Tissue engineering offers future benefits to facial contouring techniques

Perhaps one of the most promising technologies under exploration is one that may literally change the face of aesthetic facial contouring. That is the realm of tissue engineering, specifically the percutaneous injection of tissue-engineered cartilage. One expert tells Cosmetic Surgery Times he believes it's only a matter of time until this approach becomes the gold standard in facial contouring.

CONTOURING APPROACHES "In the tissue-engineered cartilage technique, a small number of cells are taken from the patient, grown in culture, and then re-injected into the body to correct and sculpt facial contours," explains Michael J. Yaremchuk, M.D., a plastic surgeon in the Department of Plastic and Reconstructive Surgery at Massachusetts General Hospital, Boston, Mass. "This innovative approach allows the potential to use your own tissue, which then becomes incorporated into your body, avoiding the late problems seen with alloplast implants." Conventional facial contouring procedures utilizing alloplastic materials such as silicone, porous polyethylene or hydroxyappetite can carry with them the remote possibility of implant extrusion or infection. Furthermore, soft tissues change and remodel over time but alloplastic implants do not, which may bring about some contouring issues down the road.

In this type of tissue engineering, cartilage is harvested from the rib, nasal septum or ear, and then after culturing is relocated to the area where facial contouring is desired. This approach has the advantage of minimal donor site morbidity, while circumventing issues of tissue rejection as seen with other techniques. Donor site morbidity using this technique is minimal, Dr. Yaremchuk explains, because of the small amount of cartilage cells harvested.

Dr. Yaremchuk notes that engineered cartilage has already been used for resurfacing the knee joint. The technique is similar: cartilage taken from the patient is cultured and re-injected through an endoscope. But some experts question the true reason for the effectiveness of the procedure. The engineered cartilage may not be responsible for the positive effects seen, says Dr. Yaremchuk, but instead to the swelling, inflammation and formation of fibrous tissue, which result in some improvement on the joint surface.

FROM LAB TO PRACTICE Dr. Yaremchuk says that injecting cultured cartilage is still in its fledgling stages and much more research needs to be done. Most of the research to date has been done in the lab using immune-incompetent animals. Issues of inflammatory response in the host and the vehicle used now need to be addressed in more immune-mature animals.

"The future of this technique may lie in the way we transfer cells, which cells are best for grafting (e.g., from the rib vs. the ear) or possibly a breakthrough medication that could abrogate an early inflammatory response. Each of these issues can have its own implications and need to be sorted out in order to get this technique out of the laboratory and into clinical practice. We're aiming to sort these issues out within the next couple of years," he says. He adds that in humans, the approach can have limitations due to the amount of tissue available at the donor site. It can also be unpredictable due to the reliability of the graft.

"If you're going to inject engineered cartilage into someone's face, it is crucial to get it right from the start, especially because the procedure is permanent. No morbidity is the only option here," he emphasizes. Still, it may represent breakthrough as a minimally invasive — or less invasive — approach to augment and contour target areas for which adipose tissue is not suited.

"Many of the aesthetic problems that today require a surgical solution can potentially have an office-based solution in the future in the form of an injection instead of a classic surgery," Dr. Yaremchuk says.

For more information
Michael J. Yaremchuk M.D.; myaremchuk@partners.org