Most Americans are not terribly fond of their fat, but what if you could put that spare tire to work -- healing wrinkles, increasing breast size or even speeding the recovery of a knee injury?
Too good to be true? Not necessarily.
For 20 years cosmetic and plastic surgeons have used fat grafts taken from their patients' own "supply" to restore fullness and decrease wrinkles in the face, but only recently have medical researchers begun investigating whether the adult stem cells found in the fat tissue could be used for healing on a wider level.
"Fat is naturally rich in adult stem cells ... and these stem cells have regenerative capabilities," says Dr. Peter Rubin, associate professor of Plastic Surgery at the University of Pittsburgh and a clinical researcher of fat stem cells.
Research is under way around the globe to explore how these regenerative capabilities can be used to heal, he says, from reconstructing the face after traumatic injury to rebuilding breast tissue for breast cancer patients after a mastectomy.
But this technology leads a bit of a double life.
Its medical applications are still in the research phase, but some cosmetic surgeons are allegedly putting this technology to aesthetic use on their patients.
Services such as stem cell face lifts or even vaginal rejuvenation promise revolutionary results with the help of the regenerative power of stem cells. Given that this technology is not yet backed by clinical data or FDA approval, however, the benefits of such procedures are questionable.
"Stem cells are a buzz word now. Some of these procedures are driven by a profit motive and some are driven by science. If it's profit-motivated, you have to take it with a grain of salt for sure," says Dr. Felmont Eaves, plastic surgeon and president-elect of the American Society for Aesthetic Plastic Surgery.
Fat to Make You Pretty
"The blood supply to a graft is very important, so since stem cells release growth factors, the concept is that if you increase stem cell density, then you can preserve greater fat retention," says Dr. Rubin.
The problem is, the machine used to make the stem cell-enriched fat is not FDA-approved, Rubin says, it's only approved for research purposes.
That doesn't mean that such procedures won't work or that they're necessarily unsafe, Rubin says.
"It's unlikely that these cells will cause harm [and] there are really great applications that can come out of this, but we need to be careful and deliberate in how we use these therapies," he says.
Dr. Mark Berman, president-elect of the American Academy of Cosmetic Surgery, has become an authority on the use of fat for cosmetic regeneration of tissue, and he says that most of the stem cell benefit occurs without specially concentrating stem cells in the fat.
While he's used concentrated stem cell fat in one woman to treat a chronically injured knee, "this is early stuff," he says. The "stem cell buzz" for things like wrinkle treatment, he says, is "misleading."
"Most doctors in the U.S. [probably all] that claim they are doing 'stem cell' fat grafting to lift eyelid and facial tissues are in reality using simple fat transfer," Berman says.
"There are very few, if any doctors in the U.S., set up to actually [concentrate stem cells]. What you'll find, doctors who say they're doing these stem cell fat grafts are not performing this step and are rather telling you that the fat is loaded with stem cells and so they don't need to do it. It's a bit disingenuous."
Both Eaves and Berman say that using stem cell for publicity casts a shadow on simple fat grafting, which they believe is a highly effect procedure in its own right.
"In the mainstream, we're seeing that after twenty years working with fat, it's a very powerful tool," Eaves says. "It can be done with safety and efficacy, [but] with the stem cell buzz, it's kind of a wild west out there," Eaves says. "People make claims and hire a press agent and they get into the news and in the public eye it's validated, but the validation really isn't there."
The Future of Fat Fixes
Plastic surgeons are "extremely enthusiastic about the role of fat stem cells in plastic surgery," Eaves says, but Berman says that most likely, this technology will be "even more important in other therapeutic uses."
Researchers abroad have used fat stem cells to close bowel cistules in patients with inflammatory bowel conditions and to regenerate bone for facial reconstruction after cancer, among other applications, Rubin says. In his own research, he is working on breast reconstruction for cancer patients as well as facial reconstruction for those in the military with facial injuries.
"This is a promising field," he says, but one that needs to be researched to ensure safety and long-term positive results. "Especially in the area of breast reconstruction, you have to be careful that those cells won't impact adjacent breast cancer cells and possibly cause cancer recurrence."
Plastic surgeon Eaves echoes this caution for those dabbling in aesthetic therapies.
"The message we would like to say is that patients is to really do their homework and make sure the procedure is a safe one," Eaves says. "Don't be suckered into a glitzy ad; find out if there's any data behind it."