Wednesday, October 27, 2010

Stem Cell Face Lifts

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Stem cells are cells that can turn into any one of a number of cell types hence the term pluripotential. Some stem cells can only turn into one of a specific cell type (multipotent, oligopotent etc). The majority of cells in an embryo have not fully differentiated or turned into their final cell type be that a skin, liver, heart or muscle cell. The majority of cells in an adult person have turned into their final cell type. Furthermore that final cell type if it is a dividing cell will only produce more of the same cell type. Stem cells can divided into more stem cells or turn into different types of cells such as skin, muscle etc. Much media exposure has been given to the embryonic stem cells, mostly those that would otherwise be discarded at fertility clinics rather than implanted. This blog is about those stem cells found in an adult human. Apparently many of these stem cells are located in the fat layer that covers the body just under the skin layer and they can be harvested by a simple liposuction procedure. Stem cell treatments have been proposed for everything from spinal cord injuries to stroke, alzheimer's, diabetes, parkinson's, arthritis, organ or limb regeneration etc. The can fix anything including the kitchen sink.

I discussed free fat grafting in my previous blogs
free fat grafting
injectable dermal fillers.
As I had stated the benefits of fat grafting are well established in terms of facial, hand etc rejuvenation with improving quality of the overlying skin as well.

Now some surgeons are claiming that they harvest the fat and then treat or manipulate it in some way to increase the content of stem cells . One surgeon employs a laser to do this. Others use a centrifuge with washing etc. They then inject the fat as a free fat graft and claim it is much better than a fat graft alone. Some do this in the face and call it a non-surgical stem cell facelift. Others do it in conjunction with a regular facelift and advertise it as a new and improved facelift. One surgeon is doing a regular facelift and injecting harvested liposuction fat without any processing into the face. This is being advertised as a stem cell facelift which is considered unethical marketing. It is just a facelift with free fat grafting.

There currently is no scientific data that supports any of these claims for the benefit of fat stem cell injections . No one can say for sure that these treatments and manipulations actually increase the number of viable stem cells in the finally injected fat or that doing so is better than just injecting small fine lines of fat that have not been exposed to room air. It is interesting that when fat grafting first started to be employed different surgeons prepared the fat in different ways in order to get "better results". These included washing the fat, straining the fat, putting the fat in insulin etc. Most of these methodologies have since fallen out of favor. Now it seems we have come full circle and are back to treating the fat before re-injection.

On the face of it these look like marketing ploys by these doctors to try and differentiate the services they offer from other doctors. That does not mean their work is necessarily bad, it may be good but that does not justify increased costs related to these marketing gimmicks.

Furthermore the stem cells become less potent at being able to differentiate or to change into other cell types as we age. Diseases associated with the aging process such as diabetes also directly affect the capability and the potency of these stem cells. So, the younger you are the better able your stem cells are to function. Facelift patients are typically older and it may turn out in the distant scientific future that patients will donate fat derived stem cells when they are younger and keep them in storage until they are needed for facelifts etc.

You can stop taking a pill or an injection treatment, but you can’t stop or retract stem cell treatments if there’s a bad side effect.

Unlike other kinds of medicines, once stem cells have been transplanted into patients, if something goes wrong you cannot stop the ‘treatment’. There’s no retraction possible because transplanted stem cells spread in the body and potentially integrate.

May 9, 2011 Addendum:
A joint task force at the annual meeting of the American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons released a position statement at the meeting recommending against the marketing and promotion of stem cell procedures in aesthetic surgery until there is adequate clinical evidence to support doing so. They also stated that the efficacy and safety of doing these procedures had not been proven. They recommended that terms such as "stem cell therapy" or "stem cell procedure" should only be used to describe treatments or techniques where the collection, concentration, manipulation, and therapeutic action of the stem cells is the primary goal, rather than a passive result, of the treatment and these should only be currently performed within clinical studies under Institutional Review Board approval. That means if the surgeon does the procedure it should be considered investigational or experimental and follow standard consent and review rules for such studies. These consent forms are different from those used in standard cosmetic surgery.

May 17, 2012 Addendum:
The Young Medical Spa in Pennsylvania was cited by the Food and Drug Administration for several violations, including some related to the use of adult stem cells for breast augmentation. A warning letter from the FDA to the MD owner/director of the spa saying the facility had radically altered adult stem cells when converting them from adipose tissue prior to injection. Stem cells can be harvested from an individual and reinjected without any processing but if they are altered, processed or treated in any way prior to injection the tissue is considered a biological product, and must meet a more demanding set of FDA criteria. These include keeping a record of investigations into cases in which patients suffered adverse reactions and specific lab testing of each batch of tissue that is injected. Failure to comply with the FDA’s letter can result in regulatory action, including seizure or injunction. According to MedCity News, there were at least six cases in which the spa failed to investigate adverse reactions following surgical procedures.

December 12, 2012 Addendum:
Dr. Allan Wu, a surgeon who works with adipose stem cells, gave a presentation at The World Stem Cell Summit in which he stated that autologous (stem cells come from the patient they are being injected into) doesn’t mean a stem cell treatment is safe and doesn’t mean that it won’t cause a life-threatening autoimmune reaction. He presented a case of a woman who had a stem cell facelift that resulted in unintended bone growth in her eye that damaged her eye and threatened her vision

Knoepfler lab stem cell blog is a good resource for the latest stem cell information

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