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Friday, November 18, 2005

Colorado Springs, Colo. -- From advances in cell membrane regeneration to the expansion of cosmetic filler options, the list of breakthroughs from which physicians are or soon will be benefiting is staggering. Nevertheless, one always must separate salesmanship from science.

Among the most exciting developments for is technology that exploits regeneration biology. It likely will change the way physicians repair tissues, according to Rod J. Rohrich, M.D., professor and chair man, , University o f Texas Southwestern Medical Center, and president of the American Society of Plastic Surgeons (ASPS).

With this technology, he says, "nerve axions could actually be healed so that you can truly repair nerves and eventually allow patients to regain function from their nerve and even spinal cord injuries. If you can control how wounds heal, you can potentially eliminate scarring and fibrosis. That will be a huge arena for burn surgery, trauma surgery and cosmetic surgery. That's an arena in wound healing that s here to stay, wherein we will be able to eventually regenerate some body parts via gene regulation. These advances could happen in our lifetime, possibly within seven to 10 years."

In the stem cell area, undifferentiated stromal cells show equally breathtaking promise for future research. They can be transformed into virtually any kind of cell, from bone marrow and nerves to organ and muscle tissue.

The profusion of fillers now or soon to be available, on the other hand, is more of a mixed bag. For example, Sculptra (poly-L-lactic acid; Dermik Laboratories), approved by the U.S. Food and Drug Administration (FDA) for use in patients with altered immune systems, will be used off-label for normal patients.

As a moderate-to-long-term filler, Dr. Rohrich says, "it may last several years. But there may be some problems with granulomas and how it interacts with patients with normal immune systems. There are pending studies to assess the long-term effects of this filler."

Later this year, Artecoll/ArteFill (polymethylmethacrylate; Artes Medical) could reach the U.S. marketplace. Already, it has earned FDA panel approval for nasolabial fold augmentation. Radiesse (formerly Radiance; calcium hydroxyapatite; BioForm Medical), he adds, holds promise for long-lasting augmentation of nasolabial folds if properly injected.

"One must exercise caution when using it in the lips because of the potential for long-term nodularity," Dr. Rohrich tells Cosmetic Surgery Times. "My overall recommendation for these longer lasting, almost-permanent fillers is that permanent fillers can end up with permanent problems. So you need to be very careful about that."

He recommends a similarly skeptical approach to radiofrequency ablative technologies, at least for now. "What's lacking here is long-term follow-up with consistent data from multiple studies done by centers that have not had a financial relationship with these devices," he says.

In similar fashion, the jury is still out regarding Aptos thread (Kolster Methods) lifts involving barbed sutures.

He says, "The use of these self-anchoring barbed sutures potentially has some advantages. However, I have concerns about whether it will really work long-term. Will it stretch through the tissue?"

Dr. Rohrich takes a critical view of diode laser-assisted liposuction, a technique upon which he and his colleagues recently reported (Plast Reconstr Surg. 2004 May; 113 (6): 1796-1804). Previous research suggested the laser could boost liposuction results.

However, he says, "when we performed experiments and a clinical study, it didn't have a beneficial effect. Its application in is questionable."

Likewise, Dr. Rohrich says physicians should be wary of mesotherapy, a method that, theoretically, helps patients by injecting a wide variety of homeopathic remedies, vitamins, minerals and antioxidants through several hundred individual injection sites.

"It's never been proven by any known scientific study," he says. "There are inconsistent formulas, and it borders on human experimentation because there's no good data from peer-reviewed studies comparing it to a placebo"

Dr. Rohrich also warns against using fillers and other treatments that have no FDA-approved indications (in contrast to off-label applications of FDA-approved materials) outside of FDA-controlled clinical trials.

Conversely, he believes noninvasive fat removal will provide cosmetic surgeons with a pleasant surprise. This technology works via focused ultrasound, allowing physicians to remove small amounts of fat by running a transducer over patients' skin.

"In multiple sessions" Dr. Rohrich says, "one can potentially reduce up to 500 cc in one session. That's really going to be exciting. The key is tissue selectivity, which allows you to melt the fat without harming the skin. If it really does do that, then you could potentially perform mild to moderate body contouring without surgery." Equipment now being tested for this purpose comes from UltraShape (Tel Aviv, Israel) and LipoSonix (Bothell, Wash.).

Disclosure: Dr. Rohrich reports no financial interests related to this article. His presentation was sponsored by a joint emerging trends committee of the Aesthetic Society Education and Research Foundation (ASERF) and the Plastic Surgery Educational Foundation (PSEF).

Dr. Rohrich is chair of the Innovative Technology Committee of the ASERF. Dr. Leroy Young chairs the PSEF Emerging Trends Committee.

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