What is Regenerative Medicine?
Regenerative medicine is a new, rapidly evolving field in medicine and surgery. It allows practitioners to harvest and concentrate a patient’s own healing abilities and place the tissue concentrate into damaged or aged tissues and organs to heal, and in many ways, to regenerate the tissues to a healthier, and many times chronologically younger state.
Platelet Rich Plasma
Boulder Plastic Surgery is proud to be one of the few practices on the front range to offer regenerative aesthetics to our patients. Utilizing your own blood or fat tissue, we can maximize your healing as well as repair the cumulative damage to your skin and other tissues caused by time and environmental factors. We are truly harnessing the power of your own cells.
The definition of regenerative medicine is to stimulate the regenerative properties of a patient’s own tissue and cells and use these to supplement the body’s natural healing processes. In theory, we are concentrating and purifying a patient’s intrinsic healing potential and placing it into sites needing tissue regenerative stimulus. Cells utilized include platelets and stem cells as well as hormonal growth factors and the tissue/stromal vascular fraction from your fat tissue.
There is a hierarchy of treatment options beginning with off-the-shelf fillers such as Juvederm progressing to utilizing regenerative medicine to enhance surgical procedures. Options for patients depend upon anatomy, tissue health, and patient desires and tolerances. Regenerative medicine options are synergistic with surgical procedures, laser treatments, and injectables.
Platelet Rich Plasma, also known as “PRP” is an injection treatment were by a person’s own blood is used. The retrieval of your blood is performed in the office using the same technique as having your blood drawn for routine testing. The blood is spun in a special centrifuge to separate its components, and to extract the most concentrated “platelet rich” portion of the plasma. Platelets are very small cells in your blood that are involved in the clotting and healing process. When PRP is injected into the damaged area it causes a mild inflammation that triggers the healing cascade. As the platelets organize in the treatment area, they release a number of enzymes to promote healing and tissue responses, including attracting stem cells and growth factors to repair the damaged tissue. As a result new collagen and elastic fibers begin to develop. As the collagen matures, it begins to shrink, causing a tightening and strengthening of the tissue in the damaged area. When treating injured or sun and time damaged tissue, a remodeling of the tissue to a healthier and younger more elastic state occurs.
Treatment results are generally visible at 4 weeks and continue to improve gradually over 3-6 months when PRP is used alone or synergistically with fillers, lasers and skin pen (aka micro-needling). Most treatments require 60-90 minutes including the drawing and processing of your blood. Generally, 2-3 treatments are advised at intervals suited to the patient’s clinical skin and tissue health. Touchup treatments may be done once a year after the initial series of treatments to boost and maintain the results.
PRPs safety has been established for over 20 years for its wound healing properties and its proven effectiveness has extended across multiple medical specialties including cardiovascular surgery, orthopedics, sports medicine, podiatry, neurosurgery, dermatology, urology, dental and maxillofacial surgery as well as aesthetic applications. PRPs use in wound healing, aesthetics and skin rejuvenation began in approximately 2004 in Europe and Asia. Areas typically treated for aesthetic purposes, volume restoration and skin rejuvenation include the face, neck, lips, and back of the hands. PRP is also used to stimulate hair growth in various forms of alopecia in both men and women.
PRP has been shown to have overall rejuvenation effects on the skin by improving skin texture, thickness, fine lines and wrinkles, increasing volume by stimulating the production of new collagen and elastin. When combined with cosmetic fat grafting procedures, it can improve fat graft take, he as well as long-term results. PRP can improve the appearance of scars as well as pigmentary irregularities. It is not designed to replace cosmetic or reconstructive surgical procedures, where appropriate, but can actually enhance and supplement the overall results of a surgical procedure.
Concentrate your healing with aesthetic regenerative medicine at Boulder Plastic Surgery and IV Seasons Skin Care.
Harness the power of your cells.
The body’s natural healing solution.
What is Fat Grafting?
Fat grafting is the utilization of your own tissue to provide volume in other areas of your body. The fat is typically taken from an area where it is less needed (usually the thighs or abdomen), and then transplanted to an area that has lost volume as a result of aging, trauma, surgery, birth defects, or other causes. Common areas for treatment include the hands, face, breast, and buttock. Typically, the transferred fat results in a long term increase in volume of the body site being treated.
Interestingly, adipose (fat) tissue has been calculated to contain up to 2,500 times more stem cells than bone marrow, and therefore is a rich, easily accessible source for regenerative tissue. The platelets in your blood release growth factors, attract stem cells and causes a mild inflammation that trigger the healing cascade. The tissue harvested and concentrated from human fat is commonly called the t-SVF, or Tissue Stromal Vascular Fraction.
Human adipose tissue is also used for what is commonly called fat or micro fat grafting, to restore and rejuvenate the volume loss associated with facial aging and aging in other body regions, including the hands. We as plastic surgeons, use fat grafting to restore traumatic or cancer related deformities, poor healing, radiation fibrosis and scarring. Adipose tissue can also be further refined into various forms and concentrations of the t-SVF (Tissue Stromal Vascular Fraction) for more specific applications, such as improving the structure, nature and aesthetics of aging tissue. Both PRP and t-SVF concentrates also improve the “take” of micro fat grafting for aesthetic and reconstructive treatments.
The refinement of human adipose into a more pure or concentrated form of t-SVF can be done enzymatically or mechanically. ALMI (Autologous Lipocyte Micronized Injection) or nano-fat, is human adipose tissue that has been mechanically processed to contain concentrated stem cells and growth factors, eliminating the much larger adipocytes (mature fat cells) when they are not needed restore significant volume in treated tissues, but deliver extraordinary rejuvenative power. This is done mechanically, not enzymatically and therefore the term t-SVF is used vrs c-SVF (Cellular Stromal Vascular Fraction), which is used for intravascular therapies.
With regenerative medicine, the intrinsic regenerative properties of a patient’s cells and tissues are used to stimulate and supplement the body’s natural healing processes. It can shorten the natural healing cascade by increasing healing potential at the site of injury.
Four factors are required for healing:
- Fertilizer: The signal proteins or growth factors that attract healing cells.
- Seeds: Cells that are attached or delivered to heal tissue, i.e. stem or progenitor cells.
- Soil: The scaffolding matrix – extra cellular support tissue.
- Water: Revascularization (Angiogenesis) – growth of new blood vessels to support tissue metabolism.
So, simply stated, regenerative medicine principles and techniques give a physician and surgeon the ability to concentrate and purify a patient’s intrinsic healing potential, and transfer to sites needing tissue regenerative stimulus.
Concentrated adipose (fat) tissue has the highest biologic value of tissues studied to date, because it delivers a natural scaffold (extra cellular support tissues), and a high concentration of mesenchymal stem cells and numerous growth factors.
The hierarchy of treatments available to patients can be individualized depending on anatomy, tissue health, patient needs and desires, tolerances and cost of the treatments. Regenerative medicine therapies are synergistic with surgery and laser treatments, and certainly compliment and enhance the results of off the shelf fillers, such as hyaluronic acid and others.
Fat Grafting Considerations
The first step of fat grafting is liposuction to the area donating the fat. The area is injected with a fluid to minimize bruising and discomfort. The fat is then removed from the body using a narrow surgical instrument (cannula) through a small incision. The fat is then rinsed and cleansed of any blood and oils that may have resulted from the harvest. The purified fat and stem cells can then be injected into the desired area using either a smaller cannula or needle. Some of the fat that is transferred does not maintain its volume over time, and as a result your surgeon may inject more than is needed in order to achieve the desired end result. Fat grafting procedures may be done using a local anesthetic, sedation, or general anesthesia depending on the extent of the procedure.
Nanofat grafting involves further processing of some of the fat cells to release the cellular messengers responsible for stimulating tissue growth. This mixture can then be injected into areas of skin damage or wrinkling to stimulate the body to repair its own tissues. This results in improvements in skin quality in areas that are traditionally neglected with surgical procedures such as fine wrinkles around the mouth or sun damaged skin of the neck.
Anyone in good health can be a candidate for fat grafting. The restoration of volume can improve youthful fullness in a number of different areas: curves can be enhanced and areas of hollowing can be improved. Fat grafting can be used to compliment a variety of procedures (such as a facelift) and many times can delay or avoid more invasive procedures. Fat grafting also delivers tissue scaffolding, growth factors and numerous healing cells ( including stem cells). In fact, fat (adipose) tissue has been calculated to contain up to 2,500 times more stem cells than bone marrow. These stem cells not only help to speed up the healing process but deliver extraordinary rejuvenative power to the area that they were transplanted to. Fat grafting is an excellent choice for anyone looking to improve contour singularly or in conjunction with another procedure.
MicroFat and NanoFat Grafting Quick Facts
- Procedure: Plump up creased, furrowed, or sunken facial skin; add fullness to lips and backs of hands. Fat grafting may be used as a natural tissue alternative to facial augmentation (implants) in certain individuals. MicroFat/Nanofat Grafting
1 to 2 hours Local with or without sedation (office procedure)
Local with sedation OR general anesthesia (operating room)
- Side Effects: Temporary stinging, throbbing, or burning sensation. Faint redness, swelling, excess fullness.
- Risk: Grafting – Contour irregularities, infection, poor take (resorption), further surgery to maintain or improve results
- Recovery: Tasks of daily living may be resumed immediately. Back to non-strenuous work (no lifting greater than 10 lbs) in 3 to 5 days. Back to normal after 3 weeks. Light exercise (1/3 of normal) beginning at 2-3 weeks.
- Bruising: 7 to 14 days
- Swelling: Moderate/Significant 2 to 4 weeks, Subtle/Mild 2 to 3 months, all of which are dependent upon extent of procedure(s).
- Duration of Results: Fat and ALMI™/Nanofat Grafting: 50% to 80% take with each treatment (surgery)
- Office Visits: 1st – 5 to 7 days / 2nd – 10 to 14 days.
- Anticipated # of visits: 5
- Bandages Worn: Compression garment for donor site(s) 2-3 weeks.
- Icing: 4 to 5 days – DONOR SITE ONLY. NO ICING to graft site(s).
- Pain Meds: Tylenol or Narcotics as needed. No Anti-inflammatories – Aspirin, Ibuprofen, Naprosyn—for 3 weeks after.