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The Future (and Beauty) of Fat

By Chris Sutton
Posted On Jun 21, 2010
How stem cells are changing the face of fat transfer

Words Patty Reiman

Fat. Not something that we usually think of fondly, but which has garnered attention in recent years for its positive association with a youthful face. In fact, if you’ve got enough of it, the cosmetic surgery industry has worked to refine fat transfer techniques over the past couple of decades, making it an attractive augmentation option. Beyond the face, industry experts are predicting that other parts of the body, too, will benefit from this “natural” augmentation option. How? Meet fat’s rising star: the adult stem cell.

Stems cells, for those who have not been following the controversy about them, are kind of like basic starter cells that can become specialized cell types. They are found in all higher organisms, and come in two types: embryonic stem cells and adult stem cells. The controversy is about the embryonic stems cells, which differentiate into all the specialized cells that become the organs, muscles and bones of the body. There is no controversy about adult stem cells, however, which act to repair and replenish cells in the body.

“Adult stem cells are a ‘natural solution’; they exist naturally in our body and provide a natural repair mechanism for many tissues of our body,” explains Todd Malan, MD, a cosmetic surgeon in Scottsdale, Arizona. “Adult stem cells are present in humans at birth and can be found in body tissue such as bone marrow and fat cells. Adult stem cells are presently being used to help fight diseases and conditions such as leukemia and diabetes.”

But to fully appreciate where this new technology is taking us, first we need to take a look at where we’ve come from.

In the Beginning…

If we look back to the early 20th century, German physician Klin Wochenschrift used fat injections in the head and neck for reconstructive purposes, and there are even earlier indications that fat had been used for volumizing the breast. So the idea of transferring fat from one area of the body to another isn’t exactly new. What is new is the time and dedication spent to advancing the methods of doing so to get better, longer-lasting results.

Fat transfer is just what it sounds like: Transferring fat from one area of the body to another, usually from the hips, thighs or abdomen. After the fat is processed and prepped, it’s injected into an area of the body that needs more fullness—usually the face, though the trend these days includes the back of the hands and the buttocks.

Mel Bircoll, MD, an L.A.-based AACS cosmetic surgeon and early pioneer of fat transfer, recalls how 30 years ago his liposuction patients would comment, “if you could only put the fat up here,” motioning to their faces or breasts. Dr. Bircoll, who says that he was the first plastic surgeon to perform liposuction in North America, saw an opportunity for pursing this line of research and began to experiment with fat transfer techniques. He began publishing his results more than 25 years ago.

Setting the stage for today’s use of fat transfer, in 1984 Dr. Bircoll presented to the scientific community his techniques for using liposuctioned fat for breast augmentation, facial rejuvenation, restoring volume to the back of the hands, and a host of reconstructive procedures. At the time, there was skepticism and a general lack of knowledge about safety and effectiveness with regard to the procedure. But with recent advances, today the aesthetic surgery community has a renewed interest in fat.

In fact, fat is garnering so much attention that some patients are opting for a fat transfer instead of the traditional surgical facelift, says Dr. Bircoll; others are adding it to the traditional lift (a facelift with fat injections placed where fullness is missing, such as the cheeks). The reason? To avoid that tell-tale windblown look, of course. “The naturalness of it is what we are looking for,” he explains.

Starring stem cells

Today, the news is all about stem cells and the promising results these are showing. According to Nathan Newman, MD, traditional fat transfer results depend upon the technique used, and can be unpredictable and inconsistent. But stem cells do not, and therefore produce better results that last longer and rejuvenate both facial structures and the skin.

“We also awaken the existing dormant stem cells at the targeted [injection] area,” says Dr. Newman, adding that the process “is based on fat grafting techniques that I have modified over the years, but the results and benefits are greatly improved with the stem cell concentration.”

Dr. Newman, a Beverly Hills cosmetic surgeon, performs a variation of the traditional fat transfer technique called the Stem Cell Lift. He harvests fat from a patient’s donor site (hips, thighs, abdomen) and then uses his own process to create a rich concentration of stem cells—double or triple the usual, he says. Those stem cells are then injected into areas of the face or hands.

While the price for Dr. Newman’s Stem Cell Lift can range from $5,500 to $9,500, “that is a fraction of a traditional facelift [cost], as it does not require general anesthesia,” explains Dr. Newman. “On average, the results turn the clock back about five to ten years and last for about five to ten years, depending on lifestyle and habits.”

Todd Malan, MD, on the other hand, is focusing his efforts with stem cell fat transfer in another area of the body: the breasts. “Stem cell enhanced fat transfer can be performed on the breasts, buttocks, hands and face, but I am currently focusing mostly on the breast.”

Why? Because so many of us are interested in enlarging our breasts, of course! (And for what could eventually be a natural and effective option for doing so, we give thanks.)

“We have seen significant improvement in fat survival in patients who have elected to undergo stem cell enhanced fat transfers to the breast,” says Dr. Malan. “The addition of activated stem cells assists in the formation of new blood vessels to help feed the grafted fat. Some of the stem cells actually differentiate into new fat cells and the stem cells aid in healing by halting swelling and inflammation as well as rejuvenating the skin.”

He also explains that these stem cells may also have something we all dream of: The ability to make the breasts a “preferred” site for new fat, meaning that those extra ounces you put on could go to enhance your cleavage, not your waistline. How does it work? “By increasing the blood supply to the transferred fat,” Dr. Malan says. “As the patients gain weight it tends to concentrate in the breasts and no longer in the problem areas where the fat was removed.”

Dispelling Myth

Unlike the controversial embryonic stem cells, these adult stem cells are derived from your own body. Furthermore, there’s no risk of allergic reaction because the fat source is your own body, not synthetic or derived from an animal source. Dr. Newman says that stem cell lifts are less risky than traditional facelifts, with about the same risk factor as most fillers.

“The main downside is that some patients may not have enough fat to remove and may need to combine the Stem Cell Lift with other procedures,” says Dr. Newman.

According to Dr. Malan, physicians or patients who aren’t in the know about advances in this area may express concern that stem cells will cause the growth of a tumor or cancer cells. But, he says, “The facts do not support this concern. This comes from a lack of knowledge regarding adult stem cells and how they truly function.”

In fact, reports Dr. Malan, early testing of stem cell-enhanced fat transfers to the breast were performed in breast cancer patients. “These stem cells were used to assist in healing damaged tissue and to replace volume lost from biopsies or lumpectomies. These patients had a lower risk of cancer recurrence than baseline. Fat derived stem cells simply do not have the ability to become cancer cells. Although yet unproven, many experts believe that these stem cells actually halt cancer growth.”

A Bright Future

With so much potential, cosmetic surgeons in the U.S. believe that stem cells could impact the future of multiple cosmetic procedures. “I foresee stem cells becoming the standard of care in many areas of medicine and surgery within the next two decades,” predicts Dr. Newman.

Dr. Malan agrees. “We are very excited about the potential benefits of fat derived stem cells. Several studies in Europe and Asia have shown that these fat stem cells can be used to repair everything from damaged heart muscle to cosmetic facial procedures. We want to help advance that knowledge and refine techniques so that one day every person that undergoes liposuction will elect to save their fat for the future benefits of stem cell therapy.”

The next step? Dr. Malan says that would be to develop an effective process to harvest and store fat so that we can benefit from ongoing advances in fat derived stem cell therapy. “We are working closely with many industry experts to help make those goals reality.”

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