inflammation in acute radiodermatitis and slows the progression of fibrosis in chronic radiodermatitis
— id: 134340, year: 2011, vol: 128, page: 363, stat: Journal Article,

A novel mouse model of cutaneous radiation injury
Thanik, Vishal D; Chang, Christopher C; Zoumalan, Richard A; Lerman, Oren Z; Allen, Robert J Jr; Nguyen, Phuong D; Warren, Stephen M; Coleman, Sydney R; Hazen, Alexes
2011 Feb;127(2):560-568, Plastic & reconstructive surgery
BACKGROUND: : Radiation therapy is a cornerstone of oncologic treatment. Skin tolerance is often the limiting factor in radiotherapy. To study these issues and create modalities for intervention, the authors developed a novel murine model of cutaneous radiation injury. METHODS: : The dorsal skin was isolated using a low-pressure clamp and irradiated. Mice were followed for 8 weeks with serial photography and laser Doppler analysis. Sequential skin biopsy specimens were taken and examined histologically. Tensiometry was performed and Young's modulus calculated. RESULTS: : High-dose radiation isolated to dorsal skin causes progressive changes in skin perfusion, resulting in dermal thickening, fibrosis, persistent alopecia, and sometimes ulceration. There is increased dermal Smad3 expression, and decreased elasticity and bursting strength. CONCLUSIONS: : This model of cutaneous radiation injury delivers reproducible localized effects, mimicking the injury pattern seen in human subjects. This technique can be used to study radiation-induced injury to evaluate preventative and therapeutic strategies for these clinical issues
— id: 122548, year: 2011, vol: 127, page: 560, stat: Journal Article,

Improved fat graft survival with mobilization of progenitor cells
Butala, Parag; Sultan, Steven M.; Davidson, Edward H.; Crawford, James L.; Szpaiski, Caroline; Knobel, Denis; Saadeh, Pierre B.; Warren, Stephen M.; Coleman, Sydney; Hazen, Alexes
2010 SEP ;211(3):S94-S95, Journal of the American College of Surgeons
— id: 113916, year: 2010, vol: 211, page: S94, stat: Journal Article,

Cryopreservation of autologous fat grafts harvested with the coleman technique
Pu, Lee L Q; Coleman, Sydney R; Cui, Xiangdong; Ferguson, Robert E H Jr; Vasconez, Henry C
2010 Mar;64(3):333-337, Annals of plastic surgery
The viability of fat grafts harvested with an established technique after cryopreservation remains unknown. This study was conducted in vitro to evaluate the viability of autologous fat grafts harvested with the Coleman technique and subsequently preserved with our preferred cryopreservation method. Eight adult females were enrolled in this study. In each patient, 10 mL of fat grafts were harvested with the Coleman technique by a single surgeon from the lower abdomen. In group 1, 5 mL of fresh fat grafts were mixed with cryoprotective agents and underwent cryopreservation with controlled slow cooling and fast rewarming. In group 2, 5 mL of fresh fat grafts without cryopreservation from the same patient served as a control. The fat graft samples from both groups were evaluated with trypan blue vital staining, glycerol-3-phophatase dehydrogenase assay, and routine histology. Viable adipocyte counts were found similar in both group 1 and group 2 (3.46 +/- 0.91 vs. 4.12 +/- 1.11 x 10/mL, P = 0.22). However, glycerol-3-phophatase dehydrogenase activity was significantly lower in group 1 compared with group 2 (0.47 +/- 0.09 vs. 0.66 +/- 0.09 u/mL, P < 0.001). Histologically, the normal structure of fragmented fatty tissues was found primarily in both groups. Our results indicate that autologous fat grafts harvested with the Coleman technique and preserved with our preferred cryopreservation method have a normal histology with near the same number of viable adipocytes as compared with the fresh fat grafts. However, those cryopreserved fat grafts appear to have a less optimal level of adipocyte specific enzyme activity compared with the fresh ones and thus may not survive well after they are transplanted without being optimized
— id: 107390, year: 2010, vol: 64, page: 333, stat: Journal Article,

FAT GRAFTING FOR THE TREATMENT OF MURINE RADIATION SKIN DAMAGE
Allen, RJ; Nguyen, PD; Varjabedian, L; Schachar, JS; Thanik, VD; Saadeh, PB; Coleman, SR; Hazen, A
2009 MAR-APR ;17(2):A18-A18, Wound repair & regeneration
— id: 97661, year: 2009, vol: 17, page: A18, stat: Journal Article,

Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves
Coleman, Sydney R; Sachdeva, Kulveen; Egbert, Barbara M; Preciado, Jessica; Allison, John
2009 Jul;33(4):482-488, Aesthetic plastic surgery
BACKGROUND: Cryolipolysis provides a method for noninvasive fat reduction that significantly reduces subcutaneous fat in a pig model without apparent damage to skin and surrounding structures. This study aimed to determine whether fat reduction in humans caused by cold exposure is associated with alteration in local sensory function or nerve fibers. METHODS: In this study, 10 subjects were treated with a prototype cooling device. Fat reduction was assessed in 9 of the 10 subjects via ultrasound before treatment and at the follow-up visit. Sensory function was assessed by neurologic evaluation (n = 9), and biopsies (n = 1) were collected for nerve staining. RESULTS: Treatment resulted in a normalized fat layer reduction of 20.4% at 2 months and 25.5% at 6 months after treatment. Transient reduction in sensation occurred in six of nine subjects assessed by neurologic evaluation. However, all sensation returned by a mean of 3.6 weeks after treatment. Biopsies showed no long-term change in nerve fiber structure. There were no lasting sensory alterations or observations of skin damage in any of the subjects evaluated. CONCLUSION: Noninvasive cryolipolysis results in substantial fat reduction within 2 months of treatment without damage to skin. The procedure is associated with modest reversible short-term changes in the function of peripheral sensory nerves
— id: 101278, year: 2009, vol: 33, page: 482, stat: Journal Article,

Current applications and safety of autologous fat grafts: A report of the ASPS Fat Graft Task Force
Gutowski K.A.; Baker S.B.; Coleman S.R.; Khoobehi K.; Lorenz H.P.; Massey M.F.; Pusic A.; Rubin J.P.
2009 ;124(1):272-280, Plastic & reconstructive surgery
TASK FORCE STATEMENT: In 2007, the American Society of Plastic Surgeons formed a task force to conduct an assessment regarding the safety and efficacy of autologous fat grafting, specifically to the breast, and to make recommendations for future research. The task force formulated specific issues regarding fat grafting and then compiled them to focus on five broad-based questions: 1. What are the current and potential applications of fat grafting (specifically breast indications, and if data are available, other cosmetic and reconstructive applications)? 2. What risks and complications are associated with fat grafting? 3. How does technique affect outcomes, including safety and efficacy, of fat grafting? 4. What risk factors need to be considered for patient selection at this level of invasiveness? 5. What advancements in bench research/molecular biology potentially impact current or future methods of fat grafting? To answer these questions, the task force reviewed the scientific literature, critically appraised the information available, and developed evidence-based practice recommendations. Although the primary issue of interest was fat grafting to the breast, other aspects of fat grafting were evaluated. copyright 2009 American Society of Plastic Surgeons
— id: 102493, year: 2009, vol: 124, page: 272, stat: Journal Article,

A murine model for studying diffusely injected human fat
Thanik, Vishal D; Chang, Christopher C; Lerman, Oren Z; Allen, Robert J Jr; Nguyen, Phuong D; Saadeh, Pierre B; Warren, Stephen M; Levine, Jamie P; Coleman, Sydney R; Hazen, Alexes
2009 Jul;124(1):74-81, Plastic & reconstructive surgery
BACKGROUND: The study of human autologous fat grafting has been primarily anecdotal. In this study, the authors aim to develop a murine model that recapitulates human fat grafting to study the fate of injected fat and the cell populations contained within. METHODS: The authors' method of fat harvesting and refinement has been described previously. The authors injected nude and tie2/lacZ mice with 2 ml of human lipoaspirate placed on the dorsal surface in a multipass, fan-like pattern. Fatty tissue was injected in small volumes of approximately 1/30 ml per withdrawal. The dorsal skin and associated fat was excised at various time points. Sections were stained with hematoxylin and eosin and cytochrome c oxidase IV. Transgenic tie2/lacZ samples were stained with X-galactosidase. At the 8-week time point, volumetric analysis was performed. RESULTS: Volumetric analysis at the 8-week time point showed 82 percent persistence of the original volume. Gross analysis showed it to be healthy, nonfibrotic, and vascularized. Hematoxylin and eosin analysis showed minimal inflammatory or capsular reaction, with viable adipocytes. Fat grafted areas were vascularized with multiple blood vessels. Cytochrome c oxidase IV human-specific stain and beta-galactosidase expression revealed these vessels to be of human origin. CONCLUSIONS: The authors have developed a murine model with which to study the fate of injected lipoaspirate. There is a high level of persistence of the grafted human fat, with minimal inflammatory reaction. The fat is viable and vascularized, demonstrating human-derived vessels in a mouse model. This model provides a platform for studying the populations of progenitor cells known to reside in lipoaspirate
— id: 100530, year: 2009, vol: 124, page: 74, stat: Journal Article,

Lower lid deformity secondary to autogenous fat transfer: a cautionary tale
Coleman, Sydney R
2008 May;32(3):415-417, Aesthetic plastic surgery
— id: 93295, year: 2008, vol: 32, page: 415, stat: Journal Article,

Autologous fat grafts harvested and refined by the Coleman technique: a comparative study
Pu, Lee L Q; Coleman, Sydney R; Cui, Xiangdong; Ferguson, Robert E H Jr; Vasconez, Henry C
2008 Sep;122(3):932-937, Plastic & reconstructive surgery
BACKGROUND: The viability of fat grafts obtained by even a well-established technique remains poorly studied and unknown. This study was designed to determine the viability of fat grafts harvested and refined by the Coleman technique. METHODS: Sixteen adult white women were enrolled in this study. In group 1 (n = 8), fat grafts were harvested and processed with the Coleman technique by a single surgeon from the abdomen of each patient according to his standardized method. In group 2 (n = 8), fat grafts were harvested with the conventional liposuction by another surgeon. After centrifugation, the resulting middle layer of tissue was collected. All fat graft samples were analyzed for the following studies: trypan blue vital staining for viable adipocyte counts, glycerol-3-phophatase dehydrogenase assay, and routine histologic examination. RESULTS: The higher viable adipocyte counts were found in group 1 compared with group 2 (4.11 +/- 1.11 versus 2.57 +/- 0.56 x 10 cells/ml; p < 0.004). The level of glycerol-3-phophatase dehydrogenase activity was significantly higher in group 1 compared with group 2 (0.66 +/- 0.09 versus 0.34 +/- 0.13 U/ml; p < 0.0001). Histologic examination showed normal structure of fragmented fatty tissues in both groups. CONCLUSIONS: Although fat grafts obtained by both methods maintain normal histologic structure, the Coleman technique yields a greater number of viable adipocytes and sustains a more optimal level of cellular function within fat grafts and should be considered superior to conventional liposuction as a preferred method of choice for fat graft harvesting
— id: 96225, year: 2008, vol: 122, page: 932, stat: Journal Article,

Treatment of radiation skin damage with Coleman fat grafting
Chang, CC; Thanik, VD; Lerman, OZ; Saadeh, PB; Warren, SM; Coleman, SR; Hazen, A
2007 NOV ;25(12):3280-3281, Stem cells
— id: 75629, year: 2007, vol: 25, page: 3280, stat: Journal Article,

Fat grafting to the breast revisited: safety and efficacy
Coleman, Sydney R; Saboeiro, Alesia P
2007 Mar;119(3):775-785, Plastic & reconstructive surgery
BACKGROUND: A 1987 American Society of Plastic and Reconstructive Surgeons position paper predicted that fat grafting would compromise breast cancer detection and should therefore be prohibited. However, there is no evidence that fat grafting to breasts is less safe than any other form of breast surgery. As discussions of fat grafting to the breast are surfacing all over the world, it is time to reexamine the opinions of the 1987 American Society of Plastic and Reconstructive Surgeons position paper. METHODS: This is a retrospective examination of 17 breast procedures performed using fat grafting from 1995 to 2000. Indications included micromastia, postaugmentation deformity, tuberous breast deformity, Poland's syndrome, and postmastectomy reconstruction deformities. The technique used was the Coleman method of fat grafting, which attempts to minimize trauma and place grafted fat in small aliquots at many levels. RESULTS: All women had a significant improvement in their breast size and/or shape postoperatively and all had breasts that were soft and natural in appearance and feel. Postoperative mammograms identified changes one would expect after any breast procedure. CONCLUSIONS: Given these results and reports of other plastic surgeons, free fat grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures. It is time to end the discrimination created by the 1987 position paper and judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure
— id: 71214, year: 2007, vol: 119, page: 775, stat: Journal Article,

Cross-linked hyaluronic acid fillers
Coleman, Sydney R
2006 Feb;117(2):661-665, Plastic & reconstructive surgery
— id: 96226, year: 2006, vol: 117, page: 661, stat: Journal Article,

Facial augmentation with structural fat grafting
Coleman, Sydney R
2006 Oct;33(4):567-577, Clinics in plastic surgery
Fat grafting through a blunt cannula has been used by plastic surgeons for altering facial contours for 100 years. Autologous tissue is completely biocompatible and is usually the safest choice for altering facial volume or contours. Fat grafts can be placed in such a fashion that they are long lasting, completely integrated, and natural appearing. Only in the past 20 years have advances in techniques and instrumentation allowed us to obtain predictable results that make fat grafting a viable option for soft tissue augmentation. Our understanding of aging and methods of rejuvenation have developed also. We now approach rejuvenation and adjustment of facial proportion with a better understanding of the need for the restoration or adjustment of facial volume
— id: 70090, year: 2006, vol: 33, page: 567, stat: Journal Article,

Structural fat grafting: more than a permanent filler
Coleman, Sydney R
2006 Sep;118(3 Suppl):108S-120S, Plastic & reconstructive surgery
Grafted fat has many attributes of an ideal filler, but the results, like those of any procedure, are technique dependent. Fat grafting remains shrouded in the stigma of variable results experienced by most plastic surgeons when they first graft fat. However, many who originally reported failure eventually report success after altering their methods of harvesting, refinement, and placement. Many surgeons have refined their techniques to obtain long-term survival and volume replacement with grafted fat. They have observed that transplanted fat not only adjusts facial and body proportion but also improves surrounding tissues into which the fat is placed. They have noted not only the improvement in the quality of aging skin and scars but also a remarkable improvement in conditions such as radiation damage, chronic ulceration, breast capsular contracture, and damaged vocal cords. The mechanism of fat graft survival is not clear, and the role of adipose-derived stem cells and preadipocytes in fat survival remains to be determined. Early research has indicated the possible involvement of more undifferentiated cells in some of the observed effects of fat grafting on surrounding tissues. Of particular interest is the research that has pointed to the use of stem cells to repair and even to become bone, cartilage, muscle, blood vessels, nerves, and skin. Further studies are essential to understand grafted fat tissue
— id: 68782, year: 2006, vol: 118, page: 108S, stat: Journal Article,

Aesthetic considerations following facial reanimation procedures
Terzis, Julia K; Rose, Elliott H; Coleman, Sydney; Walton, Robert L
2006 Jan-Feb;26(1):57-68, Aesthetic surgery journal
— id: 115161, year: 2006, vol: 26, page: 57, stat: Journal Article,

Structural Fat Grafting
Coleman SR
2005 May;115(6):1777-1778, Plastic & reconstructive surgery
— id: 58088, year: 2005, vol: 115, page: 1777, stat: Journal Article,

Hand rejuvenation with structural fat grafting
Coleman, Sydney R
2002 Dec;110(7):1731-1744, Plastic & reconstructive surgery
A simple, reliable technique of autologous fat grafting for long-lasting rejuvenation of the dorsum of the hand is presented. With this technique, small intact parcels of fatty tissue are harvested with a syringe and a blunt 3-mm cannula. Then, most of the nonviable components are removed from the harvested subcutaneous material by centrifugation, decanting, and wicking. Finally, a 17-gauge blunt cannula places the fat in minuscule parcels of tissue with many passes through five or six tiny incisions in the hand. Separation of the tiny parcels of fat maximizes contact between the surfaces of the transplanted fat and surrounding recipient tissues to encourage integration, anchoring, and long-term survival. Structured, purposeful placement of a thin layer of transplanted fat rejuvenates the dorsal hand by restoring a slight fullness to atrophic subcutaneous tissue, by softening the color and definition of exposed extensor tendons and dorsal hand veins, and by supporting the aging skin
— id: 58089, year: 2002, vol: 110, page: 1731, stat: Journal Article,