Test your knowledge: Stem cells and fat grafting
Stem cells create a lot of buzz, but the truth surrounding the use of stem cells in cosmetic surgery remains, for many, a mystery, according to plastic surgeon Kai-Uwe Schlaudraff, M.D., who is section editor of the Aesthetic Plastic Surgery Journal for fat grafting and stem cell research; scientific board member of the Swiss Stem Cell Foundation; and governor of the Aesthetic Stem Cell Society.
Dr. Schlaudraff, who practices in Geneva, Switzerland, presented “Stem Cells — where are we at?” yesterday at the American Society for Aesthetic Plastic Surgery’s (ASAPS’s) Aesthetic Meeting 2016, in Las Vegas.
Among his top priorities for physicians:
1. Understand the Terminology
Fat grafts are harvested through liposuction and contain a mixture of cellular components comparable to solid fatty tissue.
“A fat graft may be processed through washing, filtration, centrifugation, etc., but it has not been exposed to enzymatic digestion,” Dr. Schlaudraff says.
Stromal vascular fraction, or SVF, is the result of enzymatic processing, during which the “normal” fat cells are discarded. And adipose derived stem cells represent only one part of the many cell populations of the SVF, according to Dr. Schlaudraff.
“In conclusion, adding fat grafting to a facelift surgery is beneficial for the patient but it does not mean he/she had a ‘stem cell therapy,’” he says.
2. Choose the Right Provider
“There are many ‘stem cell providers’ in the market. Verify that your laboratory/bank is GMP [Good manufacturing practices (GMP) are the practices required in order to conform to the guidelines recommended by agencies that control authorization and licensing for manufacture and sale of active pharmaceutical products] approved, controlled by the FDA or National Health Authority and is certified in the latest standards for cell processing and banking. If not, therapeutic use risks to be unregulated and stored cells might be worthless for the patient,” Dr. Schlaudraff says.
Other important take-home messages from Dr. Schlaudraff’s presentation address these questions:
What is the benefit of SVF/stem cells in fat grafting and what is the right dose?
“Clinical experience in plastic surgery suggests a benefit in fat grafting performed under ‘hostile’ tissue conditions — e.g. after burns, fibrosis, radiation, to name a few,” Dr. Schlaudraff says. “Commonly, the SVF concentration is doubled in cell assisted lipo-structures, but finding the exact dose remains a challenge.”
Do we need enzymatic tissue digestion, or can we increase the concentration of SVF solely mechanically?
“So far, enzymatic digestion of fat is considered the ‘gold standard’ for obtaining high concentrations of stromal vascular fraction (SVF), since, until now, mechanical methods for SVF processing yield significantly lower cell numbers,” he says.