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Fibrocell Science, Inc. Message Board

  • br_757 br_757 Jun 25, 2011 1:20 AM Flag

    Fat vs. LaViv

    Greetings fellow FCSC longs:

    What I would like to take Jessie Livermore’s assessment of LaViv versus Fat and provide a point-counterpoint argument; but, before I begin I would like to point out that I am not a plastic surgeon. I am a dermatologist and fellowship trained Mohs micrographic surgeon.

    “Fat is much more suitable as a filler material particularly for volume correction. Volume correction is being increasingly recognized as the key to restoring youthful appearance.”

    This statement as a standalone statement is true but completely irrelevant to LaViv. Faciel aesthetic products are divided into three broad categories: Volume enhancers such as Fat, Sculptra, Silicone (microdroplet technique only). Of the three in this category Silicone provides the most dramatic result; however it is very risky due to granuloma formation and migration. Sculptra, initially indicated for HIV Lipodystrophy can provide excellent results, but is extremely technique dependent. Fat, although ideal, functions basically as a graft and has a poor take. For the adipocytes to survive neovascularization must occur and this is difficult and tenuous at best. Fat grafting has been used in the perioccular area to decrease the sunken or dark circle look around the eyes. For neovascularization to take place the adipocytes after centrifuging must be placed with a small cannula on the orbicularis muscle otherwise the graft will fail and the results will be suboptimal. Dermal fillers are the second broad category and include collagen products (Cosmoderm and Cosmoplast which are newer versions of Zyderm and Zplast), hyaluronic acid products (Restylane and Juvederm), Hydroxyappetite-based (Radiesse). These are not volume enhancers, but rather fill a crease. Collagen is a protein, hyaluronic acid is a sugar, and hydroxyappetite is a part of bone cement initially used by Otolaryngologist for correction of vocal cord damage. Each of these products has their advantages and disadvantages. Collagen is short acting (2-3 months) but is the most malleable. It provides superior enhancement in the vermillion border of the lip compared to the other products. Hyaluronic acid products last approximately 4-6 months, but are hard and less malleable. Radiesse is a deep dermal filler that may last up to a year, but it has a high propensity of forming subcutaneous nodules. The last category is neurotoxins which include Botox from Allergan and Dysport from Medicis. These products are used for dynamic rhytides and not for creases.

    LaViv is basically autologous cultured fibroblasts. Putting LaViv in the category of collagen and attributing the shortcomings of collagen to LaViv is incorrect. Fibroblasts do not only make collagen. Fibroblasts make collagen, elastin, hyaluronic acid and other extracellular matrix proteins. Therefore LaViv is the best of all worlds. It will add collagen and hyaluronic acid in addition to elastin. Finally, fat grafting is not the technique of choice in the nasolabial folds as it could potentially accentuate the problem. Prominent nasolabial folds are due to subluxation of the malar fat pads as we age. Grafting fat in the nasolabial folds would be a poor first choice.

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    • Well, K, you asked for my response and, I do have one.
      However, it is not a pleasant one a to the "eminent" dermatologist who initiates his statement with:
      "Greetings fellow FCSC longs".
      Man, you guys are really... "good", eh.

      With all due respect to "his eminence", I was somewhat horrified by a "particularly disturbing revelation".
      You see, I rather defer to "the specialist" since I am not a MD.
      I am a science guy with a business acumen.
      I was disturbed by this revelation:
      "Silicone (microdroplet technique only). Of the three in this category Silicone provides the most dramatic result; however it is very risky due to granuloma formation and migration."

      Silicone should be encased in a special shell and, used only for "mammary implants" and should never, ever be injected -- "microdroplet technique only, or, whatever".
      No, no, NO!! It is downright "dangerous" and can lead to catastrophic and irreversible consequences to patients.
      You pros need to hire another mouth-piece-doctor, who is more "mainstream" and of resolutely scrupulous integrity.

      -- I've always accepted FAT as having a "niche-placement" in the facial implant market but, it will remain forever, a niche player, at best, but, never to achieve major prominence next to the "market leading fillers".
      And I do believe there is "plausible niche placement" for laviv, next to fat in the facial filler market.
      FCSC's Laviv has the potential to replace FAT in that narrow niche segment because, we can infer that, the manufacturing and delivery process is very similar.
      However, to claim that FCSC's lativ will be a prime time "top shelf" player with Allergan's Botox-Juvederm market leading combo is a... "pipe dream" of "ginormous proportion", eh.

    • Fat has been used safely for DECADES. MDs like JesseL don't want some new product that could blow up in their face.

    • Nice post about the facts on competition.Another fact is the public dont even know yet about LAVIV but will very soon and Entertainment Tonight can have first rights to the show.Another fact one must remember is that most LAVIV competition have Black Box Warnings on their product and are dangerous to have injected.The FDA dont make these companies put this label on their product as this is by fat the worst label from the FDA a company wants on their product.Notice LAVIV dont have this label and that will increase sales for sure.

    • thebretheran Jun 25, 2011 7:40 AM Flag


      That was an excellent and informative post. I'd like to offer an alternative opinion to some extent.

      Autologous fat transfers have been done for many years and the pros and cons are well understood for the most part.

      The emerging procedure is taking small amounts of fat from the patient and separating out the "SVF" or stromal vascular fraction. This robust combination of autologous cells includes large amounts of adult stem cells, fibroblast cells, endothelial cells, red bood cells, and significant growth factors. When introduced (injected) correctly into the target tissue, these cells are demonstrating a remarkable ability to regenerate the dermis. Unlike fillers and very similar to Fibrocell, SVF does help rebuild elements of the extracellular matrix and thereby reduce the appearance of many fine lines and wrinkles. The injected adult stem cells will differentiate into fibroblast cells and the morphology is remarkably similar.

      The key to Fibrocell or any other transplanted autologous cell therapy is the action of the injected cells upon transplantation into the target tissue. Upon injection, these cells are highly active and produce significant cell signalling to resident native cells which then produce the desired regenerative effects. The cultured injected cells will apoptose within 30 days and the majority apoptose within 10 days. This is well known in the wound healing literature as studies follow closely the action of the "myofibroblasts". In the process of culturing cells, the adherence to plastic is what "activates" the cells or better put, portions of the cultured cells take on the morphology of "myo" fibroblasts and these are the cellls that promote regeneration.

      The most compelling advantage for SVF is that no cells have to be cultured at all. It is a same day-same procedure technique and per FDA guidelines, qualifies as a "minimal" manipulation and is not subject to typical regulations for a new drug, device, or biologic. The patient does not have to wait 6 weeks for treatment. These are advantages for the clinician and patient.

    • Terrific post left coast, comprehendable even for the less knowledgeable.

      Your analysis sums up why I'm not in favor of "any" instant gradification B/O or bad terms partnership. With merely a modicum of patience, the value of the company can potentially increase many times over what a day or swing traders delight would yield in the short term.

      I'd prefer the short termers screaming B/O to sell first thing Monday and just stay away. It isn't unusual at all for me to accumulate stock over many months and hold for years. Antares comes to mind. Accumulation beginning Feb.'09 through Jan.'10. Still holding many, many shares there.

      Bullish here, so it looks like more of the same for me.

      Thank you for your efforts!


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