Platelet-rich plasma: new developments in aesthetic medicine. Part 1

Over the past 20 years, the demand for cosmetic procedures among the population has increased significantly, patients tend to choose less invasive procedures for facial rejuvenation. Increasing knowledge and technology, as well as the invention of long-acting soft tissue fillers, have led to increased interest in cosmetic procedures. More and more patients are choosing less invasive procedures over surgery. Platelet-rich plasma (PRP) is the autologous concentration of human platelets in a small volume of plasma. It is a safe treatment method that, thanks to the included growth factors, can be an ideal option for a huge number of procedures.

The demands of an aging population have increased significantly over the past few decades. People who have crossed the threshold of sixty want to look as young and healthy as possible. Such demands coincided with the desire of most patients to use less invasive procedures for facial rejuvenation. However, Sclafani argues that "the ideal soft tissue filler that is easily attached to surrounding tissues, easy to administer, inexpensive, readily available, and long lasting has yet to be invented. The soft tissue fillers available today can disintegrate, cause the body to react to foreign body (encapsulation) and cost quite a lot."

How skin aging happens

We now know that the aging process of the face is not only the result of gravity, the disappearance of zygomatic fat and/or lack of collagen, but also complex processes that involve various elements of the face, which together create a cascading effect. This process affects the four main layers of the face—bones, muscles, fats, and skin—whose changes simultaneously fall under two directions, from the outer layer of the skin inward toward the bones, and from the bones toward the skin. Any change in one layer will affect the next layer, leaving the marks of aging on the face.

The most important changes in the first layer, the skeletal skeleton of the face, are observed in the foramina of the face. The nose and eye orbits do increase in size by 20% with age, the eye sockets increase over time, and the infraorbital bone moves back. Subsequently, all other structures (muscles, fat, skin tissues) begin to descend and slide from the surface of this bone. Gravity is part of the reason for this effect along with facial skeletal changes.

Contrary to popular belief, facial muscles do not weaken with age, but become firmer. This can be seen in the subcutaneous muscles of the neck, which extend from the chin to the collarbone and become more pronounced with age, similar to crow's feet and deep glabella lines. At the same time, the amount of fat in the facial area decreases with age, making the face bony, leading not only to loss of volume, but also to a lack of moisture and elasticity. Fibroblasts that produce elastin, collagen, and hyaluronic acid work better when they are tighter. Fat reduction and stretching result in poor skin function and a sagging effect.

In general, the aging process of the face is a complex cascade in which each component of the face interacts with and influences other components.

How platelet-rich plasma works

It is well known that the wound healing process is complex and is divided into three stages: inflammatory, restorative and remodeling stages. The alpha granules of platelets contain a large amount of proteins. Together, these proteins belong to the families of growth factors, cytokines, and chemokines, which are also commonly known as secretory proteins. They are essential to the entire process, as each step of the healing cascade is affected by specific growth factors/cytokines. Some studies suggest that platelet-rich plasma should achieve platelet concentrations 3-5 times higher than their normal concentration.

Due to its high concentrations of growth factors, in addition to its use in wound healing, PRP is also used in a wide range of surgical and clinical procedures. In fact, there is significant clinical evidence for the use of platelet-rich plasma in other medical fields. A significant concentration of platelets in comparison with normal blood undoubtedly represents a unique source of growth factors. After subcutaneous administration, these proteins and growth factors interact with the basal cells of the subcutaneous tissue, including fibroblasts, endothelial cells, and subcutaneous stem cells. Platelet-rich plasma is also used in the aesthetic field to stimulate the surface of the dermis as well as the deep layers of the skin. Proved

Dr. Fitzpatrick has published a study showing that topical application of growth factors stimulates the rejuvenation of photoaging facial skin, improving its clinical appearance, including new collagen synthesis. And another study showed that platelet-rich plasma actually causes increased expression of the G1 cell cycle regulator proteins, collagen type I, and matrix metalloproteinase (MMP)-1 in human dermal fibroblasts.

Platelet-rich plasma must be developed in an anti-coagulated state and must be used in grafts, flaps, wounds, or skin within 10 minutes of clot formation.

Cells, osteoblasts, fibroblasts, endothelial cells and epidermal cells have growth factor receptors in platelet-rich plasma. These transmembrane receptors in turn cause the activation of an endogenous internal signaling protein that causes the normal nucleotide sequence of cell genes to be expressed (unblocked), such as cell proliferation, matrix formation, osteoid production, and collagen synthesis. The significance of this lies in the fact that platelet-rich plasma growth factors do not enter the cell or its nucleus, are not mutagenic and act through the stimulation of normal healing, but much faster. Therefore, platelet-rich plasma does not cause tumors.

Platelet-rich plasma concentration

PRP must be created in an anti-coagulated state and used on a graft, flap, wound, or skin within 10 minutes of clot formation (clotting). There is a dose-response relationship between platelet concentration and adult mesenchymal stem cell proliferation, fibroblast proliferation and type I collagen production. It follows that the use of autologous platelet-rich plasma may promote wound healing, as shown in controlled animal studies, as for soft and hard tissues.

Therefore, the next important question arises: how many platelets are sufficient? A sufficient reaction of cells to platelet concentrations was observed with an increase in the number of platelets by 4-5 times compared to their normal content. A similar study by Louie et al showed that fibroblast proliferation and collagen type I production also increased with increasing platelet concentration, and that most responses were pH dependent with better responses at more acidic pH levels.

Platelet-rich plasma is rapidly attracting general interest, but health regulations differ around the world, making generalizing the process more difficult and often more costly.

According to Prime magazine.