Adult stem cells are found in large quantities in fat cells and act a repairman of sorts. They assist in replenishing specialized cells, such as those lost within the face in the normal process of aging, as well as maintain a normal “turnover” of regenerative organs, such as blood or skin.

Due to these properties, stem cells can be valuable “tools” for plastic surgeons and their patients.

Possible applications include rejuvenation of the skin or recreation of a youthful appearance in a patient’s complexion without the need for chemical or laser treatments—a definite plus. A cell that will maintain its shape or form long-term, and in fact continue to “graft” with time to an area that has lost either volume or turgor, is another plus.

It is amazing to consider the possibilities now available for facial reconstruction using stem cells harvested from the patient’s own body. The client is both donor and recipient, so there is no “rejection” of the tissues or cells, and the result is obviously very natural.

Another point of interest: The stem cells are harvested via liposuction.

There is no complicated procedure for gathering them up or separating them out. It is a matter of simply “spinning them down” after the liposuction, then reinserting then into the desired areas.

The advances made in plastic surgery techniques using stem cells are perhaps best stated by Richard Ellenbogen, MD, FACS, FICS. Ellenbogen is widely recognized for his work in using stem cells present in liposuctioned fat for a procedure known as the Stem Cell Facelift.

Considered by many to be the “father of fat grafting,” Ellenbogen is a two-time recipient of the American Medical Association Physician’s Recognition Award, a member of the American Society of Plastic Surgery, the American Aesthetic Plastic Surgery Society, a Fellow of the American College of Surgeons, and a Fellow of the International College of Surgeons.”

“The latest developments in adipose stem cell research were not discovered in a Petri dish or in a lab,” he says. “Instead, this promising revolution in medicine was inspired via unexpected benefits resulting from facial fat grafting. In fact, it was and is consistently observed that the transplanted fat did not feel like isolated collections of fat, but remarkably, rather more like the recipient-site tissue into which it had been transplanted.”

Ellenbogen began his career more than 30 years ago. After attending the University of Florida, where he excelled in both art and premed classes, he obtained his medical degree from the University of Miami. He went on to complete his general surgery training in New York City, where his interest in corrective surgery grew. He traveled to The Hague, Netherlands, where he served as a fellow to the Red Cross Hospital, giving assistance to children with birth defects.

Upon returning to the United States, Ellenbogen moved to Los Angeles and became board certified in plastic surgery. His Beverly Hills practice opened in 1980.

Ellenbogen also has some experience as a portrait artist, which explains his frequent references to the importance of being able to sculpt and shape the face. Currently, he is a clinical instructor of plastic surgery at the University of Southern California.

Figure 1. This noninvasive facelift works by injecting the patient’s stem cells into key facial compartments so that the skin can begin to restore and repair itself naturally.

PSP: How did you get involved in stem cell research, and what prompted you to relate that to plastic surgery?

Ellenbogen: It was the natural course to take, really. My first article on fat grafting was in 1978 in Modern Plastic Surgery.

It was only recently that we discovered we were not only grafting fat, but we were also transferring stem cells. We noticed when we transferred the fat, there were a lot of changes in the complexion of the skin. The pores became closer together; the pigmentation was lighter; all the things which are generally done through external means or treatments—creams or chemicals, such as hydrocortisone, Retinae, and hydroxyl acids. We were seeing very similar effects without applying anything externally to the skin. In fact, what I used to call it before we discovered the stem cells is the “balloon effect.” I would put the fat into the face and noticed that the skin would get shinier, and [as] the writing on a balloon gets lighter the pigmentation on the skin would be lighter.

I worked with Dr Peter Rubin from the University of Pittsburgh, who is kind of the “guru” of stem cells. The balloon effect, now known as the Stem Cell Facelift, also causes the pores to become closer, and a tightening of the skin, which in turn creates skin that is more youthful in appearance.

PSP: How are the stem cells placed into the desired areas?

Ellenbogen: There are basically two ways to put stem cells into the face. Number one, the liposuctioned stem cells can be separated out of the fat cells and reinjected. There are some Japanese surgeons who have been injecting stem cells mixed with fat cells into breast tissue in order to attempt to “grow” more natural breast tissue.

Figure 2. Example of the Stem Cell Facelift with FFG to the cheeks.

Unfortunately, to this time, this has not been the case for them or for us as well. Consequently, we feel that possibly it is the separation of the stem cells from the fat cells that decreases their viability. Therefore, it [is] better to do as little extraneously to the stem cells as is necessary for their survival.

PSP: Are there “ideal” sites for liposuctioning the fat cells, or areas in which there is a greater concentration of stem cells present?

Ellenbogen: The highest concentration of stem cells is in the back fat, traditionally called the love handles. The stem cells are more stable in these more fibrous areas. There are about a million stem cells in 10 cc (milliliters) of liposuctioned fat.

PSP: With what ease are these stem cells harvested, and are there any pre-procedural preparations necessary for the client?

Ellenbogen: There is no special preparation necessary. There is about a 2-cm incision made into the love handle, and the fat cells are liposuctioned. It is generally well tolerated and heals quickly. Clients are very pleased.

Figure 3. Example of the Stem Cell Facelift with FFG to the cheeks, cheek hollows, and nasolabial folds.

PSP: Is the stem cell facelift a multistep procedure? Do the stem cells need to be separated from the less useful fat tissues/cells prior to being reinjected into the desired regions of the face?

Ellenbogen: With research, various options have been tried, and what has been found to be most effective is just to centrifuge the cells. Separating them from the other fat cells tends to decrease their viability, so techniques that involve separating or washing the cells have been abandoned. Instead, a minimalist approach is used in order to maximize the viability of the stem cells. The layer of fat that is centrifuged out is used to correct irregularities and create a well-proportioned face.

PSP: How do the risks and benefits of the stem cell facelift compare to those of a traditional facelift?

Ellenbogen: There are no increased risks of stem cell facelift versus traditional. There are, however, a significant number of benefits—both short- and long-term—to the stem cell facelift.

Injecting the liposuctioned fat, rich with stem cells, into the subcutaneous area requires no lifting of the SMAS (superficial musculoaponeurotic system), but has the same effect as stitching with a traditional facelift. In superficial areas of the cheek, fat grafting is done for symmetry.

Additional injections can be made into the nasolabial folds and, when injected underneath the eyes they can obviate the need to perform blepharoplasty. It allows for much contouring of the cheeks and under the eyes, as well as under the temporalis muscle.

The “take” of the fat and stem cells is excellent, and there are the added benefits, previously mentioned—of improved pigmentation, closer pores, and a better overall complexion. Because the stem cells are easily accepted, they act as a rejuvenator to the tissues already there. This results in skin with an overall younger tighter appearance. The benefits are excellent both long- and short-term and very rarely need touch-ups.

PSP: What about adverse effects or risk of rejecting the cells?

Ellenbogen: There really aren’t any issues with rejection. The most common adverse effect would be the potential for “lumpy” areas, subcutaneously, at the injection sites. However, this can be avoided by carefully applied pressure to the areas of injection. We can sculpt/shape the tissue quite vigorously after injection. Again, it allows for a much more natural appearance of the skin through the contouring and shaping of the cells injected.

PSP: Is the cost of a Stem Cell Facelift comparable to that of a traditional facelift, despite the need for the additional lipo procedure?

Ellenbogen: The cost is no more than a traditional facelift. The advantage is that with the Stem Cell Facelift, it includes a general tightening of the skin, better overall condition of the skin, and it is a process where we create a different contour and shape of the face. We can give the effect of high cheekbones and blepharoplasty with the fat/stem cell grafting.

PSP: How long have you been doing facelifts with fat grafting?

Ellenbogen: I have been doing the facelifts with fat grafting for 20 years. Facelift lipo-stem cell injections can be done with or without face lifting, and there are few risks. Actual injections of fat underneath the top layer of subcutaneous tissue lifts the face in a similar way that stitches would in a traditional facelift.

PSP: What, if any, special equipment might be needed to incorporate the Stem Cell Facelift in one’s practice?

Ellenbogen: It does not require any special equipment, only simple equipment readily available at any medical supply company. The Stem Cell Facelift is more about technique and philosophy.

PSP: How might President Obama’s efforts to lift restrictions on stem cell research affect your plastic surgery work?

Ellenbogen: While the field for embryonic stem cell research is wide open, the possibilities for regrowth of spinal cord, heart disease, and myocardial infarctions are endless. These are the most important things to society. The changes made by the President will not affect the research or use of stem cells in plastic surgery, because “we’re just the beauty guys.”

Connie Jennings is a contributing writer for PSP. She can be reached at [email protected].