Repair Revolution: Surgeons use fat grafts to address extensive facial deformities

“What most studies have shown, and what I firmly believe is taking place, is that the stem cells promote blood vessel growth and blood flow via some type of angiogenic process.”

—Sydney R. Coleman, MD

More Views on Stem Cells

A rash of papers has been published in the last few years in support of Dr. Coleman’s claim that adipose-derived stem cells (ASC) have the potential to enhance angiogenesis and blood flow to the graft, promote skin rejuvenation and yield a superior cosmetic result overall.

As one paper (Handchir Mikrochir Plast Chir. 2010;42(2):124-128) coauthored by Dr. Rubin noted, “The angiogenic potential of ASCs distinguishes these cells as a highly desirable cell source for transplantation and tissue repair.”

Unfortunately, many plastic surgery practices have turned that potential into breathless marketing claims about the rejuvenating effects of stem cells. The claims have drawn the attention of the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS), which released a joint position statement in May 2011 that sought to put the brakes on the hype. According to the statement, “while stem cell therapies have the potential to be beneficial for a variety of medical applications, a substantial body of clinical data to assess plastic surgery applications still needs to be collected,” and “The marketing and promotion of stem cell procedures in aesthetic surgery is not adequately supported by clinical evidence at this time.”

Dr. Lam echoed that assessment. “Personally, I don’t think there is any evidence that stem cells are really making an impact from a fat-grafting perspective,” he said. “In fact, some of the purported benefits actually can be attributed more reliably to the estrogen and aromatase levels that are present in abdominal and thigh fat grafts. So there is a voodoo element to some of the claims I’ve seen regarding ASCs that is justifiably being challenged by [the ASAPS/ASPS statement].”

Dr. Friedman agreed that stem cell technology needs to mature before becoming a mainstay of clinical practice. One major downside that has to be overcome, he noted, is the variability in the type and extent of ASCs collected from different patients and harvest sites. Variations in the skills and experience of the surgeon doing the harvesting and processing are also a hurdle, he said.

But there have been some recent gains in solving these problems. Dr. Friedman cited, as an example, the Celution System (Cytori Therapeutics, San Diego, Calif.), which automates the extraction and separation of stem and regenerative cells from a patient’s own fat tissue to form a fat graft. The system, approved in Europe in 2010 for use in breast reconstruction and the repair of soft tissue defects, “has some real promise. This may well be the future of how we’re all going to process lipoaspirates for autologous transfer,” said Dr. Friedman.