Recently there has been a lot of discussion in the media about novel aesthetic treatments that have used buzz words or phrases that reference stem cells. Stems cell therapies are a hot topic in medicine these days. They have some legitimate medical uses currently and may hold promise for a variety of other important applications that could improve the quality of life for some patients and might even save the lives of others. Unfortunately, several unscrupulous companies and even some health care practitioners have promoted the cosmetic use of unproven, untested treatments that have had minimal study in peer-reviewed journals and are not even close to being FDA approved. There has been an incredible obfuscation of terms in the media, so that it can be very confusing.
First, it is helpful to start this discussion with the definition of a few terms:
Stem cells- are undifferentiated cells. They are the “progenitor” or precursor cells in the body that have the ability to differentiate or change into all other types of cells that make up our tissues. There are two basic types of stem cells- Embryonic stem cells and Adult stem cells. Embryonic stem cells are those obtained from embryos or other products of conception (amniotic fluid, umbilical cord blood) and these have been the source of major controversy. They have many potentially useful applications but cosmetic medicine is probably not one of them.
Adult stem cells are what most research has focused on for cosmetic, reconstructive or regenerative therapies. Adult stem cells act as a repair system for the body, replenishing adult tissues. There are three potential sources of adult stem cells in the body- bone marrow, fat cells and blood. For cosmetic applications, bone marrow harvest is obviously impractical. The other two sources however can be harvested with relative ease. Fat cells can easily be harvested with liposuction. Although that requires a somewhat invasive procedure, it may be seen as a convenient side benefit of liposuction if that procedure is already being done. It may make sense to use some of the fat instead of simply discarding it after surgery. Obtaining stem cells from a patient’s own blood requires a procedure called apheresis in which the blood is passed through a machine that extracts the stem cells and returns the rest of the blood components to the patient. This is different and a bit more involved that the process used to obtain PRP or Platelet Rich Plasma.
Platelet Rich Plasma (PRP)- is simply blood plasma that has been enriched with platelets. Several growth factors are found in platelets. These growth factors are important for the repair of certain tissues in the body and theoretically they could be useful in regenerative or cosmetic medicine. Some media attention has focused on the use of PRP to treat sports injuries in professional athletes but the effectiveness of these therapies is controversial. PRP is harvested by obtaining a blood sample from the patient and spinning it in a centrifuge in order to concentrate the platelets in the plasma, which is then separated from the rest of the blood.
Vampire Facelift- refers to a non-surgical injection of PRP into the face. Instead of using commercially available dermal fillers like Restylane or Juvederm, PRP is used as a soft tissue filler, adding volume to areas of the face. The concept of a “liquid facelift” is not a new one; it has been promoted by some plastic surgeons for several years. Although it’s a misnomer, there is some validity to the concept that adding volume back to those areas of the face that have lost volume over time can provide a lifted, more youthful appearance of the face. I have been doing this for years with products such as Perlane, Radiesse, Artefill, Sculptra, and more recently Voluma. The idea that PRP has any benefit over these commercially available fillers is unclear. Theoretically PRP may offer some advantages over traditional fillers because of the growth factors present in PRP, but this is unproven. Research would have to be done to demonstrate such an advantage and this would be very difficult to do. An alternative to PRP injections is the injection of fat enriched with stem cells. Fat transfer or fat injections have been done for years. One downside to fat grafting is that the rate of “take” of the fat is very variable. Depending on the technique used, the location of the harvest and donor site, and probably several other factors, as much as 80-90% of transferred fat may not survive, and this is very unpredictable. One theory is that adding stem cells may enhance the “take” of fat grafts but this is unproven. The cosmetic use of PRP and stem cells is not FDA approved.
Vampire Facial- is a trademarked term that refers to a procedure involving dermal needling followed by the application of PRP to the skin. The idea is that application of growth factors on the freshly injured skin would have beneficial effects. The term was popularized by the media and by coverage of several celebrities who underwent the treatment, including Kim Kardashian (photo above) and supermodel Bar Raefeli. In my opinion the term is almost as misleading as Vampire Facelift. Dermal needling has also been called skin needling, micro-needling and collagen induction therapy. This technique has been around for over a decade and more recently has become widely popular with the advent of automated devices like the Collagen P.I.N. which we use at Physicians Center for Beauty. This can be an effective non-invasive treatment for fine lines and to improve texture and tone of the skin but the addition of PRP or any other topical serums or products is less clear to me. Again,the cosmetic use of PRP is not FDA approved.
Recently, the American Society of Plastic Surgeons and the Aesthetic Society, two governing bodies of plastic surgeons in the United States, provided a position statement outlining their concerns about the unscrupulous marketing of procedures using stem cells and PRP. It stated, in part:
“The ASPS and the ASAPS are committed to patient safety, advancing the quality of care, innovative treatments, and
practicing medicine based upon the best available scientific evidence. ASPS and ASAPS are eager to learn more about
the use of stem cells in plastic surgery and enthusiastically support development of a stronger evidence base in the
utilization of stem cells in reconstructive and aesthetic surgery procedures. In the meantime growing concerns have
emerged regarding advertising claims and/or clinical practices using stem cells that have not been substantiated by
scientific evidence. These concerns include:
• Use of the term “stem cell” in aesthetic surgery procedures, such as the “stem cell face lift,” with the implication
of improved results.
• Claims that skin quality can be improved from stem cell treatments, and that outcomes from fat grafting can be
improved with stem cell therapy.
• Widespread marketing, evidenced by a Google web search using the search terms “stem cell facelift” yielding
197,000 results and “stem cell breast augmentation yielding 302,000 results, respectively.
• A lack of consistency in how these procedures are performed and how stem cells are incorporated into the
• Instructional courses, some “for profit,” that have emerged which are designed to teach methods of stem cell
extraction for aesthetic procedures.
• Many procedures being advertised by practitioners who are not board certified plastic surgeons or members of other core specialties with formal training in aesthetic procedures. Such “non-core” practitioners have not been trained in an approved residency program designed to teach the physician safe and careful evaluation of cosmetic patients or a working knowledge of the full range of aesthetic procedures.
• Specialized equipment being marketed to physicians for use in “stem cell procedures.”
• Specialized equipment to extract stem cells, including devices, may fall under FDA regulations. Some devices,
including automated machines to separate fat stem cells from fat tissues, are not yet approved for human use in
the United States.”
This position statement sums up most of the critical issues I see pertaining to the use of some very confusing and misleading terms. Unfortunately there are some unscrupulous people in the field of aesthetic medicine that can give plastic surgeons a bad name. To be fair, most of these bad actors are not in fact plastic surgeons and are simply trying to cash in on a fad. The result is that products and procedures with questionable benefit are being marketed often in a dishonest way. Truly modern day snake oil.
Thanks for reading. I welcome your questions and comments to my blog post.
Sean Maguire, M.D.