Nov. 24, 2006 -- The prospect is a tantalizing one. To erase wrinkles and fine lines, or to get bigger breasts, without cosmetic surgery. Forget silicone, forget collagen. All you would need is stem-cell therapy.
Realistically speaking, though, such applications remain a pipe dream.
Of course, it wouldn't be the first time a medical therapy had been bent in the direction of aesthetics. Take a look at Botox -- the deadly botulinum toxin initially used to treat spasms is now used to improve the appearance of frown lines.
And while stem-cell applications for the vanity market may have to wait, some researchers have begun to research the possibilities of stem cells in plastic and reconstructive medicine.
"Stem-cell research appears promising for medicine and particularly for plastic surgery," said Dr. Ronald Friedman, director of the West Plano Plastic Surgery Center and a board-certified plastic surgeon practicing in Plano, Tex.
"Hair follicular stem cells, tooth stem cells and skin stem cells all show therapeutic promise," said Denis English, editor in chief of the journal Stem Cells and Development and director of cell biology at the Center of Excellence for Aging and Brain Repair at the University of South Florida in Tampa, Fla. "These can restore hair to a bald man, teeth to those in need and skin to scarred patients."
The use of stem cells to regenerate tissue is believed to hold promise because stem cells can be nudged to develop into specialized cell types. And some researchers have turned an eye toward stem cells for this very purpose.
In October, a University of Pittsburgh team led by Dr. Peter Rubin received a three-year grant from the National Cancer Institute to explore the possibility of using stem cells derived from a patient's own fat. Rubin, assistant professor of plastic surgery and co-director of the university's Adipose Stem Cell Center, used those stem cells to create a durable, shaped piece of replacement tissue.
The research may one day allow breast cancer survivors to take advantage of a natural replacement after a mastectomy.
But with these possible applications in reconstruction, could cosmetic applications be far behind?
"Naturally, the public shows more interest in applications like breast augmentation," said Dr. Peter Costantino, director of the Center for Facial Reconstruction and Restoration at Roosevelt Hospital in New York.
"In our society, there is such a huge demand for these rejuvenation surgeries, despite their significant risks, that the pragmatist in me cannot deny the likelihood that it will not be long before someone offers a two-stage procedure starting with liposuction followed by injection of these autologous stem cells for breast augmentation or into the face to rejuvenate," said Dr. Daniel Salomon of the department of molecular and experimental medicine at the Scripps Research Institute in La Jolla, Calif.
Real-World Applications Still Far Off
Though initial research into the potential of stem cells in reconstructive surgery is promising, actual applications -- particularly those of a purely cosmetic nature -- are still distant.
"This is still very far in the future, except for tabloid speculation," said Dr. Garry Brody, professor emeritus of plastic and reconstructive surgery at the University of Southern California's Keck School of Medicine in Los Angeles. "By the time it becomes practical -- and affordable -- I suspect it will be beyond our lifetimes."
"Stem cells do have the potential to revolutionize things, but it is not "just around the corner,'" said Costantino. "You can't just inject 'fat' stem cells into a breast and just assume that it's going to make a nice-looking breast. You could just end up with something fairly lumpy and unappealing."
The cosmetic applications of stem cells are "25 to 30 years away, at the earliest," said Thoru Pederson of the department of biochemistry and molecular biology at the University of Massachusetts Medical School in Worcester, Mass.
Yet some studies are already under way.
"We are starting to see clinical trials with stem cells for reconstructive surgery," Rubin said. "A group from Japan reported on enriching liposuctioned fat with fat-derived stem cells and using the material successfully for breast enlargement."
Cosmetic Uses of Stem Cells a Low Priority
Most experts agree, however, that many other potentially curative and life-saving applications of stem cells take precedence over cosmetic uses.
"Applications to rejuvenation or enhanced personal appearance are much harder to justify at this point and will be driven more by market forces in affluent countries -- not just the U.S. certainly -- rather than by science," Salomon said.
"In my opinion, use of any cells for cosmetic surgery is still problematic," said Dr. Darwin Prockop, director of the Center for Gene Therapy at Tulane University Health Sciences Center in New Orleans. "The trials that can be justified are in patients with terminal diseases in which the potential risks and benefits are carefully evaluated."
"In all honesty, the more promising (and more quickly realized) aspects of stem cell use in plastic and reconstructive surgery will probably be in producing skin replacement grafts on a large scale," Costantino said. "This could help many, many burn and chronic wound patients."
But for now?
"Though there is an enormous amount of promise with stem cells in plastic and reconstructive surgery, the devil is in some pretty important details," Costantino said.