Not Ready for Major Invasive Surgery?

Try Lipogems, a minimally invasive, FDA cleared option that can be performed in the clinic or adjunct to arthroscopic or orthopedic surgery to help heal damaged or injured tissue.


Why do people prefer to avoid major invasive surgery? 

 “Many patients have tried conservative options such as corticosteroids, etc but with limited relief.  Some of these patients are told that they need a total joint replacement because typically there have not been other options.  Now, there are options! In the DC area, there are many people with busy working professionals that can’t take time off work and go through an extensive amount of rehabilitation after surgery.  We talk to each patient to determine what their goals are and find the right option for them. Also, patients also must consider the permanence of a surgery especially a total knee or hip replacement.  Many patients want to try other options before enduring such a permanent procedure and we have the FDA cleared options that may be right for them.”, said Nathan Yokel, MD.    

“We have many types of people that are not ready for major invasive surgery such as busy parents, working professionals, weekend warriors, etc that are exploring all options instead of major surgery. Some may be too young to have joint replacement surgery and others desire to continue their competitive weekend activities such as triathlons, ironman races, and competitive cycling.  Other people may be too ill or too old to undergo a major surgery that would be considered unsafe.  Importantly, they may have a personal preference for seeking a less invasive or natural option.”, said John L. Ferrell III, MD


Are you in the orthopedic treatment gap?

The treatment gap is the time period between limited relief or failure of conservative efforts (such as physical therapy, pain medications, activity modification, viscosupplementation) and the time when they undergo surgical intervention. Typically patients are in the “treatment gap” for 9-20 years and even 40 years for younger patients or military personnel.  Our goal is to help these patients by providing FDA cleared options backed by peer-reviewed scientific literature to help them live happier and healthier lives. 

“A lot of patients that are in the treatment gap are frustrated and stuck and they don’t know what the next step is. If they are stuck in the treatment gap for a long period of time, they may experience debilitating pain, reduced quality of life, and this may cause weight gain, depression, develop chronic diseases and other conditions that manifest due to lack of activity.  In those cases, offering them options to help with maintain or improve their quality of life. “ said Dr. Yodit Tefera. 

“Certain orthopaedic issues don’t have great surgical options. If a patient is not responding to conservative treatment, these options that we offer are a great option for patients in the treatment gap and have shown more success than the surgical procedures in some conditions.”, Said Dr. Yokel

Dr. Tefera added, “Some patients are reluctant to undergo major surgery because of the long-term recovery, are worried about asking help from others, and taking time away from work and family obligations.”


[Are you in the orthopaedic treatment gap?  Take this quiz to find out]


What options do you offer patients that are in the treatment gap?

Dr. Yokel states, “Our goal is to help these patients by providing FDA cleared options backed by peer-reviewed scientific literature to help them live happier and healthier lives.  At ROSM, we like using your own tissue to help support the healing process as a minimally invasive option or as an adjunct to your orthopaedic and arthroscopic surgery. In addition to the treatment, we are building a relationship with your physical therapists and other key players to ensure that we have a comprehensive approach to your treatment plan. Said Yokel 

Dr. Mulvaney is an Associate Professor of Medicine at the Uniformed Services University in Bethesda, Maryland and is board certified in Sports Medicine and Pain Medicine practicing at ROSM. “I chose Lipogems as part of my patient’s plan because it is FDA cleared and uses a patient’s own cleansed and purified fat tissue to support the healing of damaged or injured tissue.  Major surgery doesn’t have to be the only option.  Lipogems procedure is simple and can be performed in the office in about an hour and half using ultrasound guidance.”

  “Ultrasound guidance is helpful in evaluating the tissue depth and where the defects are located inside of your body and how large the defects are and damaged or injured the tissue.  The ultrasound guidance helps guide us to how far the needle should go when injecting therapies and make sure that we get it in the right place.” Said Dr. Joshua Martin. 


Why do you use a patient’s own fat tissue for orthopaedic issues?

Dr. Yokel said, “Fat has been shown to be a very powerful tissue that has been used for medical purposes.  There are many benefits of fat! Fat is easy to collect using a minimally invasive procedure using a local anesthetic from the abdomen or love handles.  Studies have shown that the quantity of important cells in the fat does not decline with age as it does with other cell sources. 1,2,3,4 A clear advantage of using one’s own tissue is the decreased likelihood for rejection or infection.  Because fat is a structural tissue, it provides cushion and support, allowing it to support healing of the damaged tissues.”

Dr. Mulvaney says “It is important to note that many people have enough fatty tissue reserves in either their abdomen or love handles/upper buttocks area, even your skinny or athletic patients!  Most people are happy and say “take as much fat as you would like!”. The fat can be processed using an FDA cleared device called Lipogems that washes, rinses, and resizes the fat to an optimal size using only simple saline. The output is called Microfragmented Fat and it can be injected into multiple sites in the same setting.”


What is Lipogems and is it FDA cleared for use in orthopedics? 

 “Lipogems uses a patient’s own fat with a patented system that processes and resizes the tissue in just minutes.  The processed tissue is called Micro-fragmented Fat™ (MFAT) and it is injected into injured areas to help provide cushion and support the healing of damaged tissues.  I like to use the analogy of a pothole in the road.  The pothole can be filled with asphalt and allows cars to drive over it.  MFAT is very similar, it is injected into the area where there is damaged or injured tissue and it provides cushioning to allow the area to heal naturally.  There have been over 55,000 procedures performed worldwide for the past 8 years and with positive experiences and minimal complications. There are also over 120+ peer-reviewed scientific publications about this procedure.”, said Dr. Mulvaney. 


ROSM’s top reasons for using Lipogems:

Multiple Injections in the Same Session: “It is very common for patients to suffer from multiple orthopedic issues. This is a result of common wear and tear and/or compensating for one issue leads to another issue.  This is especially true for people who put a lot of impact on their body like marathoners, triathletes, military personnel, etc.  I like using Lipogems is the system washes, rinses, and resizes your own fat tissue for multiple injection sites during a single session. For example, if you suffer from orthopedic issues in both shoulders, one knee, and one foot – one can inject in three different areas in the same setting, with minimal downtime from the procedure and minimal pain medication.” Said Dr. Ferrell. 

Natural, Minimally Invasive Procedure with Minimal Complications/Risk: Using your own tissue has minimal chance of rejection or infection. There have been over 55,000 Lipogems procedures performed with a low rate of minor complications (1-2%) and no major complications reported.  

 “The safety profile for Lipogems is excellent.  According to the evidence and our experience, it has been shown to be very helpful for more of the severe orthopaedic issues compared to the other therapies that are available.” Said Yokel.  

Strong Scientific Evidence from Leading Institutions: 

“Being on the forefront of research and technology is important to me,” Dr. Mulvaney said. “After serving in the military for the past thirty-one years, I am committed to delivering ethical and quality care to my patients. I still keep the principles that I learned from the military. I do my own research and fully evaluate technologies before I offer them to my patients. I only offer technologies that have strong scientific evidence. Lipogems fits perfectly with that philosophy.”

“As board certified orthopaedic physicians, we have been using Lipogems since the past 7 years and it is important to for us to follow the clinical and scientific evidence.  We have presented the evidence at national and international orthopaedic conferences.  Lipogems has over 120+ peer-reviewed publications with 3-year follow-up supporting Lipogems. The scientific and clinical studies were performed at leading institutions such as New York University, Harvard University, Emory University, and others. Importantly, we also collect our own evidence.” said Dr. Ferrell.  

Dr. Martin added,” From my experience, it just really works well! It is successful in about 80-90% of patients with orthopaedic issues and they only have to come in one time for the procedure.”

Economical and Efficient: “The procedure is economical and the majority of the patients receive one procedure.  In addition, Lipogems is more cost-effective than the costs of major orthopaedic surgery and may be used in multiple sites in the same setting. Major orthopaedic surgery is expensive and the recovery period can be cumbersome and lengthy. There is minimal down time required with the Lipogems procedure.  Our patients are happy with the procedure.  Even if they need the treatment to be repeated again down the road they are happy to do it. It is important to know that each patient’s results will vary.” Said Dr. Martin. 

“You have one body and it is important to take care of it and prioritize your goals.  Trying non-surgical options maybe ideal for a lot of patients since they can’t reverse surgical procedures once it is performed. Non-surgical options may play a role in helping you with your lifestyle and goals before surgical interventions.”, said Dr. Tefera.  

The Benefits of Lipogems
  • Supported by more than 120+ peer reviewed scientific publications with up to 3 years of follow-up 6
  • More than 55,000 procedures5 performed worldwide with a low rate of minor complications 15and no major complications reported6,7, 8, 9
  • Offered by leading orthopedic physicians around the world
  • Your own Micro-fragmented Fat may be injected into multiple areas at the same time
  • No risk of rejection and low risk of infection since you are using your own tissue
  • Minimal downtime after the procedure
  • Minimal pain medication required after the procedure
  • One-time procedure for a majority of patients 6,9
  • Less expensive than most out of pocket costs related to major orthopedic surgery
  • Offered by the Department of Defense and Veteran Affairs Medical Centers


Will someone need major orthopedic surgery in the future?

“It is important to know that individual results may vary. You may or may not need major orthopedic surgery in the future. You may or may not choose to have the procedure repeated if desired down the road. However, you may want to try this option if you are still suffering from your orthopedic issue and/or major orthopedic surgery has been canceled or delayed or you are not ready for major surgery.” Said Dr. Ferrell. 


If you are interested in learning more about your options, please click here:

  • Phone: (202) 996-7474
  • Book An Appointment Online: Click Here



  1. Beane, O.S., et al. (2014). “Impact of aging on the regenerative properties of bone marrow-, muscle-, and adipose-derived mesenchymal stem/ stromal cells.” PloS one 9.12. e115963. 
  2. Stolzing, A., et al. (2008). “Age-related changes in human bone marrow-derived mesenchymal stem cells: consequences for cell therapies.” Mechanisms of aging and development 129.3: 163-173. 
  3. Kern, S., et al. (2006). “Comparative analysis of mesenchymal stem cells from bone marrow, umbilical cord blood, or adipose tissue.” Stem cells 24.5: 1294-1301.
  4. Somoza RA, Welter JF, Correa D, Caplan AI. Chondrogenic Differentiation of Mesenchymal Stem Cells: Challenges and Unfulfilled Expectations Tissue Eng Part B Rev. 2014 Dec 1; 20(6): 596–608.
  6. Russo et al. Autologous micro-fragmented adipose tissue for the treatment of diffuse degenerative knee osteoarthritis: an update at 3 year follow-up. Journal of Experimental Orthopaedics (2017) 4:33 
  7. Hudetz, D, et al.  The effect of intra-articular injection of autologous micro fragmented fat tissue on proteoglycan synthesis in patients with knee osteoarthritis.  Genes.  2017, 8, 270.
  8. Bisicchia, et al. Micro-fragmented stromal-vascular fraction plus microfractures provides better clinical results than microfractures alone in symptomatic focal chondral lesions of the knee. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019
  9. Cattaneo, G., et al. Micro-fragmented adipose tissue injection associated with arthroscopic procedures in patients with symptomatic knee osteoarthritis. BMC musculoskeletal disorders, 2018; 19(1):176.



Individual results vary. Not all patients will have the same post-procedure recovery and activity level. See your physician to discuss your potential benefits and risks.The Lipogems System is a sterile medical device intended for the closed-loop processing of your own fat tissue in medical procedures involving the harvesting, concentrating and transferring of your own fat (adipose) tissue harvested with a legally marketed lipoplasty system. This can be a minimally invasive procedure that’s done in the office, to support soft tissue defects and may promote healing in orthopedics and arthroscopic surgery. Lipogems may or may not appropriate for all patients. Like any medical procedure, there is a risk for soreness, redness, swelling, and/or pain. These procedures require needle access (size, location and depth vary depending on the procedure) and this may result in (but not limited to), discomfort, pain, apprehension, bruising, tenderness, bleeding, swelling, or infiltration at the injection site. Other symptoms that may occur include lightheadedness, fainting, nausea, or vomiting. There is slight risk of infection at the injection site and have minimal risk of adverse reactions or complications as with any other injection procedure. Since the fat is from your own body there is little concern of disease transmission, allergic reaction or tissue rejection. For patients with chronic medical conditions such as autoimmune, diabetes, heart or lung disease, circulatory diseases or obesity, extreme caution may be necessary. There are rare but possible risks and complications due to fat transfer including an allergic reaction to the local anesthetic, damage to underlying structures, hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal), changes in sensation, unsatisfactory results that may necessitate additional procedures, permanent discoloration caused by a ruptured blood vessel at the treatment site, calcification, a divot in the area of the tissue harvest, peri-operative bleeding, a blood clot at the treatment or donor site, an infection, scar tissue, and a fat embolism caused by a fat injection mistakenly directed into a blood vessel, and death. The information presented is for educational purposes only. Speak to your doctor to decide if Lipogems procedure is appropriate for you. Individual results vary and not all patients will return to the same activity level. The lifetime of any procedure is limited and depends on several factors like patient weight and activity level. Your doctor will counsel you about strategies for your post-procedural care. It is important to closely

follow your physician’s instructions regarding post-procedure activity, treatment and follow-up care. Ask your doctor if Lipogems procedure is right for you. Lipogems or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Lipogems. All other trademarks are trademarks of their respective owners or holders.

Written by Dr. John

Leading the shift in orthopedics and sports medicine - ROSM (Regenerative Orthopedics & Sports Medicine) walks you down the path of healing by providing innovative treatments. Our team is incredible at healing active injured humans. We use cutting-edge technology, new techniques, and an integrative approach to get YOU active again – without surgery.