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Dr. Barry Eppley

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Posts Tagged ‘stem cell fat injections’

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

The Role of Stem Cells in Injectable Fat Grafting

Sunday, February 20th, 2011

The continuing evolution of fat grafting in plastic surgery has seen it become more dependable as well as new applications being developed. Popular target areas for fat grafting have focused on the face, breast, and buttocks. Some equate fat injections to that of synthetic injectable fillers. But beyond their injectability, there are used for entirely different purposes. Fat grafting is for larger volume problems and are used in the hope they provide some more permanent effect.

Fat grafting is not the equivalent of typical injectable fillers. Instead, it is less stiff and behaves more like a liquid…it has little substantative pushing effect on a specific tissue site. That is why if you try and use injected fat to lift up or diminish a fold or wrinkle, it does not work very well. Regardless of whether it even survives, it does not have a focused displacement effect. For areas that are very adherent, such as deep creases, folds, and lines, it just can not efface them. These commonly perceived areas of fat injections have high failure rates and that experience contributed to the perception that injected fat doesn’t work very well. Fat injections are best used as a volume fillers for the treatment of facial contour areas.

The biggest reason that fat grafting has become more accepted today is technology. Advances in harvest methods and processing (concentration) are the two main areas of improvement. Less traumatic harvesting methods that enable better quality fat to be obtained creates fat tissue that even looks better. Getting rid of extraneous liquids and debris, whether it be centrifugation or less powered purification methods, creates a more homogenous injectate material.

But the one thing that has really tipped the balance to wider acceptance and usage is that of stem cells. The realization that high concentrations of stem cells reside in fat has raised the potential that they can be used for better volume preservation and even promote healing in difficult wounds. The stem cell has been given magical properties even though whether it really has any benefit to a fat injection is far from an established medical fact. Many anectodal claims are being made about skin quality improvement and anti-aging tissue effects. While the science has yet to provide proven support of these observations, the potential of it has propelled injectable fat transplantation into one of the hottest topics in all of plastic surgery today. Once scourned and held in disrepute by most plastic surgeons, fat grafting today has undergone a complete reversal of medical acceptance…and the well known stem cell is helping it along.

In performing fat injections into the face and hands, I have observed some changes in the quality of the skin overlying grafted fat.  Sun-damaged and aging skin seems to improve in some patients (I didn’t say all patients) more than one would anticipate  just from the push of the volume from the fat under the skin alone. This newly injected fat appears to be contributing to improved healing into the areas where it is injected. From breast lumpectomy defects to facial scars, there does appear to be some healing benefits. Research suggests that these positive effects on the skin may be from exogenous factors from stem cells. Since fat has the greatest number of stem cells of any tissue in the adult human body, their potential influence is likely. The presumed effect is that they promote earlier and more abundant blood vessel growth into the surrounding and overlying tissues. This has been shown to be true when fat is injected under skin with severe radiation damage. With a new or more normal blood supply, severely radiation damaged skin becomes healthier.

How the stem cells in fat grafts may contribute to better volume preservation is more speculative. Earlier revascularization may play a role in helping some of the mature and intact fat cells survive the transplantation process. Stem cell conversation may also play a role. Once known as merely preadipocytes, some stem cells may be induced to differentiate into fat cells. That may explain the observation that injected fat volume may go down early on after surgery only to rebound months later.

Even though injectable fat grafting is rapidly becoming a common procedure in plastic surgery, there are a lot of very important questions we need to answer before we can conclude it is all that it is being touted. Currently, the marketing of it sometimes exceeds what is scientifically known about it. (e.g., stem cell facelift) We need to learn the optimal way of processing fat tissue and we really need to get some accurate information about how long fat grafts last. Much of the clinical work being presented  lacks quantifiable measurement. The good news is that injectable fat grafting is perfectly safe, we just don’t know yet the extent of its benefits or for what problems it is most effective.

 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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