A global revolution is taking hold throughout the medical aesthetic field. Increasingly, regenerative and cell-based techniques are starting to reduce or replace the need for more invasive surgery, drug or chemical-based therapies.
New approaches involve the use of stem cell-based solutions in advanced fat grafting and volumization technologies, platelet-rich plasma (PRP), platelet-rich fibrin (PRF), adipose-derived stem cell (ADSC)-based therapies and the use of stromal vascular fraction (SVF), growth factors and other anti-aging modalities.
While stem cell-based treatments and other biocellular tools are currently outlawed in some countries, the general consensus is that this will change over time as technologies and techniques improve and gain regulatory approval.
Despite the slowness of regulatory bodies to adopt standards and legal frameworks, many physicians around the world are developing regenerative procedures anyway, and aesthetic medicine is poised to drive some of these developments.
According to Luiz Toledo, M.D., a plastic surgeon in Dubai, United Arab Emirates, “We now have specialized labs devoted to the safety and efficacy of these new methods. For instance, ADSCs have the potential to differentiate towards a variety of cell lineages both in vitro and in vivo. They can be used to replace soft tissue in breast reconstruction after tumor surgery, breast asymmetry and soft tissue defects, after trauma or burns.”
Biocellular therapies combine important biological chemicals, such as growth factors, with “undifferentiated” cells that carry out tissue repair and regeneration. “Fat transfer is a starting point for many regenerative treatments,” stated Adrian Gaspar, M.D., director at Prima Piel Clinic Aesthetics, Anti Aging & Gynecology in Mendoza, Argentina.
“At the beginning of this century, we started using growth factors from platelets, or PRP, and physicians began working with stem cells derived from bone marrow,” Dr. Gaspar continued. “In the last 15 to 20 years, though, the medical community discovered that we can harvest stem cells from fat tissue.”
We harvest the fat and destroy the adipocytes in order to obtain the small, adherent cells that are attached to the extracellular matrix,” Dr. Gaspar explained. “This SVF can be used to improve stretch marks, cellulite, acne scars, melasma, wrinkles and alopecia, among other conditions. We have been conducting research to use these stem cells for vaginal rejuvenation and aesthetics of the genital area, as well.”
Globally, the industry is moving towards a convergence of biologics and medical devices, expressed Chiara Schiraldi, M.D., Ph.D., associate professor of Molecular and Cellular Biology at the Second University of Naples, Italy.
“We are still trying to understand the best and most effective ways to deal with biological substances. In addition, the medical community is working hard to simplify the problem, in order to make it easy for physicians,” she said. “One thing we do know is many practitioners employ energy-based devices to stimulate collagen growth, as well as use injectables, growth factors and other forms of stimulation that encourage the biosynthesis of collagen and promote rejuvenation.”
Overall, regenerative aesthetic procedures hold tremendous potential, noted Dr. Gaspar. “Little by little, this concept is emerging around the world. It is the combination of growth factors and stem cells.”
“Growth factors have the potential to speed up the differentiation of stem cells. Stem cells are found in white cells produced by the bone marrow, but they live in our fat,” Dr. Gaspar advised.
“These cells can differentiate approximately 100 to 150 times in our bodies. We can inject these cells into any area where the skin, tissue or wound can be healed, and the cells will differentiate,” he elaborated.
“The growth factors that exist in the granules of the platelets are essential to promote a differentiation of these stem cells,” he continued. “These are cytokines, which is the ‘language’ spoken by cells. You get stem cells to start talking with other cells and they start differentiating.”
A common denominator in regenerative aesthetics is PRP, which is employed not only in skin rejuvenation and body shaping, but also to address androgenetic alopecia, scars, striae and even vaginal and penile enhancement.
“I’ve used PRP in a wide range of procedures at my clinic,” stated Atchima Suwanchinda, M.D., a dermatologic surgeon in Bangkok, Thailand. “For instance, PRP used for facial rejuvenation after I have already treated the patient with an energy- based device, such as a laser. I’ve also combined PRP with laser treatments to address striae on the body with very good results.”
I use PRP for hair restoration, in particular when I’m treating female pattern baldness, which can be very difficult to treat,” Dr. Suwanchinda added. “Along those lines, I’ve used PRP in addressing the scalp, in general.”
These are becoming popular therapies because they work, Dr. Suwanchinda continued.
“In some cases, patients come in with complications from dermal fillers, and some of them have skin necrosis. I have seen the combination of PRP and the patient’s stem cells achieve substantial and amazing clinical results in terms of renewed and repaired skin. I’ve used PRP to inject over acupuncture points, and it could represent the future when treating some recalcitrant problems like melasma, burn scars and striae.”
According to Dr. Toledo, “A PRP injection contains two to 14 times the concentration of platelets found in normal blood. It appears that these platelets release protein and other particles to help the body start a process of self-healing.”
In plastic surgery we have used PRP mixed with fat, in a proportion of 20% PRP to 80% fat to increase the success rate of the fat grafts, Dr. Toledo reported. “So far, the results are still in their initial phase and we will need more research before we can say for sure that PRP makes a difference.”
Across the APAC region and beyond, the introduction of nanofat and micronized fat has reignited physician interest in fat transfer, noted Dr. Suwanchinda. “In my region, we have seen practitioners discovering nanofat and the results are wonderful. I’ve used this approach to address very difficult-to-treat scars, with great results. These procedures really give patients hope and provide a very impactful result.”
While regenerative approaches have already enhanced traditional fat transfer procedures, new techniques allow for a higher chance of fat survival versus traditional fat transfer. The sky may be the limit regarding regenerative aesthetics, but any time evolutionary or groundbreaking techniques are applied at the clinic level the question always arises: How does a physician manage patient expectations regarding such new therapies?
“Expectations can be very difficult to manage, especially now with ‘Dr. Google’ being present in everyone’s smartphone,” noted Dr. Toledo. “Anyone can publish whatever they want on the Internet and patients immediately see ‘miracles’ that are impossible to obtain. These patients believe what they see and come to the plastic surgeon demanding the same results they see online. If the surgeon has enough experience to convince the patient of realistic results both surgeon and patient will be pleased.”
In the near future, count on a steady increase in the use of regenerative therapies, devices and products that gain a better biologic response. While still on the fringes, evidence suggests that tissue banking; genetics-based therapies; and the expansive use of botanicals, especially anti-inflammatory botanicals, will soon move closer to the mainstream.
Even though the industry has not reached that level of sophistication, “At the very least, in aesthetics, we are discovering new techniques to enhance skin quality, improve fat regeneration after grafting, and restore volume to the face and body affected by aging,” Dr. Toledo noted.
“I have a positive feeling about how regenerative techniques can be employed in aesthetic dermatology,” stated Dr. Suwanchinda. “We still have a long way to go, but the future ahead is bright.”