Stem cell treatments

Preparations that differ from one another are offered under the heading "stem cell". The stromal vascular fraction (SVF) obtained from adipose tissue, culture-expanded stromal cells and the extracellular vesicles cells release are not the same preparation.^1,2 This article assesses what the aesthetic procedures known by that name contain, what the research actually measures, the risks, and the authorisation framework in Türkiye. It does not recommend a product, a number of sessions or an individual treatment schedule. The changes reported in research are not a guarantee of the result any particular person will obtain.

What are stem cell treatments?

Aesthetic procedures offered under the name "stem cell" do not describe a single substance or a product prepared by one and the same method; living cells, different populations of cells and preparations obtained from cells may all be considered together under this heading.³ Adding cells to a fat graft and applying a cell-derived solution to the skin are likewise not the same procedure.^4,5 To understand the result of a piece of research, therefore, one first has to know what was given, where it was applied and which change was measured.

Stem cells are defined by their capacity for self-renewal and differentiation; not every cell obtained from adipose tissue meets that definition.¹ The International Society for Stem Cell Research (ISSCR) separates established treatments such as blood stem cell transplantation from uses that are still at the research stage.⁶ That such a medical use exists does not mean that the effect of some other cell preparation offered for aesthetic purposes has also been proven.⁶

Are SVF and culture-expanded cells the same thing?

The stromal vascular fraction (SVF) is a population in which different cells obtained from adipose tissue are present together; alongside stromal and progenitor cells it also contains cells related to the vasculature and to the immune system.¹ Calling SVF "pure stem cells" therefore does not describe its content correctly.¹ Adipose tissue itself, the SVF separated from that tissue, and the cell population obtained from within the SVF under culture conditions are defined by separate terms.¹

In culture-expanded adipose-derived stromal cells, the cells are selected and expanded in a culture medium.¹ This population is not the same as fresh SVF; nor does being obtained in culture mean that all the cells are entirely alike.¹ That they come from a common tissue source does not show that these preparations can be used in place of one another.¹ The distinction matters particularly when the name of a study is being reported; shortening the preparation studied to "stem cells" alone obscures which product the result belongs to.

Is an exosome a cell?

Extracellular vesicles are particles released from cells, delimited by a lipid bilayer and unable to replicate on their own; they are not the cell itself.² The term exosome describes the subgroup of these that has a particular intracellular route of formation.² The MISEV2023 recommendations state that not all extracellular vesicles should be called exosomes without that route of formation being demonstrated.²

Cell-conditioned medium is a further, separate preparation containing the substances cells in culture release into the medium; in clinical research this medium, SVF and cell applications are examined as separate interventions.³ Giving living cells, using conditioned medium and using a solution containing exosomes cannot therefore be explained under one heading.^2,3 The definition of the content matters more than any similarity in product names.

The laboratory definition of these terms and the assessment of an effect in a patient are separate steps. MISEV2023 offers scientific recommendations for the nomenclature and characterisation used in extracellular vesicle research.² Showing that a preparation contains these particles is not a clinical comparison measuring the size of the change it will produce in a person's face. In human research such as the Park study, on the other hand, a particular preparation is tested against a particular control and with separate outcome measurements.⁵ The correctness of a definition and the demonstration of a clinical result should not be used in place of one another.

How does this differ from PRP and fat injection?

The difference in terms and scope between PRP and stem cell applications is dealt with in the PRP article. The hair and skin findings in that article are not reassessed here.

In cell-assisted fat transfer, what is being studied is the contribution of adding a cellular component to the fat graft.⁷ The comparison here is not between having fat transfer and having no procedure at all; it is between fat transfer with cell support added and conventional fat transfer.⁷ The scope, techniques and aftercare of ordinary fat injection are described in its own article. The subject of this page is what the added component provides and within which limits it can be assessed.

Which changes are to be expected, and which are not?

Research on aesthetic cell applications examines different outcomes such as retention of fat graft volume, wrinkle measurements, elasticity, hydration and pigmentation.^5,7 Each of these answers a different question; a greater proportion of the graft being retained does not show that every property of the skin changed to the same degree.⁴ In the same way, an improvement in a skin measurement is not the same result as the surgical repositioning of facial tissues.^5,8

How is adding cells distinguished from moving tissue?

In the fat graft study, volume was assessed through the retention of the transferred tissue, while the split-face study with an exosome-containing preparation used skin measurements and an aesthetic improvement scale.^4,5 In the first, the fat graft is part of the procedure; in the second, microneedling was applied to both sides of the face.^4,5 When these details are left out, the impression can arise that the whole change came from "stem cells" alone.

A favourable result carries its meaning within the preparation and the comparison used in the research. The volume finding in the Yin study does not measure the effect of another cell source or of a product merely applied to the skin.⁴ Nor was the improvement in the Park study obtained by comparison with a surgical facelift.⁵ These limits do not remove the favourable finding; they make clear which change the reader is being informed about.

Instead of a broad expression such as "rejuvenation", naming the outcome the research actually measured allows an expectation to be formed more concretely. A measurement change in wrinkles, retention of volume and an overall aesthetic assessment are not the same scale; the studies below are therefore described separately.^4,5

What does the evidence on efficacy show?

Cell-assisted fat transfer

The systematic review and meta-analysis by Zhao and colleagues included 14 articles and 722 participants in total.⁷ Cell-assisted fat transfer was compared with conventional fat transfer; in the overall assessment a result favouring cell support was reported for retention of the fat graft.⁷ The overall result and the regional subgroups are shown together below.⁷

Assessment	Standardised mean difference (SMD)	95 per cent confidence interval
Overall result	2.81	1.54-4.08
Face subgroup	3.01	1.68-4.33
Breast subgroup	1.80	-0.31 to 3.91

The values in the table are the results of the Zhao review; they are not a percentage of success or the graft volume that will be retained in a person.⁷ The SMD is a standardised expression of the mean difference between groups. An SMD of 2.81 does not mean 281 per cent or 2.81 times the volume. The confidence interval likewise shows the uncertainty of the calculated difference, not the lowest and highest result people will experience. The face and breast rows are not a direct comparison of the two regions with each other; they show the comparison between cell-assisted and conventional fat transfer within each region.⁷

In the breast subgroup the confidence interval included zero and no statistically significant difference was found; the reported P value is 0.09.⁷ This result cannot be read as proof that there is no effect in the breast region or that the two approaches are equivalent. Carrying the favourable estimate in the face subgroup over to every region is, for the same reason, not appropriate.⁷ Because the accessible abstract of the review does not give the separate numbers of people in the subgroups or the distribution of follow-up, that information is not presented here as though it were complete.⁷

In the same review complications were found comparable, and it was stated that cell support did not reduce the complication rate.⁷ That statement promises no reduction in risk; nor does the abstract's giving no numerical safety estimate establish that the methods are definitely equal in safety.⁷

In the randomised study by Yin and colleagues, 50 people were examined in two groups of 25.⁴ In the face, a fat graft with SVF added was compared with a fat graft alone; at 6 months retention of the fat graft was reported as 77.6 per cent in the SVF group and 56.2 per cent in the fat graft alone group, and the difference was found to be statistically significant (p < 0.001).⁴ These are the results of the groups compared; they are not a promise that this volume will remain in every person.

This study offers a concrete finding in favour of adding cells; the measurement, however, belongs to the 6th month and assesses SVF applied together with a fat graft.⁴ A permanent result, the same effect in another region, or the success of a cell application on its own cannot be derived from this comparison.⁴ Nor should the numbers of people in this study and in the review be added together as though they were separate, independent totals.

That the control group also received a fat graft narrows the interpretation of the favourable finding. The question examined here is the contribution of adding SVF to fat transfer for volume retention; it is not the size of the whole change relative to having no procedure.⁴ The results of the two groups are therefore kept side by side. Giving only the higher percentage and leaving out the procedure it was compared with would change what the research tested.

Changes in skin quality

The review by Chon and colleagues brought together 17 studies on adipose-derived cells, SVF and cell-conditioned medium.³ Favourable results were reported in some wrinkle and skin quality measurements; the variety of preparations, outcome measurements and follow-up periods limited the assessment.³ That variety shows that the heading "skin quality" does not measure the same thing in every piece of research.³

Appearing within the same review does not mean that living cells and the substances cells release into a medium are the same product.³ The results of different preparations are therefore not gathered here under a single "percentage of improvement with stem cells". When a concrete efficacy finding is reported, the return is to studies whose preparation and comparison are clear.

Preparations containing exosomes

28 people took part in the 12-week randomised split-face study by Park and colleagues.⁵ Microneedling was applied to both sides of each participant's face; on one side a solution containing exosomes derived from human adipose tissue cells was used, and on the other normal saline.⁵ The comparison was thus established not against a face without microneedling, but between two sides on which the same procedure was carried out with different preparations.⁵

On the Global Aesthetic Improvement Scale a significant result was reported in favour of the exosome-containing preparation (p = 0.005).⁵ Results favouring that preparation were also reported in measurements of wrinkles, elasticity, hydration and pigmentation.⁵ These findings offer favourable data about adding the solution studied to microneedling; they do not assess the injection of living stem cells or every product offered under the same name.⁵

In a split-face design, comparing two sides of the same person is important; but the fact that both sides received microneedling has to be preserved when the result is described.⁵ Nor does the research being 12 weeks long show long-term loss of effect or a need for re-treatment.⁵ The direction of the measurements is what is reported here; the p value is not used as the size of the effect in per cent.

How are authorisation and the nature of the product assessed in Türkiye?

Are a certificate and a facility's authorisation the same thing?

How health services for aesthetic and cosmetic purposes are to be provided in private outpatient diagnosis and treatment facilities is governed by the Regulation on Private Health Facilities Providing Outpatient Diagnosis and Treatment, dated 19 April 2025.⁹

The provision in force requires three conditions together. Health services for aesthetic or cosmetic purposes may be provided within a medical centre, a polyclinic or a doctor's practice; within the competences physicians have acquired through their training curriculum or through a certificate; within the medical procedures permitted at the facility where they work; and provided that the physical space and minimum medical equipment defined for a polyclinic room are in place.⁹

The certificate referred to in the regulation is one registered under Ministry legislation.⁹

The physician's competence and the facility's authorisation are separate things and both are required.⁹ A diploma alone, or any course certificate alone, does not show that all of these conditions are met. Nor is a training centre's authorisation to provide training the same thing as a physician's authorisation to carry out the procedure.^9,10

This provision covers private outpatient diagnosis and treatment facilities. A complete list of authorisation by profession and title, for every type of institution, cannot be derived from this text.⁹

There is no separate heading for stem cell application in the curriculum of the Ministry's Standard for the Certified Training Programme in Aesthetic and Cosmetic Applications, dated 3 September 2025.¹⁰ That observation concerns only the content of that standard; it is not a ruling about every specialty training, nor a conclusion that every cell application is prohibited nationwide.¹⁰ Nor does the general framework for aesthetic authorisation take the place of the particular conditions relating to tissue and cell products.^9,11

What additional conditions apply to tissue and cell products?

The Regulation on Products Derived from Human Tissues and Cells and on Centres Related to These Products, dated 4 September 2025, governs the types of centre and their forms of permission separately.¹¹ Article 12 distinguishes between a tissue and cell source centre, a tissue and cell centre, and a centre for application to humans.¹¹

Tissue and cell centres are licensed as procurement, processing-production or storage/distribution centres.¹¹ Tissue and cell source centres and centres for application to humans, by contrast, are authorised and are not separately licensed.¹¹ Describing this whole area with the single sentence "a centre licence is required" therefore erases the distinction the regulation makes.¹¹ A condition of authorisation on a product and indication basis is also laid down for centres for application to humans.¹¹

The prohibition on unlicensed activity in article 59 has to be read together with that distinction in article 12.¹¹ The document held by the centre that prepares a product is not the same document as the authorisation of the centre that will apply it to a person; the physician's competence is assessed separately from both.^9,11 That a centre is able to operate does not show that every product named may be used for every aesthetic purpose.¹¹

One exception to the scope also matters. Article 2(2)(f) places outside this regulation medical devices that fall within the scope of the Medical Device Regulation and are manufactured using derivatives of non-living human tissues or cells, or of tissues or cells that have been rendered non-living.¹¹ It cannot be concluded from that provision that all exosome products are medical devices or that they all fall into the same legal class.¹¹ The content of a product and the legislation under which it is assessed have to be explained together; use of the name "exosome" alone is not enough for classification.^2,11

This article does not present a verified current product and indication permission in Türkiye for any particular aesthetic cell or exosome product. That limit does not mean there is no regulation; the general provisions above are not used in place of the permission record for a particular product.¹¹

What are the risks and unwanted effects?

Local effects and risks tied to the preparation of cells

In Park's study assessing an exosome-containing solution together with microneedling, no serious adverse events occurred.⁵ A review describing that study reports mild, transient erythema, oedema and petechiae;¹² another review states that the erythema and petechiae resolved spontaneously within 1 week.¹³ That favourable safety observation belongs to a 12-week study of 28 people.⁵ It cannot be read as a record measuring all the risks of different products or other routes of application.⁵

The Zhao review, which examined the addition of cells to a fat graft, likewise showed no reduction in complications.⁷ A favourable result for volume retention and fewer complications are separate outcomes.⁷ Not turning an efficacy finding into a safety advantage preserves that distinction.

The ISSCR states that risks may exist during the acquisition, preparation and reintroduction of cells even in procedures using a person's own cells.¹⁴ Contamination during processing, cells being manipulated in ways that interfere with their normal function, and cells being placed where they are not normally present are among the problems the organisation draws attention to.¹⁴ "Autologous" describes that something was obtained from the person themselves; on its own it is not proof of the safety of preparation and application.¹⁴

How should reports of serious events be read?

In its warning of 3 June 2021, the United States Food and Drug Administration (FDA) reports blindness, tumour formation and infections associated with unapproved regenerative products.¹⁵ The warning covers various products, different routes of application and different medical purposes; it does not examine the outcomes of aesthetic facial applications alone.¹⁵

These reports show that serious outcomes should not be disregarded; they are not, however, risk percentages calculated in an aesthetic patient group with a known denominator.¹⁵ Just as the conclusion "every cell product carries the same risk" cannot be drawn from the FDA list, no serious event being seen in a small aesthetic study does not show that all products are free of risk.^5,15

These two sources answer different questions. The Park study offers an observation of participants followed with a particular preparation, while the FDA reports broad safety notifications about unapproved products.^5,15 It is not possible to calculate a frequency or a safety ranking by comparing the two. A research result, an event report and a product's permission status have to be kept apart.

How is the duration of the result assessed?

Does a follow-up period mean permanence?

The 6-month measurement in the Yin study reports retention of the fat graft at that date; the 12-week assessment in the Park study reports the skin outcomes examined.^4,5 These are not periods of the same kind, measuring exactly when a result begins and when it ends.^4,5 The last assessment day of a piece of research cannot be taken as the day the effect ended or as the time for re-treatment.

Measuring graft volume at 6 months, for example, does not show that the same volume will be retained in all the years that follow.⁴ In the same way, finding an improvement in a skin measurement at week 12 does not mean that the improvement will disappear that week.⁵ Deriving both a promise of permanence and a repeat schedule from one follow-up point goes beyond what the source measured.

Because the skin quality review contains a variety of preparations and follow-up periods, gathering all the results under a single product name into one common duration is also difficult.³ Research follow-up periods are given in this article; no duration of effect, aftercare schedule or repeat interval to be applied to everyone is recommended.

What matters in an assessment?

The content of the product, its purpose and its research status

An assessment begins by explaining which preparation is being used, rather than the popular name of the procedure. The same content cannot be assumed for living cells, heterogeneous SVF, conditioned medium and an exosome-containing solution.^1-3 If a piece of research is being presented, the route of application, the comparison and the target measured should be stated alongside the content; that the Yin and Park studies answer different questions is a concrete example of this.^4,5

When a result is reported, the question "improvement compared with what" matters. Volume retention compared with a conventional fat graft and a skin measurement against microneedling with normal saline are not the same comparison.^4,5 When the connection between the change a person wants to assess and the change the research measured is not clear, even a correct figure can produce a mistaken expectation.

If a procedure is said to be within the scope of research, that should not remain merely a label. The tissue and cell regulation in Türkiye separately governs a framework of approval and permission for clinical experimental studies and treatment trials.¹¹ The FDA likewise states explicitly, in the United States context, that inclusion in ClinicalTrials.gov or a firm's being registered with the FDA does not show that a product may legally be marketed.¹⁵ That United States warning does not take the place of an authorisation document in Türkiye.¹¹

Explanations of what the product is, which outcome it has been studied for and under which authorisation it is offered should therefore complete one another.¹¹ One of them being documented does not mean that the other questions have also been answered. The existence of research for a product, the result of that research, the language of its commercial presentation and permission for a particular use are separate matters for assessment.¹¹

How should marketing language be read?

What does "stem cell facelift" not explain?

In the 2013 review by Atiyeh and colleagues it is stated that the expression "stem cell facelift" is mostly used for cell-enriched fat transfer.⁸ Despite the word "facelift" in its name, this use was not treated as the same procedure as a surgical facelift.⁸ The source examines the nomenclature of that period; the observation does not mean that the content of every procedure using the same name today is automatically known.

Faced with such a name, it has to be explained whether the outcome described is tissue volume, a skin measurement or a surgical correction. Zhao's fat retention outcome and Park's skin measurements cannot be converted into a common measure of rejuvenation.^5,7 Stating the real target of the research does not diminish favourable data; it prevents the claim from becoming broader than that data.

What do "your own cells" and "approved" not prove?

The expression "your own cells" describes the source person; it does not show that the risks associated with the preparation and application of the cells have disappeared.¹⁴ Nor does the word "approved" constitute a sufficient explanation of authorisation without stating which product is assessed, for which indication and within which centre.¹¹ In the regulation in Türkiye, the types of centre and product and indication authorisation are governed by separate provisions.¹¹

Article 59(1)(d) of the regulation prohibits advertising of human tissue and cell products by any means, and does not permit activities that are not based on scientific data or that are misleading, liable to cause panic, or apt to mislead.¹¹ Nor is an improvement found in a particular measurement turned, in this article, into a promise of a result that can be given to every person. The favourable findings in this article should also be read together with the information on preparation, comparison and follow-up.

How should the figures in this article be read?

The figures do not share a unit or a denominator. The SMD in Zhao is a standardised difference between groups; the percentages in Yin express retention of the fat graft at 6 months, and the p value in Park expresses the statistical comparison in the research.^4,5,7 None of these can be used as a personal success rate covering all aesthetic cell applications.

Zhao's overall, face and breast results are kept in the same table; the breast comparison, which was not found significant, is not left behind the favourable overall result.⁷ In Yin and Park the number of participants, the comparison and the follow-up period are given alongside the result.^4,5 The figure is thus not separated from the procedure in which it was studied.

When the denominator of serious event reports is unknown, a frequency cannot be calculated; nor does no event being seen in a particular study mean that none will be seen in all subsequent applications.^5,15 No practitioner's personal results or schedule are given in this article; the results shown by the accessible research are assessed within their own limits.

References

1. Bourin P, Bunnell BA, Casteilla L, et al. Stromal cells from the adipose tissue-derived stromal vascular fraction and culture expanded adipose tissue-derived stromal/stem cells: a joint statement of the International Federation for Adipose Therapeutics and Science (IFATS) and the International Society for Cellular Therapy (ISCT). Cytotherapy. 2013;15(6):641-648. doi:10.1016/j.jcyt.2013.02.006 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹

2. Welsh JA, Goberdhan DCI, O'Driscoll L, et al. Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches. J Extracell Vesicles. 2024;13(2):e12404. doi:10.1002/jev2.12404 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

3. Chon J, Randall SE, Schumann TA, et al. A Systematic Review of Adipose-Derived Cell Therapies on Skin Quality. Aesthet Surg J Open Forum. 2025;7:ojaf098. doi:10.1093/asjof/ojaf098 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹

4. Yin Y, Li J, Li Q, et al. Autologous fat graft assisted by stromal vascular fraction improves facial skin quality: A randomized controlled trial. J Plast Reconstr Aesthet Surg. 2020;73(6):1166-1173. doi:10.1016/j.bjps.2019.11.010 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷ ↩¹⁸

5. Park GH, Kwon HH, Seok J, et al. Efficacy of combined treatment with human adipose tissue stem cell-derived exosome-containing solution and microneedling for facial skin aging: A 12-week prospective, randomized, split-face study. J Cosmet Dermatol. 2023;22(12):3418-3426. doi:10.1111/jocd.15872 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷ ↩¹⁸ ↩¹⁹ ↩²⁰ ↩²¹ ↩²² ↩²³ ↩²⁴ ↩²⁵ ↩²⁶ ↩²⁷ ↩²⁸ ↩²⁹ ↩³⁰

6. International Society for Stem Cell Research. Types of Stem Cell Treatments. Organisation page ↩ ↩²

7. Zhao J, Chen J, Xu C, et al. The efficacy of cell-assisted versus conventional lipotransfer: A systematic review and meta-analysis. Asian J Surg. 2023;46(1):35-46. doi:10.1016/j.asjsur.2022.04.031 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷ ↩¹⁸

8. Atiyeh BS, Ibrahim AE, Saad DA. Stem cell facelift: between reality and fiction. Aesthet Surg J. 2013;33(3):334-338. doi:10.1177/1090820X13478944 ↩ ↩² ↩³

9. Republic of Türkiye Ministry of Health. Regulation on Private Health Facilities Providing Outpatient Diagnosis and Treatment. Official Gazette, 19 April 2025, no. 32875. Articles 4(1)(j) and 6(10). saglik.gov.tr ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

10. Republic of Türkiye Ministry of Health. Standard for the Certified Training Programme in Aesthetic and Cosmetic Applications. 3 September 2025. saglik.gov.tr ↩ ↩² ↩³

11. Republic of Türkiye Ministry of Health. Regulation on Products Derived from Human Tissues and Cells and on Centres Related to These Products. Official Gazette, 4 September 2025, no. 33007. Ministry text ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷ ↩¹⁸ ↩¹⁹ ↩²⁰ ↩²¹

12. Jafarzadeh A, Hoseini SS, Behrangi E, Roohaninasab M, Goodarzi A. Effectiveness of regenerative medicine for skin lightening and rejuvenation: a systematic review of extracellular vesicles and conditioned media. Stem Cell Res Ther. 2025;16(1):513. doi:10.1186/s13287-025-04592-z ↩

13. Domaszewska-Szostek A, Krzyżanowska M, Polak A, Puzianowska-Kuźnicka M. Effectiveness of Extracellular Vesicle Application in Skin Aging Treatment and Regeneration: Do We Have Enough Evidence from Clinical Trials? Int J Mol Sci. 2025;26(5):2354. doi:10.3390/ijms26052354 ↩

14. International Society for Stem Cell Research. 9 Things to Know About Stem Cell Treatments. Organisation page ↩ ↩² ↩³ ↩⁴

15. U.S. Food and Drug Administration. Important Patient and Consumer Information About Regenerative Medicine Therapies. 3 June 2021. FDA ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷