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Stem Cells in Plastic Surgery

Stem Cells Facelifts, Stem Cell Breast Augmentation, Stem Cells in Plastic Surgery - Marketing Hype or Next Big Thing?

Stem Cells seem to be everywhere today: Stem Cell Breast Augmentation, Stem Cell Facelifts, Stem Cell Facial Creams, but what is it really worth? Does the marketing hype live up to the objective evidence? Are Stem Cells the panacea? First a little background.

ASPS and ASAPS Joint Stem Cell Task Force 2010

Last year, the American Society of Plastic Surgery (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) formed a Stem Cell Task Force to look into the safety and effectiveness of these Stem Cell Therapies.

What is a Stem Cell Anyway?

The idea of a Stem Cell is exciting: a cell that has the potential to change into any cell type you would want, placed where you want it. Sounds too good to be true, but science is marching towards exactly that. Currently, these types of results are reproducible under laboratory conditions, but are currently not as predictable in the patient.

Stem Cells Grafts and Stem Cell Injections

The original “Stem Cell” grafts were done for years, without doctors realizing that’s what they where doing. San Francisco Plastic Surgeons have been removing fat and transplanting it into patients’ wrinkles to reduce folds long before there was Restylane®, Juvederm®, Perlane®, Radiesse® or any other currently available prepackaged wrinkle filler. Fat grafting predates even the Bay Area’s own contribution to fewer wrinkles and larger lips, Collagen, and it turns out that fat grafts also contain stem cells.

Fat has More Stem Cells than Bone Marrow

I remember attending a presentation at the California Society of Plastic Surgery in Napa in 1995, during which the discovery of numerous and varying stem cells in liposuction aspirate was being discussed. It was at that time, we plastic surgeons began to realize that fat transplants contain more than just fat cells. Whether the fat is surgically removed and replaced as fat grafts, or is removed with liposuction and injected, stem cells are present.

Stem Cell Breast Augmentation

The first documented breast augmentation was done with fat in 1895. Surgeon Vincenz Czerny used a benign lumbar lipoma (fatty growth), to repair the breast asymmetry caused by removing a tumor. Larger volumes of fat could be used for primary breast augmentation; however, then as today, larger transplantations can be problematic:

Stem Cell Facelifts

Part of the reason the face ages is that the fat on the face atrophies (goes away). Healthy babies have big fat round faces, and youthful faces maintain this padding. As we age, we lose the fat that adds volume to, and supports the skin. The result is a longer, narrower face, and skin that sags. Replacing this lost volume is one of the holy grails of plastic surgery. Facial implants, fillers, fat injections all have there place, and each can be helpful. Most stem cell facelifts are simply fat grafting to the face. While expensive machines are available to concentrate the stem cells in the graft, most practitioners do not use them, and there is simply no evidence that concentrating stem cells helps. This is one of the questions that the Stem Cell Task Form considered, and the answer still remains unclear.

ASPS and ASAPS Joint Stem Cell Task Force 2011

I was in Boston this week for the annual ASAPS meeting, and on Monday, the ASPS and ASAPS joint position paper on Stem Cells and Fat Grafting was released. While the data looks promising, there is nothing currently in the literature to support the marketing claims you are currently hearing, and there is concern that these unsubstantiated claims will harm patients and tarnish the reputation of Plastic Surgery. The following is from the above referenced paper:

Buyer Beware

I continue to follow the debate, and as much as I want stem cells to be the next greatest thing, I also don’t want my hopes to cloud my judgement. Even among the tight knit aesthetic plastic surgery community, there is vigorous disagreement about the methods, safety and efficacy of fat grafting and the use of stem cells. At least a frame work for discussion has been defined, and the research is under way.

For now, buyer beware is still the best advice I can give. We all know that when something sounds too good to be true, it is probably not true, but we want to believe. Just because something claims to be new, it does not mean it is new, and being new has nothing to do with being better. We all want the greatest improvement with the least down time and no scars; however, there is something to be said for the tried and true. The older the procedure is, the longer it has survived, the more it has stood the test of time as a safe and reliable option.

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