Rejuvenating face with your own blood (PRP) – Review article
Authors:Dr. Abdul Hameed
Abstract
Platelet-rich plasma (PRP) is an autologous product derived from whole blood through the procedure of gradient density centrifugation.It contains above standard level of platelets and growth factors. It has been used for a variety of indications for more than 30 years, with viable outcomes.Recently, PRP has come to the attention of esthetic surgeons, with burgeoning new applications ranging from hair restoration to facial rejuvenation.The objective of this review article is to portray the present assemblage of article on PRP in accordance with the field of cosmetics, and to audit its present true applications.PRP's utility in facial cosmetics is rapidly developing and offers a promising and appealing modality.
Introduction
Platelets have long been known for their part in early hemostasis, while their tissue regenerative properties have been found just in the course of the most recent decade. Litrature reviews have demonstrated that The growth factors and other cytokines present in platelets (released in the presence of thrombin or via activation by vibration, heat, stress, or calcium chloride) include the following, all critical during tissue healing and regeneration (Table 1).
By isolating and concentrating plateletsthrough centrifugation it is possible to concentrate the growth factors ie PRP and deliver them a particular region where biostimulation is required. This highly concentrated growth factors when applied to specific region they stimulate endothelial cells and fibroblasts to proliferate and differentiate leading to angiogenesis, new collagen deposition and contraction. In addition, the concentrated activated platelets stimulate the recruitment and differentiation of mesechymal stem cells. The regenerative potential of PRP depends on the levels of growth factors released upon activation By analyzing the literature, it is found that PRP has been employed in several cosmetic applications since a few decades.
Indications
Mechanism of action
In facial rejuvenation and scars: PRP acts by
Preapring PRP
Whole peripheral blood is collected into a citrate containing tube. The tube is kept at room temperature (21-24 ̊C) and constantly gently shacked to prevent platelets from aggregating. The blood is then centrifuged. The American Association of Blood Banks technical manual, states that "platelet-rich plasma is separated from whole blood by 'light-spin' centrifugation and subsequently the platelets are concentrated by 'heavy-spin' centrifugation with removal of the supernatant plasma a dual spin technique."
Adding Calcium chloride or thrombin to trigger coagulation can activate Prp and hence degranulation of GFs to yield "activated PRP". After activation, we have about 15 to 20 minutes to work with the solution without risking the solution’s becoming gel-like and more difficult to work with.
Once acquired, PRP is infused utilizing a syringe and a small gauge needle (i.e. 30 Gage) when in its fluid shape or rather a bigger one 16-18-gage catheter if in the gel form.
Pre-treatment workup
Patients should be screened for bleeding disorder such as hemophilia, coagulation factor deficiencies, dyscrasias or Any platelet related dyscarsia should be investigated prior treatment.
Patients should not be under medications such as aspirin or clopidorgrel, that affects platelet function, should discontinued at least 15 days prior treatment
Injecting PRP
Injections into the skin are strategized to work on all 3 layers of the skin, namely, the epidermal, dermal, and subdermal layers.
minimal-trauma technique using a long needle
Scalp :Inter- follicular injections 0.05ml -0.1ml /cm2
PRP Mesotherapy : micro needling with meso pen is done and PRP solutions is sprayed on top of it and left on over night.
In hair transplant: The follicular grafts are dipped into PRP for about 15 minutes, before implantation so as to increase their survival rate after implantation.
Face :Injections are made using a 27-gauge half-inch (12 mm) needle. Injections on the face are made using intradermal injections, which means injecting up to 4-mm depth of penetration; ubdermal or hypodermal injections require injecting deeper than 4 mm and up to 12 mm. A common injection strategy on the face is to use a linear threading or tunnel technique, especially to fill wrinkles or fine lines.
Intra dermal injections 0.05 ml-0.1ml /cm2 or micro needling is done.
Treatment Sessions:
CONCLUSION
As compared to other skin rejuventation treatments, the clincal utilizing Platelet Rich Plasma (PRP) prepared with autologous blood has exhibited it to be a most safe, excellant adjunctive treatment for the tissue rejuvenation. Both superficial and deep dermal applications can bring about skin restoration and panfacial volumisation. PRP is a type of biostimulation that is protected and makes a quick, durable volumetric impact with youthful outcomes. The outcome of PRP usage depends on many factors, platelet concentration and condition, amount of plasma used, the extent of injury at the site of treatment, and patient medical conditions.The procedure is very simple to perform and with least or no side effect.
Abstract
Platelet-rich plasma (PRP) is an autologous product derived from whole blood through the procedure of gradient density centrifugation.It contains above standard level of platelets and growth factors. It has been used for a variety of indications for more than 30 years, with viable outcomes.Recently, PRP has come to the attention of esthetic surgeons, with burgeoning new applications ranging from hair restoration to facial rejuvenation.The objective of this review article is to portray the present assemblage of article on PRP in accordance with the field of cosmetics, and to audit its present true applications.PRP's utility in facial cosmetics is rapidly developing and offers a promising and appealing modality.
Introduction
Platelets have long been known for their part in early hemostasis, while their tissue regenerative properties have been found just in the course of the most recent decade. Litrature reviews have demonstrated that The growth factors and other cytokines present in platelets (released in the presence of thrombin or via activation by vibration, heat, stress, or calcium chloride) include the following, all critical during tissue healing and regeneration (Table 1).
By isolating and concentrating plateletsthrough centrifugation it is possible to concentrate the growth factors ie PRP and deliver them a particular region where biostimulation is required. This highly concentrated growth factors when applied to specific region they stimulate endothelial cells and fibroblasts to proliferate and differentiate leading to angiogenesis, new collagen deposition and contraction. In addition, the concentrated activated platelets stimulate the recruitment and differentiation of mesechymal stem cells. The regenerative potential of PRP depends on the levels of growth factors released upon activation By analyzing the literature, it is found that PRP has been employed in several cosmetic applications since a few decades.
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| Table 1: Secretory proteins and growth factors in platelet rich plasma. |
Indications
- AGA (Androgenetic Alopecia)
- Facial Skin Rejuvenation
- Acne Scars
- Striedensae
- Decreasing facial rhytids,
- Decreasing hematoma/seroma post rhytidectomy,
- Enhancing the taking rate of fat transplant,
- Stimulate collagen production in the subcutaneous tissues when used as a filler (alone or combined with hyaluronic acid),
- Improving the appearance of stretch marks and scars (alone or in combination with CO2 laser).
Mechanism of action
In facial rejuvenation and scars: PRP acts by
- Increases dermal fibroblasts proliferation
- Increased expression of MMP-1 and MMP-3 (Matrix metalloproteinase) leads to removal of photo damaged ECM
- Increased production of pro collagen type 1 peptide leads to formation of new collagen, resulting skin tightening.
- Expression of G1 cell cycle regulators accelerates wound healing Hair growth
- In the bulge area of the follicle, growth factors bind to respective receptors located in stem cells. In matrix, it acts on germinative cells of mesenchymal origin. Interactions between these two kinds of cells as well as with binding growth factors (PDGF, TGF-b and VΕGF) activate the proliferative phase of the hair, giving rise to the future follicular unit.
Preapring PRP
Whole peripheral blood is collected into a citrate containing tube. The tube is kept at room temperature (21-24 ̊C) and constantly gently shacked to prevent platelets from aggregating. The blood is then centrifuged. The American Association of Blood Banks technical manual, states that "platelet-rich plasma is separated from whole blood by 'light-spin' centrifugation and subsequently the platelets are concentrated by 'heavy-spin' centrifugation with removal of the supernatant plasma a dual spin technique."
- First centrifugation is slow (generally 1000 to 1200rpm) to avoid spinning down platelets and to isolate plasma. Platelets are mostly concentrated right on top of the buffy coat layer.
- Subsequent centrifugation is faster (2000 to 2500 rpm), so that platelets are spun down and separate as a pellet at the bottom of the tube from platelet-poor plasma (PPP) above.
- Approximately 3/4 of the supernatant is discarded and the platelet-rich pellet is resuspended in remaining amount of plasma. The resulting suspension is used as PRP.
Adding Calcium chloride or thrombin to trigger coagulation can activate Prp and hence degranulation of GFs to yield "activated PRP". After activation, we have about 15 to 20 minutes to work with the solution without risking the solution’s becoming gel-like and more difficult to work with.
Once acquired, PRP is infused utilizing a syringe and a small gauge needle (i.e. 30 Gage) when in its fluid shape or rather a bigger one 16-18-gage catheter if in the gel form.
Pre-treatment workup
Injecting PRP
Injections into the skin are strategized to work on all 3 layers of the skin, namely, the epidermal, dermal, and subdermal layers.
- layer specific transplant
- stretch the skin surface before needle insertion needle bevel up
minimal-trauma technique using a long needle
Scalp :
Face :Injections are made using a 27-gauge half-inch (12 mm) needle. Injections on the face are made using intradermal injections, which means injecting up to 4-mm depth of penetration; ubdermal or hypodermal injections require injecting deeper than 4 mm and up to 12 mm. A common injection strategy on the face is to use a linear threading or tunnel technique, especially to fill wrinkles or fine lines.
Intra dermal injections 0.05 ml-0.1ml /cm2 or micro needling is done.
Treatment Sessions:
- Usually repeated 6-8 weeks interval, until desired results achieved.
- The number of sessions required will depend on individual responds to the treatments.
- Scar reduction, usually 4 sessions are required.
- In case of hair loss problems, 6-8 sessions are required.
- Maintenance sessions are done once in few months.
Side effects.
Cosmetic PRP is a straightforward and safe procedure. As prp is produced using the patient's own blood, there is no hazard for dismissal, contamination, or a hypersensitive response. The skin may show up somewhat sunburnt for up to 48 hours with practically no related inconvenience. Gentle swelling which may keep going for 3-7 days, redness, or wounding blur inside 1-3 days are phenomenal. Applying cold packs and head elevation can minimize any swelling.
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As compared to other skin rejuventation treatments, the clincal utilizing Platelet Rich Plasma (PRP) prepared with autologous blood has exhibited it to be a most safe, excellant adjunctive treatment for the tissue rejuvenation. Both superficial and deep dermal applications can bring about skin restoration and panfacial volumisation. PRP is a type of biostimulation that is protected and makes a quick, durable volumetric impact with youthful outcomes. The outcome of PRP usage depends on many factors, platelet concentration and condition, amount of plasma used, the extent of injury at the site of treatment, and patient medical conditions.The procedure is very simple to perform and with least or no side effect.