New Research Areas Around Minimizing Scars For Cosmetic Surgeries?

New technologies are promising to be able to reduce the most visible after-effects of surgical cosmetic procedures, scarring.

The ability to truly reduce or eliminate scarring after surgery would be a godsend for surgical procedures where scars are visible. The scars are always a negative for the patient and they can become a focus that lessens the results that the surgery actually delivered. The current crop of lotions and potions have some effect, but some form of aggressive wound healing that minimized or eliminated scars would be an optimal outcome for any procedure.

In the article by published last year in the Science magazine, a research team found that they were able to reprogram fat from myofibroblasts by signaling it with the Bone Morphogenic Protein (BMP), which promote growth. In their study, they were able to find a way in regenerating fat from myofibroblasts in adults. The researchers observed that growth of hair follicles was indicative of adipocyte regeneration, which is what most of their findings resulted.  They noticed that adipocytes grew around the area where hair follicles appeared. 

If it were easy to execute, it could definitely change how aesthetic surgeons can treat scarring in patients.

There is an abundance of research on wound healing in the plastic surgery field. Possibly getting some insight from Plikus et al.’s research, aesthetic physicians and surgeons can be guided into finding a way to signal the BMP receptor, they can benefit greatly in using the approach so they could minimize the risk of acquiring a scar after the surgery and turn it into fat instead. In this manner, the adipocytes might be easier to treat as compared to the scars.

Plastic surgeons employ different techniques to minimize the scarring on the areas in which the incision was made. Silicone sheeting is one of the most popular techniques in minimizing scarring in the area. Another technique is to use corticosteroids (Janis and Harrison, 2014).

There have been many cases that examined treating wounds through methods such as laser resurfacing and injections. These two alternatives do help in accelerating wound healing, with botulinum toxins even enhancing the appearance of scars. Dermal fillers also have been seen to have regenerative properties, which could help in the process of healing.

As of the moment, the research team responsible for converting myofibroblasts to fat cells have yet to test their findings out on humans, but they were able to relate it to what they saw on the mice. It would definitely be groundbreaking especially in the field of aesthetic medicine. For now, it is up to the aesthetic physician to educate the patient how to treat their scars.

References:

• https://insights.ovid.com/pubmed?pmid=24469191
• http://science.sciencemag.org/content/355/6326/748.long

The U.T. Zerona low level laser Study... A Pig is NOT Just a Pig!

I'd like to issue a rebuttal critique, if I may, regarding the University of Texas study on the ZERONA low level laser entitled the "Effect of Low-Level Laser Therapy on Abdominal Adipocytes before Lipoplasty Procedures".

I know there has been a tremendous amount of skepticism regarding this technology and I just want to share with you my thoughts, as fellow colleagues. If anything, it is continuing the valuable discussions we have here in our group that compels me to write this.

If you are not familiar with this study, it involved the use of a swine model. This is an area I am most proficient with. I was a veterinary technician before I became a nurse. I used to run the "pig labs" for clinical research and physician training for a major medical device company and have much experience in 510K clinical trials and was well regarded as a swine expert. I tell you my background only to hope you find validity in my critique.

My biggest problem is with the 300 lb.Yucatan pigs they used in the study. There are many categories of swine for use in experimental procedures and research with some being favored for one reason or another. The more proper Yucatan pig to use for any transdermal study is a Yucatan micro-pig (about 30 pounds) which has a skin thickness similar to that of human skin, and they are relatively hairless. This breed of pig was specifically bred in the swine labs at the Colorado State University in 1978.

I'm not certain as to why these researchers decided to use 300 pound Yucatan pigs with their incredibly thick skin and coarse hair. Perhaps they thought a pig was a pig. Perhaps they wanted to see if the Erchonia laser could penetrate steel... perhaps they know something about research pigs I don't My point is, there is more to this study than what seems to be "obvious" to some.

Here are two famous references I can direct you to to validate my statement that they used an inappropriate swine model:

1. Comparisons of in Vitro Nitroglycerine (TNG) Flux Across Yucatan Pig, Hairless Mouse, and Human Skins. Journal of Pharmaceutical Research. Springer Netherlands, publisher. ISSN: 0724-8741, Vol 7, Number 6. June 1990.

2. Fujii M, Yamanouchi S, Hori N, Iwanaga N, Kawaguchi N, Matsumoto M. Evaluation of Yucatan micropig skin for use as an in vitro model for skin permeation study. Biol Pharm Bull 1997 Mar; 20(3):249-54.

My other problems with the study include:

1. The pig underwent one ZERONA session, not the standard protocol of 6 (3 a week for 2 weeks).

2. No flushing niacin or any substantial vasodilator was used to facilitate fat transferral out of the interstitial space.

3. The Erchonia lasers were positioned 12 inches above the skin when they shouldn't be any further away than 6 inches.

4. The pig was immediately euthanized on the operating table after the single treatment. How are the adipocytes supposed to render any changes in morphology if the host is dead?

Clinical studies are always under scrutiny and this study is no exception. I'd bet a guess that you will start seeing more positive reviews of the ZERONA low level laser in the months to come. And, I base this on the sheer science of the technology. Only time and true trials of the device will tell.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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