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Archive for the ‘stem cells’ Category

The Benefits of Stem-Cell Enriched Fat Grafts

Monday, October 7th, 2013

 

Fat grafting preceded by liposuction harvest is a cosmetic and reconstructive plastic surgery procedure that is here to stay. Despite the ease of fat availability in most people and the ability to virtually put it anywhere by injection, it is plagued by two as yet unsolved problems. It survival is, at best, unpredictable and the many regenerative capabilities given to it is largely unsubstantiated although well anectodally documented.

Many of the benefits given to fat grafting is credited to its stem cell content although the number and true functions of them remain unclear. Many have conjectured and even tried to supplement fat with additional stem cells but the benefits of this combination in humans have not been substantiated…until now.

In the September 28 issue of the Lancet in a special issue dedicated to surgery, an article entitled ‘Enrichment of Autologous Fat Grafts with Ex-Vivo Expanded Adipose Tissue-Derived Stem Cells for Graft Survival: A Randomized Placebo-Controlled Trial’. In this unprecedented study, the results of a triple-blind, placebo-controlled trial compared the survival of fat grafts enriched with autologous adipose-derived stem cells (ASCs) versus non-enriched fat grafts. Using patients who had liposuction harvests two weeks apart, one for ASC isolation and another for fat graft preparation, 30ml fat injections were done in each upper arm. One graft was enriched with ASCs (20 × 106 cells per mL fat), and another graft without ASC enrichment served as a control. Injected fat volumes were measured by MRI immediately after injection and four months later.

Their findings showed that the grafts that were enriched with fat-derived stem cells retained 81% of their volume compared to the standard grafts that retained just 16% of their volume. Four months later, stem cell grafts also demonstrated higher amounts of adipose tissue and newly formed connective tissues. Moreover, there was less necrosis in the stem-cell-enriched fat grafts compared to the standard grafts. (which is also why there were higher retained volumes)

This study confirms what many have suspected and even espoused, that adding stem cells to fat grafts improves their survival. At the very least it improves fat grafting reliability and may even render greater regenerative properties to them. However, such stem cell supplements is not currently allowed for human use in the U.S. under FDA regulations. It is not permitted to harvest stem cells, grown them in cell culture and then return them for implantation to a patient unless done as part of an FDA-approved clinical study. These results also do not necessarily relate to some current devices that isolate stem cells from fat for immediate re-implantation as that is not really supplementing or ‘supercharging’  the fat graft.

One alternative option to supplementing fat grafts is with platelet-rich plasma (PRP), which can be done concurrently with fat grafting, but whether this produces a similar effect to stem cells or has any positive effect at all remains theoretical.

Dr. Barry Eppley

Indianapolis, Indiana

Stem Cells and PRP in Plastic Surgery – Anti-Aging Hope or Hype?

Sunday, July 14th, 2013

 

Some have said that the power to slow down aging or to ‘heal thineself’ does not come from some external source such as potion or pills but from within. This has led to the popularity of two natural materials derived from blood and fat. Stem cells (in fat) and platelets are located throughout the body and can be relatively easily harvested and prepared into an injectable form. This permits them to delivered into almost any body site to create either improved healing or a tissue enhancement effect. This has enabled such autologous injections to be used for a wide variety of medical applications including aesthetic and anti-aging applications.

The use of embryonic stem cells in numerous medical diseases is controversial. But the use of adult stem cells for their potential cosmetic and anti-aging effects is not open to as much criticism as there does not seem currently to be much downside. The debate with their use is whether they can live up to the hype. Numerous anectodal claims are made about such injections as creating youthfulness, adding permanent tissue volume and improving the appearance of the skin. This has led to a number of procedures being touted, particularly on the internet, with such names as stem cell facelifts and stem cell-enriched fat grafts. The names suggests that they are better than the traditional procedures.

But stem cell injections in plastic surgery today are, most of the time, fat injections that undoubtably contain stem cells but in what quantity and what activity is completely unknown. Although not cleared by the FDA for this use, there are machines available that can process fat to get a stem cell concentrate which can be injected. The problem with fat-derived stem cells is no one knows for sure what happens when they are injected or if there are any significant adverse effects long-term from doing so. It is reasonably assured that fat injections are completely harmless and that stem cell injections are similarly so, but that is a long way from being shown to be absolutely so.

Conversely, evidence that stem cell injections have any positive anti-aging effects by themselves has not yet been forthcoming. There is no doubt that the promise of stem cells is great in terms of potential tissue regeneration and some observable anti-aging effects on the skin. But there is very little data from human clinical studies that currently support any of the hype or marketing claims some doctors make. Injecting stem cells under the skin has not been proven to improve the appearance of the overlying skin. (fat injections are more promising based on the volume addition) The clinical results to date are isolated case presentations and subjective observations and substantial research is still needed to figure out the potential of stem cells. Thus for now, stem cell injections like stem cell containing skin serums, must be viewed as suspect.

Unlike stem cells, the positive effects of platelets on healing is more established. Wound healing is known to be mediated by a complex array of cellular and protein and peptide interactions. Platelets play a major role in this process. Platelet-rich plasma (PRP) is blood plasma that has a high concentration of platelets due to processing techniques. During the procedure, about 60cc of blood is removed from the patient and and the PRP concentrate is then obtained by a centrifugation process. This creates a few ccs of concentrated platelets (platelet plug) that can be added to a variety of plastic surgery procedures to theoretically improve their results. Due to its platelet contents, PRP contains many different growth factors and cytokines that have potent cellular and tissue stimulation effects.

While PRP can be used alone as an injection, its small quantity (usually about 3ccs) lends itself to be mixed or combined with other materials as part of the injectate. These could include fat or, more commonly, synthetic injectable fillers. There are several commercial aesthetic products which do just that with marketed brand names such as Selphyl and the Vampire Facelift. These products create either a platelet-rich fibrin matrix or are mixed or done right after the placement of such well known fillers as Juvederm and Restylane. The benefits of PRP in these facial rejuvenation techniques, while appealing, has not been fully substantiated in widespread clinical use and ongoing patient treatments continue to evaluate what role concentrated platelets may provide for volume retention and any other anti-aging benefits.

Stem cells and PRP are naturally derived products but that does not necessarily confer that more of them in one spot will be better than what we have residing in our bodies now. Their appeal is undeniable but that has not proven just yet that their benefits are equally so.

Dr. Barry Eppley

Indianapolis, Indiana

The Stem Cell Facelift Revealed

Sunday, April 28th, 2013

 

Many treatments have been touted over the years to create a facelift-like effect from topical creams to devices in lieu of having the actual surgical procedure. Today’s ‘alternative facelifts’ have taken on a very different approach and it is done through largely an injectable approach. These are all about adding volume to the face, plumping it out in select sunken facial areas. In many ways these are facial reinflation methods which work best for those patients who have lost volume and have a little loose or saggy skin.

These volumetric facelifts are comprised of two basic approaches. The first is the generic liquid facelift which completely uses synthetic injectable fillers and promises nothing more than a limited time period of benefit. The now more appealing, and the group that has caught the most press and is also heavily marketed, is the autologous injection techniques which promise more than just a short-term effect…they promise a rejuvenation of tissues as well.

These autologous injection techniques use either blood products such as platelet-rich plasma (PRP, e.g., the Vampire Facelift) or one ‘s own fat which is obtained by liposuction. Because our fat stores are now known to contain large amounts of stem cells, these type of liposuctioned-derived injections have become known as ‘stem cell facelifts‘. They have become heavily touted on the internet and many patient testimonials as to their rejuvenative benefits can be found online.

But what is a stem cell facelift actually? In reality, it is a bit of a misnomer. It starts with liposuction to harvest fat, usually from the abdomen, which is then processed during the procedure to get rid of most of its fluid contents. (blood, tumescent fluid, free fatty liquids) What happens next varies by the doctor doing it. Some will proceed to inject the fat concentrate while others may further process the fat to obtain a greater cellular concentrate of the material which presumably has more stem cells per injected volume.

For those just taking concentrated fat and injecting it (aka fat injections), any stem cells that are in the fat are inadvertently carried along with it. How many stem cells and how active they are after being injected into the face is anyone’s guess. This is a stem cell facelift in the loosest use of the term.

To those who do a stem cell preparation step with the fat (usually a mechanical process that separates the stem cells from the fat and then they are injected along with the fat), this is a purer form of a stem cell facelift. Such higher concentrations of stem cells are purported to induce skin rejuvenation allegedly because of the growth factors that are produced by the stem cells. But no one really knows for sure.

While the appeal of the stem cell facelift is undeniable, does it really work? The regenerative properties of adult stem cells has been vigorously studied for decades in a  wide variety of medical conditions. But their use in aesthetic medicine is very new and, as a result, the medical evidence supporting their effectiveness is presently very weak. The marketing claims are high, but almost all the clinical evidence of its effectivenss is anectodal….and very short-term.

To really answer the question of the effectiveness of stem cell facelifts, split-face clinical studies would have to be done. Patients would have to submit to one-half of their face being injected with fat and the other half with fat that contained concentrated stem cells with postoperative assessment of appearance and skin improvement. Such studies are hard to conduct although patient recruitment would likely not be difficult.

Stem cells have a lot of regenerative potential but whether that applies to aesthetic conditions like facial aging remains to be seen. I like the concept very much but it remains a clinical procedure that is in the earliest stages of development. And as often happens in many developing aesthetic techniques, the marketing and promotion of it gets way ahead of the actual science to support it.

Dr. Barry Eppley

Indianapolis, Indiana

The Regulated Use of Stem Cells in Plastic Surgery

Saturday, April 6th, 2013

 

Stem cells has understandably caught the imagination of both plastic surgeons and patients alike with their regenerative potential. This has led over the past few years to surgeons promoting their benefits to patients by so-called stem cell-enhanced or derived procedures. From facelifts to fat grafts, the moniker of the words ‘stem cells’ confers an improved method which leads to better or more long-lasting results. Such promotions have been done even though the FDA has not approved any stem cell therapies for cosmetic use.

Manufacturers of devices that can create stem cell concentrates have also emerged. This is usually done by taking fat obtained by liposuction, processing it through an on-site machine, and then a near immediate stem cell preparation obtained for patient re-introduction, usually by injection, is available. Laboratories also began offering services that will also take a patient’s fat, extract the stem cells, and grow them in cell culture to be available for use weeks later. The patient’s stem cells could also be stored and used in the future if desired.

Despite the initial tremendous enthusiasm and unregulated behavior when it comes to stem cell use, that has come to an abrupt end in the past year. The American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons issued policy statements that their members should avoid offering and marketing stem cell procedures. This position is based on the scant human evidence in the medical literature to support the benefits of injecting stem cells into patients. While there may be real benefits to the use of stem cells, it is way too early to know what their actual benefits are, how they might work and what are the best indications for their use. Long-term controlled human studies need to be done for various plastic surgery indications to determine their efficacy…just like the approach used for drugs.

While plastic surgeons have been admonished by their own societies to cease stem cell therapies, the manufacturers and laboratories of stem cell-derived devices have received more stern edicts. Recent legal rulings have sided with the FDA that all companies processing stem cells or selling machines that extract and concentrate stem cells must do so through a formal FDA regulatory process involving controlled human clinical trials. There will no fast-tracking or short cutting to human use based on the comparative use of processing blood and blood-derived products. Basically the legal ruling is that fat is not blood and and large studies involving human participants is needed.

Adult stem cells are found in various locations throughout the body, but fat has the highest concentration of them. Obtaining stem cells from liposuction-derived fat has brought their potential use to quick fruition. But with this potential may come unknown risks that are more likely to be revealed (if indeed they do exist) in controlled human clinical trials than theoretical plastic surgery procedures that are highly marketed.

Dr. Barry Eppley

Indianapolis, Indiana

The Unapproved Use of Stem Cells in Cosmetic Surgery

Sunday, December 23rd, 2012

 

Stem cells are the rage in medicine and their potential application for cosmetic changes is no exception. Since fat has become discovered as a resplendid source of stem cells, it has become relatively easy to acquire one’s stem cells from liposuction harvests and grow them in great numbers. As a result, numerous private laboratories have emerged offering stem cell growth and storage. This has led to numerous doctors across the country offering so-called stem cell cosmetic procedures and injections.

The appeal of stem cells therapies to potentially improve aging, wrinkles and sagging tissues is understandably irresistable. But one of the stark realities of stem cells is that no one knows what they will actually do if implanted. While the understanding of the basic biology of stem cells is well known, how they interact with other cells and materials after being implanted is far from an exact science. There are presumed to have remarkable regenerative properties, but there is not one single scientific paper that has ever actually shown that to be true in human application. Quite frankly, stems cell for cosmetic applications in humans is really an experiment even if it is the patient’s own grown cells that being used.

This human experimentation of stem cells in cosmetic surgery is illustrated in a recent report that appeared in Scientific American. A California woman complained of a swollen eyelid, an inability to open it well and hearing a strange sound when she did months after having received a new cosmetic procedure months earlier. The procedure was a ‘stem cell facelift’ where stem cells obtained from her fat by liposuction and then isolated were injected in combination with an injectable filler around her eyes. In subsequent surgery on her eyelids, a different surgeon than the injector removed bone fragments around the eye which were the source of her swelling and eyelid motion restriction. The sounds the woman heard appeared to have been caused by bone fragments rubbing against bone fragments.

While the injectable filler used was not identified in this report it undoubtably was Radiesse, a particulated filler that contains calcium hydroxyapatite particles as part of its composition. The stem cell treatment appears to have been a concoction of Radiesse and stem cells with the theory presumably being that it would improve the longevity of the filler’s effects. What was not predicted was that some of the hydroxyapatite particles served as a nidus for stem cell conversion into bone. In hind sight, this potential reaction seems obvious. But the euphoria of using stem cells and the lack of any previous studies using this combination led to this one patient’s unprecedented iatrogenic affliction.

It is important for patients to understand that the FDA has not approved any cosmetic procedures which use stem cells…or at least so claims. The more common and widely popular use of fat injections undoubably contains stem cells but their incorporation into the injectable treatment is inadvertent and the stem cells are not altered. Extracting stem cells and isolating and manipulating them for re-injection for human cosmetic alteration is now unapproved and requires a controlled FDA-regulated study in which to do it.

Whether stem cells are the fountain of youth for humans, or at least offers some spot areas of physical improvement, will now await years of further study.

Dr. Barry Eppley

Indianapolis, Indiana

Injectable Facial Rejuvenation

Tuesday, July 10th, 2012

The desire to correct an aging facial appearance has been around as along as there is recorded history. Facelift surgery in various forms has been employed now for over one hundred years. Today’s facelift techniques are very diverse and use manipulations of all tissue levels down to the bone to achieve often dramatic improvements. Younger patients with very early signs of aging enjoy the benefits of facelifting albeit with more limited procedures geared towards the need for less dramatic changes.

But no matter how it is done, a facelift procedure is invasive and many patients want to avoid surgery if at all possible. Some patients are so opposed to surgery that they will choose any procedure  that simply isn’t surgery. With the widespread and growing use of injectable fillers and promising autologous therapies like platelet-rich plasma (PRP) and stem cells, newer methods of ‘non-surgical facelifts’ have emerged. Some of these have very catchy names and good marketing efforts behind them, which combined with the ability to do them outside of a traditional operating room setting, has caught the attention and imagination of people concerned about their aging facial appearance.

The basic concept of all of these techniques is that they are injectable. While the name ‘facelift’ has become attached them, this is not an accurate name for them. They do not achieve the same effect as a facelift nor should they be construed as having much other similarity to a facelift either. Their use of the facelift name is a marketing manuever. The only similarity between a true facelift and these injection techniques is that they treat the same problem…facial aging concerns. Therefore, the proper name for them should be Injectable Facial Rejuvenation (IFR) which signifies their non-surgical nature They may provide some degree of rejuvenation but they definitely don’t lift tissues in the conventional sense.

In reviewing the available options for Injectable Facial Rejuvenation, it is important to recognize that most of them are not standardized treatment methods and are not sanctioned by the FDA to be used in this fashion. Because these techniques have emerged largely from marketing and patient recruitment means, and not from scientific or clinical studies, there is no way to compare their effectiveness other than anectodal reports and patient testimonials. This is why how one practitioner performs one injectable technique may be different than another. Such provider variability makes it impossible to assess the effectiveness of one IFR method, let alone if one IFR method is more effective than another.

The Liquid Facelift uses either one or a variety of off-the-shelf FDA-approved injectable fillers. These could include any of the many hyaluronic-acid based fillers, such as Restylane or Juvederm, or the particulated fillers such as Sculptra or Radiesse. The concept is the select placement of them into volume-deficient or sagging facial areas that expands them, thus creating some degree of a lifting effect. This is more expansion than a lifting result. Its effects will subside as the filler absorbs. It is postulated but not proven that these fillers have a long-term collagen stimulatory effect.

The Vampire Facelift is the ultimate marketer in IFR because it is a company that sells its technique for use. Its foundation is the use of platelet-rich plasma (PRP), an autologous platelet concentrate extract which contains growth factors and cytokines. Such factors have proven laboratory performance of accelerated healing. When introduced under the skin, it is presumed that it may have some rejuvenative or stimulatory properties. This technique is also combined with injectable fillers. The theory is that the PRP and the fillers in combination may lead to an enhanced and sustained collagen response. Whether this is enough to wake up the living dead is speculative.

The Stem Cell Facelift primarily employs the injection of fat or allegedly concentrated extracts of stem cells. Stem cells have caught the imagination of the cosmetic surgery world with the belief that they will provide some rejuvenative effect. This concept is theoretically appealing but has little scientific proof that this really occurs. Most ‘stem cell extracts’ are just concentrated fat from liposuction harvests. As such, it is impossible to know how many stem cells and what their potential is in any fat concentrate. Because of the widespread uncertainty of the value and effectiveness of stem cells, the American Society of Plastic Surgeons has issued a position statement that any of its members promoting or marketing stem cell techniques as unethical behavior. In addition, the FDA has recently issued a ban on any company that grows patient stem cells for treatment. All stem cell therapies, even using the patient’s own stem cells, must be done under a clinical study protocol. This does not exclude the common use of fat injections in which stem cells exist amongst the fat cells and are incidentally injected. But promoting it as a stem cell procedure is not viewed favorably.

The Acupuncture Facelift employs the traditional Chinese technique of the introduction of needles to free up chi or energy. Allegedly, introducing needles into the face causes the production of collagen and elastin to plump up the skin. After a series of 10 treatments, wrinkles and deeper lines are purportedly reduced and skin is lifted. More likely, some mild swelling occurs as a result of the needles and results in some slight temporary skin fullness but no documented and proven lifting effect that is sustained as ever been studied or proven. This limited injection or needle approach to facial rejuvenation is the greatest stretch in calling it a facelift technique.

Injectable Facial Rejuvenation has a role to play in treating facial aging concerns but should be understood in proper context. They are not facelifts and will not lift up sagging facial tissues. They are principally plumpers or volumizers and achieve any wrinkle or fold reduction through this effect.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Fat Grafting and Stem Cells

Sunday, April 22nd, 2012

The popularity of fat grafting today has more to do than just with it’s generous supply in most patients, being composed of a natural substance and its ability to be placed by injection. All admirable qualities of a grafting material for sure. But within fat it has been discovered that stem cells exist…and a lot of them. Fat has as much as 300 to 500 times the number of stem that bone marrow has. This makes the potential to be transplanting stem cells as well as fat which theoretically may have a rejuvenative or youth-inducing effect. This has led to a lot of marketing and claims about various ‘stem cell’ procedures for aesthetic enhancement in plastic surgery. Such claims, however, remain unsupported by science as of yet.

Stem Cell Applications in Cosmetic Plastic Surgery

Monday, November 21st, 2011

The field of stem cell research has spurned a lot of new potential medical applications. Enthusiasm is high as to what stem cells may do and many almost give them magical properties and disease curative capabilities. Much of this enthusiasm is at least partially warranted based on a large number of animal and cell culture studies which show some extraordinary results.

The allure of stem cells for plastic surgery applications has not gone unnoticed. Their use in plastic surgery is spurned by several driving factors. The first is their autologous nature and our familiarity of harvesting a fat donor source of stem cells through liposuction. Many problems in plastic surgery particularly of cosmetic concern is the aging of soft tissues, exactly what stem cells can theoretically help reverse. But the pivotal technology that brings stem cell use in plastic surgery a reality is that of commercial stem cell production. There are numerous companies that have emerged that offer to grow stem cells from patients in a timely manner and at a reasonable expense. Since these are cells that are being transplanted back into the patient from which they came, there is no objection yet to their use by the FDA.

Now that stem cells are available, the next question is exactly what in plastic surgery are they good for? Stem cells are different from that of injectable fat grafting in that volume is not being replaced. Fat injections add substantial volume which is why they have made facial volumetric enhancement and breast and buttock augmentation possible. While these fat grafts do have some stem cells in them, they are not really true stem cell injections. The stem cells are inadvertent passengers along with the much greater number of fat cells. The use of such monikers as ‘stem cell injections’ and stem cell-enhanced fat injections’ used by some surgeons are marketing terms and not indicative of scientific reality.

When thinking about how to use stem cells in cosmetic plastic surgery, one potential application is their use as an adjunct or supplement to an existing technique. This would be adding stem cells to enhance the effectiveness of an established treatment method. The obvious choice would be that of adding them to fat injections. While fat injections do naturally have some stem cells, their numbers are low and their viability in question. Adding a concentrate to fat injections would increase their numbers and one would be more certain that they were viable. The question is the ratio of stem cells to the fat injectate and what is a truly effective percent. No one knows but it would seem logical that fact injections into the face would be more appropriate given the lower amount of fat used and the higher ratio of stem cell volume that could be added. Stem cells could also be added to any of the available synthetic injectable fillers used for facial wrinkles, folds and volume enhancement as a theoretical alternative to fat injections. Or they could be added to grown autologous fibroblasts for injection creating the ultimate synthesis of cell culture technologies.

The other application concept is that of pure stem cell injections alone. It would be used by injecting the cell concentrate into the desired tissue target with the intent of creating a rejuvenative effect much like the way we use synthetic injectable fillers today. Whether they could serve as an alternative to injectable fillers creating a delayed volume effect through cell stimulation or conversion to adipocytes or fibroblasts is theoretically possible. Injecting directly into facial wrinkles and folds would be easy to do as stem concentrates would flow through very small needles. Could skin thickness and texture be improved by direct stem cell injections?

 

While stem cells are now available and their biologic appeal is obvious, the cosmetic applications for which they would be most beneficial is not yet known. This is sure to create a flurry of clinical activity in this area from many inventive and entrepreneurial cosmetic practitioners in the near future.

Dr. Barry Eppley

Indianapolis, Indiana

Stem Cell and Fat Concentrates For Plastic Surgery and Anti-Aging Therapies

Saturday, October 15th, 2011

The use of stem cells in medicine has garnered much media and public attention. Because it is a natural component of human tissues and it is a pluripotent cell that has the capability of converting to many different adult cell types, it holds much promise for numerous medical therapies. While the quest for which medical diseases stem cells offers the best benefit is being investigated with much fervor, there is no question that anti-aging conditions are one logical application.

While not a disease in the truest sense, aging is a natural medical condition  that is degenerative of both cells and the substrates in which they exist. The use of stem cells and the factors that they may excrete would seem like they could offer some regenerative effects on one’s external appearance. Thinning and wrinkled skin, atrophy of fat and supportive connective tissues, and restoration of face and body contours have the potential to be enhanced with adjunctive stem cell techniques.

The promulgation of stem cells to the forefront of anti-aging treatments has been driven by the realization of their easy access. While stem cells have traditionally been thought of as existing largely in bone marrow, it is now known that fat is the richest source of adult stem cells. Estimates are that fat has 300 to 500 times more stem cells than bone marrow. Given that fat can be quickly harvested through liposuction, the acquisition of stem cells is now easy.

While plastic surgeons have trued numerous methods of isolating stem cells at the time of their harvest, the present reality is that it is not easy to obtain really true concentrates of them. Most so-called stem-cell therapies today in plastic surgery are nothing more than concentrated fat injections. While these fat injections do contain some stem cells, calling them stem cell injections or stem-cell enhanced fat injections is a stretch and more of a marketing concept that it is a true stem cell therapy.

To obtain stem cell in sufficient numbers from fat, it requires that they be isolated, grown and processed in laboratory conditions. It was only a question of time before a commercial laboratory became available to provide this service for plastic surgery and anti-aging applications. Cryo-Lip, a bio-tech startup laboratory based in Indianapolis, is now offering the service of cryopreservation of adipose-derived stem cells, fat, or both. It is now possible that patients and plastic surgeons can not only obtain viable stem cell concentrates but can have them stored and grown for future use.

While liposuction surgery is an obvious source of fat to be processed, it can also be done when one is not desiring body contour changes. The amount of fat needed for processing is in the range of between 25 to 50ml which can be obtained using a patented syringe system under local anesthesia in the office if desired. The sample is then sent to Cryo-Lip for processing and storage. The average turnaround time to obtain injectable materials is two weeks. The samples can be sent as either a fat or concentrated mesenchymal stem cell mixture. The existence of viable stem cells is confirmed by testing and analysis before being sent. If not an adequate number of viable stem cells is present in the sample, the provider is informed and the tissue is discarded at no charge to the patient.

The now easy access to stem cell concentrates allows them to be used for numerous potential cosmetic and regenerative medicine uses. Some of the well known current applications include their adjunctive use with fat for lipofilling for facial volume restoration and breast and buttock augmentation. When used as isolated stem cell concentrate injections, they have potential use for facial skin rejuvenation, wrinkle reduction and fold and crease filling.     

Dr. Barry Eppley

Indianapolis, Indiana

Stem Cells, Fat and Fat Injections in Plastic Surgery

Monday, April 11th, 2011

Stem cells have been well known for a long time and bone marrow has been the traditional source of their harvest. Stem cells have generated such interest because medical researchers believe that stem cell therapy has the potential to dramatically change how we might treat certain the human diseases. As stem cell science has continued to evolve, new approaches are being developed about how they might be better used in medical therapies.

 

One big change has been the awareness that fat has more stem cells than bone marrow. Bone marrow has been thought of for decades as the exclusive or most replete source of stem cells in the body. Even though it was known that other tissues had stem cells as well it was thought they were either too few or impractical to harvest. Then along came fat and its easy access from liposuction. This lead to the realization of the potential of its abundant stem cell source. How abundant?  I have read estimates that fat has 300 to 500X more stems cells than bone marrow. That is a lot more, not to mention the abundant supplies that are walking all around us.

Concentration of liposuctioned fat is now widely available by a variety of manufacturers and their devices. This concentrated pellet of uncultured fat tissue, known as the stromal vascular fraction (SVF), is what is believed to be a potent source of stem cell therapy. Traditionally the approach to the use of stem cells has been in the context of tissue engineering. The strategy is to have the stem cells convert and grow into the missing or damaged tissue such as bone, cardiac muscle, or new brain cells or neurons. But this more easy access to uncultured SVF from liposuctioned fat has led to its potential use for healing or regenerating tissues directly rather than using a cultured differentiation of stem cells. In essence, make the body heal directly rather than implanting tissues grown outside of the body. Some refer to this as autologous regenerative therapy or ‘heal thy ownself’.

How might this work? What is the magic of stem cells that would make them heal injured tissues? Some stem cells, known as mesenchymal stem cells, live within or are attached to blood vessels.  When injury occurs these blood vessels are disrupted or traumatized and some stem cells are released. This activates the stem cells which release a wide variety of chemicals, generically known as growth factors. These released factors attract the necessary cells and other elements for healing. One of its main functions is to promote new blood vessel growth which provides the highway for all healing elements to get to the site of injury In short, stem cells are a source of a new blood supply.

There are many ongoing clinical trials for stem cells which ranges from diabetes, heart attacks to spinal cord injury. In plastic surgery they include non-healing wounds and scar therapy. But of equal interest, although not a specific clinical trial, is in the improved or accelerated volume retention of injected fat grafts. Since we are injecting some level of concentrated fat aspirate, it must contain the stem cells from the disrupted blood vessels as well as those that resided in the fat itself. While this is undoubtably true, why does injected fat have such variable retention? Most likely there are not enough stem cells in our prepared fat concentrates or their amount is  highly variable. But injection technique and the recipient site has a lot to do with it as well.

The stem cells in fat and in prepared injectates present interesting possibilities and potential. But we have a long way to go to understand how they may be of benefit in the plastic surgery version of the ultimate version of ‘recycling’ or ‘green surgery’. 

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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