The law of unintended consequences applies to President George W. Bush when he banned embryonic stem cell research. The unintended consequence was the search for adult stem cells and the knowledge that there is an almost limitless amount of adult stem cells located in fat or adipose tissue. This fact places plastic surgeons at the epicenter of the stem cell revolution. Who better than a board certified plastic surgeon is in a position to obtain the necessary fat (liposuction) which is then processed to obtain adipose tissue derived stem cells?
These adipose derived stem cells can be utilized for a myriad of cosmetic and reconstructive procedures. For our purposes, these all-purpose stem cells are the basis of all of our facial and skin rejuvenation procedures. It is a well-documented fact that stem cells, when reintroduced into the face, causes any fat which is re-injected, to “take” better and as a secondary benefit the stem cells release a number of “growth factors” that improve skin by reducing the visible signs of aging.
It is important to realize that you cannot share your stem cells with anyone else nor can you use stem cells from another person. The fat must be processed immediately and re-injected with the stem cells during the same operation as it is difficult to store adipose tissue for further use. We have developed a “stem cell lab” within the confines of our sterile operating room. The lab equipment costs little and only requires basic laboratory experience (such as the experience obtained with a B.S. in Chemistry).
Every medical breakthrough goes through stages. First, there is disbelief followed by hyperbole. The hyperbole stage is manifest by over hyping the benefits and the beginning of named procedures such as the “Stem Cell Lift” which basically does not exist. Realistically, stem cells do not tighten skin or “lift” anything. They are a great addition to volume enhancement by increasing the take of fat grafts and clearly stem cells cause your skin to rejuvenate by erasing age spots, increase skin thickness, and improve fine lines and wrinkles. Most patients who have had our stem cell rejuvenation describe their skin as smoother and typically glowing. Stem cell augmented fat transfer has become a staple in our rejuvenation procedures and at a minimal charge to the patient.
If one were to internet search “stem cell facelift” or “non-surgical facelift” you get hundreds of search results describing outrageous claims of facial rejuvenation that exceed the results of “surgical facelifting.” There will always be people following the holy grail of “non-surgical” procedures of all types. These same people probably believe in gremlins, gargoyles, and the tooth fairy, all myths that get some play over the internet. All good myths (and lies) seem credible because they were based initially on facts. For instance, let’s look at the so-called “liquid lift” touted as some version of the “non-surgical facelift.” Plastic surgeons have known and is replete in our literature that one aspect of facial aging is due to a loss of soft tissue (mainly fat) volume, no one who studies the aging process believes that simply addressing facial volume issues will in effect result in “lifting” of facial structures, i.e. the “liquid facelift.” The proposition will always find an audience with those individuals who, for varied reasons, are frightened of surgery. The proposition of volume lifting gets momentum as its practitioners recommend using one of today’s off the shelf fillers at $200-300 per milliliter. It could take 30cc of filler to achieve the fullness necessary to claim the face is lifted. This is a perfect example of utilizing a true discovery to develop a non-surgical marketing slogan such as the “liquid lift.” If such a procedure actually worked, we could all take our marbles and go home as the answer to facial rejuvenation would be upon us. As much as this would benefit the non-surgeon, it happens to be untrue, but still worth a try if you cannot do a proper facelift or obtain autologous fat as a facial filler rather than having a basically painless and simple surgical facelift.
The Stem Cell Face Lift is another of these stylized marketing slogans based on actual scientific discovery (stem cell biology) adulterated as some sort of magic bullet that “lifts” faces. I think that the gargoyles protecting Notre Dame in Paris makes more sense than a stem cell “lifting” anything. This is not to say stem cells don’t exist or that their discovery isn’t useful when applied to the biology fat grafting and actual facial skin rejuvenation. An understanding of stem cell biology and how to isolate them from adipose tissue will probably become routine for all Plastic Surgeon’s in the near future. Hopefully, as more and more is published on the subject of stem cells there will be fewer practitioners with a financial incentive to propagate the fantasy which is the “stem cell facelift.” The final straw may be the fact that many of the non-surgeons are parlaying some knowledge of stem cell biology into a $20,000 procedure!
In the final analysis common sense dictates that stem cells are real and are a really important adjunct to my facial rejuvenation procedures, but by themselves cannot “lift” anything, particularly an aged face.
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.