Which are better: Bone Marrow or Adipose Derived Stem Cells?

August 21, 2015

In the race from body to petri dish Bone Marrow Stem Cells (BMSC) has been the standard bearer among research scientists since their discovery in the 1960’s. They have the advantage of being well-known and easily understood by researchers. The primary downside to BMSCs from the beginning has been the clinical difficulty harvesting the cells from bone marrow derived from the pelvis of the donor. This bone marrow harvesting procedure generally requires general anesthesia and is painfully difficult for the patient.

Embryonic Stem Cells, when available, were the preferred choice of many doctors until the philosophical question of the beginning of life was raised and left unanswered. The utilization of human fetuses and umbilical cords for the purpose of research has been banned in the U.S. for several years.

Adipose Stem Cells (ASC), a more recent discovery, have been shown to be easily harvested by modern techniques of liposuction with very little pain or discomfort. Liposuction is a simple office procedure without the need for general anesthesia and provides the donor with a cosmetic improvement as a secondary consequence to the attainment of large quantities of ASCs.

ASCs, besides being easy to harvest, have been shown to have 100-500 times more stem cells than an equal volume of bone marrow. When intended for immediate use, the Stromal Vascular Fraction (SVF) of the centrifuged fat contains all of the stem cells and can be used interchangeably with the isolated, cultured adipose stem cell product.

There is an increasing amount of research in the field of restorative medicine, so we are working with the Adicyte Company to harvest and make available to our patients at a future date their own adipose stem cells harvested today by liposuction. In the near future when research has become sophisticated enough to offer treatments based on autologous stem cells, your stem cells can be retrieved, thawed out and used for stem cell therapy as if they were brand new. Current therapies currently under protocol include re-growing cardiac muscle after heart attack, treating autoimmune and immunological diseases and re-growth of cartilage in damaged knees and shoulders. There is even some preliminary work in a treatment for certain cancers also.


Dr. Paul Howard now offers stem cell storage with your adipose tissue (fat) – learn more


Lift Style Lift Un-lifted

May 12, 2015

Originally posted on The Plastic Truth by Pamela Howard:

The mass marketing company, Life Style Lift filed for bankruptcy protection earlier this year.  As a result, thousands of patients have been rumored to have been stranded having pre-paid for cosmetic services now seeking legal advice to recoup their money.  Their mass marketing business plan commoditized a cosmetic surgical procedure targeting the Greatest Generation’s desire to look as good as they feel.  Many of these buyers not only got scammed on the mass marketing, but the lure of positive results based on that marketing focus instead of quality and credentials of the surgeon. The internet has been littered with their derogatory reviews and scathing blog articles. Yet, these buyers ignored these Caveat Emptor warnings and chose to compromise their finances and faces for the Debby Boone ads in hopes of “lighting up” their lives.

Life Style Lift was a company centered on a mass marketing campaign.  They first began as…

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What is the cost of Breast Augmentation?

January 22, 2015

Dr. Paul Howard:

Excellent article pointing out things most people don’t know to ask about when scheduling consultations for breast augmentation. I’ve heard bad stories about those “group consultations.”

Originally posted on The Plastic Truth by Pamela Howard:

Plastic Surgery marketing usually focuses on targeting the budget cosmetic surgery seeking patient with breast augmentation in the forefront.  You are probably reading this blog article with this primary question in mind. In this article I will explore the expenses associated with breast augmentation surgery and what you can expect financially before and after breast implant surgery.

First, let’s break down the different fees that make up the total cost of the surgery itself.  First there is the obvious cost for the implants themselves. There are several different manufacturers of saline and silicone breast implants.  Saline implants are cheaper than silicone.  However, saline implants have an average life-span of 10 years so you should expect to face another surgery down the road if you want those puppies to keep their shape.  Silicone implants are on average almost twice the price as saline.  Most surgeons charge between $800 to $1200 for…

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The Wrinkle in Botox

January 10, 2014

The Wrinkle in Botox

Why you can still expect to have a Facelift

Botox Birmingham ALWikipedia’s definition for wrinkle “is a fold, ridge or crease in the skin.”   Botox is a wonderful medical break-through that has altered how some women smile, or lack thereof.  Just like many medical breakthrough products, Botox is often over-sold to the general public giving them an unrealistic expectation of results and, often, misconceptions about turning back the clock or stopping the aging process altogether.  Medical technology has yet to advance enough to alter our DNA and stop the aging process, but has given us products such as Botox that can help prevent wrinkles from occurring to some degree.

Botox is a product that paralyzes the muscles in the injected area.  Since most wrinkles are created from the stress of the underlying muscles, paralyzing those muscles helps to prevent the muscles from contracting thus it prevents skin folds from occurring.  When used prior to the appearance of wrinkles, then Botox is preventing those folds from occurring, thus the signs of aging.  When used after the signs of aging are present, then Botox assists those muscles from contracting thus relaxing the fold, or wrinkle.  Most patients can see visible improvement over time after consistent use.  However, the “wrinkle” in Botox is that is does not erase those deep wrinkles once they are formed, but can help minimize their appearance.

Deep wrinkles are the manifestations of muscle contractions over a period of time.  Wrinkles are more than just folds, they are the visible signs of soft tissue having been broken down from the stress of the muscle contracting.  A tissue replacement, such as artificial fillers or fat grafting, is often recommended to achieve the desired result of minimizing the appearance of wrinkles beyond the capabilities of Botox.

Common areas for Botox Cosmetic are the forehead, glabella (between the eyebrows), and the crow’s feet area around the eyes.  Injecting Botox to frown lines is not advisable unless you wish to paralyze your smile for about 4-6 months.  Even if you could obtain some benefit from Botox injections to the frown lines (laugh lines – or the parentheses lines that extend from our nose down to the corners of our mouth), then the manifestations of aging would still exist as gravity is a proven cosmetic disadvantage to our facial structure.  Botox injections cannot prevent gravity from pulling down the soft tissues of our cheeks contributing to those laugh lines and creating those jowls which in turn help create marionette lines from the corner of the mouth extending down the sides of the chin.

Since it is clear no one would want to Botox those frown lines, the aging process in that area will continue thus leading to a more traditional procedure such as a facelift.  Other factors that can help minimize the appearance of wrinkles are skin care, using sun-block protection, drinking plenty of water to keep the skin hydrated, and maintaining a healthy weight.  Botox is a great product for the prevention of forehead wrinkles, but one should understand it isn’t a magic potion for all areas of the face.


The Ins and Outs of Rhinoplasty by Dr. Paul Howard

April 24, 2013

By its very nature, Rhinoplasty is one of the most personal of Plastic Surgical procedures.  Many people define the way they look and reflect their ethnicity on their noses and any changes anticipated must be fully discussed pre-operatively.  To do this the patient must have a firm and unwavering commitment to facial change as well as an honest and realistic expectation about the nose they wish to have.  This may start with a look through today’s fashion magazines to see what the “beautiful people” look like.  While it is rarely possible to recreate another’s nose, it does provide a starting point and does give the Plastic Surgeon a general idea of what the patient wants.  The process can then begin to alter the patient’s expectations to something nearer to reality.  Every patient should expect to have a more attractive nose that also breathes well, but not every patient can have the perfect little turned-up nose seen in so many of our current movie actresses.  Once the Plastic Surgeon gets a general idea of what the patient desires, then he/she can begin discussion of the details of the operation and what may or may not be possible.  During this part of the consultation, drawing expected results on the pre-operative photos or utilizing computer imaging is essential.  The only caveat regarding computer imaging is that it is always better if the operating surgeon does the imaging so that the imaged results are as close to realistic as possible.

Explaining the details of the procedure is important as the possibility of complications is hidden in these details.  For instance, describing a dorsal hump reduction should lead to the possibility of a small elevation at the bone-cartilage junction and in large reductions leads to a discussion of osteotomies and supra-tip problems.  We usually perform a septoplasty as straightening the outside of the nose can incur septal deviations that cause breathing difficulties if no septoplasty is performed.  Additionally, the sub-mucous resection of the septal cartilage can be replaced (banked) for possible future use or used to help define a nasal tip or to open an internal valve or straighten the cartilaginous dorsal septum.

The thickness or thinness of the skin needs to be addressed as each can affect the visualized result; thick skin will camouflage tip contouring while thin skin may show the tip architecture created in the finest detail.  Therefore, in a thin skinned patient more discussion of tip detail is crucial.  Explaining planes, cartilage breaks, and light reflexes may then become important.

The most important pre-operative information that must be understood clearly by the patient is that it takes at least 6 months and usually up to a year before the final result is realized and that any necessary revisions should wait at least 6 months in most circumstances.  It is important to not over-sale the cosmetic rhinoplasty.

From the Plastic Surgeon’s point-of-view, reconstructive and even cosmetic rhinoplasty is challenging and has a “steep learning curve” which means it takes a lot of cases to become facile with the instruments and the operation.  I personally was trained by one the best rhinoplasty surgeons ever (see: Rhinoplasty Tetralogy by D. Ralph Millard, Jr., MD).  My early practice encompassed a lot of broken noses due to automobile or physical trauma.  Then I gained a reputation for cleft lip and palate as well as the most difficult rhinoplasties on infants and children.  After 20 years of experience I now only concentrate on teenage and adult cleft lip rhinoplasties, complex rhinoplasty due to trauma and most cosmetic rhinoplasty.   After an extensive 26 year experience, I still find rhinoplasty to be the most taxing and the most rewarding operation that I perform.

Dr. Paul Howard is a Real Board Certified Plastic Surgeon in Birmingham, Alabama.

To Schedule a Consultation call 205-877-PAUL


The Hidden Risks of Homeopathic and Herbal Supplements on Plastic Surgery by Dr. Paul Howard

March 21, 2013

The use of complimentary or alternative medicines such as those found in herbal or homeopathic preparations has increased from 20% or our patient population to more than 60% of our patients.  The fascination of herbals, teas, and homeopathic products exists because people believe these medicines to be “natural” and therefore perceived to be “safe.”  Only recently have these products been scrutinized carefully by the medical community to determine how safe they actually are.  Safety issues are being addressed due to the fact that there are an increasing number of reports describing bleeding


Dr Paul Howard Board Certified Plastic Surgeon Birmingham Alabama

complications due to herbal remedies.  We now know the chemistry of most herbals so we can now identify the substances within each herbal preparation that are likely to cause bleeding problems.  To date, the only documented sequelae of herbals that effects Plastic Surgery is the increased risk of peri-operative and post-operative bleeding which usually manifests as more swelling and bruising than one would normally see.  In more severe cases, these homeopathic medications may even cause significant bleeding and hematomas.

A partial list of common herbal supplements that are known to cause bleeding problems is provided:

Chinese Agrimony

Chinese Peony


Fritillaria Bulbs

Dan Shen

Devil’s Claw


Geum Japonicum





Oil of Wintergreen


Red Chili Pepper

Saw Palmetto

Other dietary supplements known to effect healing or cause bleeding:

Chondroitin & Glucosamine

Fish Oil

Vitamin E

As a general rule of thumb, any herbal supplement which is known to cause or have any pharmaceutical activity should be discontinued 2 weeks prior to a general anesthetic or outpatient surgery under local or sedation.  Since many herbal or homeopathic formulations contain numerous plant extracts, it is best to stop all homeopathic remedies including herbal teas a full 2 weeks before surgery.  Patients may renew taking their supplements once uncomplicated healing has progressed for at least one week post-operatively.  It is probably in the patient’s best interest to assume all homeopathic supplements have the potential to effect healing and should be discontinued 2 weeks prior to surgery.

Dr. Paul S. Howard, Board Certified Plastic Surgeon Birmingham, Alabama

Preparing for Plastic Surgery by Dr. Paul S. Howard

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On the Training of Horses, Linebackers, Pilots and Plastic Surgeons by Dr. Paul Howard

October 11, 2012

The critical reader may come to the opinion quickly that I am only a Plastic Surgeon and probably know little about training horses or football players.  While this is essentially true, I don’t believe it disqualifies me to comment on other fields of endeavor that require many of the same complex skills that are inherit to the Plastic Surgeon.

The training of surgeons is unlike any other field of endeavor.  One can read massive amounts of material, study diligently for four years of medical school, memorize the indications for an operation, actually study the pertinent anatomy and how to perform an operation and yet know virtually nothing without taking the final exam by incising the patient’s skin and performing an actual procedure where the stakes are as high as they can be.  This discipline is entirely different than any other medical specialty as the requisite study of disease is not the endpoint of training, it is the ante that allows one in the real game which is the application of knowledge to perform a mechanical skill (surgery) which is basically unnatural and requires skills that are not genetic but entirely learned.  Since surgery is learned behavior, there is no way to be graded except by the subjective appraisal of a competent surgeon.  As time evolves and the surgeon becomes independently proficient, the grading of results requires continuous, honest self-assessment of one’s results.  The built-in weakness of the surgical training paradigm is the quality of the “on-the-job” training.  This is the primary reason why surgical, and more specifically, Plastic Surgical training, can lead to widely diffuse results in the quality of the surgeon.  These facts became self-evident to me and led me to seek the most talented and well known surgeons of my era of medicine.  Since we learn surgery by watching and imitating others, it makes perfect sense to seek the best to emulate.  This quest is how I came to know John Kirklin, M.D, Ralph Millard, M.D, and Paul Tessier, M.D.  For those who are unfamiliar with the names, these are the best of the best in surgery.

Let me begin by admitting that I am a hero worshipper.  It happens that I have a small but unique set of personal heroes that I have accumulated over a lifetime.  These men have excelled in their respective fields which happen to include the thoroughbred racing business, the aircraft industry, the National Football League, and the field of Plastic Surgery.

Those who only know horse racing by watching the Kentucky Derby the first Saturday in May every year are not privy to the complexities of thoroughbred breeding, training, and racing.  You may notice the atmosphere in Louisville, KY at Churchill Downs includes beautiful hats and the unfettered consumption of Kentucky bourbon in the form of the ever present Mint Julep.  This pageantry belies the complexity of horse genetics and gene pools as well as the training of these extremely fragile animals.  Additionally, they are trained to race beginning as a two year old animal.  The three year olds that race the Derby are still adolescent animals and behave in many ways the same as our teenaged children.  Yet, the results of their early races can lead to a multi-million dollar horse, both as a racer and later as an addition to the thoroughbred gene pool.

Dr. Ruel Cowles is a veterinary physician/surgeon whose practice and life is dedicated to the healthcare of these majestic animals.  One of my mentors, John Kirklin, MD, was an established horseman and was convinced that race horses were essentially untrained whereas gaited, dressage, and jumpers were the only horses truly trained.  Dr. Kirklin also opined that a good jumper must be at least 10 years of age.  Racing 3 year-olds in packs of 10-20 over a mile long course against the best 3 year-olds in the world would probably be a daunting task for a 10 year-old thoroughbred.   It’s like training a 15 year-old to pitch in the major leagues – you can never be sure exactly what you will get.

Dr. Cowles embodies the best of clinical veterinary medicine as well as the intellect to excel as a horse breeder.  Dr. Ruel Cowles is one of my heroes.

I have more than a passing interest in the sport of American Football.  I was, as many of my colleagues were, a high school football player.  I managed to keep my NFL dreams alive through my first year of college where the physical and mental rigors of the game caused me to turn in my shoulder pads to pursue academics full-time.  As such I developed an almost unhealthy respect for those players who made it to the NFL.  I particularly liked linebackers as that was my chosen position.  The day I met Kevin Greene, at the time playing for the LA Rams, I realized who I would have become if I had the fortitude to continue playing.  Kevin was a walk-on at Auburn University in the early 1980’s under Coach Pat Dye.  He showed early on his pass rushing prowess, but only a few NFL scouts agreed and was chosen by LA in the sixth round of the draft. From his first training camp, Kevin’s coaches and teammates understood that going easy on the veterans was not part of his game.  All Pro offensive tackle Jackie Slater found out Kevin was a “maniac” on every play, pre-season or not.  Kevin was soon inserted in the line-up for the Rams and there he stayed.  After leaving the Rams for Pittsburgh, he truly found his identity, grew his hair to his shoulders, married a beautiful Alabama girl, and became a favorite in Pittsburgh because of his aggressive and relentless style of play.  He was known for sacking the quarterback but in fact was a complete linebacker in the 3-4 scheme.  I cannot remember a single time that a running-back or receiver managed to even fall forward after he got his hands on them.  I was privileged to be Kevin’s friend through the entirety of his 16 year NFL career including multiple Pro Bowls and defensive linebacker awards.  His intensity and dedication to his craft were unparalleled.   Ten years after his retirement from the NFL, he still holds the career sack total among linebackers.  Today, Kevin is imparting his knowledge to younger players as the outside linebacker coach for the Green Bay Packers.  Kevin is also one of my heroes.

I’ve known but a few fighter pilots and one submariner personally.  There are a few common traits these people have that separate them from the rest of us.  First, they all have very acute and agile minds that can assimilate knowledge quickly and apply it so that they are constantly evaluating their performance and improving by self-evaluating and reflection.  These traits are similar to those needed for Plastic Surgeons with the added immediacy of going Mach II or being thousands of feet under water.

As a first-year resident under Dr. Ralph Millard, I became acquainted with Dr. Gregory Lovaas senior resident under Millard.  Greg was like a xenon light in a room full of candles.  He shown brightly and was a wonderful teacher to me.  Knowing Greg as I did it was not easy to imagine the government putting him in a single seat F-104 fighter with nuclear weapons.  As I learned more about Greg, I realized he was the perfect personality for such a dangerous, in-your-face profession.  Greg, as most intelligent people do, had a wondrous sense of humor that may or may not have served him well over the years. My most vivid memory of Greg is the fighter pilot/Plastic Surgeon maniac.  He taught me the fighter pilot credo – “sometimes wrong, never in doubt.”  Greg Lovaas is one of my heroes.

A young boy and his twin brother grew up fatherless during the Great Depression in rural Griffin, Georgia.  Times were tough for everyone and the twins did the best they could for themselves and their family.  As they became teenagers, sports helped fill their days.  It was an accident playing baseball that knocked out the two front teeth on one of the boys causing a speech impediment and a lasting impression as he did not have enough money to receive the necessary dental care.  The twins with no prospects on the horizon lied about their age and enlisted in the Army and the Navy.  The story goes that the twins couldn’t understand why the new recruits were homesick and even cried at night while the twins were elevated from their Hell to three square meals a day and they weren’t worked very hard.  The addition of free dental care made WWII a life altering experience, all for the good.

New pair of shoes, one suit, two new teeth and training in electronics were enough to start a new life several years after the war with a new wife and further training in repair of the new-fangled American commodity – the television set.  The younger of the twins was desperately trying to live the American Dream.  Fixing the notoriously unreliable TVs and their vacuum tubes was a decent job.  Utilizing his military training and hands-on electronics experience, twin got a job with Lockheed Aircraft in Marietta, Georgia where he taught electronics to the new hires needed to build the C-130 “Hercules” and the new super airliner – the L-1011.  The younger twin learned he had a knack for teaching and especially training people to do a job.  He eventually parlayed this experience into industrial training programs for four Southern states eventually having a training facility posthumously named after him in Montgomery, Alabama.  Twin number two, and one of my heroes, was George L. Howard, my father.

The training of Plastic Surgeon is a long grueling process due to massive amounts of material to learn, but more importantly the aptitude, mental acuity, and complex decision making necessary.  Most students of Plastic Surgery realize that the training is so long (± 6 years) because the depth of knowledge necessary is vast and by necessity practicing Plastic Surgery requires a malleable mind to attack each challenge with freshness, intensity, and thoughtfulness. These attributes are not something one can read about, but can only be obtained by acquiring the knowledge from others who already have it.  This is why it is so important to ask the credentials of a Plastic Surgeon so one can surmise the quality of his/her education in Plastic Surgery.  In Plastic Surgery, it makes perfect sense that truly the best Plastic Surgeons are the best teachers.  My final heroes are two of my Plastic Surgery mentors that encompass the best that our field has ever created.  D. Ralph Millard, Jr., M.D., and Paul Tessier, M.D. are also my heroes.

Recent history has taught us the penalty to be paid by the consumer of Plastic Surgery who is swayed by the exquisite marketing of doctors who believe for financial reasons that the least amount of education in the intricacies of Plastic Surgery is somehow better than the full training program that has been in place for 30 years.  There is no other example of attenuated training in any of the surgical specialties.  Neurosurgeons are required to train in all aspects of neurosurgery and even take a year of basic neurology training even though few neurosurgeons practice all of the aspects of the specialty.  This is mainly because for the last 100 years it is clearly shown that almost all specialists benefit from a wide and diverse basis of knowledge leading to calmness under pressure and the ability to elicit a laser-focus required of the expert.  This is true for training many kinds of endeavors and one will never find a short-cut to the training of the best race horses, NFL linebackers nor in the making of aircraft or the training of Plastic Surgeons.  Hippocrates said it best in his aphorism “Life is short, and the art is long; opportunityfleeting; experience perilous, and decision difficult.”  The first time I heard this warning was from the great cardiac surgeon John Kirklin, M.D. in his famous surgical “bluebook” to help train young cardiovascular surgeons.

To learn more about Dr. Paul Howard, please visit his web sites:





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