Saving your skin?

The past few days have seen a flurry of media excitement over a new facelift technique. Isolagen is the latest offering in the burgeoning cosmetic surgery industry. It was introduced into the UK in November and has already been used by more than 200 women. But while the 60 clinics that offer the treatment here extol its virtues and parade happy and sometimes youthful-looking recipients, other more sceptical voices have warned it may not be safe, and could spell long-term trouble for patients.

The technique involves injecting a patient's face with collagen-producing skin cells which have been taken from behind the ear. Part of the controversy surrounds the fact that Isolagen, which was introduced into the US in 1996, was later taken off the market when it was reclassified as needing a licence. In the UK it has been classified differently and so is available even without the backup of clinical trials, leading some experts to warn that women here are being used as guinea pigs.

Does that matter? Peter Ashby, a Harley Street cosmetic surgeon who uses the technique, says it's no more controversial than a skin graft. "No one raises their eyebrows or tut-tuts over a skin graft or an auto-donation of blood, where someone gives blood beforehand so it can be transferred to them during later surgery - and in effect that's what is happening with Isolagen," he says.

"What you do is take a tiny piece of skin - around 2mm by 3mm - from the crease behind the ear. It's then sent to the lab and put into a tissue culture so that it can generate new cells. When enough cells have been made, these are transferred, via a very fine needle, back into areas where there are wrinkles or lines or acne scars. The length of the process seems to depend on the patient's age - in people under 50 the cells seem to grow quite quickly, but it can take a while in older people.

"As far as any technique is concerned you can never say never about side-effects but concern should probably be directed more towards bovine collagen, which is also injected as a filler into lines and wrinkles, than Isolagen which, at the end of the day, puts back the patient's own cells. There are potentially greater risks about injecting bits of dead cow into patients than in putting back their own cells."

Ashby says patients have been delighted with the results: he's biased, of course, but, he points out, he wouldn't be using the technique if the feedback wasn't good. "We've had fabulous results with acne scars in particular - quite astounding," he says. "And patients who have had the treatment for crease lines and wrinkles are pleased with it, too."

One of these satisfied customers is Ashby's secretary, 45-year-old Hind Streamer. "I tried collagen injections but they didn't work for me," she says. "They overcorrected my lines and made my face look too full. The thing about Isolagen is it doesn't plump up your tissues too much.

"I had the tissue removed from behind my ear and it took around 10 weeks for the culture to grow. Then I had cells injected back in February, March and May, and I honestly think I look 10 years younger now. Also, while I wouldn't have considered having a surgical facelift in my 40s, this is a treatment that's sensible to have while you're younger, because your cells are better primed to grow quickly in the culture."

Or, as a cynic might argue, is it just a treatment designed to hook younger - and wealthier - women into the cosmetic surgery racket? We now spend over £200m a year on cosmetic surgery in the UK - four times more than a decade ago - with breast enlargements, nose jobs, eye-bag removals and facelifts among the most common operations.

According to Nick Percival, a consultant plastic surgeon who works at Charing Cross hospital in London, there are currently around 50 or so "face filler" products on the market, and Isolagen is just the latest kid on the block.

Fillers, he explains, are either permanent or non-permanent. Permanent products have the advantage that you don't need to keep returning to the surgeon for a refill, but non-permanent fillers mean that if the result is a touch on the generous side you can look forward to a reduction in time. Fortunately for her, actress Leslie Ash's spectacular collagen injection into her lips earlier this year was of the latter type.

"But I do have some reservations about Isolagen," says Percival. "Firstly it's expensive, at £2,500 a treatment compared with £250 for collagen. Most patients want immediate improvements because they've got some special occasion coming up, but Isolagen involves at least five visits and you don't see effects until around three months down the line.

"There's also some concern about cell mutation that might be caused by taking cells from the body and putting them back, although we haven't seen that yet. The fact is, it hasn't been around long enough to know what the long-term effects are."

David Gault, a consultant plastic surgeon based at Mount Vernon hospital in Northwood, Middlesex, says his main objection to Isolagen is the cost. "There are so many ways of filling a line or hole in someone's face and I think it's pointless to send something off to the lab to make more cells when another technique is to use the fat cells most people have elsewhere on their bodies instead. Coleman fat transfer, as it's called, takes fat cells and injects them back in where you need lines smoothing out." Cheaper and, says Gault, easier.

But for women like Streamer, the future is Isolagen. She can, she says, imagine a world in which women of 20 or 25 have skin tissue frozen so it can be thawed out, cultured and reimplanted decades later. It is, she says, a bit like putting by some money in the bank for your later years: a legacy from your youthful past to pep up your gravity-challenged future.

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