The Rise of Regenerative Medicine: Breathing New Life Into Aesthetic Care w/ Dr. Steve Cohen

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Welcome to another episode of
Park Avenue Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery.

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I'm your co-host Doreen Wu I'm excited
to be here with Dr. Lawrence Bass,

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Park Avenue plastic surgeon,
educator, and technology innovator,

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as well as our special guest plastic
surgeon, Dr. Steve Cohen from San Diego,

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California. The title of today's episode
is "The Rise of Regenerative Medicine:

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Breathing New Life Into
Aesthetic Care." Dr. Bass,

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regenerative medicine is creating a
lot of buzz in the media these days.

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What exactly is regenerative medicine?

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And will this become the future of
cosmetic medicine and plastic surgery?

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Well,

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regenerative medicine is basically a
branch of medicine or medical research and

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investigation that's
designed to get the body to

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regenerate or restore itself
to normal structure and

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function when there's a disease or an
aging change or some other problem.

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And in broad strokes,

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this falls into a few different
categories. So there are molecular

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materials that can help
with tissue regeneration.

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There are cellular materials,

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and then there's tissue based
regenerative medicine using either

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natural or biomaterials or artificial
materials that are designed to help

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the body regenerate.

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So there's a whole range of
things that are being used to

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help enable tissue
regeneration in the body,

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restoration of normal function in
a cell or an organ or a tissue.

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In a lot of ways,

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plastic surgery is really the
right field for this because I

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always said plastic surgery where the
biomaterial specialists of the body and

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the entire history of plastic
surgery has been using a

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biomaterial that's borrowed from
somewhere in the body, a skin graft,

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a bone graft, a fat graft,

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or a nerve graft,

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tendon graft to rebuild
or restore surgically

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some kind of body function.

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So this is really something that
plastic surgery has done since time was,

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and in the last 50 or
70 years research into

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wound healing and then tissue
regeneration growth factors

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and all kinds of cellular
biology that relates to

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the issues of interest to plastic
surgeons has been an increasing part of

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plastic surgery on an academic level.

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So that's really why
plastic surgery is involved.

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Let me turn to our guest
today, Dr. Steve Cohen.

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He is a very talented and very
experienced plastic surgeon

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from San Diego, California.

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We've been friends for a number of years
and have lectured together at a variety

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of meetings, and he is a true
expert on what's going on in

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regenerative medicine in plastic surgery.

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He teaches a whole range of
instructional courses on techniques

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to use this kind of
approach to best advantage.

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So Steve welcome. And we're
delighted to have you with us today.

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Thank you, Larry. Nice to be here.

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So tell me what are some of the leading
examples over regenerative medicine in

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healthcare generally and in
reconstructive plastic surgery?

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So I think, you know, there
are two main fields right now,

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we have within plastic surgery and really

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we're a good example of both
of these. We have regenerative

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techniques that are designed
to reconstruct injured tissue,

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congenitally, absent
tissue, or deformed tissue.

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And then we have techniques
that are designed to be more

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antiaging or replacement
of losses that occur

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through the aging process.

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And I think that both
have become much more

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mainstream than ever. And I do
think as you had alluded to Larry,

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this is a going to be a breakout
area that as industry becomes

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involved and realizes to what extent
this is going to be effective,

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this will start to really pick up
and become even more mainstream.

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And, and so right now,

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at least most of the focus within our
specialty are directed to things like

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rebuilding breast tissue

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rebuilding facial tissue
for reconstructive needs

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healing wounds that are
difficult to heal improving blood

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supply and circumstances where
blood supply has compromised,

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the ability to heal and in also performing

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these techniques to modulate
inflammatory conditions to

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reduce them.

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So there are probably many areas
in plastic surgery and dermatology

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that heretofore have not been
treated, but are good targets

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for instance, psoriasis and many
autoimmune diseases that lead to

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wasting like scleroderma.

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These are ideal conditions
to be treated with, you know,

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regenerative approaches.

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Well, that's a fantastic
summary of the playing field in

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plastic surgery now could you
share with us some of the potential

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applications in aesthetic
medicine and anti-aging.

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Well,

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the exciting part about
being around today and

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things I'm sure that Doreen will
find out as her future, you know,

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begins to unfold is that, you know,

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with our understanding
of the human genome,

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we know at birth in many
situations where we're headed,

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even without the genome,

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we can look at our parents or our
grandparents and our family and get a

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glimpse into our future.
And if one starts to think

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about aesthetics as more of a moving
picture versus just one moment

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in time that a patient
walks into our office,

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but a life cycle of aging,

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then we can start to devise
regenerative approaches that begin to

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really, really make sense and resonate,

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not only with our clients
and our patients, but our,

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our colleagues, because again, many
people are resistant to change and,

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you know, they get comfortable
treating things in certain ways,

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using fillers and using Botox etcetera,

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and they pooh-pooh the events that
are lying in front of their nose,

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which I think are becoming to
me much more clear than ever

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as to what the potential is.
So it's a long statement,

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but I think if one starts to
think about why people come into

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a cosmetic surgery office,

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they really come in for
only a handful of reasons.

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So let's take facial aging as an example,

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because that's kind of the area
I'm most interested in. You know,

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people come in with really three major
things we treat. We treat sun damage,

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we treat facial volume loss,

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which is not like air it's loss of
specific tissues from thinning of the

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skin to loss of the bone or

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genetically deficient bone
to loss of the, if you will,

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functional matrix of the face, the
fat compartments and the soft tissues.

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And those

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along with laxity are the
three things we treat.

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Every device is designed for them.

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Every surgery is designed
to treat these things.

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And so educating our ourselves and our
patients about what they're able to

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accomplish with that in mind is critical.

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These are now super imposed
on our genetics. So, you
know, you're born with a,

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a weak chin. Yes,

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you're probably gonna develop laxity
in the neck more rapidly than somebody

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else. Or, you know,

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if you're born in a family that
is prone to melasma, you know,

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instead of laughing at, you know,

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being in Hong Kong and seeing a mom and
their little daughter with parasols and

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hats, instead of laughing at that,

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we can realize that this is an
attempted epigenetic modification.

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And by that, I mean,

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these folks know that sun
will create hyperpigmentation.

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So the more they protect
their children from day one,

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the less of that kind of sun damage,

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irregularity and injury to their
skin tissue. They're gonna see.

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So as we start to turn the
light on these matters,

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we begin to look at things
more dynamically. So for
instance, in my practice,

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it comes up frequently.
What's the difference with
fillers versus for instance,

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fat grafting? And I

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think we've explained this in some
ways correctly and in other ways

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incorrectly, because we tell people,
well, fat is like a natural filler.

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And then we say, yeah, but
there's more variability.

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It disappears more rapidly in some people,

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it doesn't work in
others instead of going,

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when we're using your material
such as fat, if you are older,

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you have more cells that
are already senescent.

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You can't expect that that's gonna
perform the same way as youthful tissue.

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That's number one, two. We
can say, look, you know,

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based on genetics, there are rapid agers
and there are slow agers. You know,

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you go to a high school reunion, you
look at some friends, you go, "my God,

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I can't believe how great they
look. They must have had surgery."

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You look at other people, you go,
"my God, I hope I'm not that old.

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We're the same age." Because in many ways,

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and this has been the difficulty with
these studies is the genetic variation of

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how our tissues respond to environmental
injuries are different for all of us.

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So now that we're using our own tissue,

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we have to take that into account that
it's not necessarily a failure of a

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procedure in regenerative medicine.

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It's a combination of using
cells that may already be in

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states that are aged and working
with people whose genetics may not be

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as ideal as someone else. And in
addition, using our natural materials,

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that of course are never, you know,

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synthetics and programmed to disappear
within a certain amount of time.

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Once we have that in mind,

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we can actually start to look at patients
more like a moving picture. You know,

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it's kind of like Leonardo DaVinci.

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He was the first person to start
drawing an arm in different

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motions because when we pictured
an hand or an arm and it was in

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one motion or one position by an
artist that was a hand or an arm,

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what Leonardo said was no,

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the function is as
important as the appearance.

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So when we are thinking
about hands and arms,

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we need to be thinking about
each step of motion and function.

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And as we start to think about aging,

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we start to think about
the gradual decline.

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And you come to realize that when a
patient comes in for more than one filler,

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that reason is not because they
see hollowing and we go, oh yeah,

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I see the hollowing.

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It's because they're losing specific
tissue in superficial and deep fat

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compartments. And we can actually
put that same tissue back in.

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So just as we reconstruct, you know,

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things with like tissue, we
use a skin graft to repair a

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skin injury. We use fat

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tissue to rebuild the breast.

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Now we're starting to think
more on a smaller histologic and

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morphologic basis.

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And we start to use those materials
to actually replace what we're losing.

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And again, I'm sorry to be so long-winded,

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but if you think of nuclear
decay as kind of a comparison,

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you know,

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it's the amount of material you start
with and the amount of material you end

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with and how rapidly you get there.

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So the rate of nuclear decay
is based on a lot of factors.

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The rate of our tissue decay
is based on many factors,

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but by definition, if you
replace what has been lost,

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that curve of decay changes,
now you have more material,

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you have a slower rate
of decay. So, you know,

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just like we're beginning
to realize that diet,

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exercise and other kinds of epigenetic
modifications are going to keep us alive

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longer. It's no different
for facial tissues.

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This is why regenerative medicine
has to be looked at in a dynamic way,

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much like integrative medicine,
because that's really what it is.

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We're now not only aesthetically
improving our patients,

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but we're marrying this by altering
the physiology of aging and slowing

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that process. And in
some cases reversing it.

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Well,

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that's really beautifully said and
something that I tell my patients and

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I've said on this podcast multiple times,

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is that aesthetic plastic
surgery is a process.

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It's not an event.

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I think that's a good.

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Point,

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what you started by saying that
people don't come in and get one hit

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and it's all over.

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But a lot of the synthetic
materials, injectable fillers,

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things that we bring in with

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energy devices have a nearly monolithic

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approach to what they do to
modulate the equation where

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regenerative techniques

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are multidimensional and much more dynamic

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as we really unlock some of the
secrets to how these things work.

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We're going to be able to push
them in many directions and maybe

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several directions at
once in terms of restoring

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normal physiology and normal
anatomy, normal morphology.

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So I've paraphrased what you said

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in a much more simple minded way, but,
but I agree completely. That's really

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the essence of what's
going on in this field.

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Very exciting,

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because it begins to help you
focus on so many different things.

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It's the same with it's the
same with sports injuries.

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These are required injuries
early on. We treat a knee injury,

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that's, you know, ongoing or early
arthritis with steroid injections.

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They get better symptom-wise
but the steroid actually

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decreases the cartilage
interface. However,

237
00:15:32,580 --> 00:15:34,510
when we use regenerative techniques,

238
00:15:34,580 --> 00:15:37,910
even though we might only be
getting a 20% improvement,

239
00:15:38,210 --> 00:15:40,190
that's 20% more than zero.

240
00:15:40,290 --> 00:15:45,150
That's an enormous improvement
relative to our present therapy

241
00:15:45,260 --> 00:15:46,990
that has no improvement.

242
00:15:46,991 --> 00:15:51,830
And if anything reduces symptoms
while accelerating the disease

243
00:15:51,831 --> 00:15:54,310
process that they're trying to treat.

244
00:15:54,730 --> 00:15:59,630
So that's why I think our thinking has
to change and we have to become much more

245
00:15:59,631 --> 00:16:04,630
open-minded about using our own
tissue repair mechanisms, because,

246
00:16:05,010 --> 00:16:06,710
you know, we're a
complex organism. My God,

247
00:16:07,270 --> 00:16:12,070
we find amazing things like digoxin
in a plant we're bound to find

248
00:16:12,420 --> 00:16:16,830
more complicated things in a
human being that will help us

249
00:16:17,460 --> 00:16:19,150
survive longer and live better.

250
00:16:20,000 --> 00:16:24,150
Continuing our discussion of
anti-aging and turning back the clock.

251
00:16:24,420 --> 00:16:26,750
What is here and now in
regenerative medicine?

252
00:16:26,750 --> 00:16:28,390
Okay, good point.

253
00:16:29,370 --> 00:16:34,110
So we just published an article
in the aesthetic surgery journal

254
00:16:34,950 --> 00:16:39,710
a couple months ago, showing progressive
improvement in facial volume,

255
00:16:40,420 --> 00:16:45,030
following a anatomic and
regenerative fat grafting procedure.

256
00:16:45,810 --> 00:16:50,670
And what that means is when we look at
a patient and we diagnose all areas of

257
00:16:51,500 --> 00:16:55,350
deep fat loss, superficial
fat loss, skin thinning,

258
00:16:56,290 --> 00:16:57,630
and bone deficiency,

259
00:16:58,090 --> 00:17:02,990
and we treat them by replacing
the anatomic losses with a

260
00:17:03,190 --> 00:17:04,230
structural fat graft.

261
00:17:04,850 --> 00:17:09,630
And we add the cells from
fat to the skin and tissues,

262
00:17:10,370 --> 00:17:15,110
and we send them home with a biocream
of their cells that they apply

263
00:17:15,220 --> 00:17:18,750
topically. And we follow
those patients for two years.

264
00:17:18,810 --> 00:17:21,510
And we look at the midface as a,

265
00:17:21,970 --> 00:17:24,510
as kind of a glimpse into
what's happening with volume.

266
00:17:25,220 --> 00:17:29,990
When we do isolated fat grafting
in somebody under age 55 with that

267
00:17:30,270 --> 00:17:33,230
approach. So we're using
theoretically younger cells,

268
00:17:33,460 --> 00:17:37,190
less cells that are
already senescent or aged.

269
00:17:38,290 --> 00:17:39,910
We see at a month,

270
00:17:40,110 --> 00:17:45,110
a 60% improvement in facial
volume at six to nine months,

271
00:17:45,170 --> 00:17:49,030
we see only about a 25% improvement. And,

272
00:17:49,060 --> 00:17:53,400
and at 19 months we see
almost an 80% improvement

273
00:17:53,710 --> 00:17:56,800
because what's happening
is you're putting fat in.

274
00:17:56,950 --> 00:17:58,680
Most of the fat cells are dying.

275
00:17:58,681 --> 00:18:03,160
The stem cells in fat
survive at lower oxygen

276
00:18:03,161 --> 00:18:07,880
tensions. And they begin to turn into
fat cells. So you see this kind of,

277
00:18:08,260 --> 00:18:09,093
you know,

278
00:18:09,590 --> 00:18:14,440
bimodal kind of curve that
at the end actually shows

279
00:18:14,710 --> 00:18:17,160
progressive improvement in facial volume.

280
00:18:17,790 --> 00:18:20,160
This is irregardless of weight gain.

281
00:18:20,300 --> 00:18:24,440
So when you do statistical
analysis on these patients to say,

282
00:18:24,900 --> 00:18:29,360
was weight a factor? There was no
gain in any of these patients point.

283
00:18:29,480 --> 00:18:34,320
I think there was a,
a 0.3% or a 0.3% loss,

284
00:18:34,660 --> 00:18:38,880
but no gain. Two. When you look at
the amount of fat that you put in,

285
00:18:39,380 --> 00:18:41,040
it has nothing to do with the amount.

286
00:18:41,140 --> 00:18:45,240
So neither one of these affected the
statistics of that curve when you were

287
00:18:45,241 --> 00:18:46,760
under 55. However,

288
00:18:47,860 --> 00:18:51,720
if you had that same procedure
and you were older than 55,

289
00:18:52,350 --> 00:18:57,200
gradually the facial volume
trailed off to 30% residual at

290
00:18:57,520 --> 00:18:58,360
19 months later,

291
00:18:58,770 --> 00:19:02,680
which is consistent with most of
the studies in our literature.

292
00:19:03,140 --> 00:19:06,000
Now that's still a 30% gain at two years,

293
00:19:06,460 --> 00:19:11,000
but it's an indication
that more useful tissue is

294
00:19:11,001 --> 00:19:12,480
important to be using.

295
00:19:12,540 --> 00:19:16,320
And that is the first study
that's ever shown a nearly

296
00:19:17,440 --> 00:19:22,160
80% volume effect or volume improvement

297
00:19:22,540 --> 00:19:26,200
two years after a treatment. So
we're not talking about stability,

298
00:19:26,690 --> 00:19:28,640
we're actually talking
about an improvement.

299
00:19:29,420 --> 00:19:33,440
So I think that in my opinion
represents a very important

300
00:19:34,310 --> 00:19:35,760
article because it is,

301
00:19:35,860 --> 00:19:39,840
it contradicts every
article about fat grafting.

302
00:19:40,180 --> 00:19:43,800
So instead of being, not just the
surgical artist where I put it,

303
00:19:43,801 --> 00:19:48,000
where it looks pretty now we're the
surgical anatomist and we're also

304
00:19:48,040 --> 00:19:49,800
regenerative medicine experts.

305
00:19:50,380 --> 00:19:54,720
So we know that when we microneedle
these cells into the skin,

306
00:19:55,100 --> 00:19:56,880
the skin actually becomes healthier.

307
00:19:57,300 --> 00:20:02,200
The pigment actually becomes
reduced the age changes and

308
00:20:02,201 --> 00:20:07,200
the sun damage changes become reversed
in elastin, in collagen fibers.

309
00:20:07,380 --> 00:20:08,213
And there are enough,

310
00:20:08,390 --> 00:20:12,960
very good studies that now
show this very definitively.

311
00:20:13,060 --> 00:20:13,893
So to me,

312
00:20:14,410 --> 00:20:19,160
we're still talking about things
that are already either passe or

313
00:20:19,161 --> 00:20:20,400
very poorly studied.

314
00:20:21,400 --> 00:20:25,420
And that's really the point. I read that
article with a great deal of interest.

315
00:20:25,680 --> 00:20:30,580
And the challenge is in
meticulously assessing the

316
00:20:30,740 --> 00:20:33,900
patients, because so many of the articles,

317
00:20:34,520 --> 00:20:39,300
the metrics by which you're
measuring outcome are so

318
00:20:39,350 --> 00:20:44,060
crude or so haphazardly
applied that the data is only a

319
00:20:44,210 --> 00:20:46,020
very rough indication.

320
00:20:46,760 --> 00:20:51,160
And so you are much more
careful analysis of the patients

321
00:20:52,560 --> 00:20:56,780
is really what led you unlock
that nuance of the biology,

322
00:20:57,410 --> 00:21:00,180
younger fat graft patients versus older,

323
00:21:01,080 --> 00:21:05,820
and rather than putting
everybody into a giant grab

324
00:21:05,821 --> 00:21:09,420
bag and sort of losing the
granularity of the data.

325
00:21:10,050 --> 00:21:14,140
Yeah, I think, I think as we have more
of these, and again, Larry, as you know,

326
00:21:14,390 --> 00:21:16,260
we're both practicing plastic surgeons.

327
00:21:16,261 --> 00:21:21,100
So we know that data doesn't convince
always our colleagues because

328
00:21:21,101 --> 00:21:23,660
people form habits. And, you know,

329
00:21:24,660 --> 00:21:29,220
I always was taught you form a habit and
you learn to break it because you find

330
00:21:29,221 --> 00:21:32,060
something that's better.
And other people are taught.

331
00:21:33,140 --> 00:21:37,980
I want to imitate my mentor and what
they did and be as good as them versus

332
00:21:38,560 --> 00:21:42,980
we want to make things even better and
stand on the shoulders of our mentors and

333
00:21:43,010 --> 00:21:46,060
move the field beyond what
they've been able to accomplish.

334
00:21:46,720 --> 00:21:49,180
And I agree with you completely.

335
00:21:49,260 --> 00:21:53,420
I think that's the point
that to move things forward,

336
00:21:53,880 --> 00:21:58,380
you have to unlock the principle
and then learn how to amplify it.

337
00:21:58,960 --> 00:22:03,180
And so many people look at something
at a rudimentary stage and say,

338
00:22:03,210 --> 00:22:06,300
well there's an effect there,
but that's just not enough.

339
00:22:06,320 --> 00:22:10,300
And they abandon it rather than
saying, how can we harness it?

340
00:22:10,360 --> 00:22:12,220
How can we really control it?

341
00:22:12,600 --> 00:22:16,020
And how can we magnify the effect to,

342
00:22:16,640 --> 00:22:21,500
to an extent that is
clinically relevant you know,

343
00:22:22,180 --> 00:22:26,900
a 20% improvement, I mean that
you age over 30 years, 50 years.

344
00:22:27,800 --> 00:22:32,460
And if you can undo 20% in a single step,

345
00:22:32,461 --> 00:22:36,140
that is a massive change. So
it is clinically significant.

346
00:22:36,920 --> 00:22:40,140
And, and there's gonna be some
things coming down the pipe, Larry,

347
00:22:40,170 --> 00:22:45,020
that are gonna be so exciting
and potentially, you know,

348
00:22:45,310 --> 00:22:49,940
relatively straightforward and simple
kinds of things. You know, that, I mean,

349
00:22:49,960 --> 00:22:53,300
for instance, that you may be familiar
with a company, Elysian Health

350
00:22:55,040 --> 00:22:59,540
but they make a product called
basis, which is a NAD product,

351
00:23:00,120 --> 00:23:04,620
you know, so it basically, you
know, it leads to cell repair.

352
00:23:05,490 --> 00:23:08,300
They have five or six Nobel
laureates on their board.

353
00:23:09,170 --> 00:23:12,380
This is an MIT founded company. You know,

354
00:23:12,790 --> 00:23:17,500
these people are not stupid, but you
need to take this medication and,

355
00:23:17,600 --> 00:23:22,180
or vitamin or whatever you want to
call the over counter use on a regular

356
00:23:22,310 --> 00:23:27,140
basis. If you want to succeed, just
like, you know, you want more muscles,

357
00:23:27,141 --> 00:23:30,740
you gotta go to the gym, you know,
nobody's gonna just hand them to you.

358
00:23:31,080 --> 00:23:33,220
At least not in my family.

359
00:23:34,400 --> 00:23:36,900
No, , that's true.

360
00:23:36,901 --> 00:23:40,980
There's always going to be some
steps that have to be taken and

361
00:23:41,850 --> 00:23:46,560
getting those steps as
efficient and focused as

362
00:23:46,880 --> 00:23:51,440
possible is always the
trick. So as we look at this,

363
00:23:52,010 --> 00:23:56,760
let's talk for a second
about exosomes and what role

364
00:23:57,230 --> 00:24:00,720
they currently play or what role
they might play going forward.

365
00:24:01,630 --> 00:24:01,921
Well,

366
00:24:01,921 --> 00:24:06,840
it's not a well understood
area by most plastic surgeons.

367
00:24:06,900 --> 00:24:08,520
And I have to say, you know,

368
00:24:08,600 --> 00:24:13,280
I still feel like I'm at the tip of the
iceberg myself, but I think, you know,

369
00:24:13,480 --> 00:24:18,360
exosomes may turn out to be the
active ingredient in the fat

370
00:24:18,361 --> 00:24:20,120
graft that leads to regenerations.

371
00:24:20,180 --> 00:24:24,440
So what exosomes are their
cell to cell messengers.

372
00:24:24,441 --> 00:24:29,440
They're responsible for what we
call these hormonal effects that

373
00:24:29,450 --> 00:24:34,280
cells can can do, or paracrine
effects, you know, sorry to be medical,

374
00:24:34,460 --> 00:24:35,520
but that's what they do.

375
00:24:36,900 --> 00:24:40,280
So they communicate to other cells
and what they do is they repair,

376
00:24:40,750 --> 00:24:42,240
they reduce inflammation.

377
00:24:43,390 --> 00:24:47,800
They probably survey for cancer
and cells that are degenerating,

378
00:24:48,190 --> 00:24:50,240
they're able to repair.

379
00:24:50,740 --> 00:24:55,000
But what's really fascinating
about exosomes as in terms of

380
00:24:55,150 --> 00:24:57,920
antiaging in an ordeal are one,

381
00:24:58,550 --> 00:25:00,520
something called parabiosis.

382
00:25:01,260 --> 00:25:06,160
So parabiosis was a study that
was done and published in nature

383
00:25:06,390 --> 00:25:07,400
many years ago.

384
00:25:08,020 --> 00:25:12,880
And what they did was they joined the
circulations of an old mouse to a new

385
00:25:12,881 --> 00:25:13,960
mouse, a young mouse.

386
00:25:14,660 --> 00:25:19,440
And what they found is over a period
of time after they sacrificed the mice,

387
00:25:19,790 --> 00:25:24,760
that the older mouses organs, the
heart, the brain, the lungs, the liver,

388
00:25:25,460 --> 00:25:28,740
all got younger. Why did they get younger?

389
00:25:28,790 --> 00:25:33,620
These are not vampires sucking on
somebody's blood. These are mice.

390
00:25:34,280 --> 00:25:39,260
And the younger mouses had something
in their blood that circulated

391
00:25:39,480 --> 00:25:43,940
and caused repair and regeneration.
And those were exosomes.

392
00:25:43,941 --> 00:25:48,780
The study was duplicated by
taking the blood from that young

393
00:25:48,781 --> 00:25:52,740
mouse and injecting it into
the tail of the older mouse.

394
00:25:52,840 --> 00:25:57,100
And they saw some very similar findings.
When, when you hear about these things,

395
00:25:57,101 --> 00:26:01,780
we're steps away from
exosomes being used as

396
00:26:01,950 --> 00:26:05,820
anti-aging agents. Now, where
do you get exosomes? Well,

397
00:26:06,280 --> 00:26:07,540
you get them from humans,

398
00:26:07,760 --> 00:26:11,940
and this is where the FDA and
the regulatory issues become

399
00:26:12,440 --> 00:26:14,740
tricky because you know, to,

400
00:26:15,000 --> 00:26:18,340
to get exosomes from humans
requires you to culture stem cells.

401
00:26:18,350 --> 00:26:22,340
And culturing stem cells, they
go through many iterations,

402
00:26:22,810 --> 00:26:24,140
they age themselves.

403
00:26:24,840 --> 00:26:29,580
And we don't always know what's
in the packet that we get from the

404
00:26:29,740 --> 00:26:33,620
exosomes and these human
stem cells. Now that said,

405
00:26:34,600 --> 00:26:39,340
animal exosomes are close to ours. You
know, obviously monkeys are the closest,

406
00:26:39,440 --> 00:26:44,250
but, but things like
bovine kinds of exosomes.

407
00:26:44,270 --> 00:26:46,250
So exosomes that you can get from,

408
00:26:46,640 --> 00:26:51,370
from the cord blood of a calf without
even having to sacrifice the calf,

409
00:26:51,900 --> 00:26:56,690
those exosomes can actually
be used in a variety of forms.

410
00:26:57,350 --> 00:27:02,170
And it's conceivable that they can
be turned into a pill form that

411
00:27:02,171 --> 00:27:04,330
we begin to take on a regular basis.

412
00:27:05,030 --> 00:27:09,610
But these are things that are very
exciting about exosomes systemically and

413
00:27:09,870 --> 00:27:12,410
for antiaging, for aesthetics,

414
00:27:13,120 --> 00:27:17,690
topical exosomes are also very exciting,
but again, they face the same problem.

415
00:27:17,700 --> 00:27:20,130
There is no FDA labeling.

416
00:27:20,700 --> 00:27:25,530
Those of us that are using these exosomes
are using them really in a way that

417
00:27:25,531 --> 00:27:28,250
is not considered to be FDA approved.

418
00:27:28,790 --> 00:27:33,610
So we may be practicing medicine feeling
they're very safe and likely they are,

419
00:27:34,310 --> 00:27:38,810
but as we start to move towards
some of the products that can

420
00:27:39,630 --> 00:27:44,090
be in the US and on shelves,

421
00:27:44,160 --> 00:27:48,850
even in places like Nordstroms
that are significantly more

422
00:27:49,130 --> 00:27:53,130
powerful than the most powerful agent
in any cosmetic, which is retinol,

423
00:27:53,620 --> 00:27:58,370
we're gonna start to see exosomes
really blast off and they may blast

424
00:27:58,470 --> 00:28:01,050
off not so in medical treatment,

425
00:28:01,051 --> 00:28:04,810
they're blasting off because that's
what our vaccines are made from. But in,

426
00:28:04,910 --> 00:28:06,210
in cosmetic treatment,

427
00:28:06,211 --> 00:28:10,610
they may blast off on the shelves of
Nordstroms before they even enter the

428
00:28:10,611 --> 00:28:12,210
doctor's office. So.

429
00:28:14,770 --> 00:28:18,940
Yeah, they are exciting. And one
of the ways I think about this,

430
00:28:19,880 --> 00:28:24,140
and you can say whether you think
this is worthwhile form of thinking,

431
00:28:24,200 --> 00:28:28,740
but for the listeners, you know, when
we take something like a growth factor,

432
00:28:28,930 --> 00:28:29,520
well,

433
00:28:29,520 --> 00:28:34,140
that's a molecule that the
body uses to signal cells to

434
00:28:35,100 --> 00:28:39,340
increase inflammation or decrease or
increase collagen synthesis or decrease.

435
00:28:39,400 --> 00:28:43,020
And when we dribble that
onto a problem wound,

436
00:28:43,400 --> 00:28:45,100
that's being slow to heal.

437
00:28:45,101 --> 00:28:50,020
The body's getting some of that
message that it uses itself

438
00:28:50,320 --> 00:28:55,260
to tell itself how to heal
a wound and it may help with

439
00:28:55,300 --> 00:28:56,133
a problem wound,

440
00:28:56,640 --> 00:29:01,580
but the dosing and presentation of
that growth factor really doesn't

441
00:29:01,900 --> 00:29:06,540
resemble very closely how
the body signals itself

442
00:29:07,760 --> 00:29:12,540
and exosomes transferring message cell

443
00:29:12,640 --> 00:29:17,220
to cell comes closer to
resembling that kind of

444
00:29:17,330 --> 00:29:18,163
messaging.

445
00:29:18,620 --> 00:29:23,220
Although we still have a lot to
understand about the pharmacodynamics and

446
00:29:23,440 --> 00:29:28,300
dosing of how we would
ideally use exosomes.

447
00:29:28,301 --> 00:29:31,420
They're probably going
to resemble more closely.

448
00:29:32,000 --> 00:29:33,780
And that's the way I think about it.

449
00:29:34,620 --> 00:29:38,500
I think that's a good way to think about
it. I think that's actually very valid.

450
00:29:39,540 --> 00:29:40,340
On this podcast.

451
00:29:40,340 --> 00:29:43,840
We like to talk about recent
developments and new research directions.

452
00:29:44,060 --> 00:29:47,400
And Dr. Cohen, you already briefly
touched upon this earlier with NAD,

453
00:29:48,060 --> 00:29:52,080
but I'm wondering what else is in the
works that we can expect in the next five

454
00:29:52,081 --> 00:29:52,914
to 10 years?

455
00:29:53,710 --> 00:29:58,520
Well, I think, you know, understanding
more about the effect of intermittent

456
00:29:59,570 --> 00:30:03,080
starvation, will be interesting
to learn more about.

457
00:30:04,090 --> 00:30:08,640
There are many medications
that are being tested on humans

458
00:30:09,020 --> 00:30:11,920
to see if they do have
antiaging effects. You know,

459
00:30:11,921 --> 00:30:13,560
these are gonna be systemic effects.

460
00:30:14,890 --> 00:30:17,440
Early diagnosis is going
to be critical. Again,

461
00:30:17,441 --> 00:30:22,360
all of these things play into the role
of, you know, in my opinion, you know,

462
00:30:22,740 --> 00:30:26,240
the discovery of the human genome,
we know it's broken at birth.

463
00:30:26,860 --> 00:30:30,280
So I think some of some of
the way medicine will change,

464
00:30:30,370 --> 00:30:35,360
it'll become a much more
proactive and preventative kind of

465
00:30:35,640 --> 00:30:40,160
approach versus wait until
you get a disease and then
come in and we hope we can

466
00:30:40,190 --> 00:30:43,360
cure you with a big operation.
It's gonna be, look,

467
00:30:43,361 --> 00:30:44,760
you're going to get this disease.

468
00:30:45,460 --> 00:30:49,520
We need to do everything possible to
modify it. You know, every one of your,

469
00:30:50,300 --> 00:30:54,800
you know, male relatives died
at age 38 of a heart attack.

470
00:30:55,190 --> 00:30:59,560
Well, you're two years old. What do
you think's gonna happen to you likely,

471
00:30:59,740 --> 00:31:02,560
unless, you know, you've
got the luck of the draw.

472
00:31:02,580 --> 00:31:04,240
You're gonna have the same genes.

473
00:31:04,860 --> 00:31:08,560
So why wouldn't we start to be
thinking about putting those patients,

474
00:31:09,070 --> 00:31:13,880
even as children on things like
Lipitor or certainly diet modification

475
00:31:13,881 --> 00:31:16,640
and things like that, as
we become more intelligent,

476
00:31:17,340 --> 00:31:19,600
if we're able to change our habits,

477
00:31:20,230 --> 00:31:24,200
then I think we're gonna actually be
able to apply so many of these different

478
00:31:24,201 --> 00:31:29,040
things to ourselves. Same thing with
aesthetics. If we start, you know,

479
00:31:29,041 --> 00:31:32,840
Doreen at your age versus
at my age, you know,

480
00:31:32,900 --> 00:31:37,440
you have the opportunity to really
slow down your aging process. You know,

481
00:31:37,490 --> 00:31:38,760
other people are, you know,

482
00:31:38,940 --> 00:31:43,840
not able to do that quite as effectively
or without the knife, et cetera.

483
00:31:44,580 --> 00:31:49,280
So I think that in aesthetics, we're
gonna see some amazing changes.

484
00:31:49,700 --> 00:31:53,760
The other thing I should mention
about new things coming down the pike,

485
00:31:54,140 --> 00:31:58,280
we just finished a study. I think
we've done now, 50 patients.

486
00:31:58,281 --> 00:32:01,680
It hasn't been written up yet.
It's been reported overseas,

487
00:32:01,900 --> 00:32:06,520
but women that are not able to
get pregnant and go through,

488
00:32:07,100 --> 00:32:11,440
you know, huge amounts of
financial burdens to try to,

489
00:32:12,100 --> 00:32:15,200
you know, you know, create
an embryo and then implant.

490
00:32:15,201 --> 00:32:17,800
It still have kind of
high rates of failure.

491
00:32:18,690 --> 00:32:23,640
We've now done women where we've
injected the ovaries with stromal

492
00:32:23,641 --> 00:32:28,440
vascular fraction, which is the
cells in fat minus the fat cells.

493
00:32:29,090 --> 00:32:33,880
We've injected their endometrium
with stromal vascular fraction.

494
00:32:34,300 --> 00:32:38,760
And we've been able to achieve
85 to 90% success rates in

495
00:32:38,960 --> 00:32:41,520
implantation in those patients now.

496
00:32:42,020 --> 00:32:44,080
So that's another example.

497
00:32:45,950 --> 00:32:50,720
There's so many different things,
you know, genital rejuvenation,

498
00:32:50,780 --> 00:32:54,240
you know, for vaginal rejuvenation
and, you know, for erectile

499
00:32:56,190 --> 00:33:00,600
dysfunction, hair loss you know,

500
00:33:01,700 --> 00:33:06,200
sports, medicine, and wellness. These
are all things that, in my opinion,

501
00:33:07,060 --> 00:33:10,960
if they're used properly,
not like sensationally,

502
00:33:10,980 --> 00:33:15,680
but properly all will make huge
amounts of sense now to be doing.

503
00:33:17,100 --> 00:33:17,600
Lastly,

504
00:33:17,600 --> 00:33:21,640
I want to wrap up our episode today by
asking both of you for some key takeaways

505
00:33:21,641 --> 00:33:23,680
from our discussion of
regenerative medicine.

506
00:33:23,980 --> 00:33:25,480
If Dr. Bass you'd like to go first.

507
00:33:26,690 --> 00:33:31,390
So I think you can hear from this
discussion that we are really at the

508
00:33:31,750 --> 00:33:36,710
dawn of what regenerative medicine
is going to be able to do for us

509
00:33:38,330 --> 00:33:41,330
and how central a role it's going to play.

510
00:33:42,330 --> 00:33:46,770
Not only in aesthetic plastic
surgery and aesthetic medicine,

511
00:33:47,210 --> 00:33:49,170
but in all fields of medicine.

512
00:33:50,250 --> 00:33:54,450
So this is the beginning and
as the capabilities expand

513
00:33:55,290 --> 00:33:59,610
as careful study accelerates,
which is happening now,

514
00:34:00,690 --> 00:34:05,490
we are just going to see this
torrent of application kick

515
00:34:05,730 --> 00:34:10,410
in at some point that really
transforms in a major way,

516
00:34:11,530 --> 00:34:15,690
the entire way we approach clinical
care of patients. And again,

517
00:34:16,010 --> 00:34:19,650
not just in aesthetic plastic
surgery, but in medicine generally.

518
00:34:19,650 --> 00:34:24,370
Yeah, I would echo what
Dr. Bass just said that,

519
00:34:24,430 --> 00:34:29,210
you know, we're at the
beginning of a new era and,

520
00:34:29,810 --> 00:34:30,570
you know, we've,

521
00:34:30,570 --> 00:34:35,290
I've spent 20 years in this
industry and I've watched companies

522
00:34:35,650 --> 00:34:40,010
who've raised 600 million fail
and go bankrupt because the

523
00:34:40,970 --> 00:34:42,930
expectations have not been understood.

524
00:34:43,490 --> 00:34:46,490
The studies are so difficult to carry out.

525
00:34:46,770 --> 00:34:51,210
There's not a single study that
controls for the genetics of this.

526
00:34:51,570 --> 00:34:56,210
So for instance, if you look at the
methylization processes on a chromosome,

527
00:34:56,490 --> 00:35:00,090
which is a way of looking at
the youthfulness of your cell,

528
00:35:01,170 --> 00:35:03,930
some people already are
kind of too late, sorry.

529
00:35:04,610 --> 00:35:06,090
And other people are just right.

530
00:35:06,930 --> 00:35:09,610
If we can factor these things
in and understand them,

531
00:35:09,970 --> 00:35:14,850
we'll have home run studies, but right
now we're still kind of going this side,

532
00:35:15,090 --> 00:35:18,490
we put fat in, this side,
we put fat with cells in,

533
00:35:18,970 --> 00:35:20,210
and we don't see a big difference.

534
00:35:21,730 --> 00:35:24,970
And that may not really be
the right studies to be doing.

535
00:35:25,770 --> 00:35:30,090
So I think just like bone marrow
transplantation has no FDA approval.

536
00:35:30,610 --> 00:35:33,250
Just like the heart lung
machine has no FDA approval.

537
00:35:33,690 --> 00:35:36,410
There's certain things in
medicine that are going to happen

538
00:35:37,960 --> 00:35:39,560
irregardless of the FDA,

539
00:35:40,200 --> 00:35:45,160
because they make too much sense and
using our own body parts and materials and

540
00:35:45,880 --> 00:35:50,200
recycling them and using them to our
advantage makes so much sense to most

541
00:35:50,600 --> 00:35:54,360
people. And the safety is just, you know,

542
00:35:55,040 --> 00:35:56,480
unparalleled because it's us now.

543
00:35:56,710 --> 00:36:00,000
It's going to be a brave
new world. Well, Dr. Cohen,

544
00:36:00,180 --> 00:36:01,960
I'd like to thank you for joining us.

545
00:36:02,030 --> 00:36:06,800
It's been a tremendous pleasure and very
appreciative to have someone with your

546
00:36:06,801 --> 00:36:11,720
level of expertise in this field sharing
perspectives on what's happening.

547
00:36:12,370 --> 00:36:13,920
Thank you, Larry. It's been a pleasure.

548
00:36:14,510 --> 00:36:15,800
I'll let go, Dr. Bass,

549
00:36:15,800 --> 00:36:19,520
and express my thanks to Dr. Cohen for
taking the time to share your insight and

550
00:36:19,521 --> 00:36:23,040
expertise with us, and thank you to
our listeners for joining us today,

551
00:36:23,060 --> 00:36:26,600
to hear about the growing and exciting
potential of regenerative medicine.

552
00:36:27,040 --> 00:36:30,320
I hope you found this episode as
fascinating and informative as I did.

553
00:36:30,900 --> 00:36:34,360
If you think of other exciting
developments or trends
in plastic surgery that

554
00:36:34,361 --> 00:36:36,720
you would like us to discuss
in an upcoming episode,

555
00:36:36,860 --> 00:36:40,080
please reach out by email or
Instagram. We'll see you next time.

556
00:36:41,330 --> 00:36:44,020
This is Doreen Wu thanking
you for joining Dr. Bass,

557
00:36:44,080 --> 00:36:48,260
Dr. Cohen and me for this discussion of
the role of regenerative medicine in the

558
00:36:48,261 --> 00:36:50,420
future of plastic surgery and anti-aging.

559
00:36:50,880 --> 00:36:53,100
Be sure to tune in next
time and don't forget,

560
00:36:54,600 --> 00:36:57,980
be sure to tune in next time. And don't
forget to subscribe to our podcast,

561
00:36:58,320 --> 00:37:01,620
to stay up to date with all of the
exciting content that is coming your way.

562
00:37:02,470 --> 00:37:06,500
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery

563
00:37:06,630 --> 00:37:11,100
Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,

564
00:37:11,900 --> 00:37:13,780
educator, and technology innovator.

565
00:37:14,080 --> 00:37:16,580
The commentary in this
podcast represents opinion.

566
00:37:16,770 --> 00:37:19,300
This podcast does not
present medical advice,

567
00:37:19,640 --> 00:37:23,660
but rather general information about
plastic surgery that does not necessarily

568
00:37:23,720 --> 00:37:26,820
relate to the specific conditions
of any individual patient.

569
00:37:27,200 --> 00:37:31,860
No doctor patient relationship
is established by listening
to or participating

570
00:37:31,960 --> 00:37:32,793
in this podcast,

571
00:37:33,050 --> 00:37:37,020
consult your physician to advise you
about your individual healthcare.

572
00:37:37,360 --> 00:37:38,900
If you enjoyed this episode,

573
00:37:39,120 --> 00:37:43,220
please share it with your friends and
be sure to subscribe to our podcast on

574
00:37:43,221 --> 00:37:47,100
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575
00:37:47,400 --> 00:37:49,660
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