The power to ‘heal thyself’ is no better illustrated in plastic surgery than in the potential of two popular and well-marketed natural body components, stem cells and platelets. Since these are located throughout the body in vast numbers and can be harvested and concentrated into injectable forms and put back into the same person, they are known as autologous healing or enhancement therapies. Both have become very popular in plastic surgery for use in a wide variety of reconstructive and aesthetic applications.
While the use of embryonic stem cells in curing certain diseases is controversial, the use of adult stem cells for their potential cosmetic and anti-aging effects is no less debatable. Harvesting fat through liposuction as a source of stem cells, they are then ‘recycled’ and put back into the patient in the form of an injectable composition, with the assumption that tissues can be repaired, built back up or maintained. Numerous anecdotal claims are made about such injections creating youthfulness, adding permanent volume and improving the appearance of the skin. This has led to a number of touted procedures carrying such names as stem cell facelift, stem cell breast augmentation and stem cell-enriched fat grafting.
Most of the time such stem cell injections are nothing more than fat injections, which unavoidably contain stem cells. In other cases, the injections may be derived from fat grafts that have been processed through machines used to isolate fat stem cells by spinning the fat to separate the layers (although such machines have not been cleared by the FDA). While such ‘stem cell’ injections are unlikely to be harmful, they have not been proven to have anti-aging effects.
But are such touted stem cell procedures in plastic surgery believable? There is no doubt based on current research findings and direction that stem cells will eventually have a significant impact on the ability to regenerate tissues and may even have very observable anti-aging effects. But there is very little data from human clinical studies that currently support any of the hype or marketing claims some doctors make. Injecting stem cells under the skin has not been proven to improve the appearance of the overlying skin; there just isn’t enough evidence yet that it is effective. The clinical results to date are anecdotal, and years of research are still needed to figure out what stem cells can and cannot do. When used today, they should be done with the understanding that they are a lot like chicken soup — it can’t hurt, and may even possibly help.
Unlike stem cells, the effects of platelets on healing are much more established. Whether it is bone or soft tissue, healing is known to be mediated by a complex array of intracellular and extracellular events that are regulated by signaling proteins. While not regulated exclusively by platelets, they certainly play a major role. Platelet-rich plasma (PRP) is blood plasma that has a high concentration of platelets due to processing techniques. During PRP-based procedures, about 60cc of blood is removed from the patient and the PRP concentrate is then obtained by a centrifugation process. This creates a teaspoon-sized platelet concentrate that can theoretically be used to improve the results of plastic surgery procedures such as facelifts and fat grafts. Due to its platelet contents, PRP contains many different growth factors and cytokines that are well known to have significant wound healing effects.
While PRP can be used alone, a variety of procedures have been developed that combine it with different types of injectable fillers. Marketed brand names such as Selphyl and the Vampire Facelift create either a platelet-rich fibrin matrix or are used in conjunction with other well-known fillers such as Juvederm and Restylane. The benefits of PRP in these facial rejuvenation techniques, though appealing, have not been fully substantiated in widespread clinical use, and the cosmetic surgery community continues to evaluate the efficacy of this autologous therapy.