Generating More Than Buzz

A sold-out crowd was treated to high-level discussions on regenerative technologies, harnessing the body’s natural healing process, promoting overall health and wellbeing, creating a holistic approach to the treatment of patients, and more at the inaugural Genesis: Innovations in Aesthetic Regenerative Medicine on December 7 in New York City.

A unique gathering of leading aesthetic providers and scientists merged the clinical data and practical use of aesthetic regenerative medicine as part of a program spearheaded by course directors Shino Bay Aguilera, DO, and Doris Day, MD, FAAD. The event also featured the excitement of industry partners sharing their technologies with the stellar group of clinicians, unveiling new innovations, and demonstrating and reviewing clinical studies.

“There’s a hunger for this information,” Dr. Day said. “There’s a hunger to make sure that this keeps going, that this is the conversation starter and it’s the beginning of something really big because there are a lot of regenerative meetings, but there (wasn’t) a meeting that takes into account the practical applications from an aesthetics point of view.”

The broad discussion featured a diverse range of perspectives, and organizers are already eagerly looking forward to this year’s event. Below are some highlights from the inaugural meeting.

DECODING AGING SKIN

Saranya Wyles, MD, PhD, followed the course directors’ opening remarks with a history of aesthetic regenerative medicine.

“We talked a lot about the hallmarks of aging, about cellular senescence, mitochondrial dysfunction, telomere dysfunction, all the root causes of aging, of why and how we age,” Dr. Wyles said. “It’s more than just collagen and elastin. It’s more than just thinking about the extracellular matrix. It’s really about the functional skin health and ultimately how that affects our systemic aging as well.”

Dr. Wyles called this an exciting time because better questions are being asked and better research is being done.

“It’s really exciting because people are demanding the science,” she said.

REGENERATIVE AESTHETIC TOOLKIT

Jordan R. Plews, PhD, a biochemical engineer and stem cell researcher who is CEO of ELEVAI Skincare, discussed advancing from synthetic biomolecules to exosomes and beyond.

“My talk focused mostly on aesthetics and skincare and the advances really in the last, about, 40 to 50 years—covering this basic shift from synthetic molecules, things that are derived in a lab, things that maybe we’re extracting from a plant, things that are approximating the natural proteins like peptides, and then showing how, more recently, we’re shifting slowly but surely to a place where we’re using more cell-derived proteins, actual natural human cell-matched proteins, so that we’re getting a lot closer to topping up what is decreasing with age naturally,” he said.

Dr. Plews further discussed changes occurring in the skin with age and tools to push back.

“If you think about aging more like a degenerative disease, almost like a boat with a hole in it, you don’t want to wait until the boat is filled with water to start bucketing it out,” he said. “We need to be proactive, and I think that’s really what Genesis is about: being proactive with regenerative therapies rather than things that are maybe substituting or filling or replacing biology.”

HAIR HEALTH

Elizabeth Bahar Houshmand, MD, FAAD, spoke on the regenerative growth factors transforming hair health.

“Hair loss is a disease,” Dr. Houshmand said. “We know that it affects over 50 million men in the United States and 30 million women. Hair loss can start at a very early age and it can continue throughout life. I think hair is deemed cosmetic, but we know that there’s a medical component. So … my talk focused on what are the new aspects? What is science- and evidence-based? I talked about PRP. I talked about nanofluorosomes. I talked about peptides and so many other things to help with hair loss. Remember that your scalp and your hair follicle is like an organ. You have to promote its health.”

Dr. Houshmand noted today’s injectable options that have been scientifically proven to help stimulate the hair follicle.

“There is a very exciting area of the hair follicle called the hair bulge,” she said. “It has stem cells. The stem cells that are there help the different stages of the hair cycle called antigen, catagen, and telogen. Those three areas, if we can prolong the antigen phase, that’s how we’re going to grow and stimulate your hair. And we now have products that are able to travel down to the hair bulge.”

MOLECULAR CUES OF RENEWAL

Julie Woodward, MD, spoke about decoding human stem cell-derived secretomes. She discussed how the skin-specific whole secretome offers complete skin rejuvenation, is ethically sourced, and plays a pivotal role in young cells.

“This is just the tip of the iceberg to this field,” Dr. Woodward said. “It’s a brand-new and evolving field. There are so many new technologies coming out, and we’re all concerned, and the FDA is concerned about safety of these products. That’s one reason this meeting is being held: to quell our anxieties and make sure that we feel like we’re delivering the most ethical and safe care for all of our patients.”

POWER OF PDGF

Samuel Lynch, DMSc, DMD, presented on clinical applications for platelet-derived growth factor (PDGF).

“Pure PDGF is the first and only growth factor that’s been FDA approved in regenerative medicine,” Dr. Lynch said. “It has four different FDA approvals in other areas of medicine, and we’re just now bringing it to aesthetics. … It is the growth factor that, one, tells the body that there’s an injury because it’s only released from the platelets at a site of injury when the platelets stick together and clot, and two, then it stimulates the whole healing cascade to begin. So, it’s critical. What else does it do other than those amazing things? It also starts the whole process of recruiting all the wonderful regenerative stem cells, mesenchymal stem cells, and increasing the production of collagen types 1, 3, 6, and now your natural production of your hyaluronic acid, fibronectin, and elastin.”

Dr. Lynch noted that his company is working on a clinical trial with Dr. Aguilera that involves using recombinant pure PDGF in conjunction with calcium hydroxyapatite to further stimulate the upregulation of collagen production and achieve more dramatic results with biostimulators.

EVOLUTION OF PDRN/PN

Lanna Cheuck, DO, FACS, presented on the evolution of polydeoxyribonucleotide (PDRN) and polynucleotides.

“We talked about … the differences, the similarities, what it does, but also looking at specific nuances in the aesthetic field in addition to preventing post-inflammatory hyperpigmentation and also a case study in using it for vascular occlusion,” Dr. Cheuck said.

Dr. Cheuck discussed how her background as a urologic surgeon and her interest in various trends out of Korea led her in part to aesthetic medicine.

“Salmon sperm, obviously, is something that has come into lure in the last decade, especially from Korea,” she said. “But I also realized by doing my research that the placental DNA/PDRNA was actually utilized in cervical vaginal dystrophies.”

POLYNUCLEOTIDES MECHANISM

Dr. Wyles returned to the stage to present a topic that she called a “Trojan horse for oxidative stress.”

“I’m really excited about the toolkit that polynucleotides offer,” Dr. Wyles said. “It’s new and it’s emerging, but I think we still need a lot of studies to show how exactly it’s working for skin regeneration. Polynucleotides are essentially different small chains of sodium DNA—either A, T, C, (or) G. They’re considered purines or pyrimidines. And what I talked about in that talk was really trying to define its mechanism. It’s very early in its applications for aesthetics, and I think we need more studies to see how it can be effective.”

ADVANCED TECHNIQUES

Azza Halim, MD, MS, presented on advanced techniques and protocols for polynucleotide therapy.

“Not every patient is going to get the same protocol or the same treatment,” Dr. Halim said. “This is the reason when we customize the different cocktails, as I call them with the PDRN, we have to understand the ingredients; we have to understand also any kind of reactivity or cross-reactivity with products. Also, understanding which devices and delivery methods, and we also have to understand the legalities that are involved. … So, the take-home was patient safety, efficacy, what’s FDA approved, and staying within guidelines in order to deliver optimal results to the patients.”

PRACTICAL APPLICATION OF BIOSTIMULATORS

Dr. Houshmand said the No. 1 factor that ages someone is not a wrinkle or a line but rather overall luminosity and hyperpigmentation of the skin. Biostimulators, she said, can help with that overall health and structure of the skin.

“There’s been a lot of growth with combination therapies, understanding that you can customize the biostimulators and that they have different properties you can customize for the patients,” Dr. Houshmand said. “I think that’s been the biggest advancement and I love combining that with home care options.”

IMPORTANCE OF CELL SOURCE

Dr. Plews discussed different types of stem cells: pluripotent (PSCs), mesenchymal (MSCs), and hematopoietic (HSCs).

“The key takeaway there is we want to be working with the types of cells that are naturally responsible for healing and repair in the body when we’re talking about aesthetics and repairing after doing an aesthetic procedure,” Dr. Plews said. “So much of aesthetics today is about creating a controlled micro-injury, kicking off the wound healing cascade, and we want to make sure that we’re working with the right cell types that are going to be beneficial and biocompatible with those four phases of healing to get complete healing and the most quick and efficient healing.”

ETHICAL CONSIDERATIONS

Dr. Woodward also discussed ethical considerations in stem cell treatments.

“When it comes to safety of a lot of these products … there are so many levels to the ethics,” Dr. Woodward said. “The sourcing is a huge one. Are the sources of these exosomes and growth factors from safe sources? Is there DNA that’s helpful but also DNA that’s harmful? What about the messenger and micro RNA that’s in these products? And because these things haven’t been fully elucidated yet and there are so many different growth factors and peptides and cytokines and exosomes in these products, and we don’t know the function of all of them yet, the FDA is very cautious, particularly for injecting them. And that’s why it’s not legal to inject any of these products, these exosomes, into humans as of yet.”

EXOSOMES AND THE FUTURE OF SKIN REGENERATION

David Goldberg, MD, JD, said his interest in exosome technology dates back to an International Master Course on Aging Science (IMCAS) meeting 3 years ago, when he realized the need for more science in this area. Since then, he has been a leader in clinical trials in that area, and he presented some of his data at Genesis.

One study analyzed the use of exosomes when compared with platelet-rich plasma (PRP), which is commonly utilized after radiofrequency (RF) microneedling. Each patient had one side of the face treated with RF microneedling and the other with exosomes.

“We did biopsies on them, looking for changes in collagen and any elastin and mucopolysaccharides,” Dr. Goldberg said. “The risk of this study was that the exosomes wouldn’t do as well as PRP. It turns out that, clinically, the results are about the same, but a little bit better with the exosomes and the histology. … PRP requires blood drawing; exosomes do not. PRP also uses the cells of people who could be older and sometimes they’re not as regenerative. Exosomes are younger. So, my prediction over the next few years is you’re going to see a lot of these exosomes that are based on science are going to replace PRP.”

In another study, Dr. Goldberg and colleagues analyzed how exosomes are delivered to the skin for hair growth, because they are not approved to be injected in the US. They treated 15 patients with topical exosomes, half delivered via RF microneedling and half delivered following ultrasound.

“Both are pushing these things into the skin, and it turns out they both lead to growth of hair, but the ultrasound does a better job,” Dr. Goldberg said. “So what we’re going to find out over the next bunch of years is that it’s not only where the exosomes are derived from—we know there are a bunch of different sources they can be derived from—but it’s also how they’re going to be delivered to the skin.”

CELL-DERIVED TOPICALS

Dr. Plews’ third talk discussed key considerations when selecting cell-derived topicals.

He noted that this category includes various types of products, including conditioned media, oral mucosal epithelial (OME), extracellular vesicle (EV), and exosomes.

“Most of these differences in jargon have a purpose, but generally speaking, the industry doesn’t quite know the difference between a lot of these and often lumps them together into one category,” Dr. Plews said. “The exosome is really only as good as the cell it comes from, and more than that, how you treat the cell. So, I think it’s important to note that you need to start with the right cell in order to be able to produce the right exosome so it’s treating the right cell in the right way to get that to happen. These cells are not just releasing magical exosomes or magical secretory proteins all the time. To maximize them, you should be triggering them on creating the right environment.”

PDRN IN PLASTICS AND BEYOND

Sheila Barbarino, MD, FACS, presented research about PDRN in plastics and the mechanism of action.

“What I love about it is the mechanism of action and how it works, and how the results are immediate,” she said. “We’re seeing more and more patients being impatient to see results, and all of them want long-term results and all of them want something that’s going to stimulate and regenerate our own natural tissue over the long-term. PDRN checks a lot of those boxes.”