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PROFILES Modern Facelift Textbook

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STEM CELL FACELIFT

There is a lot of talk these days about the miracles of stem cell therapy for any number of conditions, from joint injections for injured athletes to the promise of new treatments for chronic conditions such as heart disease, diabetes, or neurological problems. Nowhere is the hype greater than for the anti-aging claims made for cosmetic stem cell treatments. It’s downright confusing. So, let’s help you work through the confusion to understand exactly what stem cells do and how they apply to cosmetic facial enhancements.

Let’s first get one thing out of the way. When you hear about stem cell facelifts, this has nothing to do with an actual facelift. A facelift is a surgical procedure in which loose and sagging facial skin and muscle is tightened. A stem cell ‘facelift’ is not a facelift at all. It refers to injection of stem cells into the face in order to provide cosmetic benefit, either on its own or often as part of a facelift or fat transfer procedure.

WHAT ARE STEM CELLS?

To start with, let’s define stem cells. Stem cells are unspecialized cells that are capable of differentiating into many other types of cells and are also capable of renewing themselves through cell division, sometimes after long periods of inactivity. There are two main types of stem cells, embryonic and adult stem cells.

Embryonic stem cells are derived from embryos and are the subject of tremendous controversy. Adult, or somatic, stem cells are undifferentiated cells that have been found in almost every tissue and organ in the body. They function largely to maintain and repair the tissues in which they are found. Research on adult stem cells is exciting for plastic surgeons because it may be able to help with all kinds of problems we face, including enhancing wound healing, burn treatment, and development of tissue replacements, such as skin or even appendages such as ears, for people who are born missing body parts or who have lost tissue to injury.

ARE STEM CELLS BEING USED IN COSMETIC PROCEDURES?

The last few years have seen the rise of many clinics specializing in stem cell injections. Many of these clinics are making exaggerated and unsubstantiated claims about stem cell treatments as being the fountain of youth. In truth, most of these treatments are not actually even using isolated stem cells. Most are using Platelet rich plasma (PRP), a concentrate of plasma derived from your own blood sample that is rich in platelets and growth factors. Or, they are harvesting fat cells and combining them with enzymes and growth factors before re-injecting them into the target area. In other words, they are just concentrating the stem cells that are already present in the harvested blood or fat tissue. They are not growing large numbers of stem cells in the lab. Despite the embellished claims, there are no reliable scientific studies to date that demonstrate these types of injections to provide any far-ranging or long-lasting anti-aging benefit in terms of soft tissue rejuvenation when used alone. When used during a facelift, PRP at most may help to speed up healing a little. When injected into the face on its own (deceptively called a ‘Vampire Facelift’), studies have shown PRP to be equivalent to other FDA approved fillers in its ability to produce some collagen. This treatment may be attractive to people who want an all-natural approach to anti-aging by using their own blood products in place of other injectable fillers. However, the amount of filling that can be achieved with PRP has been shown to be less predictable than that achieved with popular fillers such as Juvederm and Voluma. In short, there’s a lot of hype for results that are less than earth shattering.

In fact, our own Dr. Solieman was involved in one of the early studies looking at the efficacy of PRP used during a facelift procedure. The study did not show a significant improvement in healing rates compared to untreated controls.

STEM CELLS AND FAT TRANSFER

Where stem cells may have some usefulness for cosmetic purposes is in enhancing the efficacy of fat transfer procedures. The main downside of fat transfer for facial volume augmentation is that not all of the fat cells survive the procedure and, so, some of the cosmetic benefits are lost. In most recent studies, approximately 50% to 75% of untreated fat cells are retained long-term after fat transfer procedures. We as surgeons are always looking to improve on these results and stem cells may offer some promise in this area. In experimental studies, stem cells have been isolated after liposuction (so called Adipose-derived stem cells or ASCs) and have been added in a concentrated amount to transferred fat during the same procedure to enrich the fat cells through a process called cell-assisted lipotransfer. There is some uncertainty about the value of this procedure with most studies being small in number and not particularly well controlled. Results are mixed with some studies showing little support and more studies recently showing a significant improvement in retention rates of transferred fat cells. These procedures are not without disadvantages, including increased cost and surgery time, however, as evidence begins to mount in favor of consistently improved results using cell-assisted lipotransfer, we expect this technique to be increasingly adopted by surgeons performing fat transfer procedures.

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