Three volunteers, skin type two and three, were tested in separate one-centimeter square areas with the ER:Yag laser (Sciton, Palo Alto, CA). Three 1 cm2 squares were treated at 100 microns depth with a 100% coverage (full field) and three 1 cm2 squares at 300 microns depth with 11% coverage (fractional) in each subject. Each treated area had topical application of; 1) gel vehicle only 2) gel and platelet rich plasma (PRP) 3) gel, PRP,and ADSCs. ADSCs were obtained from a “mini-liposuction” procedure using tumescent anesthesia and PRP was obtained from peripheral blood. The biologic agents were then topically applied to the wounds with a pipette and allowed to dry for 5 minutes. The treated skin was dressed with a gel to maintain the cells in an anaerobic environment. Sequential photographs were obtained and evaluated.
Results
Fractional wounds under all conditions healed rapidly. Epithelialization occurred within 24 hours or less in all 9 fractional wounds. 100 micron full field wounds healed more slowly. The surface area that had re-epithelialized was measured and compared to the total area of the wound and a percent healing was calculated. Mean time 50% epithelialization in the vehicle only group was 10 days, compared with 6 days in the PRP group, and 4 days in the PRP plus ADSCs group. Full re-epithelialization was achieved in a mean of 14 days with PRP and 7 days with PRP plus ADSCs. None of the areas treated with the gel vehicle alone were fully healed at the end of the 14 day observation period.
Figure 1. 5 days post-treatment: 100 micron full field resurfacing (top), 300 micron 11% fractional resurfacing (bottom), vehicle dressing only (left), vehicle + PRP (center), vehicle+ PRP+ ADSCs (right)
Figure 2. 7 days post-treatment: 100 micron full field resurfacing (top), 300 micron 11% fractional resurfacing (bottom), vehicle dressing only (left), vehicle + PRP (center), vehicle+ PRP+ ADSCs (right)
Figure 3. 8 days post-treatment: 100 micron full field resurfacing (top), 300 micron 11% fractional resurfacing (bottom), vehicle dressing only (left), vehicle + PRP (center), vehicle+ PRP+ ADSCs (right)
CONCLUDING REMARKS
This pilot study showed faster healing times compared to a vehicle dressing only of laser wounds treated with PRP and PRP plus ADSCs. These results suggest the possibility of reduced recovery times from full field laser resurfacing treatment.
The PRP and PRP plus ADSCs were applied topically using a pipette to the forearm and abdominal skin of volunteers. Facial skin heals more quickly than abdominal and forearm skin and thus healing after treatment with PRP and ADSCs is likely to be more rapid than that observed in the forearm and abdominal skin treated in this study. Administration of the PRP and cells with a pipette, as was done in this study, is not likely to be practical when treating facial skin and further work is planned using a canula or a needle to implant these biological agents in the subcutaneous space and/or dermis of subjects just prior to treatment with the laser. A split face study using ADSCs and PRP applied in a thin coat with a brush following treatment or with subcutaneous/dermal injection prior to treatment is recommended.
REFERENCES
1.Manstein D, Heron GS, Sink RK, Tanner H. Fractional thermolysis: A new concept for cutaneous remodeling using microoscopic patterns of injury. Laser Surg Med. 2004;34:426-428.
2.Geronemus R. Fractional thermolysis: current and future applications. Laser Surg Med. 2006;38:169-176.
3.Bowen R. A novel approach to ablative fractional resurfacing of mature thermal burn scars. J Drugs Dermatol. 2010;9:389-393.
4.Waibel J, Beer K. Ablative fractional laser resurfacing for the treatment of a third-degree burn. J Drugs Dermatol. 2009;8:294-297.
5.Plant-Bernard V, Silvertre JS, Cousin B, et al. Plasticity of human adipose lineage cells toward endothelial cells; physiological and therapeutic perspectives. Circulation 2004;109:656-663.
6.Zuk PA, Zhu M, Ashjian P, et al. Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell. 2002;13:4279-4294.
7.Moseley TA, Zhu M, Hedrick MH. Adipose derived stem and progenitor cells as fillers in plastic and reconstructive surgery. Plast Reconstr Surg. 2006;118 (3 suppl):121s-128s.
8.Strawford A, Autelo F, asured with 2 H2O. AmJ Physiol Endocrinol Metab. 2004;256:E577-E588.
9.Matsumoto D, Sato K, Gonda R, et al. Cell assisted lipotransfer: Supportive use of human adipose derived cells for soft tissue augmentation. Tissue Engineering. 2006;12:3375-3382.
ABOUT THE AUTHOR
Dr. Robert Bowen is an Internal Medicine and Pulmonary specialist, Board Certified in Cosmetic Laser Surgery by the American Board of Laser Surgery. He is a Fellow of the American Society of Laser Medicine and Surgery and has published research articles on laser medicine. Dr. Bowen is a Diplomate of the American Board of Anti-Aging Medicine and a graduate of the Aesthetic Medicine Fellowship.
Chapter 2
Cell-Assisted Facial Fat Transfer – The Natural Filler
Robert Bowen M.D., FCCP, FASLMS
Clinical Associate Professor of Medicine WVU-East;
Medical Director, The Center for Positive Aging, Martinsburg, WV
ABSTRACT
A key feature of facial aging is loss of volume, both of fat and bone. Attempts to create a more youthful looking face should address these components to be successful. Autologous fat holds appeal for this purpose
Keywords: Cell-assisted lipotransfer, adipose derived stem cells, stromal vascular fraction, platelet rich plasma, liposculpture, autologous fat transfer, platelet derived growth factors, fat grafting
INTRODUCTION
A key feature of facial aging is loss of volume, both of fat and bone. Attempts to create a more youthful looking face should address these components to be successful. Autologous fat holds appeal for this purpose due to the absence of tissue rejection and allergic reactions. Autologous fat is also readily available in many patients, and can be obtained from lipoaspiration performed under local anesthesia.
Autologous fat transfer has been used surgically for a century and for a quarter of a century using lipoaspirate. More recently, techniques have focused on maintaining adipocyte viability by minimizing trauma, resulting in increased graph survival.1-4 This paper introduces the concept of cell-assisted fat transfer, a complementary approach that augments gentle harvest and implantation techniques with adipose derived mesenchymal stem cells (ADSCs) and growth factors from platelet rich plasma (PRP).
Stem cells have the characteristics of both replicating themselves and differentiating into a variety of other cells. Embryonic stem cells are found in the blastocyst 5 to 6 days post fertilization and are truly pluripotent, meaning that they can differentiate into any type of mature cell. These cells require sterile culture, tissue expansion, and differentiation prior to any therapeutic use and the usage of embryonic stem cells remains controversial on a bioethical level. Conversely, adult mesenchymal stem cells are found in many tissues, including bone marrow and adipose tissue,5 and are multipotent, meaning that they can differentiate into many different cell types, including vascular tissue, bone, cartilage, and fat. In addition to their cellular regenerative potential, they also exhibit chemotaxis and the ability to modulate inflammation.6-8
Adipose