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Stem cells: What they are and what they do
Researchers believe stem cells offer great promise for new medical treatments. Learn about stem cell types, current and possible uses, ethical issues and the state of research.
By Mayo Clinic staff
You've heard about stem cells in the news, and perhaps you've wondered if they might help you or a loved one with a serious disease. You may wonder what stem cells are, how they're being used to treat disease and injury, and why they're the subject of such vigorous debate.
Here are some answers to frequently asked questions about stem cells.
Why is there such an interest in stem cells?
Researchers hope stem cell studies can help to: * Increase understanding of how diseases occur. By watching stem cells mature into cells that eventually become bones, heart muscle, nerve cells, and other organs and tissue, researchers and doctors may better understand how a variety of diseases and conditions develop. * Generate healthy cells to replace diseased cells (regenerative medicine). Researchers hope they can train stem cells into becoming specific cells so that those specialized cells can be used to regenerate and repair diseased or damaged tissues in people. People who might benefit from stem cell therapies include those with spinal cord injuries, type 1 diabetes, Parkinson's disease, Alzheimer's disease, heart disease, stroke, rheumatoid arthritis, osteoarthritis and multiple sclerosis. Stem cells could also be grown to become new tissue for use in transplant medicine. * Test new drugs for safety and effectiveness. Before using new drugs in people, researchers could use stem cells to test the safety and quality of investigational drugs. For instance, nerve cells could be generated in order to test a new drug for a nerve disease. Tests could show whether the new drug had any effect on the cells and whether the cells were harmed.
What are stem cells?

CLICK TO ENLARGE | Stem cells: The body's master cells |

Stem cells are the body's raw materials — cells from which all other cells with specialized functions are generated. Under the right conditions in the body or a laboratory, stem cells divide to form more cells, called daughter cells. These daughter cells either become new stem cells (self-renewal) or become specialized cells (differentiation) with a more specific function, such as blood cells, brain cells, heart muscle or bone. Stem cells are unique — no other cell in the body has the natural ability to generate new cell types.
Where do stem cells come from?
Researchers have discovered several sources of stem cells: * Embryonic stem cells. These stem cells come from embryos that are four to five days old. At this stage, an embryo is called a blastocyst and has about 150 cells. These are pluripotent (ploo-RIP-uh-tunt) stem cells, meaning they can divide into more stem cells or they can specialize and become any type of body cell. Because of this versatility, embryonic stem cells have the highest potential for use to regenerate or repair diseased tissue and organs in people. * Adult stem cells. These stem cells are found in small numbers in most adult tissues, such as bone marrow. Adult stem cells are also found in children and in placentas and umbilical cords. Because of that, a more precise term is somatic stem cell, meaning "of the body." Until recently, it was believed that adult stem cells could only create similar types of cells. For instance, it was thought that stem cells residing in the bone marrow could give rise only to blood cells. However, emerging evidence suggests that adult stem cells may be more versatile than previously thought and able to create unrelated types of cells after all. For instance, bone marrow stem cells may be able to create muscle cells. This research has led to early-stage clinical trials to test usefulness and safety in people. * Adult cells altered to have properties of embryonic stem cells (induced pluripotent stem cells). Scientists have successfully transformed regular adult cells into stem cells using a technique called nuclear reprogramming. By altering the genes in the adult cells, researchers can reprogram the cells to act similarly to embryonic stem cells. This new technique may help researchers avoid the controversies that come with embryonic stem cells, and prevent immune system rejection of the new stem cells. But, it's not yet known if altering adult cells will cause adverse effects in humans. Researchers have been able to take regular connective tissue cells and reprogram them to become heart cells. The new heart cells were injected into mice with heart failure, where they improved heart function and survival time. * Amniotic fluid stem cells. Researchers have also discovered stem cells in amniotic fluid. Amniotic fluid fills the sac that surrounds and protects a developing fetus in the uterus. Researchers have identified stem cells in samples of amniotic fluid drawn from pregnant women during a procedure called amniocentesis. During this test, a doctor inserts a long, thin needle into a pregnant woman's abdomen to collect amniotic fluid. The fluid can be tested for abnormalities, such as Down syndrome, and fetal maturity. The procedure is generally considered safe for the developing fetus and the mother. More study of amniotic fluid stem cells is needed to understand their potential.
Why is there a controversy about using embryonic stem cells?
Embryonic stem cells are obtained from early-stage embryos — a group of cells that forms when a woman's egg is fertilized with a man's sperm. Extracting stem cells from embryos raises significant ethical questions.
Where do these embryos come from?
The embryos being used in embryonic stem cell research come from eggs that were fertilized at in vitro fertilization clinics but never implanted in a woman's uterus because they were no longer wanted or needed. The excess embryos were frozen and later voluntarily donated for research purposes. The stem cells can live and grow in special solutions in test tubes or petri dishes in laboratories.
Why can't researchers use adult stem cells instead?
While research into adult stem cells is promising and moving forward rapidly, adult stem cells may not be as versatile and durable as embryonic stem cells are. Adult stem cells may not be able to be manipulated to produce all cell types, which limits how they can be used to treat diseases, and they don't seem to have the same ability to multiply that embryonic stem cells do. They're also more likely to contain abnormalities due to environmental hazards, such as toxins, or from errors acquired by the cells during replication. However, researchers have found that adult stem cells are more adaptable than was initially suspected. There have been significant advances in work with adult stem cells, and more studies are under way.

By Mayo Clinic staff
A stem cell transplant is the infusion of healthy stem cells into your body. A stem cell transplant may be necessary if your bone marrow stops working and doesn't produce enough healthy stem cells. A stem cell transplant can help your body make enough healthy white blood cells, red blood cells or platelets, and reduce your risk of life-threatening infections, anemia and bleeding.
Although the procedure to replenish your body's supply of healthy blood-forming cells is generally called a stem cell transplant, it's also known as a bone marrow transplant or an umbilical cord blood transplant, depending on the source of the stem cells. Stem cell transplants can use cells from your own body (autologous stem cell transplant), or they can use stem cells from donors (allogenic stem cell transplant).

The ability of stem cells to self-renew and give rise to subsequent generations with variable degrees of differentiation capacities,[2] offers significant potential for generation of tissues that can potentially replace diseased and damaged areas in the body, with minimal risk of rejection and side effects.
Hair follicles also contain stem cells, and some researchers predict research on these follicle stem cells may lead to successes in treating baldness through an activation of the stem cells progenitor cells. This treatment is expected to work by activating already existing stem cells on the scalp. Later treatments may be able to simply signal follicle stem cells to give off chemical signals to nearby follicle cells which have shrunk during the aging process, which in turn respond to these signals by regenerating and once again making healthy hair. Most recently, Dr. Aeron Potter of the University of California has claimed that stem cell therapy led to a significant and visible improvement in follicular hair growth[citation needed]. Results from his experiments are under review by the journal Science (journal).
[edit] Missing teeth
In 2004, scientists at King's College London discovered a way to cultivate a complete tooth in mice[15] and were able to grow them stand-alone in the laboratory. Researchers are confident that this technology can be used to grow live teeth in human patients.
In theory, stem cells taken from the patient could be coaxed in the lab into turning into a tooth bud which, when implanted in the gums, will give rise to a new tooth, and would be expected to grow within two months.[16] It will fuse with the jawbone and release chemicals that encourage nerves and blood vessels to connect with it. The process is similar to what happens when humans grow their original adult teeth.
Many challenges remain, however, before stem cells could be a choice for the replacement of missing teeth in the future.
Wound healing
Stem cells can also be used to stimulate the growth of human tissues. In an adult, wounded tissue is most often replaced by scar tissue, which is characterized in the skin by disorganized collagen structure, loss of hair follicles and irregular vascular structure. In the case of wounded fetal tissue, however, wounded tissue is replaced with normal tissue through the activity of stem cells.[33] A possible method for tissue regeneration in adults is to place adult stem cell "seeds" inside a tissue bed "soil" in a wound bed and allow the stem cells to stimulate differentiation in the tissue bed cells. This method elicits a regenerative response more similar to fetal wound-healing than adult scar tissue formation.[33] Researchers are still investigating different aspects of the "soil" tissue that are conducive to regeneration.

Both looking and feeling younger are now possible through the Autologous Stem Cell Transplant

THE ABILITY TO LOOK YOUNGER HAS BEEN POSSIBLE WITH the onslaught of anti-aging treatments and cosmetic procedures. However, the ability to actually become younger is now possible through the new Autologous Stem Cell Transplant (ASCT). ASCT holds great promise against a wide variety of illnesses, such as Alzheimer's Parkinson's, cancer, diabetes, arthritis, spinal cord injuries, and aging itself.

"The therapy does not prevent you from getting the diseases," Dr. Lucero explains. "But because it has a regenerative effect on organs, it may delay the onset of a particular disease. Nearly all diseases have a degenerative component, and that's what the therapy helps. For example, in the case of diabetes, there may be a degeneration of the cardiovascular system leading to ischemic heart disease, peripheral neuropathy of the legs, and retinopathy of the eyes. The therapy can help restore the heart, legs and eyes, and may help reduce diabetes. However, it will not take the disease away."

The transplant, which takes four hours (three hours to culture the stem cell, and one hour to harvest and infuse back into the patient), harvests 100 cc of dormant stem cells from the patient's fat cells through liposuction. They are placed in a fat-dissolving solution to separate the cells from the fat, centrifuged, then placed in a growth factor solution, allowing the substrate to increase in number viable to the transplant. Then, the cells are washed and infused back to the patient intravenously. ASCT has also been dubbed as the ultimate anti-aging therapy, as it offers rejuvenation in terms of looking younger and feeling stronger. "Since aging is a degenerative disease, the therapy induces the mesenchymal stem taken from the adipose tissue to become multiple new cells inside the new liver, bone, muscle, skin and nerve cells, as required by the body," says Dr. Lucero. "Because of its regenerative effects, it makes a person younger both on the outside and inside." Some effects reported were increased energy levels (as if subtracting 10 years from one's current age), short-term memory improvement, mood relaxation, sleep pattern improvement, increased libido, and the will to exercise. Dr. Lucero advocates the Holistic Medical Rejuvenation, which combines the ASCT with liposuction, body contouring or any other form of plastic surgery, during the three-hour waiting period for the stem cells.

"I've had essential tremors, meaning I shake, particularly my right hand, for 10 years but the organ causing it was never detected," shares Dr. Lucero's wife Tinette. "One afternoon, Dr. Bill Paspaliaris noticed my hand shaking and said I was in an early stage of Parkinson's. I told my husband I wanted to try ASCT, since my medication wasn't helping. He did the procedure by extracting one million dormant stem cells from my fat cells through liposuction. While waiting for the stem cells to culture, he performed abdomen liposuction and did my lower eye bags, as well. What's amazing was the next day, I was up and about, as if I didn't have surgery the day before. I healed much better and faster as compared to my other surgeries. There is truly a holistic approach to rejuvenation -- externally through plastic surgery, and internally through the ASCT."

Full recovery period for the mere harvesting of fat cells is about one to two weeks, while for combination surgery, it requires around four to six weeks. "The therapy is, in many ways, a mild fountain of youth," Dr. Lucero say's. "According to highly respected scientists worldwide, we can eventually counter the effects of aging itself, and will one day enable people to live and be healthy up to the ages 120 to 130."

What methods are used in conventional aesthetic medicine?

What are the latest technologies available?
What stem cells to use?
Bioethical Issues?
What are the choices?
What are the problems?
Is there a future for stem cell in aesthetic medicine?
Illustrate the latest developments in aesthetic Medicine.
Stem Cell Therapy Enters Aesthetic Medicine
VIENNA, April 26 /PRNewswire/ --
- Vienna Based Cosmetic Surgeon is the First to Use Cutting Edge Technology in Europe
Breast enlargement, treatment of wrinkles and facial rejuvenation now can be achieved with highly improved success rates. "For some time we have known, that stem cells exist in fat and that we remove these cells in liposuction,", says Vienna based cosmetic surgeon DDr. Karl-Georg Heinrich, "We have learned what we can do with these valuable living cells and as a result we now harvest them instead of dumping them." DDr. Heinrich successfully uses stem cell therapy in his institute (Clinic DDr. Heinrich). That makes him the first in Europe to take this pioneering step.
In Japan the use of stem cells in cosmetic medicine has been evaluated in a clinical study with remarkable results. Based on these data the technique is now approved in the European Union.
"The future has already begun," says DDr. Heinrich, "We now can use the patient's own living cells as a filler where ever more fullness is needed. Simply speaking we now have a method which allows us to take the best part of own fat - living stem cells - and use them optimally."
This opens new horizons in aesthetic medicine: Breast enlargement with stem cells provides volume gain achieved not by plastic but by living tissue. The enlarged breast will feel and look perfectly natural. And what is true for the breast is also true for other parts of the body like bottom, hips, thighs, calves etc. DDr. Heinrich: "With stem cells we not only get 100% natural results - these will also last a lifetime."

Aesthetic Dermatology
Marketing Stem Cells for Aesthetic Medicine 'Possibly Unethical'
By: DIANA MAHONEY, Skin & Allergy News Digital Network
The stem cell facelift sounds like science: transplanting adult stem cells from the body's own fat tissue into the face so the stem cell growth factors can generate new tissue and restore the smoothness and skin tightness of youth.
However, the problem, according to Dr. J. Peter Rubin, codirector of the Adipose Stem Cell Center at the University of Pittsburgh, is that the science "just isn't there yet," so marketing stem cell procedures for aesthetic medicine is "premature and possibly unethical."
Of approximately 9,000 reports in the medical literature about stem cells, only 20 are peer-reviewed studies about their use in aesthetic procedures, Dr. Rubin said at the annual meeting of the American Society for Aesthetic Plastic Surgery, and none "demonstrate superiority of stem cell facelift over [conventional] facelift with standard fat grafting."
Despite the dearth of evidence demonstrating the safety or efficacy of stem cell therapies in aesthetic medicine, the procedures are being widely marketed, he said, noting that in some cases, the treatments don't even include any stem cell work, but simply involve regular fat grafting.
In an effort to discourage the proliferation of unsubstantiated claims about stem cell therapies, a joint task force of the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) released a position statement at the meeting recommending against the marketing and promotion of stem cell procedures in aesthetic surgery until there is adequate clinical evidence to support doing so.
Specifically, the ASAPS/ASPS position statement stressed that "the marketing and promotion of stem cell procedures in aesthetic surgery is not adequately supported by clinical evidence at this time," and as such recommends that: * The use of phrases such as stem cell therapy or stem cell procedure be reserved for treatments or techniques in which the collection, processing, and therapeutic action of stem cells are the primary goal of treatment rather than the passive result. "Standard fat grafting procedures that do transfer some stem cells naturally present within the tissue should be described as fat grafting procedures, not stem cell procedures," according to the document. * Data on outcomes and safety should be collected and reported by physicians performing stem cell therapies to advance the knowledge and the science of the process. * Stem cell therapies in aesthetic and reconstructive surgery should be conducted within clinical studies under Institutional Review Board approval. * Stem cell procedures should be performed in compliance with Food and Drug Administration regulatory guidelines.
"There are encouraging data from laboratory and clinical studies suggesting the use of adult stem cells is promising, but there is not enough science to justify the widespread marketing of it," said Dr. Rubin.
The goal of the position statement is not to diminish enthusiasm about the potential for stem cell treatments," he said, "but to support evidence-based practices in order to protect patients' best interests."
Dr. Rubin receives educational support from Covidien. Putting the Stem Cells/Aesthetic Medicine Issue in Focus by jfrentzen 3/2/2010 11:29:00 AM
The growing media attention paid to the married between cosmetic surgery and stem cells has been very upbeat and almost blissfully "forward thinking." PSP is no stranger to this interpretation of where we are headed -- adding stem cells into the aesthetic medicine mix sounds very promising. Therefore, it satisfies my journalistic senses when a physician offers a common-sense view of where we stand with this "marriage." From WFAA-TV: Dallas doctor uses stem cell injections in cosmetic surgery:
Dr. Jeffrey Caruth, an OBGYN practicing cosmetic surgery, started the procedure by removing fat from several parts of her body to create volume in her face and chest. Under local anesthetic, she was awake during the entire surgery. Her hands were strapped down to keep her from touching the sterile area. It was a procedure Jones called painless. “You know when you're hungry and your tummy is grumbling before it's time to eat, it kind of felt like that,” she said.
Caruth said stem cells help solve a problem that has plagued prior procedures. “The problem has been with traditional fat grafting that you put a volume of fat into the face, the buttocks and then in a month or two or three there is significant volume loss due to death of the fat cells you put in,” he said. To help the fat survive, it was injected with Jones' stem cells for regenerative purposes. Caruth used an enzyme to pull the stem cells out of her fat. A machine then created a concentrated solution of stem cells, which are injected into a fresh batch of fat for double the power. “You're going to get twice the graft survival versus other methods,” Caruth said.
Jumping down the page, I appreciate the comments from Jeffrey Kenkel, MD, a well-known aesthetic practitioner who puts the whole stem cell slash plastic surgery debate into perspective:
...While he has great hope for stem cells, he said they aren't predictable enough yet to guarantee results. “There is a tremendous amount of excitement about stem cells," he said. "We just don't have a lot of information about them, about how they work and how we control them to do what we want them to do." Kenkel agrees stem cells will change medicine in the near future, but said more scientific and objective research is needed. “Are the stem cells going to stick around and actually control how that person heals and what kind of results they have?" he said. "We just don’t' have the answer to those questions yet." Through my experience, anti aging is a misnomer. Logically speaking, there is no such treatment regime as anti aging, as AGING is inevitable.
All these treatment are meant for graceful aging, and not ANTI AGING-- until you lock yourself in a cryotherapy container and get frozen in time( a concept made popular by HOOOOOOllywooooodd) The process of aging begins on the day you were born. Of course we don't call it aging then, but rather... development.
In the past, age is determined by the number you were born, or by the number stated on your identity card. But with the development of science, technology, and medicine, age is not CHRONOLOGICAL anymore, but rather... BIOLOGICAL / PHYSIOLOGICAL. This posting is an introduction the next few postings on Aesthetics and "Anti Aging".....
For the past 3 decades, there has been a quantum leap in the beauty industry. Now, cosmetology
Has become a specialty in medicine. It is believed that human strive for excellence in life to achieve much goals for the simple reason of continuous existence. And one effective way to do so is by appearing attractive to the opposite sex.

Aesthetic / Cosmetic medicine was in its infancy stages in the 1980s and 1990s. Until recently in the mid 2000 decade, aesthetic / cosmetic medicine has exponentially taken off and is now a very well excepted field of medicine. The drive of this explosive growth has mainly been due to technological advances.

Aesthetic means “to look pleasing” and Cosmetic means “to beautify an appearance”.

Aesthetic / Cosmetic medicine is a field in medicine that usually involves minimal cutting, no general anesthesia, and patients are usually self pay. This relatively new field of aesthetic / cosmetic medicine basically involves three main categories. 1. Injectables - such as Botox and dermal fillers to help decrease the look of the natural aging process. 2. Lasers - this technology has rapidly surpassed some of the traditional medical training and can be used for a wide variety of applications such as hair removal, vein removal, collagen stimulation, nontraditional liposuction, hair stimulation, teeth whitening, and many more. 3. Minimally invasive cutting and suturing – These are minor procedures that do not require general anesthesia such as hair transplants and certain skin lifts etc...
Of course, these three categories are presented to simplify a more involved field of medicine.

Aesthetic Medicine is constantly evolving and is not what one learned in medical school. Traditionally aesthetic and cosmetic medicine has been a field that was exclusive to dermatologist and plastic surgeons. Currently, physicians from all specialties perform aesthetic procedures. Within the United States, some states allow medical technicians to do procedures with supervision by a physician. Similarly, many states also allow nurses to perform procedures with supervision by a medical doctor. While other states allow these procedures to be performed by nurses without supervision as long as the facility has a medical director present in the building. However, the majority of states require that only physicians perform these aesthetic procedures.

This is now possible because new technology have made procedures more simple, easier to use, and more accessible to the doctor and patient. Many previous procedures that required a hospital operating room are now noninvasive and office based procedures. Since many of these procedures are currently done in private medical offices, hospitals cannot dictate which specialty can do the procedures based on hospital politics or policies. Another large factor that allows a large variety of physicians to perform these procedures is simply that most patients are “self pay”. These procedures are considered “elective” or “cosmetic” which are not considered a medical necessity. This disables insurance companies or the government in determining which type of physician can perform or be compensated for these aesthetic procedures (since insurance companies or the government are not the ones reimbursing these physicians).

With advancing technology and new discoveries in medicine, different medical fields experience changes. For example, at one time cardiothoracic surgeons were the leaders, authoritative figures, and money makers in a hospital. With the invention of the stent, cardiologists have literally overthrown these historic giants. There have been turf wars among specialties for ages. The best example of this has been seen with interventional cardiologists, interventional radiologists, and vascular surgeons competing to do similar or the same procedures. Many fields in medicine overlap, this can be seen with a family practitioner delivering a baby and doing well child exams on that baby - thus, taking the job of an OB/GYN and pediatrician. This can also be clearly seen with a family practitioner performing colonoscopy in a small rural town but being hindered from performing them in large metropolitan cities because of turf wars and politics.

Many specialties feel entitled to different procedures. However, entitlement does not translate to being more qualified. [No field of medicine would be foolish enough to criticize each other given the vast array of medical knowledge each specialty holds] Botox injections or the use of lasers are not beyond the scope of medical knowledge to most physicians who get appropriate training. This field of medicine was not created to take away from the dermatologist or plastic surgeon that spent countless years of training in their respected field. The reality is that the plastic surgeon and the cosmetic derma surgeon will never be at a loss of business from other specialties practicing aesthetic / cosmetic medicine. Dermatologists take care of complicated skin conditions such as cancer and plastic surgeons spend hours in the operating room performing complicated reconstructive surgeries. These procedures can never be emulated or performed by a non trained physician of other fields.

The danger lies in the fact that since the procedures associated with aesthetic and cosmetic medicine are minimally invasive, this might give healthcare professionals the false sense of being complacent that nothing can go wrong. This word of caution also applies to the dermatologist or surgeon who might not have been trained in these minimally invasive procedures or use of lasers. Just because a healthcare provider of any specialty can perform some of these procedures, that does not mean they should. Health professionals who plan to implement aesthetic / cosmetic medicine into their practice should have appropriate training and understanding of the technology, as well as a complete understanding of the risk and complications associated with the practice of this type of medicine.

The bottom line is that all physicians and healthcare providers who choose to take part in this exciting field of cosmetic and aesthetic medicine are moving forward together and we need to stay ahead of the current technology and remain advocates for patient safety. Contents of Aesthetic Medicin
The general objectives of aesthetic medicine are: * Prevention and treatment of all forms of aesthetic pathology * Application of techniques to improve beauty and appearance * Prevention of aging * Promotion of health and psychological, physical and personal well-being
These objectives of aesthetic medicine coincide with the three objectives that the World Health Organisation has assigned to medicine: * The healing of illness * The prevention of illness * The promotion of good health
The following list includes many, but not all, of the procedure that are included under the heading of aesthetic medicine:
Aesthetic medicine of the skin * Prevention, diagnosis and treatment of skin aging * Prevention and treatment of photo aging * Aesthetic medicine and cosmetic skin treatments (facial and body) * Aesthetic medicine and cosmetic hair and nail treatments * Expression wrinkles * Skin stretch marks * Skin flaccidity * Prevention and treatment of skin pigmentation alterations * Aesthetic side effects due to infectious or immunological pathologies * Anti-aesthetic scars and keloids; secondary and hypertrophic * Hyperhidrosis * Hair pathologies: hypertrichosis, hirsutism * Aesthetic medicine treatments of androgenic or acquired alopecia (partial or universal) * Skin circulation alterations: telangiectasia, couperose skin, hemangioma * Non-malignant skin damage * Tattoos
Phlebotomy aesthetics and lymphatic pathology * Prevention of periphery circulation alterations * Treatment of varicose and micro-varicose veins * Varicose ulcers * Prevention and treatment of lymphatic pathology
Endocrinology and Aesthetic-Metabolism-Cellulitis * Over weight and obesity * Lipodystrophy * Cellulitis
Obstetrics and aesthetic gynaecology * Advice on pregnancy and post-birth * Aesthetic medicine during menopause
Combined treatment with aesthetic surgery * Preparation for aesthetic surgery operations * Recovery and treatment after aesthetic surgery operations
Prevention and general good health care * Prevention and treatment of aging (general) * Prevention and treatment of stress * Toning and vitalisation treatments * Collaboration in the treatment of alterations in the appreciation and acceptance by the patient of his or her appearance
Specific techniques of Diagnosis and Treatment
Aesthetic medicine uses all the diagnosis and therapeutic techniques of general medicine.
The scientific community validates the various therapeutic techniques used in aesthetic medicine, through independent organisations and by the Spanish public authorities.
In the case of the techniques that require the use of specialised equipment, the apparatus used must be duly authorised and homologised. If sanitary health products or medicines are used, then these must be approved by the competent health authority and administered according to the conditions and indications that are specified in the prospectus.
Technical interventions in Aesthetic Medicine * Infiltrations, mesotherapy for facial and corporal rejuvenation * Lipoaspiration, liposuccion, liposculpture: conventional, ultrasonic, high frequency and laser treatments * Mini and micro hair transplants * Ambulatory aesthetic phlebectomy * Microsurgery of varicose veins * Sclerotherapy of varicose veins and telangiectasia * Resection of benign skin pathologies * Implants and contour threads * Botulinum toxin * Aesthetic ablative laser treatments
Diet therapy * Guidance on specific diets according to pathology
Electrotherapy / Phototherapy * Electrotherapy of muscular stimulation * Vibratory platforms * Iontophoresis of products for aesthetic medicine treatments * Ablative, semi-ablative and non-ablative laser therapy * Phototherapy * Ultra-sound: sonophorosis and localised ultra-sound * Follicular treatment: electric hair removal (electrolysis, thermolysis) and photo therapy (laser and Intense Light Pulse) * Diathermocoagulation, electrocoagulation * Mono, bipolar and dual radio frequency * Photodynamic therapy * Intense Light therapy * Carboxytherapy * Ozone therapy
* Orientation on physical exercise * Hydrothermal aesthetic medicine (hydrotherapy, thermotherapy, cryotherapy, mud wraps and general and specific massage) * Pressure therapy
* Use of medicinal plants in aesthetic medicine
Lifestyle and behaviour traits * Implementation of appropriate behavioural habits for a healthy life * Prevention of damage from excessive sun exposure
* Homeopathic treatments applied to aesthetic medicine
Traditional Chinese medicine * Application of acupunture to aesthetic medicine * Diet therapy according to traditional Chinese medicine
* Treatment of aesthetic complaints using body and facial mesotherapy
Chemical and physical skin treatments * Peelings using physical techniques * Chemical peeling; superficial, medium and in depth * Superficial dermoabration * Cryotherapy * Micropigmentation of congenital and acquired alterations * Application of factors affecting growth and techniques of genetic engineering * Facial implants using various material including facial autologous fat * Contour thread lift
Techniques of relaxation * General treatments * Oxygen and ozone therapy * Treatments to fortify immunity * General tonifying treatments * Thermalism and balneotherapy
Dental treatments * Dental health and hygiene * Teeth whitening Medical aesthetics
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Medical Aesthetics is a branch of medicine which deals with beautification of body with help of medical knowledge and surgery.[1][dubious – discuss] It primarily covers treatments involved with the skin, though other parts of the body may be involved. Medical aestheticans find employment with dermatologists, hospitals, laser skin care clinics and spas.[1]
In cases involving medical problems such as trauma, plastic surgery, cancer treatment and burn recovery, medical aesthetic procedures may be invoked for preventive or palliative reasons. In other cases, medical aesthetic procedures may be involved for cosmetic purposes.[1] Medical aesthetics complements reconstruction surgery and the need for surgeons to incorporate this aesthetic sense, of how faces should be sculpted with soft tissue and bone, has been felt.[2]
Typical medical aesthetic products/services include:[3] * Use of botulinum toxins i.e. botox - the most popular MA treatment for sagging skin.[4] * Sclerotherapy (or Microsclerotherapy) for varicose veins and spider veins. * Rhinoplasty or nose reshaping * Facials or skin peels involves procedures which can remove the skin wrinkles because of aging. * Excessive sweating (Hyperhydrosis). * Medical Skin Needling (Collagen Induction Therapy) to improve skin quality, reduce wrinkles etc.
The terms "medical aesthetics" and "medical cosmetology" are sometimes used ambiguously. Peng, Whang and Zhou (2000) opine that "the task of medical aesthetics is to study the human body in its entirety, concentrating on both internal and external beauty and put the findings into practice, whereas the task of medical cosmetology is to study and assess only the external beauty of the human body and to take action on that basis."[5]
In the classical sense, the term "medical aesthetics" refers to the discipline of aesthetics in the field of medicine. However, skin care commercial entities have begun to describe personnel carrying out cosmetic intervention as "medical aestheticians". This has led to the the term being considered disreputable in the medical fraternity.[citation needed]
There is debate as to the relation between medical aesthetics on the one hand and classical subdisciplines of medicine such as dermatology and reconstructive/plastic surgery.[6] Medical professionals often come to this field through dermatology.[7]
Considered to be a growth industry, medical aesthetics is a booming field according to some experts.[8] Medical cosmetology is criticised at times for the overwhelming majority of interventions for purely cosmetic or commercial reasons. This field has seen rapid progress amongst the Chinese medical community from the 1980s onwards. What is Aesthetic Medicine? | | |

Aesthetic Medicine: A Booming Discipline! Aesthetic Medicine comprises all medical procedures in the field of Aesthetics excluding all surgical procedures which require an operating table and general anesthesia (such as breast implants, liposuction, surgery of obesity, facelifts, rhinoplasty, etc.).
The exciting field of Aesthetic medicine is the answer to a new trend in the Medical World. Patients not only want to be in good health, they also want to enjoy life to the fullest, be fit and have great looks. Indeed, patients are now asking for quick, non-invasive procedures with minor downtime and very little risk. As a general rule, the needle is increasingly replacing the scalpel...
This recent trend explains the current success of Aesthetic Medicine around the globe. These risk-free, non-surgical aesthetic procedures consist of: Chemical Peels Aesthetic Mesotherapy, Shapes and Cellulite Control Nutrition Artificial Hair Transplant Aptos/Contour Threads Skin analysis & basic skin care Microdermabrasion Chemical Peeling Ultrasound / Iontophoresis Micro current EMS Oxygen therapy Hair Analysis & Hair care Ear piercing & body piercing Temporary tattooing Cosmeceuticals Trichology Botox Dermafiller Laser for hair removal Laser for pigmentations Laser for pimples IPL Radio frequency Pulsed Radio Frequency Laser lipolysis Carboxytherapy The real benefit of practicing Aesthetic Medicine is the difference of care that practitioners are offering to their patients. These patients are voluntary patients who do not suffer from any illness. They are usually happy and in excellent health. They simply want a quick fix or a preventative procedure against the aging effects of time.
This, along with the very lucrative business it represents, is the benefits any doctor should expect by expanding his/her own practice to an Aesthetic Practice.'s Head Reshaped With Fat From His StomachFeatured Article
Main Category: Cosmetic Medicine / Plastic Surgery
Article Date: 01 Mar 2012 - 0:00 PST

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Hang onto that belly fat, it may come in useful! In a UK first, surgeons at King's College Hospital in London, have taken fat from a man's stomach and injected it into his head to help reshape it. The patient had had some of his skull removed, and surgery to reconstruct a shattered eye socket, cheekbone, and leg, following injuries sustained when he fell while climbing up a drainpipe outside his house.

The patient is Tim Barter, a visual effects supervisor on the Dr Who television series. In June 2009, Barter, then 32, fell 25 ft (over 7.5 m) off a drainpipe onto a brick wall as he tried to gain entry into his house in Brixton, through an upstairs window. He had lost his keys the night before on a night out.

His neighbours found him a short while later, and he was taken by ambulance to the Major Trauma Centre at King's College Hospital.

Barter was in a coma for 10 days. When he woke up, he discovered he had a brain haemorrhage, a shattered eye socket, cheekbone, and a broken leg.

Barter says he does not remember the fall at all. He says he probably broke his leg when he fell onto a brick wall that temporarily broke his fall, and then must have landed on his face after he carried on falling.

Rob Bentley, a Craniofacial Surgeon at King's, told Barter that to ease the swelling in his brain from the haemorrhage, they had removed part of his skull.

Barter learned that he would also need further surgery to reconstruct his cheekbone, eye socket and leg.

In a statement released from King's this week, he says:

"My head felt really strange. I only had skin over where the skull had been removed so it was very soft to touch, particularly when the hair had started to grow back."

Barter was in hospital for several weeks, while he had titanium plates fitted to shape his shattered eye socket and hold the bone together. These were inserted through his mouth so as not to leave scars on his face.

He then went home, but couldn't go outside much: doctors told him to stay indoors to rest and repair. Barter was worried that he would not be able to work again.

"Life stopped for a number of months. I couldn't work and I had double vision. I was frightened that my eyesight would never go back to normal and that I would have to give up my job for good," he said.

Eventually, in December 2009, some six months after his fall, surgeons at King's fitted a titanium plate to replace the removed piece of skull in Barter's head.

Up until having the plate fitted, simple things like going to the toilet gave him intense headaches, explained Barter, "Bending down to do anything was agony," he said.

Experts at King's had made the plate from a mirror image of the other side of Barter's skull, modelled using computer technology.

Bentley, who is also Director of Trauma, said:

"Tim came to us with significant head and facial injuries and was treated here both in the initial phases and also for his secondary reconstruction."

He explained that Barter's case highlights an area of expertise that he has developed at King's over the last nine years, during which time they have inserted over 250 such prostheses with the lowest infection rates in the world.

Later, the surgeons then also took fat from Barter's stomach and injected it into his temple to fill a hole that had appeared when some inactive muscle collapsed.

This is the first time a patient has undergone such a procedure in the UK.

Bentley and his team at King's developed the new and unique cosmetic technique to restore the face after injury.

Since the surgery, Barter has completely changed his life. He is keeping fit (he sees a personal trainer four times a week), is improving his diet (he has consulted a nutritionist), has had his teeth reconstructed and his eyes lasered so he does not have to wear glasses.

And the trauma of the fall has not put him off heights: if anything it has given him a love of tough sports, including sky-diving, rock climbing, fencing and kayaking.

He says he is now "simply making the most of everything" and even loves the sensation of falling in the extreme sports he is practising, and jokes that the "split second" at the end is only "an occasional problem".

Bentley and his patient Barter, will be talking about the methods used at King's to repair Barter's injuries on BBC Breakfast at 08:10 am on Thursday 1 March. Statistics Show Clients Choosing Medical Spas Over Plastic Surgeons | | The latest statistics show 4 of the top 5 non-surgical procedures have actually dropped in 2007. Botox injections were down 12.8%, but sales of Botox Cosmetic were up 29% over the same period. Indicating people are going elsewhere for the top non-surgical procedures.Las Vegas, NV (PRWEB) March 4, 2008 -- The latest aesthetic industry statistics reveal that people are turning to physician-run practices or medical spas for their non-surgical procedures. According to an International Association for Physicians in Aesthetic Medicine (IAPAM) study, most women most feel that non-physician owned medical spas are unsafe. In addition, the IAPAM report also indicates that 78% of women rated medical credentials as very important when choosing an aesthetic treatment provider. Botox injection, which is the number one non-surgical procedure performed by plastic surgeons, was down 12.8% in 2007 according to the American Society for Aesthetic Plastic Surgery (ASAPS) industry statistics report. That report, however, only includes members of the ASAPS, and Allergan, the maker of Botox Cosmetic, showed a 29% increase in sales over the same period. In fact, four of the five top non-surgical procedures were all down between 4.2-16.5% from the previous year."It's quite obvious that non-surgical procedures are no longer the domain of the plastic surgeons," says Jeff Russell, executive-director of the International Association for Physicians in Aesthetic Medicine (IAPAM). "The statistics indicate the public is moving away from requiring plastic surgeons to do their Botox injections," continues Russell. "You are as likely to find a Botox brochure in your family physician’s office as a plastic surgeons."Another association, the International Medical Spa Association, says there are now over 2,500 medical spas, up significantly from 250 in 2004. This confirms that the ASAPS statistics show not a decline in procedures, but a shift from the procedures being done solely in plastic surgeons offices to now also being done in a medical spa or an aesthetic practice.Russell feels that this decline means the public is more accepting of non-plastic surgeons performing many of these procedures. Physicians with proper aesthetic medicine training are perfect candidates for filling the public’s desire for aesthetic medicine procedures like Botox and dermal filler injections, as well as laser and light based procedures."Aesthetic medicine continues to be a billon dollar industry fueled by over 11,000 people turning fifty every day," says Russell. "As long as physicians treat expanding their practices with aesthetic procedures as a business unit, they will do very well in this environment.""We're finding that many of our Aesthetic Medicine Symposium attendees are family physicians and OB/GYNs looking at targeting their existing patients for aesthetic procedures," says Russell. "The IAPAM feels that complete physician aesthetic medicine training is the most important part of a successful medical spa or aesthetic practice. Those physicians who thought all they needed was to attend a Botox training course, are finding themselves in very difficult times.”About the International Association for Physicians in Aesthetic Medicine (IAPAM)The International Association for Physicians in Aesthetic Medicine is a voluntary association of physicians and supporters that sets standards for the aesthetic medical profession. The goal of the association is to offer education, ethical standards, credentialing, and member benefits. IAPAM membership is open to licensed medical doctors (MDs) and doctors of osteopathic medicine (DOs). More information about the Symposium can be accessed through | aesthetics continues to grow Lipofilling on the rise and more combination treatments expected in 2012Despite the economic slowdown, the aesthetic medicine market is booming. Statistics compiled by associations and trade bodies show growth worldwide.

The IMCAS Industry Tribune 2012 predicts an annual growth of 11.2% for surgical and non-surgical treatments across Europe, USA, Pacific Asia and Latin America, reaching €5.4bn–€6.4bn by 2016. According to the tribune, Asia carries out 31% of all surgical procedures worldwide, followed by North America, Europe, Latin America and Africa.

The American Society of Plastic Surgeons (ASPS) estimates around 13.8 million surgical and non-surgical procedure were performed in the US in 2011.

ASPS president Dr Malcolm Roth: "While the rate of economic recovery in the US is still uncertain, 2011 proved to be a good year for plastic surgery." The top five procedures in the US were breast augmentation, nose reshaping, liposuction, blepharoplasty and facelift.

The society noted that facelifts have replaced tummy tucks in the top treatments, despite the rise of cheaper, non-surgical facial rejuvenation treatments. But Dr Roth attributes their popularity to a new generation of patients. “We are seeing notable increases in surgical procedures such as facelifts that reflect the demands of an ageing boomer population. However, the overall growth of cosmetic procedures is being primarily driven by a substantial rise in minimally invasive procedures,” he says.

And substantial is right. Compared with 1.6 million surgical procedures, nearly 12.2 million cosmetically minimally invasive procedures were carried out in the US last year. Botulinum toxin type A treatment topped the list at 5.7 million, followed by soft tissue fillers and chemical peels. Fat injections rose by 19% on the previous year, with 68,000 treatments.

The 2012 BAAPS UK audit included fat transfer procedures for the first time. Fat injections, or transferring autologous fat to volumise other areas, rose by 5% for both men and women. Data released by the International Society of Aesthetic Plastic Surgeons (ISAPS) reports lipofilling as the third most popular non-invasive procedure worldwide—topped only by botulinum toxin and hyaluronic acid.

Lipofilling is increasingly being touted as the natural alternative to dermal fillers for facial volumisation. Fat is harvested from the thighs or stomach during liposuction, providing a two-for-one treatment, understandably popular among consumers. But controversy has surrounded its use in breast augmentation. Critics say longer-term results—five to 10 years’ worth of data—are needed before the technique can be deemed safe for use in cosmetic surgery, showing there is no increased risk of breast cancer.

The BAAPS survey shows surgical procedures by BAAPS members increased by 5.8% from 2010 to 43,069. The order of popularity stayed the same. The top five across the UK are breast augmentation, blepharoplasty, breast reduction, face/neck lift, and rhinoplasty.

Male treatments

The American Society of Aesthetic Plastic Surgeons (ASAPS) last year reported that in 2010, over 750,000 men underwent surgical and non-surgical procedures—an increase of 88% since 1997. In the UK, men underwent 10% of all cosmetic procedures last year. Most were concerned about fixing the appearance of their nose, followed by breast reduction (gynaecomasty), blepharoplasty, ear correction (otoplasty) and liposuction.

Demand for male abdominoplasty increased by 15% over the last 12 months. BAAPS notes that a 2011 rise in abdominoplasty and liposuction may result from a rise in obesity surgery, such as gastric bands, which leave patients with excess, loose skin. Bodycraft Weight Loss, a London-based provider of bariatric surgery, has had to expand to meet increasing demand—two new clinics have been opened in London and the company has seen 20% more interest in 2012.

According to IMCAS research, trends in 2011 included more natural results and localised, less-invasive surgical lifting with shorter scars.

With demand for injectable treatments at an all-time high, innovative, non-invasive therapies are expected to be introduced during 2012. And as more technology platforms are introduced, the use of combination treatments is predicted to increase, particularly to maintain results from surgery.WHAT IS A STEM CELL? | Stem cells may originate from the embryo or in adult form can be found in umbilical cord blood, adipose (fat tissue), blood and niches in organs. Stem cells have the ability for self renewal and replication. They also are capable of forming any type of tissue or organ in the body. Embryonic stem cells originate from the inner mass blastocyst. They are pluripotent and capable of forming any organ in the body. | | | Adult stem cells from the blood, bone marrow, brain, eye, muscle, gastrointestinal tract, pancreas, liver, skin form progenitor cells that can differentiate and form specific tissues.Adult stem cells from one organ are capable of forming tissue from another organ , a condition which is called plasticity. Adult stem cells derived from adipose tissue or umbilical cord blood have the capacity to form many types of differentiated cells such as neuron stem cells, pancreatic stem cells, cardiomyocytes, blood and bone cells.Research done in animal models and clinical trials on humans show that stem cells are capable in differentiating into specific tissue such as heart muscle, pancreatic islets that produce insulin, neurons that would be capable of transplantation into patients that have damaged organs.Adult stem cells are capable of being transferred into any one single organ of the body. Stem cells from the bone marrow form hematopoietic cells which produce blood ,immunological cells, neurons, oligodendrocytes, astrocytes (brain cells), liver and stromal cells that form heart, skeletal muscle fat, cartilage and bone. Umbilical cord blood is also a source of stem cells capable of differentiating into many different organ tissues. Isolating adult stem cells from the bone marrow and umbilical cord blood require special laboratory techniques to isolate them and expand their numbers in culture. Various agents are used to take the stem cells and differentiate them into specialized tissues.The methods of isolating these stem cells; differentiating them and then using transplantation methods into the blood stream or directly into the damaged organs is an ever growing field of research. | Cell Research Shows Applications in Aesthetics and MedicineFriday, February 18, 2011 4:51 PMResearchers are finding that stem cells show promise in helping with wound healing and fat transfer integration. Physicians and medical experts are predicting that stem cells will be the next revolution in medicine. Doctors are just now starting to understand where stem cells will help and how to use them to their full potential. Some patients are even saving their stem cells now for use in the future when we have a better grasp on the technology. "Now that we've had this year of using stem cells in our patients effectively, we're starting to see that the potential is far greater than what we even anticipated," said Dr. Todd Malan, a cosmetic surgeon from Scottsdale, AZ. "The potential for getting really nice healing effects and reducing inflammation after surgery is huge. Using stem cells to treat wounds and injuries, surgical scars - not just for fat transfer - and all of the exciting information that’s coming out in using stem cells for non-cosmetic applications is very exciting." Dr. Malan says that research is being done to see how stem cells can be helpful in many non-cosmetic areas such as chronic heart disease, cancer, liver failure, etc. "I see that in the near future, we're going to be counseling our patients that have liposuction that you want to store your fat. You want to be able to have that fat later on in life in case you need it for these diseases." Stem cells are making a significant mark in the cosmetic world as well, most popularly in fat transfer procedures where fat is removed from one part of the body and injected into another to add volume. Many physicians are claiming to perform a "stem cell facelift" meaning that since there are stem cells in fat, when the fat is injected into the face, you're getting a stem cell facelift. Some physicians are offering a stem cell enhanced facelift procedure in which they remove fat from a patient and process it to condense and separate the stem cells. The fat cells from which the stem cells were extracted is no longer viable and must be discarded. The physician can inject those stem cells directly, but most mix them with another vial of still viable fat prior to injection. Then it can be said that the fat transfer was enhanced by stem cells. "Stem cell facelifts are now popular here in the US because it's not just a filling effect; it's a tissue rejuvenation where we actually promote new collagen formation in healing of the tissue," says Dr. Malan A popular use of fat transfer is in breast augmentation, but the terms natural breast augmentation and stem cell breast augmentation can be confusing for patients. As Dr. Malan explains, "Many physicians use the term 'Natural Breast Augmentation' because they're transferring fat in lieu of using an implant or filling fat. A stem cell breast augmentation is where you actually take fat and enrich it with stem cells from a different batch of fat and that’s what you inject into the breast for improved survival." Adding the stem cells to the fat improves the fat's integration back into the injected area. The stem cells aid in the development of blood supply for the new fat cells and more survive the grafting process. They're being used in many applications, including vaginal rejuvenation and buttock augmentation. Dr. Malan says, "Using the stem cells, we're actually able to rejuvenate that tissue to grow new blood supply to improve the results. It helps the body replace this fibrous or bad scar tissue with healthy tissue so that we see much better results."Brazilian Butt Lift: Adding Shape And Volume With Your Own FatFriday, March 02, 2012 2:49 PMFor ages, the question of moving unwanted fat to a more desirable location has been asked by women everywhere. With the Brazilian Butt Lift, which relies on fat transfer, this is now a possibility. For years, breast augmentation has been the most popular body enhancement procedure amongst women. However, a rising trend that has emerged that adds volume below the waist, to the buttocks. Buttock augmentation has been available for quite some time but it is only in recent years that advances in the fat transfer process has made augmenting the derriere a rising star.
Model PhotoAlso known as a Brazilian Butt Lift, this form of buttock augmentation uses fat from the patient to add volume to the buttocks. The best of both worlds, patients benefit by getting rid of unwanted fat from an undesirable area and fuller and shapelier buttocks. According to Dr. Robert Burke, who perfoms Brazilian Butt Lifts in Michigan, "In just the past few years, one of the most common procedures women ask for is buttock augmentation to treat sagging or a lack of fullness in the rear. This trend has been preset by celebrities such as J-Lo or Kim Kardashian, whose posterior curves are renowned and women want to look like that." At his Michigan practice, The Michigan Center for Cosmetic Surgery, Dr. Burke says this is a large subset of patients who never would have come in for cosmetic enhancement but the Brazilian Butt Lift offers them a return two-fold. As women grow older, unwanted fat may accumulate that is stubborn to any form of diet and exercise. Or after bearing children, fat may have redistributed to other areas. Regardless, the Brazilian Butt Lift offers patients a way to get rid of unwanted fat and reusing it in a more desirable location. "Patients want their buttocks area to look better - they want it to look younger, be lifted and they want the skin to be smooth. They are showing more skin than ever but they also want to look and feel good in clothes and this procedure achieves that," states Dr. Burke. In addition to adding volume and shape to the buttocks, Dr. Burke says many of his patients are also seeking cellulite reduction. "Currently, there are several ways to temporarily mask the appearance of cellulite. This means patients have to continually return for treatments because the treatment is not long lasting. If the patient has severe cellulite, since there are different degrees of cellulite, these treatment may not help at all," states Dr. Burke, "When we perform the Brazilian Butt Lift, we often do it in conjunction with what I have found to be the best treatment for cellulite so far, a surgical option to reducing the appearance of cellulite. We actually separate the fibrous bands beneath the skin that are responsible for the lumpy bumpy appearance of cellulite." Which is why Dr. Burke is also interested in the newest FDA approved cellulite reduction device Cellulaze. "This is a laser treatment with a side firing laser fiber that is placed within the sub-cutaneous area where it may treat cellulite at the source by breaking up the connective tissues beneath the skin," explains Dr. Burke, "This device is promising but if further results and studies show results, it would be an ideal addition to the Brazilian Butt Lift." During the Brazilian Butt Lift, fat is removed through a liposuction method that preserves the fat cells rather than destroying them. "Previously, fat transfers required multiple attempts due to unsuccessful grafts, in most cases due to fat not surviving in the recipient site. With advances in technology, fat survival rates have increased - cutting down the number of attempts to just one procedure," explains Dr. Burke, "In addition, the manner of fat removal plays a key role. We use a special filter during liposuction that filters out all the fluids and tissue and leaves more intact fat cells. We also turn the suction on the liposuction device down, which slows down the process but increases the viability of the fat cells."
Actual Before and After Brazilian Butt Lift Results by Dr. Robert BurkePure fat is then extracted and placed in syringes to be injected into the buttocks. "After the fact cells are removed, we process them and add Platelet Rich Plasma (PRP) from the patient, which is found in the patient's blood. The plasma ingredients includes platelet derived growth factors that actually help cells to live in the new site," states Dr. Burke. Since the fat may be injected in several locations, the physician has the capability to precisely shape the buttocks verses simply adding an implant, as traditional buttock augmentation required. "Using the Microdroplet technique, we make tiny incisions that are hidden in the gluteal folds and inject the harvested fat in many different directions to add volume and shape the buttocks," describes Dr. Burke.
Actual Before and After Brazilian Butt Lift Results by Dr. Robert BurkeThere are several benefits that the Brazilian Butt Lift has in comparison to traditional Buttock Augmentation, including downtime. "Interestingly enough, many people are under the misconception that they can sit down for several weeks after a Brazilian Butt Lift but contrary to popular belief patients can sit down immediately," says Dr. Burke, "Most of the augmentation is performed in the upper part of the gluteal area and what you sit on is called your ischial tuberosity, or your sitting bones. As long as patients don’t place pressure on the area which has been augmented, they can sit right away. Most of our patients recover in our out-patient suite and then they go home." While the media has been a buzz with injections of other substances to add volume to the buttocks, Dr. Burke says there really aren't any other volumizing agents that rival the fat retrieved from the patient. "It would be nice if there was a butt injection that we could use to fill in a small area, much like how we use facial fillers but frankly, there aren't any good butt injections that have been developed that will provide enough volume other than using your own material, your own fat." Cells--Aesthetic Miracle? Have you seen advertisements that “stem cells” are used in all kinds of aesthetic procedures, such as breast augmentation, face lifts and wrinkle treatments? Before we all jump on the bandwagon, I’d like to share some cautionary information—not to put a damper on the exciting potential of stem cell usage, but to balance the excitement with some facts.First, what are stem cells?Stem cells are “undifferentiated” cells. That means that they have the potential to become any other cell type, such as skin cells, muscle cells, bone cells—you get the idea. Where do stem cells come from?So far, stem cells have come from one of two sources: · Embryos · AdultsEmbryonic Stem Cells:Embryonic stem cells come from labs that create embryos for in vitro fertilization. Multiple embryos are created, but only one embryo is inserted during each in-vitro cycle. What to do with the others? Throw them away? Keep them? Use them for research? There’s been an ongoing ethical debate with persuasive opinions on all sides. Fortunately, we have another source now: adult stem cells. Adult Stem Cells:After we’re born, we retain stem cells in the tissues of our brains, liver, blood & blood vessels, skeletal muscles, skin and liver. These stem cells are your body’s National Guard. They show up when you need them, but otherwise, they wait. If they are “activated” by disease or injury, they divide and conquer. For example, if you cut your finger while chopping onions, your stem cells get a message to get busy and repair the tissue and skin that was damaged. Originally, scientists thought that stem cells from the liver would only make liver cells and stem cells in bones would only make bone cells, etc, but recent studies show that most stem cells can “differentiate” to make other cell types. This is great news because everybody has stem cells, compared with the limited availability of embryonic cells, not to mention the ethical debate about using embryonic stem cells. Stem Cell Usage in Aesthetic MedicineThere are ads all over the Internet, in magazines and newspapers and on radio & TV that you can get larger breasts through stem-cell injections instead of a breast implant; that it lasts a lifetime, is less expensive and has an easy recovery. Some doctors and centers advertise that they can plump your lips or fill your wrinkles with stem cell enriched fat instead of fillers and that it’s permanent, ie, you’ll never need to come back for a refill like you do with Juvederm. Sounds great! So what’s the problem?This is the problem: the marketing of stem cell treatments is way ahead of the proven safety of stem cell treatments. That creates risk for everyone who is exposed to their use before safety has been absolutely proven. Remember what I said about stem cells’ ability to become other types of cells? Can injected stem cells become cancer cells? Can they can create a new disease? Nobody is certain yet. Scientific studies are performed over the course of several years and the scientific community simply hasn’t had those years of study to be absolutely certain whether there are side-effects of stem cell injections and if so, what those side effects might be. Adult Stem Cells–A Coming Revolution?Research on adult stem cells is generating an increasing amount of attention these days. Scientists have found adult stem cells in many more types of tissues than they once thought possible. Certain adult stem cells have the ability to differentiate into several cell types, given the right conditions. If differentiation of adult stem cells can be controlled in the laboratory, these cells may become the basis of therapies for many serious injuries and diseases. Jeremy Mao, DDS, PhD, associate professor of dental medicine at Columbia University Medical Center (New York City), and his colleagues have received a $2.5 million grant from the National Institute of Biomedical Imaging and Bioengineering (in the National Institutes of Health) to use stem cells to engineer soft tissue and develop a process that may ultimately allow scientists to use a patient's own stem cells to generate tissue for facial reconstruction following disfigurement from war, cancer surgery, or accidents. "Stem cells may be of benefit in facial reconstruction by either triggering damaged tissue to repair itself or by actually differentiating into the likeness of the tissue that needs to be regenerated," says Gary Motykie, MD, a plastic surgeon in Los Angeles. "It is consistently observed that transplanted fat does not feel like isolated collections of fat but rather more like the recipient-site tissue into which it has been transplanted." Currently, surgeons graft from the patient's own tissue, which creates additional wounds. Grafted cells also fail to stay alive, causing implants to shrink up to 70% and lose their volume. Attempts have been made to use fat cells left over after liposuction, but those cells have a limited life span, according to Mao. In the study, Mao and his team showed that human adult stem cells can create long-lasting implants in mice. The implant is created by placing the stem cells into an FDA-approved scaffold that mimics the conditions needed to turn stem cells into fat cells. Because stem cells have the ability to replicate, they can regenerate the soft tissue, keeping the implant from shrinking. In mice, these cells have successfully created fat cells that could be implanted, and they retained their size and shape for at least 1 month. "Although their true role in tissue regeneration still needs to be further studied, the role of stem cells in facial reconstruction may involve them being injected alone or integrated into facial porous implants," Motykie says. According to Mao, the implants can be molded and therefore may also be used for breast reconstruction—a potentially safer alternative to silicone or saline implants that can rupture and interfere with the detection of recurring cancer. | This 16-year-old was diagnosed with a rhabdomyosarcoma of the right orbit in infancy and received radiation therapy, which severely affected his right-side facial growth. He was treated with 100 mL of fat, which was harvested from his abdomen and injected in his face. The patient is shown 1 month after the procedure and, although the clinical result is excellent, at 6 months about 50% of the fat was resorbed and the patient was retreated. |
Fat In, Fat OutResearchers at Georgetown University Medical Center (Washington, DC) report that they may have discovered a natural way to fill in crows' feet and get rid of unwanted fat in the thigh and abdominal areas by injecting neuropeptide Y (NPY), a chemical that is found in the body. They also report that blocking the NPY receptor (Y2R) can prevent the development of fat, which can revolutionize plastic surgery and the treatment of diseases that are associated with obesity. "In the case of the neuropeptide Y blocker, having the ability to safely and predictably target and eliminate adipose deposits would be the ‘smart bomb' of cosmetic surgery," says Joseph P. Niamtu III, DMD, a cosmetic surgeon in Richmond, Va. "The implications of these are amazing and could possibly take the literally mechanical mechanism of liposuction out of the equation—which sounds too good to be true." According to Niamtu, the bane of aesthetics and reconstructive surgery is that there always seems to be too much or too little fat, and usually the opposite of what you want or need. The ability to create fat in the face and neck may solve the aesthetic filler situation as a truly natural, autogenous, permanent facial filler. Most patients would opt for their own tissue if it were a permanent solution and if it were predictable. In the study, researchers led by Zofia Zukowska, MD, PhD, professor and chair of the department pf physiology and biophysics at Georgetown University, injected NPY into a specific area of the body of laboratory mice. They found that NPY and Y2R are activated during stress, leading to apple–shape obesity and metabolic syndrome. The weight gain and metabolic syndrome, however, were prevented by administering Y2R blocker into the abdominal fat. | See also "Adipose Stem Cells" by Richard Ellenbogen, MD, FACS, FICS, and Gary Motykie, MD, in the December 2006 issue of PSP. |
The researchers report that this is the first study to show that stress has a direct effect on fat accumulation, body weight, and metabolism. Blocking Y2R resulted in local elimination of adipose tissue. According to Zukowska, the ability to add fat as a graft can be useful for facial rejuvenation, breast surgery, buttock and lip enhancement, and facial reconstruction. Using injections like the ones tested in the study could also make fat grafts predictable, inexpensive, biocompatible, and permanent. "Like all futuristic ideation, one must temper the dream with reality and first provide evidenced-based proof that this new technology can in fact work safely and predictably," Niamtu says. "Just to think about it is exciting. Surgeons live in a world of fat in most every discipline, and the ability to control it would change history and medicine." and ASPS Issue Joint Position Statement on Stem Cells and Fat Grafting Stem cells in aesthetic surgery promising, but marketing claims are too far ahead of the science * ShareThis Email PDF Print While we remain enthusiastic about the future potential of stem cell therapies in aesthetic surgical procedures, unsubstantiated claims for such therapies will harm patients and tarnish the reputation of the industry. Boston, MA (PRWEB) May 09, 2011 A joint task force of the two leading plastic surgery associations, the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS), today released a position statement on the use of stem cells in aesthetic surgery during The Aesthetic Meeting 2011, the annual meeting of ASAPS. Based on a systematic review of the peer-reviewed literature, the task force concluded that while there is tremendous potential for the future use of stem cells in aesthetic surgical procedures, the scientific evidence and other data are very limited in terms of assessing the safety or efficacy of stem cell therapies in aesthetic medicine. The task force, led by plastic surgeon and noted expert on fat-derived stem cells, J. Peter Rubin, MD, of the University of Pittsburgh, was convened to address the growing concerns emerging from the plastic surgery community over advertising claims and clinical practices using stem cells that have not been substantiated by scientific evidence.“There are encouraging data from laboratory and clinical studies to suggest that the use of adult stem cells is a very promising field,” said Dr. Rubin, “but as our comprehensive review of the current scientific literature shows, the data available today do not substantiate the marketing claims being made to patients seeking aesthetic surgery and aesthetic medical treatments.”Based on the current state of knowledge, the task force made the following recommendations to ASAPS/ASPS members and their patients: * Terms such as "stem cell therapy" or “stem cell procedure” should be reserved to describe those treatments or techniques where the collection, concentration, manipulation, and therapeutic action of the stem cells is the primary goal, rather than a passive result, of the treatment. For example, standard fat grafting procedures that do transfer some stem cells naturally present within the tissue should be described as fat grafting procedures, not stem cell procedures. * The marketing and promotion of stem cell procedures in aesthetic surgery is not adequately supported by clinical evidence at this time. * 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. Until further evidence is available, stem cell therapies in aesthetic and reconstructive surgery should be conducted within clinical studies under Institutional Review Board approval, including compliance with all guidelines for human medical studies. * The collection and reporting of data on outcomes and safety by any physician performing stem cell therapies is strongly encouraged in order to advance the knowledge and science of stem cells. * Stem cell based procedures should be performed in compliance with FDA regulatory guidelines. If devices are employed that are subject to regulation by the FDA, surgeons should use these devices with appropriate approval in place, especially when used for investigational purposes. * Patients are advised to seek consultation for aesthetic procedures by a surgeon certified by the American Board of Plastic Surgery. These physicians are able to properly evaluate a patient's concerns and offer a wide range of safe solutions. Extreme caution should be exercised when a physician is promising results from any treatment that sound too good to be true.“While we remain enthusiastic about the future potential of stem cell therapies in aesthetic surgical procedures, unsubstantiated claims for such therapies will harm patients and tarnish the reputation of the industry,” said Felmont F. Eaves III, MD, ASAPS President. “This joint position statement will provide guidance for our members, the public and the media.”“This systematic review brings into sharp focus the fact that the marketing for stem cell therapies in aesthetic surgery is pushing far ahead of the current science," added Phil Haeck, MD, ASPS President. “Understandably, there is considerable public enthusiasm over the potential for stem cell treatments in plastic surgery. However, we need to keep our patients’ best interests in mind, which means being committed to supporting evidence-based medicine, not unsubstantiated claims. We eagerly await the evidence showing that stem cells treatments are safe and effective in this field.” Stem Cell Faceliftby Connie Jennings Richard Ellenbogen, MD, FACS, FICS, discusses the revolution taking place in rejuvenation techniquesAdult stem cells are found in large quantities in fat cells and act a repairman of sorts. They assist in replenishing specialized cells, such as those lost within the face in the normal process of aging, as well as maintain a normal "turnover" of regenerative organs, such as blood or skin.Due to these properties, stem cells can be valuable "tools" for plastic surgeons and their patients.Possible applications include rejuvenation of the skin or recreation of a youthful appearance in a patient's complexion without the need for chemical or laser treatments—a definite plus. A cell that will maintain its shape or form long-term, and in fact continue to "graft" with time to an area that has lost either volume or turgor, is another plus.It is amazing to consider the possibilities now available for facial reconstruction using stem cells harvested from the patient's own body. The client is both donor and recipient, so there is no "rejection" of the tissues or cells, and the result is obviously very natural.Another point of interest: The stem cells are harvested via liposuction.There is no complicated procedure for gathering them up or separating them out. It is a matter of simply "spinning them down" after the liposuction, then reinserting then into the desired areas.The advances made in plastic surgery techniques using stem cells are perhaps best stated by Richard Ellenbogen, MD, FACS, FICS. Ellenbogen is widely recognized for his work in using stem cells present in liposuctioned fat for a procedure known as the Stem Cell Facelift.Considered by many to be the "father of fat grafting," Ellenbogen is a two-time recipient of the American Medical Association Physician's Recognition Award, a member of the American Society of Plastic Surgery, the American Aesthetic Plastic Surgery Society, a Fellow of the American College of Surgeons, and a Fellow of the International College of Surgeons.""The latest developments in adipose stem cell research were not discovered in a Petri dish or in a lab," he says. "Instead, this promising revolution in medicine was inspired via unexpected benefits resulting from facial fat grafting. In fact, it was and is consistently observed that the transplanted fat did not feel like isolated collections of fat, but remarkably, rather more like the recipient-site tissue into which it had been transplanted."Ellenbogen began his career more than 30 years ago. After attending the University of Florida, where he excelled in both art and premed classes, he obtained his medical degree from the University of Miami. He went on to complete his general surgery training in New York City, where his interest in corrective surgery grew. He traveled to The Hague, Netherlands, where he served as a fellow to the Red Cross Hospital, giving assistance to children with birth defects.Upon returning to the United States, Ellenbogen moved to Los Angeles and became board certified in plastic surgery. His Beverly Hills practice opened in 1980.Ellenbogen also has some experience as a portrait artist, which explains his frequent references to the importance of being able to sculpt and shape the face. Currently, he is a clinical instructor of plastic surgery at the University of Southern California.PSP: How do the risks and benefits of the stem cell facelift compare to those of a traditional facelift?Ellenbogen: There are no increased risks of stem cell facelift versus traditional. There are, however, a significant number of benefits—both short- and long-term—to the stem cell facelift.Injecting the liposuctioned fat, rich with stem cells, into the subcutaneous area requires no lifting of the SMAS (superficial musculoaponeurotic system), but has the same effect as stitching with a traditional facelift. In superficial areas of the cheek, fat grafting is done for symmetry.Additional injections can be made into the nasolabial folds and, when injected underneath the eyes they can obviate the need to perform blepharoplasty. It allows for much contouring of the cheeks and under the eyes, as well as under the temporalis muscle.The "take" of the fat and stem cells is excellent, and there are the added benefits, previously mentioned—of improved pigmentation, closer pores, and a better overall complexion. Because the stem cells are easily accepted, they act as a rejuvenator to the tissues already there. This results in skin with an overall younger tighter appearance. The benefits are excellent both long- and short-term and very rarely need touch-ups.PSP: What about adverse effects or risk of rejecting the cells?Ellenbogen: There really aren't any issues with rejection. The most common adverse effect would be the potential for "lumpy" areas, subcutaneously, at the injection sites. However, this can be avoided by carefully applied pressure to the areas of injection. We can sculpt/shape the tissue quite vigorously after injection. Again, it allows for a much more natural appearance of the skin through the contouring and shaping of the cells injected.PSP: Is the cost of a Stem Cell Facelift comparable to that of a traditional facelift, despite the need for the additional lipo procedure?Ellenbogen: The cost is no more than a traditional facelift. The advantage is that with the Stem Cell Facelift, it includes a general tightening of the skin, better overall condition of the skin, and it is a process where we create a different contour and shape of the face. We can give the effect of high cheekbones and blepharoplasty with the fat/stem cell grafting.Stem Cells as Promising Future Tissue Fillerby Mark Attala, MBBS Literature review and commentary on adipose-derived stem cells in aesthetic applicationsStem cells have received significant attention as an ideal source of regenerative-capable cells because of their multipotentiality and ability to replicate. Furthermore, stem cells have been used in a limited fashion for decades with great clinical success. This article reviews some of the recent literature about stem cells and their use as a promising filler, and will discuss potentials and limitations.The literature regarding stem cells were reviewed and summarized to include reported indications for use of stem cells as a filler, either a single agent or in combination with hyaluronic acid gel or acellular dermal matrix. We will briefly use the fat graft model and discuss its limitations compared with stem cells.EMBRYONIC STEM CELLSEmbryonic stem cells are derived from the inner cell mass of the blastocyst and have the capacity to differentiate into all tissues of the body.1 Both mouse and human embryonic stem cells have demonstrated an in vitro capacity to form cardiomyocytes, hematopoietic progenitors, neurons, skeletal myocytes, adipocytes, osteocytes, chondrocytes, endothelial cells, and pancreatic islet cells when cultured under specific growth factor conditions.2,3Multiple limitations, however, currently exist regarding the use of human embryonic stem cells in regenerative medicine. This includes unregulated differentiation and formation of teratomas and teratocarcinomas, especially in undifferentiated states and the potential immune response to an embryonic stem cell-derived tissue graft. Concerns have been raised over the acquisition of immunogenic residues secondary to culture on mouse feeder cells.4Somatic nuclear cell transfer, also referred to as therapeutic cloning, involves the transfer of nuclei from postnatal somatic cells into an enucleated ovum. Mitotic divisions of this cell in culture lead to the generation of a blastocyst capable of yielding a whole new organism.5A 51-year-old female patient before (top) and after 6 months of fat grafting to the face (bottom).ADULT STEM CELLSIn contrast with embryonic-derived tissues, adult stem cell sources avoid the ethical concerns regarding fetal tissue harvesting for tissue-engineering purposes. For tissue-engineering purposes, a well-studied adult stem cell population includes mesenchymal stem cells. Mesenchymal stem cells have been isolated from bone marrow, umbilical cord blood, and adipose tissue. The tissue origin of mesenchymal stem cells seems to be a major determinant of progenitor characteristics. Adipose tissue-derived stem cells, in particular, fulfill several requirements proposed for successful clinical use in regenerative applications6: They can be readily harvested during a minor liposuction procedure under local anesthesia, and they have been successfully used in regenerative applications in numerous animal models. During this procedure, they demonstrated the capacity to differentiate into cartilage, bone, muscle, and adipose tissue. TISSUE-SPECIFIC STEM CELLSIn addition to embryonic stem cells and mesenchymal stem cells, tissue-specific "resident" stem cells have been identified in almost all postnatal tissues and organs.7 They are capable of both self-renewal and differentiation throughout an individual's life span and utilize both mechanisms to maintain a steady state and regenerate injured tissue.8Stem Cells as FillersFor years, both physicians and scientists have been searching for the perfect tissue filler—one that can be injected into different body areas and tissue planes, can survive in ischaemic tissues, and produces a long-lasting reproducible augmentation, without the drawbacks of current technology.A 37-year-old patient before (top) and 8 months after fat grafting to the midface and an upper-lip lift (bottom).Autologous fat grafting technique suffers from the drawbacks of donor-site morbidity and, more importantly, significant resorption of the grafted fat. Adipose tissue engineering using adult human stem cells has been found to overcome the shortcomings of autologous fat grafting in reconstructing facial defects. Mesenchymal stem cells that can self-renew and differentiate into mature adipocytes have been used to generate adipose tissue through both in vitro and in vivo cell-transplantation studies.11Neuber was the first to publish findings regarding the use of autologous fat transplantation in 1893. He filled scars with autologous fat and found a reduction of transplant resorption by decreasing graft particle size.12 Unfortunately, despite more than 100 years of clinical use since then, little has been developed to improve free fat graft performance, and clinical experience has been lackluster.13,14 Specifically, the clinical longevity of the graft is highly variable and the volume of large grafts in particular decreases significantly over time. Histologically, progressive loss of transplanted adipocytes is noted along with a conversion of the graft to fibrous tissue, oftentimes with cyst formation. The presumed mechanism of tissue loss appears to be primarily insufficient vascularity and cell death. However, scientific confirmation of this as the only mechanism involved is limited. Other mechanisms—such as mechanical disruption of cells, lipid-induced membrane damage, apoptosis, or perhaps other potential mechanisms—are possible but have not been well studied.15 It has been suggested that the augmentation effect of fat grafting is attributed to an active role and differentiation of adult mesenchymal stem cells from the stromal fraction of the transplant.16,17,18,19ADIPOSE STEM CELL-DERIVED AGENTSIn this article, the author has reviewed recent studies that have demonstrated the use of adult stem cells as a single agent or in combination with other filler materials. In one study, Yoshimura and colleagues treated 23 patients with either demonstrable soft-tissue defects or breast augmentation using stem cell-supplemented fat transplantation for soft-tissue fill. This data has been presented in both the United States and Japan. It suggests that this approach may be feasible and effective.20 Despite the promising results of the trial, the final determination of the success and potential complications must be predicated on the complete study and its peer-reviewed evaluation.In animal studies and trials undertaken to improve the results outcome, adipose-derived stem cells (autologous) were injected in combination with non-animal stabilized hyaluronic acid to improve graft vascularization and survival. Acellular dermal matrix was injected to improve the graft durability and Alginate powder mass transfer, thus allowing for subcutaneous injection and protecting cells from shearing forces. A 42-year-old patient before (top) and 12 months after fat grafting to the midface (bottom).Non-animal stabilized hyaluronic acid and adipose tissue-derived stem cells hold promise as a tool to achieve lasting volume fill in reconstructive surgical soft-tissue augmentation.21 In the proposed combination, the gel functions as a temporary scaffold, providing structural stability to the cells. The combination of the filler with the autologous cells could improve the clinical outcome, preventing migration and resorption of the fat graft in this challenging host area of great mobility. While the synthetic matrix is slowly resorbed, differentiating or existing adipose-derived stem cells can synthesize new extracellular matrix and reorganize the matrix into the mature form found in fat.22In a comparative study, one group was injected with mesenchymal stem cells and hyaluronic acid while the second and third group was injected with acellular dermal matrix (ADM) and hyaluronic acid, respectively.In the first group, the mesenchymal stem cells, when combined with hyaluronic acid, were able to fill in deep folds with progressive improvement of skin tone and decreasing lines of expression more than the second and third group, where either hyaluronic or mesenchymal stem cells were injected as a single agent. When combined with hyaluronic acid, mesenchymal stem cells were able to fill in deep folds, with progressive improvement of skin tone and decreasing lines of expression.23,24To obtain more durable soft-tissue filler, ADM was seeded with adipose-derived stem cells in one study where histologic analysis showed that adipose-derived stem cells were successfully seeded onto ADM. The thickness of the implanted material and the vascular density were highest 8 weeks postoperatively.25For maximizing and facilitating adipose-derived stem cells, mass transfer is undertaken, ultimately allowing for subcutaneous injection to protect cells from shearing forces. Alongside this process, Alginate powder was dissolved in saline, and adipose-derived stem cells were encapsulated (1 million cells/mL) in alginate using an electrostatic bead generator. The study shows that adipose-derived stem cells can be readily cultured, encapsulated, and injected in alginate microspheres. Stem cells suspended in alginate microspheres survive in vivo and are seen to replicate in vitro.26CONCLUSIONStem cell technology has flourished as an exciting field, encompassing almost every organ and tissue system. Current concepts of stem cell biology have provided much insight into the physiological and pathological states of tissue regeneration. These previous reports and early clinical series show that adipose-derived stem cells offer the possibility of providing durable and autologous filler without the drawbacks of current technology.Most of the reviewed studies are animal studies, and it is still too early to claim adipose-derived stem cells as the perfect tissue filler. Longer-term studies will allow greater understanding whether adipose-derived stem cells have the potential for a clinically relevant benefit in soft-tissue augmentation.According to a recent study published in the official medical journal of the American Society of Plastic Surgeons (ASPS), cosmetic surgery procedures are predicted to exceed 55 million annually by the year 2015.However, it is often forgotten that a significant portion of these cosmetic surgeries are for reconstructive purposes; to improve the functionality of physical abnormalities and help restore them to a more normal appearance. Despite modern medicine, most of these reconstructive procedures are still rather primitive in nature. They still require invasive cutting and lengthy recoveries. For a one year old infant undergoing cleft chin plastic surgery, this can be especially detrimental. Fortunately, stem cell technology may some day revolutionize procedures such as these.What are stem cells?
As you probably already know, stem cells are a type of cell which has the unique ability to develop into various types of tissue – muscle, skin, nerve, brain, etc. In other words, their cell type has not been pre-determined (as is the case with the other cells in your body). While it’s true there is ethical and moral controversy surrounding human embryonic stem cells, fortunately scientists have discovered other sources for obtaining them. For example, umbilical cord blood is extremely rich in stem cells; this can be harvested during birth without affecting the baby. There are also a variety of other stem cell sources which do not involve the use of human embryos.How will stem cells be used in plastic surgery?
The possibilities are endless, but let’s take a look at a few of the ways researchers believe they will someday be incorporated in both cosmetic and reconstructive plastic surgery:ReconstructiveScar Revision Surgery: This procedure has remained largely unchanged over the past several decades. Basically, it involves a plastic surgeon cutting out scar tissue and suturing the skin back together, in hopes that it will be more aesthetically pleasing after healing. Unfortunately, the effectiveness of scar revision is extremely limited. By using stem cells, doctors may be able to actually re-grow skin which has been damaged. This will be especially helpful for burn victims.Cleft Palate Surgery: A cleft palate is a congenital abnormality where the two plates that form the roof of the mouth are not fused together. This results in an open gap between the nasopharynx and the nose. In order to correct this abnormality, plastic surgeons must remove tissue from one or both sides of the mouth in order to rebuild the palate. Sometimes multiple surgeries are required. Scientists believe stem cells may offer an alternative; they will be used to grow the appropriate tissue to fill in the gap.CosmeticBreast Implants: Instead of using plastic bags filled with saline or silicone, eventually it might be possible to actually grow new breast tissue through the use of stem cells. Breast augmentation is typically considered a cosmetic procedure, but that’s not always the case. We receive a high percentage of posters on our breast implant forum whom are inquiring about reconstructing their breasts following a mastectomy.Jaw, Chin, and Cheek Implants: Today’s facial implants consist of hard silicone which is shaped to fit over the bone’s natural contours. Being that these implants are made out of a foreign substance, it’s not uncommon for the body to reject them. The other drawback is that jaw and cheek implants rarely look natural. In the future, cheek implants may be replaced with natural cheek augmentation using stem cells instead.Rhinoplasty: This is largely considered to be the most complicated facial plastic surgery procedure. The internal structure of the nose consists of a wide array of parts, as well as different types of tissue. When a nasal valve is collapsed due to weak or damaged cartilage, currently the only option a plastic surgeon has is to use cartilage from elsewhere on the body. Unfortunately, nasal cartilage is very unique and vastly different than that which is found in the ears and ribs. In fact, it has a tendency to warp deform, sometimes years after it has been placed in the nose. However stem cells may make it possible for doctors to generate cartilage which is virtually identical to that which is found in the nose Care, Skin Cureby Schae Kane Jennifer Linder, MD, on recent breakthroughs in skin care product ingredients, usage, and trendsFinding the "perfect skin care solution" for all types of skin used to be easy—not all skin types had a good solution. That is changing rapidly as new skin care formulations flood the professional and consumer market. The technology factors in a person's skin type—ethnicity, lifestyle, and genetics—can be sorted out in order to provide recommendations that are the "perfect fit" for virtually all patients. How did we get here so fast?Within just the past couple of years, the science of skin care matured and manufacturers have combined chemical and organic/natural ingredients in frankly new and exciting formulations.Although a multitude of ingredients are marketed as antiaging remedies, what can physicians and their patients really believe? Jennifer Linder, MD, a board-certified dermatologist, fellowship-trained Mohs skin cancer surgeon, biomedical engineer, and chemist, recently spoke with PSP about current research, proven ingredients, and the future of skin care and antiaging remedies.THE BASICSIn the midst of new product launches and claims about a variety of new ingredients and their effects on the skin, Linder emphasizes the importance of thorough daily care and moisturization for patients' skin. Many consumers look for a "cure-all" in topical skin care products, but good moisturization can mend—or at least mask—a multitude of imperfections, she explains. Hydrated skin looks better and overall works more effectively than dehydrated skin because moisture heals barrier deficiencies and helps keep the skin's outside layer functioning appropriately. "Most great skin care products have great moisturizers," Linder says. A good moisturizer has two components: an occlusive moisturizer that acts as a sealant and a humectant that acts as a sponge. These two components help skin retain moisture as well as receive additional moisture from the topical product itself, she adds.One of the ingredients used in skin care products to help skin retain moisture is hyaluronic acid. Hyaluronic acid helps the skin retain moisture and can help to diminish the appearance of fine lines and wrinkles, Linder says, adding that the moisture itself plumps up skin cells and can brighten the overall appearance of the skin. She encourages skin care professionals and physicians to educate patients on the overall care of their skin—not just repairing current damage. In general, the best way to take care of skin is to prevent further damage—appropriate cleansing, moisturization, and daily use of a sunscreen are the foundation of any skin care regimen.TRENDS IN SKIN REPAIRThe use of peptides in skin care products has been increasing in recent years. Peptides are chains of amino acids that change cell behavior based on signals. They have been heavily researched and are currently used in so-called antiaging skin care products. A variety of peptides have been shown to slow cell breakdown, and some studies now indicate that certain peptides can in fact trigger new cell growth, according to Linder. For example, Acetyl hexapeptide-8 has been shown in some studies to trigger collagen production. Acetyl hexapeptide-8 is considered a neurotransmitter-affecting peptide that inhibits soluble N-ethylmaleimide-sensitive factor attachment protein receptors (SNARE) complex. Linder has used Acetyl hexapeptide-8 with her patients to achieve very favorable results. "Basically, this ingredient is applied to areas of dynamic wrinkling—crow's feet, forehead lines, frown lines, and smile lines," she explains. "It helps to inhibit the repetitive motion that causes those rhytides and ultimately softens their appearance." Linder recommends using a product containing Acetyl hexapeptide-8 on a BID basis. If used per physician's instructions, the peptide subtly slows down the muscle contraction and over time diminishes the appearance of fine lines. Acetyl hexapeptide-8, when used in topical skin care products, works a lot like Botox. For some patients, a topical application is a more appealing option. However, for deeper lines and wrinkles, Botox typically achieves better results than a topical product, Linder adds.Some products combine peptides with antioxidants, she continues. When used in conjunction with one another, peptides and antioxidants work together "to grab free radicals that damage the skin, protecting the cells from their breakdown effects and then send signals to skin cells, generating new cell growth."However, as with all skin care products and "cures," Linder reminds patients and medical professionals that they need to be educated on product ingredients as well as the concentration of those ingredients in skin care products. A particular active ingredient may be listed on a product label, but that doesn't necessarily mean there is a lot of that ingredient in the actual formula. | | Before and 1 month after treatment with Palmitoyl tetrapeptide-7 and Palmitoyl oligopeptide serum and with support products. | | | Before and 3 months after treatment with Axetyl hexapeptide-8 serum and with support products. | | | Before and 3 months after treatment with Axetyl hexapeptide-8 serum and a Palmitoyl tetrapeptide-7 eye cream with support products. | | | Before and 6 weeks after treatment with Palmitoyl tetrapeptide-7 and Palmitoyl oligopeptide serum and with support products. |
"Medical research on peptides documents results based on a specific concentration of the peptide in any given product or application," she says. "However, many products might use a smaller concentration of the peptide." Smaller concentrations diminish expected results, and patient compliance with any skin care product is critical to results.Other effective peptides recommended by Linder include the following: * Palmitoyl pentapeptide-4: stimulates types I and III collagen and fibronectin; * Palmitoyl oligopeptide: stimulates multiple dermal fibroblast production and decreases elastase (the enzyme that breaks down elastin); * Palmitoyl tetrapeptide-7: DHEA-derived; reduces IL-6 production to reduce inflammation; and, * Palmitoyl tripeptide-38: stimulates type I and IV collagen and hyaluronic acid synthesis.Other ingredients are being studied to evaluate their effectiveness in the prevention and repair of skin damage. For example, Linder has modified certain formulas in her product line (PCA Skin Clinical Care Products) to include caffeine. "Studies are beginning to show lots of benefits from the use of caffeine in skin care," she says. "In fact, data suggests that caffeine can actually prevent UV damage in skin cells."TECH TALKIn addition to skin care protocols and topical products, Linder incorporates a variety of procedures in her skin care practice. Dermabrasion, chemical peels, and laser procedures are all available for patients who need a more aggressive approach to skin repair. Linder's practice has seen a shift from more ablative procedures to a lighter touch. Nonablative, Fraxel-based procedures are increasingly common, and her group has seen a favorable impact on long-term results in patients. "Doing a series of light chemical peels over a specific time frame is a great option for patients," she says. "[They] have less downtime, less damage to their skin, and using appropriate topical products like peptides can help train new skin cells to produce more collagen on their own." Incorporating lighter procedures into her patient offering has also benefited Linder's practice overall. Patients have less downtime and are more satisfied with the results. PAs and other staff members can perform some of the procedures, so patients have the opportunity to bond with the entire staff as well as with the physician, she says. "Skin care is a very personal business. The more comfortable a patient is with our entire team, the more we'll be able to do for them and the happier they will be with the results."ORGANIC VERSUS NATURALThe terms "organic" and "natural," when used to describe skin care products, can be very misleading in skin care science, Linder cautions. "No skin care product can ever be 'all natural,' " she says. For example, "Take Vitamin C and alascorbic acid. One is found in an orange, and one is a lab chemical. But they have exactly the same molecular structure. Most natural ingredients, like titanium dioxide, need to be processed to some degree so that they can be used in a skin care product." Skin care products require preservatives to keep them safe for patients and consumers. Many people believe that natural preservatives are better for skin, but the truth is that they just aren't as effective, she says. Natural preservatives are commonly used in food, but skin care products have different requirements and, thus, product manufacturers use a different way of compounding preservatives into the overall structure of their skin care offerings.Linder endorses the use of preservatives in skin care products, and believes that shifts in public opinions and perceptions about preservative safety can be described as "a natural ebb and flow." "Public opinion tends to shift to and from certain extremes, but reality is that there are a lot of well-designed skin care products on the market, and companies are responsible in their formulations. In fact, many skin care products use the same preservatives used in food products. If they are safe for ingestion, then topically they don't pose any harm, either."THE BUZZ ABOUT STEM CELLSRecent studies have begun to investigate the relevance of stem cells in skin care science, Linder says. Stem cells are intriguing, and with many possible uses in the health care field it is natural for researchers to explore options and test theories. In fact, there is significant cutting-edge research that shows an impact on bone growth and wound healing when skin cells are inserted under the skin, she adds.However, she cautions about touting stem cells as a possible antiaging remedy. "Stem cells are viable, living cells," she says. "Putting them in a topical product that sits on a shelf for a month or more isn't really an option." The preservatives and stabilizing ingredients necessary in topical products would effectively kill the stem cells, thereby eliminating their ability to activate any kind of new cell growth. In general, it is difficult to take much of the data gained in current research on stem cells and extrapolate it to skin care products, Linder says. However, she adds that there is great hope for the future, as stem cells can be used in office procedures to generate cell growth and reverse the signs of aging. PATIENCE FOR PATIENTSOverall, good skin care and results take time, she notes. Patients will see the best results over several months, even when using the best products and products with the highest concentration of active ingredients. Generally, immediate results can be seen when skin is hydrated properly, but long-term benefits take time to be visible to the naked eye. "If it works fast, it isn't necessarily good for your skin," she cautions.For example, several skin care products contain an ingredient called DMAE (dimethylaminoethanol), a naturally occurring substance that facilitates the synthesis of a neurotransmitter acetylcholine. On The Web!See also "The Greening of Skin Care Products" by Wendy Lewis in the April 2008 issue of PSP.Products containing DMAE have claimed to diminish fine lines in a matter of hours, and it has been demonstrated that DMAE causes some degree of skin tightening, Linder says. However, a 2009 study published in the British Journal of Dermatology showed data indicating that the DMAE triggers swelling in cell fibroblasts. The cells swell, and then they die. While short-term results may appear favorable, DMAE ultimately kills the cells that produce collagen, causing significant long-term damage."Essentially, doctors have to trust that products will work the way they say they will," Linder says. "Our patients rely on us to provide quality care and get good results. That's why understanding the research and being informed about appropriate ingredients is so essential in our industry."Everyone is talking about stem cell facelifts. Internet sites and blogs are abuzz with discussions about which celebrities have undergone these "revolutionary" liquid lifts, but is there really such a thing as a stem cell facelift?Can they really help you tap into the fountain of youth? Or are they just a clever new way to package and market a facial rejuvenation technique that has been used for ages (namely, fat injections)?Is There Such a Thing as Stem Cell Facelift?A stem cell facelift is not a facelift. A facelift involves an incision or a series of incisions, and a lifting of the skin or connective tissue to help treat facial laxity or sagging. Stem cell facelift refers to fat injections to the face. Fat injections are designed to add volume to facial areas that lack fullness. During a stem cell facelift, fat cells (and potentially the stem cells within them) are extracted via a gentle liposuction procedure and then re-injected into your face to restore fullness and enhance contour in your cheeks, temples, lips and under-eye hollows. The surgeon does not take out enough fat from the chosen donor site to provide any contour to that area. Put another way: Your love handles or abdomen will not benefit from a stem cell facelift.Doctors are also using the same fat injection techniques for hand rejuvenation, neck rejuvenation, vaginal rejuvenation and breast augmentation.Fat Injections: Where Do the Stem Cells Come From?Viable adult stem cells are not controversial like embryonic stem cells. Adult stem cells live in fatty tissue. They are the building blocks for any and all of the cells in the human body, including fat cells.There are about 1 million fat cells in 10 millimeters of fat removed via liposuction. Once injected, those stem cells may become activated by internal growth factors, and this may spur the growth of new blood vessels and collagen. Certain fat processing techniques may yield higher concentrations of adult stem cells. No such techniques are approved for use in the U.S. at this time. There are many techniques that can quickly process and re-inject fat for fat grafting procedures, such as Cytori's PureGraft System.Stem Cell Facelift CostFat injection to the face costs can range from $5,500 up to $15,000. Risks of fat injections in the face include lumps or bumps of injected fat and/or dissatisfaction with the results. There may be contour deformities at the donor site as well.Stem Cell Facelifts: The Bottom LineBuyer beware, cautions the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS). All three organizations recommend steering clear of any procedure billed as a stem cell facelift or liquid facelift, at least for now. The ASAPS and ASPS issued a joint statement urging consumers to hold off on any "stem cell" cosmetic procedures. The groups state that such technologies do hold promise, but there is not enough evidence to support their use at this time.Fat injections do have a role in facial rejuvenation on their own or in combination with other facial procedures such as facelifts, but they are not a type of facelift.If you are interested in facial rejuvenation, discuss your concerns with a board-certified plastic surgeon or facial plastic surgeon, and let the physician tell you about all your options. There are many other tried and true procedures that can correct the visible signs of aging on your face, including brow lift, lip augmentation or soft tissue filler augmentation with Sculptra or Juvederm. to Fund Adult Stem Cell Research Sabina Castelfranco | Malta * * * * * * "This was the launch and the announcement of an international research collaboration on intestinal stem cells. Now, it's very exciting because it's sponsored by the Vatican," says Professor Curt Civin of the University of Maryland New research into the potential use of adult stem cells in the treatment of intestinal disease has been announced in Rome. The announcement was made following a meeting of an international task force at Italy's national health institute. The Vatican says it will provide funding for the research.International researchers and doctors involved in the Vatican-financed project announced Friday that they want to assess the potential of intestinal stem cells - a relatively new field - for therapeutic use. They held a working meeting at Italy's national health institute in Rome.Professor Curt Civin, is the dean and director of the stem cell center at the University of Maryland. He took part in Friday's meeting. He says the research is at a very preliminary phase but important nonetheless."This was the launch and the announcement of an international research collaboration on intestinal stem cells," said Civin. "Now, it's very exciting because it's sponsored by the Vatican."Cardinal Renato Martino, who was also at the meeting, said the Vatican fully supports the project because it does not involve embryonic stem cells. The Vatican has already agreed to donate $2.7 million to the research.Doctor Ruggero De Maria of Italy's National Health Institute says this type of research has not been done before."Since these cells can be taken by endoscopy and they are so potent, it would be worth it to try to develop technologies to expand these cells and to see whether they can be used," he said.Professor Civin adds that it will be some time before clinical treatment will be available but the stem cells have great potential."These are stem cells that are constantly rejuvenating throughout our lives even as adults and these cells generally generate kilograms of replacement cells in our intestine, every time we swallow a bite of food," he said.The Roman Catholic Church is opposed to embryonic stem cell research because it involves the destruction of embryos but supports the use of adult stem cells found in the bodies of all humans. Scientists have said that adult cells are less versatile than embryonic ones and they have had more trouble growing adult stem cells in the laboratory.IAPAM Reports on Top Aesthetic Medicine Trends for 2012The International Association For Physicians in Aesthetic Medicine (IAPAM) has surveyed its membership, its medical faculty, and has consulted with numerous experts in aesthetic medicine, to develop a forecast for the top aesthetic medicine treatments or trends physicians can expect to see in 2012. Ultimately, physicians with successful aesthetic practices in 2012, will need to offer “combination” treatment packages, integrating: botox and other facial injectables, medical skin care, IPL/laser rejuvenation and non-invasive body contouring.The IAPAM ( sees the market for minimally-invasive procedures continuing to grow in 2012. Dr. Tom D. Wang, President of the AAFPRS agrees that “consumer interest in aesthetic procedures and treatment has continued in strong fashion. However, some effects from the recent recession still linger. Some patients [are] choosing to have less invasive injectable treatments or non-surgical procedures in an effort to defer facial surgery for the time being.” To capture this knowledgeable patient population, physicians must be expertly trained (IAPAM’s physician-lead botox training at and need to offer the latest aesthetic medicine procedures, utilizing the most current technologies and must package synergistic treatments for the most effective, yet cost effective results.

1. Combining Non-Invasive Procedures Gives the Best ResultsDr. Gregory Buford, notes that, “as we head into 2012, consumers are becoming more savvy about which tips and tricks from their practitioners really work and which do not.” Drs. Tess Mauricio and Buford see “more application and research on combination treatments. More aesthetic providers are abandoning mono-therapy and combining medical skin care, facial injectables, and laser conditioning and offering these synergistic packages to their clients. This “Holy Triad” of facial rejuvenation can be extremely effective in addressing age-related changes on multiple levels and produce results far more dramatic than previously seen.”

The IAPAM agrees that successful aesthetic practices are those that offer patients a combination of minimally invasive procedures. Just offering Botox ® alone is not enough to provide a physician with a successful, and more importantly, a profitable aesthetic practice. “The key is combining neurotoxins like Botox ®, Dysport ® or Xeomin ® with other complementary skin rejuvenation procedures,” says Jeff Russell, IAPAM Executive Director.

2. New Cosmetic Injectables will Offer Choice to ConsumersNew neurotoxins, specifically Xeomin ®, will capture increasing segments of the injectables market in 2012. Dermatologist, Dr. Bruce Katz, comments that, “Xeomin ®, the latest neurotoxin [will] rival Botox ®” in 2012. Dr. Francesca Fuso mentions, “there are new neurotoxins that are still undergoing clinical trials. They will have the same effect as Botox ®, but instead of being injected, they can be applied topically. If these new products are approved in 2012, they will provide patients with yet another option in a year of options.” Finally, new fillers, such as Belotero ® and LaViv ® will offer increased choice to both physicians and patients in the dermal filler arena. Dr. Mitchel Goldman MD, recognizes that, “the approval of LaViv ® the first autologous fibroblast filler and Belotero ® along with the FDA approval of Lip Augmentation with Restylane ® will enhance the use of fillers in 2012 and provide additional products to enhance patient care.”

3. Expanded Uses for Neurotoxins

Dr. Houtan Chaboki, offers an interesting insight into alternative uses for Botox ® and other neurotoxins. One trend [that he is seeing] is the use of neuromodulators (Botox & Dysport) to reshape the face, instead of wrinkles. From microbotox to migraines to multiple sclerosis, the uses and markets for neurotoxins will continue to expand in 2012.

4. Higher Demand for Non-Invasive Body Contouring TreatmentsNon-invasive devices like the Zerona ® and VelaSmooth ® will continue reshaping the body, with new entrants expected in 2012. Dr. Mitchel Goldman MD adds, “the advancement of lasers and energy devices such as Ulthera’s focused ultrasound, Bela Countour ® and Exilis radiofrequency and Lutronic’s advanced Nd:YAG laser will enhance treatment of skin laxity and pigmented lesions.”

5. Turning Back the Hands of Time

Dr. Fusco also envisions that, “in 2012 lots of people will be having work done on their hands.” Turning back ‘the hands of time’ of the hands typically requires a combination of dermal fillers as well as IPL/laser rejuvenation to help eliminate age/sun spots.

6. Lasers are For More than Hair RemovalDr. Bruce Katz predicts “a higher demand for laser treatments in 2012. Some of the newer laser treatments offer truly compelling results without invasive surgery, significant pain and substantial downtime.” IPL (Intense Pulse Light) and lasers can accomplish a full range of anti-aging treatments including: skin tightening, vein removal, removal of age and sun spots, skin resurfacing, as well as treating acne scars and rosacea.

ConclusionThe market for anti-aging treatments will continue to grow in 2012. With new technologies, as well as new ways to bundle and market existing procedures, the trend toward more minimally invasive procedures does not appear to be going away any time soon. Jeff Russell, Executive Director of the IAPAM concludes that, “as we have seen with our past annual trends predictions, the key is to create an anti-aging program for each patients needs. Patients just do not come in for Botox ®; they want a combination anti-aging treatments which often includes neurotoxins, dermal fillers and skin rejuvenation with chemical peels, microdermabrasion and skin care.” * Fat maybe reabsorbed so the patient is left without an acceptable result after a period of time * No long term clinical trials to show that the fat injected into breast does not hinder or mimick the detection of breast cancerNo one wants to go through a medical procedure that would leave you to a questionable result (antlers growing new horns) cells are unspecialized cell types that have remarkable capacity to give rise to the large numbers of other specialized cell types. Embryonic stem cells are one type of stem cells that people are very excited about as these are cells that come from very earlier stages of embryonic development.The state and federal restrictions that exist on the embryonic stem cell research do not save a single embryo from destruction but only delay medical research as the embryos that will be used to these researches are already being thrown away. (Sean Morrison, Director of University of Michigan Centre for stem cell biology)There are federal laws that govern all human subject research including any research in which stem cells will ever be tested in patients and in any research in which anyone would be asked to donate embryos for the derivation of the new stem cell lines. We have embryonic stem cell research oversight committees that have been set up at all federally set up institutions to review any type of research whether it’s done on patients or even just on the laboratory dish with embryonic stem cells. FDA regulates private companies, etcThe ethical focus surrounding the issue should be for the human welfare.Religious viewsquestionable. No single religion has a right to impose their belief onto the rest of the population. |

Concept of aesthetics medicine (medi-spas, luxury clinics) in 2000s.…...

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