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I Want To Be A Fibroblast!

medical spa md fibroblastWhat criteria is most important when choosing a treatment or technology to stimulate fibroblasts for skin rejuvenation?

Being a dermatologist focused on aesthetic treatment options for improving skin's condition  it's quality and overall appearance I clinically and scientifically overlook tons of different approaches.

Basically, and I think we can agree on this, many treatments try to target the fibroblast. Its about the stimulation of this branched tissue cell who's function is to maintain the structural integrity of connective tissues by continously secreting precursors of the extracellular matrix such as ground substance, a variety of fibers notably the reticular and elastic ones and cytokines.

The goal in many skin rejuvenation treatments is to activate and stimulate the fibroblasts... and there are countless strategies to do this: You might choose chemical peels, energy based devices such as non-fractionated or fractionated resurfacing lasers, intense pulsed light (IPL), infrared light or radiofrequency. One might think of dermal filler substances such as hyaluronic acid or – better – calciumhydroxylapatite (there are even publications on a stimulating effect botulinum toxin type a...). Further one might consider microneedling, dermabrasion, etc..

Or think about "newer" technologies such as platelet rich plasma, carboxytherapy, nitrogen plasma energy, kinetic HA (kinetic Hyaluronic Acid). And last but not least cosmeceuticals (this list is not exhaustive!!).

Which strategy to choose? It's actually very difficult to find way through this jungle!

I would like to encourage and activate the discussion here and ask for your opinion: What are the most important criteria for you when you do your choice? Is it about mangeability, about downtime, about scientific proof, about safety, about treatment protocols (such as e.g. multiple treatments), about clinical experience of other physicians, about availability, about the learning curve, about the deligability, about the costs?

What's your decision maker here?

Reader Comments (8)

I think that the primary decision maker is really: outcome / cost of treatment. It's not a linear progression either. The "lotions and potions" that are sold over the counter can overlap with the expense of medical treatments. There's also a barren wasteland of information that is disseminated to physicians except a the researcher levels. I would love to find a matrix that is not put out by one of the technology companies that actually compares various treatments. (Noting of course that many treatments are 'stacked' for increased effectiveness.)

This is a great topic for discussion by the way and I hope others will weigh in with their thoughts. I don't have experience with some of the newer tech that's coming out and would love to hear from those who do.

07.29 | Unregistered CommenterDermgal

"platelet rich plasma, carboxytherapy, nitrogen plasma energy, kinetic HA (kinetic Hyaluronic Acid)"
I feel so out of the loop with some of these, but I am ecstatic to find a community that both knows about these newer therapies and is willing to share that information with us less fortunate lugs who have our heads down grinding out a living.
(I have been looking at "microneedling" since it's so low cost to deliver but I haven't decided to add it to the menu yet.)

07.29 | Unregistered CommenterShelly DO

I've been offering microneedling with the rollers for the last five years but it's never really taken off the way that fractionated lasers have. (Perhaps due to the fact that the treatment itself is pretty nasty looking.) Fractional lasers are effectively doing the same thing but since it's a cleaner 'technology' and not perceived as a 'meat tenderizer' patients are much more accepting of it, even though the technology-type of solution is about a thousand times more expensive to get in to. It's this kind of decision making that reminds me that we're really in the perception business.

I would also like to hear from those working with platelet rich plasma, carboxytherapy, nitrogen plasma energy, or kinetic HA treatments. Some of the stem cell stuff looks interesting too.

07.29 | Unregistered CommenterAaron MD

What a great topic for discussion! To answer the question, "what would be the decision maker for me", I would choose safety, treatment outcome and long term benefits. I am surprised that hard chamber hyperbaric oxygen therapy was left off of the list of treatments that stimulate the proliferation of fibroblasts. Among the many benefits of hard chamber HBOT is that it stimulates the proliferation of fibroblast and endothelial cells and it continues to do so for up to 72 hours after the treatment time. It also stimulates the body's own production of stem cells by 16 fold, it completely hyperoxygenates every cell in the body during treatment time starting a healing process where there would be none, it works in synergy with other medications, it is very safe, and it provides long term benefits for the entire body.

07.29 | Unregistered CommenterKelly

Ok, I'll be the first to say cost... I'm generally more inclined to choose treatments that have very high margins and lower consumable costs. After that it would be patient satisfaction.

07.30 | Unregistered CommenterAaron MD

A general discussion is great but I'd really be interested in what Dr. Zenker thinks of each of these since she's actually researching them. @Dr. Zenker, How about that?

Dear colleagues, I think in this matter ''marketing is everything''. The more companies make advertisement, the more patients strongly believe in those procedures. As doctors we should not depend on the adds.
I have over ten years experience in medical esthetic field. I try to treat my patients with a great care. I prefer to perform the procedures which are more efficient and make less harm.
Even needling of the skin without any medical substance stimulates fibroblasts. We have to be sure that those technologies which companies try to sell do effect stimulation over 50-100% or more than needling. Other wise you cannot offer it to a patient considering the possibility of side effects.

I use a technology or a procedure depending on what my patients need and their expectations. The greater is expectation, the bigger is risk to get some harm. I tell all naked truth before I perform the procedure. The mechanism should had to be proven and written in medical books not just in studies have to be done by those companies which sells products. Physics, physiology, pharmacology, histology does not change so fast.

New doctors who wishes to enter this field try to get the newest technologies and make their own adds based on those machines. Please, do not forget that ''it is not the oven, it is cook who makes the meal''.

08.3 | Unregistered CommenterD D

Haven't run across this in my area yet. Sounds both promising and a way to differentiate. The "cook may make the meal" but you want to have a good oven too.

09.4 | Unregistered CommenterReMD

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