The Cutting Edge Of Cosmetic Surgery — & What We Don't Know About It
These treatments use ingredients from inside our own bodies...and the bodies of strangers.
“I’m a little nervous, but I’m mostly excited… I’ve never done anything like this before,” Melissa Klein tells us while perched on the edge of an oversized velvet chair in a high-end hotel room in New York City. The 26-year-old marketing manager is here to meet with Rian Maercks, MD, a Miami-based plastic surgeon licensed in Florida and New York who sees patients in Manhattan on business trips. He says he’s used medical offices in the past for these remote appointments, but insists that gossip from other doctors surrounding his unconventional procedures has pushed him to find more private places to work.
Klein first noticed Dr. Maercks’ work on social media and reached out because she wants to finally do something about her undereye circles. Most dermatologists recommend plumping and smoothing the spot, called the tear trough, with hyaluronic acid (HA) filler injections. But today, Dr. Maercks is using something extra that he claims will make the results last five times longer than the normal procedure. He photographs Klein and removes her makeup, then unpacks his oversized Louis Vuitton bag and begins to stack his tools on the table behind her: dozens of boxes of filler, syringes, rubber gloves, and, most unusually, a small vial of another woman’s placenta.
He rehydrates the small, yellow flakes of dried human placental tissue by mixing it with saline, then starts to empty the small, clear bottles of Restylane filler into syringes before mixing it all together into new, larger syringes. He sprays Klein’s right undereye with cold air to momentarily freeze the skin to minimize pain, and starts injecting syringe after syringe into her temples, forehead, lips, chin, and jawline, massaging as he goes to sculpt the filler into place. Over the course of the next 30 minutes he’ll complete what he calls “aesthetic facial balancing,” his technique that uses high volumes of filler to create perfect symmetry and can cost more than $10,000.
HA filler normally lasts less than a year, but Dr. Maercks says that the placenta addition in Klein's procedure will allow his work to stick around for the better part of a decade — long past the time the filler portion has metabolized. This claim isn’t backed by science, per se; it’s the result of tests that Dr. Maercks has been doing since around 2012, when he tried a similar concept on himself using filler supplemented with a stem cell activator (not Amniofill). He documented the procedure on YouTube — an astounding self-injection of 35 syringes’ worth of material, which is 34 more than most people start with. He says that he hasn’t done another round of filler since, crediting his current results — lifted cheekbones, smooth undereyes, and next to no wrinkles — to the stimulation of new cells.
What he added to his filler, he won't say — just that it wasn't Amniofill — but notes that it's the mystery addition that plays a role in his results.
“I treated myself six years ago and I look a lot better and younger than I did [then], but there's 100% certainty there's no product left in my face,” he explains. “For the year or two that [the] product is degrading, it's stimulating local cells to make new tissue.”
The secret to his treatment, he claims, is the activation of stem cells, the deeply-polarizing branch of regenerative science discovered in 1978 in umbilical cord blood: simple cells that can replicate and morph into other cells to repair any part of our bodies. Stem cells are packed into placenta and umbilical cord blood, since this organ is tasked with growing new life, but turning them on for purposes other than reproduction is far less understood.
The science hit a snag in 2001, when George W. Bush, citing moral and ethical reasons, signed a mandate to stop all federally funded research on embryonic stem cells, pushing the science into the private sector. For skeptics, experimenting is like playing God with the very building blocks of life; for the curious, it’s the slightly sci-fi future of medicine — and in 2018, it’s officially entered the beauty world with procedures that call on blood, skin, placenta, and penises as their star ingredients. But how far is too far on the quest to look younger? And what are the safety and ethical questions we have to ask ourselves when diving into this new world needle first? Is there room for exploitation, and who's really at risk in the end?
Whose Placenta Is This, Anyway?
The human placenta Dr. Maercks uses in treatments like Klein’s is sterilized through a secret process called “pureon” by its manufacturer, Mimedx. The Marietta, Georgia-based biotech company specializes in “regenerative and therapeutic biologics,” like skin grafts and allografts, which are basically sheets of processed skin, placenta, or umbilical cord tissue that pack the growth factors that turn on stem cells.
The one Maercks used on Klein is called Amniofill, one of Mimedx’s newest offering, which is used on-label to treat non-healing wounds and scarring, but doctors like Maercks are experimenting with the possibilities in cosmetic procedures, too.
As you might expect, a company that specializes in dried placenta isn’t very conventional. The nickname for Mimedx’s owner, 78-year-old Pete Petit, is “The Trump of Georgia,” and not simply because he was the now-President’s 2016 Georgia finance chair. He’s said to be active within the GOP and reportedly hopes that Trump will start to roll back regulations that have hindered the company’s growth in the past. Companies built up by Petit over the last four decades have been investigated by the DOJ, FBI, and SEC, and were a hot target for short sellers on Wall Street who bet money against its stocks succeeding. Just this week, Bloomberg reported that Mimedx is under federal investigation. But with all the focus on Mimedx’s financials, it’s surprising that no one is questioning where the placenta and skin is actually coming from.
People donate their materials, thinking they're doing something altruistic for the sake of health or medicine of another individual, when really that material is being used for a profit.
Brenden Parent, director of applied bioethics at NYU
Here lies one of today’s most hotly debated ethical dilemmas: Is it okay to use someone else’s biological material in a quest to activate our own stem cells for elective procedures? What’s more, is it ethical to profit? It’s illegal to buy or sell human organs in the United States, so instead, Mimedx uses a donation program. Take a glimpse at its website that solicits donations and you’ll see blue-eyed babies and butterflies floating above messaging that implies donations regenerate wounds and save lives. And some might — but where does a 26-year-old who wants to plump her face factor in?
Klein told us that she did her research and doesn’t have any reservations about the use of placental tissue in her filler procedure, “I trust Dr. Maercks,” she says. He says his other patients echo that sentiment. “You know, I thought there would be some resistance [because] this is human tissue, but, really I haven't seen that,” he says. “[It’s] donated, so I don't think there's a big ethical issue there.”
Mimedx declined to comment on this story, so we weren’t able to ask them our big question: Do the women who voluntarily give their placentas know all the places they might go? But Brenden Parent, director of applied bioethics at NYU, says that consent and safety are the big issues at play. He says that you cross an ethical line when “people donate their materials, thinking they're doing something altruistic for the sake of health or medicine of another individual, when really that material is being used for a profit." Mimedx, for the record, is reportedly worth $2 billion and sells products like Amniofill for a wide range of uses, including off-label cosmetic procedures.
As far as the safety goes, we’re still a bit in the dark. Doctors we spoke to say that growth factors do work to turn on stem cells, especially those from a placenta, but they just don’t totally know how, which means that the side effects are also unknown. The FDA, which is tasked with regulation, says that unproven stem cell therapy could damage healthy cell function and could lead to things like tumors. In 2014, a class-action lawsuit against Skinmedica, a skin-care company owned by Allergan (a major pharma company also behind Botox, Juvederm, and Latisse ), claimed that its TNS Serum, which has human growth factors derived from human baby foreskin, posed a cancer risk that wasn’t disclosed to consumers for many years. The case was settled and the serum is still available today — for $320 for a little over one ounce. And it’s not the only formula making headlines.
Penises & PRP: Hollywood’s Go-To Treatment Behind Closed Doors
As you might assume, Hollywood doctors have also gotten involved in the world of stem cells, but it’s a lot more conservative — at least among the procedures we know about.
New York-based celebrity facialist Georgia Louise woke up to a media flurry a few weeks ago when client Cate Blanchett told Vogue Australia that she and Sandra Bullock swear by what they call “the penis facial,” a secret, $900 treatment done by Louise that Blanchett jokes smells like semen. What actually earned it that name is epidermal growth factors (EGF), from cloned penile tissue – proteins that cause cells to grow and become more specialized — which, Louise says, stimulates our own growth factors and stem cells when applied topically.
The star ingredient, progenitor cells, were extracted from the foreskin of a single Korean baby, and then cloned, mixed with proteins, and blended into a serum. “The cells are taken from baby foreskin purely because they're the most healthy and vibrant cells that have scientifically been proven to help heal the skin and reverse the signs of aging,” Louise explains. After a chemical peel and microneedling is done to prime the skin, the serum is smoothed onto the face, then locked in with a thick mask so it fully absorbs. The glowing results are something that celebs can’t seem to stop talking about.
Louise has been doing the treatment on her celebrity clients for about two years, but only in the past six months has it become her most-requested procedure thanks to the fast, radiant results. She’s tight-lipped about the South Korean manufacturer that makes her serum, but assures us that the parents of the child consented to having his foreskin cells cloned and incubated at a stem cell bank. “I use serum that is sourced from a legitimate, licensed, bioengineer chemist,” she says, noting that she believes stem cells are the unavoidable future of beauty. “You're going to see more of it.”
On the West Coast, Karyn Grossman, MD, a Los Angeles-based, board certified dermatologist, is currently patenting a treatment she calls “undereye eraser,” which mixes growth factors from your own blood with filler to activate stem cells to volumize the skin under the eyes without a side of ethical dilemmas or baby penis foreskin. She says it makes dark circles less noticeable by thickening the skin with a rush of your own hard-working growth factors.
Grossman’s treatment is a bit like the now well-known “vampire facial,” (which applies platelet rich plasma that is spun from your own blood, or PRP, over microneedled skin for maximum absorption). But instead of simply using PRP, it adds a hit of poly-l-lactic acid to the mix (also found in a biostimulation filler called Sculptra) which she says gets deeper into the skin to repair and stimulate when it piggybacks on your own plasma. “It’s quickly become our most requested procedure,” Dr. Grossman tells us, noting that she does dozens of treatments every single week. And for those who don’t want to dabble in someone else’s placenta, it’s the ideal choice.
Dr. Grossman is a stickler for safety, so she has her patients wear metal eye shields and only does this procedure in her Santa Monica office. She says it takes a few rounds to get optimal results, so packs of four treatments go for up to $3,000, based on the area treated. She says that the growth factors from your blood stimulate your fibroblasts, which in turn create more collagen, which means younger-looking skin — and this is just the beginning. “Looking inward and seeing what your body can do, and how it can heal itself, is going to affect all aspects of medicine,” she says, noting that she gave PRP treatments a fair amount of skepticism in the beginning, but has seen the science behind growth factors work right before her eyes.
Soon, we might even be able to trick our own bodies into acting healthier and looking younger without drawing blood or a trip to the dermatologist. “For some years, we've been looking at medications that change your body's immune response,” Dr. Grossman says, noting that cancer-fighting drugs have been the pioneers. “We can use the same medications to help to kill viral cells like wart cells. So we're really looking at our body to help to repair itself.”
She says this science will eventually work its way into all aspects of aesthetics, but notes it could still be a long way’s off. “We're in the infancy on how to use our own body to repair itself, or even to help other people,” she says. “The growth of these ideas has really taken off in the last five years, but we're really just starting.”
The FDA is working at the same time on what the future of regulation will look like. “This is no longer the stuff of science fiction. This is the practical promise of modern applications of regenerative medicine,” say FDA commissioner Scott Gottlieb, M.D. in a regenerative medicine policy framework released in November. “But this field is dynamic and complex. As such, it has presented unique challenges to researchers, health care providers, and the FDA as we seek to provide a clear pathway for those developing new therapies in this promising field, while making sure that the FDA meets its obligation to ensure the safety and efficacy of the medical products that patients rely upon.”
Who's Really At Risk In The End?
Things will look very different in 20 years, but one thing is certain: Experimenting with early procedures comes with both breakthroughs and risks for the consumer. But the danger isn't only for the people getting their faces tightened or plumped — it's also for the donors. The doctors of the aforementioned procedures closely track where they source their materials from. But growing consumer demand for raw materials for cosmetic treatments increases the risk that poor and marginalized people may be exploited by the less scrupulous. Governments have struggled for years to combat a black market in organs like kidneys and livers. There is some evidence a similar black market may be emerging for cosmetic treatments.
Earlier this year, an Indian journalist reported that impoverished women in Nepal were selling skin from their backs to be used in plastic surgery procedures. Soma Basu, the journalist in India who broke the story, claimed that not only were impoverished Nepalese women being targeted to sell square inches of their fair skin for fast cash, but she says that sex traffickers were even stealing skin off women's backs in brothels. "I came across six, seven survivors who have come back, who have fled, including people who have sold their skin to traffickers," Basu says. "A lot of women were drugged when the skin was taken away, so when they woke up, they thought maybe they were tortured while they were unconscious."
Following the story, the Nepalese government opened an immediate investigation. "We are stunned by the report," the Women, Child, and Social Welfar Minister Kumar Khadka told Thomson Reuters. "We will investigate and if found to be correct, the government will make all efforts to stop this heinous crime." But this is just one incident, Basu says. "With [an] increase in aesthetic surgeries all across the world, this industry is rising. There is so much demand."
And at that point, when eternal youth could come at the cost of someone else's life, you have to ask yourself: How much is looking younger really worth?
Correction: An earlier version of this story stated that Dr. Maercks used Juvederm on his patient. It was actually Restylane, a different FDA-approved hyaluronic acid filler. The story has been updated to reflect the change.
Correction: An earlier version of this story failed to include pertinent details of Dr. Maercks' 2012 self-injection. It has been updated to reflect more in-depth information.