Pertinent Insights On Adjunctive Modalities To Facilitate Fat Pad Restoration

The purpose of fat pad restoration is to restore volume that has atrophied due to factors such as autoimmune conditions, diabetes, weight and pressure, excessive biomechanical forces, cortisone injection therapy, trauma, previous surgery, etc. In the cavus foot, typically patients have anterior displacement of the fat as it collects at the forefoot sulcus. These patients relate pressure under the ball of the foot and a feeling that their socks are bunched under their toes. These patients have anterior displacement of the natural fat pad.

By injecting a filler, the material restores volume. However, depending on the product one uses, the body resorbs a majority of the water portion of the product. For example, Sculptra® Aesthetic (Galderma) comes in a powder form that one mixes with sterile water. I also add lidocaine but that is a personal preference. Once the body resorbs the water portion, the filler starts performing its function. The function of most fillers is to stimulate collagen. This collagen restores tissue in areas where there is a loss of soft tissue.

Unfortunately, not all patients respond to the fillers in the same way. We have utilized some additional modalities to help ensure the best outcomes. At six weeks post-injection, patients should have a good foundation as to the amount of improvement they have from the injections. If the first injection was not adequate, one can use a touchup of the filler.

Other modalities I have found helpful to enhance effects of fat pad restoration are infrared technology and the Genesis Plus laser (Cutera). One would use infrared technology or the Genesis Plus laser directly over the injection site. These treatments provide direct energy to the injection site of the soft tissue surrounding filler. With both treatments, an increasing oxygenation occurs through vasodilation. By increasing circulation and oxygenation, the tissue can respond and enhance the distribution of collagen cells so the filler can perform its function to the maximum degree. I prefer gentle massage and manipulation of the tissue in conjunction with the therapy and I have the patient perform massage therapy three times a day. It is recommended to perform the infrared technology or laser treatments two times a week for three to four weeks.

For more info, see www.bocaratonfootcare.com .