Surgical Aesthetics

JAN-FEB 2014

For plastic surgery and cosmetic surgery trends, techniques and equipment, plastic and cosmetic surgeons turn to Surgical Aesthetics for the latest on breast augmentation, liposuction, rhinoplasty and more.

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January/February 2014 ❘ © ISTOCKPHOTO.COM advertised as beneficial in everything from esthetic facials to increasing the success of fat grafts. And research continues to explore new applications. "At some point in the future, when the regulatory barriers come down a bit, I think it will be interesting to see what happens when we start enhancing the fat transfers with concentrated stem cells and the stromal vascuStem cells hold promise for a variety of lar fraction from the fat," says Dr. medical indications, and many physicians D'Amico. "We know that fat transand researchers are awaiting a softening fer by itself works, but the interestin the stance of U.S. regulatory agencies ing questions going forward will be toward these biologic materials. to see whether we can enhance the effect, enhance the viability." In 2011, a joint task force of the American Socifat under the eyes—I underfill and then use PRP ety for Aesthetic Plastic Surgery (ASAPS) and the as the icing on the cake to fill in that difference. It American Society of Plastic Surgeons (ASPS) issued gives me an added safety factor and reduces the a position statement on stem cells and fat graftnodules that you sometimes see." ing, which stated, among other points, that "the Though he cautions that more studies are marketing and promotion of stem cell procedures needed to prove that PRP enhances the survival of in aesthetic surgery is not adequately supported by fat grafts, anecdotally Dr. Grazer is seeing better clinical evidence at this time." survival of fat and improved skin texture with a combination of fat and PRP. "The PRP is almost like a fertilizer for the fat stem cells," he says. What Lies Ahead PRP has also become a hot topic in hair Research holds the promise of many more exciting restoration surgery, where it is being used to treat applications for autologous biological materials in alopecia and improve the sustainability of hair plastic surgery, particularly when it comes to fat. grafts. In October 2013, Miao, et al, published a Cryopreservation of fat is a growing field. "Women study comparing isolated epidermal and culture might, at the time of mastectomy, have their fat dermal papilla cells. The cells, which were mixed suctioned and stored," says Dr. Roth. "They can with varying concentrations of PRP and implanted have some fat grafted at the time of the mastecon to the dorsal skin of nude mice, were compared tomy, and then for additional treatment, they don't to cells not treated with PRP (Dermatologic have to have liposuction again. All the fat is waiting, Surgery, October 2013). They found a significant stored, ready to be used." difference in newly formed follicles in the PRPDoctors may be able to one day clone a paenhanced cells (344+/-27 with 10% PRP vs. 288+/tient's fat cells, so that much smaller amounts of without PRP). fat could be harvested, then cloned into larger As the indications for PRP continue to grow, amounts for breast or buttock augmentation. many remain skeptical of both the efficacy and the Dr. D'Amico posits that, in the future, surgeons evidence to support it. "There have been a lot of might not even need to harvest a patient's own fat. stories in the press, and they've been hyped up," "One of the things that may come off the shelf in a Dr. Roth says. "The jury is still out, and the science few years is an actual scaffold of fat," he says. Plasis still not there for a lot of indications." tic surgeons already use matrices of bone and skin that are decellularized. "The idea would be to take cadaver or donor fat and decellularize it, just like What About Stem Cells? we do now with skin. That scaffold comes in and Stem cells, which have garnered a lot of popular press for their regenerative powers, are being continued on page 29 23

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