Stem cells have been used for a decade in orthopedics to renew joints. They have been used to treat blood disorders like leukemia. They’ve been dispatched in the alleviation of genetic maladies, dental ailments, a whole slew of illnesses. That’s because they are pluripotent – master cells able to develop into blood, brain, bones, and all of the body’s organs. When they’re injected into a joint, for example, they can become ligaments or tendons.
So, the thinking went in the medical industry, why not marshal these regenerative forces for aesthetic purposes? After all, “once you put them in – whether it’s in the chest to smooth out the décolletage or the face to take care of wrinkles or soften scars or even in the scalp to grow hair – they become that cell whether it’s skin or fat or blood vessels,” explains New York City dermatologist, Cheryl Karcher. “The results,” says Dr. Karcher, “are unbelievable.”
Adipose-derived, i.e. harvested from the body’s own fat, these cells can be used on their own in liquid form known as nanofat or following injections of fat, also known as fat grafting or fat transfer. Because they are autologous, meaning they come from your own body, there is no risk of rejection, allergic reaction or viral transmission.
New York and Dubai-based dermatologist, Steven Victor, cautions on the terminology, however as technically, the cells in question are not pure stem cells, but stromal vascular fraction cells. It is a heterogeneous population of cells, he explains, which includes hormones and active repair enzymes known as cytokines. They are found in the walls of the capillaries. Abdominal fat is especially rich in these capillaries.
The difference between nanofat and fat transfer is that the former is a skin rejuvenation procedure while the latter is used for volumization. Nanofat injections result in smoother, brighter, more radiant skin according to Dr. Karcher. Since the cells that are being injected actually become skin cells, “they fill up wrinkles where skin cells were lost,” she explains. And not only do these new cells produce more collagen and elastin, but they are not as damaged by ultraviolet light as the old cells simply because they’re newer.
When injected into the scalp, the nanofat has been found to fuel hair growth. Whether the cells become new hair follicles or stimulate dormant ones is not yet known, but the results don’t seem to be in dispute. “I just saw a man three months after and he’s got new hair,” says Dr. Karcher.
The procedure appears to be especially effective with women. “Female hair loss is where I’ve seen a home run,” says New York City sports medicine specialist, Vijay Vad, MD. “The results I’ve seen in patients I’ve sent Cheryl [Karcher] are a grand slam out of the ball park.” Good candidates are those with thinning hair, in the early stages of alopecia (baldness).
The minimally invasive procedure begins by numbing the lower abdomen with a local anesthetic. A small amount of fat is then extracted through a cannula – only 20 – 30 ccs, less than two fluid ounces. The fat is then passed through a number of different-sized filters, 30 times back and forth with each filter, until there is no fat in the remaining liquid. That fluid is then injected wherever necessary in the hands, chest, face and scalp. “It really doesn’t hurt that much although I will numb the area,” says Dr. Karcher. Optimal results appear in six months.
Dr. Karcher then follows up these injections with a PRP treatment. Platelet Rich Plasma is obtained from a blood sample via a centrifugal process. Platelets emit growth factors which give cells signals to repair the environment they’ve been placed in so they don’t just morph into fat. “You have to give stem cells a stimulus to become tendon-like, cartilage-like or skin and hair-like,” explains Dr. Vad. “When you mix them with PRP, the repair potential is big.”
Dr. Steven Victor goes a step further by injecting fat into the face, before proceeding with nanofat. The fat used in this procedure – known as fat grafting or fat transfer – is not thinned out into a liquid-like substance like it is with nanofat. As such, it is used to lift, volumize and re-contour. Calling it SAVA – Subcutaneous Autologous Vascular Augmentation – Dr. Victor obtains two small samples of fat from the stomach, hips or thighs. One sample is processed to extract the stromal vascular cells and the other is injected into the face, hands and chest (wherever necessary) using a fine cannula.
But how much of the fat will remain and how long will the results last? A number of studies have reported reabsorption rates of 30%–70% within a year. The success of this procedure depends on a variety of factors, chief among them the experience and skill of the doctor. “If you know how to do it correctly and you’re good,” says Dr. Victor, “100% takes. It’s all technique. I’ve probably done a couple of thousand faces in my career so artistically, I think I’m pretty good at it.”
The fresh fat and the skin are then injected with the nanofat liquid obtained from the second sample of fat. “By putting this into the transplanted fat, the fat will stay up to about 10 years. I have patients now 10 years +, they still look great,” reveals the dermatologist.
And what about weight gain or loss – would that affect the results? “Losing weight will not affect the results of SAVA and gaining weight will probably further improve the results,” says Dr. Victor. “Don’t forget,” points out Dr. Karcher, who also performs fat grafting, “that weight fluctuations would show up on your face regardless of whether or not you put fat in there.”
There’s one more step with SAVA and that’s an intravenous injection of the stromal vascular cells. Their anti-inflammatory and angiogenic (meaning they form new blood vessels) properties combat the aging processes of inflammation and reduced blood flow, according to Dr. Victor. “The intravenous SVFCs help you feel younger and stronger. Patients report increased energy, better sleep, and thinking clearer and reduced stiffness.”
There’s virtually no downtime. Patients are able to go out the following day. “There’s minimal bruising, minimal swelling. I bruise people much more with Botox, Restylane and Juvederm than I do with this,” says Dr. Victor. The effects are immediate and continued improvement can be seen for several years: “I have patients who have noticed improvement for three years. It’s amazing.”
So, given the promising results of nanofat and fat grafting, why isn’t everyone queuing up for these procedures? The catch is that it’s expensive says Dr. Karcher. “And that’s because it costs me a lot to. I use the highest quality PRP kits that give you the highest concentration of platelets. I get the finest sterile system – the same system that orthopedics use – to get the stem cells. It’s a closed system, so there’s no way any infection can take place.” The price is $5,000 to $8,000. But, it’s a one-time treatment for the hands, chest, face and scalp whereas PRP treatments for hair growth alone cost $1,200 – $1,500 a pop and require three to six sessions. “Nanofat ends up being cheaper in the long run,” concludes the dermatologist.
Dr. Victor charges $25,000 for SAVA. Between the surgeon, the OR and the anesthesia, it’s not more expensive than a facelift, explains the dermatologist. “And I think it’s a better procedure because you look natural.” But processing tissue to the highest standard is expensive. Dr. Victor’s teams follows all CGTPs (Current Good Tissue Processes) in an FDA-registered lab on the premises.
“Following all the good tissue processes is like running an operating room,” reveals Dr. Victor. “There are all these things you have to do for safety and sterility. Other people will make stem cells and won’t follow any of these rules and regulations. Every time we make stem cells, we test them for sterility, we test them for cell count and viability.”
Patients should be vigilant about the doctor and the processes when it comes to these procedures as misinformation abounds. For instance, doctors will tell patients that PRP contains stems cells, but that it not true according to Dr. Victor who condemns instances of office receptionists handling tissue among other flagrancies.
“The dark side is there are a lot of charlatans in that world,” cautions Dr. Vad. But, the future is bright. “Biologic technologies – stem cells, exosomes, growth factors – are going to have a giant impact on skin, beauty and sports medicine,” declares Dr. Vad. “The potential is limitless as far as wrinkles and hair loss. I think what Botox was in the 1990s, biologic therapies is going to be in the 2020s.”