Stem Cells At A Glance
- Best ResultsUnknown
- Treatment RecoveryNil to 7 days
- Procedure Time40 min
- Skin SpecialistDavin Lim, Dermatologist
- Duration of ResultsUnknown
- AnaestheticSedation, blocks, numbing
- Back to Work2-5 days
Stem Cells for Acne Scars
Stem cells are very early in development however the results are promising. Over the past 5 years there has been significant progress & understanding in the way stems are harvested, processed & re-injected into scar tissue. Stem cells have the promise of remodelling atrophic acne scars. In my practice I use both autologous stems (harvested from fat) & exogenous processed cells.
FactsFacts on Stem Cells for Acne Scars
- Stem cell therapy is still at its infancy of development
- Stems can be delivered from harvesting your own tissue
- ASC or adipose stem cells are harvested from fat
- Extraction, processing & injection of ASC is different from liposuction
- Enriched stems can be added to processed macro/micro fat
- PRP-Stems have been reported in the literature
- Stems & fat transfer maybe considered in moderate to severe atrophy
- 2-4 sessions are usually required
What is the theory behind stem cells therapy for acne scars?
Skin concerns such as altered skin texture, scarring, photo-aging & wrinkles can be largely eliminated by increasing the individual’s own stem cells. Repair from wounding is much more complex than just activating stem cells to repair damaged tissue (scars).
What is the current status of stem cells in the context of acne scarring?
We probably have 10 to 20 years to go before stem cell harvesting gives reproducible results. In the past 6 years, there have been significant breakthroughs in the way we understand ASC or adipose tissue stem cells. We now know that fat tissue contains millions of stem cells, about 20 to 50 fold more per volume than bone marrow.
These stem cells are termed pluripotent stems, in theory, they can differentiate to form fibroblasts. These cells produce collagen & elastin. Additionally, vascular tissue can be formed by endothelial cells. This cascade of regeneration can, in theory, fill in the holes of acne scars (atrophic scar tissue).
Cytokines, growth factors & other nutrients can be transferred within the harvested fat. These compounds can aid in wound remodeling & scar revision.
What is the difference between stem cell harvesting and fat transfer?
The current thinking (as of 2020) is that harvesting, processing & injecting autologous fat (from the same individual) for adipose stems, is different to fat transfer from liposuction. In the context of acne scar revision, the aim of autologous transfer include-
- Volumetric filling of atrophic tissue. This means a buffer or spacer to fill in the holes of atrophic acne scars. In most cases of significant atrophy there is fat loss, hence fat transfer or grafting can be effective. See the section on fat transfer for more information.
- Stem cell harvesting for pluripotent cells to remodel scar tissue. This harvesting technique is different from normal grafting as tissue has to be handled in a different manner. This fat is processed to nano fat (devoid largely of adipocytes), but rich in stem cells & growth factors. Other techniques include collagenase processing of harvested fat to yield a higher concentration of stem cells.
- This is then added to the mixture of harvested macro & micro fat, to form an enriched mixture of fat cells & stem cells. This mix is then injected into atrophic areas. This form of stem cell transfer can address adipose poor volumetric changes (fat cell injection) as well as dermal atrophy (lack of collagen, elastin & hyaluronic acid). Fat transfer itself is not ‘stem cell therapy’, you need a hyper concentration of adipose derived stems before the term ‘ stem cell therapy’ is given. This is science, not a marketing term.
Are the results from fat transfer & stem cell therapy predictable?
The problem with both fat transfer & autologous stem cell therapy is that the results are less predictable than dermal fillers. Undoubtedly the current state of knowledge yields much better results compared to when I first did fat transfer 12 years ago. The fact remains that even with meticulous processing, fat resorption rates of up to 65% can be seen. Additionally there have been a paucity of good studies beyond 1-2 years in the context of longevity.
Regardless of resorption rates, stem cell & adipose tissue transplantation still has a role in the management of moderate to severe atrophic scars. The reasoning behind this is that in some patients the volume of filler may exceed over 15 MLS. Costs play a big factor in the management of clinically significant atrophic scars
It is important to understand that scar revision largely relies on your own immune system to remodel scar tissue. If you can not remodel tissue, procedures like stem cell & adipose tissue can assist your immune system to repair scars. In those people who struggle with tissue remodelling, the only viable option is dermal fillers.
Everyone wants a permanent solution, including dermatologist & plastic surgeons. Our aim is to treat scars & then discharge patients. The fact remains that your results are largely reliant on your immune status. This can not be controlled by physicians.
What is PRP & is it the same as stem cell therapy?
PRP is a super easy procedure of taking your own blood, spinning it down (less than 10 minutes) then either sprinkling the solution on the wounds left from microneedling (or laser). In some cases, it is injected into your skin. The role of PRP is controversial. PRP has better evidence in the context of hair growth & joint therapy.
PRP does not contain stem cells, as it stands for platelet-rich plasma. PRP contains growth factors derived from platelets with a typical hyper-concentration of between 4.5 to 6.0 X.
I do not routinely offer PRP as I believe that it has only marginal effects on healing times & no added benefit in the context of revision of atrophy. I do believe that fat transfer gives better & more predictable results than PRP. I also know of the case reports of adding PRP to fat grafts for˜boosted results. Once again the level of good evidence for this technique is lacking.
If you feel inclined to opt for PRP with stems, let me know, as I do not routinely perform this procedure nowadays. (I used PRP for nearly every case of scar revision from 2014 to 2016 with the under and over technique. I do believe that heal is ever so slightly faster with PRP but the end results are not superior. Happy to discuss.)
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What are the factors to consider if you are contemplating stem cells for acne scars?
Predictability of correction is one of the most important factors in scar revision. As stated, even with meticulous care with stem cell extraction, processing & delivery, uptake is still not predictable, or at least not as predictable as dermal filler injections.
Good candidates for stem cell therapy & fat transfer include-
- Healthy adults
- Constant BMI- body weight
- Good diet, non-smoker
- Significant atrophy (volume depletion of approximately 3-5 ml of HA required for correction)
- Ability to understand the current scientific status of stems & fat transfer
- Ability to understand that multiple procedures (2-4) maybe required for optimal results
- Ability to understand that studies have not yet reached the data time log required to give predictable outcomes for everyone
When are dermal fillers preferable over stem cell or fat transfer?
Small volume deficits of 1-2mls can predictably be corrected with dermal fillers. Dermal fillers offer 1:1 or 1: 1X correction. The latter can be seen with collagen stimulating fillers such as Sculptra or Radiesse in a hyper-dilute solution.
What are other options for acne scars?
If scars are atrophic, chances are that one has many deep dermal & hypodermal tethering or attachments of scar tissue down to the fat layer. For this type of acne scarring I perform multi-level subcision (keyhole surgery of the face). This breaks the bonds, allowing release of scar tissue. If there is a significant amount of scar tissue, I may defer fat grafting till a later date as extensive subcision leaves a void of tissue that may be counterproductive to stem cell & adipose tissue uptake (arterial blood supply should be within 300 to 500 microns of vessels).
If you also have superficial scar patterns such as boxcar, pick, icepick & undifferentiated scars, I may also use nano-fat superficially to help remodel these scars, often in combination with lasers, peels or RF Microneedling.
What are biostimulatory agents & why do I rate them highly?
Biostimulation is the new buzz word for 2024. It means stimulation of your immune system to produce collagen. Biostimulants do this much more predictably than adipose stem cells.
Biostimulatory injectables include Rejuran S, PLLA, PDLLA, CAH & hybrid HA molecules.
Read more to understand how I use these agents for acne scars.
What are apple or plant stem cells?
These stem cells are derived, as the name suggests from apples. Marketed as a natural supplement, these stem cells are harmless. There is no scientific evidence that consumption of stem cells derived from plants can remodel scar tissue. Regardless, they are harmless & cost effective. Indonesian apple stems can be bought online for less than 50 USD.
If they don’t work, dig a hole in your backyard, plant some stems & you may very well have an orchard of trees in a few years time.
What are other stem cells that I use?
Calecim is a company based in Singapore that produces umbilical cord-derived stem cells. I have used this product extensively from late 2019 to the present date. There are several white papers & numerous case reports on the use of Calcium in the context of wound repair. In summary, papers show a marginal improvement in erythema or redness post-laser. It also has a high patient satisfaction rate.
I do not routinely offer exogenous stems as I personally do not think the science is quite there yet. The stratum corneum is a barrier for topicals (creams, gels, lotions, serums) & hence dermal penetration is limited. If you really want me to use this product, let me know. You have my thoughts on this.
Davin’s Viewpoint on Stem Cells and Acne Scars
This is a developing field of scar revision. When I performed fat transfer in 2008-2010 we had less than perfect results, mainly with unpredictable resorption. Additionally we were trying too hard to correct surface scars with macro fat. Not ideal as it lacked the finesse of low molecular weight hyaluronic acid dermal fillers. From 2011 to 2020 most scar revision experts transitioned to dermal fillers, including myself. Dermal fillers offer one standout characteristic over fat; predictability. This is what I call 1:1 or 1: 1X solutions. The latter is a reference to collagen stimulating fillers.
In the past few years we have re-explored fat as a natural source of stems & as a buffer-spacer filler. Extraction, processing & injecting techniques are very different. Regardless of progress, the predictability rate, though much better than 10 years ago, still remains less than dermal fillers. The pros and cons of fat stem cells & transfer will be discussed with you in detail following a clinical examination.
*As of 2024, Australia will have a host of new injectables known as biostimulants. This group of injectables have been shown to be a safe and effective treatment for atrophic acne scarring. They work in a very similar manner as stems, namely to upregulate cells that produce endogenous collagen. Read more to understand.
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