Stem Cell Applications: Dreams and Facts
3 December 2019 onur
Those who follow my blog already know the answer to the question. For those who do not, let’s start with a recap.
What are the 3 basic principles of facial aesthetics?
Holism, individuality and scientificalness.
Take one out, and the others are meaningless. All applications in facial aesthetics should be compatible with these 3 basic principles.
In this article, we will focus on the principle of “scientificalness”.
In facial aesthetics, all treatments that we will apply and you will undergo must be “scientific”.
For instance, after the discovery of the “X” treatment method, it cannot and should not be directly marketed on the Internet and applied to patients. Don’t be fooled by the fact that this is the case in our beautiful country. Set your own standards to match the international standards.
Initially, a scientific and ethical board examines whether a treatment is appropriate in humans. These boards are established in universities, ministries of health, FDA and so on. This is a necessity in the modern age.
You design a study, and the patients included in this study are informed that this treatment method is still “experimental”. Then experiments begin, and data is collected using scientific methods. It is essential that these data be objective, that is, based on measurement rather than individual tastes and opinions. In plastic surgery, these data can be obtained from standardized photographs, 3D models, radiological examinations and various other tools. At the end of the study, the data are analyzed statistically, and it is determined whether the result is statistically significant. While clinically observable differences are often supported statistically, minor statistical differences are sometimes not clinically significant per se. Then you present your work at scientific congresses and submit it for publication in respected peer-reviewed journals of the scientific community. In these journals, about 6 different peers review your article in aspects including but not limited to scientificalness, ethics, contribution to knowledge and originality, and if even one of them rejects it, the article will not be published as a scientific article. Reputable scientific journals publish roughly 10% of the articles they receive and filter out the rest.
Anything that has not been published scientifically is just a “story”.
Anything that has been published scientifically, on the other hand, is open to criticism and refutation in the future.
Let’s get to the matter of stem cells.
A stem cell is a type of cell that can transform into other cell types in the body.
We can classify them into two main groups: embryogenic stem cells, which are illegal to use medically, and mesenchymal stem cells, which are in the medical research phase. Stem cells can transform into various tissue types such as bone, cartilage, adipose tissue, connective tissue and vascular tissue in, for instance, the laboratory environment and then help repair damaged tissues.
In our clinic, we derive stem cells most frequently from adipose tissue. Adipose tissues are harvested by liposuction and undergo a special series of processes so that the stem cells in them can be isolated. The number of these cells can even be increased by multiplying them in growth medium. These cells are then used in various experimental and clinical studies.
Let’s clarify the key bit for you from the beginning:
We harvest the fat,
We spend a few thousand dollars to isolate the stem cells from the fat and even reproduce the cells in the medium,
Then we draw the fluid containing these cells into an injector,
Then we inject it into your face.
This is the summary of the process.
So far, everything is clear.
But what happens next? That is somehow blurred.
Under what conditions will these cells turn into specific cell types on your face? What clinical effect will be achieved? Will there be an externally noticeable difference?
Will you look younger?
How young can you look on average with how many stem cells and at what cost?
If a visual effect can be achieved, is it permanent? Or is it temporary? Should it be repeated?
Is there a clinically significant difference between the results we can achieve with nanofat / isolated stem cells / cultured stem cells / stem cell-enriched fat grafts?
Do stem cell applications slow down the aging process? Are they reversible?
These questions are yet to be answered.
This issue is mediatized in such a way that the imagination of the patients is electrified.
Particularly if there is speculation involving some famous people.
They think that it is a very advanced technology with cells being harvested and injected, and those cells magically renewing the skin, slowing down the aging process and rejuvenating the face.
This is absolutely not the case.
As far as we can observe in the clinic, the stem cells obtained from fat tissue create a “slight improvement in quality” on the skin surface within 1 year after the application. There is an improvement in skin structure, connective tissue organization, pigmentation, and sun damage on the surface. We first noticed this effect in the long-term follow-up of patients who had facial fat transfer. There was an “increase in skin quality” on the face of the patients that could not be explained by the transfer of fat tissue alone. Later, this improvement at the tissue level was associated with the presence of stem cells in the fat tissue.
Then, the question arose whether there would be an increase in the effect we observed clinically if the rate of stem cells in the adipose tissue was increased. In terms of facial rejuvenation applications, the current answer to this question is no. In other words, stem cell isolation/enrichment procedures, which require an additional cost of several thousand dollars, do not have an additional, clinically observable benefit.
In experimental studies, there is scientific evidence that adipose tissue survival rate is increased in stem cell-enriched fat transfers. If 20-30% of the fat in a fat transfer procedure is saved, stem cell enrichment can increase this rate by 5-10%.
However, a review of the literature shows that there are no clinical studies indicating that isolated stem cell application alone without fat tissue has a visible rejuvenating effect on the human face.
There are such studies in rats. But not in humans.
Another heresy about stem cells is to sell procedures as part of the “stem cell popularity wave” although they have nothing to do with stem cells. The most common example to this is the marketing of PRP application as a “stem cell” application. There are coagulation cells (platelets) in your blood in PRP, and they are not stem cells.
Another is “stem cell creams”.
Utter charlatanism. It is not possible for any living cell to pass through the skin barrier in a cream and make an impact in the body. That is incompatible with human nature. It is impossible for a cream to pierce through your dinner table and fall on the floor. It is equally impossible for it to pass the skin barrier.
Today, the only treatment method approved by the FDA as personalized cell therapy for cosmetic purposes is the “fibroblast culture”. Although this is a cellular therapy, it is not a stem cell therapy. The skin is harvested from the back of the ear, the fibroblast cells in this skin are separated, grown in culture for 3 months and injected into the face. It is effective but very expensive. It is a therapy with a low cost/benefit ratio.
Do not think of stem cell isolation as a science fiction application performed only by futurist doctors having very special equipment.
Every plastic surgeon can perform liposuction to harvest 100 ml of fat from the human body. You give this fat to a company, they give you back the stem cells in an injector, you take it and inject it. It’s that simple. It does not require any investment or expense. All expenses are borne by the patient. If your patient has unlimited resources, you don’t need to think twice.
However, if your patient is going to use their precious time and resources for this procedure, you should consider the cost/benefit ratio in favor of your patient.
In my own clinical practice, I prefer the “nanofat” procedure when I want a stem cell effect.
In the nanofat procedure, you take the adipose tissue and pass it through a filter which kills 95% of the fat cells. Stem cells survive because they are resistant to filtration. You can then apply this filtered fat to the skin/subcutaneous tissue using very fine needles or cannulas. Since the fat cells are already dead, the body completely clears them within 4-6 weeks. There are yet unproven theories that stem cells receive the “Tissue damage detected” signal among the debris of lysed fat cells and gain a regenerative potential. In nanofat application, it is our body and not the laboratory that isolates stem cells. The procedure is 5-10 times cheaper. The clinical effect is almost identical.
We use the nanofat procedure in cases where the skin is damaged due to injury, in the treatment of superficial wrinkles around the mouth and eyes, and to slow down volume loss due to aging.
It’s useful. Just don’t expect miracles.
You can contact me for more detailed information about the current situation in stem cell treatments.
If you are proficient in English, you can also check out this publicly accessible article on Google.
The Role of Stem Cells in Aesthetic Surgery: Fact or Fiction? Plastic and Reconstructive Surgery, August 2014, Adrian Mc Ardle (Stanford University, USA)
Take good care…
… of yourself and your beauty.