Dermal fillers replace volume lost with age, and lasers work with collagen. However, the aging process of the face consists not only in the loss of collagen and the action of gravity, but also in the resorption of bone tissue. Platelet-rich plasma is a natural, safe and effective treatment that addresses all aspects of aging (including bone loss).
Review of the literature on the use of platelet-rich plasma
When using PRP, different preparation methods are important as they affect the quality of the product. Platelet activation is required for the release and binding of growth factors, but the mode of activation can affect the resulting matrix, the availability of growth factors, and healing. Moreover, some methods saturate leukocytes, as well as platelets, while others are characterized by a shortage of leukocytes. Leukocytes can play an important role in the healing process, and their incorporation into platelet-rich plasma results in increased platelet concentrations.
Davis et al conducted a literature review of dermal wounds that showed complete and partial improvement in wound healing with PRP compared to control wound healing.
Among the studies available for reading, there were three main types of wounds treated with PRP: open and chronic wounds, acute surgical wounds with primary closure, and acute surgical wounds with secondary closure. In both chronic and acute wound studies, complete wound closure was more likely for wounds treated with platelet-rich plasma.
One systematic review concluded, based on meta-analysis and scientific evidence, that platelet-rich plasma can be used for local wound healing. Fifteen randomized clinical trials and 25 case-control studies were found. 36 publications testified to the positive results of the use of platelet-rich plasma.
The articles were divided into three topics related to cosmetic surgery: wound healing, fat grafting, and bone grafting. Carter et al. have described significant beneficial effects of platelet-rich plasma for many applications, including enhanced wound healing, improved survival of fat grafts, and improved bone graft regeneration.
Tissue remodeling with platelet-rich plasma
Autologous PRP has attracted the attention of many fields of medicine. One study looked at the effects of activated platelet-rich plasma (aPRP) and platelet-poor plasma (aPPP) on the remodeling of the extracellular matrix, a process that requires the activation of dermal fibroblasts necessary for the rejuvenation of aging skin.
Both plasmas stimulated cell proliferation, peaking in cell growth at 5% aPRP. In addition, aPRP and aPPP increased the expression of type I collagen, MMP-1 protein, and mRNA in human dermal fibroblasts.
aPRP and aPPP promote tissue remodeling in aging skin and can be used as an adjunctive treatment with skin rejuvenation lasers in cosmetic dermatology. Although the optimal platelet concentration has not been established, current PRP preparation methods have been reported to involve approximately 300-700% enrichment, in which the platelet concentration is consistently increased to over 1,000,000 platelets.
Such factors regulate processes including cell movement, cell binding, proliferation and differentiation, and promote extracellular matrix accumulation by binding to specific cell surface receptors.
In skin constantly exposed to UVB, collagen degeneration and changes in the location of elastic tissue lead to disruption of the structural integrity of the extracellular matrix, causing skin wrinkles. The elasticity of the skin is also reduced. Compared to a control group treated with sera in one study, aPRP and aPPP showed a significant increase in fibroblast proliferation.
Cells exposed to 5% or 10% aPRP also showed significantly higher levels of proliferation than positive control cells. These results indicate that aPRP and aPPP promote fibroblast proliferation. That PRP and PPP improve collagen production is evidenced by the expression of type I collagen chains a1 and a2 in cells treated with 5% aPRP or aPPP.
This stimulation of new collagen synthesis can compensate for defects that result from fragmentation or loss of collagen in photoaging and aging skin. The accumulation of such new synthesized collagen can improve the structural integrity of the extracellular matrix of the skin and stimulate the production of new collagen by fibroblasts. Similarly, stimulating MMP-1 in photoaging skin may help eliminate collagen fragments that damage skin matrix tissue, thus providing a better scaffold for new collagen to be deposited.
In a more recent study, injections of platelet-rich plasma into the face and neck for recovery showed good results.
Results of treatment with platelet-rich plasma
Platelet-rich plasma with fractional laser improves skin elasticity and reduces redness. Moreover, the treatment increased the length of the dermal-epidermal junction, the amount of collagen and fibroblasts. Platelet-rich plasma with fractional laser treatment is a good combination of skin rejuvenation treatments. The proliferation of keranocytes and fibroblasts, as well as the production of collagen, may explain the ability of platelet-rich plasma to increase skin elasticity.
In a study evaluating the effectiveness of a single injection of autologous platelet-rich fibrin matrix (PRFM) for the correction of deep nasolabial folds, blood was collected from 15 adult patients, and activated autologous platelet-rich fibrin matrix was produced using a patented system. Then this substance was injected into the dermis and the immediate subcutaneous layer under the nasolabial folds. The treatment items were photographed before and after treatment.
The attending physician rated the folds on the Wrinkle Rating Scale, and the patients rated their appearance at the post-procedure visit using the Global Aesthetic Improvement Scale. Patients were evaluated at 1, 2, 6 and 12 weeks after the procedure. Patients did not experience fibrosis, roughness, induration, movement restrictions, or lumpiness. The author of the study concluded that PRFM could provide long-term nasolabial fold repair without the use of foreign materials.
PRFM has significant potential to induce skin improvement (note: the system used in this study uses thrombin to produce a stronger fibrin mixture and therefore cannot be considered 100% autologous).
Objective results of the use of platelet-rich plasma
The study by Amgar et al. is one of the few studies that focuses only on objective results of platelet-rich plasma. The study uses biometrics for scientifically measured ways to evaluate the results of PRP injections. Skin hydration was performed after compensation of the environmental humidity level. Hydration was expressed as a standard index. Anisotropy measures the distribution of micro lines over 360 degrees and is expressed as a percentage.
After significant swelling of the skin, a series of micro lines are observed on the surface of the skin. The projection and distribution of micro lines in two dimensions in all directions is an indicator of the youthfulness of the skin. The older the skin, the more such lines change their direction and become parallel.
With the accumulated knowledge of this procedure, we now have the most complete, versatile and active treatment for skin rejuvenation and anti-aging.
In another study in which platelet-rich plasma was used with fractional lasers for skin rejuvenation, a high concentration of platelet-rich plasma stimulated the production of type I collagen, MMP-1 and MMP-2 in human skin fibroblasts. Ablative fractional CO2 lasers are an excellent way to treat acne scars, although this technique is associated with long-term redness and swelling in the treated area, which can cause discomfort in the daily life of patients. Treatment with platelet-rich plasma after an ablative fractional CO2 laser treatment accelerates the recovery of laser-damaged skin and improves the clinical appearance of acne scars.
In sites treated with platelet-rich plasma, more rapid recovery of transepidermal water loss was observed. The redness and melanin index in the PRP treatment were lower than in the control sites. Biopsy samples from PRP-treated sites showed thicker collagen bundles than samples from control sites.
The findings of the histological evaluation performed by Sclafani et al. support clinical observations regarding soft tissue improvement. As early as 7 days after the procedure, activated fibroblasts and new collagen deposits were seen, which were visible throughout the study. The development of new blood vessels was seen on the 19th day. Also at this time, intradermal accumulation of adipocytes and stimulation of subcutaneous adipocytes were seen. Injection of PRFM into the deep layers of the skin and subcutaneous layers stimulates a large number of cellular changes that can be turned to your advantage.
Based on Prime magazine.
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