Introducing Regenerative Medicine to the Aesthetic Practice

Cameron Chesnut, MD, a facial plastic surgeon in Spokane, Wash., says regenerative medicine is evolving, and many physicians are either interested in or already incorporating it into their practices.

In his presentation, “Optimizing Outcomes and Recovery with Regenerative Medicine,” at this year’s virtual annual meeting of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), Dr. Chesnut discussed regenerative medicine in terms of areas of promise, scientific hurdles, safety, risk, the FDA, and advertising considerations for platelet-rich plasma (PRP), platelet-rich fibrin (PRF), adipocytes, mesenchymal stem cells, wound healing, fat grafting, and more.

“Technically PRP is regenerative medicine, a lot of people are utilizing that in their practice, so what are the next levels? What does that mean? That's where you get into the PRFs and the stem cells and autologous versus allogeneic stem cells—all these kinds of different options that exist,” says Dr. Chesnut.

Practicing Regenerative Medicine

Dr. Chesnut says he uses regenerative medicine in his practice every day. It has broad application, from wound healing to hair restoration and post-procedural recovery.

“The more change that there is to have, the more that regenerative medicine can really shine,” says Dr. Chesnut, who emphasizes the benefits of being able to offer patients both better results and less downtime.

“And so one of our objectives is to use regenerative medicine to decouple that very direct relationship a little bit and decrease downtime while still being able to be as aggressive or get those same surgical results. And if we can improve the results that we're getting at the same time that we're decoupling the downtime, even better.”

Update on the Science

A lot of the available data available is in vitro, says Dr. Chesnut.

“We know what defines a stem cell based off of surface markers and how that cell behaves.”

Thus, fat and bone marrow are both accessible and excellent sources for aesthetic physicians, he says.

“So there's that type of science. That's just defining what they are and what they do,” says Dr. Chesnut.

But what does it mean when these stem cells are used as a regenerative or rejuvenative modality? What’s going to happen?

“That's where things get a little bit trickier and that's harder to study because a lot of us know that with fat transfer, even years later we see improvements that we wouldn't have expected,” he says, for example, changes to overlying skin.

Such skin changes are the result of a stem cell-released paracrine effect that changes the surrounding tissues over time, but this is still not clearly defined, he says.

“We have ideas as to what's happening, but exact mechanisms are still out there.”

And it’s the same with PRP, a very basic regenerative medicine modality. It may have incredible growth factor capacity, but PRP changes based on nutrition, hydration, medications and more.

“It's difficult on a real-life scenario to say what something like PRP is doing on a consistent level because my PRP is changing, let alone how it's physiologically interacting with my tissue.”

NEXT: PRP, Stem Cells & Regulation