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Fibroblast Treatment

Nov 17, 2017 | Ask Nicola then, Combination treatments

Recently, there has been a surge in interest in this ‘new’ treatment. Hopefully this will answer some questions.

What is it?

The ‘’Fibroblast Treatment” is a term usually used by clinics/aestheticians to describe a ‘minimally invasive, non-surgical blepharoplasty’. A blepharoplasty is an operation to ‘lift’ the eyelids, either upper or lower or both. It can be done under local anaesthesia or under general anaesthesia. I’ll come to that later.

But what are FIBROBLASTS?

Fibroblasts are the main cells present in the skin, in particular the dermis which lies just under the epidermis. They make up over 70% of dermal cells and are responsible for producing, among other things, collagen, elastin and all the components of the ground substance of the dermis. In short, they work constantly to maintain the main part of the skin structure but can be stimulated to work even harder if the skin is injured. By trauma of any kind, a blunt force, a cut, a tear or by heat, as in a burn.

So when you read “FIBROBLAST TREATMENT”, it could mean anything that stimulates these cells and does not necessarily mean what it says. Read on.

EYELIDS

The skin around our eyes is, by necessity, quite thin. It needs to be to allow rapid free movement as we blink. We blink, on average about 28,800 per day so you can imagine, we ask a lot of that type of skin. Apart from being thinner than skin on, say, your nose, it also needs to be quite elastic. This gives eyelids the ability to ‘snap back’ into position. Every time.

As we get older, we lose collagen and elastin in ever increasing amounts from our skin. Consequently, it becomes even thinner, looking creppy in appearance and loses its ability to snap back. So we develop ‘hooded eyes’ from our upper lids or ‘baggy eyes’ if it involves our lower lids. We look just plain exhausted if it involves both!

So how can we treat this?

As mentioned above, a simple surgical operation (a blepharoplasty) to remove an ellipse of this stretched, thinner, excess skin can be carefully carried out and this can restore the younger appearance of eyelids by losing the creppy, loose, wrinkled skin. In the right hands, this is a wonderful operation and I have heard over the years, while anaesthetising for plastic surgeons, it is an operation many plastic surgeons would happily have themselves.

So why look for alternatives?

Well, there are a few reasons. Mainly, I think people are afraid of a surgeon’s knife but, as I’ve already said, in the correct hands, there is no need to worry. It is precise and the results can be fabulous.

Secondly, there is the issue of a General Anaesthetic which frightens many people (no need, trust me. I’m an Anaesthetist. They are safe) Also, in this country, the level of training is incredibly high, the risks are minimal.
The third reason is downtime. On average, downtime post-surgical blepharoplasty is 10 days but I have seen less time ( a week say) more often than I have seen longer ( up to 3 weeks).

So what are the alternatives?

Clearly, the only other way to reduce the creppy, excess skin around the eyes is to cause the skin itself to shrink back to its former position. To get it to rejuvenate and heal. So how can we do that?
We know, as doctors, that heat causes skin to shrink. We have known it for years. It shrinks in 2 ways. Firstly, it shrinks immediately if temperature is particularly high ( think of a piece of bacon shrinking in a dry pan before it cooks) and, secondly, we also know it shrinks slowly as it heals after a burn. That’s the reason we sometimes need to do multiple operations over months to release contractures (tightness) in skin which have happened after a particularly intense heat injury (burn).

Now, if we can control the temperature and the length of time the skin is exposed to that temperature then we can control the amount of contraction we get. Many new treatments available on the market nowadays use this property of the skin to shrink in response to heat. And there are different types of energies available which will produce heat.

1. LIGHT.OtherwiseknownasLasers.They’vebeenusedinmedicinefor years. They provide excellent precision and are a treatment for ablation (removal) of pigmented lesions, acne scars and deep wrinkles amongst other things. They produce very little tightening properties so they’re useful in medicine when you don’t want that! For example, treatment of vocal cord nodules.

2. SOUND.Ultrasound technologies.Alsowellknowninmedicineand useful for rehabilitation therapies. This produces less contraction than RF (radiofrequency, see below).

3. RADIOFREQUENCY. Myenergyofchoice.Usedinmedicinefor50years and well understood. Uses precise heat but also allows it to dissipate (spread) to a very precise amount. This technology causes the most contraction of them all.

4. PLASMA ENERGY. (or just plasma)Thisenergyisalsoknownasthe FOURTH STATE. We have solids, liquids, gases and finally PLASMA. Plasma is just electrified gas. Most of the matter in the universe is plasma. The sun is plasma, the Northern Lights are plasma. Flourescent lights are plasma. If we use this energy in an instrument, it causes very precise burning of tissues and is used in many areas in medicine. It can be used to remove tonsils, for example. Because of its very focused nature, it does not cause much heat dissipation and, consequently, does not cause as much contraction as say, Ultrasound or Radiofrequency.

5. MECHANICAL. Some needling therapies (mesotherapy) can cause slight contraction of skin as it stimulates the skin to heal.

So can any of these energies be used to shrink eyelids?

Probably only 3 of them could. RF (radio frequency), PLASMA energy and, lastly, mechanical (needling). All 3 are precise but only 2 cause local heating of the skin. Mechanical(needling) does not and causes the least amount of skin contraction.

Treatments have arrived on the market which use PLASMA and they are being marketed as FIBROBLAST treatments. As you can see from the explanation, they do indeed stimulate fibroblasts. But so do many other therapies on offer. For example, RF treatments (FRACTORA) also cause local shrinking and contraction of eyelids. Fibroblasts are definitely stimulated.

As for the future, RF assisted FACETITE will soon progress to include non- surgical blepharoplasties as the handpieces available become smaller and ever more prescise.

Are there any risks with PLASMA ENERGY as used in ‘FIBROBLAST TREATMENT’?

In the right hands, it is safe enough, but downtime of swelling and redness is significant (a week to 10 days ) and repeat treatments are recommended. (up to 3 ) . Late pigmented changes in the treated areas can be a problem, especially in darker skin. Finally, there have been reports of peri-orbital tissue infections.

SO TO SUMMARISE..

1. Fibroblast treatment doesn’t mean a specific treatment as fibroblasts are skin cells. All skin treatments are fibroblast treatments.

2. Fibroblast Treatment as a name has been used to describe a type of non – surgical blepharoplasty (eye lift) using PLASMA device. There are several different PLASMA devices on the market.

3. What is the advantage of this treatment for lifting the eyelids versus a surgical approach?

The advantages given are

1. No knife is required 2. Reduced downtime. 3. Said to be equally effective 4. Cost

True, no knife is required but downtime is as significant (a week) as a surgical treatment. Secondly it needs to be done 3 times (so 3 weeks downtime at least ) and, thirdly, results are not as significant as surgical blepharoplasty.

The cost, therefore is the same as a surgical blepharoplasty under local anaesthetic.

So, no, I can see no advantage over Surgical Blepharoplasty at the moment. For this reason, as they say in Dragon’s Den, I’m out.

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