날짜: 2014.4.26-4.27 학회: 대한미용외과학회 -Hip Rejuvenation Using Injectable Barbed Threads and Squeezed Fat Tissues. / Minimally Manipulated Ex Vivo Stem Cell Proliferation Methods as a Medical Procedure. Hip Rejuvenation Using Injectable Barbed Threads and Squeezed Fat Tissues.
Lee, Hee Young M.D., Yang,
Hyun Jin M.D., BaroYL & Kangnam Plastic Surgery. Seoul, Korea
Gluteal
rejuvenation surgeries are usually performed for vertical level elevation.
Deciding the elevation point of hip lifting from the ground in a standing
position is never easy because of its weights and strong muscle movements. There
are several methods available for hip lifting. Non-absorbable suspensory PTFE
strings like Goretex™ or poly-propylene meshes are often used for lifting
effects, although they have possibilities of stiffness and abrupt loss of
effects. Otherwise, in most cases, simple volume augmentations with implants or
fat graft are easier methods for true and relative lifting effects. However, we
find that both actual suspension and volume replacement are all required in
most cases. For
suspensory structures, we use extremely thick barbed threads ranging from 5 to
15cm, with 0.6mm diameter, #2 USP. We choose between polydioxanon absorbable threads
or polypropylene non-absorbable threads for the actual suspension. Threads are
pre-filled in 19 gauge needles (MISJu™) for easy and rapid performances. Each
thread can resist around 4 kg, which means 20-30 threads can easily build up 100
kg suspensory structure on one side within 10 minutes. Then, fat tissues are
injected meticulously for volume. One importance is to observe and determine the
level of effects during the surgery. Good results are never made with merely instruments
and materials. First,
we design and mark the harvesting and injection areas on the skin in a standing
position. Then, we harvest fat according to the design. The harvested fat is
squeezed to remove water and drugs, blood, free oil, and to destroy older,
vulnerable adipocytes through pressure and mesh. Even if the thickness of cell
membranes were all similar, bigger cells with diameter around 100㎛
would be 8 times weaker and more fragile than that of 50 ㎛. It means that
heavy adipocytes have 3-4 times risk of immediate destruction during injection
and early edematous period. When the volume of fat is composed by bigger cells,
squeezing would reduce the overall injection volume to about 30%-50% but the total
numbers of cells would remain quite the same. When threads are unused,
minimum 600 ml of aspirates are necessary. However, if the threads are used,
300 ml is essential for the volume of aspirates. If the fat graft is excluded,
the entire procedure including anesthesia would not pass 1 hour. We have performed 20 cases of gluteal
surgeries for 10 years. Severe post-operative back pain for couple of weeks was
seen from couple of patients during intense change. However, there was no
considerable complication and the overall objective results or levels of
satisfaction were far better than the volume augmentation cases. Summary of full procedures; 1) Design in standing position
before anesthesia, 2) General anesthesia, 3) Tumescent fluid injection and Fat
harvesting, 4) Squeezing selection of stable adipocytes with removal of old and
fragile adipocytes, 5) Multidirectional threads injection during the squeezing
processes, 6) Injection of squeezed fat tissues using half blunted 19 gauge
needles, 7) Dressing with broad taping. Minimally
Manipulated Ex Vivo Stem Cell Proliferation Methods as a Medical Procedure. Hee Young Lee.
M.D., Hyun Jin Yang. M.D., BaroYL & Kangnam Plastic Surgery, Seoul, Korea
Recent
issues on stem cell therapy are focused on several legal aspects of cell
manipulation. However, from the doctor’s perspective, everything still remains
in the gray zone because no one has ever clearly defined the character and roles
of cells before. When we
try to make cell products for sales, the law is relatively clear but if the doctor’s
use was within the medical institutes, no law is required. Traditionally, doctor’s
use and manipulation of any kind of drugs were not regarded as ‘drug
manufacturing’ or ‘drug sales’. It was considered just a part of medical practice
even when they received payments. If a doctor receives payments from the patient
after injections of botulinum toxins, it is not a drug sale. Rather than these
legal issues, ethical issues within medical practices are much more serious.
However, there is no clear guideline in stem cell therapy for the doctors,
except they recommend ‘minimal manipulations’, in which the term does not
explain much about the procedure. Therefore, we started to make medical
protocols for the minimal cell manipulation as they recommended and especially
focused on the cell expansion, the utmost important step in making real effects,
because the main reason of ‘no effect’ has been on the ‘cell doses’. The new method
that we have developed is a new ex vivo expansion method which minimizes
manipulation as much as possible. This method skips every step that was
regarded as essential to the expansion of cells. Among our trials, we were
successful in removing trypsin, which is known to be the most significant manipulation
during re-attachment and re-seeding of cells. We were also able to remove ‘passages’,
the processes of changing vessels, which are another possible environmental
stimulation. We believe that permanent expansion is now possible with just
basic components of plasma without any heterogenic materials like hormones,
growth factors, enzymes. We believe
that no other methods could further minimize manipulation than the method we
have developed. With the removal of enzymes and passages, we can highly ensure
that our protocol is the most minimized manipulation available out today. We accomplished
minimization through using new devices such as 1) completely closed, re-usable culture
vessels with air filter 2) independent internal scrapers indirectly powered by
magnets to avoid disruption of cell environments, 3) mechanical cell to cell
dividing devices to reduce cell injury, 4) programmed air pressure/vacuum
ventilating CO2 incubator, 5) colony pattern visualizing living cell counter.
New classification of cells, based on the culture history such as SA numbering,
shows the accumulated numbers of manipulation (numbers of detachments and
attachments). We
understand that further character evaluations and clinical results with basic
studies for validations need to be made.
Our
main purpose for this paper is to share and introduce to doctors, the wide
possibilities of stem cell therapy and the safe and ineffective clinical
methods of stem cell therapy that will be available for the world within couple
of years. |