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International research uncovers potential for stem cell therapies

Regulators are beginning to address stem cell therapies, which show promise for skin rejuvenation as well as many other clinical applications, as research into this burgeoning field continues to grow worldwide.

And to standardize terminology, technologies and studies, says William H. Beeson, M.D., the International Society for Cellular Therapy recommends calling stem cells from any source "multipotent mesenchymal stromal cells" (Dominici M, Le Blanc K, Mueller I, et al. Cytotherapy. 2006;8(4):315-317). Dr. Beeson is a facial plastic surgeon based in Carmel, Ind., and assistant clinical professor, departments of dermatology and otolaryngology — Head and Neck Surgery at Indiana University.

"To be classified as such, (stem cells) must exhibit plastic adherence in culture, express specific antigens and not others, and demonstrate multi-potential differentiation potential," he says. In the latter area, they must show the ability to differentiate into osteoblasts, adipocytes and chondroblasts in vitro.

Embryonic stem cells are derived from the morula and are totipotent. "That means that they can differentiate into any tissue, including placental tissues. Blastocysts are pluripotent, meaning that they can differentiate into any tissue except placenta — including teratomas," Dr. Beeson says.

Dr. Beeson
Conversely, the stem cells that Dr. Beeson and his colleagues are attempting to develop for facial aesthetic applications are multipotent and derived mesodermally. "Adipose-derived stem cells (ASCs) can be processed from either liposuctioned or excised fat. Adipose tissue contains 100 to 1,000 times the number of pluripotent cells per cubic centimeter compared to bone marrow," Dr. Beeson says.

ONGOING RESEARCH Recent studies have shown that ASCs have anti-aging effects. In one study, ASCs reversed damage to fibroblasts caused by UVB (Song SY, Jung JE, Jeon YR, et al. Cytotherapy. 2011;13(3):378-384. Epub 2010 Nov 9).

"ASCs also reduced the number of apoptotic cells and shifted the cell cycles from necrosis to early apoptosis," Dr. Beeson. "This study concluded that ASCs mediated their anti-aging effects through a paracrine function on the fibroblasts, and can reverse the damage in photodamaged fibroblasts at both the cellular and genetic levels."

A minimally invasive technique for inner thigh lifting incorporating a novel design for the dermoadipose flap resection and using the adductor major tendon to anchor the inferior flap is safe, effective and offers decreased morbidity with better and more durable cosmetic results compared to other thighplasty procedures, according to its innovator, Guillermo Blugerman, M.D.

Cosmetic and plastic surgeons agree that replenishing volume loss is key among the goals of facial rejuvenation. But how best to achieve that volume restoration remains a subject of debate. There's the autologous filler — fat — and then there's an array of other injectable fillers that each have their own strengths and weaknesses.

There's more than one way to apply minimally invasive treatments to any given patient both safely and successfully, say experts who discussed how they would approach several typical cases during Vegas Cosmetic Surgery 2011 in June. From neuromodulator dosing to filler choices, "There's room for a lot of individual preference. That's the art of it — there is no right answer," says Corey Maas, M.D., a San Francisco facial plastic surgeon.

Pleasing Aesthetic outcomes are equally important in both male and female patients undergoing cosmetic facelift surgery. However, facelift procedures in males may be considered more challenging, as some surgical endpoints can differ from those in their female counterparts. Understanding the nuances and particular surgical goals of the male cosmetic patient is crucial in helping to achieve positive Aesthetic outcomes.

The key to an effective and long-lasting midface facelift is understanding how to safely reposition the malar fat pad. "The most important advance in facial rejuvenation in the past 25 years has been our understanding of the mid-face," says Luis Vasconez, M.D., professor, division of plastic and reconstructive surgery, University of Alabama, Birmingham. Key to this understanding is the so-called malar fat pad, which he says is a misnomer: "It is not fat, but fibroadipose tissue."