Fillers have become a mainstay in cosmetic and rejuvenation treatments in aesthetic medicine today. A recent study demonstrates that a novel tissue-engineered filler, developed using a combination of adipose stem cells (ASC) and micronized acellular dermal matrix (Alloderm), is showing promise for many cosmetic and medical indications. Its developers claim it offers a softer, more natural appearance and may raise the bar in terms of aesthetic outcomes in procedures utilizing dermal fillers.

Various filling methods such as fat injection and grafts, as well as popular collagen and hyaluronic acid fillers, are used for cosmetic and medical indications for the treatment of rhytids, loss of subcutaneous tissue secondary to congenital malformation, trauma and extirpation. However, many of these approaches have several limitations including donor-site morbidity and deformity, unsatisfactory and unpredictable results and may have related issues of potential allergy associated with complications and subsequent toxicity to the filler.

Optimizing Dermal Injectables

“In using this unique approach with ASCs and micronized Alloderm, we hoped to circumvent many of the common problems encountered with other filler approaches used in plastic surgery,” says Jin Soo Lim, M.D., of the Department of Plastic Surgery at The Catholic University of Korea, Seoul, Korea. “It appears that ASCs are an ideal autologous cell source for adipose tissue engineering, and its combination with Alloderm can result in a softer, more natural injectable soft tissue filler.”

Dr. Lim and his team aimed to develop a unique soft tissue filler using the combined strengths of adipose tissue equivalents (which were constructed using ASCs) and micronized Alloderm. In the study, cultured human ASCs were first labeled with fluorescent green protein (to determine whether adipose formation in complexes originated from seeded cells or from surrounding perivascular tissue) and then attached to micronized Alloderm (5×105 cells/1mg). These ASC-Alloderm complexes were subsequently cultured in adipogenic differentiation media for two weeks, and then injected subcutaneously into the dorsal cranial region of nude male mice. Of the eight mice used in the study, four control mice were injected only with micronized Alloderm, and four were injected with ASC-Alloderm complex. The viabilities of the ASCs in micronized Alloderm were determined at 1, 4, 7 and 14 days, and the complexes, which had been cultured for 14 days and implanted in vivo for two months, were histologically evaluated by light, confocal and scanning electron microscopy (SEM).

Results showed that the ASCs in the micronized Alloderm were alive during all time points in the culture period. Light microscopy and SEM evaluations showed that the ASC-Alloderm complexes cultured for 14 days contained round cells with large lipid vesicles and many spherical cells thought to be adipocytes, respectively. Histologic evaluation showed that the ASCs in implanted ASC-Alloderm complexes, which were harvested from mice at two months post-injection, differentiated into adipocytes which had the green fluorescent dye. The H&E evaluation in the control mice which had only received micronized Alloderm showed that some fibroblast-like cells and small capillaries had infiltrated the micronized dermal matrix, whereas in the mice that had received ASC-Alloderm complexes, markedly increased numbers of large signet-ring cells and large capillaries were observed.

“Micronized Alloderm can potentially be a useful medium in which human ASCs can grow and differentiate and serves as a good scaffold for human ASCs when constructing fat tissue for filling and plastic reconstruction purposes,” Dr. Lim says. “This newly grown fat tissue can be used in many medical and cosmetic three-dimensional soft tissue filling scenarios and may ultimately prove to be more advantageous than other currently available filler procedures and modalities.”

All in the Mix

Alloderm can be injected alone as a filler but in order to achieve long-lasting cosmetic results, cell in-growth and revascularization of the micronized Alloderm is necessary — but according to Dr. Lim, this does not occur in all patients. Sufficient amounts of ASCs have the ability of high proliferation and a strong differentiation to adipocytes and endothelial cells, and mixing the Alloderm with ASCs can potentially improve the aesthetic results of this tissue-engineered filler. Dr. Lim says that, due to the natural approach of this novel soft tissue filler, common unwanted adverse events as sometimes seen with other filling modalities can be avoided.

“The differentiated adipocytes from the ASCs mixed in the micronized Alloderm medium make the injected micronized Alloderm a more acceptable soft tissue substitute, and the differentiated endothelial cells enhance the implantation of the injected soft tissue constructs,” Dr. Lim adds.

Selecting Stem Cells for the Filler

The choice of stem cells and scaffolding used in tissue engineering plays a central role in the degree of success of adipose tissue engineering. According to Dr. Lim, injectable scaffolds can widen the scope of engineered adipose tissue and Alloderm used on its own has been successfully implemented in soft tissue augmentation for the treatment of wrinkles and scars.

Its developers allow that the ASC-Alloderm complex approach is a more complex and time-consuming procedure than using off-the-shelf dermal fillers. Nevertheless, they say, it can result in a viable injectable soft tissue filler with enduring aesthetic benefits.

REFERENCE

Yoo G, Lim JS. Tissue engineering of injectable soft tissue filler: using adipose stem cells and micronized acellular dermal matrix. J Korean Med Sci. 2009;24:104-109. Epub 2009 Feb 28.

Botox and dermal fillers are household terms these days and people are no longer shy to talk about it. In fact, according to survey statistics released today by the American Society for Aesthetic Plastic Surgery (ASAPS), nearly 9 out of 10 respondents (87 percent) openly discuss their dermal filler treatments with others, and 7 out of 10 (70 percent) receive support from the people they told.

This trend shows that aesthetic injectable treatments continue to evolve into mainstream and widely accepted options for the everyday use. Survey results found that the typical aesthetic injectable patient is a married, working mother between 41-55 years of age with a household income of under $100,000. The survey also found that women receiving aesthetic injectable treatments are health-conscious and philanthropy minded, with the majority incorporating exercise (95 percent) and healthy eating habits (78 percent) into their lives, and many volunteering with charitable organizations that matter to them (32 percent).

In addition, nearly seven out of 10 respondents believe that BOTOX® Cosmetic (72 percent) and hyaluronic acid dermal fillers (65 percent) are important parts of their aesthetic routine. “Most people have great success with BOTOX® Cosmetic and dermal fillers; however, we need to make patients aware that even though injectables are not ’surgery,’ their administration is a medical procedure with risks that depend on the training and experience of the clinician, the clinical setting and the technique used,” says Laurie Casas, MD involved in the survey.

Hyaluronic acid dermal fillers ranked as the third most popular procedure performed last year. The most common injectable dermal fillers are Restylane, Juvederm, Sculptra, Zyderm and Zyplast, and Bio-Alcamid.

Dermal fillers are being used to reduce or eliminate wrinkles, raise scar depressions, enhance lips, and replace soft-tissue volume loss.

Types of Dermal Fillers

Several classes of dermal fillers are marketed in the United States today. They include:

• collagen based fillers (i.e. Zyplast and Cosmoderm),
• hyaluronic acid based fillers (i.e. Restylane and Hylaform), and
• calcium hydroxyl apatite fillers such as Radiesse.

New promising dermal fillers are in development that will offer superior capabilities in the future.

Autologous (your own) fat is also used as a dermal filler. Your surgeon can take fat from one area (where you do not want it) and inject it into another (where you want it, such as facial wrinkles, or any other area with a loss of volume). This procedure is called lipoinjection or lipografting.

Injection of fillers usually requires the use of either a topical numbing cream or a local injection of numbing medication. Then, using a small needle, the dermal filler is injected into each wrinkle or scar that requires treatment. Some mild burning and stinging is normal and quickly resolves.

The results can last from three months to five years, depending on the filler being used. Collagen provides the shortest duration with effects lasting anywhere from three to six months. Restylane tends to last a bit longer with effects lasting from six months to one year. Radiesse can provide results that last greater than 3 years.

Dermal Fillers and Lasers

These two are very compatible. In fact, if your aesthetic physician is trained and has lasers, he or she can enhance your results dramatically by doing a combination treatment, which may stimulate the growth of new collagen and improve the skin texture. Typically IPL or laser photo rejuvenation (photo facial) is done as a separate procedure. An advanced aesthetic clinic will be able to offer a dermal filler-laser treatment combination in one seating.

Bad economy continues to cause growth in aesthetic medicine: the use of Botox and anti-wrinkle dermal fillers is on the rise, and physicians are looking for extra income by offering non-invasive treatments. Many patients are looking for inexpensive alternatives to cosmetic surgeries and good deals. But cheap may not work in this field.

We hear from many aesthetic physicians that diluting Botox vials and dermal fillers to save costs has become a wide spread practice among non-medical providers advertising prices below the actual cost. This is a bad way to save money for patients and an extremely dangerous way for providers to cut costs.

Bad treatments and improper use of botulinum toxin (Botox, BTXA, Dysport, Myobloc, Neurobloc and Xeomin) and dermal fillers, such as Restylane, Juvederm, Sculptra, Zyderm and Zyplast, Bio-Alcamid, etc., can lead to exaggerated or droopy arches, uneven brows, drop of the lip, impaired speech, drooling or worse. A Botox party or a deep discount at a spa may cost double or triple to repair a cheap injection.

Watch this news report from Texas about the dangers of dermal fillers.