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STEM CELLS IN PLASTIC SURGERY?

You would think we were on the midway of the county fair – clinics and doctors hawking their “Stem Cell Facelifts” all over the internet! To quote one: “Cutting Edge Cosmetic Surgery, Without Cutting!” For, “Cosmetic, Lichen Sclerosus, Joints, and Surgical Correction.” What is this all about? Stem Cells?

Stem cells are cells that can:

Self-renew indefinitely
Give rise to daughter cells that go on to “differentiate” as they form different types of tissues like nerves, fat, and bones.

By self-renewal I mean that when a stem cell divides in two, one of the cells remains a stem cell and the other becomes a daughter cell that can go on to differentiate. This concept is key to an understanding of how humans grow from a fertilized egg to an adult. It also provides a potential means of treating many diseases. The idea is that if doctors can replace a defective part or a particular function of the human body with a stem cell that can grow into a new part or fulfill the needed function, tremendous opportunities arise for medical progress.

Where do stem cells come from? They are present in the developing embryo as well in certain tissues in the adult – bone marrow, blood, and fat! Certain people must have a lot of stem cells judging from their waistlines!

In plastic surgery this type of tool would be invaluable. Old skin could be replaced with new skin, a stretched out and deflated breast could be exchanged for a youthful one, and even a missing finger could be grown, much like a salamander regrows its tail! But where are we now? Can medical science do these things?

If one looks online, you would think that the answer was, “Yes!” Stem cell facelifts, stem cell breast augmentation, and various clinics and doctors even promise stem cell vaginal rejuvenation – and all of these procedures are said to be “minimally invasive.” It’s like drinking from the Fountain of Youth – no surgery involved!! But what are the facts?
The most potent type of stem cell is an embryonic stem cell (ESC) that can differentiate into any type of human tissue. These are not available for medical use because of ethical concerns in obtaining them as well as the risk of these cells forming dangerous tumors. The next most potent type of stem cell is called a mesenchymal stromal cell (MSC). Although it cannot differentiate into as many different types of cells as the ESC (only bone, cartilage, muscle, and fat), these are easily harvested with liposuction.

Where are we now with stem cell therapy?

If you want to add fat to a particular spot on your body, such as a sunken cheek, you can take the fat by means of liposuction. In this fat are stem cells. If you can isolate these cells, concentrate them, and then add them back to the fat to be used for fat injection, there is theoretically a greater chance of survival of the fat cells. There are encouraging studies that have used this technique, but there are also studies where there has been no increased fat cell survival. More studies are needed.

This has not kept many medical practitioners from making false claims as to their success rates with the use of stem cells. They term their procedures “stem cell facelifts,” but in reality they at best are nothing more than fat grafting with or without MSC’s added back in. The maximum result you would obtain from this technique is a better survival of the injected fat cells, not a facelift since a facelift is much more than just injecting fat into the face.

Numerous other clinics offer platelet-rich plasma treatments for facial rejuvenation and market these as stem cell treatments. But what are the facts? Platelets are substances found in the blood which are fragments of a particular type of cell found in the bone marrow – they are not even cells, much less stem cells! To sum all of this up, let me quote from a recent article in the journal Plastic and Reconstructive Surgery (PRS 2014; 2:193-200), “Overstating potential benefits based on early and incomplete evidence can only serve to erode the public’s trust in the medical profession and, more concerning, compromise the safety of our patients.”

Safety? Some may argue that there is little if any danger involved in suctioning fat from your body and then reinjecting a portion of it back into the body with fat. After all, aren’t they just your own cells? Let me give an example of how danger may arise. MSC’s may be suctioned out of the body and then grown in a test tube – known as cell culture – to increase their numbers. Cell culture usually involves the use of nonhuman serum in which the cells are grown, usually obtained from calves. Disease can be introduced at this point, including Mad Cow Disease that involves a rapid degeneration of the victim’s brain tissue, always resulting in death! There may also be a transformation of these cultured MSC’s into cancerous cells that, if reinjected, may have disastrous consequences.

Do stem cells age? The answer is that they do. Stem cells taken from an older person do not have the same regenerative power as they once did. Does it make sense, then, to inject an older person’s aging stem cells back into them in an attempt to rejuvenate their body? The answer seems to be obvious!

Stem cell therapy is in its infancy. Let the buyer beware! In the California Gold Rush of the 1800’s, many a claim of fortune proved to be Fools’ Gold! Be careful that the same doesn’t happen to you!!

Comments? They are welcomed!

George Sanders, M.D.

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