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Sunday Front Page Article

R.I. doctor is the Robin Hood of plastic surgery, taking stem cells and rich stores of fat from the thighs and giving them to the face

By G. Wayne Miller | Journal Staff Writer

PROVIDENCE – As his team prepares the operating suite for what will be hours of the most delicate surgery on the most distinctive part of anatomy, Dr. Patrick K. Sullivan stands in an adjacent room, gloved hands drawing purple lines on his patient’s face. Susan, 59, has traveled from the West Coast to avail herself of the doctor’s exquisite expertise, which is informed by his longstanding passion for painting and sculpture.

She has come for so-called facial rejuvenation — a face-lift, in lay terms. Like other types of surgery, significant advances have been made in recent years, thanks to research. And one of the pioneers is Sullivan, division chief of aesthetic surgery and associate professor of plastic surgery at the Warren Alpert Medical School at Brown University. In his work, he applies the frontier science of regenerative medicine, in which the body rebuilds itself.

“What do you feel we are going to be able to do for you?” Sullivan had asked Susan two days before, when, after an extensive email and telephone correspondence that satisfied both that they should meet in the operating room, she visited his office.

“I’m hoping that my jowls will be minimized and the creases will be minimized and I’ll get back to having my previous neckline,” Susan said.

“I can see that you have a lot going on in your neckline. It has a beautiful contour.”

Susan, a retired public-policy analyst for a federal agency, agreed — but age, she said, had robbed some luster from that beauty.

“Tell me about your cheeks,” Sullivan said. “What’s happened over time?”

“They have fallen!”

Susan laughed. She pointed just below a cheekbone.

“I have kind of this hole back here, which I assume used to have fat in it. So it’s kind of this hollowed-out, dragging look.”

The surgeon outlined his strategy.

“The lifting procedure that we do with the multi-layer lift can help give more fullness back in that area where, like you said, it’s been hollowed-out or rather gaunt,” he said. “And then we’ll lift that tissue up and keep it in that position. Because, as you said, it’s fallen over time with gravity and things like that.”

Unlike the traditional face-lift, which relies on stretching skin, a technique that can produce disappointing results — what has been called the “alien” or “frozen” look — Sullivan’s surgery involves injections of fat and its associated stem cells, which are at the heart of regenerative medicine. Body, refresh thyself.

“There’s not going to be anything added to it, just what your body already has,” the surgeon told Susan. “So it’s your fat, your stem cells.”

Using tiny, custom-built tubes known as cannulas, he would harvest the yellowish flesh innocuously from her thighs, leaving no trace, no scars or deformities.

Susan related the journey that led her to Rhode Island. It began in Las Vegas, where her West Coast plastic surgeon and his staff heard Sullivan present a paper at a meeting of the American Society for Aesthetic Plastic Surgery. They were impressed. So was Susan when they informed her of the marvels of regenerative medicine.

“I did my research,” she said. “I trust that he will give me a natural look. I don’t really want to run around with everybody saying ‘she had plastic surgery’ or whatever.”

And there are worse things that are said when things go wrong.

Now, as Sullivan completes the lines on his patient’s face that will define his sculpture, Susan’s trust is about to be tested.

In the operating suite in rental space at Rhode Island Hospital, the doctor’s team stands ready.

Sullivan was no child of privilege, not someone born with a medical pedigree — unless you count his father, who aspired to be a doctor but was forced to leave college when the tuition became too burdensome. So Dad worked the Minnesota iron mines and other blue-collar jobs. He and his wife, a schoolteacher, had nine children. Sullivan was the last.

The young boy developed an interest in painting and sculpture — and then came a coincidence that would unite that childhood passion with a different if distinctly related calling. He was in second grade when his oldest brother came home from medical school with an anatomy text, which his parents permitted him to read. Curious to see firsthand what lay hidden beneath skin, he performed his first dissection: of a fresh-killed chicken, on the kitchen floor.

Sullivan graduated from St. John’s University in Collegeville, Minnesota, in 1975, and from Mayo Medical School in 1979; and then, after a general surgery residency, completed three years study of head/neck surgery and otolaryngology at the University of Colorado, where he decided on a career in plastic and reconstructive surgery.

Following a residency at Brown, where he would later be professor, Sullivan trained for almost a year with distinguished plastic surgeons in Zurich and Paris, where he frequented the Louvre and Musée Rodin, two of the world’s great art museums.

“The combined study of art and science has enabled me not to just talk about an artistic approach for each patient but to actually bring about a very natural enhancement for them in the operating room,” said Sullivan, who lives in Barrington.

Today, Sullivan lectures and publishes regularly, influencing others beyond Rhode Island.

Dr. Ivona Percec, a plastic surgeon and researcher with the Perelman School of Medicine at the University of Pennsylvania, is among his disciples. She describes Sullivan as an innovator, calling him “the ultimate plastic surgeon, who has created a legacy of facial rejuvenation procedures of which our profession should be proud.”

And, she says, he remains committed to teaching — and learning. “He is not only an incredibly kind person who supports resident and physician education,” Percec told The Journal, “but also a broadly open thinker who constantly strives to learn more.”

Said Dr. J. Peter Rubin, professor and chairman of the department of plastic surgery at the University of Pittsburgh: “Dr. Sullivan is nationally recognized for his expertise in both aesthetic surgery and pediatric reconstructive surgery. The work he is doing with fat-grafting and regenerative therapies has broad-reaching applications for improving the lives of our patients across generations.”

The monitor beeps. Sullivan’s team is quietly busy.

Susan lies on the table, sedated but not with general anesthesia, which would have required intubation, which carries risk. Local anesthetic will block pain, and the sedation mix will erase memory, but avoid the potential complications and often difficult post-operative recovery from the lingering effects of general anesthesia and a breathing tube inserted into the trachea.

“Look at this beautiful sedation; she just doesn’t move at all,” Sullivan says. “Not everybody is as good as Dr. Panaro!”

Dr. Heather Panaro trained at Massachusetts General Hospital and is a clinical assistant professor of surgery at Brown. Nurse Beata Sochacka and technician Lynn Rainey are also part of Sullivan’s team.

One pinprick at a time, the surgeon pulls a small volume of fat with associated stem cells from Susan’s thigh and places it, one injection at a time, beneath the creases on her cheeks and jowls, as Sullivan mapped in purple preoperatively. Rainey, who has been with Sullivan for almost two decades, tracks the surgeon’s moves.

“Zero-point-five on the left …,” Sullivan says, marking the volume of fat in cubic centimeters. “We put the injection in here and it swelled up more than usual….We’re just going to hold off on this a little bit and put some pressure on it because the needle could hit a blood vessel.”

The surgeon is similarly respectful of nerves. During his many hours dissecting cadavers in a Brown lab, he perfected his knowledge of fine facial anatomy.

About an hour in, Sullivan moves higher on Susan’s face. He will use a scalpel for the first time, cutting through her scalp to reach the tissues beneath her forehead, which he will pull up, or lift.

“Even though we’re not doing eyelid surgery,” Sullivan says, “we’re going to suture the eyelids closed to protect them, since we’re bringing up all this instrumentation. We don’t want corneal abrasions.” He will not cut near her eyes, but the tools he will use will repeatedly pass by them, so he exercises an abundance of caution.

Sullivan cuts into her scalp, behind her hairline but avoiding the follicles. The incisions will not be seen.

“If you cut down through them, it might give a little bald spot,” he says. “You shouldn’t lose any hair.”

In preparation for tightening the forehead tissues from within, Sullivan inches along the surface of her skull with an endoscope; the scope-tip camera sends an image to a monitor to help guide him. The sound of metal on skull is audible, and perhaps properly described as unsettling, at least to the layperson.

“The reason we’re down to the bone here is the blood vessels are so incredibly exuberant in the scalp area. This way, if you’re on the bone, you’re safe.”

Sullivan brings his expertise to a variety of patients, including children born with craniofacial, cleft palate and other deformities who require reconstructive surgery; with some, he incorporates regenerative medicine, as outlined in a recent paper, “Autologous Fat Grafting in the Pediatric Population,” submitted to Plastic and Reconstructive Surgery, Journal of the American Society of Plastic Surgeons.

He frequently travels abroad, including with the Operation Smile and Smile Train programs, to provide free care to needy children. He teaches techniques developed by him and others at foreign hospitals and universities where such expertise is lacking.

Still, elective work remains a pillar of his practice. Insurance ordinarily does not cover this type of surgery and, depending on how extensive it is, the cost can range from less than $10,000 to about $30,000. Like other plastic surgeons, Sullivan offers payment plans.

His success has brought prominent people to him, including, this fall, professional golfer Brad Faxon. The surgeon completed upper eyelid rejuvenation for Faxon, now a Fox Sports golf analyst. Faxon applauded the results.

“His reputation in Rhode Island was well-documented for all types of surgery,” Faxon said, “but more remarkable was how well-known he is not just throughout the United States but internationally as well .… My recovery has been great, and I cannot say how pleased I was.”

Said Sullivan: “My patients tend to be people who want to be their best and be able to go about their life without people telling them they look tired when they are not. People most often come for professional reasons. They have very legitimate problems that we can help them with. Vanity is not the motivator in my patient population.”

In assessing a candidate for facial rejuvenation, Sullivan considers input from a candidate’s cardiologist, internist and other professionals.

“Everybody has to clear them to make sure they’re not only healthy medically but we also want to make sure we get a good report that they are healthy emotionally, too — that they seem very solid and have great reasons for having this done.”

Some, Sullivan said, are professional.

“Many of my patients want to stay in the workforce or they at least want to be major contributors. Some feel they are being passed up by promotions that are given to younger people. They feel that the younger people are favored because they seem to represent new ideas. There is definitely age discrimination out there.”

Others, he said, seek remedy from inherited conditions. He cites a 22-year-old patient who “had bags and circles under her eyes. She had puffiness under her eyes. People in [job] interviews asked her was she tired or if she had been partying the night before. Our lower eyelid surgery was done through invisible incisions on the inside of the lower lid. The puffiness in circles were removed. She was able to get a job.”

Before Susan visited Sullivan’s table, she showed him photos of herself going back decades to help him understand the look she wanted. The two discussed her motivation.

“A lot of my patients feel that they have internal age and an external age and they oftentimes don’t match,” Sullivan said. “What do you feel like on the inside?”

“I don’t know, 43?”

“It usually ranges from 21 to about 45, 46 years old. I have a person I just operated on who is 68 and said her internal age is 26.”

Several weeks after her facial rejuvenation, Susan returned to Sullivan’s office. The bruising, swelling and pinpricks were gone, along with all other traces of surgical trauma. Her husband, who had expressed qualms before the surgery, was delighted, Susan said.

“You’re back, the sutures are out, what does it feel like?” Sullivan said.

“It feels very good,” Susan said. “I’m very happy. I still have a little numbness in my have a little numbness in my jaw, but other than that, I feel great. I look better.”

“You say you look better. How do you feel you look now?”

“My face fits more of my body, I guess I would say. I just look more youthful. And I am going to be 60 in December.”

“Wow,” her surgeon said.

‘Nip. Tuck. Or Else.’

The popularity of surgical and non-surgical cosmetic procedures in the U.S. continues to rise. Skyrocket may be the appropriate description, as statistics compiled by the American Society for Aesthetic Plastic Surgery reveal. Last year, according to the society, Americans spent $13.5 billion on the procedures – an increase of $1.5 billion in just one year. (Graphic, Page A1.) In releasing the 2015 report last March, American Society for Aesthetic Plastic Surgery president Dr. James C. Grotting cited some of the factors behind the rising popularity of cosmetic procedures. “It refl ects a healthy and robust economy wherein many people can afford to, and want to, invest in themselves,” he said. “As editor Joel Stein aptly pointed out last year in a TIME Magazine article, “Nip. Tuck. Or Else.” “More people now perceive aesthetic enhancements and procedures as essential. I personally believe the motivating factors for that are varied, but remaining competitive in the workforce is certainly a common factor. Youth is a commodity, and people are investing in themselves to maintain a younger, healthier appearance.” Read the full 2015 report: www.surgery.org/sites/default/files/ASAPS-Stats2015.pdf jaw, but other than that, I feel great. I look better.”

“You say you look better. How do you feel you look now?”

“My face fits more of my body, I guess I would say. I just look more youthful. And I am going to be 60 in December.”

“Wow,” her surgeon said.

— gwmiller@providence-journal.com
(401) 277-7380 OnTwitter: @GWayneMiller