Dr. Jeffrey Michaelson withdraws fat cells from a patient.
Dr. Jeffrey Michaelson withdraws fat cells from a patient. Photos courtesy CORE Institute

The pros and cons of easing joint damage with injections of your own fat.

Joyce Wiswell Contributing Writer

At 75, Judith Jacobson has no interest in slowing down. So, when knee pain threatened to curtail her active schedule, she took action by trying a relatively new orthopedic procedure called Lipogems, which uses her own body fat to cushion and support her damaged joints.

“I’m an avid traveler, and I don’t like to be limited,” said the West Bloomfield resident. “Gel shots helped me initially, but, as time went on, they were less and less effective. I will need a knee replacement eventually, but this buys me two to five years.”

Dr. Jeffrey Michaelson - white male smiling in a suit and tie in front of a leafy outdoors background
Dr. Jeffrey Michaelson CORE Institute

After taking a year and a half to study various regenerative procedures, the CORE Institute in Southfield, Novi and Brighton has been offering the FDA-approved Lipogems since January 2017. Orthopedic surgeon Jeffrey Michaelson, M.D., calls it “just one more tool in our tool kit.”

The Lipogems procedure (not a stem cell therapy) uses a patient’s own fat cells to help repair, reconstruct or replace damaged or injured tissue in the joints like knees, hips and shoulders.

The process takes about an hour. First, the doctor makes a tiny puncture and removes a small section of fat from the midsection or love handles — not enough, Michaelson quipped, for a bonus tummy tuck. The fat is processed, then a small needle is used to inject the tissue into a joint — the knee, in Jacobson’s case.

The “remarkably not painful” procedure requires only local anesthesia, Michaelson said. “You would think it would [hurt] because people are awake the whole time, but I am amazed at how little pain people have. People will feel sore in their belly afterward; I tell them they’re going to feel like they got punched in the gut. Within a week, they start feeling better.”

Jacobson, who had the procedure in October, said she experienced “very, very mild discomfort. My belly had a lot of bruising and it looked awful, but it didn’t really bother me,” she said.

But not everyone is sold on these new regenerative procedures.

Dr. Robert Kohen
Dr. Robert Kohen CORE Institute

“All of us want it to work — I do as a surgeon and as a person with joint pain,” said Robert B. Kohen, M.D., who has offices in Farmington Hills and Madison Heights. “There is little, if any, standard peer-reviewed, randomized controlled trials. I get asked about it half a dozen times a week. We need to be careful discussing expectations and what has been proven.”

Kohen, who stressed his high respect for Michaelson’s abilities and integrity, called himself “a midterm adopter” who’s just not ready to completely embrace these new procedures. “I’m trying to strike a balance between being excited and being skeptical,” he said.

Kohen is concerned that insurance does not pay for it; Lipogems costs between $4,000 and $6,000 at the CORE Institute, which Michaelson pointed out is less than what stem cell clinics charge.

“People ask, ‘Why are you so much less?’ I am not making my living on this; this is just one more thing I can offer you,” said Michaelson, who volunteers as executive vice president of the Fresh Air Society of Tamarack Camps. (His wife, Jodi, sits on the board of Congregation Shaarey Zedek, which the couple and their four children attend.)

How long Lipogems can offer relief is not yet known. “Ideally it would be ‘once and done,’ but the data collection still has to bear that out,” Michaelson said. “The nice thing about using your own cells is that you never have to worry about a reaction. There is a lot of data to prove its safety, but what we don’t know is its longevity.”

Michaelson prepares an injection of fat cells after impurities have been removed; the fat cells will be injected into a damaged joint.
Michaelson prepares an injection of fat cells after impurities have been removed; the fat cells will be injected into a damaged joint. CORE Institute

Michaelson recommends caution when deciding to try these new therapies. “Most of the stem cell clinics popping up are run by chiropractors, so they hire nurses or physician assistants to do the injections,” he said. “Be wary of clinics that offer it for everything, including Parkinson’s.” It can’t help bone-on-bone conditions or a destroyed joint, he added.

Michaelson advises asking lots of questions, “The days of ‘the doctor said it and the doctor is right’ are gone.”

Kohen concurred. “My advice is to find a board- certified doctor and have an honest discussion about your expected outcomes.”

Jacobson said her decision to try Lipogems was easy. “I think of it like a mechanical issue,” she said. “If there is something that can be done, let’s go into the shop and take care of it.”