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Posted September 23, 2011 in Stem Cell Rejuvenation

The use of one’s own fat to modify facial and body proportions has been performed for over 100 years. The plastic surgeon, using a syringe and a needle, removes fat from one part of the body (called harvesting) and injects it into another part of the body. This is a technique commonly referred to as fat grafting or fat transplantation.

Fat grafting now plays a critical role in both aesthetic and reconstructive surgery.

Recent evidence now suggests the enormous regenerative and restorative potential of fat, which we now know is attributed to stem cells.

Stem cells are cells that have the potential to become almost any type of cell in the human body including muscle, nerves, blood vessels, cartilage and bone. They are abundant in fat and bone marrow. In fat they are dormant, which means that they will not divide into specialized cells unless removed and/or manipulated. The ability of a stem cell to divide and become another cell is called differentiation. It is at this point that the cell becomes “specialized”. A good example of a specialized stem cell is a zygote or fertilized human egg whose destiny is, of course, a human being!

As mentioned previously, fat or adipose tissue is an abundant source of stem cells. When these fat cells are removed or harvested, they have the potential to become “specialized” and are referred to as adipose-derived stem cells or ADSC’s. Several laboratory studies have shown the potential of these specialized cells to differentiate into other human tissue including bone, cartilage, cardiac muscle and blood vessels. In the last decade, there have been several published clinical applications of ADSC’s in humans in all specialities including gastro-enterology, cardiology, plastic surgery and craniofacial surgery. A remarkable and exciting development is the potential use of stem cells in heart attack victims. It has been predicted that stem cells will change the way we manage heart attack victims in the near future with recent studies showing very promising results.

In Plastic Surgery the use of stem cells in reconstruction and aesthetic surgery is growing rapidly as we continue to learn new applications and it’s benefits.

Several theories exist regarding as to why there is clinically apparent rejuvenation and restoration of skin and other human tissue. One of the most popular theories is the so-called “Niche” theory. Fat that is harvested and then transplanted into a different part of the body displays a “stem cell” effect: New blood vessels are formed in areas of poor blood supply, various growth factors are released that help to promote better wound healing, local immunity is improved, damaged tissue is rehydrated and the overlying skin is rejuvenated.

Several techniques of fat grafting exist, yet one of the most popular techniques is that by Dr. Coleman from the US. He has popularized fat grafting in the United States and many people through out the world practice his technique. Essentially fat is harvested from the abdomen or buttock. A local anaesthetic solution containing adrenalin is injected into the area first. Then, a blunt tip cannula attached to a syringe is used to gently suck out the fat. The fat is centrifuged (spun in a machine at 3000r/m) for 3 minutes to isolate the fat cells, separating it from blood and other fluids. This isolated fat (which now contains an abundance of stem cells) is introduced into the desired area using small blunt tip cannulas via small 1ml syringes.

The majority of human trials have taken place within the realms of breast cancer surgery particularly following radiation. It is therefore essential that complications be minimized when performing the procedure and that safety standards are in place. In August 2011, the Plastic and Reconstructive Surgery Journal (PRS) published a Multicenter Study from 3 Major European Breast Centers to assess the complications and cancer risk when performing fat grafting in the breast. 513 patients underwent 646 fat grafting procedures following breast cancer surgery. The indications for fat grafting were to fill defects in the breast following reconstruction or to improve damage caused by radiation. Coleman’s technique was used to harvest the fat in all cases. Patients were followed up at an average of 19 months following treatment.

Complications were extremely low with a 0.5% infection rate. There was no evidence that the fat grafting interfered with breast cancer detection. Woman over the age of 40 should have regular screening mammograms and this study confirms that in the hands of experienced radiologists, the fat injection sites are easily distinguished from potential cancer sites.

Furthermore, the recurrence of developing a new cancer in the mastectomy group patients was comparable to patients who did not receive fat grafting in other studies. There is however, a slightly increased chance (1%) of developing a recurrence in those that previously received breast conservation surgery. (Breast conservation surgery is when the surgeon removes only a portion of the breast and therefore is a “preserving” procedure.) There is a fear that by injecting fat into a previous tumour site, you may add a stimulus factor and create an environment for new cancer cells to develop. Some animal studies suggest this, however opponents of these animal studies have found errors in their design.

To date there is no single study that has proven that stem cells injected into the body has a tumorogenic (cancer causing) effect. The current status is that fat filling of the breast does not affect radiological follow up in breast cancer patients and does not increase the risk of cancer in post-mastectomy patients.

The controversy regarding radiological screening and potential for stem cells causing cancer has lead to its conservative and restricted use in the United States. In Europe however, fat grafting is done far more extensively and the majority of the studies relating to fat grafting are derived from major European breast units.

Fat grafting of the breast has remarkable clinical benefits in patients following mastectomy especially after having radiation. A study was performed by Italian plastic Surgeons and they published their data in PRS Aril 2007. 20 patients were extensively studied after having fat injections for radiation side effects. Dramatic improvements in symptoms in all patients were observed with very little side effects. All of the chest ulcers (that were a result of radiation) healed. Almost all patients had a full recovery of their symptoms. Another article published in August 2011 looked specifically at patients with severe pain following mastectomy and radiation. Almost all patients displayed a significant drop in pain following fat grafting. 80% of patients stopped taking their usual chronic pain medication at a year following fat grafting.

There have been several other publications that confirm the clinical benefits of fat grafting in breast surgery including the Journal of Plastic and Reconstructive Surgery, the Wound Healing Journal and the Aesthetic Surgery journal.

In Aesthetic surgery, regional placement of fat is used extensively in the following areas: hands, nasolabial folds, marionette lines, lips, cheeks, eye area, chin, jaw line and body. Recently there has been a strong interest in performing breast augmentation with one’s own fat. Although a time consuming procedure, some patients are good candidates for fat breast augmentation. This is a technique that is not commonly performed but as techniques of fat grafting improve, and new equipment is introduced that improves the efficacy, viability and time consumption of fat grafting, so too will we see a rise in breast augmentation being performed with one’s own fat.

The latest and most sophisticated technology in stem cell use comes from a company called Cytori therapeutics. They have developed the “Celution System”, a device that further enhances or enriches the fat graft by increasing the amount, availability and viability of “pure stem cells”. These isolated and concentrated stem cells are referred to as adipose-derived regenerative cells (ADRC’s). One can think of an ADRC as a Super Stem Cell. Recent studies in different specialities have yielded extremely promising results and the device has recently been made available to South Africa. Cytori have also developed a “Puregraft” system. This replaces or modifies Coleman’s technique when it comes to simple fat grafting. Using this system, many surgeons now feel that fat grafting has may become simpler, faster and more reliable than traditional methods.

As we continue to improve our fat grafting techniques and we continue to understand the full benefits of stem cell rejuvenation, so too will we see major clinical benefits. Current work is already underway with regards to cryopreservation of adipose tissue. The ability to freeze and store one’s own fat will become a reality in the not too distant future, carrying with it exciting prospects. Stem Cell rejuvenation is now already current practice in many parts of the world and will continue to grow in popularity amongst health care providers as we learn and share more about it’s use.

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