Alan Widgerow

University of California, Irvine | UCI · Plastic Surgery

Objective Retention rates of lipotransfer remain variable, with the underlying cause associated with tissue oxygenation and blood supply barriers. One promising new method of improving tissue oxygenation is micro/nanobubbles (MNBs), which are small gas bubbles (<100 μm) generated within a saline solution. MNBs are stable and carry a significant amo...

Objective Utilizing biological scaffolds for cartilage tissue engineering is a promising tool for improving auricular reconstruction. Decellularized auricular scaffolds provide a means of regenerating cartilage for in vivo implantation, but identifying the ideal regenerative mix remains challenging. Methods Human cadaver auricular cartilage was de...

BACKGROUND Injectable biostimulators are widely used to improve facial aging signs. This study was performed to compare the genetic pathways affected by 2 different injectable biostimulators. METHODS Randomized 13-week study ( n = 21) comparing gene expression after poly l -lactic acid (PLLA-SCA) and calcium hydroxylapatite (CaHA-R) injections (ba...

Introduction: Exosome technology is a promising new advancement in therapeutic options but is still in its early stages, leading to uncertainties. A small pilot study compared traditional peptide technology (Regenerating Skin Nectar with TriHex Technology® and TriHex Technology® peptide + Octapeptide) to two leading exosome products (Stem cell deri...

Introduction: This study was conducted to question the findings of a prior study published in Journal of Drugs in Dermatology (JDD) in September 2023, which reported that a topical firming and toning body lotion (FTB—SkinMedica®, Allergan Aesthetics, an AbbVie Company, Irvine, CA, USA) upregulated several genes in a UV-irradiated 3D full-thickness...

Background: Dermatoporosis (DP) is a condition associated with thinning skin layers and resultant fragility. Much of the thinning is related to fibroblast dysfunction, production of destructive inflammatory cytokines, breakdown of the extracellular matrix (ECM), and weakening of the dermo-epidermal junction. A major contributor to this change in t...

Introduction This study was conducted to validate the findings of a prior study published in JDD in September 2023, which reported that a topical firming and toning body lotion (FTB – SkinMedica®, Allergan Aesthetics, an AbbVie Company, Irvine, CA) upregulated several genes in a UV irradiated 3D full-thickness human skin model, outperforming other...

This paper outlines a process undertaken by a physician to design a peptide aimed at impacting the extracellular matrix. From a position of very little expertise, a new peptide was designed with amino acid constituents based on the structural proteins collagen and elastin. Sequencing was also considered, given the periodic repetition observed in th...

Microtia and anotia are congenital auricular anomalies that negatively impact the psychosocial development of those affected. Because auricular cartilage is a type of elastic cartilage that lacks regenerative capacity, any notable defect in its structure requires a surgical approach to reconstructing the auricle. While there are several reconstruct...

Background This study follows an initial scientific validation linking sodium ascorbate (SAC) with elastin conservation and the clinical trial histology observation that the full formulation tested there stimulated elastin development. In an effort to explain the increased elastin response, a candidate was sought that may provide synergy to SAC dur...

Background: Dyschromia can be associated with increased production and/or reduced clearance of pigmentation in the skin. Multiple pathways are involved in causality. A novel topical product was recently developed, which contains actives that have been validated through in-vitro and clinical studies to counteract pigmentation related to photodamage...

Background A new antioxidant serum has been formulated with sodium ascorbate, a sodium salt of Vit C, which aims to address facial photodamage while maintaining a low irritation profile and preserving elastin. Detailed background science has been submitted in a previous publication. This open‐label study was conducted to validate the science by dem...

Background: This paper describes the background research and validation related to the formulation of a novel antioxidant product. Two defined outcomes were sought. Firstly, a combined efficacy of antioxidant ingredients in quenching free oxygen radicals. Secondly, the investigation into whether a vitamin C derivative sodium salt was elastin conse...

Dermatoporosis as a disease entity is relatively newly described, the title conceived as recently as 2007. The background of chronic skin fragility, bruising, and atrophy appears to start in some patients as early as their mid-forties, but is full blown over the age of 65 years. The dehydration and fragility of the skin with recurrent bruising and...

Background Approximately 20% of retained foreign bodies are surgical needles. Retained macro-needles may become symptomatic, but the effect of microsurgical needles is uncertain. We present the first animal model to simulate microsurgical needle retention. Given a lack of reported adverse outcomes associated with macro-needles and a smaller cutting...

Purpose: Currently, no treatment corrects the contractile nature of Dupuytren myofibroblasts (DMFs) or prevents recurrence following surgery. Antifibrotic and proadipogenic growth factors are released when adipose-derived stem cells (ASCs) are cultured with platelet-rich plasma (PRP), a platelet concentration from whole blood. Reprograming myofibr...

Objective Bioscaffolds for treating soft tissue defects have limitations. As a bioscaffold, allograft adipose matrix (AAM) is a promising approach to treat soft tissue defects. Previously, we revealed that combining superficial adipose fascia matrix with AAM, components of the hypodermis layer of adipose tissue, improved volume retention, adipogene...

Background: Dyschromia can be caused by abnormalities in the increased production and/or reduced clearance of pigmentation in the skin. Causes of hyperpigmentation include excessive sun exposure, medications, hormones, post-inflammatory hyperpigmentation (PIH), and medical disorders, such as melasma. A novel topical product was recently developed,...

Objective: This review aims to evaluate the effectiveness of the two most commonly used oxygen delivery methods for the treatment of thermal burn wound healing: hyperbaric oxygen therapy (HBOT) and topical oxygen therapy (TOT). Method: The PubMed database was searched for articles discussing the use of HBOT or TOT in the treatment of thermal bur...

Background Acne scarring remains a significant problem. Laser therapy has produced varying results with deeper ablative therapies occasionally associated with side effects including delayed healing, infection, scarring, erythema, acne, milia, edema and dyspigmentation. Objective Can adjuvant topical therapy impact the healing process and outcome o...

Background Restorative Eye Treatment with TriHex Technology (RET) is a topical eye product with peptides and botanicals that reduce the appearance of crow’s feet, under-eye bags, and dark circles. INhance with TriHex Technology (IH) is a topical product that has been clinically proven to accelerate the clearance of bruises and aid in the reduction...

Background: Key cellular players regulating human skin pigmentation include melanocytes in the epidermis that synthesize melanin, neighboring keratinocytes that receive and distribute melanin in the upper layers, and fibroblasts in the dermis that affect overlying melanocytes and keratinocytes. In addition, endocrine factors from the blood supply...

Background: Autologous fat grafting is commonly used for soft tissue repair (~90,000 cases/year in the US), but outcomes are limited by volume loss (20-80%) over time. Human allograft adipose matrix (AAM) stimulates de novo adipogenesis in vivo, but retention requires optimization. The extracellular matrix derived from superficial fascia, intersti...

Background: Adipose tissue is an easily accessible source of stem and progenitor cells that offers exciting promise as an injectable autologous therapeutic for regenerative applications. Mechanical processing is preferred over enzymatic digestion, and the most common method involves shuffling lipoaspirate (LA) between syringes and filtering to pro...

PURPOSE: Advances in microtia reconstruction, including ear scaffolding and prosthesis, have a high failure rate due to the avascular nature of cartilage, loss of structure, and immunogenic reaction to foreign material.1 Improvements in bioengineered materials and scaffolding have started to tackle these issues, but there is a noticeable gap in the...

Objective: Following previous clinical trials, an antiaging product (Restorative Skin complex [RSC]; Alastin Skin Care Carlsbad, a Galderma company), was investigated for its effects on Klotho gene regulation, telomere length, and histological biopsy changes to provide a comprehensive picture of the mechanism and efficacy of its anti-aging effect....

Background: A new Hyaluronic acid (HA) formulation was developed based on high molecular weight (MW) compounds used on the surface of the skin while using peptides to stimulate the high MW HA production by fibroblasts and keratinocytes from within the skin layers. Detailed science has been submitted to this journal in a previous publication. This...

Background: Skin preconditioning prior to and following procedures, has previously been demonstrated to hasten and optimize healing, and decrease the symptoms and signs associated with invasive surgery. These trials involved the use of multiple topical products. In an effort to control costs and to increase patient compliance, a single surgical pr...

Introduction: Hyaluronic acid (HA) plays an important role in cellular and extracellular matrix (ECM) homeostasis. Recent studies demonstrate that low molecular weight (MW) HA has proinflammatory characteristics while high MW HA is considered anti-inflammatory and regenerative. In formulating a topical HA product, the possibility of creating a foc...

Importance: In a patient-centered field such as plastic surgery, patient-reported satisfaction can measure the success and value of surgery, since it is not uncommon for patient and surgeon assessments to differ. Currently, there is no standard for evaluating patient-reported satisfaction postauricular reconstruction. Objective: To systematically r...

The utilization of stem cells for applications in a variety of fields related to regenerative medicine and tissue engineering is an exciting research topic. An assortment of mesenchymal stem cells (MSCs), including adipose-derived stem cells (ASCs) and bone marrow-derived stem cells (BMSCs), provide an ideal source for tissue engineering applicatio...

Background: Burns are devastating injuries, carry significant morbidity, and require long-term treatment or multiple reconstructive procedures. Wound healing and secondary insults caused by burn wound conversion are amendable to therapeutic intervention, where ischemia has been cited as one of the major factors (Dermatol Surg. 2008;34:1159-1169)....

The techniques used to make preoperative markings before soft tissue reconstruction have remained relatively unchanged since the earliest years of plastic surgery. Using skin-marking pens, many surgeons continue to draw markings freehand as "best estimates" before their first incisions. Although efficient for the experienced surgeon, this strategy...

TriHex Technology (Alastin Skincare, Carlsbad, CA) has been shown clinically to promote healing and outcomes post procedures and has been demonstrated clinically to improve lipid droplet dissolution and patient-reported outcomes post procedure. Histologically, the formulations have proven to regenerate collagen and elastin. The use of the technolog...

Background Over time human skin thins and loses elasticity, and topical treatments attempt to reverse this process. Objectives Assess the efficacy of TransFORM Body Treatment (TFB) in skin rejuvenation compared to a bland moisturizer on the extensor and volar forearms. Methods Blinded participants were given two products to apply on the designate...

The cover image is based on the Original Contribution New approaches to skin photodamage histology—Differentiating 'good' versus 'bad' Elastin by Alan D. Widgerow and Karl Napekoski https://doi.org/10.1111/jocd.13865.

Background Regenerating Skin Nectar with TriHex Technology ®(RSN) has been shown clinically to promote healing and outcomes post procedures. TransFORM Body Treatment with TriHex Technology ® (TFB) has demonstrated clinically to improve lipid droplet dissolution and patient reported outcomes post procedure. Histologically, both have proven to regene...

Background Photodamage creates changes within the skin layers known as solar elastosis. This presents as fragmentation of collagen and elastin fibers, decreases in the extracellular matrix (ECM) ground substance, as well as hyaluronic acid decrease in the thinning epidermis. Traditional immunohistochemistry (IHC) staining has failed to differentiat...

Background Physicians strive to improve the post-surgical experience and optimize patient reported recovery outcome measures (PROMs) following elective cosmetic surgical procedures. Our previous pilot feasibility study demonstrated twice daily post-operative topical body treatment with tripeptide and hexapeptide (TFB), reduced PROMs of swelling, in...

Background: Microtia is an inherited condition that results in varying degrees of external ear deformities; the most extreme form is anotia. Effective surgical reconstruction techniques have been developed. However, these usually require multi-stage procedures and have other inherent disadvantages. Tissue engineering technologies offer new approac...

Background Skin topical preconditioning prior to and after surgical procedures is a relatively new concept, particularly in relation to the efficient removal of tissue breakdown products. Clinical trials demonstrate improvements, such as less induration, when surgery is combined with topical product preconditioning and with usage post-surgery. Obj...

Stem cells and tissue engineering have made great strides in plastic surgery. This review of the literature evaluates some current background information and recent advances in our laboratory to bring these areas more into the clinical setting.

Injectable procedures have come to play an enormous part in everyday aesthetic medical practice. Whether its use is directed at volumizing with fillers, decreasing volume using enzymes, skin-tightening using multi-needle approaches, or neuromuscular blockade, the injectable route is the means of delivery in all these cases, making injectable proced...

Background Time spent under the microscope is often a limiting factor as plastic surgery residents work toward proficiency in microsurgery. This study describes and assesses a novel application of a digital microscope compatible with smart devices which can consistently and reliably magnify microsurgical fields. Methods A digital microscope was use...

Anti-aging strategies using topicals with active agents demand validation and proof of efficacy. One investigation in this realm involves gene expression testing. This study undertakes gene expression analysis of Alastin Skincare Regenerating Skin Nectar (RSN) using an in vitro human skin model. The current study is similar to other published human...

There are two accepted theories that describe the pathophysiology of fat grafting results. The first is that once grafted, there is at least partial survival of the adipocytes to achieve a lipofilling effect. The second theory is that the grafted adipocytes undergo necrosis, and it is the remaining stromal components and stem cells that recruit hos...

To the Editor We read with interest the case report by Sebaratnam et al.¹ Recently a new type of white adipose tissue (WAT), dermal WAT (dWAT), has been identified and is recognized as playing a role in skin processes such as hair follicle growth, thermoregulation, wound healing, and signal transmission.² This layer lies in the reticular dermis enc...

INTRODUCTION: Microtia is a congenital condition that results in external ear deformities of varying degrees, of which the most extreme form is anotia. The current surgical reconstruction techniques all require a multi-stage approach and have other intrinsic disadvantages. Cartilage engineering is an alternative treatment approach in the field of e...

Background: Ever since the classification of Dupuytren disease into the proliferative, involutional, and residual stages, extensive research has been performed to uncover the molecular underpinnings of the disease and develop better treatment modalities for patients. The aim of this article is to systematically review the basic science literature...

Purpose: The preservation of transplantable tissue is directly tied to and limited by the ischemia time. Micro/nanobubbles (MNBs) are miniature gaseous voids that allow for the oxygenation of tissue given their high oxygen-carrying capacity. One of the current limitations of islet cell transplantation for type 1 diabetes is poor islet survival, ca...

This paper introduces the concept of “skin bed preparation” prior to surgical procedures. Following the theory of chronic wound bed preparation and adapting the skin model to one of chronic wound changes related to extrinsic and intrinsic factors, a topical formulation aimed at recycling the extracellular matrix (ECM) from accumulated waste product...

Non-surgical fat reduction procedures have gained in popularity over the past few years and remain in great demand. The process results in accumulation of breakdown products, lipid droplets, that are slowly absorbed over a period of months. This paper outlines the physiological process whereby lipid droplets are absorbed through a process of autoph...

Background: Non-surgical fat reduction through cold application, cryolipolysis, is an extremely popular procedure. Apoptosis of the fat cell content may take around 3 months to resolve. Objective: A topical test product was compared to a bland emollient as an adjunct to the cryolipolysis procedure of the upper arms to determine if the product coul...

Introduction Oxygen is one of the most important elements in all stages of wound healing. It is involved in killing bacteria during the inflammatory phase, increasing keratinocyte differentiation and reepithelization during the proliferative phase, and supporting myofibroblast differentiation and collagen cross-linking during the maturation phase....

Introduction Extracellular vesicles (EVs) are cell-secreted packages that deliver cargo to target cells to effect functional and phenotypic changes. They are secreted by many different cell types, including adipose-derived stem cells (ADSCs), which are a promising field of study in regenerative medicine. Our aim was to perform a systematic review o...

Mixed reality, a blending of the physical and digital worlds, can enhance the surgical experience, leading to greater precision, efficiency and improved outcomes. Various studies across different disciplines have reported encouraging results using mixed reality technologies, such as augmented and virtual reality. To provide a better understanding o...

Diabetes mellitus (DM) is a chronic disease that results in a variety of systemic complications. Recently, stem cell-based therapies have been proposed as potential modalities to manage DM related complications. Mesenchymal stem cell (MSC) based therapies are often considered as an ideal stem cell-based treatment for DM management due to their immu...

Despite the vast amount of technological advancement seen in the operating room, surgical markings are still drawn as "best estimates" the same way Susruta drew them in the sixth century BC. Many of the flaps used in plastic surgery have precise geometries that are hard to replicate by hand. In this article, the authors describe a novel approach in...

In developed countries, over 100 million people per year form scars, of which 30% become hypertrophic. These scars are defined histologically by the presence of persistently contractile myofibroblasts. Recent in vitro research suggests that certain bone morphogenic proteins (BMP) can induce scar myofibroblast dedifferentiation and reprogramming int...

Introduction: An antiaging regimen that aids in clearing the matrix of waste products and stimulating neocollagenesis and neoelastogenesis was tested among a group of subjects over the course of 12 weeks to assess its efficacy in women with mild to moderate wrinkles and skin sagging on the face. Materials and methods: The efficacy of the product...

Adipogenesis is a complex process whereby the multipotent adipose-derived stem cell is converted to a preadipocyte before terminal differentiation into the mature adipocyte. Preadipocytes are present throughout adult life, exhibit adipose fat depot specificity, and differentiate and proliferate from distinct progenitor cells. The mechanisms that pr...

Treatment of hypertrophic scars and other fibrotic skin conditions with autologous fat injections shows promising clinical results; however, the underlying mechanisms of its antifibrotic action have not been comprehensively studied. Adipose-derived stem cells, or stromal cell-derived factors, inherent components of the transplanted fat tissue, seem...

Up to 15 billion dollars of US health care expenditure each year is consumed by treatment of poorly healing wounds whose etiologies are often associated with aberrancies in tissue oxygenation. To address this issue, several modes of tissue oxygen delivery systems exist, including Hyperbaric Oxygen Therapy (HBOT) and Topical Oxygen Therapy (TOT), bu...

Hair follicles: Secret to prevent scars? Although some animals easily regenerate limbs and heal broken flesh, mammals are generally not so gifted. Wounding can leave scars, which are characterized by a lack of hair follicles and cutaneous fat. Plikus et al. now show that hair follicles in both mice and humans can convert myofibroblasts, the predomi...

Since its introduction 20 years ago for the treatment of chronic wounds, negative pressure wound therapy use has expanded to a variety of other wound types. Various mechanisms of action for its efficacy in wound healing have been postulated, but no unifying theory exists. Proposed mechanisms include induction of perfusion changes, microdeformation,...

Optimization of fat grafting continues to gain increasing attention in the field of regenerative medicine. “Nanofat grafting” implements mechanical emulsification and injection of standard lipoaspirate for the correction of superficial rhytides and skin discoloration; however, little is known about the cellular constituents of the graft. Based on r...

Normal aging and photoaging of the skin are chronic processes that progress gradually. The extracellular matrix (ECM), constituting over 70% of the skin, is the central hub for repair and regeneration of the skin. As such, the ECM is the area where changes related to photodamage are most evident. Degradation of the ECM with fragmentation of protein...

In this work, we demonstrate the use of a thin, self adherent, and clinically durable patch device that can collect fluid from a wound site for analysis. This device is manufactured from laminated silicone layers using a novel all-silicone double-molding process. In vitro studies for flow and delivery were followed by a clinical demonstration for e...