Dr. Neavin Speaks Internationally in Brazil on Fat Grafting to the Face

Dr. Neavin was honored over the weekend to be a guest speaker for the 2019 Plastic Regenerative Surgery meeting in Porto Alegre, Brazil, where he presented lectures on facial fat transfer and male plastic surgery.  The meeting comprised a legendary crowd of plastic surgeons from South America, which many argued to be the true mecca of the world for aesthetic plastic surgery.

The meeting was organized by The Brazilian Society of Plastic Surgery along with the support of the International Society of Plastic Regenerative Surgeons (ISPRES), an organization formed to promote and advance the science of regenerative plastic surgery through research and innovation.

The two day meeting featured some of the biggest names and innovators in the field of plastic surgery from Brazil and Argentina, including Raul Gonzalez, from Sao Paulo, Ronaldo Righesso from Bento Concalves, and Marcelo Maino, David Sena, Giulano Borille, and Carlos Uebel, from Porto Alegre.

The meeting started off with faculty dinner hosted by Dr. Carlos Uebel where there was no shortage of tasty, marinated meats of every cut — barbecued Brazilian style of course, and fine wines and chocolates.

The following morning, the meeting commenced with a series of presentations on perspectives and innovations in fat grafting. Included in this meeting was the well known international speaker, Dr. Sydney Coleman from the University of Pittsburgh Medical Center, who pioneered much of the way plastic surgeons perform fat grafting today.  Dr. Coleman shared some of his latest modifications of his technique with intriguing slides.

Following this series, were several breast surgery presentations, with an emphasis on fat transfer to the breast for both reconstructive and aesthetic purposes.  The series comprised six lectures on breast anatomy as it applied to fat transfer, indications for fat transfer to the breast, and oncological safety implications.

Next up, was the topic of buttock surgery.  Fat grafting of the buttock, also commonly called Brazilian butt lift (BBL),  has gained significant popularity across the world.  Oddly enough, the term BBL was coined by an American surgeon, despite the fact that Brazilians have been performing fat transfer to the buttock for years before it became known in the United States.

One of the hot topics at the meeting was safety in fat transfer.  There have been recent report of several deaths from BBL surgery from the United States.  In fact, the incidence for major complications from BBL surgery appear to be far greater in the US than in Brazil or other South American countries.  While the reason for this is not totally understood, it is more likely related to the enormous volumes  of fat that many unqualified plastic surgeons are injecting into the buttock in the States than simply a result of careless statistical reporting.  

It may be surprising to learn that Brazilian plastic surgeons on average inject much less fat into the buttock than many plastic surgeons in the US.  Dr. Neavin subscribes to the philosophy of “safety first” — there are indeed risks of overfilling the buttock. Perhaps the Brazilians learned this much earlier than their Northern neighbors.

Fat transfer fatalities have largely been the result, as recent studies have demonstrated, from intramuscular injections in very large volumes. A task force, spearheaded by the American Society of Plastic Surgeons,  has recently been created to better both understand and reduce complications related to BBL surgery.  Dr. Neavin believes that perhaps the first step should be oversight into who should and shouldn’t be doing this surgery.

“The unfortunate fact is, many doctors with no plastic surgery training are performing BBLs,” says Dr. Neavin.  The second step he hopes may entail stratifying risks associated with volume of fat.

“More isn’t always better.  High volumes mean high pressure.  And under high pressure, if large veins are injured in the muscle, fat may find the vein as a path of least resistance.  We have to be careful about overdoing it,” says Dr. Neavin.

Following talks on fat transfer to the buttock were four presentations on fat transfer for general reconstructive and cosmetic roles with speakers Dr. David Sena and Dr. Nelson Piccolo, including facial and hand rejuvenation, as well as vaginal and genital enhancement.  Dr. Piccolo presented interesting techniques on fat transfer to the vaginal wall and vulva with remarkable results. Dr. Sena, who has now authored several books on medicine, shared some incredibly detailed anatomy illustrations of the face delineating its multiple fat compartments.

After a coffee break, Dr. Neavin approached the podium along with Dr. Marco Pellon and Dr. Abel Chajchir for the face and periorbital sessions for fat transfer.  Dr. Neavin spoke on the “power’ of fat grafting for facial remodeling, and demonstrated the architectural changes of the face that occur with aging, and indications and approaches to restructure the face with fat or fillers. After the lecture, Dr. Neavin was asked by the moderator on indications for buccal fat removal as it relates to to facial shape, since buccal fat removal remains a popular procedure in Brazil.

“Patient selection is the key,” said Dr. Neavin. “If we can remodel the face with volume alone and get the definition we want without removing fat, that’s the ideal situation.  However, in certain bottom heavy faces, volume in the upper third of the face alone won’t do it.  In these cases, we should consider buccal fat removal.”

The last section of the day involved business strategies.  Dr. Neavin presented a talk on male plastic surgery, including trends, ideas for attracting male clients, and penis enhancement with fat and platelet rich plasma, while Dr. Sena discussed technology in plastic surgery.

Sunday, April 7, the meeting began with a live surgery.  A face lift with fat transfer and breast augmentation was performed, with Dr. Sydney Coleman demonstrating his method for fat processing — which differs from Dr. Neavin’s.  While Dr. Coleman centrifuges fat, Dr. Neavin prefers to filter it.  Of note, other doctors may just decant fat, and others strain it.  It is meetings such as this where leaders in the field can share what works — and doesn’t work for them.  

Following the surgery, was a debate on methods of fat grafting. Abel Chajchir from Argentina, as well as fat grafting guru Sydney Coleman from the University of Pittsburgh Medical Center shared the debate stage on this topic.  While most panelist agreed on several topics, differences of opinion emerged most of fat transfer to the breast and the use of growth factors with fat.

“I’m still a firm believer in breast implants for augmentation.  There is a role for fat, of course, but I avoid it when I can because many women don’t have enough, it often is unpredictable, and it can sometimes make mammography difficult,” Dr. Neavin said to the audience.

The day ended with interviews by Dr. Sena and a faculty dinner  where Dr. Neavin was awarded with a faculty medal from the Brazilian Society of Plastic Surgeons.

“This was a special weekend,” Dr. Neavin said.  “I am truly grateful for this invitation to speak here and I’m overwhelmed by everyone’s warm welcome and hospitality.”

After the meeting ended, Dr. Neavin had an opportunity to site see.  Colleague, and a good friend, Dr. Pedro Piccinini of Porto Alegre showed Dr. Neavin some of the town — then hit a surprise birthday party of yet another dear friend, Dr. Sena.

It was a perfect ending to a perfect meeting.