Lipostructure Fat Grafting / TriBeCa Plastic Surgery review: Lipostructure! 12

The patient physician relationship is one of the most sacred in our society. It is legally protected and it forms the basis of successful and in some cases life saving partnerships in medicine. But when it goes bad, it can be bad.

Recently, in the world of plastic surgery attack blogs and complaint boards have come about denouncing practioners and “botched surgery”. Proponents argue that internet web blogs and sites serve as a warning or information source to patients. Detractors state that it represents an unregulated and often unsubstaniated attack. You can guess which side the doctors and which side the patients fall on.

Take the case of Dr. Sydney Coleman, a board certified plastic surgeon in New York (www.lipostructure.com), who has a seriously unhappy patient. As reported by Jim Leonardo of Plastic Surgery News, a publication from the American Society of Plastic Surgeons, “The trouble began shortly after Dr. Coleman performed corrective plastic surgery on the patient, who, after leaving the recovery room, was never again seen by the physician or his staff. Several weeks later, however, the patient telephoned the practice insisting that Dr. Coleman pay his airfare from Chicago to New York for a follow-up appointment - and if Dr. Coleman refused, he threatened to use the Internet to damage his practice.”

By report, Dr. Coleman declined to pay the airfare and the patient created a website decrying his treatment and outcome. Because the patient initially used Dr. Coleman’s name as part of the website address Dr. Coleman sued to get it back (see the National Arbitration decision in July 2006 here: http://domains.adrforum.com/domains/decisions/743682.htm ).

But that wasn’t the end of it. The patient re-registered a second name and reposted the website. And then, cleverly paid for advertisement placement of the site.

A little more research into this site confirms any practioner’s worst fears. There’s a lot of negativity. And there are a lot of claims, but not a lot of data.

The site states “Recently, a website associated with Dr. Coleman has posted a direct response to our support group website and suggests that the information we are providing is not accurate. As a result, we will soon be posting detailed information about malpractice lawsuits and other complaints filed against Dr. Coleman.”

Perhaps not suprisingly however, years later the site still remains empty about numbers of malpractice suits, complaints or unhappy patients. More troubling for those trying to find where the truth really lies is the patient him (or her) self has not even posted their _own_ pictures

“I met Dr. Coleman in 2003. Before discovering Dr. Coleman, I had several skin peels and dermabrasions for various facial scars all performed by a board certified plastic surgeon. The plastic surgeon encouraged me to continue the procedures thinking the next one would “do the trick”. Overtime this philosophy left my face sullen, pigmented and stripped of the tops layers of skin. I finally went to another plastic surgeon for a second opinion. He looked at my sullen face and suggested Dr. Coleman. This plastic surgeon attended a seminar where Dr. Coleman presented his research on lipostructure. He suggested that I get a consultation from Dr. Coleman as he feared the procedures being performed on my face were leaving me with a new kind of facial deformity.

I had a consultation with Dr. Coleman who explained his LipoStructure technique in great detail. I remember his extensive picture taking of my face and his explanation of harvesting, purifying and then placing fat taken from other parts of my body (in my case my inner thighs) into my face for restructuring and contouring. At every step in the process, he explained in detail the expectations, risks and how the healing processes would evolve over time. He explained that it sometimes took a few procedures to get the fat interspersed correctly through out my face and that it was a very delicate procedure that needed a healing curve to optimize the results. Basically, the procedure needs a patient to be patient.

The procedure itself is not painful. You are under sedation/anesthesia by a licensed anesthesiologist and wake up with bandages on the areas where fat was removed and where it was re-deposited. His office staff is helpful and gives very clear directions as to how to care for the areas post operatively. Once the bandages are removed then the healing process begins. As a pharmacist, I can tell you that the healing curve is very patient specific. Some people bruise easier than others and some require more time for swelling to subside so there is no exact timeline for these healing steps. Most importantly since they are regulated by your own body clock, the steps can not be rushed. Also, if there is one point to reinforce is that you must follow directions given by the staff. For example, after a period of time, ice is not warranted nor is the use of steroids helpful to decrease any swelling. The swelling will go away over time and can not be rushed. I think that this is the hardest part that some find annoying and at times disconcerting. I found it helpful not to keep looking in the mirror - waiting for instant results because the results do not come instantly but rather evolve through a rejuvenating process, restoring what was loss through aging or in my case trauma. Over time the rejuvenating results are apparent. There is swelling, bruises, redness in the eyes and even a little discomfort post the procedure, but as time goes by all disappear and the results of the procedure are natural and rejuvenating.

The transplanted fat feels like normal body structures. If the transplanted fat is near bone or cartilage then it feels like bone or cartilage. The LipoStructure system feels natural to the touch. Using this technique, Dr. Coleman refined and restructured my face but most importantly brought back myself confidence. Would I do it again? Yes. It changed my life and gave me the self confidence I needed to reach my goals.“

-- Helen, Pharmacist

OH! Here we go again. Another attempt by Sydney Coleman...to bury us even further. If you look under this same complaint board, you will discover another posting on Coleman that April Smith originated "AGAINST" Sydney Coleman...over one hundred and fifty days ago. These recent posts of "THE NEW" April Smith, have only appeared within the last several weeks...in an obvious attempt to confuse those searching for the truth...after possibly having read the multitude of "horror stories" by those intentionally mutilated and experimented on by this psychopath. These new April Smith posts...which praise Coleman...are in complete opposition to the "REAL APRIL SMITH TESTIMONIAL AND ALL OTHERS EXPOSING HIM.

This is not Rocket Science here folks. Go to other Sydney Coleman complaint posts...right here on this same complaint site and all listed, including those with pictures. See the ones already posted at the "Fat Graft Support Site" regarding hatch jobs by Sydney Coleman. Any praise for this beast, is a pathetic attempt at covering his tracks, of those he maimed in an attempt to gain experience by experimenting and intentional mutilation for whatever sick pleasure he may have derived?

See the pictures. They do not lie and please do not risk your safety. Coleman has a video of a woman who is pleased with her breasts...and she states that they have looked beautiful for years? My God, the fat that he put into my face and left it lopsided and huge like a basketball?...when it began to go down over a four year period? it did so...unevenly. Some areas went down faster than others. So how? are hers still uniform and looking great?

Also note, this was done without my knowledge or consent. I hired him to put fat into my lips and minimize wrinkles at the outer corners of my eyes. I was knocked out for over seven hours and discovered different areas of my body mutilated by him. Read the other post here on Coleman...there is pleanty already shared by a handful of victims.

I looked forty before his handiwork...now I look sixty. At least that is what I was told in an emergency room situation, after the stress of all of this and high blood pressure problems which sent me there. All for the self love of Sydney...by Sydney.

is it scar tissue, fat...

Plastic and Reconstructive Surgeon, Dr D
A Report by the
Health and Disability Commissioner
(Case 99HDC00541)

Commissioner’s Opinion/99HDC00541
2 June 2000 1
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
Complaint
The Commissioner received a complaint from the consumer, Ms A, about the treatment she
received from the provider, Dr B. The complaint was that:
• Ms A consulted Dr B on 13 August 1997 to discuss upper eyelid rejuvenation.
• Dr B persuaded Ms A that lower eyelid lipo-infiltration was also needed and on 2 April
1998 Dr B performed corrective surgery to Ms A’s upper and lower eyelids.
• Dr B did not inform Ms A about possible complications of lipo-infiltration. If he had
done so she would not have had the procedure done.
• Two months after surgery Ms A complained of persistent asymmetry of the right upper
eyelid fold and lumpiness of the left infra-orbital region.
• Ms A was reviewed by Dr B on 15 July 1998. Dr B noted persistence of the superficial
deposits of the left infra-orbital region and offered to correct this asymmetry and to revise
the upper eyelid fold.
• The second operation took place on 1 October 1998 at a private hospital, under general
anaesthetic.
• Ms A was reviewed by Dr C on 30 October 1998. She was unhappy with the result of her
left lower eyelid revision. She complained of a residual lump and a small concavity at the
junction of the eyelid skin with the orbital margin.
• Ms A “wants her old face back”. She wants Dr B to take responsibility for the problems
she has had with her eyelid surgery. She also wants Dr B to pay the second hospital and
anaesthetic bills as well as the cost of any future corrective surgery.
Investigation process
The Commissioner received the complaint on 13 January 1999 and an investigation was
commenced on 30 March 1999. Information was obtained from:
Ms A Consumer
Dr B Provider / Plastic and reconstructive surgeon
Relevant clinical records were obtained and viewed. The Commissioner obtained advice
from an independent plastic and reconstructive surgeon.
Health and Disability Commissioner
2 2 June 2000
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
Information gathered during investigation
Dr B is a plastic and reconstructive surgeon. He attended an advanced aesthetic surgery
workshop at an overseas University in February 1997 and has been using the technique of
Lipostructure™ or Lipoinfiltration since then. The technique was pioneered by Dr D and
involves transplanting small amounts of refined fat from the abdomen or thigh within the
body for the purpose of making structural improvements. Dr B advised the Commissioner
that he initially applied the technique to cases of traumatic atrophy of fat tissue such as facial
and lower limb trauma. Following success with several trauma patients Dr B began applying
it to consumers complaining of subcutaneous atrophy in the eyelids, upper cheeks and lip
areas. Dr B advised the Commissioner that he has performed lipostructure on approximately
20 consumers since he first began using the technique.
Ms A was acquainted with one of Dr B’s relatives, upon whom he had performed eyelid
rejuvenation surgery (blepharoplasty). Ms A was impressed with the results and wrote to Dr
B on 7 January 1997 requesting information about the cost of a consultation and an “upper
eyelid operation”. Ms A also queried what laser treatment was available and whether an
overnight stay in hospital was required for upper eyelid surgery.
Dr B wrote to Ms A on 15 January 1997. He informed her that blepharoplasty was one of the
rejuvenative surgery options available and indicated it was:
“[T]he standard operation done to remove excessive skin and fat pads from the eyelids
and in selected patients a tightening of the capsulopalpebral ligament of the lower eyelid
to the orbital septum to give the lower eyelid a shorter vertical height and more youthful
appearance.”
Dr B noted that laser resurfacing was better suited for the very fine ageing lines in the skin
but was being used frequently for the lower eyelids. He also noted that while some surgeons
believed swelling and bruising were reduced with the laser, he preferred to use a scalpel
blade.
Dr B advised Ms A in the letter that the operation would be performed under local anaesthetic
with sedation and that she might need to spend a night in hospital. He indicated that the
consultation would cost $95.00, with a surgical fee of $1, 500.00 plus GST.
Ms A wrote to Dr B on 7 February 1997 querying the cost of the procedure and whether
upper eyelid surgery could be performed at his rooms.
Ms A consulted Dr B on 13 August 1997. Dr B advised the Commissioner that Ms A
indicated she wanted her upper eyelids done but was actually concerned about hollowness
and a tired look under her eyes. He advised that “lipo-infiltration was [his] interpretation of
her request”.
Ms A advised the Commissioner that Dr B talked about the various techniques available but
was “gung ho” about lipo-infiltration and presented it as a very positive option. She said he
made it sound like a very simple procedure and told her he would make a few cuts, take fat
Commissioner’s Opinion/99HDC00541
2 June 2000 3
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
out of her stomach or leg and inject it under her eyes. She said he told her the fat would be
sculpted like clay to achieve the desired look.
During the consultation Dr B established that Ms A was a smoker and indicated that she
should not smoke for at least one month prior to surgery and for six weeks afterwards. Ms A
said she knew, prior to any and every surgery, that people who smoke are told to stop and that
this had to do with oxygen being received. She said she understood the instruction was so
she would make a better and quicker post operative recovery. Ms A said she did not
understand that the operation would not succeed if she smoked.
Dr B advised the Commissioner that smoking is considered a definite contra-indication for
cosmetic surgery of any kind and that much of the consultation focused on this issue. He said
he told her quite a lot about the risks of smoking, that there would be a lot of swelling with
this technique and more bruising than would be experienced with standard cosmetic surgery
techniques. Dr B indicated that the information provided to Ms A was recorded in a letter he
sent to her immediately following the consultation. In that letter, which was dated 13 August
1997, Dr B noted that Ms A specifically wanted:
“… correction of the lower eyelid and tear trough areas where you rightly perceive that
there has been an increasing hollowing of the soft tissues of your lower eyelids which is
consistent with the shrinkage of the fat layer of the face in this area with ageing”.
Dr B noted that Ms A was a smoker and that this was a significant risk factor for any
corrective surgery. He also commented on a “prominent superficial vein running obliquely
across the lateral aspect of [her] right lower eyelid”.
Dr B recorded a discussion about standard blepharoplasty, laser resurfacing and lipoinfiltration
or lipostructure. He wrote:
“Lipostructure has been popularised by [Dr D] from [overseas] and involves the
harvesting by atraumatic technique of some of your own fat from either the lower
abdomen or thighs and this fat is then refined in a Centrifuge and reinjected as small fat
parcels in to the soft tissue layers of the region that needs structural support.
In your case the infiltration of your own refined fat in to the infraorbital and eyelid
regions would correct the contour deformity and also improve the texture of the skin and
give the excess skin somewhere to go so that this has the overall effect of rejuvenating the
appearance of the lower eyelids to produce a more youthful appearance. It may be
necessary to remove the small superficial vein although I suspect that with infiltration of
fat around this area the vein would be less prominent under the skin and a decision about
this would need to be made at the time.”
Ms A was advised in the letter that the surgery could be performed under local anaesthetic in
Dr B’s rooms, and that the bruising and swelling could take up to three or four weeks to
resolve. She was advised that she would have to stop smoking for at least one month
beforehand and six weeks afterwards because “one cigarette causes fifty minutes of tissue
ischaemia [oxygen reduction] and this would almost certainly result in poor take of the small
fat parcel grafts which would then lead to fat liquefaction [fat necrosis or dying tissue],
infection and possible abscess formation”.
Health and Disability Commissioner
4 2 June 2000
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
Dr B offered to perform surgery on both Ms A’s eyelids for $1, 250.00, including GST.
Dr B subsequently sent Ms A an article written by Dr D. He also enclosed a hand written
consent form.
Dr D’s article, entitled “The Technique of Periobital Lipoinfiltration”, discussed uses,
preoperative manoeuvers, technique, postoperative care and evaluation of post-operative
results. Complications identified by Dr D included underinfiltration (too little fat implanted),
overinfiltration (too much fat implanted), migration (overfilling forcing implanted fat into an
unplanned or improper location), clumping (caused by uneven filling) and infection (which
Dr D recorded could often be traced to breaks in sterile technique). Other problems included
bruising, oedema, induration [abnormal hardening of tissue] and “… prolonged erythema
[flushing of the skin] at the incision sites”.
The consent form provided by Dr B indicated:
“The technique of lipostructure has been personally explained to me by [Dr B] and I
completely understand the nature and consequences of the procedure. The following
points have specifically made clear:
1. There will be small scars from the injection sites.
2. There will be swelling and bruising of the eyelids of the face which can persist for
several weeks.
3. There is possibility of temporary injury to the nerves supplying the skin and muscles
in the periorbital area.
4. Infection is possible in any type of surgery including lipostructure.
5. I agree that I will not smoke cigarettes for four weeks prior to surgery and for 8 weeks
after surgery.”
The consent form was signed by Ms A on 21 August 1997.
Ms A advised the Commissioner that she knew there would be bruising, swelling and
possible nerve damage but “these were not presented as risks, more like side effects”. She
said she did not know what fat liquifaction was and that fat necrosis was never mentioned.
Dr B advised the Commissioner that “side effects and risks are all the same thing”. He
indicated that no surgery is free of side effects or risks and that risks are about “risk
management”. He said this is achieved by careful selection of patients for the operation plus
making sure the surgeon is properly trained and that the surgery is performed in proper
facilities. Dr B indicated that complications associated with the technique were listed in Dr
D’s article but he (Dr B) does not dwell on complications and does not want to talk a patient
out of surgery unnecessarily. Dr B indicated that his consent form listed the complications,
which are technique related and mostly avoidable, taken from Dr D’s article.
Ms A advised the Commissioner that Dr B did not discuss Dr D’s article with her. Dr B was
unable to recall whether any discussion took place.
Commissioner’s Opinion/99HDC00541
2 June 2000 5
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
Ms A advised the Commissioner that she decided to have lipo-infiltration because Dr B was
so convincing and sold her on the procedure. She said he convinced her he was
knowledgeable and capable and that it was a simple procedure.
Dr B advised the Commissioner that Ms A made the decision to have lipo-infiltration based
upon his evaluation of her facial form, subcutaneous atrophy and a discussion of the options
available, including standard blepharoplasty, laser resurfacing and the risks posed by her
smoking history. He advised that lipoinfiltration offered the best choice for creating a more
youthful appearance with respect to the lower eyelids and that a “modest skin only upper
eyelid reduction would also be appropriate”.
Ms A was asked to supply photographs of herself at ages 20 and 30 to enable Dr B to
estimate and plan the surgical procedure.
Ms A wrote to Dr B on 26 August 1997 enclosing the photographs he requested. She
indicated:
“Thank you for the article on Lipoinfiltration. Also, thank you so much for your
discounted fee. I do appreciate it.
As I look at the photos I notice a difference between 20 and 33 years of age. The glamour
shot is different again. I believe that at the time this glamour shot was taken, I was
around 38. I do notice more fullness when I was 20 that’s for sure.
I hope these help you. I must admit a slight fear, but I know you will do a great job.
…
I do understand the smoking issue and may get acupuncture done. I’d rather do it this
way to relieve the stress that I would experience if I was to do it cold turkey. I wouldn’t
want my mind and body to be stressed at the time of the Lipoinfiltration.
[Dr B], I just have one question. When I lose weight it tends to start in my face and work
its way down. I’m not planning to lose any, but if I did, how would that affect my face.
Would my cheekbones drop and the fat that has been put under my eyes stay where it is?
I have drawn a picture. I hope this question makes sense. …”
On 7 September 1997 Dr B wrote to Ms A. He thanked her for her photos and indicated:
“These photographs are very interesting when compared to the most recent ones I have
taken of you which show quite a significant loss of subcutaneous tissue in the tear trough
area of your lower eyelids with a vertical lengthening of your lower eyelid as a result.
There has also been a significant loss of subcutaneous tissue over the prominence of your
cheek bones.
I therefore believe that as recommended, lipoinfiltration with your own refined fat grafts
would give you the best aesthetic improvement at this stage and the diagram that you have
drawn in your letter asking about the separation between the tear trough and the cheek
area; my response would be that with the lipoinfiltration we would hope to fill in this area
Health and Disability Commissioner
6 2 June 2000
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
so that there is a smooth contour between your lower eyelid extending inferiorly on to
your cheek prominence.
Please do not hesitate to get back to me if you have any further questions about this.”
Surgery was scheduled for 30 October 1997 but was postponed due to Dr B’s planned
overseas travel which meant he would not be available for post-surgical follow-up. Dr B’s
clinical record dated 30 October 1997 noted that Ms A had been making “great efforts to give
up smoking over the last month and in fact has not had a cigarette for two weeks”. Surgery
was re-scheduled for 19 November 1997.
Ms A’s surgery was carried out on 2 April 1998. Clinical notes recorded:
“Fat was … harvested using [Dr D’s] technique from both lower medial thighs and then
refined in the centrifuge.
A total of 3 ccs of refined fat was infiltrated in to each lower eyelid infraorbital region to
correct the hollowness and contour defect. The fat was infiltrated both in the orbicularis
layer and in the subcutaneous layer.”
Ms A advised the Commissioner that she had one or two cigarettes in the two weeks prior to
the surgery and did not smoke straight after surgery. She indicated that she would then have
the “odd puff” but was not smoking chronically. Ms A said she was struggling but did
“extremely well”. She said that when she saw Dr B on 8 April 1998 he told her she was
healing well and said “see what not smoking does”. Ms A said she drank a lot of water and
Dr B was pleased with how she was looking after herself.
Dr B said he suspected Ms A had been smoking post operatively. He said she admitted
slipping up a couple of times but his recollection was that she was smoking according to her
usual (10-15 per day) habit. Dr B advised the Commissioner that he warned Ms A there
could be a loss of fat grafts if she continued to smoke and indicated that fat grafts can be lost
up to three months after surgery because the process of revascularisation (the re-development
of blood vessels within tissue) takes some time. The issue of smoking was not documented
in the clinical notes.
Dr B’s clinical notes recorded that Ms A’s upper eyelid sutures were removed and that the
area had healed well. It was noted that there was some obvious swelling and bruising of the
lower eyelids consistent with lipo-infiltration. Photographs were taken and it was agreed that
Ms A would return in one month’s time. Dr B advised the Commissioner that Ms A admitted
to having disturbed the right upper eyelid suture during the night by pulling on the thread
near the eyebrow which caused a puckering and distortion of the scar compared to the left
upper eyelid scar.
Ms A consulted Dr B on 17 June 1998. Dr B’s clinical note recorded some minor asymmetry
of the right supra-tarsal fold which he attributed to Ms A having pulled on the suture postoperatively.
Dr B advised the Commissioner that it was evident Ms A had not kept to the
‘no-smoking’ policy and that Ms A confirmed this. He said he expressed his dismay at her
Commissioner’s Opinion/99HDC00541
2 June 2000 7
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
“inability to co-operate with instructions” with respect to her interference with the sutures
and that she was smoking when he had told her not to.
Ms A advised the Commissioner that this was three months after the surgery and that, while
she was probably back to smoking 10-15 cigarettes a day, “this was way past the date [she]
was told not to”.
Dr B documented redness and queried fat parcels. He prescribed the antibiotic Augmentin.
Dr B advised the Commissioner that with the degree of inflammation experienced by Ms A
smoking was a definite contra-indication. He said he suspected the area was inflamed
because of fat necrosis and took a biopsy of the area in order to confirm this.
Dr B advised the Commissioner that Ms A was very distressed and his aim was to try to get
her through his period. He said he told her he thought the area would settle and that he wrote
a letter to her afterwards because she made a “big deal” about her upper eyelid, which was a
result of her pulling on a suture and causing distortion of the scar.
In his letter to Ms A dated 17 June 1998, Dr B acknowledged her unhappiness with the
asymmetry of her infraorbital regions. He recommended she regularly massage the area with
Vitamin E or other moisturiser for three months to help soften the scars. He noted that if the
infraorbital region did not settle down he would revise this at no extra charge.
Ms A consulted Dr B on 15 July 1998. Dr B advised the Commissioner that Ms A was not
happy with the persisting lumpiness of the fat grafts and the relative asymmetry of her right
upper eyelid. He said she had to be reminded that the asymmetry of her own doing. Dr B
advised Ms A that these were minor complications and could be corrected under local
anaesthetic in his office minor theatre, at no extra charge. Ms A was offered a second
opinion but declined it.
Clinical notes record:
“[Ms A] was reviewed again at […] on the 15.7.98. She still has some superficial fat
deposits from the fat grafting of the left infraorbital margin and these are not shrinking
and I think she would benefit from a lower lid blepharoplasty to tighten her lower eyelid
skin and at the same time these redundant fat grafts could be trimmed. She would also
need a minor right lower blepharoplasty and ligation of the superficial vein that is
prominent here.
The plan is to wait at least three more months and we will schedule her for surgery in
October 1998 at the Rooms and she will need some oral sedation when she arrives.
No further charge will be made for this surgery.”
Ms A wrote to Dr B on 18 July 1998 complaining about the asymmetry of her left infraorbital
region and detailing the effects her appearance was having on her life. She advised Dr B that
she wanted her old face back.
Health and Disability Commissioner
8 2 June 2000
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
Dr B’s clinical notes dated 22 July 1998 record:
“[Ms A] wrote to me on the 18.7.98 with a lot of concerns about the asymmetry of her left
infraorbital region where there is some superficial fat graft that has displaced and will
probably need trimming in October. She also perceives some asymmetry of her right
upper supratarsal fold where there was some concertinaring of the wound margins when
she accidentally pulled on the suture post operatively and I have said I am happy to revise
this for her as well.
I phoned her at work today and she assured me that she does not want to sue me and that
she does not want a second opinion. She accepts my advice about waiting for six months
post op before attempting any further revision and she is also now happy about having it
done here at the rooms under local anaesthetic because I think this will be safe and
hospitalisation is not necessary.”
Ms A was reviewed by Dr B on 9 September 1998. Dr B advised the Commissioner that it
was decided Ms A would have her revision surgery at the private hospital under general
anaesthetic, rather than at his rooms. He advised that, under the circumstances, he considered
it a wise decision given her anxiety levels. Dr B stated that he made it clear to Ms A he
would not charge her any further surgeon’s fees but that hospital and anaesthetist fees would
be her responsibility.
Clinical notes recorded:
“I saw [Ms A] again on the 9.9.98 at the […] surgery where we discussed plans for her
further periobital aesthetic surgery.
She has agreed to have the surgery done under local anaesthetic with sedation at [the
private hospital] on the 1.10.98 and the plan is to do bilateral lower eyelid skin only
blepharoplasties with ligation of the superficial vein on the right lower eyelid and
recontouring of the fat grafts to the left lower eyelid.
She also wants a small excess of skin excised from the medial right upper eyelid scar.”
The second surgery was performed on 1 October 1998. Dr B advised the Commissioner that
he revised Ms A’s right upper eyelid scar, coagulated a superficial vein in the right lower
eyelid, resected the lumps of focal fat necrosis under the left lower eyelid and performed a
conservative bilateral lower eyelid-skin only blepharoplasty.
The operation note also recorded:
“The skin was very thin and she has been warned both pre and postoperatively to restrict
all smoking activity because this will jeopardise the chances of healing of her eyelid
incisions and also could end up with significant skin necrosis because of the thinness of
her skin here.”
Commissioner’s Opinion/99HDC00541
2 June 2000 9
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
The Histology/Cytology Report dated 2 October 1998 indicated:
“Clinical details:
Previous fat grafts lower left eyelid.
Macroscopic:
Some irregular pieces of fatty tissue measuring up to 7mm.
Microscopic:
Sections show fibrous connective and adipose tissue with small amounts of striated
muscle. Occasional microscopic cysts associated with multinucleated histiocytes are seen
within the fatty tissue. The appearances are those of focal fat necrosis. The appearances
are otherwise unremarkable and there is no evidence of inflammatory disease or
neoplasia.
Diagnosis: fatty tissue left lower eyelid – focal fat necrosis.”
Ms A wrote an undated letter to Dr B following the 1 October surgery. She indicated:
“I received your letter explaining the revision procedure that was done in my second
operation. My eyes are healing well and I am now pleased with these most recent
results.”
Ms A complained about second hospital bill and asked Dr B to take responsibility for it. Dr
B wrote to Ms A on 12 October 1998 indicating:
“…
At no time have I undertaken to be responsible for the hospital and anaesthetic costs
which you have incurred during the admission of the 1.10.98 and it clearly states in my
notes that I was prepared to make no extra surgical fee for the revisional surgery and this
is documented in my notes on the 15.7.98 and again on the 9.9.98 when you agreed to
have the surgery done under local anaesthetic with sedation at [the private hospital]
because of your fear of having any further procedures done under local anaesthetic. As it
turned out the Anaesthetist felt that it was more appropriate for you to have a general
anaesthetic because of your level of anxiety and as well as the second hospital bill you
should expect to receive a second anaesthetic bill from [Dr E]. …”
Ms A advised the Commissioner that she did not receive a second anaesthetic bill from Dr E.
On 15 October 1998 Ms A wrote to Dr B advising that she intended to take the matter before
the Small Claims Court.
Ms A requested a second opinion from the New Zealand Foundation for Cosmetic Plastic
Surgery regarding Dr B’s surgery and was interviewed and examined by Dr C on 30 October
1998. Dr C documented in his report that Ms A was satisfied with the result of the surgery on
her right upper and lower eyelids but was not happy with the result of her left lower eyelid
revision. Dr C recorded that Ms A complained of a residual lump and a small concavity at
the junction of the eyelid skin with the orbital margin and that a 2.5mm diameter rounded fat
deposit was visible beneath the eyelid skin. Dr C also documented a small indentation in the
Health and Disability Commissioner
10 2 June 2000
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
eyelid where the skin appeared to be adherent to the underlying muscle and a mild degree of
post-inflammatory hyper-pigmentation of the eyelid skin, consistent with the recent revision
surgery. Dr C formed the opinion that it was too early to make a decision about the result of
the second operation. He indicated:
“[Ms A] must be patient and wait at least three months, preferably six, before
contemplating any further surgery. Scar formation in the early phase of wound healing
can be exaggerated and scar maturation and resolution may take upwards of six to twelve
months. Any area that has been reoperated on may take even longer to settle. The
patient’s smoking habit is a known risk factor and can adversely affect wound healing due
to impairment of blood supply and cellular toxins. The superficial fat deposit may
spontaneously reduce in size and become less noticeable. Likewise the small indentation
may improve as the scarring softens. There may not be any need for further surgery. I
have offered to review [Ms A] over the next few months but I would encourage her to
settle her differences with [Dr B] and allow him to monitor her progress. …”
Dr C also noted:
“[Dr B] has provided [Ms A] with sufficient written and verbal information for her to sign
a consent form that she ‘completely understands the nature and consequences of the
procedure’. He has stressed the necessity to stop smoking to reduce complications. He
has documented his operative procedures in detail. He has seen the patient on several
occasions following surgery and has also kept in contact by phone and letter. The degree
of detail in the notes is far above average and would indicate to me that he is careful and
conscientious in his assessment, treatment and followup. It is difficult for me to equate
this attention to detail and informed consent with negligent surgery. Complications can
occur with virtually any operation, despite preventive measures. Surgery, especially
cosmetic, is not an absolute science. [Dr B] has attempted to the best of his ability to
correct [Ms A’s] concerns. [Ms A] remains unhappy. I would not recommend any more
surgery just yet and would suggest that [Dr B] obtains one or more opinions from
overseas experts in eyelid surgery before deciding on a plan of action.”
Dr B advised the Commissioner that Ms A has not presented for further follow-up with him,
is unrealistic about her responsibilities regarding the doctor-patient relationship, post
operative instructions and the continued harmful effects of smoking on her general health and
facial appearance.
Ms A consulted Dr F, a second plastic and reconstructive surgeon on 20 January 1999. Dr F
advised:
“I do not see a great deal of hope in trying to re-operate to remove the fat. It would be
very difficult technically to get the contour exactly right and furthermore the scar of the
healing operation may tend to pucker up the thin eyelid skin even further and create new
different contour irregularities.”
Commissioner’s Opinion/99HDC00541
2 June 2000 11
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
Independent advice to Commissioner
The advisor commented as follows in respect to the Commissioner’s written questions:
“… There are no binding specific written guidelines issued by any professional body to
my knowledge for rejuvenation surgery of the eyelids. The specific standards that I
would apply are:
Consultation and Examination:
This involves taking a case history and obtaining information about the past and present
health, medication requirements, smoking and tendency to bleeding. Enquiry is made into
the reasons for requiring the surgery and patient expectations.
The examination involves a thorough check of the eyelids and surrounding areas,
including the eyebrows and the orbits. Particular note is made of excess skin and excess
swelling, loss of subcutaneous fat, lack of tone in the eyelids and visual acuity. Following
this a full discussion takes place involving the methods of treatment and their advantages
and disadvantages.
For eyelid rejuvenation the basic treatments are to remove excess of skin and excess
orbital fat, if that is a problem. Other aspects of the treatment can include a forehead lift
to elevate the eyebrows and tighten the upper eyelids and the injection of fat to fill out
hollow areas. All treatments have their advantages and disadvantages and these should be
discussed with the patient. The consultation and examination is documented and this can
be augmented by the drawing of diagrams and the taking of photographs.
Surgery:
Surgery is done in an appropriate facility and much eyelid surgery can be done under a
local anaesthetic as an outpatient in a day stay facility. Where there are concerns about
patient apprehension a general anaesthetic is advised.
Post operatively the patient is reviewed regularly until wound healing is complete and the
sutures removed. Usually patients are reviewed some weeks after surgery to assess the
results once the swelling and bruising has subsided.
Were these standards followed?
I believe they were. There had been considerable correspondence between [Ms A] and
[Dr B] before surgery and well documented records. The initial concern of [Ms A] was to
have her upper eyelids treated but the consultation notes indicate that she wanted her
under eyelids done and not the upper eyelids at the moment.
Is Lipoinfiltration a recognised and acceptable technique?
The technique of injecting fat into parts of the body to improve appearance has been
advocated increasingly in the last 10 or so years. Considerable refinements of the
technique, especially in handling the fat, and injecting small amounts only have produced
Health and Disability Commissioner
12 2 June 2000
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
acceptable results. [Dr D] from [overseas] ran a course in [another country] on this
technique some years ago and I note that [Dr B] attended this course.
What level of training is required before lipoinfiltration can be offered cosmetically?
There is no specific training requirement for offering new techniques. This is mainly up
to the Practitioner offering the technique. I would, however, expect that anyone offering
such a technique would have considerable experience of liposuction surgery and had
attended meetings and courses in which the procedure was discussed, demonstrated and
the advantages and disadvantages considered.
Was [Dr B’s] level of training and experience reasonable?
Yes. He has indicated that his initial experience of lipoinfiltration or lipostructure, was
with accident cases with a gradual move towards aesthetic patients.
What should a consumer contemplating lipoinfiltration be told about the expected risks?
This is the normal informed consent process. I note in [Dr D’s] article the complications
are discussed. It is not easy for a layperson reading such an article to understand medical
terminology and such information requires discussion with the Surgeon.
Could the effect [Ms A] desired have been achieved using any other technique?
Not to my knowledge.
What caused the lumpiness?
There are several reasons for this. The eyelid skin is extremely thin and any accumulation
of the fat cells into little globules will be quite recognisable under the thin skin. If the
skin were thicker it would have a better chance of disguising minor irregularities. Fat
necrosis is a complication of fat injections. Sometimes the fat can become thickened or
calcified into small lumps and this appears to be a not uncommon complication with fat
injections, although the newer methods of fat preparation for injection, as described in [Dr
D’s] article, are supposed to reduce the chances of this happening.
Could the lumpiness be related to the Surgeon’s technique?
This is possible, although I think that the reasons given in the previous paragraph
contributed to this.
Could smoking have contributed to or caused the lumpiness?
It may have had a part to play in reduced blood supply to the infiltrated fat thus causing
the necrosis.
Commissioner’s Opinion/99HDC00541
2 June 2000 13
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
Was massage an acceptable remedy?
Massage after eyelid surgery has been strongly recommended for a number of years and
its main advocate is [Dr G] who was a Visiting Professor some years ago and who
popularised this technique. It was, however, for persons who have had the basic
excisional type of blepharoplasty in order to reduce swelling and tightness. Massage
would certainly help reduce the swelling but would not eradicate the residual fatty lumps.
Could further surgery correct the residual lump and concavity?
Without seeing the patient it is not possible to give a definite answer to this. Based on the
information supplied, she has already had two procedures on the lower eyelids and there
will be a certain amount of underlying scarring resulting from these. Further surgery
would create more scar tissue and getting the contour exactly right would be difficult as
the thin overlying skin will tend to show up any minor irregularities.”
My advisor also commented that there is a growing trend to blame smoking for the
development of fat necrosis, which is caused by a lack of, or impaired, blood supply to the
transplanted fat. He indicated that there are other reasons for fat necrosis occurring, but that
these reasons are not always understood.
Response to Commissioner’s Provisional Opinion
Dr B responded to the Commissioner’s provisional opinion as follows:
“…
I agree with everything documented except for the last two pages 23 and 24.
Right 6 states that every consumer has the right to the information that a reasonable
consumer, in that consumer’s circumstances, would expect to receive including … an
explanation of the options, risks, benefits etc.
[Ms A] in my opinion received a reasonable amount of information, was encouraged to
read and reflect on this carefully and in fact had a 6 month pre-operative period in which
to further discuss this with me both verbally and in writing as you have correctly
documented.
[Ms A] is an intelligent woman, and she received from me all knowledge, technical
details and specific risks known about lipo-infiltration by [Dr D’s] method available at
that time. I first saw her at a medical clinic in […] and not having [Dr D’s] article in my
possession then undertook to include it with my initial detailed consultation letter to her.
I dispute the claim that a layperson would have difficulty understanding the specific
details in [Dr D’s] article relating to known complications. This article is a review article
based on his 10 year experience [overseas] with this technique for fat grafting. It was
published in Operative Techniques in Plastic Surgery which is a quarterly journal
Health and Disability Commissioner
14 2 June 2000
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
characterised by sound explanation of the indications, techniques and potential
complications of a number of reconstructive and cosmetic procedures.
Your own description of the complications section of the article on page 5, 4th paragraph
as a layperson testifies to the clarity of the article … underinfiltration (too little fat
implanted), overinfiltration (too much fat implanted), migration, clumping and
infection. My consent form focused on the specific morbidities relating to the technique
of adding fat to the soft tissues and especially to the risk factor of smoking. There is
extensive scientific evidence now in the plastic surgery literature relating to the dangers of
smoking on the healing of all tissues but specifically to grafts and I would be happy to
provide your advisor with a bibliography provided by a leading plastic surgeon
[overseas].
Right 7 refers to the right to make an informed choice and give informed consent.
[Ms A] claims she was not fully informed despite the documents of material presented to
her, which complimented the verbal discussion. She broke the agreement regarding the
most serious risk factor (smoking) which I went to all reasonable lengths to inform her of.
She claims that she would not have consented to having lipoinfiltration if she had known
what the potential unsatisfactory results could have been. I contend that I would not have
agreed to the surgery if I could have predicted that she would not comply with the clear
pre and post-operative instructions.
I have had considerable experience with the technique of lipo-infiltration now and to date
have had no problems with non-smoking patients. The fundamental principle of fat
grafting as with skin and cartilage grafting is that the implanted graft must become
revascularised and this depends on the healthy ingrowth of tiny blood vessels which the
inhalation of nicotine and other toxic chemicals in cigarettes opposes. The fat grafts,
which are not adequately revascularised, die and become hard lumps of fibrotic soft tissue
felt and seen under the skin.
I strongly disagree with your opinion that I did not meet my obligations to ensure that [Ms
A] was fully informed and I refer you to the opinion expressed by an independent
colleague [Dr C] who has personally examined and consulted with [Ms A].
These are my comments and you will note that they dispute your provisional opinion and
preliminary conclusions.”
Commissioner’s Opinion/99HDC00541
2 June 2000 15
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
Code of Health and Disability Services Consumers’ Rights
The following Rights in the Code of Health and Disability Services Consumers’ Rights are
applicable to this complaint:
RIGHT 4
Right to Services of an Appropriate Standard
2) Every consumer has the right to have services provided that comply with legal,
professional, ethical, and other relevant standards.
RIGHT 6
Right to be Fully Informed
1) Every consumer has the right to the information that a reasonable consumer, in that
consumer’s circumstances, would expect to receive, including –
b) An explanation of the options available, including an assessment of the expected
risks, side effects, benefits, and costs of each option;
RIGHT 7
Right to Make an Informed Choice and Give Informed Consent
1) Services may be provided to a consumer only if that consumer makes an informed choice
and gives informed consent, except where any enactment, or the common law, or any
other provision of this Code provides otherwise.
3 Provider Compliance
1) A provider is not in breach of this Code if the provider has taken reasonable actions in
the circumstances to give effect to the rights, and comply with the duties, in this Code.
2) The onus is on the provider to prove that it took reasonable actions.
3) For the purposes of this clause, “the circumstances” means all the relevant
circumstances, including the consumer’s clinical circumstances and the provider’s
resource constraints.
Opinion: No breach
In my opinion Dr B did not breach Right 4(2) of the Code of Health and Disability Services
Consumers’ Rights as follows:
Right 4(2)
Ms A originally wrote to Dr B requesting information about upper eyelid surgery. During a
consultation on 13 August 1997 Dr B determined that Ms A was concerned about a tired look
under her eyes and recommended lipoinfiltration to correct this. I accept the advice of my
independent plastic and reconstructive surgeon that lipoinfiltration is a recognised and
acceptable technique and that Dr B was properly qualified to undertake the procedure. The
Health and Disability Commissioner
16 2 June 2000
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
effect Ms A desired could not have been achieved using any technique other than
lipoinfiltration.
My advisor informed me that fat necrosis is a recognised complication of fat injections and
can occur independently of the surgeon’s technique. It is caused by a lack of blood supply to
the fat cells, although the technique described by Dr D and utilised by Dr B is supposed to
reduce the chances of this happening. In my opinion Dr B provided services in accordance
with professional standards and did not breach Right 4(2) of the Code of Health and
Disability Services Consumers’ Rights.
Opinion: Breach
In my opinion Dr B breached Rights 6(1)(b) and 7(1) of the Code of Health and Disability
Services Consumers’ Rights as follows:
Right 6(1)(b)
Ms A complained that she was not told of possible complications of lipo-infiltration. While
Dr B provided her with a copy of Dr D’s article which outlined complications associated with
lipo-infiltration my advisor commented that this was difficult information for a layperson to
absorb and its contents should have been discussed with Ms A. Dr B did not do this.
Dr B indicated that he does not dwell on complications and does not want to talk a consumer
out of surgery unnecessarily. He provided a consent form which listed some of the
complications contained in Dr D’s article and which Ms A signed. It indicated there would
be small scars from the injection sites, that swelling and bruising of the eyelids would occur,
that temporary injury to the nerves supplying the skin and muscles in the periobital area could
occur and that infection was possible. In signing the document Ms A undertook that she
would not smoke cigarettes for four weeks prior to surgery and for eight weeks afterwards.
Dr B informed Ms A that smoking was contra-indicated because a single cigarette causes 50
minutes of tissue ischaemia, which would almost certainly lead to poor uptake of the fat
grafts leading to fat liquefaction (fat necrosis), infection and possible abscess formation. The
parties disagreed on how well Ms A adhered to the no-smoking policy. My advisor informs
me that fat necrosis is a complication of lipoinfiltration and that, while smoking may
contribute to a reduction in blood supply leading to necrosis, the lumpiness experienced by
Ms A, and diagnosed as fat necrosis after histological investigation, could have been caused
by other factors. There is no evidence in Dr B’s clinical notes that Ms A was informed of this
possibility, independently of his advice that complications could develop if she did not stop
smoking for a period of time, both pre- and post-operatively. Right 6(1)(b) sets out the
information a consumer can expect to receive without having to ask. The onus was on Dr B
to show that this information had been provided, as indicated by Clause 3(2) of the Code. In
my opinion Dr B did not fully explain the risks associated with lipoinfiltration and breached
Right 6(1)(b) of the Code of Rights.
Commissioner’s Opinion/99HDC00541
2 June 2000 17
Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no
relationship to the person’s actual name.
Right 7(1)
Ms A complained that had the possible complications been explained, she would not have
had the procedure performed. In the absence of information indicating Dr B fully explained
all the risks, including those outlined in Dr D’s article and that tissue breakdown can occur
independently of the smoking risk, I conclude that despite Ms A signing a consent form
acknowledging the risks had been explained to her, Dr B did not meet his obligations to
ensure she was fully informed. Ms A was therefore not able to make an informed choice
about the proposed surgery. In my opinion Dr B breached Right 7(1) of the Code by
providing services to Ms A without sufficiently informing her about the potential
complications of the procedure and allowing her to make an informed choice and give
informed consent.
Actions
I recommend that Dr B takes the following actions:
• Apologises in writing to Ms A for his breach of the Code. This apology is to be sent to
the Commissioner’s office and will be forwarded to Ms A.
• Reads the Code of Health and Disability Services Consumers’ Rights.
• Ensures that consumers are fully informed about the risks associated with lipoinfiltration,
independent of the smoking risk, as part of his informed consent procedure.
• Refunds Ms A’s initial surgical costs.
Other actions
A copy of this report will be sent to the Medical Council of New Zealand, the New Zealand
Foundation for Cosmetic Plastic Surgery and ACC, with the request that it reconsiders Ms
A’s eligibility.

--------------------------------------------------------------------------------
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Abstract:

Purpose: Autologous Coleman fat transfer is used in the periocular area and intraorbitally for soft-tissue volume augmentation in postenucleation socket syndrome. This article aims to identify areas of low fat absorption and the histopathology of excised fat.

Methods: Noncomparative case series of patients who underwent excision/debulking of injected autologous fat in the inferior sulcus/lower eyelid.

Results: Five of 20 patients with postenucleation socket syndrome who had received intraorbital and sulcus Coleman fat transfer, required fat reduction (sculpting) from the inferior sulcus and lower eyelid due to persistent "overfill" 8 months to 17 months after fat transfer. Between 0.2 ml and 1.4 ml of fat was removed. The excised fat was pale, rubbery, and compact in comparison with the normal lower eyelid fat pad. Histopathology showed healthy adipose cells but with chronic inflammation and fibrous septa.

Conclusions: Fat survival is greater than anticipated in the lower eyelid and inferior sulcus. Therefore, judicious use in these areas is suggested. The grafted fat is distinguishable from the fat in the lower eyelid both clinically and histopathologically.

2 hours 46 minutes ago by Unhappy Patient [send email]
THERE ARE SO SO MAMNY ARTICLES SIMILAR TO THE ABOVE POSTED ONE. YOU JUST HAVE TO KNOW WHERE TO LOOK FOR THEM:)

2 minutes ago by Unhappy Patient [send email]
ONE DOCTOR WRITES ( IN A MEDICAL BOOK) PREVENTING PROBLEMS IN FAT GRAFTING IS QUITE SIMPLE.
UNFORTUNATLY, OVERCORRECTION IS A GREATER PROBLEM FOR REPAIR THAN UNDERCORRECTION.
NO MORE THAN ONE CC OF FAT CAN BE PLACED UNDER THE EYELIDS AND IT MUST BE PLACED UNDER THE ORBICULARIS MUSCLE WITH GREAT CARE. ONE HUNDRED PERCENT OF FAT IN THIS POSITION IS RETAINED. IF NOT DONE PROPERLY, IT BECOMES LUMPY AND CANNOT BE CORRECTED.
BE CAREFUL NOT TO REMOVE TOO MUCH FAT FROM THE DONOR AREA OR YOU WILL BE FAT GRAFTING TO THIS SITE IN THE FUTURE TO CORRECT DENTS.
FAT IS INJECTED WITH 1CC SYRINGES IN MANY PASSES. I DO NOT USE AS MANY PASSES AS COLEMAN DOES, AND I DO NOT USE AS MUCH FAT. I RARELY USE MORE THAN 40G OF FAT ON THE FACE. SIDNEY SOMETIMES USES 5 TIMES THAT. I RARELY MAKE MORE THAN 4 OR 5 PASSES PER MILLILITER. SIDNEY USES 4 OR 5 TIMES THAT.
I USE MEDROL DOSEPAK IN THE POSTOPERATIVE PERIOD SIDNEY DOES NOT USE STEROIDS.
DO NOT USE TOO MUCH FAT. YOU CANNOT COUNT ON IT DISAPPEARING. MAINTAIN A MINIMUL OVERCORRECTION IN ALMOST ALL AREAS.
WE CAN BE BETTER SURGEONS IF WE DO NOT HAVE WORRIES ABOUT OUR PREVIOUS PATIENTS.
ETC, ETC, ETC.

I SUPPOSE I CAN GO ON AND ON. I AM ONLY SORRY THAT I DID NOT READ ALL THE ARTICLES OFFERED IN MEDICAL JOURNALS AND TEXT BOOKS BEFORE I HAD SURGERY WITH COLEMAN. AND BY THE WAY, HE IS NOT THE INVENTOR OF ANYTHING. SIDNEY RELPCATED THE SUCCESS OF DR.--------------- AND I BELIEVE THE FRENCH WERE THE FIRST TO EXPERIMENT WIT THIS TECHNIQUE. UNFORTUNATLY, IT IS STILL TO THIS DATE, AN EXPERIMENT.

Mutilations by Dr. Sydney Coleman without patient consent and results of experimentation.
Me and then those from "wearecolemanpatient."

http://www.imagehosting.com/show.php/1798513_whiteblouseagain006.jpg.html

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http://www.imagehosting.com/show.php/1798499_01270814062.jpg.html

"wearecolemanpatients" pictures of mutialtion by coleman.

1. http://www.imagehosting.com/show.php/1796701_cl002.jpg.html

2. http://www.imagehosting.com/show.php/1796705_BB0022.jpg.html

3. http://www.imagehosting.com/show.php/1796711_neckweb1.jpg.html

4. http://www.imagehosting.com/show.php/1796734_neckweb2.jpg.html

5. http://www.imagehosting.com/show.php/1796737_Slide1.jpg.html

6. http://www.imagehosting.com/show.php/1796743_Slide2.jpg.html

7. http://www.imagehosting.com/show.php/1796752_Slide3.jpg.html

8. http://www.imagehosting.com/show.php/1796758_Slide4.jpg.html

9. http://www.imagehosting.com/show.php/1796761_Slide5.jpg.html

10. http://www.imagehosting.com/show.php/1796764_Slide22.jpg.html

12. http://www.imagehosting.com/show.php/1796777_Slide32.jpg.html

13. http://www.imagehosting.com/show.php/1796780_Slide42.jpg.html

14. http://www.imagehosting.com/show.php/1796781_Slide52.jpg.html

15. http://www.imagehosting.com/show.php/1796782_Slide82.jpg.html

I would like to politely ask? that only "Coleman Victims, " or those who know someone who is one... attempt e-mailing me. Unless of course... you have information that would be helpful in exposing him in any way. Suggestions or thoughts you may be wanting to share, after reading these posts... are also very much welcomed.

But I do not have time, nor the patience required, to answer people who write asking? if I feel they should see Coleman or not? Telling me that they are "now" worried after having already scheduled an appointment... or had been planning on doing so... until having read these posts? But still wondering and have a few questions?

If you are still wondering? I cannot help you? Perhaps another person here, who has been so kind to share...is still feeling kind enough to address something like this. Please contact them in the future. My feeling is that, more than likely...you will get the same response.

Exception being. Some have not seen our pictures and may lack the skills to the links provided. The only way I know how to get to them, is by writing myself an e-mail and dragging them over to it, mailing it to myself. And after it arrives, clicking onto the links. Viola! They appear in living color...with "more" than enough detail...to obliterate any future thoughts of seeing Coleman

Anyone working with Coleman is aware of the goings on... including Dr. Alesia Saboeiro. She has been there a number of years... witness to the complaints and seeing the results of his mutilations. It's like working under/beside Hitler... choosing to look the other way... for the ole mighty dollar? Question the integrity of Dr. Saboeiro as well!

Anna Smith is a Coleman advocate. Too late. The truth has been spoken by too many of his victims. Will let all know when the MySapce page is up, revealing Coleman Mutilations.

Your phony testimonials may work in your office, Coleman, but not here, not in real life.

I am a Coleman victim. 15 years out and my life-destroying saga continues. I have little money now btu finally found someone to help. My problem is that my facial structure -- my cheekbones seems to have been enlarged and moved. They are uneven and make me look like a cro-magnon creature. If anyone knows how to dissolve this hard bone structure, please post it. Coleman is a criminal who should be disbarred from the profession. But no one will support these victims. Capitalism at its best.

hi jaune. is this happened to you 15 years ago...?
do you think that Dr Coleman used all this people as an experimental test...?