Novel Injectable Tissue-Regeneration Facial Procedure

Anya Romanowski, MS, RD

Disclosures

October 20, 2017

In This Article

The Birth of Injectable Tissue Regeneration

Will we see a revolution in antiaging treatment in the next 5 to 10 years? Medscape interviewed Dr Steven R. Cohen of FACES+ Plastic Surgery, Skin and Laser Center, who has pioneered an injectable tissue-regeneration procedure that replaces the facial tissues that are degenerating while stimulating new blood vessel formation, unleashing the body's ability to repair itself from aging.

Medscape: Dr Cohen, how did you first come upon the concept of injectable tissue regeneration?

Dr Steven R. Cohen: In 2002, I became very involved in regenerative medicine. Around that time, a company in San Diego (MacroPore Biosurgery) bought a smaller company (StemSource) that was trying to capitalize on the observation that there were stem cells and bioactive cells in fat tissue.

My "aha moment" came when they first presented this information to me. What struck me was how we found digoxin—an early cardiology medication for heart failure—in plants. I thought that if we're finding these kinds of things in plants, we probably have much more complicated mechanisms within the human body and perhaps some of these could be used for therapeutic applications.

These cells in fat function as an orchestra to heal, repair, and reduce inflammation within the patient's body. They are uncommitted cells that could potentially benefit many organs in the body, if one could figure out how to harness them for tissue engineering.

These cell-based approaches are applicable in the aesthetic arena, where you're basically treating a chronic injury when it comes to facial aging. We grow for 22 years, and we decay for the rest of the time due to cumulative wear and tear resulting from sun damage, environmental exposure, volume loss, genetics, and laxity. Initially, the body keeps up with the decay by using its own stem cells, which are present in every organ. It's a microscopic, sustainable event. However, you eventually outstrip that, which is when people seek care, and we typically recommend a filler to replace the volume loss.

Medscape: How does this procedure differ from other fat-grafting techniques?

Dr Cohen: Injectable tissue regeneration is a technique where we harvest some of the patient's fat. The fat is drawn through a cannula into a syringe, much like taking blood.[1] Although it's similar to a filler, when we use the patient's own fat tissue, we don't necessarily get the heightened kind of look of a synthetic filler, which some people like, but personally I'm not in favor of.

If a patient has lost volume in two or more areas of their face, it means the tissue in both the deep and the superficial fat compartments are starting to shrink. My hypothesis is that as the microcirculation of the skin surface is compromised by sun damage, the underlying dermis and fat begin to shrink or atrophy. With deflation comes laxity, and this is facilitated by facial expression, which since the perpendicular connections to the surface shrink, the layers of the skin begin to shear, producing laxity. Well, if you replace that with like tissue in the proper compartments when it first becomes apparent, then you're increasing the patient's facial volume, or mass, and now literally changing the mathematical curve of decay.

In addition, you are making new blood vessels and reversing the changes in elastin and collagen that occur with aging. If this is done earlier, when first perceived by the patient, then it may be preventive, and possibly laxity will not occur to the same extent, if at all.

What we're seeing is when we measure facial volume over a 2-year period in these patients, we actually see trophism.[1] Their facial volume improves for 24 months, in spite of no weight gain. What that means is that, along with increasing facial volume, we also have microscopic findings of tissue regeneration and formation of new blood supply. In fact, we are actually reversing some of the age-related changes in elastin and collagen.

Full face before procedure

Fillers look good, but 1 or 2 years later when the filler disappears, the tissue is still 2 years older. With injectable tissue regeneration using fat, however, the tissue actually becomes more youthful during that 1- to 2-year period because it has a new blood supply. I imagine this would be the case with any other organ system.

Full face after 18 months

We like the improvement in appearance that volume brings, but if you look at it a little bit more rigorously, what's actually happening is we're making our tissues not only look better but possibly live longer because in all likelihood, our cells function better by this approach. That's the unique aspect.

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