Facial Reconstruction by Biosurgery: Cell Transplantation Versus Cell Homing

Abstract

The face distinguishes one human being from another. When the face is disfigured because of trauma, tumor removal, congenital anomalies, or chronic diseases, the patient has a strong desire for functional and esthetic restoration. Current practice of facial reconstruction using autologous grafts, synthetic fillers, and prostheses is frequently below the surgeon's and patient's expectations. Facial reconstruction is yet to take advantage of recent advances in seemingly unrelated fields of stem cell biology, chemical engineering, biomaterials, and tissue engineering. "Biosurgery," a new concept that we propose, will incorporate novel principles and strategies of bioactive cues, biopolymers, and/or cells to restore facial defects. Small facial defects can likely be reconstructed by cell homing and without cell transplantation. A critical advantage of cell homing is that agilely recruited endogenous cells have the potential to harness the host's innate capacity for regeneration, thus accelerating the rate of regulatory and commercialization processes for product development. Large facial defects, however, may not be restorable without cell delivery per our understanding at this time. New breakthrough in biosurgery will likely originate from integrated strategies of cell biology, cytokine biology, chemical engineering, biomaterials, and tissue engineering. Regardless of cell homing or cell delivery approaches, biosurgery not only will minimize surgical trauma and repetitive procedures, but also produce long-lasting results. At the same time, caution must be exercised against the development of products that lack scientific basis or dogmatic combination of cells, biomaterials, and biomolecules. Together, scientifically derived biosurgery will undoubtedly develop into new technologies that offer increasingly natural reconstruction and/or augmentation of the face.

Evolution and Trends in Reconstructive Facial Surgery: An Update

“…Currently, facial defect are mainly restored by the patient's own tissues (autologous), allogeneic tissues, xenogenic tissue, synthetic materials, or prosthesis [1]. All of these may require multiple staged surgeries and even then in the best of cases may not achieve satisfactory appearance and function [2].…”

“…The more boisterous argument against facial allotransplantation is in relation to the risks associated with lifelong immunosuppression which include susceptibility to infection, malignancies, and numerous drug related toxicities [1]. Although, it is hoped that as the technology for immunosuppression improves, this limitation can be overcome and facial allotransplantation can become a common place for even less severe deformity [2,67].…”

“…When the face is disfigured as a result of trauma, tumor resection, infectious diseases, or congenital anomalies, the physical and psychosocial effects are extremely detrimental [1]. It ranges from distortion of self-image and low selfesteem to withdrawal from social interaction which may lead to chronic stress and depression with suicidal tendencies [1,2].…”

“…It ranges from distortion of self-image and low selfesteem to withdrawal from social interaction which may lead to chronic stress and depression with suicidal tendencies [1,2]. Therefore, the task of correcting facial disfigurement is a challenging one to the reconstructive surgeons [3].…”

“…The patients have strong desire for a fully functional and aesthetic restoration without any alteration to their pre-morbid personality [1,3]. Consequently, medical science has evolved over the years, latching on developments in related fields of science such as computer technology and tissue biotechnology, in a stride to achieve optimal outcomes in facial reconstruction [1,4,5].…”