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Liu B, Sood R, Wang F, Zhang F, Sun L, Qiu X, Zhao D, Lineaweaver WC. Principles and clinical applications of transcutaneous laser-assisted drug delivery: A narrative review. Scars Burn Heal 2024; 10:20595131241234715. [PMID: 38505821 PMCID: PMC10949547 DOI: 10.1177/20595131241234715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Introduction Transcutaneous laser-assisted drug delivery (LADD) is recognized as a developing therapy for skin disorders. Method Current literature was reviewed to summarize current applications for LADD. Discussion 12 clinical applications for this therapy are currently reported. Conclusion LADD has potential for wide application in skin disorder treatment. Lay Summary Laser assisted drug delivery improves drug bioavailability for treatment of skin disorders. This technique is being assessed clinically in disorders ranging from skin cancers to alopecia.
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Affiliation(s)
- Baoyi Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Rajiv Sood
- Burn and Reconstruction Centers of America Augusta, Augusta, GA, USA
| | - Fuyang Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Feng Zhang
- Burn and Reconstruction Centers of America Augusta, Augusta, GA, USA
| | - Lu Sun
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Xing Qiu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Dewei Zhao
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
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Wenande E, Chandra Gundavarapu S, Tam J, Bhayana B, Thomas CN, Farinelli WA, Vakoc BJ, Rox Anderson R, Haedersdal M. Local vasoregulative interventions impact drug concentrations in the skin after topical laser-assisted delivery. Lasers Surg Med 2022; 54:1288-1297. [PMID: 35593006 PMCID: PMC9675883 DOI: 10.1002/lsm.23558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The ability of ablative fractional lasers (AFL) to enhance topical drug uptake is well established. After AFL delivery, however, drug clearance by local vasculature is poorly understood. Modifications in vascular clearance may enhance AFL-assisted drug concentrations and prolong drug dwell time in the skin. Aiming to assess the role and modifiability of vascular clearance after AFL-assisted delivery, this study examined the impact of vasoregulative interventions on AFL-assisted 5-fluorouracil (5-FU) concentrations in in vivo skin. METHODS 5-FU uptake was assessed in intact and AFL-exposed skin in a live pig model. After fractional CO2 laser exposure (15 mJ/microbeam, 5% density), vasoregulative intervention using topical brimonidine cream, epinephrine solution, or pulsed dye laser (PDL) was performed in designated treatment areas, followed by a single 5% 5-FU cream application. At 0, 1, 4, 48, and 72 h, 5-FU concentrations were measured in 500 and 1500 μm skin layers by mass spectrometry (n = 6). A supplemental assessment of blood flow following AFL ± vasoregulation was performed using optical coherence tomography (OCT) in a human volunteer. RESULTS Compared to intact skin, AFL facilitated a prompt peak in 5-FU delivery that remained elevated up to 4 hours (1500 μm: 1.5 vs. 31.8 ng/ml [1 hour, p = 0.002]; 5.3 vs. 14.5 ng/ml [4 hours, p = 0.039]). However, AFL's impact was transient, with 5-FU concentrations comparable to intact skin at later time points. Overall, vasoregulative intervention with brimonidine or PDL led to significantly higher peak 5-FU concentrations, prolonging the drug's dwell time in the skin versus AFL delivery alone. As such, brimonidine and PDL led to twofold higher 5-FU concentrations than AFL alone in both skin layers by 1 hour (e.g., 500 μm: 107 ng/ml [brimonidine]; 96.9 ng/ml [PDL], 46.6 ng/ml [AFL alone], p ≤ 0.024), and remained significantly elevated at 4 hours (p ≤ 0.024). A similar pattern was observed for epinephrine, although trends remained nonsignificant (p ≥ 0.09). Prolonged 5-FU delivery was provided by PDL, resulting in sustained drug deposition compared to AFL alone at both 48 and 72 hours in the superficial skin layer (p ≤ 0.024). Supporting drug delivery findings, OCT revealed that increases in local blood flow after AFL were mitigated in test areas also exposed to PDL, brimonidine, or epinephrine, with PDL providing the greatest, sustained reduction in flow over 48 hours. CONCLUSION Vasoregulative intervention in conjunction with AFL-assisted delivery enhances and prolongs 5-FU deposition in in vivo skin.
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Affiliation(s)
- Emily Wenande
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - Sarat Chandra Gundavarapu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua Tam
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Brijesh Bhayana
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carina N. Thomas
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William A. Farinelli
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin J. Vakoc
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - R. Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Merete Haedersdal
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark
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Stompor-Gorący M, Machaczka M. Recent Advances in Biological Activity, New Formulations and Prodrugs of Ferulic Acid. Int J Mol Sci 2021; 22:ijms222312889. [PMID: 34884693 PMCID: PMC8657461 DOI: 10.3390/ijms222312889] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 01/18/2023] Open
Abstract
Trans-ferulic acid (FA) is a derivative of 4-hydroxycinnamic acid, which is found in many food products, fruits and beverages. It has scientifically proven antioxidant, anti-inflammatory and antibacterial properties. However, its low ability to permeate through biological barriers (e.g., the blood-brain barrier, BBB), its low bioavailability and its fast elimination from the gastrointestinal tract after oral administration limit its clinical use, e.g., for the treatment of neurodegenerative diseases, such as Alzheimer's disease. Therefore, new nanotechnological approaches are developed in order to regulate intracellular transport of ferulic acid. The objective of this review is to summarize the last decade's research on biological properties of ferulic acid and innovative ways of its delivery, supporting pharmacological therapy.
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Affiliation(s)
- Monika Stompor-Gorący
- Department of Human Pathophysiology, Institute of Medical Sciences, University of Rzeszow, Kopisto 2a, 35-959 Rzeszów, Poland;
- Correspondence:
| | - Maciej Machaczka
- Department of Human Pathophysiology, Institute of Medical Sciences, University of Rzeszow, Kopisto 2a, 35-959 Rzeszów, Poland;
- Department of Clinical Science and Education, Division of Internal Medicine, Södersjukhuset, Karolinska Institutet, 11883 Stockholm, Sweden
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Souto LRM, Souto MPA. Invited Discussion on: Treatment of Scars with Laser-Assisted Delivery of Growth Factors and Vitamin C: A Comparative, Randomised, Double-blind, Early Clinical Trial. Aesthetic Plast Surg 2021; 45:2375-2378. [PMID: 33973049 DOI: 10.1007/s00266-021-02303-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
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Oliveira GV, Metsavaht LD, Kadunc BV, Jedwab SKK, Bressan MS, Stolf HO, Castro RG, Bezerra SMFMC, Calil DA, Addor FAZ, Fraga JCS, Reis CMS, Reis-Filho E, Silva MR, Ramos-E-Silva M, Hexsel DM. Treatment of keloids and hypertrophic scars. Position statement of the Brazilian expert group GREMCIQ. J Eur Acad Dermatol Venereol 2021; 35:2128-2142. [PMID: 34263958 DOI: 10.1111/jdv.17484] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/31/2021] [Indexed: 12/23/2022]
Abstract
Keloids (K) and hypertrophic scars (HS) are abnormal responses to wound healing that occur as the result of dermal inflammation. Despite the advances on their treatment, many patients still suffer from the negative effects of excessive scarring; its approach is impaired by the lack of objective data on different treatments and the large genetic variability among patients and the difficulties in producing multicentre studies. Their incidence among the Brazilian population is high, as the result of an admixture of Amerindians, Europeans and Africans ancestral roots. With the aim of producing multicentre studies on K and HS, a panel of senior Brazilian dermatologists focused on their treatment was invited to contribute with the K and HS Treatment Brazilian Guidelines. In the first part of this study, different treatment modalities for keloids and HS are fully reviewed by the panel. The second part of the study presents a consensus recommendation of treatment for different types of lesions. More than a literature review, this article aims to show the pitfalls and pearls of each therapeutic option, as well as a therapeutic approach by the Panel of Experts on keloids and Scars on a highly mixed population, providing simple guidelines.
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Affiliation(s)
- G V Oliveira
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Mario Penna/Luxemburgo Hospital, Keloids and Scars Ambulatory, Belo Horizonte, Brazil
| | - L D Metsavaht
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Santa Casa de Misericórdia, Rio de Janeiro, Brazil
| | - B V Kadunc
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Surgical and Cosmetic Dermatology, São Paulo, Brazil
| | - S K K Jedwab
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Skinlaser Director, São Paulo, Brazil
| | - M S Bressan
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Maura Bressan Dermatology, Campinas, Brazil
| | - H O Stolf
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,UNICAMP, Campinas, Brazil
| | - R G Castro
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Brazil
| | - S M F M C Bezerra
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Federal University of Pernambuco, Recife, Brazil
| | - D A Calil
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Brazilian Society of Dermatology, São Paulo Session, São Paulo, Brazil
| | - F A Z Addor
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Albert Einstein Hospital, São Paulo, Brazil
| | - J C S Fraga
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Military Hospital, Belo Horizonte, Brazil
| | - C M S Reis
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Dermatology Residency Program, ESCS-DF, Brasilia, Brazil
| | - E Reis-Filho
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Dermatology Residency Program, ESCS-DF, Brasilia, Brazil
| | | | - M Ramos-E-Silva
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Dermatology Residency Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - D M Hexsel
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,International Society for Dermatologic Surgery (ISDS), Hexsel Dermatology Clinics and Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil
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Management of facial burns: an update. Curr Opin Otolaryngol Head Neck Surg 2021; 29:299-303. [PMID: 34183560 DOI: 10.1097/moo.0000000000000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews literature on the recent progress made on management of facial burns. The discussion focuses on those aspects of the management in which recent studies brought new ideas, and reviews some that failed to change practices in the management of facial burns. RECENT FINDINGS Recent innovations and models have been proposed in an attempt to reduce the incidence of unnecessary intubations in patients with burns to the face and with suspected inhalational injury. However, the decision to secure the airway is still a challenging one. A new escharotomy method based on facial subunits principles has been described, while the practice of early tangential excision is still debated in the literature. Tarsorrhaphy without occluding the eyes has also been described in the management of peri-oral burns. Self-retaining and expandable stents for the nose have also been demonstrated to be effective in preventing nasal stenosis. 3D printed face masks have been more recently developed to improve the current wound-care methods used in facial scar management. SUMMARY This article highlights recent developments in the management of facial burns in areas such as acute facial burn care, subsequent wound care and facial scar management. It highlights areas wherein progress has been made, as well as the need for further studies in certain areas.
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Hong EM, Pham TT, Seo S, Moy WJ, Borden P, Hansen K, Kim S, Mo JH, Wong BJF. Electrochemical Therapy of In Vivo Rabbit Cutaneous Tissue. Laryngoscope 2021; 131:E2196-E2203. [PMID: 33666252 DOI: 10.1002/lary.29461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/12/2021] [Accepted: 02/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To examine the acid-base and histological changes in in vivo rabbit cutaneous tissue after electrochemical therapy. STUDY DESIGN In vivo rabbit tissue study. METHODS The shaved skin on the backs of female Oryctolagus cuniculi were assigned to treatments with or without tumescence with normal saline. Two platinum-needle electrodes were inserted into each treatment area and connected to a direct current (DC) power supply. Voltage (3-5 V) was varied and applied for 5 minutes. The wound-healing process was monitored via digital photography and ultrasonography until euthanasia at day 29. Treatment areas were biopsied, and specimens were sectioned through a sagittal midline across both electrode insertion sites. Samples were then evaluated utilizing light microscopy (hematoxylin and eosin, Masson's Trichrome, and Picrosirius red). RESULTS Treatment sites developed mild inflammation that dissipated at lower voltages or became scabs at higher voltages. Ultrasonography demonstrated acoustic shadowing with spatial spread that increased with increasing voltage application. The 4- and 5-V sites treated with saline had localized areas of increased tissue density at day 29. Although specimens treated with 3 V did not look significantly different from control tissue, 4- and 5-V samples with and without saline tumescence had finer, less-organized collagen fibers and increased presence of fibrocytes and inflammatory infiltrates. CONCLUSIONS Electrochemical therapy caused localized injury to in vivo rabbit cutaneous tissue, prompting regenerative wound repair. With future development, this technology may offer precise, low-cost rejuvenation to restore the functionality and appearance of dermal scars and keloids. LEVEL OF EVIDENCE NA Laryngoscope, 131:E2196-E2203, 2021.
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Affiliation(s)
- Ellen M Hong
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Tiffany T Pham
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Soohong Seo
- Department of Dermatology, Korea University Anam Hospital, Seoul, South Korea
| | - Wesley J Moy
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Pamela Borden
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Kyle Hansen
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Sehwan Kim
- Department of Biomedical Engineering, School of Medicine, Dankook University, Cheonan, Republic of Korea.,Beckman Laser Institute Korea, Dankook University, Cheonan-si, Chungnam, Republic of Korea
| | - Ji-Hun Mo
- Beckman Laser Institute Korea, Dankook University, Cheonan-si, Chungnam, Republic of Korea.,Department of Otorhinolaryngology, School of Medicine, Dankook University, Chenoan, Republic of Korea
| | - Brian J F Wong
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California-Irvine, Irvine, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, School of Medicine, Orange, California, U.S.A
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Ragab SEM, Nassar SO, Morad HA, Hegab DS. Platelet-rich plasma in alopecia areata: intradermal injection versus topical application with transepidermal delivery via either fractional carbon dioxide laser or microneedling. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fernandez-Gonzalez P, Vitale M, Truchuelo MT. Early and maintained application of the secretion of Cryptomphalus aspersa (SCA) 40% improves cutaneous healing after ablative fractional laser in skin aging. J Cosmet Dermatol 2020; 20:1140-1145. [PMID: 32929855 PMCID: PMC8048427 DOI: 10.1111/jocd.13720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ablative fractional laser generates a regulated skin damage, which secondarily improves skin aging. AIMS The main objective of the present study was to figure out if the adverse effects induced by laser and the skin recovery could improve with the application of a cosmetic product based on the secretion of Cryptomphalus aspersa (SCA). PATIENTS/METHODS A prospective double-blind controlled study with vehicle in 10 patients with skin aging. The patients received one session of fractional ablative CO2 laser, and the formulation with SCA 40% was applied immediately and maintained throughout the 21-day duration of the study. The active treatment (SCA) was applied to one hemifacial area and vehicle to the other, and the patient acting was her own control. Clinical evaluations, dermoscopy, photography, and other parameters like cutaneous hydration, elasticity, and wrinkles were evaluated. In addition, the severity of the adverse effects was evaluated. RESULTS Significant greater decrease in the density of microcolumns produced by laser was detected on the active-treated side, indicating greater and faster postprocedure recovery compared to the vehicle-treated side. In addition, side effects were reduced and some antiaging effects were more apparent on the side treated with SCA 40%. CONCLUSION SCA 40% applied immediately after ablative laser, and during the next days, it can accelerate laser-induced damage regeneration. In addition, SCA improves the cosmetic outcome after laser application.
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Affiliation(s)
| | - Maria Vitale
- Medical Department of Cantabria labs at Madrid, Madrid, Spain
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Wolf DA, Beeson W, Rachel JD, Keller GS, Hanke CW, Waibel J, Leavitt M, Sacopulos M. Mesothelial Stem Cells and Stromal Vascular Fraction for Skin Rejuvenation. Facial Plast Surg Clin North Am 2018; 26:513-532. [PMID: 30213431 DOI: 10.1016/j.fsc.2018.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The use of stem cells in regenerative medicine and specifically facial rejuvenation is thought provoking and controversial. Today there is increased emphasis on tissue engineering and regenerative medicine, which translates into a need for a reliable source of stem cells in addition to biomaterial scaffolds and cytokine growth factors. Adipose tissue is currently recognized as an accessible and abundant source for adult stem cells. Cellular therapies and tissue engineering are still in their infancy, and additional basic science and preclinical studies are needed before cosmetic and reconstructive surgical applications can be routinely undertaken and satisfactory levels of patient safety achieved.
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Affiliation(s)
- David A Wolf
- Johnson Space Center, Houston, TX, USA; EarthTomorrow, Inc, 1714 Neptune Lane, Houston, TX 77062, USA; Purdue University, West Lafayette, IN, USA
| | - William Beeson
- Facial Plastics, Indianapolis, IN, USA; Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | | | - Gregory S Keller
- Facial Plastics, Santa Barbara, CA, USA; Facial Plastics, Los Angeles, CA, USA
| | - C William Hanke
- Dermatology, Indianapolis, IN, USA; Laser and Skin Center of Indiana, 13400 North Meridian Street, Suite 290, Carmel, IN 46032, USA; ACGME Micrographic Surgery, Dermatologic Oncology Fellowship Training Program, St. Vincent Hospital, Indianapolis, IN, USA; University of Iowa-Carver College of Medicine, Iowa City, IA, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jill Waibel
- Dermatology, Miami Dermatology and Laser Institute, 7800 Southwest 87th Avenue, Suite B200, Miami, FL 33173, USA; Baptist Hospital of Miami, Miami, FL, USA; Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Matt Leavitt
- Dermatology, Orlando, FL, USA; Advanced Dermatology and Cosmetic Surgery, The Hair Foundation, 260 Lookout Place Suite 103, Maitland, FL 32751, USA; University of Central Florida, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA; Nova Southeastern University, 4850 Millenium Boulevard, Orlando, FL 32839, USA
| | - Michael Sacopulos
- Medical Risk Management, Medical Risk Institute, 676 Ohio Street, Terre Haute, IN 47807, USA
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