Dr. Sam Lam Plastic Surgery Forum

Hi Dr Lam, I was just wondering what is your take wrt Juvista's (From Renovo) potential as a prophylactic scar treatment? It seems very promising from what I have read. I am considering surgical revision of a traumatic ankle scar (>2 yrs) and sometimes I wonder if it best to wait until Juvista is available (2011 and beyond I guess at the earliest) before attempting the revision. Appreciate your thoughts. Thanks.

Rdgs,
MH

hmmm, never heard of it. interesting though. i cannot advise since i am unaware of your condition, it is not a facial condition (my focus and limitation of my practice), and i have never heard of it. keep me informed as it is released. thanks for sharing.
best,
sml

Cambree wrote:Hi Dr Lam, I was just wondering what is your take wrt Juvista's (From Renovo) potential as a prophylactic scar treatment? It seems very promising from what I have read. I am considering surgical revision of a traumatic ankle scar (>2 yrs) and sometimes I wonder if it best to wait until Juvista is available (2011 and beyond I guess at the earliest) before attempting the revision. Appreciate your thoughts. Thanks.

Rdgs,
MH

Juvista, as you might know by now, is going to come out in approximately 2014. They're currently still doing clinical trials but the company has stated that it will have a 60% improvement in general. Meaning, according to them, that if you have mild scarring and you use Juvista you'll end up with a barely noticable scar. And if you have bad scarring you'll end up with an "acceptable" one.

Now, what is acceptable is probably subjective and Juvista's claims have so far not really been backed up, as far as I know. I've only seen two photographs of it's usage. One was very disappointing and the other one was good. But I think it will end up being something worthwhile. Don't expect your skin to be 100% back to normal after having been treated with it. But I think it's fairly safe to say that you can see a significant improvement.

There are also other things being experimented with such as ACell and there's another drug in the pre-clinical trial stage called Cutasil which has a different approach than Juvista which is also promising. But the idea of realizing true scarless healing after surgery is being pursued by many doctors/scientists/business people out there. It is something that will at some point be real. But I think all of these treatments that I mentioned will probably not realize that (scarless healing). I've spoken to to various people and they're saying that it's going to come around but it will still be a while.

So I guess you could consider using Juvista if it ends up coming through the FDA trials well. It could be the best thing available in the short term. It will probably be a more beneficial treatment for your condition than anything available now.

thanks for the helpful info!

Hi,

Many thanks for the insight and information. I was wondering though I don't see any conclusive news wrt when juvista is going to make a debut. i do know it expects to report on its phase III results in Europe in the first half of 2011. That bit about it becoming available in 2014, can you clarify the source of this news? If this is true, it is quite the dampener because i was hoping it wouldn't take that long.

MH

this is something that i will follow at my major meetings that i attend. interesting.

Cambree wrote:Hi,

Many thanks for the insight and information. I was wondering though I don't see any conclusive news wrt when juvista is going to make a debut. i do know it expects to report on its phase III results in Europe in the first half of 2011. That bit about it becoming available in 2014, can you clarify the source of this news? If this is true, it is quite the dampener because i was hoping it wouldn't take that long.

MH

Yes, the outcome of the first phase 3 trial is due in the first half of 2011 and then there's another phase 3 trial coming after that...and if the FDA approves it, it will ultimately come around in 2014...approximately. Mark Ferguson, the CEO of Renovo (which is the company that is making Juvista) has stated that he expects his company to start making profits no sooner than 2015 as they are making losses right now, so yeah, it will be about 3 years until Juvista is available. I'll see if I can find a site where you can see the confirmation of this.

If you really can't wait, you could consider e.g. ACell which is experimental but available at this point in time. The costs can range from $39 to $350 or so, depending partly on which type of ACell is used (sheets or powder). Apparently good results are being achieved by its usage in that less or no scarring is formed after an excision of an existing scar. I've seen photos of one instance where it was used and indeed, it looked as if less redness was there if any at all and it healed with way less scarring. Although once again, it wasn't 100% normal looking skin. I'll see if I can post the photo tomorrow.

I'll also see if I can give you a phone number and an e-mail adress of someone who is knowledgeable regarding this so-called extra cellular matrix approach who is reliable and professional. You could ask him or her what you can expect from this treatment as every patient's situation is ultimately unique; in general good results are achieved and this has also been proven scientifically (that the approach should result in a good outcome) but still doctors can't promise you anything or say anything without first having looked at your specific condition.

I'll see if I can post that info I mentioned tomorrow.

Cambree wrote:Many thanks for the insight and information.

dr. lam wrote:thanks for the helpful info!

You're welcome!

Ok, here are some photo's from someone who used ACell then. You should know that the first photo may be a bit disturbing as you can see the wound there...so you if you think you can't handle that I'd advise you to just go right to the last one(s). Basically the first one shows an open wound, so...

Wound site just after excision:
http://img267.imageshack.us/i/bild001wf.jpg/

Six days later:

http://img832.imageshack.us/i/bild013y.jpg/

Thirty three days later:

http://img823.imageshack.us/i/bild005nr.jpg/

Fourty seven days later:

http://img255.imageshack.us/i/bild018cc.jpg/

So as you can see the way it's healing is definately better due to the ACell. I've heard that the final results won't be there until three months after ACell application so this person is now kind of halfway through that period. So things will probably improve even further.

And here's e.g. Renovo's Wikipedia page where it states that Juvista is planned for release in 2014:

http://en.wikipedia.org/wiki/Renovo_plc

If you scroll to the bottom of this page you can read a bit about Cutasil which is very promising, as well:

http://sirnaomics.com/products2.html

They have a pretty bold statement on their website:

Sirnaomics has demonstrated accelerated wound closure with a topically applied siRNA mixture that results in wound repair and a return of normal skin morphology (without a scar and with return of follicles).

So it's interesting to see if they can back that up or not. They're going into clinical trials next year...so I have no idea when they're going to release their product but clinical trials, as you may know, take a few years in general. Some products go through them faster than others, though. So fingers crossed, I guess.

Here's how you can contact Esther Middelkoop who is very knowledgable. She's sort of on the forefront of research regarding skin regeneration:

http://www.onderzoekinformatie.nl/en/oi ... RS1252679/

You could try to contact her with questions. She lives in Holland, though; I don't really know of anyone in the US who is as widely knowledgable as I think Esther is.

If you are looking for someone to talk to in the US you could try contacting these people:

http://www.scar-club.com/

Scar club is a group of doctors/surgeons/researchers who share information regarding the latest developments regarding the treatment of scars and Esther Middelkoop is a member. Through contacting them you might find someone equally knowledgable in the US.

I also found what apparently is Esther Middelkoop's telephone number:

0251-275505

ok, typically i do not allow external references but i will let this stand, as it may help someone.

dr. lam wrote:ok, typically i do not allow external references but i will let this stand, as it may help someone.

My apologies, Mr. Lam. Maybe I scrolled through the rules a bit too fast during the registering.

no problem. in general, i am just trying to limit spam and also promotional material but it seems as if you are quite genuine in your remarks.
sml