Cellular technologies in cosmetology

Yana Goncharova, Doctor of Medical Sciences, Professor of the Department of Dermatovenereology and Cosmetology of Donetsk National Medical University. M. Gorky, director of the aesthetic medicine clinic “Lege Artis” (Ukraine)
Oksana Selezneva, consultant physician at the International Center for Biotechnology "Biostem" INVH named after. V. K. Gusak of the Academy of Medical Sciences of Ukraine, curator of the program for the preservation of umbilical cord blood stem cells (Ukraine)

Wide range of possibilities
Of course, the use of cellular technologies is not limited to cosmetology; rather, it is a small but dynamically developing part of all the possibilities of this method.

The effects expected from the introduction of cellular material can be replacement (introduction of cellular mass of keratinocytes and fibroblasts into a burn wound or diabetic ulcer for the purpose of its epithelization), restorative (introduction of autologous stromal stem cells, pre-differentiated, into the cells of a diseased organ: heart, liver, pancreas, etc.), stimulating (introduction of fetal stem cells, platelet-rich plasma, fibroblasts).

Stem cells have found wide application in the treatment of the musculoskeletal system, burn disease, endocrine pathology, diseases of the blood, liver, heart, and nervous system. And this is not a complete list where, using cellular technologies, we have achieved an improvement in the patient’s quality of life, increased vitality and performance. And if we talk about the quality of life, then this is where the question of cosmetology arises, since a person wants not only to prolong his life, but also to remain healthy, active, with minimal external signs of aging on the skin.

Now we are at the next evolutionary stage of cosmetology, when we already know exactly how to make the most of injections of botulinum toxin and fillers, and have already come close to the essence of solving the problem of aging - cell rejuvenation.

In this regard, fibroblasts are one of the most interesting points of application of cellular technologies, since they provide the morphofunctional organization of the skin under normal conditions and in pathology, actively participating in restoring its integrity after damage, realizing both physiological and reparative histogenesis in the dermis. They also occupy a significant place in the system of neuroendocrine regulation of the skin, since they are capable of synthesizing biologically active peptides, hormones, neuropeptides, biogenic amines, etc. Dermal fibroblasts have androgen and estrogen receptors, through which they respond to hormonal influences, mediating the effect of sex hormones on human skin. Fibroblasts play a major role in the immune response, organizing connective tissue responses to infection or damage. Based on the above, it is dermal fibroblasts that should be the main point of application of therapeutic interventions for skin pathologies.

The safest option is to administer your own cells or products made from your own cells, such as your own fibroblasts or platelet-rich plasma. The logical question is, what kind of rejuvenation can we talk about if we end up introducing our own “old” cells? Answer: the cells, although old, are grown on an enriched nutrient medium

Fibroblasts are actively used to correct skin defects. The dermal equivalent can be represented as the result of the combination of a carrier and a culture of native or allogeneic fibroblasts. Fibroblasts together with keratinocytes are used to create a combined “skin analogue” and are successfully used in cambustiology. Huge research work is being carried out on the use of fibroblasts in such fields of medicine as urology, neurosurgery, cardiovascular, dentistry, etc., when “carriers” from various organic materials are populated with fibroblast cultures to obtain grafts for transplantation of various organs.

Accumulated experience

Now let's get back to cosmetology. In the process of aging of the body, a decrease in the total population of fibroblasts is observed (every year the number of active fibroblasts in the dermis decreases by approximately 1%), as well as a decrease in the production of collagen types 1 and 3, intercellular substance and hyaluronic acid, which is naturally a change qualitative and quantitative composition of the dermis.

As a result, the dermal layer becomes thinner, the level of moisture contained in it decreases, the skin stretches and becomes flabby. This is how wrinkles form. This happens especially quickly and noticeably in open areas of the body and in folds. In order to neutralize age-related changes, back in the 70s of the last century, aesthetic medicine began to actively practice injections of artificial collagen. The results were quite good, but they did not last long: three to six months. In addition, if the drugs were administered incorrectly, complications arose, or rather, defects: compactions and irregularities formed at the injection site. As a result, it was decided to look for ways and means of using natural collagen. At that time, there was already data from more than half a century of studying cell technologies, but the experience of growing individual cells was insufficient.

In 1997, the Isoladgen company created a drug with the same name and patented a method for restoring skin and soft tissue defects using fibroblast injections. Having carried out successful clinical trials, the technique began to be actively used: first in surgery - for the treatment of burns, long-term non-healing extensive wounds and other skin injuries requiring tissue regeneration; a little later in cosmetology - to get rid of acne; in anti-age therapy – for the correction of wrinkles and rejuvenation, as well as in trichology – for the treatment of alopecia. However, due to the discovery at the end of the twentieth century of such chronic and dangerous infections as viral hepatitis B and C, HIV/AIDS, and prion infections, the use of cellular technologies has been significantly limited.

The safest option is to administer your own cells or products made from your own cells, such as your own fibroblasts or platelet-rich plasma. The logical question is, what kind of rejuvenation can we talk about if we end up introducing our own “old” cells? Answer: the cells, although old, are grown on an enriched nutrient medium. In addition, the process of introducing biological material itself is already a good stimulation for the body. The rejuvenation program using our own fibroblasts, developed jointly with the Biostem laboratory and the Lege Artis clinic, including both preclinical and clinical studies, has demonstrated its safety and effectiveness.

Application in cosmetology

The indication for the introduction of one's own fibroblasts is a decrease in the firmness and elasticity of the skin - two functions of the dermis, which are indirectly, through the function of collagen and glycosaminoglycans, associated with the activity of dermal fibroblasts. Since the decline in fibroblast activity and a decrease in their number is associated in most cases with age-related changes, they are also the main indication.

The results expected from the procedure of introducing your own fibroblasts are an improvement in the firmness and elasticity of the skin. It is also worth noting the improvement in complexion, smoothing of fine wrinkles, improvement in the appearance of scars

Contraindications: pregnancy and lactation, systemic diseases, neoplastic processes. To exclude the above conditions, in addition to collecting medical history data, the necessary laboratory tests are carried out.

Stage I of the program: collection of material. It is performed in the area behind the ear using a punch biopsy under local anesthesia with lidocaine cream. Fresh biological material is immediately delivered to the cell and tissue culture laboratory, where, after preliminary preparation, the process of growing cells begins.

Stage II of the program: growing cells. Cell cultivation is performed using nutrient medium DMEM and F12 in a 1:1 ratio with the addition of 20% FBS (fetal bovine serum) and FGF (fibroblast growth factor). Culture flasks are placed in a CO2 incubator set to 37 °C and 5% CO2. For the purpose of scaling, the culture of dermal fibroblasts is passaged using solutions of Versene and trypsin. After obtaining the required number of cells (20 million), some of them are injected into the patient, the remaining cells are frozen in cryogenic media and placed in liquid nitrogen for long-term storage.

Stage III of the program: introduction of biological material. A suspension containing fibroblasts is injected intradermally using mesotherapy, mainly into problem areas of the face (wrinkles, scars). It is important how many cells we introduce. Based on our experience, the most optimal is from 3 to 5 million fibroblasts, the amount is determined microscopically in the laboratory itself. The frequency of procedures is once every 3 weeks. The number of procedures per course is 4–5.
At the end of the course of treatment, some of the cells can be stored in a cryobank. Thus, they can be activated at any time and the course of treatment repeated. Repeated procedures are recommended no more than once a year.

With an eye on the future

The results expected from the procedure of introducing your own fibroblasts are an improvement in the firmness and elasticity of the skin. It is also worth noting the improvement in complexion, smoothing of fine wrinkles, improvement in the appearance of scars. In this case, one should count not only on a quick effect, which can be explained by the irritating effect of the biological material, but also on a long-term one, due to the beginning of the functioning of that part of the fibroblasts that have “taken root” in the dermis. Of course, we can agree that similar effects can be expected from many other methods used by cosmetologists. However, none of them provides a direct increase in the number of their own fibroblasts due to their own, introduced from the outside. Although some of these fibroblasts undergo destruction, as shown in in vitro studies, the “debris” of such fibroblasts is a powerful stimulating biological material.
Of course, it would be incorrect to say that the introduction of cells can turn back time and solve the problems of aging. Moreover, when conducting cell therapy, we do not abandon traditional correction methods (injection of fillers, botulinum toxin injections, hardware cosmetology, etc.). However, it is the introduction of one’s own fibroblasts that makes it possible to rejuvenate the cellular composition and provide a real improvement in the condition of the main elements of the dermis. That is why fibroblasts have a huge application in regenerative medicine. This is a new step in the development of aesthetic medicine, allowing us to evaluate aesthetic dermatology as one of the areas of quality of life medicine.

First published: KOSMETIK international journal, No. 2/2012