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Dobke et al. Plast Aesthet Res 2020;7:1 I http://dx.doi.org/10.20517/2347-9264.2019.65 Page 3 of 8

Table 1. Survey of plastic surgeons regarding modalities impacting the practice of facial and neck rejuvenation
Modality rank Score
1. Non-invasive stem cell and regenerative approaches 135
2. Molecular level interventions, e.g., prevention of telomeres attrition protecting skin DNA and structural proteins from aging, 119
from loss of native growth factors
3. Improvements in percutaneous delivery of cosmeceuticals, personalized cosmetics 115
4. Genomic interventions 109
5. Tissue contouring/repair by energy delivering modalities 100
6. Refinements in body shaping by surgical techniques including tissue fllers and scaffolds 96
7. Skin resurfacing, tightening techniques (light, lasers) 69
8. Nutrition, specific, personalized diets, skin nutrients, control of obesity and malnutrition 48
9. Nanorobotic tissue rebuilding techniques 44
10. Alterations/adjustments in skin and gut microbiota 41
11. Immune system manipulations 33
12. Auto- and allo- transplantations for cosmetic purposes (other than fat transfers) 33

search were evaluated by the author and two independent reviewers (non-academic practitioners) in an
attempt to identify for this review and summarize the literature on the topic in the context of relevancy to
current research and practitioners’ interests as affirmed by a survey of practicing board-certified plastic
surgeons. These board-certified plastic surgeons participated in the survey ranking the clinical importance
(current and future) of twelve issues and their predicted or expected impact on the practice of face and
neck rejuvenation. Each respondent ranked the twelve categories by assigning a score “12” to the modality
expected to exert the most prominent impact in descending fashion, ending on “1” given to the treatment
with the least expectations. Scores were then totaled and ranked for each of the issues.

Twelve board-certified plastic surgeons were surveyed, ranking areas of current and future research and
clinical developments targeting facial and neck aging which will likely have the highest impact on the
practice of rejuvenation [Table 1]. The results of the survey indicate that nano and regenerative medical and
surgical developments and new technologies are expected to have the largest influence moving forward and
reaffirm the hypothesis reflected originally.

COMBINING NANO AND REGENERATIVE TISSUE RESEARCH AND TECHNOLOGIES
Primary technologies enabling interventions at the molecular level, e.g., prevention of telomere attrition
and subsequent protection of DNA and structural proteins of the skin from loss of growth factors and
ultimately aging or the use of platelet-rich plasma for skin rejuvenation, are examples of applications of
such emerging nanotechnology and regenerative techniques [1,4,9,10] .

Nano materials and formulations currently tested in cosmetic medicine include scaffolds for cells and
fillers, agent (e.g., growth factors) delivery, applications for cellular modification, isolation and tracking,
and nanodevices/robots (e.g., biosensors). Their small size and ability to enter even cell organelles as
[9]
well as technologies enabling the release of active agents are key . Nano systems, nano-assisted cosmetic
interventions, and regenerative medicine and surgery have the potential to change facial rejuvenation.
Leveraging and enhancement of endogenous stem cells and self-repair mechanisms will likely lead to the
development of precision cosmetology (similar to precision medicine) by identification of signaling and
effective tissue intercellular substrates and intracellular targets; and current trends, which are generally
based on physician intuition and experience, will begin to disappear as palliation of signs of facial and
[11]
neck aging progress . Futuristically, one can imagine a synergy of nano and regenerative systems by
cosmeceuticals or stem cell delivery by nanocarriers steering towards a specific target organ, e.g., face or
[12]
neck, by external magnetic fields and light-triggered release of active agents .