Stem Cells and Fat Grafting: My Thoughts
Perhaps the hottest topic that we have today in cosmetic surgery is stem cells. Do they exist? How do we use them? What are they good for? Are there risks? Unfortunately, even the most dogged proponents or detractors do not have clear answers to the above points. I believe that at this time there is more hype than fact, and the public should be wary of following the latest and greatest marketing push that may have little merit.
Herein are my current thoughts on the topic of stem cells and cosmetic surgery, which are subject to change as I continue researching and exploring this idea. I think that there is some kind of improvement that occurs in the skin after fat transfer over the first 1 to 2 years following the procedure. However, I am uncertain as to how to label the reason for these changes. When I was moderating a panel last year in Las Vegas of several fat grafting surgeons, I had pretty clearly divided opinions among the panelists as to stem cells. Some individuals were staunchly arguing that they not only existed but also clearly accounted for the favorable changes seen after a fat transfer. The other side of the line up the argument was posed that the changes that occurred with a fat transfer were due to the increasing light on the skin with augmented tissue. I stand somewhat in the middle of both extremes. I see some microcirculatory improvements in the skin but do not know clearly how to attribute these changes.
Two years after a fat transfer procedure, the patient looks a lot better. Are there stem cell changes to the folds around her mouth and to her skin overall or is it just better light that strikes the face after it is sufficiently augmented?
As many of you know, I perform quite a few hair transplant procedures and I have come to truly think about how fat grafting is very much like hair grafting. A tiny free parcel of fat or hair is moved to another location and after taking up residence gains blood supply and flourishes. In the world of hair restoration, there has been much recent talk of how a transplanted hair graft into a scarred area can actually soften the scar because of the stem cells that are possessed within each hair follicle in the bulge region. I think this could account for why fat grafts could also have beneficial effects on the skin.
Obviously, most of what you have read is pure conjecture without true science to support it. I think the one thing that I am very careful of at this point is to try to concentrate stem cells for injection, as none of us truly know what the long-term consequences of doing so really are. Further, I try to refrain from using the marketing verbiage of stem cells to sell fat grafting, as fat transfer alone is such a wonderful procedure with outstanding results with or without purported stem cell effects.
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