What’s up with Stem Cells?

First of all, what is a stem cell and why are they now so popular?  One of the essential wonders of mankind is that all human beings are derived from two cells – one egg and one sperm cell.  These two cells and their DNA become a single cell which divides and subsequently differentiates into all of the individual cells which comprise the human organism.  As the early cells divide to reproduce themselves some of them begin to differentiate into the cell lines that form different parts of the body as well as the blood flowing in our veins.  These cells which are only partially differentiated and still have the potential to become more than one type of cell are called stem cells.  If these cells are liberated during the embryonic phase of development they are called embryonic stem cells.   If the embryo is allowed to grow and the cells differentiate further the cell lines become more specific to each body part.  As these cell lines develop into their structures (skin, muscle, fat, blood) they lose their ability to reverse course and again become “pluripotential” stem cells.  Once they differentiate down their pluripotent lines they become more and specific as to their ultimate destination (i.e. skin, blood, brain, muscle, fat).  These slightly more differentiated cells are called multipotential stem cells and include our now famous adipose (fat) derived stem cells.   Think of this process as a gently flowing river – if one puts in and is slowly taken downstream there will come a point where it is not possible to paddle back upstream to the starting point.  As we travel further downstream, our momentum increases so that it becomes less possible to reverse course.  At this point where reversal, or in the cellular world – re-programming, becomes impossible, you have multipotent stem cells.  A little further downstream you have more specific adipose derived stem cells which after transversing a white water rapid becomes the fat cells and fatty tissue.  The fat tissue itself is the end of the river as it flows into the sea.  Luckily each part of our body retains a few less differentiated multipotent stem cells so that the end tissue (fat in this case) can keep renewing itself as cells live and are programmed to die (apoptosis) and be regenerated by fat cell division and adipose stem cell differentiation.  As much as we wish our excessive fatty tissue would die off, it would be catastrophic to our health as fat cells have been shown to be highly active and responsive to many chemical, protein or hormonal stimuli.  So, some fat is good and too much is not so good!

The coolest discovery occurred when adipose derived stem cells (ADSC) where discovered as a precursor to fat and were available and relatively easy to isolate from our fat and have all the necessary growth factor proteins to stimulate these cells to grow into the fatty tissue we all love so.  These growth factors, primarily platelet derived growth factor (PDGF) and
transforming growth factor – Beta (TGF-B) among other proteins and cytokines stimulate the growth and vascularization of adipose tissue especially if used as a “fat graft.”  An unintended consequence of augmenting fat grafts with ADSC is that many of the stimulated cellular products have a trophic and rejuvenating effect on the adjacent skin.  This effect is particularly noticeable on facial skin which is aged, sun damaged, and environmentally damaged.  It has been shown that the ADSC augmented fat graft induces neoangiogenesis (blood vessel growth) causing an improved blood supply and “take” of the fat grafts (protein and growth factor modulated), increased collagen and extracellular matrix synthesis (macrocryptin and pre-adipocyte modulated) as well as the simulation of the ADSCs to transform (multipotent) into fibroblasts which further augment the damaged
skin.  The rejuvenation and thickening of the skin is primarily due to the increased collagen synthesis.  The possible addition of activated platelet rich plasma (a-PRP) may help to enhance even further the tissue response to fat grafting.

If I lost you at the river metaphor, I can summarize that the addition of science to the art of facial rejuvenation will yield some miraculous rejuvenating effects simply by understanding the biology (science) behind the plastic surgical art.

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Unveiling the “Lifestyle Lift*” by Paul S. Howard, MD

The Truth about the marketing madness

One of the most disturbing aspects of medical care as practiced today is the unpleasant
marriage of medicine and industry creating what is known as the medical-industrial complex.  The medical-industrial complex is manifest in many ways including the extinction of the private, solo medical practitioner and the rise of things like copyrighted medical procedures.  In the not too distant past, most doctors were solo practitioners and thus provided the kind of medical care that made physicians respected and pillars of the community.  Among surgeons the attempt to copyright a surgical procedure is distasteful as the important surgeons we have known in our training taught surgery without taking credit or financially benefiting from their ideas and procedures, even if revolutionary in nature.  If an operation shows particular promise and represents a true advancement in medical care, it is usually submitted to a peer reviewed journal where its merits are debated among professionals in the field and either accepted for publication or not, depending on the originality of the idea and its ability to advance medical knowledge, but never for financial gain.

The recent introduction of the copyrighted named surgical procedure uncovers one of the
weaknesses in trademark and copyright law as the procedure on which the trademark is licensed does not have to be in any way original except the name itself has to be unique.  The only reason to give an operation that is not original a trademarked name is for the purpose of marketing for financial gain.  Many less informed patients may believe that a trademarked name for a surgical procedure implies that the procedure, whether unique or not, is the most important aspect of patient care usually proven with a slick marketing plan.  It is clear that the “named” procedure is of miniscule importance when compared to the ability of the surgeon and whether the procedure is the correct one to treat the problem addressed.

The “Lifestyle Lift” is the latest marketing madness purposing a questionable procedure by marketing the name rather than the credentials of the physicians who perform the trademarked “Lifestyle Lift.”  I suspect that on occasion the “Lifestyle Lift” may actually provide a satisfactory result, if by luck the right patient sees the advertisement and gets a surgeon provided by the company, who performs the procedure resulting in a happy patient.  I get to see the results of the “Lifestyle Lift” and are asked to explain why such a well marketed operation did not accomplish the facial rejuvenation promised.  Many times, the patient dissatisfaction results from the limited improvement on the cheeks only while the neck, eyes and mouth, of equal importance, are not addressed with the “Lifestyle Lift.”   Most Plastic Surgeons find that addressing all of the aging issues usually allows the procedures to be “blended” together for optimal results.

Life Style Face Lift Revision Surgery

Dr. Paul Howard is a Board Certified Plastic Surgeon in Birmingham, Alabama. To schedule a consultation with Dr. Howard, call 205-871-3361.

*The LifeStyle Lift is a registered trademark, registered by Lifestyle Lift Holding, Inc. Michigan.

To learn more about Dr. Paul Howard and his Facelift Procedure Click Here!

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