Stem Cells in the Treatment of Refractory Chronic Migraines.

BACKGROUND: Autologous adipose-derived stromal vascular fraction (SVF), which is rich in mesenchymal stromal cells, has been reported to be effective for the treatment of trigeminal neuropathic pain and chronic migraine and tension-type headaches. It is possible that stem cell activity targets neurogenic inflammation, which is a well-documented aspect of migraine pathogenesis. METHODS: Adult patients with severe migraine-related disability as measured by the Migraine Disability Assessment (MIDAS) score who failed botulinum toxin injections and at least 3 prophylactic drugs were included in this study. The primary outcome measure was the change in MIDAS score 3 months after treatment. Standard liposuction was performed to obtain adipose tissue, from which SVF was isolated by centrifugation. A sample of each patient's SVF was tested for the number of nucleated cells and their viability. Between 8 and 10 mL of SVF with 2.5-8.6 million viable cells were injected into the pericranial, neck, and trapezius muscles. RESULTS: One man and 8 women were enrolled in the study. The mean age was 48 years, the mean duration of headaches was 16 years, the mean number of prophylactic drugs tried was 10, and the mean MIDAS score at baseline was 122. Three months after the procedure the mean MIDAS score was 88. Seven out of 9 patients had a decrease in their MIDAS score, but only 2 had meaningful improvement. CONCLUSION: The use of autologous adipose-derived SVF may be effective in the treatment of chronic refractory migraines. It is possible that the use of allogenic stem cells could offer a more practical and more effective approach.

Basics of Lasers: History, Physics, and Clinical Applications.

Lasers are increasingly used by plastic surgeons to address issues such as wrinkles and textural changes, skin laxity, hyperpigmentation, vascularity, and excess fat accumulation. A fundamental understanding of the underlying science and physics of laser technology is important for the safe and efficacious use of laser in medical settings. The purpose of this article was to give clinicians with limited exposure to lasers a basic understanding of the underlying science. In that manner, they can confidently make appropriate decisions as to the best device to use on a patient (or the best device to purchase for a practice).

Radiofrequency Physics for Minimally Invasive Aesthetic Surgery.

Radiofrequency energy has a wide range of medical applications, including noninvasive treatment of wrinkles and body contouring. This technology works by differential heating of skin and soft tissue layers causing dermal remodeling or adipolysis, ultimately leading to observable effects. This article reviews the physics of radiofrequency as applied clinically.

Aesthetic Applications of Radiofrequency Devices.

Radiofrequency (RF)-based devices are used to improve face and neck laxity, a major feature of aging that until recently could only be addressed with surgery. Although these treatments are not meant to replace surgical procedures, patient satisfaction studies have been consistently high. For physicians offering these skin rejuvenation procedures, it is essential to have intimate knowledge of how the devices work, select appropriate candidates, set realistic expectations, and combine treatments to optimize outcomes. This article discusses the various noninvasive RF technologies currently in use and reviews pertinent clinical studies evaluating their efficacy and safety.

Minimally Invasive Radiofrequency Devices.

This article reviews minimally invasive radiofrequency options for skin tightening, focusing on describing their mechanism of action and clinical profile in terms of safety and efficacy and presenting peer-reviewed articles associated with the specific technologies. Treatments offered by minimally invasive radiofrequency devices (fractional, microneedling, temperature-controlled) are increasing in popularity due to the dramatic effects they can have without requiring skin excision, downtime, or even extreme financial burden from the patient's perspective. Clinical applications thus far have yielded impressive results in treating signs of the aging face and neck, either as stand-alone or as postoperative maintenance treatments.