Mark Berman

The Aging Face: A Different Perspective on Pathology and Treatment

Probably because the thrust of the pathology of the aging face has been attributed to the effects of gravity (skin and muscle loosening and falling), treatment of such is generally directed toward lifting procedures. Indeed, results from such procedures are generally beneficial, but in many cases the patient appears unnaturally skeletonized. A brow-lift may eliminate some wrinkles and frown lines, but does anyone (naturally youthful) really have eyebrows a centimeter above the orbital rim? Our goal has been, and continues to be, to strive for excellence, and in the case of the aging face, this would be an improved and more youthful appearance. This paper will discuss the main pathology of the appearance of aging, which is the general dissipation of facial fat over time. It will also provide discussion as to thoughtful correction of the problem not only with lifting techniques but also with consideration to filling procedures. The judicial use of fat-grafting and various synthetic implants serve as the principal tools for volume correction. It is acknowledged that the skin undergoes photo-damage, which also contributes to the appearance of aging, but this is treated by treating the skin in a multitude of ways.

A Prospective Safety Study of Autologous Adipose-Derived Stromal Vascular Fraction Using a Specialized Surgical Processing System:

Autologous adipose-derived stromal vascular fraction (SVF) has been proposed as a remedy for a number of inflammatory, autoimmune, and degenerative conditions. This procedure had mainly been evaluated in veterinary medicine and outside the United States when this study was initiated. This study looks at adverse events to evaluate safety as its primary objective and secondarily follows efficacy of SVF as deployed through intra-articular injections and intravenous infusions for a variety of orthopedic and non-orthopedic conditions. We hypothesized that autologous SVF deployment using a specialized surgical processing system (the CSN Time Machine® system, trademark name for the MediKhan Lipokit/Maxstem system; MediKhan, Los Angeles, California) was safe (ie, minimally acceptable adverse events) and that clinical efficacy could be demonstrated. This was a prospective case series. After institutional review board approval, 1698 SVF deployment procedures were performed between 2011 and 2016 by us and other affiliates with our same system trained by us as a nearly closed sterile surgical lipotransfer procedure on 1524 patients with various degenerative, inflammatory, and autoimmune conditions with a majority involving the musculoskeletal system. All outcome test data were collected in an online database over a 5-year period. Our study shows a very low number of reported adverse events and a reduction in pain ratings after 6 months or more across a variety of musculoskeletal diseases and improvements in a variety of other degenerative conditions. Our system for producing adipose-derived SVF therapy for our patients was safe and benefits could be measured for a long time after SVF deployment. Further controlled long-term studies for specific disease conditions with large patient populations are necessary to further investigate the benefits observed.

Validation of Acoustic Wave Induced Traumatic Brain Injury in Rats

Background: This study looked to validate the acoustic wave technology of the Storz-D-Actor that inflicted a consistent closed-head, traumatic brain injury (TBI) in rats. We studied a range of single pulse pressures administered to the rats and observed the resulting decline in motor skills and memory. Histology was observed to measure and confirm the injury insult. Methods: Four different acoustic wave pressures were studied using a single pulse: 0, 3.4, 4.2 and 5.0 bar (n = 10 rats per treatment group). The pulse was administered to the left frontal cortex. Rotarod tests were used to monitor the rats’ motor skills while the water maze test was used to monitor memory deficits. The rats were then sacrificed ten days post-treatment for histological analysis of TBI infarct size. Results: The behavioral tests showed that acoustic wave technology administered an effective insult causing significant decreases in motor abilities and memory. Histology showed dose-dependent damage to the cortex infarct areas only. Conclusions: This study illustrates that the Storz D-Actor effectively induces a repeatable TBI infarct, avoiding the invasive procedure of a craniotomy often used in TBI research.

Gore-Tex® ePTFE in Nasal Surgery and Review of Long-Term Results

More than 10 years have passed since the author first used Gore-Tex® expanded polytetrafluoroethylene (ePTFE) as a facial implant material. To date, the material has been tolerated very successfully without any signs of degradation or alteration. Previous research studies have confirmed the stability of the material. It has become increasingly popular and has recently received FDA approval as Subcutaneous Tissue Augmentation Material (SAM®) for use as a soft tissue filler of the face. More importantly, this author has documented two specific areas for consideration. First, the material does not need to be used by itself as an independent implant material. It can be bonded to other materials, such as silicone rubber, and thus be used for its unique surface properties while enjoying the structural integrity of the silicone rubber. (This use has not received FDA approval.) Secondly, as an added precaution, it is wise to prepare the material before implantation by vacuum impregnation with an antibiotic solution. Before use of this type of preparation was started in June 1989, the author experienced 9 infections out of 67 facial implants with Gore-Tex (13%). Since vacuum impregnation was initiated, there has been 1 infection out of 165 implantations (0.61%). There have been no infections or extrusions with nasal surgery since antibiotic impregnation was started.

Autologous Stromal Vascular Fraction Containing Stem Cells Combined with Low Intensity Shock Wave for the Treatment of Human Erectile Dysfunction

Objective: This study seeks to determine whether the addition of autologous Adipose-Derived Stem Cells (ADSCs) may safely synergize with the clinical effects of Low-Intensity Shock Wave Therapy (LIST) to improve Erectile Dysfunction (ED) in a small series of men. Methods: Under IRB protocols, 52 patients with multifactorial ED were treated with LIST immediately followed by a single intracavernosal injection of lipoaspirate derived autologous Stromal Vascular Fraction (SVF). Human SVF derived using our protocols has been shown to contain Mesenchymal Stem Cells (MSCs) and Hematopoietic Stem Cells (HSCs). Subjective outcomes testing with the International Index of Erectile Function (IIEF) Score and Erectile Hardness Score (EHS) were administered to the patients at baseline and every 3 months for 2 years. All patients were queried for adverse reactions and all outcomes were self-reported. Results: Excellent safety was seen and none of the patients experienced any adverse reactions related to LIST or harvesting and deployment of SVF. A retrospective review of efficacy indicated that 37 out of 52 patients (71%) responded positively to the question of whether they experienced “overall improvement” after their treatment. Mean IIEF reference questionnaire scores and Mean Erectile Hardness Grading Score (EHS) were also reported by patients. Mean IIEF scores went from 10.21 baseline to 18.40 at 6 months (p=0.0008). Mean EHS scores improved from 1.34 baseline to 2.17 at 6 months (p=0.012). Conclusion: Intracavernosal deployment of autologous SVF combined with low-intensity acoustic shock wave therapy to the penis appears to be safe and may offer some benefits to a cross-section of patients who suffer from ED. Larger trials are indicated to identify which types of stem cells are optimal, which subsets of ED patients appear to benefit the most, and which types of shock wave protocols yield the best results. Autologous Stromal Vascular Fraction Containing Stem Cells Combined with Low Intensity Shock Wave for the Treatment of Human Erectile Dysfunction Elliot B Lander* and Mark H Berman Cell Surgical Network, Rancho Mirage, California, USA *Corresponding author: Elliot B Lander, Cell Surgical Network, Country Club Drive, Rancho Mirage, California, USA, Tel: 760-346-0145; Fax: 760-776-0041; E-mail: elliot@cellsurgicalnetwork.com Received August 03, 2018; Accepted September 11, 2018; Published September 17, 2018 Citation: Lander EB, Berman MH (2018) Autologous Stromal Vascular Fraction Containing Stem Cells Combined with Low Intensity Shock Wave for the Treatment of Human Erectile Dysfunction. Stem Cell Res Ther 8: 438. doi: 10.4172/21577633.1000438 Copyright:

The ratio of ADSCs to HSC-progenitors in adipose tissue derived SVF may provide the key to predict the outcome of stem-cell therapy

BackgroundStromal vascular fraction (SVF) represents an attractive source of adult stem cells and progenitors, holding great promise for numerous cell therapy approaches. In 2017, it was reported that 1524 patients received autologous SVF following the enzymatic digestion of liposuction fat. The treatment was safe and effective and patients showed significant clinical improvement. In a collaborative study, we analyzed SVF obtained from 58 patients having degenerative, inflammatory, autoimmune diseases, and advanced stage cancer.ResultsFlow analysis showed that freshly isolated SVF was very heterogeneous and harbored four major subsets specific to adipose tissue; CD34high CD45− CD31− CD146− adipose-derived stromal/stem cells (ADSCs), CD34low CD45+ CD206+CD31− CD146− hematopoietic stem cell-progenitors (HSC-progenitors), CD34high CD45− CD31+CD146+ adipose tissue-endothelial cells and CD45−CD34−CD31−CD146+ pericytes. Culturing and expanding of SVF revealed a homogenous population lacking hematopoietic lineage markers CD45 and CD34, but were positive for CD90, CD73, CD105, and CD44. Flow cytometry sorting of viable individual subpopulations revealed that ADSCs had the capacity to grow in adherent culture. The identity of the expanded cells as mesenchymal stem cells (MSCs) was further confirmed based on their differentiation into adipogenic and osteogenic lineages. To identify the potential factors, which may determine the beneficial outcome of treatment, we followed 44 patients post-SVF treatment. The gender, age, clinical condition, certain SVF-dose and route of injection, did not play a role on the clinical outcome. Interestingly, SVF yield seemed to be affected by patient’s characteristic to various extents. Furthermore, the therapy with adipose-derived and expanded-mesenchymal stem cells (ADE-MSCs) on a limited number of patients, did not suggest increased efficacies compared to SVF treatment. Therefore, we tested the hypothesis that a certain combination, rather than individual subset of cells may play a role in determining the treatment efficacy and found that the combination of ADSCs to HSC-progenitor cells can be correlated with overall treatment efficacy.ConclusionsWe found that a 2:1 ratio of ADSCs to HSC-progenitors seems to be the key for a successful cell therapy. These findings open the way to future rational design of new treatment regimens for individuals by adjusting the cell ratio before the treatment.

Effective Treatment of Traumatic Brain Injury in Rowett Nude Rats with Stromal Vascular Fraction Transplantation

Traumatic brain injury (TBI) affects 1.9 million Americans, including blast TBI that is the signature injury of the Iraq and Afghanistan wars. Our project investigated whether stromal vascular fraction (SVF) can assist in post-TBI recovery. We utilized strong acoustic waves (5.0 bar) to induce TBI in the cortex of adult Rowett Nude (RNU) rats. One hour post-TBI, harvested human SVF (500,000 cells suspended in 0.5 mL lactated Ringers) was incubated with Q-Tracker cell label and administered into tail veins of RNU rats. For comparison, we utilized rats that received SVF 72 h post-TBI, and a control group that received lactated Ringers solution. Rotarod and water maze assays were used to monitor motor coordination and spatial memories. Rats treated immediately after TBI showed no signs of motor skills and memory regression. SVF treatment 72 h post-TBI enabled the rats maintain their motor skills, while controls treated with lactated Ringers were 25% worse statistically in both assays. Histological analysis showed the presence of Q-dot labeled human cells near the infarct in both SVF treatment groups; however, labeled cells were twice as numerous in the one hour group. Our study suggests that immediate treatment with SVF would serve as potential therapeutic agents in TBI.